|
9.
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
v Introduction The use of complementary medicine, and in particular the use of herbal remedies, has increased recently in the United States due in part to media coverage, patient dissatisfaction with allopathic practitioners, and a movement for patient empowerment. As a result, complementary medicine, with its many modalities – including acupuncture, chiropractic, biofeedback, herbal medicine, folk medicine, and others – continues to emerge into the mainstream[1-5] of medicine. In fact, the use of the term "complementary" medicine to describe these forms of therapy[3-4] would seem to indicate that "unconventional" or "alternative" medicine is becoming more accepted by the general medical community. Eisenberg and colleagues,[2] in 1993, reported that one-third of the respondents in a nationwide population-based survey had used some form of alternative therapy in 1990. Expenditures for alternative therapies totaled approximately $13.7 billion a decade ago, 75% of which were out-of-pocket expenses. In a later survey for the year 1997,[5] 42.1% of respondents had used alternative therapies and expenditures had increased to $21.2 billion. Use of herbal remedies increased almost fivefold between 1990 and 1997.[5] Despite these increases, few studies to date have evaluated the effectiveness of complemen-tary therapies.[2,5-9] Encouragingly, guidelines have been recommended for conducting such trials, and the body of research in this are is growing.[6] The present study is the first to investigate the effect of ethnicity on the use of herbal remedies, specifically in a Hispanic versus a non-Hispanic white or NHW patient population. It has been documented that ethnicity influences health behaviors, and therefore different therapies may be employed by patients with diverse backgrounds.[1,10-13]Culture includes ethnicity, but also comprises knowledge, practices, symbols, understandings, representations, beliefs, values, customs, traditions, behavioral norms, and laws expressed by a designated group. People identifying with a specific culture may also have the same material traits of ethnicity, religion, or social group.[10-11] Culture can influence a patient’s health behaviors, his or her perception of wellness, disease, and treatment of a disease.[10] Cultural background has been documented to affect both the patient’s response to the primary health care system and the provider’s response to the patient.[11-14] Additionally, culture may help define the medical problems perceived by the patient.[11-16] To measure a surrogate variable for culture, we identified ethnicity, Hispanic or NHW. All other ethnic groups were excluded because of their low numbers in this clinical setting. The elderly population was chosen because they had been immersed in their respective cultures for longer periods of time, and thus their herbal remedy use was felt to be more representative of their ethnicity and culture. Table 1 lists the top five perceived medical problems participants were seeking to treat with herbal remedies. More than 50% of both ethnic groups used herbs for preventive reasons or health maintenance. Hispanic subjects used herbs to a greater extent than NHW subjects for ailments such as dyspepsia and upper respiratory infections. On the other hand, a greater proportion of NHW participants used herbal remedies for perceived skin problems, including burns and irritations. Anxiety and insomnia were combined into one category because there was a 100% correlation of the two; every participant who listed one also listed the other problem. Table 2 lists botanical nomenclature for commonly used herbal remedies. Table 3 shows herbs users’ sources of information on herbal remedies. The 10 most frequently used herbs are listed in Table 4. Yerba buena (spearmint), poleo (brook mint), and manzanilla (chamomile) were used by Hispanic participants to a greater extent than by NHWs. Hispanic participants also used osha (wild celery root), alhucema (lavender), yerba manza, and volcanico significantly more than did NHW participants. Table 5 shows the top five herbal remedies used for each of the five most frequently cited self-perceived medical problems listed in Table 1. There were statistically significant differences in herb use by ethnicity, education, and income. But after controlling for education and income in the logistic regression analysis, only ethnicity remained associated with herb use at a statistically significant level. Discussion In this study, the influence of ethnicity was evident in the pattern of herbal use. Compared with 47% of NHWs, 77% of Hispanic subjects had used herbal remedies at some point in their lives. Hispanic subjects displayed more culturally traditional patterns of use, whereas NHW users followed more recent, even faddish, trends. This was reflected in part by the different groups’ sources of herbal remedies. Majorities in both study groups obtained their herbal remedies from grocery/drug stores, but a significantly larger number of Hispanic participants grew or gathered their herbs, whereas NHW participants were more likely to use a commercially processed form. It is likely that the use of herbs by Hispanics is based on a verbal tradition that is handed down from one generation to the next. Growing and gathering one’s own herbs and then using the raw, unprocessed form of the herb places less economic strain on the user. Differences that could be attributed to ethnicity were evident in sources of knowledge: 85% of Hispanic participants received their information on herbal remedies from a family member, compared with 65% of the NHW participants. In contrast, 37% of NHW subjects learned of herbal use through magazines or books, compared with only 15% of Hispanics. Eighty-five percent of Hispanic subjects had a parent who used herbal remedies, compared with 26% of NHW participants. Few Hispanic participants received their information on herbal remedies from curanderas, traditional Hispanic healers, but this may be underreported because of a reluctance on the part of the Hispanic participants to disclose this source. It is interesting that allopathic health care providers were virtually ignored as sources of information on herbal remedies. As complementary medicine becomes more prevalent and more accepted in our health care system, it is important for allopathic health care practitioners to become educated about herbal remedies and their effectiveness. The form of herbal remedy administered varied with ethnicity. Herbal remedies as a tea were used by 94% of Hispanic participants, compared with 44% of NHWs. On the other hand, 44% of NHW participants used herbal remedies as a capsule or tablet, compared with 23% of Hispanic participants. The use of a processed capsule or tablet is more consistent with NHW background than the use of raw herbs in the form of a tea, which is more consistent with the Hispanic culture. Additionally, ethnicity was associated with patterns in the use of herbal remedies. The majority of participants used herbal remedies for health maintenance, but more Hispanic patients used herbal remedies for symptoms, such as those of dyspepsia and upper respiratory infections. Among Hispanics there is a condition termed "empacho," which is a perceived gastrointestinal disturbance.[14] Hispanic participants in our study may be using herbal remedies to treat the symptoms of empacho. The main symptom or problem for which NHWs used herbal remedies was skin disorders, and the corresponding remedy was aloe vera. In our study, the choice of herbs was also associated with ethnicity. Significantly more Hispanic participants used yerba buena, manzanilla, poleo, osha, alhucema, yerba manza, and volcanico than did the NHW sample. Aloe vera and garlic were the only herbs used more often by NHWs. Hispanics may use herbs more often as first-line therapies for perceived ailments, while NHW participants may use over-the-counter medications to a greater degree. This likely reflects the cultural differences between the two ethnic groups. The five herbal remedies most often used by patients in our study were yerba buena, manzanilla, poleo, osha, and alhucema (same frequency) and yerba manza and volcanico (same frequency). The pattern of use of our population is similar to the one reported by Trotter,[10] who investigated herbal use in south Texas Hispanics. The top five herbal remedies used in that area of the country were manzanilla (chamomile), savile (aloe vera), ruda (rue), yerba aniz (anise), and yerba buena (spearmint). In our study, patients most likely to use herbal remedies were Hispanic and of a lower socioeconomic group. The NHW participants who used herbs were younger, better educated, and had more income (> 55% with < $1,000/month). Our findings also agree with those of Brown and Marcy[8] in Oregon, where the NHWs most likely to use herbal remedies were in a higher socioeconomic group. This study illustrates that ethnicity may play a part in patients’ use of herbal medicine. It is important that pharmacists who practice in culturally diverse areas question their patients regarding their use of herbal medicine. Conclusion We compared the patterns of herbal use between two ethnic groups, Hispanic and NHW. The differences we found may have been attributable to cultural differences between the two groups. The traditional use of herbal remedies in the Hispanic culture may account for the larger proportion of Hispanics who have ever used herbal remedies. Not only was the prevalence of herbal use associated with ethnicity, but so was the choice of herbs, the form of administration of herbal products, the sources of information used, and the perceived medical problems for which herbs were used. These differences remained statistically significant after age, income, and educational level were controlled. Describing the use of herbal remedies in a patient population may help practicing pharmacists and physicians better understand who uses herbs, and the problems these patients are seeking to treat with herbal remedies.
REFERENCES 1. Kraul AM. Healers and strangers: immigrant attitudes toward the
physician in 2. Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine
in the 3. Lopez L. Managed care cautiously embraces complementary medicine. J 4. Riedlinger J, Montagne M. Alternative medicine in managed care
pharmacy. J 5. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative
medicine use in 6. Gaus W, Hogel. Studies on the efficacy of unconventional
therapies: problems and 7. Cook C, Baisden D. Ancillary use of folk medicine by patients in
primary care 8. Brown JS, Marcy SA. The use of botanicals for health purposes by
members of a 9. Elder NC, Gillcrist A, Minz R. Use of alternative health care by
family practice 10. Trotter RT. Remedios caseros: Mexican American home remedies and 11. Dole EJ. Cultural diversity and pharmaceutical care. Pharmaguide:
guide to 12. Santiago-Irizarry V. Culture as cure. Cultural Anthropology. 1996;11: 3-24. 13. Levy RA, Hawks JW. Multicultural medicine & pharmacy
management II. 14. Caudle P. Providing culturally sensitive care to Hispanic clients. Nurse
Pract. 15. Thomson GE. Discrimination in health care. Ann Intern Med. 1997;126:910-2. 16. Caldwell SH, Popenoe R. Perceptions and misperceptions of skin
color. Ann 17. Cummings SR, Strull W, Nevitt MC, Hully SB. Chapter 5: Planning
the Ernest J. Dole, PharmD, PhC, FASHP, BCPS, is associate professor,
College of Pharmacy, University of New Mexico Health Sciences Center,
Albuquerque. Robert L. Rhyne, MD, is associate professor, Department of
Family and Community Medicine, School of Medicine, University of New
Mexico Health Sciences Center, Albuquerque. Carla A. Zeilmann, PharmD,
BCPS, is assistant professor, St. Louis College of Pharmacy, St. Louis. At
the time of this study, Dr. Zeilmann was a resident in geriatric
pharmacotherapy. Betty J. Skipper, PhD, is professor, Department of Family
and Community Medicine, University of New Mexico School of Medicine,
University of New Mexico Health Sciences Center, Albuquerque. Melvina L.
McCabe, MD, is associate professor, Department of Family and Community
Medicine, University of New Mexico School of Medicine, University of New
Mexico Health Sciences Center, Albuquerque. Tieraona Low Dog, MD, is
medical director, Treehouse Center of Integrative Medicine, Albuquerque.
Correspondence: Ernest J. Dole, PharmD, PhC, FASHP, BCPS, College of
Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM
87131-1066.
The Influence of Ethnicity on Use of Herbal Remedies in Elderly Hispanics and Non-Hispanic Whites. J Am Pharm Assoc 40(3): 350-365, 2000. Copyright 2000 American Pharmacists Association (APhA) Reprinted with permission of APhA.
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||