Complementary Therapy as a Health Practice: the Effects of Culture on Increasing Patterns of Use Among Ethnic Groups

The Holistic HomiesBridgette Han, Yuelin He, Darynn Gayle ParagasCARE Summer Symposium 2020Stanford CARE Summer Research Immersion

The Holistic Homies

Darynn Gayle ParagasB.S. Language & International

Health - concentrations in French & Health AdministrationClemson University, SC

Yuelin HeB.S. Computational and

Systems Biology - concentrations in Biological Data

SciencesUCLA

Bridgette HanB.A. Asian American Health

Disparities: Research, Policy, and Practice

Duke University

Complementary Therapy (CT)

● Therapies that are usually used alongside

conventional treatment1

● Some have physical and mental health benefits2,3

● Cultural values can influence the utilization of

healthcare4,5

1. What are complementary and alternative therapies? | Cancer Research UK. Accessed July 14, 2020. https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/about/difference-between-therapies2. Büssing A, Michalsen A, Khalsa SBS, Telles S, Sherman KJ. Effects of Yoga on Mental and Physical Health: A Short Summary of Reviews. Evidence-Based Complementary and Alternative Medicine. doi:https://doi.org/10.1155/2012/1654103. 5. Li JX. Tai chi: physiological characteristics and beneficial effects on health. British Journal of Sports Medicine. 2001;35(3):148-156. doi:10.1136/bjsm.35.3.1484. Lee JH, Goldstein MS, Brown ER, Ballard-Barbash R. How does acculturation affect the use of complementary and alternative medicine providers among Mexican-and Asian-Americans? Journal of Immigrant and Minority Health. 2010;12(3):302–309.5. Dong X, Bergren SM, Chang E-S. Traditional Chinese Medicine Use and Health in Community-Dwelling Chinese-American Older Adults in Chicago. Journal of the American Geriatrics Society. 2015;63(12):2588-2595. doi:10.1111/jgs.13828 1

Why Complementary Therapies?

Asian Indian

Chinese

Filipino

Japanese

KoreanVietnamese

2

No agreement between studies that look at rates of patient CT disclosure to physicians6

1.6. Kelak JA, Cheah WL, Safii R. Patient’s Decision to Disclose the Use of Traditional and Complementary Medicine to Medical Doctor: A Descriptive Phenomenology Study. Evid Based Complement Alternat Med. 2018;2018. doi:10.1155/2018/4735234

Research Question

How does the use of Complementary Therapies vary among Asian Americans (Asian Indians, Chinese, and Filipinos) over time in comparison to other U.S. ethnic groups?

3

2007, 2012, & 2017 NHIS

Stratified Random Sampling

All units in cluster are sampled

Cluster Sampling 2007, 2012, & 2017

U.S. Adults

Non-Hispanic White (NHW)Non-Hispanic Black (NHB)HispanicsAmerican Indian/Alaska Natives (AI/AN)Asian IndianChineseFilipino 4

CT Outcome VariablesBody-Based Therapies Biologically-Based Therapies

Mind-Body Therapies

6

Predictor VariablesNativity Status

Self-Reported Health Status

Socioeconomic Status (SES) Region

Age

SexLevel of Education

7

Race/Ethnicity

Importance that Physician Shares CultureLevel of

Education

Data Analysis

● Across all 3 years

● Age-Adjusted rates for each CT

category

Trend Analysis

● Only 2017

● Analysis of Variance (ANOVA)

across racial groups

● Logistic Regression

○ Race

○ Race + Demographic Factors

○ Race + Demographic Factors +

Health Status

Cross-Sectional Analysis

5

Trend Analysis of CT Use - 2007, 2012, 2017

Sample Sizes2017 : 26,508 2012: 34,221 2007: 23,235

Body-Based Mind-Body Biologically-Based

8

Participant Demographics

2017 NHIS Participant Sex 2017 CT Respondent Use

9n= 26,506

4326 3998 868

Usage Rates of Body-Based Therapies

YogaTai ChiQi Gong

10

Usage Rates of Mind-Body Therapies

MeditationProgressive RelaxationGuided Imagery

11

Usage Rates of Biologically-Based Therapies

NaturopathyHomeopathyTraditional Healers

12

15

Logistic Regression Models by CT CategoryBiologically-Based Mind-Body Based Body-Based

Female

PoorBetter

Very Important

Male

Other Factors

Other Findings

20

Nativity StatusSocioeconomic

Status (SES)

Limitations

● NHIS collects data via interview

○ Language Barrier (mainly

English & Spanish)

○ Recall Bias

○ Social Desirability Bias

Intrinsic Limitations

● Missing Values

○ Related variables ~90% N/A

values

○ Trend Analysis: grouped “no” +

“N/A”

● Aggregating CT variables into

categories

Specific Limitations

23

Importance of Study

7. Büssing A, Michalsen A, Khalsa SBS, Telles S, Sherman KJ. Effects of Yoga on Mental and Physical Health: A Short Summary of Reviews. Evidence-Based Complementary and Alternative Medicine. doi:https://doi.org/10.1155/2012/1654108. Li JX. Tai chi: physiological characteristics and beneficial effects on health. British Journal of Sports Medicine. 2001;35(3):148-156. doi:10.1136/bjsm.35.3.148

Culture plays a significant role in the type of CT used

Yoga has origins in India7 Tai Chi & Qi Gong have origins in China8

21

25

There is an influence of culture in the use of complementary therapies.

Effects of this influence in alternate practices may be unknown.

We must further understand the relationship between culture and complementary therapies to allow us to bridge the gap between

conventional and complementary medicine.

Acknowledgements

Malathi Srinivasan, MD

Sukyung Chung,PhD

Randall StaffordMD, PhD

Nora SharpCARE Program Manager

Latha Palaniappan, MD MS; Ying Lu, PhD; Zhiwei Liang, MD; Shozen Dan; Stanford Department of Biomedical Data Sciences

Thank you