The Complementarity and Substitution between Unconventional and Mainstream Medicine among Racial and Ethnic Groups in the United States

Racial and ethnic differences have been extensively studied in modern medical research in the United States as equality in health has become one of the priority issues of health policies. To some extent, racial and ethnic differences are a more important issue in the research of complementary and alternative medicine (CAM) than in mainstream medicine (MSM), because some forms of CAM originated from the native countries or regions of the ethnic and racial minority groups in the United States. For example, acupuncture was introduced by the Chinese culture and herbal medication use is prevalent among native Asians, Mexicans, and American Indians. One study found that 44 percent of a Mexican-American sample used herbal medicine and about 30 percent used spiritual healing (Keegan 1996). As compared with non-Hispanic white (NHW) primary care patients, Hispanics were found to be more likely to use folk remedies (Palinkas and Kabongo 2000). Also, one study showed that African American women used CAM for a wide range of health conditions and prevention (Cushman et al. 1999). Another study of Chinese immigrants showed that 95 percent of the sample used self-treatment and home remedies (Ma 1999). In a sample of Navajo Indians, 62 percent used native healers and 39 percent used healers on a regular basis (Kim and Kwok 1998). Despite the possibility that minority groups may be more predisposed to CAM use through their respective and distinctive cultures than NHW in the United States, several studies have demonstrated that NHW in the United States were more likely to be CAM users than the members of the minority groups (Bausell, Lee, and Berman 2001; Bair et al. 2002; Baldwin et al. 2002; Ni, Simile, and Hardy 2002; Shumay et al. 2002). Other studies showed no significant racial or ethnic differences in the prevalence of CAM use (Elder, Gillcrist, and Minz 1997; Liu et al. 2000; Cherniack, Senzel, and Pan 2001; Mackenzie et al. 2003; McCurdy et al. 2003). One possible explanation for these conflicting findings may be that the content of CAM defined in the studies differed. For example, Asians were higher users of acupuncture and oriental medicine and Hispanics were higher users of dietary supplements and home remedies, whereas NHW were higher users of chiropractic massage and vitamins (Najm et al. 2003). Although some researchers suggested that CAM was a substitute for MSM in the United States (Gundling 1998), more studies demonstrated that the unconventional treatments were complementary to the MSM (Eisenberg et al. 1993,1998; Spigelblatt et al. 1994; Paramore 1997; Astin 1998). Using a nationally representative sample, one study examined the association between the utilization of CAM and MSM, and found that CAM was more of an “add on” to MSM than a substitute (Druss and Rosenheck 1999). It is still unknown, however, whether the complementarity of CAM to MSM is characteristic of only the majority culture or racial group in the United States and how the utilization of and association between CAM and MSM differ by racial and ethnic minority groups. One of the major challenges in studying CAM use among minority groups is to get a sample that is large enough to produce nationally representative estimates for each minority group and to make the estimates from these subpopulations comparable. Following the conceptualization of a previous study (Druss and Rosenheck 1999), the current study utilized a sample of 46,673 subjects representing the U.S. population to: describe racial and ethnic differences in the utilization patterns of 12 common CAM types and MSM; and test whether a specific type of CAM is a substitute for or a complement to MSM among five racial and ethnic groups in the United States.