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Use of Complementary Therapy by Adolescents With Asthma
Marina Reznik, MD;
Philip O. Ozuah, MD, MSEd;
Karen Franco, MD;
Robyn Cohen, MD;
Ferrell Motlow, MD
Arch Pediatr Adolesc Med. 2002;156:1042-1044.
ABSTRACT
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Background About 40% of adult Americans use complementary or alternative medicine
(CAM) for health problems.
Objective To determine the prevalence of reported use of CAM in a population of
urban adolescents with asthma.
Design/Methods We used a multistaged, stratified sample approach at an inner-city high
school. An asthma screening survey was administered to 3800 registered students,
aged 13 to 18 years. We identified a subset of 200 respondents who answered
yes to each of the following questions: (1) Does your physician think that
you have asthma? (2) Do your parents think that you have asthma? (3) Do you
think that you have asthma? A self-completion questionnaire was administered
to a sample drawn from this cohort. Differences in proportion were tested
by  2 analyses.
Results Of the 160 participants, 63% were female, 68% were Hispanic, 26% were
African American, 33% had weekly symptoms, and 14% had daily symptoms. Overall,
80% of participants reported using CAM for asthma. The most commonly reported
CAM included rubs (74%), herbal teas (39%), prayer (37%), massage (36%), and
Jarabe 7 syrup (24%). Subjects with daily or weekly symptoms were more likely
to use CAM for each episode of asthma (72% vs 51%; P
= .005). The 61% of subjects who had a family member who used CAM were more
likely to use CAM again (84% vs 39%; P<.001).
Of the respondents, 59% reported that CAM was effective. Subjects who perceived
CAM to be effective were more likely to use it again (96% vs 22%; P<.001).
Conclusions Most adolescents with asthma in this study used CAM. The prevalence
of CAM use in this study population was twice the national average for adults.
INTRODUCTION
COMPLEMENTARY OR alternative medicine (CAM) has captured public attention
in recent years. National surveys show a trend toward increasing use of CAM.1-2 Adult use of CAM increased from 33.8%
in 19901 to 42.1% in1997.2
Of particular note, adults with chronic diseases such as asthma are among
the most frequent users of CAM.3-4
Asthma is the most prevalent chronic disease affecting children and
adolescents in this country.5-6
Some reports suggest that the use of CAM may be high among adolescents with
asthma.7 However, the extent of CAM use has
not been widely studied in this population.8-9
Such use, if documented, may be relevant and significant for physicians who
treat teenagers with asthma. Thus, the aim of this study was to determine
the prevalence of reported use of CAM in a population of urban adolescents
with asthma.
SUBJECTS AND METHODS
OPERATIONAL DEFINITION
Complementary or alternative medicine was defined, in accordance with
the existing literature,1 as medical interventions
not taught widely at US medical schools or not generally available at US hospitals,
such as acupuncture, herbal teas, chiropractic, and massage therapy.
SUBJECTS AND SETTING
We conducted a multistaged stratified survey in October 2000 at a high
school in the Bronx, NY, where 57% of the students were Latino, 35% were African
American, and 3% were white. Incomes were at or below 130% of the federal
poverty level in 83% of families of students at this school. This study was
approved by the institutional review board at Montefiore Medical Center, Bronx.
First, we developed, piloted, and modified a questionnaire to screen
for asthma. Then, we conducted a survey of 3800 registered students (aged
13-18 years). On the basis of the results of the screening survey, we identified
a subset of 200 children with the most positive screening results for asthma.
These subjects answered yes to all of the following questions: (1) Does your
physician think that you have asthma? (2) Do your parents think that you have
asthma? (3) Do you think that you have asthma?
SAMPLING AND DATA COLLECTION
To assess the use of CAM, we developed, piloted, and modified a self-completion
questionnaire. This questionnaire was administered to the cohort with the
most positive screening results for asthma. We discussed feasibility and arranged
logistics with the high school administration through several meetings. Students
were located by their class schedules and assembled in a school auditorium
to complete the questionnaire. The investigators distributed and collected
all questionnaires. Of the 200 students targeted, 160 were present in school
on the day of the study. All 160 students completed a questionnaire.
Subjects were surveyed regarding severity of asthma symptoms, use and
perceived efficacy of CAM, and demographic information. To assess severity
of asthma symptoms, subjects were asked about frequency of asthma symptoms,
medical visits, missed school days because of asthma, and prescribed medications
for asthma.
The questionnaire included items about specific CAM therapies that were
developed on the basis of a literature review1-2,10-11
and clinical experience. From the findings of this review, we determined the
most commonly used CAM therapies for asthma to include teas (eg, chamomile,
ginger, wild root, and eucalyptus), rubs (eg, camphor [Vicks VapoRub; The
Procter & Gamble Company, Cincinnati, Ohio]), foods (eg, garlic, onion,
watercress, castor oil, cod-liver oil), massage, prayer, and syrups (eg, Jarabe
7). Jarabe 7 is an herbal preparation commonly available at botanicas and
grocery stores in many Puerto Rican communities. It consists of sweet almond
oil, castor oil, tolu, wild cherry, licorice, cocillana, and honey.10 Subjects were surveyed about use of these therapies
in the past year. In addition, subjects were asked to list other CAM therapies
not on the list (through open-ended questions), whether they used CAM instead
of conventional treatments for asthma, if they were satisfied with CAM therapy,
if they would use CAM again, if anyone else in their family ever used CAM,
and who recommended CAM.
To assess disclosure of CAM use to pediatricians, subjects were asked
whether they told their physician that they used CAM therapies and if they
would like to discuss CAM treatment of asthma with their physician. We obtained
demographic information regarding each participant's age, sex, ethnicity,
and immigration (defined as birth or prior residence in a country other than
the United States).
STATISTICAL ANALYSIS
Differences in proportions were tested by 2 or Fisher
exact test as appropriate for dichotomous variables. Data were maintained
in SPSS version 10.0 statistical software (SPSS Inc, Chicago, Ill).
RESULTS
Of the 200 subjects identified, 160 (80%) completed the survey. Of these
respondents, 63% were female; 68%, Hispanic; 26%, African American; and 24%,
immigrants. The mean age was 15.7 years. Assessment of asthma severity showed
that 33% had weekly symptoms of asthma and 14% had daily symptoms of asthma.
Overall, 80% of subjects reported using CAM for asthma, and 66% indicated
that they would use CAM again for the treatment of asthma. The most commonly
used CAM were rubs and herbal teas, as seen in the following tabulation:
Characteristics of CAM use in the 128 respondents who reported CAM use
are listed in the following tabulation:
We found no significant association between CAM use and ethnicity or
immigrant status.
In our examination of the correlates of CAM use, subjects with daily
or weekly symptoms of asthma were more likely to use CAM for each episode
of asthma (72% vs 51%; P = .005). In addition, 61%
of respondents had a family member who used CAM, and these respondents were
more likely to indicate that they would repeat the use of CAM (84% vs 39%; P<.001).
In assessing the perceived efficacy of CAM, 59% of subjects perceived
CAM to be as effective as conventional treatments for their asthma. These
subjects were more likely to report that they would repeat the use of CAM
(96% vs 22%; P<.001).
COMMENT
The results of this study demonstrate the extent of CAM use in inner-city
Bronx adolescents with asthma. We found that 80% of adolescents with asthma
used CAM for treatment of their asthma. The prevalence of CAM use in our study
population was twice the national average reported for adults 10 years earlier.2 However, in a 1998 survey, Breuner et al12
reported that 70% of 163 homeless adolescents receiving health care at a youth
clinic in Seattle, Wash, used CAM. Our findings support this earlier report.
We noted that 24% of subjects in our study used Jarabe 7 for their asthma.
This herbal preparation is commonly available at botanicas and grocery stores
in many Puerto Rican communities. It is a mixture of sweet almond oil, castor
oil, tolu, wild cherry, licorice, cocillana, and honey.10
Alternative therapies are generally used as adjuncts to, rather than
as replacements for, conventional therapy.1
Other studies have reported clinical improvements with pediatric CAM use in
synergy with traditional medicine, eg, in children treated with massage therapy
for asthma.13 In 1994, the percentage of patients
treated in general pediatric practices who used alternative therapies was
approximately 11%.11 This percentage increased
to 21% in 1997.14 The percentage is substantially
higher for children and families faced with chronic, recurrent, or fatal conditions
such as cancer, asthma, cystic fibrosis, and juvenile rheumatoid arthritis.
In children and adolescents with these conditions, rates of CAM use range
from 46% to 70%, depending on age, background, and access to services.9, 15-16
Some limitations to our study should be noted. First, we relied on self-reports
by adolescents and could not independently verify the information that was
reported. Some of the responses may have been inaccurate, a limitation of
all self-report surveys. Second, some subjects met the of the responses may
have been inaccurate, a limitation of all self-report surveys. Second, some
subjects met the inclusion criteria for our study but were absent from school
on the day the survey was administered. The absentees might have been different
from the subjects who participated in the survey. However, we were able to
recruit 80% of the population of interest to our study. It is unknown whether
a study of middle- or upper-class adolescents with asthma would provide different
results from those in our study. Our study population was composed of primarily
inner-city, poor, and minority children.
CONCLUSIONS
Most adolescents in this study used CAM for their asthma. Of particular
significance was the prevalence of CAM use in this study population, which
was twice the national average reported for adults.2
These findings have implications for physicians treating adolescents with
asthma in the inner city.
| What This Study Adds
Many Americans use complementary and alternative medicine (CAM). However,
very little is known about the use of CAM among adolescents with asthma. Such
information is important for clinicians to know, especially if a substantial
proportion of adolescents use CAM in place of prescribed medications.
We found that the prevalence of the use of CAM in this group of adolescents
was twice the national rate reported for adults. In addition, 21% of adolescents
used CAM instead of prescribed medications. Correlates of use of CAM are described.
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AUTHOR INFORMATION
Accepted for publication June 3, 2002.
This study was presented in part at the annual meeting of the Pediatric
Academic Societies, Baltimore, Md, April 29, 2001; and at the Eastern Society
for Pediatric Research, Atlantic City, NJ, March 17, 2001.
We thank David Appel, MD, for his assistance with this study.
Corresponding author and reprints: Philip O. Ozuah, MD, MSEd, Children's
Hospital at Montefiore, 3544 Jerome Ave, Bronx, NY 10467 (e-mail: pozuah{at}pol.net).
From the Albert Einstein College of Medicine, Children's Hospital at
Montefiore, Bronx, NY.
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