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© 2003 American Public Health Association
LETTER |
Both authors are with the Latin American Health Institute, Boston, Mass, and the Dept. of Family Medicine and Community Health, Tufts University School of Medicine, Boston.
Correspondence: Requests for reprints should sent to M. Barton Laws, PhD, Latin American Health Institute, 95 Berkeley St, Boston, MA 02116 (e-mail: bart{at}lhil.org).
Bair et al. found that use of complementary and alternative medicine (CAM) by Latina women around menopausal age in Newark, NJ, is less common than use by women of other ethnicities in certain other cities.1 The study operationalized CAM use in ways that do not correspond to the methods or labels typically used in Caribbean and South American societies.2–5 For example, "folk medicine," an anthropological term,6 would not be recognized by most users.7
In 1995–96, we developed a series of items in Spanish and English on the use of nonallopathic healing,8 based on discussions with key informants, review of the literature, field testing, implementation in a household survey,9 and qualitative interviews with Latina mothers attending a pediatric clinic. We implemented the sequence in a survey, based on area probability sampling, of women 40 years and older living in 11 Massachusetts cities.10
The sequence in English included "teas, herbs or home remedies," "Herbalist," "Christian faith healing service," "Spiritist," and the untranslatable terms botánica (stores that sell herbs and religious supplies) and Santero, (a practitioner of a Caribbean system of African origin), among others. (Table 1
; the full sequence, in English and Spanish, is available from the corresponding author.) There were 499 respondents, 137 of whom were Latina. Ninety-seven percent of the Latina respondents were interviewed in Spanish, and 96.4% were born in Puerto Rico or outside the United States.
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For comparison with the findings of Bair et al., we limited this analysis to women aged 40 to 55 years (N = 281). We found much higher rates of use of nonallopathic healing methods among Latina respondents, with use of home remedies the most common modality (38.1% of respondents). Respondents specified almost all of these as plant products such as star anise, orange leaf, tilo, and uña de gato ("cat’s claw"), available at local botánicas and bodegas, or groceries. The much lower proportion of Latinas whom Bair et al. reported as using herbal remedies (8%) may have resulted from the specification "such as homeopathy or Chinese herbs or teas." Christian, Santeria, and Espiritismo spiritual healing do not fit into any of the categories used by Bair et al. A far higher proportion of Latina women (59%) in our sample reported using at least one nonallopathic method in the past year than women of other ethnicities (
2 = 66.777, P < .0005). These results demonstrate the importance, in cross-cultural studies, of conducting formative research to identify appropriate item specifications. Otherwise, comparisons are likely to be invalid.
References
1. Bair YA, Gold EB, Greendale GA, Sternfeld B, Adler SR, Azari R, Harkey M. Ethnic differences in use of complementary and alternative medicine at midlife: longitudinal results from SWAN participants. Am J Public Health.2002;92:1832–1840.
2. Harwood A. Mainland Puerto Ricans. In: Harwood A, ed. Ethnicity and Medical Care. Cambridge, Mass: Harvard University Press; 1981.
3. Brandon G. Sacrificial Practices in Santeria, an African-Cuban Religion in the United States. In: Holloway JE, ed. Africanisms in American Culture. Bloomington: Indiana University Press; 1991.
4. Weiss CI. Controlling domestic life and mental illness: spiritual and aftercare resources used by Dominican New Yorkers. Cult Med Psychiatry. 1992;16:237–271.[Medline]
5. Koss-Chioino JD. Traditional and folk approaches among ethnic minorities. In: Aponte JF, Rivers RY, Wohl J, eds. Psychological Interventions and Cultural Diversity. Boston, Mass: Allyn and Bacon; 1995.
6. Kleinman A. Patients and Healers in the Context of Culture. Berkeley: University of California Press; 1980.
7. Laguerre M. Afro-Caribbean Folk Medicine. South Hadley, Mass: Bergin & Garvey; 1987.
8. Laws MB, Carballeira N. Latinas and unconventional healing. In: Programs and abstracts of the 126th Annual Meeting of the American Public Health Association; November 15–18, 1998; Washington, D.C. Session 1225.
9. Laws MB, Mayo SJ. The Latina Breast Cancer Control Study. J Community Health.1998; 23:251–267.[Web of Science][Medline]
10. Laws MB, Mayo SJ. Year II Findings of the Latina Breast Cancer Control Study. In: Programs and abstracts of the 125th Annual Meeting of the American Public Health Association; November 9–13, 1997; Indianapolis, Ind. Session 4021.
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