title: A multivariate test of an expanded Andersen Health Care utilization model for complementary and alternative medicine (CAM) use in African Americans.
abstract: OBJECTIVE
  The objectives of this study were (1) to determine which Andersen Model variables [predisposing, enabling, and need (PEN)] are related to complementary and alternative medicine (CAM) use by African Americans in the past 12 months; and (2) to determine whether the addition of disease states to the Model will explain significant variation in CAM use in the past 12 months.
  
  
  METHODS
  The 2002 National Health Interview Survey was used with 4256 African American adults (n = 23,828,268 weighted) selected as the study population. The dependent variable, CAM Past 12 Months, represented participants' use of at least 1 of 17 CAM modalities during the past 12 months. The Andersen Model variables [predisposing (e.g., age); enabling (e.g., insurance); and need (e.g., medical conditions)] and prevalent disease states (> or =10%) comprised the independent variables. Logistic regression analyses, incorporating the sampling weights, were employed.
  
  
  RESULTS
  Among predisposing factors, CAM use was associated with middle-aged to older, more educated, and female African Americans. Region (Northeast less likely than South) was the only significant enabling factor. Need factors had the most frequent relationships, with more medical conditions, more physician visits, better health status, prescription and over-the-counter medication use, more frequent exercise, and having activities of daily living limitations being associated with CAM use. After adjusting for PEN factors, the disease states of pain/aching joints, recurring pain, and migraine were related to CAM use.
  
  
  CONCLUSIONS
  African American CAM users are middle-aged to older, female, educated, and have more medical conditions (especially pain-related). Users report higher utilization of "traditional" care (e.g., physician visits), indicating that CAM is likely a complement to conventional treatment in this population. Health care providers should use these factors as prompts for inquiring about CAM use in African American patients.
authors.affiliation: College of Pharmacy, Pharmacy Administration Division, Center for Pharmacoeconomic Studies, University of Texas at Austin, Austin, TX 78712, USA. cmbrown@mail.utexas.edu
authors.forename: Carolyn
authors.initials: C
authors.lastname: Brown
authors.forename: Jamie
authors.initials: J
authors.lastname: Barner
authors.forename: Tom
authors.initials: T
authors.lastname: Bohman
authors.forename: Kristin
authors.initials: K
authors.lastname: Richards
mesh_terms: D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D005843:Geography; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D012737:Sex Factors; D055815:Young Adult
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