Age and ethnic differences in cold weather and contagion theories of colds and flu.

Age and ethnic group differences in cold weather and contagion or germ theories of infectious disease were explored in two studies. A cold weather theory was frequently invoked to explain colds and to a lesser extent flu but became less prominent with age as children gained command of a germ theory of disease. Explanations of how contact with other people causes disease were more causally sophisticated than explanations of how cold weather causes it. Finally, Mexican American and other minority children were more likely than European American children to subscribe to cold weather theories, a difference partially but not wholly attributable to ethnic group differences in parent education. Findings support the value of an intuitive or naïve theories perspective in understanding developmental and sociocultural differences in concepts of disease and in planning health education to help both children and their parents shed misconceptions so that they can focus on effective preventive actions.

Influence of race and ethnicity on alternative medicine as a self-treatment preference for common medical conditions in a population of multi-ethnic urban elderly.

The use of complementary and alternative medicine (CAM) is prevalent among elderly individuals. While race and ethnicity may influence the choice of CAM, it is uncertain how this influence affects an individual's choice of CAM or conventional medicine. Furthermore, it is unclear whether this choice of CAM or conventional medicine might vary for different medical conditions. A survey of CAM use was performed on a convenience sample of 338 multi-ethnic urban elderly subjects who attended clinic at two large university-affiliated hospitals over 2 years. The survey asked about individual CAM therapies used, and whether subjects would prefer conventional (prescription or over-the-counter) or CAM (herbal or other) treatment for three different medical conditions: colds, insomnia, and back pain. Hispanic ethnicity and female gender were the best predictors of CAM use. Blacks were more likely than whites to utilize CAM. Hispanics were more likely to choose herbal medications to self-treat colds and insomnia than whites or blacks, or low-back pain than whites. More Hispanics chose herbal medications to treat insomnia than over-the-counter or prescription medications.

Child health care decision making and experiences of Caribbean women.

INTRODUCTION: The purposes of this study were to (a) obtain data about the child health care decision making and practices of immigrant English-speaking women from the Caribbean region and (b) describe their experiences with the U.S. health care system and providers of care. METHOD: A qualitative design with purposeful sampling was used. Data were obtained from 12 women through focus group interviews. RESULTS: Three descriptive categories were identified: child/family focus, childhood illnesses and remedies, and relationships with providers. Findings included use of "parallel utilization" practices by the caretakers; use of herbs and other alternative practices; a strong informal social support network within the community; and frustration with and lack of trust in health care providers. DISCUSSION: Immigrant children and children of immigrant Caribbean adults are a vulnerable population that may be at risk for poor health and mental health outcomes when receiving care from multiple or inconsistent providers, when providers are unaware of folk practices administered to these children by caretakers, and because of a lack of research about the efficacy of folk medicines used in children either alone or in combination with prescribed Western medicines.

[Turkish and German patients of general practitioners--diseases, drug expectations and drug prescriptions]. / Türkische und deutsche Hausarztpatienten--Erkrankungen, Arzneimittelerwartungen und Verordnungen.

AIM OF THE STUDY: to assess the diseases and complaints and the concepts for treatment of patients and drug prescriptions relative to their ethnic origin: Turkish immigrants (T) or German citizens (D). METHODS: Questionnaire survey of patients of general practitioners before and after consultation. The survey was conducted separately for Turkish and German patients, involving nine GP's practices for each group. Sample sizes were 253 Turkish and 637 German patients, respectively. Only responses of patients younger than 60 years of age were evaluated (T: 216/G: 357). Reason: Relative to the entire Turkish population in Germany the number of ethnic Turks older than 60 is too small for comparative purposes. RESULTS: The two most frequent reasons for a visit to the doctor by Turkish migrants were pain of varied origin (T: 44 % / G: 21 %; p > 0.001) and colds or diseases of the respiratory tract (T: 41 % / G: 25 %; p > 0.001). Turkish and German patients differ significantly with respect to their mentioning of pain and colds. The concept of treatment of the Turkish patients is compared to German patients more adjusted to medicaments and less to counselling and discussion with the doctor. The physicians' prescribing frequency on the other hand conforms primarily to the disease of the patients and not to their ethnic group. To confirm this, compare the share of drug recipients per disease group: Respiratory tract: T: 79 % / D: 84 %, alimentary system: T: 58 % / D: 60 % and locomotor system: T: 49 % / D: 39 %. Secondly the physicians' prescribing frequency conforms to the patients' expectations of medicaments: Of the patients who expected a prescription T: 79 % and D: 77 % respectively were given a prescription and of those who did not expect a prescription T: 55 % / D: 51 % did receive it. Again the patients' ethnic group had no influence on the prescribing frequency. Significantly more Turkish than German patients (T: 23 % / D: 9 %; p < 0.001) received pain-relieving drugs. This is especially true for Turkish patients with illnesses of the respiratory, alimentary and locomotor system. This is the explanation: More Turkish than German patients name pain as their consulting reason. Again the prescribing frequency does not depend on the ethnic group. It depends on the patient' s pain. CONSEQUENCES: The treatment concept of Turkish patients is more directed to drugs. They request a drug more intensively and are more convinced of the medicaments' effectiveness than German patients are. In spite of this, physicians give a prescription according to the indication of the patient independent of his ethnic origin. The insistence on a prescription is significantly higher in Turkish than in German patients.

Misconceptions about colds and predictors of health service utilization.

OBJECTIVE: Colds accounted for 1.6 million emergency department (ED) visits and 25 million ambulatory visits by children and adults in 1998. Although most colds are caused by viruses and do not require medical intervention, many families seek health care for the treatment of colds. Parental misconceptions about the cause and appropriate treatment of colds may contribute to unnecessary health service utilization. The objective of this study was to determine predictors of reported ED use and ambulatory care use for colds among families with young children. METHODS: This study was an observational, prospective cohort study to determine attack rates for respiratory illnesses within families that have at least 1 child who is 6 months to 5 years of age and enrolled in out-of-home child care. Families were randomly selected from 5 pediatric practices in Massachusetts and were considered eligible when the child was enrolled in child care with at least 5 other children for >or=10 hours per week. Enrolled families were asked to complete a survey that assessed knowledge about colds, antibiotic indications, and frequency of health service utilization. Predictors of self-reported use of health care services were assessed in multivariate logistic regression models. RESULTS: Of the 261 families enrolled in the study, 197 families (75%) returned completed surveys. Although 93% of parents understood that viruses caused colds, 66% of parents also believed that colds were caused by bacteria. Fifty-three percent believed that antibiotics were needed to treat colds. Parents reported that they would visit the ED (23%) or their doctor's office (60%) when their child had a cold. Predictors of ED use on multivariate analysis included Medicaid insurance (odds ratio [OR]: 17.6 [2.2-139.3]), history of wheezing (OR: 18.3 [4.4-75.8]), and belief that antibiotics treat colds (OR: 4.2 [1.4-12.9]). Predictors of ambulatory care use included parent younger than 30 years (OR: 10.0 [1.6-64.3]), history of wheezing (OR: 5.6 [1.1-29.7]), and belief that antibiotics treat colds (OR: 3.8 [1.7-8.5]). CONCLUSIONS: Misconceptions about the appropriate treatment of colds are predictive of increased health service utilization. Targeted educational interventions for families may reduce inappropriate antibiotic-seeking behavior and unnecessary health service utilization for colds.

Antibiotic use for the treatment of upper respiratory infections in a diverse community.

BACKGROUND: Previous studies have not addressed whether cultural factors influence beliefs and practices related to the treatment of upper respiratory infections (URIs). The purpose of our project was to assess beliefs, care-seeking behavior, use of antibiotics, and means of obtaining antibiotics for the treatment of URIs among different ethnic groups in an urban community. METHODS: A total of 192 adults completed a self-administered questionnaire indicating their likelihood of seeking care, the perceived effectiveness of treatment methods, and their usual use of treatment regimens for 2 scenarios consistent with uncomplicated URIs. Respondents were also asked about their use of antibiotics not prescribed by a physician for a URI. RESULTS: A majority of subjects reported a belief in the effectiveness of antibiotics for URIs and indicated they are likely to seek care for URIs. Many (26%) had obtained antibiotics from sources other than a physician's prescription (e.g., directly from pharmacists or a supplier outside the United States). Many (31%) believed that antibiotics should be available over the counter. Individuals who reported using antibiotics for a URI were more likely than those who did not to obtain them without a prescription (35% vs. 11%, P = .001). Subjects with a cultural background from countries where antibiotics are available over the counter are more likely to use antibiotics not prescribed by a physician than those from countries with variably enforced regulations or the United States (40%, 30%, and 20%, respectively, P = .049). CONCLUSIONS: Members of an ethnically diverse community believe antibiotics are effective for colds, are very likely to seek care for colds, and often obtain antibiotics without a prescription. The ease of antibiotic access worldwide may influence their use in some communities in the United States.

Home-based therapies for the common cold among European American and ethnic minority families: the interface between alternative/complementary and folk medicine.

BACKGROUND: Most studies of alternative/complementary medicine use in children have focused on children with chronic illness and have not addressed the more common form of complementary medicine: popular home-based interventions and therapies for common low-morbidity sickness episodes. Also, there has often been a distinction between alternative/ complementary medical practices used by the general population and those used by members of ethnic minority groups and commonly referred to as folk medicine or ethnomedicine. OBJECTIVE: To describe the home-based therapies and practices that parents from diverse ethnocultural backgrounds use to treat the common cold in their children. METHOD: Interviews with mothers of children coming for care at a number of clinics and physicians' offices. Included were mothers from European American, African American, Puerto Rican, and West Indian-Caribbean heritages. RESULTS: Mean number of home-based remedies for the common cold did not differ among ethnic groups (controlling for maternal age, maternal education, number of children, and health insurance status). There were differences among groups regarding the frequency of use of specific remedies. CONCLUSIONS: Home-based remedies for colds in childhood are commonly used. Many of the treatments are complementary to biomedical treatment (ie, antipyretics, over-the-counter cold remedies, fluids). Very few are potentially hazardous if taken in moderation. Mothers from ethnic minorities use similar amounts of homebased interventions when compared with mothers from the majority culture.