Use of alternative therapies by a low income population.

Patients in a family health center clinic were surveyed about their use of alternative/complementary medicine. These were mostly low-income individuals on Medicaid. The aim was to estimate prevalence and patterns of use of medically unconventional therapies such as chiropractic, homeopathy, and acupuncture in this population. Nearly two hundred patients (N = 199) filled out questionnaires inquiring about medical conditions and illnesses, personal health habits (physical activity, tobacco smoking, alcohol intake, etc.), and use of preventive measures or therapies that are neither taught widely in US medical schools nor generally available in US hospitals, and which we refer to as 'alternative' therapies (ATs). The term 'alternative' is not intended to imply that ATs are necessarily chosen to replace, rather than to be used in combination with standard treatments, although that may indeed be so in specific cases. Twenty-nine percent of respondents (58/199) reported using at least one type of AT, as defined for the purposes of the survey. Frequency of use varied somewhat, with greatest AT use reported by those over 29 years of age with more education and higher incomes (p < 0.10, defined as chi 2 tests at p < 0.10). While no significant differences were found between AT users and nonusers with respect to exercise participation, alcohol intake or smoking, there was a difference with respect to the reporting of at least one medical condition (p < 0.01). Among those who have used ATs, 90% reported more than one medical condition. Of those reporting no AT use, 70% indicated only a single medical condition for which they had sought treatment. In conclusion, use of alternative therapy (AT) appears to be common in all socio-economic groups, although AT use is apparently slightly less among low-income persons than in the general population. It is therefore important for physicians and other medical providers to be aware that their patients may be using ATs. Obviously, such practices should be taken into account in case management.

Elder health programs in state health agencies.

Due to the rapid rise in the population of those aged 65 and older, public health programs that target this group merit special attention. State health agencies can play leading roles in providing and coordinating elder health programs by identifying needs and formulating guidelines in collaboration with federal, local, and private organizations. The Massachusetts Department of Public Health initiated the Elder Health Programs Unit in 1988, with a mission to assist elders in maintaining their highest level of functional status in community settings and to provide opportunities for older adults to take greater responsibility for their own health. The extent of involvement in elder health programming of other state health agencies outside of Massachusetts is not well documented. Through the distribution of a national survey, we set out to determine how many state health agencies offer elder health services.