Prevalence of and factors associated with herbal remedy use in the United States Item Type text; Dissertation-Reproduction (electronic) Authors Delate, Thomas Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 03/10/2021 19:31:09 Link to Item http://hdl.handle.net/10150/279949 INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. 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Mi 48106-1346 USA 800-521-0600 PREVALENCE OF AND FACTORS ASSOCLVTED WITH HERBAL REMEDY USE IN THE UNITED STATES by Thomas Delate A Dissertation Submitted to the Faculty of the DEPARTMENT OF PHARMACEUTICAL SCIENCES In Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY In the Graduate College THE UNIVERSITY OF ARIZONA 2002 UMI Number 3050304 UMI' UMI MIcrofomn 3050304 Copyright 2002 by ProQuest Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Leaming Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor. Ml 48106-1346 2 THE UNIVERSITY OF ARIZONA ® GRADUATE COLLEGE As members of Che Final Examinacion Commlccee, we cercify chat we have read che dissertaclon prepared by ThoMas M. Delate enticled wiFVAi.KiirF. OF AMP gACTORS ARsnrTATUD WITH wcthai. iiBmg)Y DSE TW THE miTTED STATES and recommend chac Ic be accepced as fulfilling Che dissercacion requiremenc for che Degree of Doctor of Philosophy / Oc- Men joe^ Coons, Ph.D Dace JALalne R. DraugaJ.i.s, rn.u. Cti^el p. XebmrLtz, Eb.D.. Robin B. Harris. Ph.D. Dace Final approval and accepcance of chis dissercacion is concingent upon che candidace's submission of che final copy of che dissercacion Co che Graduace College. I hereby certify chac I have read chis dissercacion prepared under my direccion and reconaend chac ic be accepced as fulfilling che dissercacion requirement. Disserta Dace Stephen . Ph.D. 3 STATEMENT BY AUTHOR This dissertation has been submitted in partial fulfillment of requirements for an advanced degree at The University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library. Brief quotations from this dissertation are allowable without special permission, provided that accurate acknowledgment of source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the head of the major department or the E)ean of the Graduate College when in his or her judgment the proposed use of the material is in the interests of scholarship. In all other instances, however, permission must be obtained from the author. SIGNED: 4 ACKNOWLEDGEMENTS I would like to thank Dr. Stephen Joel Coons for his role as dissertation chairperson and my doctoral program advisor. His guidance and support throughout my doctoral program experience were invaluable. I would like to thank the members of my Dissertation Committee, Dr. JoLaine Draugalis, Dr. Robin Harris, Dr. Ron Vogel, and Dr. Michael Lebowitz, for their constructive suggestions regarding the methods, analysis, and the interpretation of the results of this research. I would like to thank the Arizona Center for Phytomedicine Research and its Director, Dr. Barbara Timmermann, for financial support of and my Graduate Research Assistantship during this research. I would like to thank the faculty at The University of Arizona who provided me with training and instruction during my doctoral program. I would like to thank Denise deGeus and Jacob Abarca for their insightful assistance in the design and construction of the questionnaire. I would like to thank the Center for Survey Research and Analysis and its Director, Christopher Barnes, for all of their assistance in the survey process. I would like to thank the American Foundation for Pharmaceutical Education for their fmancial assistance during my tenure as AFPE Pre-Doctoral Fellow. I would like to thank the present and former Pharmacy Administration graduate students for sharing ideas, experiences, and friendships. Last but not least, I wish to thank my wife. Dr. Rebecca Sedjo, my daughter Victoria and the Delate and Sedjo families for their encouragement and succor during my doctoral program. 5 TABLE OF CONTENTS LIST OF TABLES 7 ABSTRACT 9 1. INTRODUCTION 11 STATEMENT OF THE PROBLEM 13 PURPOSE OF THE RESEARCH 17 RESEARCH OBJECTIVES 18 RESEARCH HYPOTHESES 20 DEFINITIONS 20 2. REVIEW OF THE LITERATURE 23 CONSUMER USE OF HERBAL REMEDIES: AN EPIDEMIOLOGIC OVERVIEW 23 HEALTH STATUS AND USE OF HERBAL REMEDIES 65 FINANCIAL CONSIDERATIONS REGARDING HERBAL REMEDY USE 72 PUBLIC POLICY REGARDING HERBAL REMEDIES 79 SATISFACTION WITH HERBAL REMEDIES 85 CONCOMITANT USE OF HERBAL REMEDIES AND PHARMACEUTICALS 88 3. METHODS 97 OVERVIEW OF THE INVESTIGATION 97 METHODOLOGY 98 MEASUREMENT 105 STATISTICAL ANALYSIS 120 HYPOTHESIS TESTS 125 LIMITATIONS 126 4. RESULTS AND DISCUSSION 130 SAMPLING FRAME 130 PREVALENCE OF USE OF HERBAL REMEDIES 133 PREVALENCE OF HERB-PHARMACEUTICAL CONCOMITANT USE 135 HEALTH STATUS OF RESPONDENTS 139 FACTORS ASSOCIATED WITH HERBAL REMEDY USE 141 FACTORS ASSOCIATED WITH HERB-PHARMACEUTICAL 6 TABLE OF CONTENTS - Continued CONCOMITANT USE 149 REASONS FOR USING OR NOT USING HERBAL REMEDIES 157 FINANCL<VL CONSIDERATIONS REGARDING HERBAL REMEDY USE 165 SATISFACTION WITH HERBAL REMEDIES 171 PERCEPTIONS OF PUBLIC POLICY REGARDING HERBAL REMEDIES 172 HERBAL REMEDIES AND MANUFACTURERS 178 HYPOTHESIS TESTING 183 5. CONCLUSIONS AND RECOMMENDATIONS 185 CONCLUSIONS 185 RECOMMENDATIONS 189 APPENDIX A: ENGLISH LANGUAGE CATI SCRIPT OF THE RESEARCH SLTIVEY INSTRUMENT 196 APPENDIX B: SPANISH LANGUAGE CATI SCRIPT OF THE RESEARCH SURVEY INSTRUMENT 206 APPENDDC C: WEIGHTS FOR THE SCORING OF THE SF-12 MCS-12 AND PCS-12 217 APPENDIX D: SAMPLING OUTCOMES 220 APPENDIX E: HERBAL REMEDIES REPORTED 226 REFERENCES 229 7 LIST OF TABLES TABLE 2.1. Market survey data of top 15 brands of herbal remedies sold in food, drug, and mass merchandise outlets from July 1998 through May 1999 27 TABLE 2.2, Market survey data of top 15 herbal remedies sold in food, drug, and mass merchandise outlets from January 1, 2000 through December 31. 2000 28 TABLE 2.3, Recent epidemiological studies of herbal remedy use among adult Americans 30 TABLE 2.4. Recent studies examining herbal remedy use by adults in the U.S 32 TABLE 2.5, History of laws regulating herbal remedies in the twentieth century in the United States Si TABLE 2.6, Popular indications for, contraindications of. and potential pharmaceutical interactions with the six most popular herbal remedies in the U.S 90 TABLE 2.7, Categories of herbal remedy and pharmaceutical interaction effects 91 TABLE 3.1. Pre-determined response choices and coding values for independent variables 109 TABLE 3.2. Weight matrix for data 121 TABLE 4.1 Sample response outcomes 131 TABLE 4.2 Sociodemographic characteristics of respondents in sample and U.S. population 132 TABLE 4.3 Herbal remedy use and herb-pharmaceutical concomitant use: prevalence. 95% confidence interval, and extrapolation to total U.S. adult population 134 TABLE 4.4 Herbal remedies and pharmaceuticals reported being used concomitantly and their potential interactions 137 T ABLE 4.5 Comparisons of health status scores 140 TABLE 4.6 Comparisons of sociodemographic characteristics between herbal remedy users and non-users 142 TABLE 4.7 Correlations of health status scores and age with herbal remedy use and herb-pharmaceutical concomitant use 144 TABLE 4.8 Multivariate logistic regression modeling of factors associated with herbal remedy use 146 TABLE 4.9 Comparisons of sociodemographic characteristics between herb- pharmaceutical concomitant users and non-concomitant users 151 TABLE 4.10 Multivariate logistic regression modeling of factors associated with herb-pharmaceuticai concomitant use 155 TABLE 4.11 Primary reason for using herbal remedies 158 TABLE 4.12 Health conditions or diseases herbal remedies reported to be used to treat 160 8 LIST OF TABLES - Continued T ABLE