INTRODUCTION

Asian-American immigrants commonly use herbal medicine or a combination of WM and herbal medicine (Kim, et al., 2002). TCM, one of five Complementary and Alternative Medicine (CAM) therapies classified by the National Institutes of Health (NIH), includes herbal and nutritional therapy, restorative physical exercises, meditation, acupuncture, and remedial massage (NCCAM, 2002). Traditional Chinese medicine is also called Traditional, Eastern, or Oriental medicine.

Awareness of Asian-American's use of TCM, often in combination with WM, is an increasingly salient issue for health care professionals, especially as the Asian-American population increases. In 2000, Asian-Americans in the U.S. numbered 10 million, or 3.6 percent of the American population (Census, 2002). They are expected to grow by more than triple to 37.6 million by the year 2050, comprising 9.3 percent of the population (Census, 2002). Over the next half century, they are expected to be the fastest growing ethnic group in America (Armas, 2004).

The World Health Organization (WHO) estimated that four billion people or 80 percent of the world's population presently use herbal medicine for some aspect of primary health care (Ho, 2001). The use of herbal medicine and acupuncture are among the two most common types of TCM in the U.S. by the Asian-American population (Ka, 1998). Studies have shown that herbal medicine prevents and treats stroke and ischemia (Lin, et al., 2000) and reduces the size of enlarged spleen due to liver fibrosis (Yang, et al., 2000). In other studies, herbal medicine has been found to improve the condition of patients with Alzheimer Disease (Oishi, et al., 1998) and the swallowing reflex in patients with Parkinson's disease (Iwasaki, et al., 2000). Likewise, acupuncture has been proven effective in relieving postoperative pain, nausea during pregnancy, nausea and vomiting resulting from chemotherapy, and dental pain (WHO, 2003). It can also alleviate anxiety, panic disorders, and insomnia (WHO, 2003). Although scientific evidence from these studies is strong for many uses of acupuncture and some herbal medicines, more research is needed to determine the safety of TCM when taken in conjunction with WM.

Information on the potential toxicity of these remedies is often not well documented or readily available (Rees, 2003). Herbs may cause adverse effects, such as allergic reactions, toxic reactions, mutagenic effects, and interactions between TCM and pharmaceutical drugs, some of which can result in death (Bensoussan, et al., 2000). Anaphylaxis is the most common critical reaction, and other adverse effects include bronchospasm, circulatory failure, and intestinal obstruction (Rees, 2003). The potential for adverse reactions increases due to the lack of control over poor quality and potentially harmful herbs (Rees, 2003). Because herbal remedies are often a complex mixture of chemicals of uncertain concentrations, they are difficult to classify and test in research experiments (Rees, 2003).

Unregulated or inappropriate use of TCM and practices not only cause negative or dangerous effects, but miscommunication between providers and patients also increases the risk of these effects (WHO, 2003; Johnson, 2002). Doctors rarely know when their patients are taking alternative medicines that could be incompatible with the treatments that they are prescribing (Rees, 2003). A study found that 63 to 72 percent of respondents who had used TCM in the past year and seen their medical doctor did not disclose to their doctor that they had received at least one type of TCM therapy (Eisenberg, et al., 1998). The prevalence of herbal remedy use increased by 380 percent from 1990 to 1997 and an estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies (Complementary and Alternative Medicine in the United States, 2005). Many Asian-American patients feel uneasy telling their doctors that they are taking both TCM and WM because of their fear of disapproval and a belief that Western doctors are neither knowledgeable nor interested in TCM (Ho, 2001). This lack of communication between patients and their health care providers increases the risk of adverse effects between TCM and WM.

As a response to previous research, this study examines the risks and benefits associated with the use of TCM and WM by Asian-American college students in New England. Studying the Asian-American college student population is important because the majority of research on TCM has focused on Asian-American adults and elderly, but no study has yet been conducted on Asian-American college students and their use of TCM and WM. One study, however, has found that TCM use was higher among those who had some college education (50.6 percent) than among those with no college education (36.4 percent) (Eisenberg, et al, 1998). As a result, college students are a higher risk population because they are likely to experiment with and be able to assess different types of medical therapies and may not be aware of herb-drug interactions.

SCOPE OF RESEARCH

The purpose of this study is to describe the risks and benefits of TCM and WM and the implications for college campus health services to provide culturally competent and integrative care. The goal is to understand the rationale behind the choice of TCM or WM by investigating which factors are associated with each type of care. By understanding the needs and wishes of Asian-American students, we can suggest a university health care system that addresses the differences in traditional culture and beliefs, especially with regard to the practice of medicine. Understanding the prevalence of students' use of TCM and WM and the risks and benefits of both types of care is a first step toward improving communication between health care providers and their patients. Knowledge of the factors associated with students' use of TCM and WM can improve the quality of health care by increasing college campus health providers' cultural sensitivity, facilitating better communication between students and their healthcare providers, as well as meeting the needs for an integrated approach in the university health care system.

This study examined the risks and benefits associated with the use of TCM and WM, access to TCM in health services, communication between providers and students, and interventions necessary to improve the quality of care for students. Better understanding of the factors associated with students' use of TCM and WM may lead to an increased awareness and promotion of an integrative approach in health services.

METHODS

Survey questionnaires of students in New England and face-to-face interviews with students in the Boston area were conducted to understand the perceived benefits and risks of TCM and WM, as well as determine the prevalence of Asian-American college students using these therapies. In addition, the aim of the survey questionnaire is to understand some of the perceived risks and benefits so that these issues can be explored in greater detail during the interview. The study was exempt from review by the Tufts University Institutional Review Board (IRB) because the surveys and interviews were recorded in such a manner that human subjects either cannot be identified, directly or through identifiers linked to the subjects, or that disclosure of the human subjects' responses could not place the subjects at risk of criminal or civil liability or damage to the subjects' financial standing, employability, or reputation.

The principal investigator began the recruitment process for the study. Asian-American college students were recruited from a selection of Asian-American organizations at four-year private and public colleges in New England through a New England Index website (www.newenglandindex.com/necolleges.html). These states include Massachusetts, Connecticut, Maine, New Hampshire, Vermont, and Rhode Island. Every third school from the list of colleges on the website was reviewed for Asian-American organizations and email addresses of its leaders. Emails sent to those leaders included a general description of the research project with the consent form and questionnaire attached (Appendix A). The email also stated that the research is intended for Asian-American college students only. The leaders were asked to read the consent form, fill out the survey, and email only the completed survey back to the principal investigator. In addition, they were asked to forward the original email to their members. The participants' names were kept confidential, and each survey was identified by a unique code assigned by the principal investigator. Students who completed the survey and emailed it back to the principal investigator were entered into a lottery for a $50 gift certificate to the store of their choice.

Among the Asian-American college students surveyed, 14 students in the Boston area participated in a 30-minute semi-structured interview with the principal investigator. The interview recruitment process involved asking students in the survey questionnaire to participate in a 30-minute interview with the principal investigator in the Boston area. Fourteen students offered to participate in the interview, which was scheduled at a time and place that was most convenient for the student. The interview explored the students' experiences with TCM, WM, or both (Appendix B). The interview consisted of questions regarding their use of TCM and WM, the benefits and limitations of each type of care, and factors influencing their choice of TCM and WM. Furthermore, students were asked about interventions in health services regarding TCM and WM that would improve the quality of care. Students each received $20 compensation at the end of the interview. Interviews were recorded on audiotape and transcribed by two undergraduate students and the principal investigator.

In addition to student interviews, staff and faculty from the Boston area were interviewed to examine the role of TCM and WM in the context of the national health care system. These key informants included doctors and professors who are knowledgeable in the field of TCM and WM. Face-to-face interviews and telephone interviews were conducted to understand the trends in the use of TCM among Asian-American college students and possible interventions for integrative medicine in college campus health services. The interviews were semi-structured and lasted approximately 30 minutes.

Results from survey questionnaires were coded into the Statistical Package for the Social Sciences (SPSS, version 12.0). Descriptive statistics were analyzed on SPSS and responses to open-ended questions were typed into a text document in Microsoft Word for manual coding. Guidelines for data analysis for the interviews were derived from Weiss' book (1995), Learning from Strangers: The art and method of qualitative interview studies. The case-focused analysis for concrete cases, which was used for this study, takes the respondents' experience and shares it with the reader. The materials were sorted so that the same issues are brought together, regardless of where the material originally appeared in the interview transcripts. The material was then organized into tables and figures for easier comprehension. Some interesting among respondents were also used to tell a story of particular issues.

RESULTS

Student Questionnaires

The sample of survey participants included 102 Asian-American students from 16 colleges in New England. The demographic information of these students are portrayed in Table 1 (The survey instrument is available in Appendix A). Students from colleges in Massachusetts represented 10 of the 16 colleges in the survey. Students from six other colleges in Connecticut, New Hampshire, Vermont, and Rhode Island, were also included in the survey.

Table 1. Demographic characteristics of respondents (n = 102)

Approximately 68 percent of students in the sample used a combination of TCM and WM in the past year. Among those who used TCM, more than 17 percent of students used TCM more than ten times in the past year, as shown in Table 2.

Table 2. Number of times spent utilizing TCM and WM in the past year (n=102)

Individual Student Interviews

Interviewees came from colleges in the Boston area, including Tufts (n=5), MIT (n=3), Harvard (n=2), University of Massachusetts at Boston (n=2), Boston College (n=1), and Massachusetts School of Pharmacy (n=1). Responses from survey questionnaires were used to guide the development of interview questions and helped identify issues concerning TCM and WM use among Asian-American college students. Students were asked whether they used TCM, WM, or both, for their medical needs. (The interview instrument is available in Appendix B). Twelve out of 14 interviewed students stated that they used both types of care. Among the interviewed students who used TCM and WM, six said they used WM more than TCM, and five used both equally. Students were asked about the specific types of TCM and WM used, as well as the reasons their use. As depicted in Table 3, the most common types of TCM used by interviewed students were herbs, acupuncture, and acupressure. The use of herbs was the most prevalent among Asian-American college students with 79 percent of students reportedly using herbs. Furthermore, 14 percent of students reported using herbs with alcohol; 36 percent cooked herbs in chicken soup; and 29 percent drank herbal teas. Acupuncture and acupressure were used by 57 percent of students. Other common types of traditional therapy used by college students include coin rubbing, ointments, steaming, and Tai Chi. Reasons for using these traditional practices were to relieve minor aches and pains, cure common illnesses, bring the body back to balance, cleanse the body, and provide nutrients and energy. In one case, a student declared that acupuncture cured her eczema when WM could not. Most students did not use TCM to cure serious diseases, but rather to heal the body from “common viruses” and to provide them with more energy.

Table 3. Types of TCM and therapy used by interviewees (n=14)

When students were asked about their use of WM, the majority mentioned over-the-counter medicines or hospital prescriptions. As shown in Table 4, students used WM to cure common illnesses or suppress the symptoms of colds, headaches, stomachaches, cramps, and allergic reactions. WM was also used for emergency care, such as in reducing pain and inflammation, fixing fractures, sealing cuts, or killing bacteria. When Western supplements, such as vitamins, were used for providing nutrients and energy, it was often quick and simple, as opposed to the labor-intensive and painful methods of TCM that students cited.

Table 4. Types of Western Medicine or Therapy Used by Interviewees (n=14)

Students were asked about the benefits and limitations of TCM, as presented in Tables 5 and 6, respectively. Benefits were defined as factors that would encourage their use of TCM, and limitations were defined as factors that would prohibit or discourage their use of TCM. The most common benefits of TCM described by students were that it is natural, prevents major diseases, helps the entire body, and gives an overall good after-effect feeling. Additionally, some students stated that TCM is cheaper, safer, and more tasteful than WM. Students described taking TCM as more personal and comfortable. For example, TCM is usually given by loved ones, such as a parent, husband, or wife, and is practiced in the home as opposed to a clinical setting. Each dose is customized to meet the individual needs of the patient and is dependent on the type and severity of the illness, as well as the age, size, and condition of the patient. Students explained that TCM is more effective for smaller, less serious illnesses, such as stomachaches, headaches, and colds.

Table 5. Perceived Benefits of TCM

Many limitations prevent or reduce the use of TCM among Asian-American college students. For example, students stated that the lack of scientific validity, effectiveness, promotion, and trust are the main reasons why students refrain from using TCM. Although some students find TCM to be cheaper than WM, other students cited limited access and high costs of TCM as barriers to their use in the U.S. While TCM may relieve symptoms, students claimed that it does not cure diseases and takes a while to produce its desired effects. As opposed to some students who enjoy the TCM therapies, other students stated that their experiences with TCM are painful, inconvenient, time-consuming, and even repulsive in terms of its taste, odor, and appearance. Some students believed that TCM has a placebo or psychological effect and should not be used for “serious” illnesses, such as surgery or infection. The stigma that TCM is ineffective and psychological prevents many students from disclosing their use of TCM.

Table 6. Perceived Limitations of TCM

Similar to questions regarding TCM, students were asked to describe the benefits and limitations of WM. As shown in Table 7, students stated that the benefits of WM are its scientific proof, reliability, and strength. In addition, students explained that WM is more effective for more “serious” diseases, such as surgery and infections, is convenient to take, and works faster than TCM.

Table 7. Perceived Benefits of WM

Despite its scientific validity and ongoing research, WM has many drawbacks, such as its side effects, dependency, costs, and ineffectiveness after repeated use, as portrayed in Table 8. Students believed that WM is a business for doctors and health insurance companies to make money rather than to care for their patients' health and well being. Prescription drugs and dosages are standardized for everyone, so that they could be produced in bulk. WM was considered impersonal because doctors are overwhelmed by the number of patients, and the hospital setting and experience can be a scary and traumatic one. The impersonal and often unfriendly hospital setting makes WM seem even more like a business—a place where patients pay to have their needs taken care of and leave when doctors have provided their services.

Table 8. Perceived Limitations of WM

Although most students use a combination of TCM and WM, they do not relay this information to their health care providers. Some students are concerned over the lack of communication between patients who use TCM and their Western doctors. As stated by one student interviewed in this study:

“A lot of the Asian people that go to Western doctors…never ever would say outright, like `Oh, I just went to the traditional doctor and got this medicine and I am using it right now.' I guess because of fear or anything. If there were more doctors that could regulate [the use of both types of medicine], I think that would help the patient overall.”

Because of the lack of communication and other limitations of TCM, students stated that they want more promotion of TCM (n=7), more research on TCM (n=4), and increased access to TCM practitioners (n=3). Other comments included the desire for more certified TCM practitioners, improved quality control of TCM, more culturally competent Western doctors, and insurance coverage of TCM.

Most students said that an integration of TCM and WM in health services would improve the quality of their health care. Students believed that the benefits of integrative medicine, include further research, scientific evidence, and the Food and Drug Administration (FDA) approval of TCM. Additionally, increased promotion and certification of TCM practitioners would lead to greater use of TCM by students. Students hoped that the increased use of TCM would result in insurance to cover the costs of TCM. In addition, integration of TCM and WM in health services would increase cultural competency of healthcare providers. The majority of students stated that having a Western doctor, who is knowledgeable not only in TCM and WM, but also in students' traditional beliefs, religion, and culture, would be a positive intervention in college campus health services.

Staff and Faculty Interviews

Faculty from Tufts University and guest speakers at a Harvard Medical School conference on integrative medicine were invited to an interview on students' use of TCM and WM. Dr. Richard Glickman-Simon, a physician of WM and professor of alternative medicine at Tufts University, and Dr. Beverly Wedda, the founder and physician at an integrated medical practice, agreed to participate in the interview.

Throughout the interviews with medical faculty and staff, integrative medicine emerged as a common theme. Integrative medicine is the combination of mainstream medical therapies and CAM therapies including TCM, such as herbs and acupuncture that has scientific evidence of safety and effectiveness. The WHO defined an integrative system as one in which CAM is “officially recognized and incorporated into all areas of health care provision.” Integrative medicine is influenced by a philosophical and holistic outlook, mind body system, spirituality, belief system, and the environment. Dr. Richard Glickman-Simon believes that integration in college campus health services is possible under supervision of someone who can make healthcare decisions on behalf of a patient and work closely with acupuncturists in a TCM community:

“…medical director or senior physician on staff who is open to this and has some experiences, not necessarily doing acupuncture but working with acupuncturists and understanding under what circumstances it can be done safely, and if there is mutual respect between practitioners at the site and the director” (Glickman-Simon, personal communication, 2004).

By providing access to TCM at college campus health services, providers are giving students a choice to use either TCM or WM, and they can monitor that choice to reduce adverse effects (Glickman-Simon, personal communication, 2004).

Two examples of successful integration in clinical practice in Massachusetts are Choices Integrative and Preventive Family Practice, directed by Dr. Beverly Wedda, and the Dana Farber Institute Center. Dr. Wedda's clinic is based on prevention and wellness care, lifestyle approaches to health and well-being, and the safe and effective integration of CAM therapies into healing and treatment plans. Because natural herbal remedies do not have many side effects or interactions with WM, Dr. Wedda stated that she has not seen or heard of any adverse effects in clinical practice with patients who use both TCM and WM. In addition, health care providers can reduce or prevent negative reactions that result from interactions between TCM and WM by learning more about TCM, avoiding herbs and pharmaceutical drugs that would produce adverse effects, and having better communication with patients (Wedda, personal communication, 2004). Similarly to Dr. Wedda's clinic, the Dana Farber Institute Center has established the Zakim Center for Integrative Therapies (Complementary and Alternative Medicine in the United States, 2005). These therapies include massage therapy, acupuncture, and nutritional guidance, and cancer treatment, such as chemotherapy and radiation (Complementary and Alternative Medicine in the United States, 2005). The Zakim Center's website states that patients who use the traditional therapies with their medical or surgical care have a more comprehensive treatment plan and help their bodies to regain health and vitality (Complementary and Alternative Medicine in the United States, 2005). Integrative medicine not only is shown to provide safe and effective care, but also results in greater patient satisfaction and well-being.

Unfortunately, total integration of WM and TCM is difficult because of the lack of access, resistance to change, and costs. While the use of TCM, especially herbs, is common among the Asian-American population, only 8.8 percent of primary care providers would recommend herbal medicine for their patients. In addition to the lack of evidence and trust, physicians are question insurance coverage for CAM. Physicians caution that “the consequences of including CAM services in health insurance plans are unknown and require careful consideration” (Complementary and Alternative Medicine in the United States, 2005). Thus, most patients pay for these services out-of-pocket and do not disclose their use of CAM to their healthcare providers, which raises safety issues, such as the potential for herb-drug interactions. According to Dr. Wedda, it would require time, communication, and cooperation for full integration in college campus health services.

In order to make the transition of TCM into WM easier, Dr. Wedda believes that there should be more information to support the benefits of integrative approach, such as placebo controls and science-based studies. Physicians and providers also need to be more open to change, which may be driven by consumer demand. Integrative medicine is an investment in short-term care because the prevention of health problems is seen in the long term. Since college campus health services provide only acute care for approximately four years of a student's life, getting health service directors and insurance companies to invest in short-term care for students may be challenging. As a result, health service directors need education to see the value of integrative medicine and the benefits of investing in the health of their students (Wedda, personal communication, 2004). Insurance companies may cover the costs of TCM if it is shown to prevent disease and ultimately lower the costs of treatment.

DISCUSSION

While students perceive risks and benefits of TCM and WM, most opt to use both types of care. The majority of students interviewed use TCM in conjunction with WM without fully understanding its risks and benefits while they are in college. In addition, students feel uneasy about telling their health care providers that they are receiving both TCM and WM at the same time. The lack of communication and the risk of adverse effects from taking TCM and WM is a concerning issue that must be addressed by college campus health providers. Many students explained that they would like better communication and more understanding of cultural beliefs from their health care providers. In addition, concern over possible interaction of pharmaceutical drugs and herbs lead students to prefer an integration of TCM and WM in college campus health services.

With increasing demands for an integrative approach on college campus health services, more efforts should be expanded to investigate possible ways to incorporate traditional practices into university health care systems so health providers and Asian-American students can develop a more open relationship. Health service providers need more knowledge and understanding of students' use of TCM so that cultural competency can be integrated into all aspects of health service. Health service providers must research the different types of TCM used by Asian-American college students, acknowledge and promote the use of TCM on campus, and ask questions regarding students' use of TCM in a caring and nonjudgmental way. Promotion of TCM may include pamphlets describing the different types of TCM, such as herbal medicine, acupuncture and acupressure, moxibustion, and qi gong. Furthermore, all health service providers should have a list of trustworthy and accessible TCM clinics for referral of students. Student health insurance should cover the costs of TCM, especially acupuncture, since it has been shown to be effective in many research studies. Having certified acupuncturists and herbalists in health services are also of great importance to Asian-American college students, who stated that they would trust these providers because of their degrees and training. An integration of TCM and WM in health services would not only provide more comprehensive and cost-effective care, but also decrease risks of side effects and interactions for students who are already using both therapies.

Potential concerns include the cost and effectiveness of integrative medicine in campus health services. Integration in college campus health services may be possible with the support of the majority of students, health service providers, as well as the director of health services. If TCM can be shown to be effective for preventative as well as curative care, then the integration of TCM and WM would be cost-effective and sustainable not only for Asian-Americans, but for all students. Future clinical trials should test the effectiveness and safety of traditional Chinese medicines and practices such as herbs, acupuncture, and acupressure. In addition, future studies should investigate the views of health service directors on the integration of TCM and WM in college campus health services. Future research is the key to better understanding of the use of TCM and WM among Asian-American college students so that appropriate interventions can be developed to meet to the needs of a growing population.

Limitations

Certain limitations of this study should be noted. The use of a convenience sample from colleges and universities in the Boston area means that the findings are preliminary, are not generalizable, and require replication. Furthermore, the responses of college students who are in programs other than the four-year Bachelor program are not studied. In addition, compensation for student participation in the interview may result in selection bias. Further research should be done to reduce selection bias and to examine not only undergraduate students, but also students who are in other college programs, such as those in associates degree programs, vocational schools, and graduate and professional schools. Results should be used to raise health care providers' awareness of students' use of TCM in conjunction with WM and to suggest possible interventions for college campus health services.

AUTHOR AFFILIATION

Kimberly H. Nguyen is pursuing a Master of Public Health degree in Epidemiology and Biostatistics at Tufts University School of Medicine. All correspondence should be addressed to Kimberly.Nguyen@tufts.edu.

REFERENCES

1) Armas, G. (2004, May 3). Asian population sees surge in growth across America. Tufts Daily. pp. 1, 22.

2) Asian-American population: 2000. (2002). U.S. Census Bureau. Retrieved April 30, 2005 from http://www.census.gov/prod/2002pubs/c2kbr01-16.pdf.

3) Bensoussan, A., Myers, S., & Carlton, A. (2000). Risks associated with the practice of traditional Chinese medicine: an Australian study. Archives of Family Medicine, 9(10), 1071-1078.

4) Chung, R., & Lin, K. (1994). Help-seeking behavior among Southeast Asian refugees. Journal of Community Psychology, 22(2), 109-120.

5) Complementary and Alternative Medicine in the United States. (2005). National Academies Press. Retrieved May 5, 2005 from http://books.nap.edu/catalog/11182.html.

6) Eisenberg, D., Davis, R., Ettner, S., Appel, S., Wilkey, S., Van Rompay, M., & Kessler R. (1998). Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 280(18):1569-75.

7) Four-Year Colleges in New England. (2000). The New England Index. Retrieved January 22, 2004 from http://www.newenglandindex.com/necolleges.html.

8) Ho, N. (2001). Understanding traditional Chinese medicine—a doctor's viewpoint. Singapore Medical Journal, 42(10), 487-492.

9) Iwasaki, K., Wang, Q., Seki, H., Satoh, K., Takeda, A., Arai, H., and H. Sasaki. (2000). The effects of the traditional Chinese medicine, “Banxia Houpo Tang (Hange-Koboku To)” on the swallowing reflex in Parkinson's disease. Phytomedicine, 7(4), 259-263.

10) Johnson, S. (2002). Hmong health beliefs and experiences in the Western Health Care System. Journal of Transcultural Nursing, 13(2), 126-132.

11) Ka, V. (1998). Hard choices: the use of Western versus Chinese traditional medicine by the Chinese homebound elderly, New York City. Journal of Long Term Home Health Care, 17(2), 2-10.

12) Kim, M., Han, H., Kim, K., & Duong, D. (2002). The use of traditional and Western medicine among Korean American elderly. Journal of Community Health, 27(2), 109-120.

13) Lin, C., Yen, F., Hsu, F., and J. Lin. (2000). Anti-hypercholesterolaemia, antioxidant activity and free radical scavenger effects of traditional Chinese medicine prescriptions used for stroke. Journal of Pharmacy & Pharmacology, 52(11), 1387-1393.

14) Oishi, M., Mochizuki, Y., Takasu T., Chao E., & Nakamura, S. (1998). Effectiveness of traditional Chinese medicine in Alzheimer disease. Alzheimer Disease & Associated Disorders, 12(3), 247-250.

15) Rees, D. (2003). Healing in perspective. Philadelphia, PA: Whurr Publishers.Weiss, R. (1995) Learning from strangers: the art and method of qualitative interview studies. New York: The Free Press.

16) What is Complementary and Alternative Medicine? (2002). National Center for Complementary and Alternative Medicine. Retrieved on December 3, 2004 from http://nccam.nih.gov/health/whatiscam/.

17) World Health Organization: WHO Traditional Medicine Strategy 2002-2005 (Geneva: WHO, 2002). Retrieved November 10, 2004 from http://www.who.int/medicines/library/trm/trm_strat_eng.pdf.

18) Yang, H., Chen, Y., Xu, R., Shen, W., & G. Chen. (2000). Clinical observation on the long-term therapeutic effects of traditional Chinese medicine for treatment of liver fibrosis. Journal of Traditional Chinese Medicine, 20(4), 247-250.

Appendix A.

Survey: The Use of Traditional and Western Medicine

Among Asian American college students

Are you an Asian American college student? If yes, please continue with this survey. If no, please disregard this survey.

Please type in the letter “X” next to the answer for each question.

Gender: ___M ___F

Age: ___18 ___19 ___20 ___21 ___other (please type in age)

Ethnicity: ___Chinese ___Japanese ___Korean ___Taiwanese ___Vietnamese ___other (please list)

Proficiency in English and native language:

___can proficiently speak, read, and write in English only

___can moderately speak, read, and write in English only

___can proficiently speak, read, and write in English and in native language

___can moderately speak, read, and write in English and in native language

___can proficiently speak, read, and write in English and can moderately speak, read, and write in native language

Length of residency in the US:

___less than 1 year ___1-3 years ___4-6 years ___7-9 years ___greater than 9 years

How often do you utilize Western medicine in a year? (1)

___0 ___1-3 ___4-6 ___7-9 ___more than 10 times

What are your major reasons for use of Western medicine? (please check all that apply)

___head trauma/headache

___cardiovascular

___cold/flu

___dental

___musculoskeletal

___other (please list)

How often do you practice traditional medicine in a year? (2)

___0 ___1-3 ___4-6 ___7-9 ___more than 10 times

What are your major reasons for use of traditional medicine?

___head trauma/headache

___cardiovascular

___cold/flu

___dental

___musculoskeletal

___other

Behaviors that are important for you personally to keep healthy. “X” under Very Important, Fairly important, or Not important for each factor

Behaviors that are important in helping you recover when you become sick. “X” under Very Important, Fairly important, or Not important for each factor

Confidence in various persons or institutions who could help you recover when you are sick. “X” under Very Important, Fairly important, or Not important for each source

Free Response Question

What are the differences between Western and traditional medicine that would make you use one over the other?

Any additional comments:

*Please type your name on the consent form and keep it for your records. Email ONLY this survey to the principal investigator -Kimberly.Nguyen@tufts.edu

Thank you for taking this survey!!! If you would like to participate in a 30-minute interview with the primary investigator about your experiences with traditional and Western medicine, please state that in the email. You will be compensated with $20 for your time.

(1) Western medicine is defined as visits to the doctor's office, outpatient clinic, emergency room, hospitalization, use of doctor-prescribed medications, or over-the-counter medications or vitamins.

(2) Traditional medicine is defined as the use of herbal medicine, acupuncture, moxibustion, acupressure, topical ointments, oriental massage, or nourishing teas and soups.

Appendix B.

Interview Questions for Students

OR:

In your opinion, would the following interventions improve, worsen, or have no effect on the quality of health care for you?

Appendix C.

Interview Questions for Key Informants

For college campus health service providers and doctors:

For other professionals in the field of TCM and WM: