Tjam, Erin Y.2006-07-282006-07-2819971997http://hdl.handle.net/10012/199There is clear evidence that variations in health exist across cultures. Differences in mental, physical, and functional health, service utilization patterns, health beliefs, and health management behaviors have been found between the Chinese and the general North American elderly. Health and cultural differences also contribute to variations in medication use. For the Chinese elderly, medication use is complicated by dissimilar medication metabolism, and the concomitant use of Western and Chinese medicines (TCM), which may result in greater risks for adverse drug reactions, medication non-compliance, and increased cost. Information on the determinants of medication use by culture is lacking. Numerous methodological problems exist in the literature on the study of minority cultures and the determinants of medication use including sampling, measurements, and statistical analysis. In addition, there is no previous study on the type of TCM available to the general public. In the present study, the sampling issue was addressed by a phonologically based surname search method, which yielded a high hit rate (86.1%), and this method was representative and user friendly. The Minimum Data Set for Home Care and a supplementary questionnaire on cultural measures were used to generate comprehensive, reliable and valid data. Multivariate linear and logistic regression analysis, as well as examination of interaction terms were employed. The availability and standard of the TCM products sold in the Kitchener/Waterloo area were surveyed, and results indicated serious labelling inadequacies and violations of the Food and Drugs Act. Four sets of data were analyzed for this study: the Chinese-Canadians in the Kitchener/Waterloo area; the Red-Cross Canadians from 6 Ontario cities; the Chinese-Hong Kong; and the general Canadian population. Significant differences were found in socio-demographic variables like age, marital status, education level, and living arrangement. For measures of health status, the Chinese-Canadians were the healthiest, followed by the Red-Cross Canadians, then the Chinese-Hong Kong. Determinants of medication use were analyzed for the Chinese-Canadian and the Red-Cross Canadian samples. Over 50% of the Chinese-Canadians used TCM for a combination of reasons. More respondents in the Red-Cross Canadian sample used all forms of medications, and the number of medication used was also higher for the Red-Cross Canadians. Variations existed in the determinants of medication use within culture and across cultures. For the Chinese-Canadians, determinants for any medication use were country of origin from Southeast Asia (OR=8.71), lived with child (OR=0.22), and number of diseases (OR=17.09); for TCM use, the determinants were health beliefs (a positive curvilinear relationship), presence of pain symptoms (OR=5.82), and being hospitalized (OR=15.10); for Western medicine use, they were lived with child (OR=0.14), presence of physical health problems (OR=11.46), and number of diseases (OR=15.17); for polypharmacy including TCM, they were presence of social isolation problems (OR=3.85) and number of diseases (OR=4.49); where for polypharmacy excluding TCM, the determinants was number of diseases (OR=3.78). Determinants for number of any medication used were number of diseases and an interaction term between perceived poor health and number of diseases, which accounted for 61% of the variances; for number of TCM used, the determinants were formal services used, pain symptoms, and an interaction term between social isolation problems and number of diseases, which explained 32% of the variances; for number of Western medicine used, they were perceived poor health, physical health problems, and number of diseases, which accounted for 56% of the variances. Variations were found within the Chinese-Canadians. Pain symptoms and being hospitalized were only significant for medication use involving TCM. Possible reasons to this were discussed. For the Red-Cross Canadians, determinants for Western medication use were cognitive performance score (OR=0.70) and number of diseases (OR=2.26); for polypharmacy, the determinants were feels lonely (OR=3.51), number of diseases (OR=1.64), and medication not reviewed (OR=0.23). Determinants for number of Western medication used were cognitive performance score, number of diseases, perceived poor health, and medication reviewed, which accounted for 30% of the variances. Variations existed in the determinants of medication use by culture. Medication reviewed and feels lonely, although present in similar proportions in the two cultures, were only significant for the Red-Cross Canadians. Reasons contributing to this were discussed. In conclusion, there is strong evidence that the health status and medication use patterns are different by culture. These variations have important implications to policy and program formation and to future research.application/pdf13165452 bytesapplication/pdfenCopyright: 1997, Tjam, Erin Y.. All rights reserved.Harvested from Collections CanadaDoctoral Thesis