Table 2.

Characteristics of Included Studies: Caregivers’ and Children’s Beliefs about, and CAM Practices for Pediatric Asthma

Author, Year	Design	Population	Results	Comments
1. Adams, 2007 [44]	Survey; Correlational	66 caregivers of urban children with asthma recruited from 3 clinics in Boston, Massachusetts; 42 (65%) Black	79% of caregivers reported CAM use in the past year (results not reported by race-ethnicity) Caregivers of older children reported more positive beliefs about CAM Beliefs about CAM were positively associated with risks for non-adherence to ICS medications	Prayer, Vicks Vaporub®, massage, herbs, oils and foods were most common among Black respondents
2. Ang, 2005 [39]	Survey, descriptive	53 caregivers of children with asthma recruited from primary care and subspecialty care clinics in Stony Brook, New York; 17% Black or interracial	25% of Black caregivers reported CAM use 67% of caregivers wanted CAM to be a part of their child’s asthma care (results not reported by race-ethnicity)	Prayer, home remedies, vitamins were most common among Black respondents
3. Bokhour, 2008 [33]	Qualitative; individual interviews	37 caregivers of children with asthma recruited from 3 Boston, Massachusetts clinics; 47% Black	18% of Black caregivers were intentionally non-adherent to ICS therapies; they were more likely to characterize asthma as intermittent
4. Bonner, 2002 [38]	Randomized controlled trial	119 families of children with asthma recruited from a general pediatric practice or pulmonary clinic in New York City, New York were randomized to intervention (education) or control conditions; 22% Black, 76% Latino	At time of enrollment, 9% of all families reported having a non-western view of asthma management, including treatment with herbal remedies Those in the education condition reported less endorsement of herbal treatment after the intervention
5. Branganza, 2003 [43]	Cross-sectional survey	310 caregivers of children with asthma outpatient attending a pediatric clinic in the Bronx, New York; 37% Black	89% of Black caregivers reported CAM use 59% perceived CAM to be as effective as ICS or β2- agonists 44% used CAM as first treatment of acute asthma Only 18% informed their provider about CAM use	Rubs, prayer, massage, teas and oils were most common among Black respondents
6. Cane, 2001 [25]	Qualitative; focus groups	66 mothers of children with asthma living in London; unspecified number reported their race-ethnicity as Black Caribbean		Teas and rubs were most common among Black Caribbean respondents
7. Conn, 2005 [34]	Survey, correlational	67 caregivers of children aged 3–7 with asthma in Rochester, New York; 41 (61%) Black	Only 22% of caregivers reported being completely adherent with ICS The most common ICS concern was with safety	Results not reported by race-ethnicity; majority of subjects were Black
8. Cotton, 2011 [40]	Survey, correlational	151 adolescents with asthma recruited from a children’s hospital in Cincinnati, Ohio; 85% Black	71% used CAM for symptom management in prior month	Relaxation and prayer were most common among Black respondents
9. Handelman, 2004 [28]	Qualitative, interviews using ethnographic methods	19 low income children aged 5–12 and 17 mothers recruited from pediatric asthma and primary care clinics at a pediatric hospital in Boston, Massachusetts; 13 (68%) Black, African or Black Caribbean	23% believed they were being overmedicated with ICS 18% feared addiction to ICS 9 of the 13 ‘Black’ children believed they developed asthma after exposure to a contagion 2 of the 13 ‘Black’ caregivers believed their child developed asthma from pollution or chemical exposure	Herbs and home remedies were most common among respondents Results not reported by race-ethnicity
10. Klein, 2005 [45]	Qualitative, focus groups	81 White, Black and Hispanic/Puerto Rican adolescents and young adults with asthma, diabetes or eating disorders recruited from school health classes (suburbs) or teen centers (urban) in Monroe County, New York	Those with CAM experience found CAM to be effective	Results not reported by race-ethnicity, by disease state or by urban/suburban residence
11. Laster, 2009 [35]	Qualitative, focus groups	28 parents of children with asthma were recruited from an asthma camp, from an outpatient child psychiatry clinic or from an ongoing asthma research trial in Atlanta, Georgia; 93% Black	Caregivers administered ICS medication intermittently fearing addiction
12. Mansour, 2000 [36]	Qualitative, focus groups	40 Black parents of children 5 to 12 years old with asthma were recruited from 4 schools in low-income, urban Cincinnati, Ohio	Parents were most concerned about the safety of ICS	Parents preferred alternative treatments, such as calming techniques, breathing exercises, visualization or biofeedback techniques, and dietary manipulations.
13. Mazur, 2001 [26]	Qualitative, structured individual interviews	48 caregivers of children with asthma recruited from a specialty asthma clinic in Houston, Texas; 21 (44%) Black	81% used CAM to treat their child’s asthma	Prayer and over-the-counter treatments were most commonly used by Black caregivers
14. Naimi, 2009 [37]	Mixed; observational cohort and qualitative individual interviews using grounded theory	40 teens, aged 15–18, were recruited from allergy and adolescent clinics in Philadelphia, Pennsylvania; 75% Black	Median ICS adherence obtained by overt electronic monitoring was 43% 6 subjects did not believe ICS was necessary; 3 feared addiction	Results not reported by race-ethnicity.
15. Peterson, 2002 [29]	Qualitative; individual interviews using ethnographic methods	20 Black caregivers of children with asthma recruited from local clinics (10 each from Seattle, Washington and New Orleans, Louisiana)	60% had a biologic orientation to disease causation. Alternative explanations for the origins of asthma included obesity, breast milk or exposure to an asthma contagion
16. Reznik, 2002 [41]	Survey, correlational	160 inner city high school students who self-identified as having been diagnosed with asthma were recruited form the Bronx, New York; 26% Black	80% reported CAM use for asthma 54% disclosed CAM use to provider	Rubs, teas, prayer, massage and foods were most commonly used Results not reported by race-ethnicity
17. Rich, 2002 [30]	Qualitative, content analysis of videos using grounded theory methods	20 adolescents and young adults recruited from pediatric and specialty care clinics at urban pediatric hospital and at an urban health clinic in Boston, Massachusetts; 10 (50%) Black	Most believed in a hereditary origin of asthma Alternative explanations for the origins of asthma included exposure to an asthma contagion Most subjects were ambivalent about taking ICS One subject felt that ICS was a form of medical experimentation	Results not reported by race-ethnicity
18. Sidora Sidora Arcoleo, 2007 [42]	Secondary analysis	228 parents of children with asthma, aged 5–12, recruited from six pediatric primary care practice sites in Rochester, New York; 37% Black, 8% Latino	83% of Black caregivers used CAM to treat their child’s asthma compared to 64% of White caregivers 399 unique CAM therapies were reported by 147 caregivers CAM was used in more severe disease	Mind-body therapies and manipulative therapies were reported most frequently by respondents Results not reported by race-ethnicity
19. Sidora Arcoleo, 2010 [31]	Survey, correlational	109 caregivers of children aged 7–15 with asthma were recruited from pediatric asthma/allergy and general pediatric clinics and the emergency room at a public city hospital in the Bronx, New York; 54% Black or Afro-Caribbean	Caregivers in the Bronx were compared to a sample obtained from upstate New York (see Yoos, 2007) Bronx parents had a higher degree of discrepancy between their lay illness representation and the biologic model of asthma than the comparison group
20. Van Dellem, 2008 [27]	Qualitative; focus groups	40 children with asthma and 28 mothers of children with asthma from the Netherlands, Turkey, Morocco or Surinam living in Amsterdam, the Netherlands Subjects were recruited by one physician from a larger multicenter home study. 9 children and 6 mothers were Surinamese Creole, defined as having a mixed African and European background..	Majority believed in a genetic causation of disease. Surinamese mothers held the most positive attitudes towards ICS
21. Yoos, 2007 [32]	Survey, correlational	228 caregivers of children with asthma aged 5–12 recruited from 6 pediatric clinics serving predominantly urban, minority families or community pediatric practices serving primarily middle-class families in upstate New York; 37% Black	There was a high degree of discrepancy between the caregivers illness representation and the biologic model of asthma 27% thought ICS should be a last resort 33% believed that children should be taken off ICS as quickly as possible 71%worried about ICS side effects

ICS: inhaled corticosteroid