Table 3.

Characteristics of Included Studies: Beliefs about, and CAM Practices for Adult Asthma

Author, Year	Design	Population	Results	Comments
1. Apter, 1998 [48]	Cohort, correlational	50 adults recruited outpatient clinics in Hartford, Connecticut and its suburbs; 11 (20%) Black and 18 (36%) Hispanic	Black and Hispanic subjects had significantly lower mean ICS adherence rates measured objectively over six weeks compared to White subjects 12% of subjects believed their asthma was too mild to warrant ICS treatment	Results not reported by race-ethnicity
2. Apter, 2003 [8]	Cohort, correlational	85 adults recruited from specialty, primary care and general medicine practices in Philadelphia, Pennsylvania; 65% Black	Black subjects had significantly lower mean ICS adherence rates measured objectively over six weeks compared to White subjects More concern about the safety of ICS was associated with lower adherence rates	Results not reported by race-ethnicity
3. Baptist, 2010 [46]	Qualitative; focus groups	46 adults recruited from Ann Arbor and Detroit, Michigan; 43.5% Black	Subjects feared ICS side effects Use of CAM (home remedies) was common CAM users preferred CAM to prescription therapies for acute asthma and for daily control No CAM user discussed CAM use with provider	Steam inhalation, teas, Vicks Vaporub®, and coffee was reported by respondents; results not reported by race-ethnicity
4. George, 2003 [18]	Qualitative; focus groups	15 Black females recruited from specialty or primary clinics in Philadelphia, Pennsylvania who had either declined to participate in a study of objective ICS use or who had less than 50% ICS adherence in the study	Subjects believed they were being overmedicated with ICS and that they were better judges of their need for ICS than their providers Subjects feared that ICS could cause liver or kidney damage, infertility, and cancer There was concern that tolerance or addiction to ICS could occur One subject reported that she has been told that ICS could serve as a birth control method
5. George, 2006 [19]	Qualitative; semi-structured individual interviews using the naturalistic inquiry approach	28 Black adults, aged 21–48, recruited from a specialty clinic in Philadelphia, Pennsylvania	36% held a non-biological explanatory model for asthma All subjects (100%) reported CAM for asthma 93% preferred an integrative approach to asthma self-management (CAM and ICS) CAM was characterized as natural, effective, and potentially curative Many subjects perceived that they were being overmedicated with ICS Two subjects likened ICS use to medical experimentation	Vicks Vaporub®, teas, steam inhalation, black coffee, water, bathing rituals, rain avoidance and prayer were most common among respondents Three potentially dangerous Cam therapies were reported: ingestion of large quantities of Hall’s® lozenges, ingestion of Vicks Vaporub®, and Echinacea
6. George, 2009 [17]	Qualitative; two semi-structured individual interviews using the naturalistic inquiry approach	25 subjects recruited from specialty and primary care clinics in Philadelphia, Pennsylvania Baltimore, Maryland and Washington DC; 76% Black	96% used 19 unique types of CAM for acute asthma 52% chose CAM for the initial treatment of acute asthma 84% preferred an integrated approach (CAM and ICS) for acute asthma Safety, attack severity, speed and strength of integrated care and the ability to develop a tailored treatment plan were reasons given for CAM use	Fresh air, water, unstructured relaxation/breathing techniques, and prayer were most common among respondent Results not reported by race-ethnicity
7. Le, 2008 [7]	Cohort, correlational	86 subjects recruited from a specialty clinic and through advertising in Baltimore, Maryland; 71% African American, 1% Hispanic, 5% “other” minority group	Compared to White subjects, minority subjects had significantly lower mean ICS adherence rates measured objectively over four weeks Many subjects believed they were being overmedicated with ICS Fear that ICS tolerance could develop or that ICS use could lead to serious adverse side effects was associated with lower ICS adherence rates
8. Ponieman, 2009 [47]	Cohort, correlational	261 adults were recruited from general internal medicine clinics in East Harlem, New York, and New Brunswick, New Jersey; 30% Black, 57% Latino.	49% worried about ICS side effects of ICS therapy 37% worried about addiction or tolerance to ICS	Results not reported by race-ethnicity
9. Webb, 1971 [50]	Qualitative; individual interviews	23 women receiving care at public health clinics in Jefferson, Lafayette, St. Landry, and St. Martin Parishes, Louisiana; race not reported; all photos are of Black patients	11 subjects with asthma reported folk beliefs derived from local Voodoo practices	The most common beliefs included two cures for asthma: placing hair from a child with asthma into a hole bored in a tree at the height of the child; when the child outgrows the height of the hole, asthma will be cured; the transfer of asthma from humans to a Chihuahua kept as a house pet
10. Wells, 2008 [49]	Mixed methods-Cohort, correlational survey and analysis of electronic ICS refill rates	1,006 patients who were both members of a large health maintenance and received care from a multispecialty medical group in Southeast Michigan; 33.4% Black	Compared to Whites, Blacks had lower ICS refill rates Compared to Whites, Blacks did not perceive ICS as a necessity, did not see their providers as a source of asthma control and were less ready to take ICS
11. Zahradnik, 2011 [51]	Descriptive, survey	278 adults recruited from 16 Brooklyn, New York health fairs and community events; 44% Black	91% identified providers as a source of asthma information 25% identified herbalist as the source of asthma information; and 13% identified a spiritual leader as their source Subjects who identified an herbalist or spiritual leader as their source of asthma care has lower asthma knowledge scores	Results not reported by race-ethnicity

ICS: inhaled corticosteroids