succeeds or fails. Support, however, is double-edged: it can also reinforce opposition to behavioral change.

Fourth, some groups may react more positively, for cultural reasons, to particular types of interventions, as can be seen for the use of alternative therapies (Jones, 2001; Loera et al., 2001). Hispanic and Asian older adults use both folk medicine and Western medicine, depending on the illness and symptoms, as well as their ability to obtain traditional health care (AppleWhite, 1995; Torsch and Ma, 2000). Despite the heavy promotion of alternative therapies and their common use by older adults, such therapies are inadequately studied. If they have any effect, they could produce health differences. The effect could also be negative, in deterring or delaying the search for more effective therapies. Not only healthy behaviors are promoted. Nutritional supplements that may or may not be useful are also promoted, as more broadly, are such unhealthful behaviors as smoking and the consumption of fast food. Racial and ethnic groups differ in such behaviors, but what role promotion plays and how best to communicate opposing messages to particular groups is unknown.

NEEDED RESEARCH

Given how little is known with any certainty about the effects of health promotion interventions on racial and ethnic differences, fairly basic research issues need to be addressed. What health care seeking behavior is typical of different groups is probably the place to start.

Research Need 17: Measure the use of complementary and alternative therapies by racial and ethnic groups.

How are these therapies incorporated into self treatment? Do these therapies have any substantial health effect, and how do they affect quality of life? The answers to such questions may provide guides for the design of health promotion interventions.

Subsequently, research could proceed to identify the appropriate health care seeking behavior and risk behaviors to target across different ethnic groups. Information is limited on the prevalence of health risk behaviors in older cohorts, especially Asian and American Indian and Alaska Native populations. Reliable information on obesity, diet, and sedentary life-style patterns would allow for a better understanding of how these risks affect morbidity and functional disability in these populations. Better information would help guide the selection of interventions and the selection of target groups in the population.

Some research could also be directed at understanding differential responses to health promotion by age, socioeconomic status, and racial and



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