barnes - cdc national health stat cam

7/29/2019 Barnes - CDC National Health Stat CAM

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Number12 n December10,2008

ComplementaryandAlternativeMedicineUseAmongAdultsandChildren:UnitedStates,2007

byPatriciaM.Barnes,M.A.,andBarbaraBloom,M.P.A.,DivisionofHealth InterviewStatistics,NationalCenter forHealthStatistics;andRichardL.Nahin,Ph.D.,M.P.H.,

NationalCenter forComplementaryandAlternativeMedicine,National InstitutesofHealth

AbstractObjectiveThisreportpresentsselectedestimatesofcomplementaryand

alternativemedicine(CAM)useamongU.S.adultsandchildren,usingdatafromthe2007NationalHealthInterviewSurvey(NHIS),conductedby theCentersforDiseaseControlandPreventions(CDC)NationalCenterforHealthStatistics(NCHS).Trendsinadultusewereassessedbycomparingdatafromthe2007and2002NHIS.

MethodsEstimateswerederivedfrom theComplementaryandAlternativeMedicinesupplementsandCorecomponentsofthe2007and2002NHIS.Estimatesweregeneratedandcomparisonsconductedusing theSUDAANstatisticalpackage toaccountfor thecomplexsampledesign.

ResultsIn2007,almost4outof10adultshadusedCAMtherapyinthepast12months,with themostcommonlyused therapiesbeingnonvitamin,nonmineral,naturalproducts(17.7%)anddeepbreathingexercises(12.7%).AmericanIndianorAlaskaNativeadults(50.3%)andwhiteadults(43.1%)weremore likely touseCAM thanAsianadults(39.9%)orblackadults(25.5%).Resultsfrom the2007NHISfound thatapproximatelyoneinninechildren(11.8%)usedCAM therapy in thepast12months,with themostcommonlyusedtherapiesbeingnonvitamin,nonmineral,naturalproducts(3.9%)andchiropracticorosteopathicmanipulation(2.8%).ChildrenwhoseparentusedCAMwerealmostfivetimesas likely(23.9%)touseCAMaschildrenwhoseparentdidnotuseCAM(5.1%).Forbothadultsandchildren in2007,whenworryaboutcostdelayedreceiptofconventionalcare,individualsweremorelikelytouseCAMthanwhenthecostofconventionalcarewasnotaworry.Between2002and2007increasedusewasseenamongadultsforacupuncture,deepbreathingexercises,massagetherapy,meditation,naturopathy,andyoga.CAMuseforheadorchestcoldsshowedamarkeddecreasefrom2002 to2007(9.5%to2.0%).Keywords:complementaryandalternativemedicinecNationalHealthInterviewSurvey

IntroductionComplementaryandalternative

medicine(CAM)coversaheterogeneousspectrumofancienttonew-ageapproaches thatpurporttopreventortreatdisease.Bydefinition,CAMpracticesarenotpartofconventionalmedicinebecause thereis insufficientproofthat theyaresafeandeffective(1).Complementaryinterventionsareusedtogetherwithconventionaltreatments,whereasalternativeinterventionsareusedinsteadofconventionalmedicine.

Generally,personswhochooseCAM

approaches

are

seeking

ways

to

improve theirhealthandwell-being(2,3)ortorelievesymptomsassociatedwithchronic,eventerminal,illnessesorthesideeffectsofconventionaltreatmentsforthem(4,5).OtherreasonsforchoosingtouseCAM includehavingaholistichealthphilosophyoratransformationalexperience thatchangesonesworldviewandwantinggreatercontroloveronesownhealth(6,7).ManytypesofCAMpractitioners try totreatnotonly thephysicalandbiochemicalmanifestationsofillness,butalsothenutritional,emotional,social,andspiritualcontext inwhichtheillnessarises.TheoverwhelmingmajorityofpatientsusingCAM

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics


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Page2 NationalHealthStatisticsReports n Number12 n December10,2008approachesdoso tocomplementconventionalcarerather thanasanalternativetoconventionalcare(6,8).

According tothe2002NationalHealthInterviewSurvey(NHIS),one-thirdofadultsusedsomeformofCAM(9).CommonlyusedCAMtherapiesincludednonvitamin,nonmineral,naturalproducts;deepbreathingexercises;meditation;chiropracticcare;yoga;massage;anddiet-based therapies(9).CAMwasmostoftenused to treatbackpainorbackproblems,headorchestcolds,neckpainorneckproblems,jointpainorstiffness,andanxietyordepression.Although lessprevalent,strongassociationswerestillseenforindividualsusingCAMapproaches to treatorprovidesymptomreliefforcancer,cardiovasculardiseases,andlungdiseases(10,11).CAMusewasmoreprevalentamongwomen,amongadultswhohadhighereducationalattainmentorwhoengaged in leisure-timephysicalactivity,aswellasamongadultswhohadoneormoreexistinghealthconditionsorwhomadefrequentmedicalvisits intheprioryear(12,13).

ThisreportisbasedonCAMsupplements thatwereadministeredaspartof theSampleAdultandSampleChildquestionnairesofthe2007NHIS,as

well

as

asupplement

that

was

part

of

theSampleAdultquestionnaireof the2002NHIS.Due toexpandedquestionsforadultsandtheinclusionofquestionsforchildren,datafromthe2007NHISshouldprovideadditionaldetailaboutCAMusebyadults,aswellasprovidingthefirstnationaldataonCAMusebychildrenaged017years.Inparticular,thisreportexaminestherelationshipofCAMuseanddemographicandhealthbehaviorsamonggroupsnotpreviouslystudiedindetail, includingracialandethnicgroupsandchildren.Inaddition, thereportprovidesanupdateonwhousesCAMandthe therapiesusedbyexaminingchanges inadultusebetween2002and2007.SubsequentreportswillexaminethecostsofCAMuseandthereasonsindividualschoose touse,ornotuse,CAM.

MethodsDatasource

ThestatisticsshowninthisreportarebasedondatafromtheAdultandChildComplementaryandAlternativeMedicinesupplements,theSampleAdultandSampleChildCore,and theFamilyCorecomponentsof the2007NHIS,aswellastheAdultComplementaryandAlternativeMedicinesupplement, theSampleAdultCore,and theFamilyCorecomponentsofthe2002NHIS(14).TheNHIS isinthefieldcontinuously,conductedby theCentersforDiseaseControlandPreventionsNationalCenterforHealthStatistics.Itisasurveyofanationallyrepresentativesampleof theciviliannoninstitutionalizedhouseholdpopulationof theUnitedStates.Basichealthanddemographic informationarecollectedonallhouseholdmembers.Alladultmembersof thehouseholdwhoarehomeat the timeof theinterviewareinvited toparticipateandrespondforthemselves.Proxyresponsesareacceptedforadultsnotpresentatthetimeoftheinterviewbutaremandatoryforchildren.Additionalorsupplementalinformation,suchastheCAM, iscollectedononerandomlyselectedadultaged18yearsorover(thesampleadult)andonerandomlyselectedchildaged017years(thesamplechild)ineachfamily.Informationon thesampleadultisself-reportedexceptinrarecaseswhenthesampleadult isphysicallyormentallyincapableofresponding,and informationon thesamplechild iscollectedfromanadultwho isknowledgeableabout thechildshealth,usuallyaparent.

The2007ComplementaryandAlternative

Medicine

supplement

includedquestionson36 typesofCAMtherapiesused intheUnitedStates(Table1).Thesetherapiesincluded10typesofprovider-basedCAM therapies(e.g.,acupuncture,chiropracticandosteopathicmanipulation, traditionalhealers),aswellas26otherCAMtherapiesforwhich theservicesofaproviderarenotnecessary(e.g.,

nonvitamin,nonmineral,naturalproducts;specialdiets;movementtherapies).Alistanddescriptionsof the36CAM therapies included inthe2007NHISarefoundin theTechnicalNotesfollowingthisreport.Using theclassificationsystememployedby theNationalCenterforComplementaryandAlternativeMedicine(NCCAM), the36CAM therapiesweregrouped intofivebroadcategoriesforanalyticalpurposes:Alternativemedicalsystems;Biologicallybased therapies;Manipulativeandbody-basedtherapies;Mind-body therapies;andEnergyhealing therapies.Following thetaxonomyofunconventionalhealthcareproposedbyKaptchukandEisenberg(15),folkmedicinepractices(e.g.,coveringawartwithapennythenburying thepenny, treatingacoldwithchickensoup)andreligious(faith)healing(e.g.,prayingforonesownhealth,orhavingothersprayforoneshealth)arenotincluded in thedefinitionofCAMused inthisreport.Inclusionanddevelopmentofthe2007supplementwassupportedbysevenInstitutes,Centers,orOfficesof theNationalInstitutesofHealth:NCCAM;NationalHeart,Lung,andBloodInstitute;NationalInstituteofAllergyand

Infectious

Diseases;

National

InstituteofMentalHealth;NationalInstituteofChildHealthandHumanDevelopment;OfficeofDietarySupplements;andOfficeofBehavioralandSocialScienceResearch.

The2007NHISCAMsupplementvaried inseveralwaysfromthe2002NHISCAMsupplement.Inorder tomoreaccuratelyrecorduseofCAMintheUnitedStates,the2007NHISexpanded thenumberofCAMtherapiesto36from the27usedin the2002survey;inparticular,sectionswereaddedontraditionalhealers(e.g.,Curandero,Hierbero,Sobador,etc.)andonmovementtherapies(e.g.,Alexandertechnique,Feldenkreismethod,TragerPsychophysicalIntegration).The2007surveyalsoexpandedthenumberofdiseases treatedwithCAM to81fromthe73usedin2002.Thesectiononnonvitamin,nonmineral,naturalproductsin2007wassubstantiallychangedfromthatusedin2002 intwo


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NationalHealthStatisticsReports n Number12 n December10,2008 Page3ways:First,the listofproductswasexpandedfrom35in2002to45in2007.Second, thereferenceperiodforuseoftheseproductswasreducedfrom12monthsin2002 to30days in2007.Finally, the2007surveyincludedquestionsontheprevalenceofCAMusebychildrenandthediseasesorconditionsbeing treated.

Therewereseveralreasonsfor theabovechanges.First,afterpublicationofthe2002NHISdata(9),NCCAMreceivedsuggestionsfrom thecommunityforadditionaltherapiestobeadded.Second,anumberofnonvitamin,nonmineral,naturalproductsbecamecommonlyavailableafterthe2002CAMsupplementwasdesigned.Third,thereferenceperiodfornonvitamin,nonmineral,naturalproductswasshortenedfrom12months to30days tobemorecongruentwithothernationalsurveysofdietarysupplementuse,suchastheNationalHealthandNutritionExaminationSurvey.Finally,pilottestingofthe2007CAMsupplementled tosomequestions inthe2002surveybeingdroppedorsubsumed intootherquestions.Statisticalanalysis

In2007,

NHIS

interviews

were

completedin29,266households,whichyielded75,764personsin29,915familiesandahouseholdresponserateof87.1%Thisreport isbasedondatafrom23,393completedinterviewswithsampleadultsaged18yearsandoverand9,417completed interviewsforsamplechildrenaged017years.Thefinal2007sampleadultandsamplechildresponserateswere67.8%and76.5%,respectively.In2002,NHISinterviewswerecompleted in36,161households,whichyielded93,386persons in36,831familiesandahouseholdresponserateof89.6%.Thisreport isalsobasedon2002datafrom31,044completedinterviewswithsampleadultsaged18yearsandover.Thefinal2002sampleadultresponseratewas74.3%.ProceduresusedincalculatingresponseratesaredescribedindetailinAppendixIoftheSurveyDescriptionDocumentof theNHISdatafiles(16).

Allestimatesandassociatedstandarderrorsshown in thisreportweregeneratedusingSUDAAN,asoftwarepackagedesigned toaccountforacomplexsampledesignsuchasthatoftheNHIS(17).Allestimatesforadultswereweighted,using thesampleadultrecordweight, torepresent theU.S.civiliannoninstitutionalizedpopulationaged18yearsandover.Allestimatesforchildrenwereweighted,using thesamplechildrecordweight, torepresent theU.S.civiliannoninstitutionalizedpopulationaged017years.

In tablesshown inthisreport,estimateswitharelativestandarderrorofmorethan30%but less thanorequalto50%are identifiedwithanasterisk(*),indicating theyarestatisticallyunstabledue tosmallsamplesize.Estimateswitharelativestandarderrorofgreater than50%are indicatedwithadagger()andarenotshown.

Mostestimatespresentedin thisreportwereageadjustedusing theprojected2000U.S.populationasthestandardpopulation(18,19).Ageadjustmentwasused toallowcomparisonofvarioussociodemographicsubgroupsthathavedifferentagedistributions(seeTechnicalNotes).Estimateswerecomparedusingtwo-tailedsignificance testsatthe0.05level.Noadjustmentsweremadeformultiplecomparisons.Termssuchasgreaterthanandless thanindicateastatisticallysignificantdifference.Termssuchassimilarornodifferenceindicatethat thestatisticsbeingcomparedwerenotsignificantlydifferent.Lackofcommentregardingthedifferencebetweenanytwostatisticsdoesnotmean thatthedifferencewas testedandfound tobenotsignificant.Strengthsand limitationsofthedata

AmajorstrengthoftheCAMdatain theNHIS isthattheywerecollectedforanationallyrepresentativesampleofU.S.adultsandchildren,allowingestimationofCAMuseforawidevarietyofpopulationsubgroups.Thelargesamplesizealsofacilitatesinvestigationof theassociationbetween

CAMandawiderangeofotherself-reportedhealthcharacteristicsincluded intheNHIS,suchashealthbehaviors,chronichealthconditions,injuryandpoisoningepisodes,accesstomedicalcare,andhealth insurancecoverage.Thesamplesizesforboth the2007andthe2002NHISallowfordetailedanalysisofCAMuseamongHispanicsubpopulations,butnotamongsubpopulationsofAsiansandotherminoritygroupswithsmallerpopulations.

TheNHISquestionshaveseverallimitations.First,theyaredependentonrespondentsmemoryor theirwillingnesstoreportuseaccurately.Second,thecollectionofsurveydataatasinglepoint intimeresultsinaninabilitytoproduceconsecutiveannualprevalenceestimates;anditreduces theabilitytoproducereliableprevalenceestimatesforsmallpopulationsubgroups,as thiswouldrequirea largersampleormore than1yearofdata.Third,CAMuseamongchildrenmightbehigher thanourresultsindicate,especiallyamongadolescentswhomaynotrevealtheirCAMusetoparentsorotherhouseholdadults.Finally,there isadifferencein thereferenceperiodsforuseofnonvitamin,nonmineral,naturalproductsin2002(12months)and2007(30days).Generally,shorterreferenceperiodsresultinbetterrecallandbetterdata.ResultsUseofcomplementaryandalternativemedicineinpast12monthsadults(Table1)+ In2007, theCAMtherapiesmost

commonlyusedbyU.S.adultsin thepast12monthswerenonvitamin,nonmineral,naturalproducts(17.7%),deepbreathingexercises(12.7%),meditation(9.4%),chiropracticorosteopathicmanipulation(8.6%),massage(8.3%),andyoga(6.1%).

+ AmongU.S.adults,theuseofsomemindbodytherapiesincreasedbetween2002and2007.Specificmindbodytherapiesshowingincreaseduse included:deep


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Page4 NationalHealthStatisticsReports n Number12 n December10,2008breathingexercises,meditation,andyoga.

+ Between2002and2007,increasedusewasalsoseenforacupuncture,massage therapy,andnaturopathy.

+ Between2002and2007,therewasasignificantdecrease intheuseoftheAtkinsdiet.

Useofcomplementaryandalternativemedicinechildren(Table2)+ In2007, theCAMtherapiesmost

commonlyusedbyU.S.childreninthepast12monthswerenonvitamin,nonmineral,naturalproducts(3.9%),chiropracticorosteopathicmanipulation(2.8%),deepbreathingexercises(2.2%),yoga(2.1%),andhomeopathictreatment(1.3%).

+ ChildrenwhoseparentusedCAMtherapywereabouttwiceaslikelyasallU.S.children tohaveusednonvitamin,nonmineral,naturalproducts(9.2%and3.9%),chiropracticorosteopathicmanipulation(5.7%and2.8%),deepbreathingexercises(5.4%and2.2%),yoga(4.7%and2.1%),andhomeopathictreatment(2.8%and1.3%)

in

the

past

12

months.

Useofselectednonvitamin,nonmineral,naturalproductsadults(Table3)+ In2007, themostcommonlyused

nonvitamin,nonmineral,naturalproductsusedbyadultsforhealthreasonsin thepast30dayswerefishoiloromega3orDHA(37.4%),glucosamine(19.9%),echinacea(19.8%),flaxseedoilorpills(15.9%),andginseng(14.1%).

Useofselectednonvitamin,nonmineral,naturalproductschildren(Table4)+ In2007, themostcommonlyused

nonvitamin,nonmineral,naturalproductsusedbychildrenforhealthreasonsin thepast30dayswereechinacea(37.2%),fishoiloromega3orDHA(30.5%),combinationherb

pill(17.9%),andflaxseedoilorpills(16.7%).

MedicalconditionstreatedwithCAMadults(Table5andFigures1and2)+ In2007,adultsusedCAMmostoftentotreatavarietyofmusculoskeletal

problemsincludingbackpainorproblems(17.1%),neckpainorproblems(5.9%),jointpainorstiffnessorotherjointcondition(5.2%),arthritis(3.5%),andothermusculoskeletalconditions(1.8%)(Table5).

+ TheprevalenceofCAMuseforbackpainorproblems,neckpainorproblems,jointpainorstiffness,andarthritisandfibromyalgia isrelativelyunchangedsince2002(Figure1).

+ TheuseofCAM therapiesforheadorchestcoldsshowedamarkeddecreasefrom2002to2007(9.5% to2.0%)(Figure2).Asmallerdecreaseinusewasseenforstomachorintestinal illness(Figure2).

+ Asmall increaseinCAMusewasseenfor treatingcholesterolproblems(Figure3).

MedicalconditionstreatedwithCAMchildren(Table6)+ In2007,amongchildrenwhoused

CAMinthepast12months,CAMtherapieswereusedmostoftenforbackorneckpain(6.7%),headorchestcolds(6.6%),anxietyorstress(4.8%),othermusculoskeletalproblems(4.2%),andADHD/ADD(2.5%).

UseofCAMbyselectedcharacteristicsadults(Table7)+ In2007,almost4outof10adults

(38.3%)hadusedsometypeofCAMin thepast12months.

+ Consistentwithresultsfromthe2002NHIS,in2007CAMusewasmoreprevalentamongwomen,adultsaged3069,adultswithhigher levelsofeducation,adultswhowerenotpoor,adultslivingintheWest,formersmokers,andadultswhowerehospitalizedin thelastyear.

+ Foradultsyoungerthan65yearsofage, in2002and2007, thosewithprivatehealth insuranceweremorelikely thanthosewithpublichealthinsuranceoruninsuredadults

0

2

4

6

8

10

12

14

16

18

Back pain

2002 2007

NOTE: Estimates are age adjusted using the projected 2000 U.S. population as the standard population.

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2002 and 2007. Estimates are based on householdinterviews of a sample of the civilian noninstitutionalized population.

Neck pain Joint pain Arthritis, gout,lupus,

fibromyalgia

Disease or condition

Percent

Figure1.Percentageofadults18yearsofageandoverwhousedcomplementaryandalternativemedicineduringthepast12monthstotreatselectedmusculoskeletaldiseasesandconditions,byyear:UnitedStates,2002and2007


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NationalHealthStatisticsReports n Number12 n December10,2008 Page5

0

2

4

6

8

10

Disease or condition

Head or

chest cold

Anxiety/depression

Stomach orintestinal

illness

Cholesterol

2002 2007

NOTE: Estimates are age adjusted using the projected 2000 U.S. population as the standard population.

Percent

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2002 and 2007. Estimates are based on householdinterviews of a sample of the civilian noninstitutionalized population.

Figure2.Percentageofadults18yearsofageandoverwhousedcomplemenaryandalternativemedicineduringthepast12monthstotreatselecteddiseasesandconditions,byyear:UnitedStates,2002and2007

0

5

10

15

20

25

30

Parent Other relative

Respondent

Used CAM Did not use CAM

NOTES: CAM is complementary and alternative medicine. Estimates are age adjusted using the projected 2000 U.S.population as the standard population.

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2007. Estimates are based on household interviews of asample of the civilian noninstitutionalized population.

Percent

Figure3.Percentageofchildrenunder18yearsofagewhousedcomplementaryandalternativemedicineduringthepast12months,bycomplementaryandalternativemedicineusebyparentorotherrelativerespondent:UnitedStates,2007

tousebiologicallybasedtherapiesandmanipulativeandbody-basedtherapies.Thosewithprivateinsurancewerealsomorelikelyto

usemind-body therapies in2007,aresultnotfoundin2002.

+ In2007,butnot2002,adultsyoungerthan65yearsofagewithpublic

healthinsurance(2.6%)were lesslikelytousealternativemedicalsystemsthanuninsuredadults(4.0%)oradultswithprivatehealthinsurance(3.9%).

+ Similarto2002, in2007,CAMusagewaspositivelyassociatedwithnumberofhealthconditionsandnumberofdoctorvisitsinthepast12months;however,aboutone-fifthofadultswithnohealthconditionsandone-quarterofadultswithnodoctorvisits in thepast12monthsusedCAMtherapies.

+ Inboth2002and2007,whenworryaboutcostdelayedthereceiptofconventionalmedicalcare,adultsweremore likely touseCAMthanwhen thecostofconventionalcarewasnotaworry.

+ Inboth2002and2007,whenunabletoaffordconventionalmedicalcare,adultsweremore likely touseCAMthanwhenthecostofconventionalcarewasaffordable.

+ AmongHispanicsubpopulationsin2007,Mexicanadults(18.2%)werelesslikelythanPuertoRican(29.7%),MexicanAmerican(27.4%),Dominican(28.2%),andCentralorSouthAmerican(23.4%)adults touseCAM therapies.

+ PuertoRicanandMexican-Americanadultsweremore likely thanMexicanadults tousebiologicallybasedtherapiesormanipulativeandbody-basedtherapiesin2007.

UseofCAMbyselectedcharacteristicschildren(Table8andFigure3)+ In2007,approximatelyoneinnine

children(11.8%)usedsometypeofCAMtherapyduring thepast12months(Table8).

+ Childrenweremorelikelytohaveusedbiologicallybasedtherapies(4.7%),mind-bodytherapies(4.3%),ormanipulativeandbody-basedtherapies(3.7%) thanalternativemedicalsystems(2.6%)orenergytherapies(0.2%)(Table8).

+ Girlswerenomore likely thanboystousesome typeofCAM therapy.However,girls(4.9%)weremore


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Page6 NationalHealthStatisticsReports n Number12 n December10,2008likelythanboys(3.8%) tousemind-body therapies(Table8).

+ Foralltherapiescombined,CAMusewasmore likelyamongadolescentsaged1217years(16.4%) thanyoungerchildrenaged511years(10.7%)orpre-schoolchildrenaged04years(7.6%)(Table8).

+ Whitechildren(12.8%)were twiceaslikelyasblackchildren(5.9%) touseCAMtherapies(Table8).

+ Non-Hispanicchildren(12.8%)were1.5 timesaslikelyasHispanicchildren(7.9%)touseCAM therapies(Table8).

+ ChildrensuseofCAMincreasedastheirparentseducationlevelincreased(Table8).

+ Childreninfamiliesthatwerenotpoor(14.6%)weremore likely touseCAMtherapiesthanchildren innear-poororpoorfamilies(9.3%and7.0%)(Table8).

+ Childrenwithprivatehealthinsurance(13.7%)weremore likely thanuninsuredchildren(10.2%)orchildrenwithpublichealth insurance(8.6%) touseCAMtherapies(Table8).

+ Regionally,lowerproportionsofchildren intheSouth(8.8%)usedCAM

than

of

children

in

the

Northeast(12.6%),Midwest(13.6%),orWest(14.4%)(Table8).

+ CAMusagebychildren ispositivelyassociatedwithnumberofhealthconditionsin thepast12months(Table8).

+ CAMusagebychildrenisalsopositivelyassociatedwithnumberofdoctorvisitsin thepast12months(Table8).

+ Whenfamilyworryaboutcostdelayedthereceiptofconventionalmedicalcare,childrenweremorelikely touseCAMthanwhenthecostofconventionalcarewasnotaworry(Table8).

+ Whenfamilieswereunabletoaffordconventionalmedicalcare,childrenweremore likely touseCAM thanwhenthecostofconventionalcarewasaffordable(Table8).

+ ChildrenwhoseparentusedCAMwerealmostfivetimesaslikely(23.9%) touseCAMaschildren

whoseparentdidnotuseCAM(5.1%)(Figure3).

DiscussionWhiletheprevalenceofmany

individual therapieswassimilarbetween2002and2007,acupuncture,deepbreathingexercises,massagetherapy,meditation,naturopathy,andyogashowedsignificant increases.Theincreasesforacupuncture,massagetherapy,andnaturopathymay inpartbeduetothegreaternumberofstates thatlicensethesepracticesandacorresponding increaseinthenumberoflicensedpractitionersbetween2002and2007.Thissametimeperiodhasalsoseen largenumbersofarticlesinthelaypressextollingthebenefitsof thesetherapies,increasingawarenessoftheminthegeneralpopulation.Together,increasedopportunityandincreasedawarenessmayexplainmuchoftheobserved increaseinadultuseofCAM.

Whiletheuseof thesetherapieshasincreasedfrom2002 to2007,scientificresearchprovidedonlylimitedevidenceofclinicalefficacyfor thesetherapies.Forinstance,theNationalLibraryofMedicinejournaldatabase,PubMed,identified40systematicreviewsinvolving

acupuncture,

massage

therapy,

naturopathy,oryogapublishedbetween2002and2007.Of these,only10(25%)ofthesystematicreviewsfoundsufficientevidencetoconcludethatagivenCAMtherapywaseffectiveforagivencondition:acupunctureandyogaforbackpain(20,21),acupunctureforkneepain(includingosteoarthritis)(2224),acupunctureforinsomnia(25),andacupuncturefornauseaorvomiting(includingpostoperative,chemotherapy-induced,andpregnancy-induced)(2629).Inaddition,asystematicreview(30)concluded thatbothacupunctureand,toalesserextent,massage therapyshouldbe includedamongrecommendedtherapiesfortreatingbackpain.Thatreviewservedasthebasisforjointclinicalpracticeguidelinesreleasedby theAmericanCollegeofPhysiciansandtheAmericanPainSociety(31).

Three typesofspecialdiets(Macrobiotic,Atkins,andZone)saw

significantdecreases inusebyU.S.adultssince2002,with theAtkinsdietseeingthelargestchange.Interestingly,thisdecreaseoccurreddespite thecompletionandpublicationoftwowellpublicizedstudiesinmajormedicaljournalsdemonstratingtheshort-termsafetyandefficacyoftheAtkinsDietforweight loss(32,33).ItmaybethatthepublicwasinfluencedbysubstantialnegativecoverageoftheAtkinsdiet inthepopularpress,aswellascontinuingphysicianconcernsabout thediet(34).

BesidestheNHIS,theonlynationalsurveyofCAMusecoveringthefullagerangeofchildrenwas the1996MedicalExpendituresPanelSurvey(MEPS).The1996MEPSincludedquestionson theuseofseveralCAMproviders(e.g.,acupuncturist,chiropractor,massagetherapist,etc.),butdidnotincludequestionson theuseofnonpractitionerCAMtherapies(e.g.,dietarysupplements,relaxationtechniques)(35,36).BecauseverydifferentdefinitionsofCAMwereusedinMEPSandthe2007NHIS,directcomparisonsofprevalencecannotbemade.However, itispossibletocomparerelativerankorderofselecteditems in the twosurveys.Forexample,theMEPS(36)rankorder(highesttolowest

prevalence

)of

therapist-based

CAM interventionsusedbychildrenwaschiropracticcare,massagetherapy,acupuncture,andhomeopathyandnaturopathycombined,whiletheNHISorderwaschiropracticorosteopathicmanipulation,homeopathyandnaturopathycombined,massagetherapy,andacupuncture.Itisnotclearwhetherthesedifferencesreflectchanges in thepatternsofCAMuseovertimeordifferencesinsurveydesign.

ThespecificsociodemographicfactorsfoundtobeassociatedwithachildsuseofCAM,differedbetweenthe1996MEPSand the2007NHIS,althoughbothsurveysfoundanassociationwithchildrenwhowereolder,white,hadmultiplevisitswithaconventionalmedicalprovider,orhadaparentwhousedCAM(35,36).OnlyMEPSidentifiedfemalegenderasassociatedwithCAMuse inchildren.OnlyNHIS identifiednon-Hispanicorigin,highereducationoftheparent,


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NationalHealthStatisticsReports n Number12 n December10,2008 Page7higher income(povertystatus),notliving intheSouth,andhavingausualplaceofcareasassociatedwithachildsuseofCAM.

InadditiontoNHISandMEPS,therehavebeenseverallimitedpopulationsurveysofCAMusebychildren in theUnitedStates(3739).ThesesurveyshavevariedconsiderablyfromNHISandMEPSin theirdatacollectionmethods,geographicdistribution,agerange,referenceperiod,and thechoiceoftherapiesdefinedasCAM.Thus,directcomparisonsoftheoverallprevalencerateofCAMuseortheratesofuseofanygivenCAMtherapyfromthesesurveyscannotbemadewith theNHIS.

Toourknowledge,the2007NHISisthefirstnationalsurveyofnonvitamin,nonmineral,naturalproductusebychildren017yearsofage.Manyofthesameproductsusedmostoftenbyadultswereusedmostoftenbychildren;threeof thefourmostprevalentnonvitamin,nonmineral,naturalproductsusedbyadults(Echinacea,fishoiloromega3orDHA,flaxseedoilorpills),wereamongthe topfourproductsusedbychildren.Thisisnotsurprisinggiventhatchildren,especiallyyoungerchildren,are

dependent

on

adults

for

their

health

care.Childrenwhoseparentusednonvitamin,nonmineral,naturalproductsweremorethantwiceas likelyaschildrenwhoseparentdidnotusethem tohaveusedthis typeofCAM(40).

Severaloftheproductsusedmostoftenbychildrenaregenerallyusedforhearthealthorcancerprevention(e.g.,fishoilorflaxseed).However, intheNHIS,more thanone-halfoftheseproductswerenotused totreatorprevent thechildsspecificconditions,suggestingwellnessasareasonforuse.

MorewidelyusedCAM therapiessuchaschiropracticorosteopathicmanipulation;nonvitamin,nonmineral,naturalproducts;andmassage therapy,aswellaslesserusedtherapiessuchastheAlexander technique,biofeedback,andenergyhealing therapieshavebeenstudiedbyvariousresearchers(12).TheattentiongiventospecificCAM

modalitiesbythescientificcommunitydoesnotcorrelatewith theprevalenceofuseby thepublicasmeasuredbythe2007NHIS.Forexample, theInstituteofMedicine identified79systematicreviewsofacupunctureand38studiesofhomeopathy(placingthem3rdand4thamongallCAMtherapies),yetNHISfound that lessthan1.5%oftheadultU.S.publicusedeachofthesetherapies inagivenyear.Infact, thereisnomeaningfulcorrelationbetweenthenumberofpublishedstudiesofaCAMtherapyanditsuseby theU.S.public.CAM therapieswithrelativelyinfrequentuseby thepublic(e.g.,biofeedback,hypnotherapy,acupuncture)are thosewith thehighestlevelofacceptanceandreferralbyphysiciangroups, includingpediatricians(4143),typifying the inadequatecommunicationbetweenpatientsandprovidersconcerningCAM issues(8).Toimprovepatient-providercommunication,theacademichealthcommunity(44)andNCCAM(45)haveinitiatedprograms toencourageandfacilitatesuchdiscussions.Conclusions

Examinationofthedatafromthe2007

and

2002

NHIS

suggests

that

overalluseofCAM intheadultU.S.noninstitutionalizedpopulationhadheldrelativelysteady.However,over this5-yearperiodtherehasbeensubstantialvariation intheuseofspecificCAMtherapies.The2007NHIScontainedanumberofquestionsassessingthereasons individualschosetouseordiscontinueuseofvariousCAMtherapies.Futureanalysesofthesedatamayhelpexplainsomeoftheobservedvariation intheuseof individualCAMtherapies.The2007NHISprovidedthefirstdataonanationallyrepresentativesampleofchildrenaged017years.ItwasfoundthatoverallCAMuseinchildren issubstantially less than inadults.However,childrenaremorelikelytouseCAM ifaparentorotherrelativeusedCAM.Whilepainconditionshaveremained theprimaryhealthproblemsforwhichCAMisusedbyadults, this islessclearinchildren.

Inotherregards,thecharacteristicsofadultandchildCAMusersaresimilarforexample,education,povertystatus,geographicregion,thenumberofhealthconditions,thenumberofdoctorvisits inthe last12months,anddelayingornotreceivingconventionalcarebecauseofcostareallassociatedwithCAMuse.References1. NationalCenterforComplementary

andAlternativeMedicine.Expandinghorizonsofhealthcare:Strategicplan20052009.Availablefrom:http://nccam.nih.gov/about/plans/2005.AccessedonJuly7,2008.

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22.KwonYD,PittlerMH,ErnstE.Acupunctureforperipheraljointosteoarthritis:Asystematicreviewandmeta-analysis.Rheumatology(Oxford).45(11):13317.2006.

23.WhiteA,FosterNE,CummingsM,BarlasP.Acupuncturetreatmentforchronickneepain:Asystematicreview.Rheumatology(Oxford)46(3):38490.2007.

24.BjordalJM,JohnsonMI,Lopes-MartinsRA,BogenB,ChowR,LjunggrenAE.Short-termefficacyofphysicalinterventionsinosteoarthritickneepain.Asystematicreviewandmeta-analysisofrandomisedplacebo-controlledtrials.BMCMusculoskeletDisord8:51.2007.

25.ChenHY,ShiY,NgCS,ChanSM,YungKK,ZhangQL.Auricularacupuncturetreatmentforinsomnia:Asystematicreview.JAlternComplementMed13(6):66976.2007.

26.EzzoJM,RichardsonMA,VickersA,AllenC,DibbleSL,IssellBF,etal.Acupuncture-pointstimulationforchemotherapy-inducednauseaorvomiting.CochraneDatabaseSystRev(2):CD002285.2007.

27.HelmreichRJ,ShiaoSY,DuneLS.Meta-analysisofacustimulationeffectsonnauseaandvomitinginpregnantwomen.Explore(NY)2(5):41221.2006.

28.ShiaoSY,DuneLS.Meta-analysesofacustimulations:Effectsonnausea

andvomitinginpostoperativeadultpatients.Explore(NY)2(3):20215.2006.

29.DuneLS,ShiaoSY.Meta-analysisofacustimulationeffectsonpostoperativenauseaandvomitinginchildren.Explore(NY)2(4):31420.2006.

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31.ChouR,QaseemA,SnowV,CaseyD,CrossJT,Jr,ShekelleP,etal.Diagnosisandtreatmentoflowbackpain:AjointclinicalpracticeguidelinefromtheAmericanCollegeofPhysiciansandtheAmericanPainSociety.AnnInternMed147(7):47891.2007.

32.FosterGD,WyattHR,HillJO,McGuckinBG,BrillC,MohammedBS,etal.Arandomizedtrialofalow-carbohydratedietforobesity.NEnglJMed348(21):208290.2003.

33.GardnerCD,KiazandA,AlhassanS,KimS,StaffordRS,BaliseRR,etal.ComparisonoftheAtkins,Zone,Ornish,andLEARNdietsforchangeinweightandrelatedriskfactorsamongoverweightpremenopausalwomen:TheATOZWeightLossStudy:Arandomizedtrial.JAMA297(9):96977.2007.

34.PhysiciansCommitteeforResponsibleMedicine.HealthAdvisory.AtkinsDiet.Availablefrom:http://www.atkinsdietalert.org/advisory.html. Accessed on July 7, 2008.

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36.YussmanSM,RyanSA,AuingerP,WeitzmanM.VisitstocomplementaryandalternativemedicineprovidersbychildrenandadolescentsintheUnitedStates.AmbulPediatr4(5):42935.2004.

37.WilsonKM,KleinJD,SesselbergTS,YussmanSM,MarkowDB,GreenAE,etal.UseofcomplementarymedicineanddietarysupplementsamongU.S.adolescents.JAdolescHealth38(4):38594.2006.
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useofcomplementaryandalternativemedicine.AmbulPediatr2(2):10410.2002.

39.HughesSC,WingardDL.ChildrensvisitstoprovidersofcomplementaryandalternativemedicineinSanDiego.AmbulPediatr6(5):2936.2006.

40.WheatonAG,BlanckHM,GizliceZ,ReyesM.Medicinalherbuseinapopulation-basedsurveyofadults:Prevalenceandfrequencyofuse,reasonsforuse,anduseamongtheirchildren.AnnEpidemiol15(9):67885.2005.

41.BermanBM,SinghBB,HartnollSM,SinghBK,ReillyD.Primarycarephysiciansandcomplementary-alternativemedicine:Training,attitudes,andpracticepatterns.JAmBoard

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42.BermanBM,BausellRB,LeeWL.Useandreferralpatternsfor22complementaryandalternativemedicaltherapiesbymembersoftheAmericanCollegeofRheumatology:Resultsofanationalsurvey.ArchInternMed162(7):76670.2002.

43.SawniA,ThomasR.Pediatriciansattitudes,experienceandreferralpatternsregardingComplementary/AlternativeMedicine:Anationalsurvey.BMCComplementAlternMed

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RS.Talkingwithpatientsaboutalternativeandcomplementarymedicine.RheumDisClinNorthAm25(4):81522.1999.

45.NCCAMeducationalcampaign.Timetotalk.NationalCenterforComplementaryandAlternativeMedicine(online).Availablefrom:http://nccam.nih.gov/timetotalk/.AccessedJuly7,2008.

46.OfficeofManagementandBudget.Revisionstothestandardsfortheclassificationoffederaldataonraceandethnicity.FederalRegister62(21):5878290.1997.
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Page10 NationalHealthStatisticsReports n Number12 n December10,2008Table1.Frequenciesandage-adjustedpercentagesofadults18yearsofageandoverwhousedcomplementaryandalternativemedicine inthepast12months,bytypeoftherapy:UnitedStates,2002and2007

2002 2007Difference Percent Percent

Number in (standard Number in (standard betweenTherapy thousands error) thousands error) percents

AlternativemedicalsystemsAcupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,136 1.1 (0.07) 3,141 1.4 (0.10) 0.3Ayu rveda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 0.1 (0.02) 214 *0.1 (0.03) . . . Homeopathic treatment . . . . . . . . . . . . . . . . . . . . . . . . 3,433 1.7 (0.09) 3,909 1.8 (0.11) 0.1 Naturopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 498 0.2 (0.03) 729 0.3 (0.04) 0.1Traditional healers1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 812 0.4 (0.06) . . .

Curandero. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 *0.0 (0.00) . . . Espirit ista . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . Hierbero or Yerbera. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 *0.0 (0.01) . . . Sh ama n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 0.1 (0.02) . . . Bo ta ni ca . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 *0.0 (0.02) . . . Native American healer or Medicine man. . . . . . . . . . . . . . . . . . 224 *0.1 (0.05) . . . So ba dor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 0.1 (0.03) . . .

Biologically basedtherapiesChelation therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 *0.0 (0.01) 111 *0.0 (0.02) . . . Folk medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 0.1 (0.02) . . . . . . . . . Nonvitamin,nonmineral,naturalproducts2 . . . . . . . . . . . . 38,183 18.9 (0.28) . . . . . . . . . Nonvitamin,nonmineral,naturalproducts2 . . . . . . . . . . . . . . . . . . 38,797 17.7 (0.37) . . . Dietbased therapies1,3 . . . . . . . . . . . . . . . . . . . . . . . . 7,099 3.5 (0.12) 7,893 3.6 (0.15) . . .

Vegetarian diet. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,184 1.6 (0.08) 3,351 1.5 (0.10) 0.1 Macrobiotic diet . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 0.2 (0.03) 171 0.1 (0.02) 0.1 Atkins diet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,417 1.7 (0.09) 2,673 1.2 (0.09) 0.5Pritikin diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 0.1 (0.02) 78 . . . Ornish diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 *0.0 (0.01) 77 *0.0 (0.02) . . . Zone diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430 0.2 (0.03) 205 0.1 (0.02) 0.1 South Beach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,334 1.1 (0.09) . . .

Megavitamin therapy . . . . . . . . . . . . . . . . . . . . . . . . . 5,739 2.8 (0.11) . . . . . . . . . Manipulative andbodybasedtherapies

4Chiropractic care . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,226 7.5 (0.19) . . . . . . . . . Chiropracticorosteopathicmanipulation4 . . . . . . . . . . . . . . . . . . . 18,740 8.6 (0.27) . . . Ma ssag e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,052 5.0 (0.16) 18,068 8.3 (0.23) 3.3Movement therapies1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,146 1.5 (0.10) . . .

Feldenkreis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 *0.0 (0.01) . . . Alexander technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 *0.1 (0.02) . . . Pi la te s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,015 1.4 (0.09) . . . Trager Psychophysical Integration . . . . . . . . . . . . . . . . . . . . . . 37 *0.0 (0.01) . . .

MindbodytherapiesBiofeedback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278 0.1 (0.02) 362 0.2 (0.04) 0.1 Meditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,336 7.6 (0.20) 20,541 9.4 (0.27) 1.8Guided imagery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,194 2.1 (0.10) 4,866 2.2 (0.16) 0.1 Progressive relaxation. . . . . . . . . . . . . . . . . . . . . . . . . 6,185 3.0 (0.12) 6,454 2.9 (0.15) 0.1 Deep breathing exercises . . . . . . . . . . . . . . . . . . . . . . 23,457 11.6 (0.24) 27,794 12.7 (0.30) 1.1Hypno sis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505 0.2 (0.03) 561 0.2 (0.04) 0.0 Yoga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,386 5.1 (0.16) 13,172 6.1 (0.21) 1.0Tai chi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,565 1.3 (0.08) 2,267 1.0 (0.08) 0.3Qi gon g. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 527 0.3 (0.04) 625 0.3 (0.04) 0.0 Energyhealingtherapy/Reiki . . . . . . . . . . . . . . . . . . . . 1,080 0.5 (0.05) 1,216 0.5 (0.06) 0.0 *Estimatesprecededbyanasteriskhavearelativestandarderrorofgreater than30%andlessthanorequalto50%anddonotmeetthestandardofreliabilityorprecision.. . . Categorynotapplicable.0.0Figuredoesnotmeetstandardsofreliabilityorprecisionandquantitymorethanzerobutlessthan0.05.Estimateswitharelativestandarderrorgreaterthan50%are indicatedwithadagger,butarenotshown.p


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NationalHealthStatisticsReports n Number12 n December10,2008 Page11Table2.Frequenciesandage-adjustedpercentagesofchildrenunder18yearsofagewhousedcomplementaryandalternativemedicineinthepast12months,bytypeoftherapy:UnitedStates,2007

Allchildren ChildrenwhoseparentusedCAM1

Therapy Number inthousandsPercent

(standarderror) Number inthousands

Percent(standard

error)Alternativemedicalsystems

Acupuncture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ayurve da . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Homeopathictreatment. . . . . . . . . . . . . . . . . . . . . . . . Naturopathy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Traditional healers2 . . . . . . . . . . . . . . . . . . . . . . . . . .

Curandero. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Espiritista . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hierbero or Yerbera . . . . . . . . . . . . . . . . . . . . . . . . . Shaman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Botanica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NativeAmericanhealerorMedicineman. . . . . . . . . . . . Sobador. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Biologically basedtherapiesChelation therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . Nonvitamin,nonmineral,naturalproducts. . . . . . . . . . . . . Dietbasedtherapies2 . . . . . . . . . . . . . . . . . . . . . . . . .

Vegetariandiet. . . . . . . . . . . . . . . . . . . . . . . . . . . . Macrobiotic diet . . . . . . . . . . . . . . . . . . . . . . . . . . . Atkins d i e t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pritikin diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ornish diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Zonediet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SouthBeach . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Manipulativeandbodybased therapiesChiropracticorosteopathicmanipulation . . . . . . . . . . . . . Massage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Movementtherapies2 . . . . . . . . . . . . . . . . . . . . . . . . .

Feldenkreis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alexandertechnique . . . . . . . . . . . . . . . . . . . . . . . . Pilates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TragerPsychophysicalIntegration. . . . . . . . . . . . . . . .

MindbodytherapiesBiofeedback. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Meditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Guided imagery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Progressiverelaxation. . . . . . . . . . . . . . . . . . . . . . . . . Deepbreathingexercises . . . . . . . . . . . . . . . . . . . . . . Hypnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yoga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tai chi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Qig o n g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Energy healing therapy . . . . . . . . . . . . . . . . . . . . . . . .

150 79

907 237 767

56 510

40 29 34 98 63

72 2,850

565 367

21 88 16 48 18

128

2,020 743 299

29 54

245 39

119 725 293 329

1,558 67

1,505 113

50 161

0.2 (0.05) *0.1 (0.04)

1.3 (0.22) 0.3 (0.09) 1.1 (0.18)

0.7 (0.15)

*0.1 (0.02)

*0.1 (0.05) *0.1 (0.03)

*0.1 (0.04) 3.9 (0.32) 0.8 (0.11) 0.5 (0.07)

*0.1 (0.05)

*0.2 (0.05)

2.8 (0.25) 1.0 (0.13) 0.4 (0.07)

*0.1 (0.03)

0.3 (0.07)

0.2 (0.05) 1.0 (0.12) 0.4 (0.09) 0.5 (0.09) 2.2 (0.22)

*0.1 (0.04) 2.1 (0.18)

*0.2 (0.05)

0.2 (0.05)

27 7

354 111 106

5 73

7 5

13 3

7 1,194

181 98

62

48

754 297

57 4

41 12

36 400 197 164 704

18 618

56 4

52

*0.2 (0.09)

2.8 (0.59)

*0.8 (0.26)

*0.6 (0.24)

9.2 (1.08) 1.4 (0.36)

*0.7 (0.24)

*0.4 (0.17)

5.7 (0.74) 2.2 (0.47)

*0.4 (0.18)

*0.3 (0.15)

*0.3 (0.12) 3.0 (0.51) 1.5 (0.40) 1.3 (0.37) 5.4 (0.76)

4.7 (0.63)

*0.4 (0.19)

*0.4 (0.17) *Estimatesprecededbyanasteriskhavearelativestandarderrorofgreater than30%andlessthanorequalto50%anddonotmeetthestandardofreliabilityorprecision.Estimateswitharelativestandarderrorgreater than50%areindicatedwithadagger,butarenotshown.Quantityzero.1Thechildsparentwasalso thesamplechildrespondent,thesampleadult,andusedCAM.Othersamplechildrespondentsarenot included.2Thetotalsof thenumbersandpercentagesof thecategories listedunderTraditionalhealers,Dietbased therapies,andMovement therapies,aregreater thanthenumberandpercentageoftheirrespectivecategoryheadingbecauserespondentscouldchoosemore thanoneof thecategories.NOTES:CAM iscomplementaryandalternativemedicine.Thedenominators forstatisticsshownexcludepersonswithunknowncomplementaryandalternativemedicine information.Estimatesareageadjustedusing theprojected2000U.S.populationasthestandardpopulationusing threeagegroups:04years,511years,and1217years.DATASOURCE:CDC/NCHS,NationalHealthInterviewSurvey,2007.Estimatesarebasedonhouseholdinterviewsofasampleof thecivilian,noninstitutionalizedpopulation.


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Page12 NationalHealthStatisticsReports n Number12 n December10,2008Table3.Frequenciesandage-adjustedpercentagesofadults18yearsandoverwhousedselectedtypesofnonvitamin,nonmineral,naturalproductsforhealthreasons inthepast30days,bytypeofproductused:UnitedStates,2007

Usedselectednonvitamin,nonmineral,naturalproducts1

Number in Percent2Nonvitamin, nonmineral,naturalproducts thousands (standarderror)

Fish oil or omega 3 or D H A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,923 37.4 (1.13) Glucosamine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,132 19.9 (0.91) Echinacea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,848 19.8 (1.01) Flaxseedoilorpills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,416 15.9 (0.87) Ginseng. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,345 14.1 (0.87) Combination herb p i l l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,446 13.0 (0.83) Ginkgobiloba . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,977 11.3 (0.88) Chondroitin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,390 11.2 (0.82) Garlicsupplements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,278 11.0 (0.66) CoenzymeQ 1 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,691 8.7 (0.60) Fiberorpsyllium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,791 6.6 (0.61) Green teapills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,528 6.3 (0.65) Cranberry(pills,gelcaps) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,560 6.0 (0.63) Saw palmetto . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,682 5.1 (0.46) Soysupplementsor isofavones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,363 5.0 (0.53) Melatonin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,296 4.6 (0.48) Grapeseedextract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,214 4.3 (0.43) MSM(methysulfonylmethane) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,312 4.1 (0.37) Milk thistle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,001 3.7 (0.49) Lutein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,047 3.4 (0.38) 1Respondentsmayhaveusedmore thanonenonvitamin,nonmineral,naturalproduct.2Thedenominatorusedinthecalculationofpercentageswas thenumberofadultswhousednonvitamin,nonmineral,naturalproductswithinthepast30days,excludingpersonswithunknowninformation forusageofthespecifiednonvitamin,nonmineral,naturalproduct.NOTE:Estimateswereageadjustedusing theprojected2000U.S.populationas thestandardpopulationandusing fouragegroups:1824years,2544years,4564years,and65yearsandover.DATASOURCE:CDC/NCHS,NationalHealthInterviewSurvey,2007.Estimatesarebasedonhouseholdinterviewsofasampleof thecivilian,noninstitutionalizedpopulation.

Table4.Frequenciesandage-adjustedpercentagesofchildrenunder18yearsofagewhousedselectedtypesofnonvitamin,nonmineral,naturalproducts,forhealthreasonsinthepast30days,bytypeofproductused:UnitedStates,2007

Usedselectednonvitamin,nonmineral,naturalproducts1Number in Percent2

Nonvitamin,nonmineral,naturalproducts thousands (standarderror)Echinacea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524 37.2 (4.94) Fish oil or omega 3 or DHA . . . . . . . . . . . . . . . . . . . . . 441 30.5 (4.88) Combination herb pill . . . . . . . . . . . . . . . . . . . . . . . . . 296 17.9 (3.94) Flaxseedoilorpills . . . . . . . . . . . . . . . . . . . . . . . . . . 233 16.7 (4.85) Prebiotics or probiotics . . . . . . . . . . . . . . . . . . . . . . . . 199 *13.6 (4.49) Goldenseal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 *8.6 (3.83) Garlicsupplements . . . . . . . . . . . . . . . . . . . . . . . . . . 84 *5.9 (1.85) Melatonin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 *5.8 (2.02) Fiberorpsyllium . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Cranberry(pills,gelcaps). . . . . . . . . . . . . . . . . . . . . . . 33 *1.8 (0.83) Ginkgobiloba. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Creatine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Ginseng . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Soysupplementsor isofavones. . . . . . . . . . . . . . . . . . . 15 DHEA3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 *Estimatesprecededbyanasteriskhavearelativestandarderrorofgreater than30%andlessthanorequalto50%anddonotmeetthestandardofreliabilityorprecision.Estimateswitharelativestandarderrorgreaterthan50%are indicatedwithadagger,butarenotshown.1Respondentsmayhaveusedmore thanonenonvitamin,nonmineral,naturalproduct.2Thedenominatorusedinthecalculationofpercentageswas thenumberofchildrenwhousednonvitamin,nonmineral,naturalproductswithin thepast30days,excludingpersonswithunknowninformation forusageofthespecifiednonvitamin,nonmineral,naturalproduct.3DHEAisdehydroepiandrosterine.NOTE:Estimateswereageadjustedusing theprojected2000U.S.populationas thestandardpopulationusingthreeagegroups:04years,511years,and1217years.DATASOURCE:CDC/NCHS,NationalHealthInterviewSurvey,2007.Estimatesarebasedonhouseholdinterviewsofasampleof thecivilian,noninstitutionalizedpopulation.


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NationalHealthStatisticsReports n Number12 n December10,2008 Page13Table5.Frequenciesandage-adjustedpercentagesofadults18yearsofageandoverwhousedcomplementaryandalternativemedicine inthepast12months,byselecteddiseasesandconditionsforwhichitwasused:UnitedStates,2007

UsedCAMastreatmentPercent2

Diseaseorcondition1 Number inthousands (standarderror)Back pain or problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,325 17.1 (0.54) Neck pain or problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,031 5.9 (0.33) Joint pain or stiffness, or other joint condition. . . . . . . . . . . . . . . . . . . . . . . . . 4,537 5.2 (0.27) Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,057 3.5 (0.23) Other, specify . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,733 3.3 (0.23) Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,293 2.8 (0.23) Cholesterol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,827 2.1 (0.17) Head or chest cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,693 2.0 (0.17) Other musculoskeletal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,498 1.8 (0.19) Severe headache or migraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,359 1.6 (0.16) Insomnia or trouble sleeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,191 1.4 (0.16) S t re ss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,124 1.3 (0.15) Stomach or intestinal illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 974 1.2 (0.14) De pressio n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 962 1.2 (0.16) Regular headaches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 813 1.0 (0.15) Hypertension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 842 0.9 (0.12) Fibromyalgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 755 0.8 (0.11) Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 650 0.7 (0.12) Sprain or strain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605 0.7 (0.10) Coronary heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 586 0.7 (0.10) 1Respondentsmayhaveusedmore thanoneCAM therapy to treatadiseaseorcondition,butwerecountedonlyonceundereachdiseaseorcondition treated.ThequestionsaboutusingaCAMtherapy totreatadiseaseorconditionwereonlyaskedofrespondentswhohadused the therapywithin thepast12months.Theexception tothis is thequestionsaboutusingnonvitamin,nonmineral,naturalproductsto treatadiseaseorconditionwhichwereonlyaskedofrespondentswhohadusednonvitamin,nonmineral,naturalproductswithin thepast30days.2Thedenominatorusedinthecalculationofpercentageswas thenumberofadultswhousedCAMwithin thepast12months,excludingpersonswithunknowninformationaboutwhetherCAMwasused to treat thespecifiedcondition.NOTES:CAM iscomplementaryandalternativemedicine.Estimatesareageadjustedusing theprojected2000U.S.populationasthestandardpopulationusing fouragegroups:1824years,2544years,4564years,and65yearsandover.DATASOURCE:CDC/NCHS,NationalHealthInterviewSurvey,2007.Estimatesarebasedonhouseholdinterviewsofasampleof thecivilian,noninstitutionalizedpopulation.

Table6.Frequenciesandage-adjustedpercentagesofchildrenunder18yearsofagewhousedcomplementaryandalternativemedicineinthepast12monthsbyselecteddiseasesandconditionsforwhich itwasused:UnitedStates,2007

UsedCAMastreatmentNumber in Percent2

Diseaseorcondition1 thousands (standarderror)Other, specify . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 625 8.3 (1.14) Back or neck pain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 705 6.7 (0.87) Head or chest cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515 6.6 (1.24) Anxiety or stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 4.8 (0.87) Other musculoskeletal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 4.2 (0.83) ADHD/ADD3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 2.5 (0.54) Insomnia or trouble sleeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 1.8 (0.50) Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 *1.6 (0.49) S in usit is. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 *1.5 (0.62) Other al lergies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 *1.4 (0.46) Influenza or pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Respiratory allergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 *1.3 (0.62) Sore throat other than strep or tonsillitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 *1.1 (0.43) De pressio n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 1.0 (0.27) Abdominal pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 *0.8 (0.30) *Estimatesprecededbyanasteriskhavearelativestandarderrorofgreater than30%andlessthanorequalto50%anddonotmeetthestandardofreliabilityorprecision.Estimateswitharelativestandarderrorgreaterthan50%are indicatedwithadagger,butarenotshown.1Respondentsmayhaveusedmore thanoneCAM therapy to treatadiseaseorcondition,butwerecountedonlyonceundereachdiseaseorcondition treated.ThequestionsaboutusingaCAMtherapy totreatadiseaseorconditionwereonlyaskedofrespondentswhohadused the therapywithin thepast12months.Theexception tothis is thequestionsaboutusingnonvitamin,nonmineral,naturalproductsto treatadiseaseorconditionthatwereonlyaskedofrespondentswhohadusednonvitamin,nonmineral,naturalproductswithin thepast30days.2Thedenominatorusedinthecalculationofpercentageswas theestimatednumberofchildrenwhousedCAMwithin thepast12months,excludingpersonswithunknowninformationaboutwhetherCAMwasused totreat thespecifiedcondition.3ADHDisAttentionDeficitHyperactivityDisorderandADD isAttentionDeficitDisorder.NOTES:CAM iscomplementaryandalternativemedicine.Estimatesareageadjustedusing theprojected2000U.S.populationasthestandardpopulationusing threeagegroups:04years,511years,and1217years.DATASOURCE:CDC/NCHS,NationalHealthInterviewSurvey,2007.Estimatesarebasedonhouseholdinterviewsofasampleof thecivilian,noninstitutionalizedpopulation.


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Page 14 National Health Statistics Reports n Number 12 n December 10, 2008Table7.Age-adjustedpercentagesofadults18yearsofageandoverwhousedselectedcomplementaryandalternativemedicinecategories inthepast12months,byselectedcharacteristics:UnitedStates,2007

Complementary and alternative medicine categories

Characteristic All CAM1Biologically

basedtherapies2

Mindbodytherapies3

Alternativemedical

systems4Energyhealingtherapy

Manipulativeand body-

basedtherapies5

Percents (standard errors)Total6,7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.3 ( 0.50) 19.9 ( 0.39) 19.2 ( 0.38) 3.4 (0.16) 0.5 (0.06) 15.2 (0.34)

Sex7Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F ema le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

33.5 ( 0.63) 42.8 ( 0.61)

17.8 ( 0.50) 21.9 ( 0.50)

14.4 ( 0.44) 23.8 ( 0.53)

2.7 (0.18) 4.2 (0.23)

0.4 (0.08) 0.7 (0.08)

12.2 (0.39) 18.1 (0.46)

Age1 82 9 ye ars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 03 9 ye ars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 04 9 ye ars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 05 9 ye ars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 06 9 ye ars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 08 4 ye ars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36.3 ( 1.14) 39.6 ( 0.96) 40.1 ( 0.97) 44.1 ( 1.14) 41.0 ( 1.21) 32.1 ( 1.11) 24.2 ( 2.32)

15.9 ( 0.86) 19.8 ( 0.77) 20.4 ( 0.79) 24.2 ( 0.92) 25.4 ( 1.07) 19.3 ( 0.92) 13.7 ( 1.89)

21.3 ( 0.92) 19.9 ( 0.81) 19.7 ( 0.81) 22.9 ( 1.00) 17.3 ( 0.88) 11.9 ( 0.69)

9.8 ( 1.58)

3.2 (0.41) 3.6 (0.34) 4.6 (0.38) 4.9 (0.40) 2.8 (0.34) 1.8 (0.31)

*1.9 (0.86)

*0.3 (0.10) 0.5 (0.11) 0.8 (0.21) 1.0 (0.16) 0.5 (0.14)

15.1 (0.85) 17.2 (0.70) 17.4 (0.69) 17.3 (0.78) 13.8 (0.80)

9.9 (0.70) 7.0 (1.38)

Race and ethnicity

7Hi spa nic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NonHispanic white, single race. . . . . . . . . . . . . . . . . . . . . . . . . NonHispanic black or African American, single race . . . . . . . . . . . . NonHispanic American Indian or Alaska Native, single race . . . . . . . NonHispanic Asian, single race. . . . . . . . . . . . . . . . . . . . . . . . . NonHispanic Native Hawaiian or Other Pacific Islander, single race . .

23.7 ( 0.95) 43.1 ( 0.61) 25.5 ( 0.93) 50.3 ( 4.63) 39.9 ( 2.07) 43.2 (12.60)

11.8 ( 0.68) 22.7 ( 0.49) 12.3 ( 0.72) 23.7 ( 4.09) 19.6 ( 1.62)

*26.1 (11.79)

10.6 ( 0.63) 21.4 ( 0.49) 14.8 ( 0.76) 23.3 ( 5.68) 23.4 ( 1.42)

*24.5 (12.01)

3.0 (0.33) 3.7 (0.21) 1.4 (0.24)

*13.2 (5.84) 5.4 (0.79)

*0.1 (0.03) 0.7 (0.08)

*0.2 (0.07)

*0.3 (0.14)

6.7 (0.50) 18.7 (0.45)

6.5 (0.52) 13.4 (3.12) 11.1 (1.32)

Hispanic or Latino origin7

Puerto Rican . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mexican . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mexican American . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cuban or Cuban American. . . . . . . . . . . . . . . . . . . . . . . . . . . . Dominican (Republic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Central or South American . . . . . . . . . . . . . . . . . . . . . . . . . . . .

29.7 ( 2.95) 18.2 ( 1.48) 27.4 ( 2.05) 22.9 ( 3.71) 28.2 ( 4.31) 23.4 ( 2.15)

14.2 ( 2.36) 8.9 ( 1.03)

14.0 ( 1.59) 11.2 ( 2.84) 12.3 ( 3.61) 12.8 ( 1.79)

16.8 ( 2.42) 6.9 ( 0.95)

11.6 ( 1.43) 14.1 ( 3.08) 18.5 ( 3.77) 10.0 ( 1.36)

*2.4 (0.80) 3.9 (0.71) 2.1 (0.57)

3.5 (0.93)

7.6 (1.48) 4.1 (0.63) 7.9 (1.08) 8.5 (2.07)

*5.3 (2.15) 7.4 (1.23)

Education8Less than high school. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . High School Graduate or GED9 recipient . . . . . . . . . . . . . . . . . . . Some Collegeno degree. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Associate of Arts Degree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bachelor or Arts or Science Degree . . . . . . . . . . . . . . . . . . . . . . Masters, Doctorate, Professional Degree . . . . . . . . . . . . . . . . . . .

20.8 ( 0.90) 31.0 ( 0.85) 45.0 ( 1.08) 47.2 ( 1.39) 49.6 ( 1.05) 55.4 ( 1.34)

9.8 ( 0.64) 16.3 ( 0.60) 24.4 ( 0.94) 24.9 ( 1.17) 27.5 ( 0.96) 30.1 ( 1.24)

7.6 ( 0.56) 12.1 ( 0.53) 22.0 ( 0.84) 24.3 ( 1.26) 25.5 ( 0.85) 34.2 ( 1.34)

2.1 (0.36) 2.0 (0.22) 4.3 (0.43) 3.6 (0.46) 5.4 (0.42) 6.1 (0.66)

0.4 (0.10) 0.7 (0.14)

*0.5 (0.17) 0.8 (0.13) 1.2 (0.28)

6.4 (0.58) 11.5 (0.58) 18.0 (0.85) 18.2 (1.00) 20.7 (0.84) 23.6 (1.15)

Poverty status7,10P o o r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ne ar poo r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No t po or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

28.9 ( 1.02) 30.9 ( 1.01) 43.3 ( 0.64)

13.7 ( 0.78) 15.6 ( 0.76) 23.0 ( 0.52)

16.5 ( 0.84) 16.0 ( 0.81) 21.6 ( 0.50)

3.2 (0.47) 2.6 (0.35) 3.9 (0.21)

*0.5 (0.16) 0.5 (0.13) 0.6 (0.08)

8.4 (0.60) 10.1 (0.63) 18.1 (0.45)

Health insurance11Under 65 years:

P ri va t e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Un in su re d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65 years and over:P ri va t e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Un in su re d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

42.7 ( 0.65) 30.6 ( 1.19) 31.5 ( 0.97) 37.1 ( 1.21) 29.1 ( 1.30)

*11.1 ( 4.91)

21.3 ( 0.49) 14.9 ( 0.85) 17.0 ( 0.76) 23.4 ( 1.06) 17.2 ( 1.11)

22.0 ( 0.53) 18.7 ( 0.99) 16.2 ( 0.78) 14.2 ( 0.82) 11.5 ( 0.84)

3.9 (0.22) 2.6 (0.33) 4.0 (0.41) 2.0 (0.34) 1.7 (0.36)

0.6 (0.09) *0.3 (0.11) 0.7 (0.14)

19.0 (0.51) 9.6 (0.70) 9.8 (0.68)

11.7 (0.80) 8.2 (0.78)

Marital status7

Never married. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . M a rri e d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cohabit ing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Divorced or separated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Wi d o w e d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36.0 ( 1.05) 37.6 ( 0.71) 38.1 ( 1.83) 38.5 ( 1.48) 26.1 ( 2.98)

18.6 ( 0.87) 19.0 ( 0.50) 21.0 ( 1.62) 20.4 ( 1.01) 12.5 ( 1.81)

20.8 ( 0.89) 17.5 ( 0.55) 20.7 ( 1.60) 20.3 ( 1.10) 14.7 ( 2.10)

3.8 (0.39) 3.2 (0.20) 4.1 (0.87) 2.9 (0.30) 1.6 (0.39)

0.8 (0.16) 0.4 (0.07) 1.1 (0.33) 0.7 (0.13)

13.5 (0.67) 15.0 (0.49) 15.8 (1.49) 16.4 (1.24)

8.2 (2.13) See footnotes at end of table.


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NationalHealthStatisticsReports n Number12 n December10,2008 Page15Table7.Age-adjustedpercentagesofadults18yearsofageandoverwhousedselectedcomplementaryandalternativemedicinecategories inthepast12months,byselectedcharacteristics:UnitedStates,2007Con.

ComplementaryandalternativemedicinecategoriesManipulative

Biologically Alternative Energy andbodybased Mindbody medical healing based

Characteristic AllCAM1 therapies2 therapies3 systems4 therapy therapies5Region7 Percents(standarderrors)

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.0 (0.95) 18.2 (0.72) 21.1 (0.82) 3.8 (0.32) 0.8 (0.20) 15.0 (0.67) Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.4 (1.08) 20.4 (0.76) 20.6 (0.81) 2.8 (0.29) 0.5 (0.10) 17.9 (0.87) South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.5 (0.84) 17.7 (0.68) 15.0 (0.59) 2.4 (0.23) 0.3 (0.07) 11.5 (0.48) West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44.6 (1.02) 24.4 (0.88) 23.2 (0.85) 5.6 (0.43) 0.9 (0.12) 18.4 (0.68)

Leisuretimephysicalactivity7,12Neverorunabletoengage inactivity . . . . . . . . . . . . . . . . . . . . . 23.6 (0.64) 11.5 (0.42) 9.8 (0.41) 2.2 (0.19) 0.2 (0.06) 8.5 (0.43) Engage insomeactivitybut lessthanregular . . . . . . . . . . . . . . . . 43.3 (0.80) 22.5 (0.68) 22.4 (0.64) 3.6 (0.28) 0.7 (0.11) 16.8 (0.57) Engage inregularactivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51.5 (0.80) 28.1 (0.71) 27.5 (0.71) 4.8 (0.32) 0.8 (0.11) 21.7 (0.65)

Bodyweightstatus7,13Underweight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.4 (2.97) 16.7 (2.40) 17.0 (2.17) *3.4 (1.15) 8.6 (1.62) Healthy weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.0 (0.71) 20.7 (0.60) 21.6 (0.58) 4.7 (0.29) 0.7 (0.10) 17.8 (0.54) Overweight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.3 (0.79) 19.0 (0.57) 18.4 (0.66) 2.7 (0.22) 0.5 (0.09) 14.6 (0.52) Obese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.6 (0.81) 21.2 (0.71) 17.8 (0.63) 2.9 (0.27) 0.5 (0.10) 13.3 (0.56)

Lifetimecigarettesmokingstatus7,14Currentsmoker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35.6 (1.04) 17.0 (0.79) 19.4 (0.80) 2.4 (0.29) 0.5 (0.11) 12.8 (0.66) Formersmoker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48.1 (1.06) 26.8 (0.90) 24.7 (0.94) 4.8 (0.43) 0.9 (0.21) 19.2 (0.81) Neversmoker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36.0 (0.60) 18.6 (0.45) 17.8 (0.45) 3.3 (0.20) 0.5 (0.06) 14.8 (0.41)

Lifetimealcoholdrinkingstatus7,15Lifetimeabstainer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.5 (0.82) 11.1 (0.58) 11.0 (0.57) 2.2 (0.28) 0.3 (0.08) 7.5 (0.47) Formerdrinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.6 (1.29) 19.3 (0.99) 19.8 (1.02) 3.2 (0.38) *0.4 (0.15) 12.8 (0.83) Current infrequentor lightdrinker. . . . . . . . . . . . . . . . . . . . . . . . 44.6 (0.70) 23.7 (0.60) 23.0 (0.56) 4.0 (0.25) 0.7 (0.10) 18.3 (0.51) Currentmoderateorheavierdrinker. . . . . . . . . . . . . . . . . . . . . . 45.4 (1.04) 24.2 (0.87) 22.3 (0.83) 3.8 (0.37) 0.7 (0.13) 19.3 (0.75)

Hospitalized inthe lastyear7Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.1 (1.43) 20.2 (1.16) 23.7 (1.26) 3.4 (0.50) *0.4 (0.14) 16.2 (1.10) No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.9 (0.51) 19.9 (0.40) 18.8 (0.39) 3.4 (0.16) 0.6 (0.06) 15.1 (0.34)

Numberofhealthconditions7,160conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.3 (0.93) 10.0 (0.68) 9.8 (0.72) 1.4 (0.22) *0.1 (0.05) 7.5 (0.53) 12conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33.3 (0.84) 16.5 (0.63) 16.2 (0.63) 2.2 (0.22) 0.2 (0.06) 12.5 (0.53) 35conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.3 (0.85) 22.8 (0.72) 19.5 (0.66) 3.9 (0.31) 0.7 (0.13) 18.1 (0.70) 6ormorecondit ions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.8 (0.91) 28.4 (0.80) 30.6 (0.86) 5.7 (0.42) 1.1 (0.17) 22.1 (0.76)

Numberofvisitstoadoctor inpast12months70 visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.5 (0.94) 13.0 (0.67) 13.2 (0.73) 2.0 (0.26) 0.4 (0.11) 6.0 (0.43) 1 visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.3 (0.96) 16.8 (0.78) 14.7 (0.70) 2.7 (0.31) 0.3 (0.08) 10.7 (0.64) 23 vi si t s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.4 (0.86) 20.9 (0.72) 19.7 (0.69) 3.1 (0.28) 0.5 (0.10) 15.0 (0.60) 49 vi si t s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47.2 (0.93) 25.1 (0.81) 23.8 (0.79) 4.2 (0.36) 0.7 (0.14) 20.6 (0.74) 10 or visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.4 (1.15) 25.3 (1.00) 28.8 (1.07) 6.7 (0.57) 1.2 (0.23) 28.3 (1.09)

Delayedconventionalcarebecauseofworryaboutcost7Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48.2 (1.38) 26.3 (1.15) 27.7 (1.29) 5.6 (0.56) 1.1 (0.18) 17.6 (1.02) No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.0 (0.51) 19.1 (0.39) 18.2 (0.39) 3.2 (0.16) 0.5 (0.06) 14.9 (0.36)

Didnotreceiveconventionalcarebecausecouldnotafford it7Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46.1 (1.50) 24.8 (1.31) 26.3 (1.36) 4.9 (0.54) 1.1 (0.20) 16.7 (1.19) No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.5 (0.51) 19.4 (0.40) 18.5 (0.39) 3.3 (0.17) 0.5 (0.06) 15.0 (0.36)

Usualplaceforhealthcare7Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.1 (0.53) 20.1 (0.41) 19.6 (0.41) 3.5 (0.17) 0.5 (0.06) 15.9 (0.38) No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.5 (1.23) 18.1 (1.01) 17.2 (0.91) 3.2 (0.37) 0.8 (0.20) 10.9 (0.70) *Estimatesprecededbyanasteriskhavearelativestandarderrorofgreater than30%andlessthanorequalto50%anddonotmeetthestandardofreliabilityorprecision.Estimateswitharelativestandarderrorgreaterthan50%are indicatedwithadagger,butarenotshown.Quantityzero.1AllCAM includesacupuncture;ayurveda;homeopathictreatment;naturopathy; traditionalhealers,chelationtherapy;nonvitamin,nonmineral,naturalproducts;dietbased therapies;chiropracticorosteopathicmanipulation;massage;movementtherapies;biofeedback;meditation;guided imagery;progressiverelaxation;deepbreathingexercises;hypnosis;yoga;taichi;qigong;andenergyhealing therapy.2Biologicallybased therapies includechelation therapy;nonvitamin,nonmineral,naturalproducts;anddietbased therapies.3Mindbody therapies includebiofeedback;meditation;guidedimagery;progressiverelaxation;deepbreathingexercises;hypnosis;yoga;taichi;andqigong.


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Page16 NationalHealthStatisticsReports n Number12 n December10,20084Alternativemedicalsystemsincludeacupuncture;ayurveda;homeopathic treatment;naturopathy;and traditionalhealers.5Manipula

barnes - cdc national health stat cam

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