National Center for Complementary and Alternative Medicine

The Use of Complementary and Alternative Medicine in the United States

In December 2008, the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics (part of the Centers for Disease Control and Prevention) released new findings on Americans’ use of complementary and alternative medicine (CAM). The findings are from the 2007 National Health Interview Survey (NHIS), an annual in-person survey of Americans regarding their health- and illness-related experiences. The CAM section gathered information on 23,393 adults aged 18 years or older and 9,417 children aged 17 years and under. A similar CAM section was included in the 2002 NHIS, providing the opportunity to examine trends in CAM use, too.1

Figure 1 CAM Use by U.S. About CAM through well-designed scientific studies— Adults and Children CAM is a group of diverse medical and questions such as whether these therapies health care systems, practices, and prod- are safe and whether they work for the ucts that are not generally considered part purposes for which they are used. NCCAM’s 38.3% of conventional medicine. Complementary mission is to explore CAM practices using 36.0% medicine is used together with conven- rigorous scientific methods and build an tional medicine, and alternative medicine evidence base for the safety and effective- is used in place of conventional medicine. ness of these practices. Integrative medicine combines conven- How Many People Use CAM tional and CAM treatments for which there In the United States, approximately is evidence of safety and effectiveness. 38 percent of adults (about 4 in 10) and While scientific evidence exists regarding approximately 12 percent of children

11.8% some CAM therapies, for most there are (about 1 in 9) are using some form of key questions that are yet to be answered CAM, shown in figure 1.

1 Unless noted otherwise, the statistics are for CAM use during the 12 months prior to the 2007 survey. Comparisons from the 2002 NHIS are indicated. Adults Adults Children (2002) (2007) (2007)

National Institutes of Health 2 The Use of Complementary and Alternative Medicine in the United States

Figure 2 CAM Use by Age - 2007

50 44.1% 40.1% 41.0% 39.6% 40 36.3%

32.1% 30 24.2%

20 16.4%

10.7% 10 7.6%

0-4 5-11 12-17 18-29 30-39 40-49 50-59 60-69 70-84 85+ Age

Figure 3 CAM Use by Race/Ethnicity Who Uses CAM Most Among Adults - 2007 People of all backgrounds use CAM. However, CAM use among adults is greater among women and those with higher levels of 60 50.3% education and higher incomes. Figure 2 shows the percentage 50 of people using CAM by age. Figure 3 shows CAM use by 43.1% 39.9% race/ethnicity. 40

30 CAM Therapies Used the Most 25.5% 23.7% Nonvitamin, nonmineral natural products are the most commonly 20 used CAM therapy among adults. Use has increased for several therapies, including deep breathing exercises, meditation, massage 10 therapy, and yoga. Figure 4 shows the percentage of people using the most common CAM therapies and therapies with significant

White Asian Black increases between 2002 and 2007. Indian/ Hispanic American Alaska Native Use of Natural Products The most popular natural products are fish oil/omega 3, glucosamine, CAM Therapies Included in the 2007 NHIS: An asterisk (*) indicates a practitioner-based therapy. For echinacea, and flaxseed. Figure 5 ranks the top 10 natural products definitions of these therapies, see the full report or used among adults in 2007 and 2002 (note that the 2007 survey contact the NCCAM Clearinghouse (see page 4). asked about use in the last 30 days, whereas the 2002 survey asked Acupuncture* Meditation about use in the last year). Ayurveda* Movement therapies Biofeedback* Natural products Health Conditions Prompting CAM Use Chelation therapy* (nonvitamin and non- Chiropractic or osteopathic mineral, such as herbs People use CAM for an array of diseases and conditions. American manipulation* and other products from adults are most likely to use CAM for musculoskeletal problems Deep breathing exercises plants, enzymes, etc.) such as back, neck, or joint pain. The use of CAM therapies for Diet-based therapies Naturopathy* head or chest colds showed a substantial decrease from 2002 to Energy healing therapy/Reiki* Progressive relaxation 2007. Figure 6 ranks the top 10 conditions prompting CAM use Guided imagery Qi gong Homeopathic treatment Tai chi among adults for 2007 and 2002. Hypnosis* Traditional healers* Massage* Yoga The National Center for Complementary and Alternative Medicine 3

Figure 4 10 Most Common CAM Therapies Among Adults - 2007

20 17.7% Therapies with significant increases between 2002 and 2007 are 15 12.7% 2002 2007

9.4% Deep breathing 11.6% 12.7% 10 8.6% 8.3% Meditation 7.6% 9.4% 6.1% Massage 5.0% 8.3% 5 3.6% Yoga 5.1% 6.1% 2.9% 2.2% 1.8%

Yoga Massage Therapies Relaxation Treatment Meditation Osteopathic Diet-Based Progressive Chiropractic & Homeopathic Deep Breathing Natural Products Guided Imagery

Figure 5 10 Most Common Natural Products Among Adults 40.3% 40 37.4% 40

30 30 2007* 24.1% 2002* 21.1% 19.9% 19.9% 19.8% 20 20 15.9% 14.1% 14.9% 13.0% 12.0% 11.8% 11.7% 11.3% 11.2% 11.0% 10.5% 8.7% 9.4% 10 10

Garlic Garlic Ginger Fish Oil/ Ginseng Ginseng Fish Oil/ Omega 3 Echinacea Herb Pills Echinacea Omega 3 Chondroitin Peppermint Glucosamine Combination Glucosamine Ginkgo Biloba Supplements Ginkgo BilobaSupplements St. John’s Wort Supplements Flaxseed Oil/Pills Coenzyme Q-10 Soy Supplements *Percentages among adults who used natural products in the last 30 days. *Percentages among adults who used natural products in the last 12 months.

Figure 6 Diseases/Conditions for Which CAM Is Most Frequently Used Among Adults 20 20 17.1% 16.8%

15 15 2007 2002

9.5% 10 10

6.6% 5.9% 5.2% 4.9% 4.9% 4.5% 5 5 3.7% 3.5% 3.1% 2.8% 2.1% 2.4% 2.0% 2.2% 1.8% 1.6% 1.4%

Other Arthritis Anxiety Head or Head or Arthritis Back Pain Neck Pain Joint Pain Insomnia Back Pain Neck Pain Joint Pain Insommia Cholesterol Chest Cold or Migraine Chest Cold or Migraine Stomach Upset Recurring Pain MusculoskeletalSevere Headache Severe Headache Anxiety/Depression 4 The Use of Complementary and Alternative Medicine in the United States

CAM Use Among Children Figure 7 10 Most Common Therapies Among Children The 2007 NHIS asked selected adult respondents about CAM 3.9% use by children in their households. Overall, approximately 4 12 percent of children use some form of CAM. Use is greater among: 3 2.8% • Children whose parents used CAM (23.9%) 2.2% • Adolescents aged 12-17 (16.4%), compared to 2.1% younger children 2 • White children (12.8%), compared to Hispanic 1.3% children (7.9%) and black children (5.9%) 1.1% 1.0% 1.0% 0.8% • Children whose parents had higher education 1 levels (more than high school: 14.7%) 0.5% • Children with six or more health conditions (23.8%) • Children whose families delayed conventional care because of cost (16.9%) & Yoga Natural Massage Products Therapies Figures 7-9 show survey findings on CAM use by Treatment MeditationDiet-Based ProgressiveRelaxation Osteopathic Homeopathic children, including top therapies, natural products, and Chiropractic Deep Breathing Traditional Healers diseases/conditions.

Figure 8 Most Common Natural Products Among Children* About NCCAM NCCAM’s mission is to explore complementary and alternative healing 40 37.2% practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals. 30.5% To Obtain the Report 30 The report’s citation is Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12. Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. December 2008. It is available, 20 17.9% along with a press release and graphics, at nccam.nih.gov/news/camstats.htm. 16.7% People who do not have access to the Internet can contact the NCCAM Clearinghouse (see below) for a copy. 10 For More Information NCCAM Clearinghouse The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice,

treatment recommendations, or referrals to practitioners. Fish Oil/ FlaxseedOil/Pills Echinacea Omega 3 Herb Pills Combination Toll-free in the U.S.: 1-888-644-6226 TTY (for deaf and hard-of-hearing callers): 1-866-464-3615 *Percentages among children who used natural products in the last 30 days. Web site: nccam.nih.gov E-mail: [email protected]

Additional Reports Figure 9 Diseases/Conditions for Which CAM Is NCCAM plans to collaborate with NCHS on further analyses of Most Frequently Used Among Children the survey findings. Among the areas of interest to the researchers are CAM costs and spending, dietary supplements, and reasons for CAM 8 use. Future reports will be published by NCHS and posted on the 6.7% 6.6% NCCAM web site. 7 6 4.8% 5 4.2% 4 3 2.5% 1.8% U.S. Department of Health 2 and Human Services 1 National Institutes of Health National Center for Complementary

and Alternative Medicine *D424* Other ADHD Head or Insomnia Chest Cold Created December 2008 D424 Back/Neck Pain Anxiety/Stress Musculoskeletal