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Complementary and Alternative Medicine Use Among Adults: United States, 2002 Patricia M Number 343 + May 27, 2004 Complementary and Alternative Medicine Use Among Adults: United States, 2002 Patricia M. Barnes, M.A., and Eve Powell-Griner, Ph.D., Division of Health Interview Statistics; and Kim McFann, Ph.D., and Richard L. Nahin, Ph.D., M.P.H., National Center for Complementary and Alternative Medicine, National Institutes of Health Abstract Introduction Objective—This report presents selected estimates of complementary and Complementary and alternative alternative medicine (CAM) use among U.S. adults, using data from the 2002 medicine (CAM) is a group of diverse National Health Interview Survey (NHIS), conducted by the Centers for Disease medical and health care systems, Control and Prevention’s (CDC) National Center for Health Statistics (NCHS). therapies, and products that are not Methods—Data for the U.S. civilian noninstitutionalized population were presently considered to be part of collected using computer-assisted personal interviews (CAPI). This report is based conventional medicine. The U.S. on 31,044 interviews of adults age 18 years and over. Statistics shown in this report public’s use of CAM increased were age adjusted to the year 2000 U.S. standard population. substantially during the 1990s (1–11). Results—Sixty-two percent of adults used some form of CAM therapy during This high rate of use translates into the past 12 months when the definition of CAM therapy included prayer specifically large out-of-pocket expenditures on for health reasons. When prayer specifically for health reasons was excluded from CAM. It has been estimated that the the definition, 36% of adults used some form of CAM therapy during the past 12 U.S. public spent between $36 billion months. The 10 most commonly used CAM therapies during the past 12 months and $47 billion on CAM therapies in were use of prayer specifically for one’s own health (43.0%), prayer by others for 1997 (5). Of this amount, between $12.2 one’s own health (24.4%), natural products (18.9%), deep breathing exercises billion and $19.6 billion was paid (11.6%), participation in prayer group for one’s own health (9.6%), meditation out-of-pocket for the services of (7.6%), chiropractic care (7.5%), yoga (5.1%), massage (5.0%), and diet-based professional CAM health care providers therapies (3.5%). Use of CAM varies by sex, race, geographic region, health such as chiropractors, acupuncturists, insurance status, use of cigarettes or alcohol, and hospitalization. CAM was most and massage therapists. These fees are often used to treat back pain or back problems, head or chest colds, neck pain or more than the U.S. public paid out-of- neck problems, joint pain or stiffness, and anxiety or depression. Adults age 18 pocket for all hospitalizations in 1997 years or over who used CAM were more likely to do so because they believed that and about half that paid for all out-of- CAM combined with conventional medical treatments would help (54.9%) and/or pocket physician services (12). they thought it would be interesting to try (50.1%). Most adults who have ever used Explanations for this growth in CAM have used it within the past 12 months, although there is variation by CAM CAM use have been proposed, including therapy. marketing forces, availability of information on the Internet, the desire of Keywords: complementary and alternative medicine c National Health Interview patients to be actively involved with Survey medical decision making, and dissatisfaction with conventional U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics 2 Advance Data No. 343 + May 27, 2004 (western) medicine (13). This conditions (20,21), the public’s wide use Methods dissatisfaction may be related to the of many untested CAM therapies might inability of conventional medicine to have unanticipated negative Data source adequately treat many chronic diseases consequences. For example, the U.S. and their symptoms such as debilitating Department of Health and Human The statistics shown in this report pain (1). Rates of CAM use are also Services banned the sale of the herbal are based on data from the Alternative exceptionally high among individuals supplement ephedra in 2003 after Health/Complementary and Alternative with life threatening illnesses such as concluding that the risks associated with Medicine supplement, the Sample Adult cancer (14) or HIV (15). It appears that use of this product by the general public Core component, and the Family Core the majority of people use CAM as a greatly outweighed any potential benefit component of the 2002 NHIS (24). The complement to conventional medicine, (22). It has been found that other herbal NHIS, one of the major data collection not as an alternative (1,3,5). products interact or interfere with the systems of CDC’s NCHS, is a survey of As used by the U.S. public, CAM normal pharmacology of some a nationally representative sample of the consists of many heterogeneous systems pharmaceutical drugs with potentially civilian noninstitutionalized household of medicine as well as numerous fatal consequences (23). CAM users population of the United States. Basic stand-alone therapies (16). Several health and demographic information systems of CAM are practiced as part of often do not share information about such use with their conventional health were collected on all household the health care system in U.S. members. Adults present at the time of immigrants’ countries of origin (17). For care providers (5), thereby increasing the possibility of serious interactions. the interview are asked to respond for example, Ayurveda is practiced in India themselves. Proxy responses are at a national level within the Federal Even when conventional health care accepted for adults not present at the health system. Traditional Chinese providers are aware that their patients time of the interview and for children. medicine, which includes acupuncture, are taking herbal products, serious Additional information is collected on acupressure, herbal medicine, tai chi, interactions could result if providers are one randomly selected adult age 18 and qi gong, is often practiced in the unfamiliar with the scientific literature same hospitals or clinics as conventional on CAM. Understanding the prevalence years or over (sample adult) and one medicine in China. Kampo, the system and reasons for CAM use is a first step randomly selected child age 0–17 years of traditional herbal medicine in Japan, toward improving communication (sample child) per family. Information is covered by the national health between health care providers and their on the sample adult is self-reported insurance plan and is practiced by many patients. except in rare cases when the sample medical doctors (18). Immigrants from This report is based on a CAM adult is physically or mentally incapable these and other countries of origin may supplement that was administered as of responding, and information on the continue to rely on CAM as part of their part of the sample adult questionnaire of sample child is collected from an adult medical treatment in the United States the 2002 NHIS. The report focuses on family member who is knowledgeable even as they seek care from who uses CAM, what is used, and why about the child’s health. conventional health care providers. it is used. It also examines the The Alternative Health/ Some of these systems may eventually relationship between the use of CAM Complementary and Alternative prove to be low cost health care options and the use of conventional medical Medicine supplemental questionnaire for use by the U.S. public. practices. In particular, the report included questions on 27 types of CAM Despite the diverse ways in which examines the relationship of CAM use therapies commonly used in the United these systems and therapies developed, States (table 1). These 27 CAM they appear to have several and demographic and health behaviors among groups not previously studied in therapies included 10 types of provider- characteristics in common: the use of based CAM therapies (e.g., acupuncture, complex interventions, often involving detail, including race and ethnic groups, the economically disadvantaged, and the chiropractic care, folk medicine), as well the administration of many medications as 17 other CAM therapies for which or medicinal substances at the same elderly. The 2002 NHIS included the services of a provider are not time; individualized diagnosis and questions that asked respondents about necessary (e.g., natural products, special treatment of patients; an emphasis on their use (ever and during the past 12 diets, megavitamin therapy). The CAM maximizing the body’s inherent healing months) of 27 different CAM therapies. supplement, unlike earlier surveys, ability; and treatment of the ‘‘whole’’ This report defines CAM broadly by person by addressing their physical, including therapies or practices that may includes specific types of CAM diets mental, and spiritual attributes rather not be considered CAM, such as prayer such as Atkins, Macrobiotic, Ornish, than focusing on a specific pathogenic specifically for health purposes and Pritikin, and Zone; a comprehensive process as emphasized in conventional high-dose vitamin therapy, and examines range of mind-body therapies, including medicine (19). the use of these practices in specific biofeedback, deep breathing techniques, Notwithstanding the growing populations. guided imagery, hypnosis, progressive scientific evidence that some CAM relaxation, qi gong, tai chi, and yoga; therapies may be effective for specific Advance Data No. 343 + May 27, 2004 3 and the use of prayer for health than’’ indicate a statistically significant For therapies used during the past 12 purposes. Inclusion and development of difference. Terms such as ‘‘similar’’ or months, respondents were asked more the 2002 supplement was supported, in ‘‘no difference’’ indicate that the detailed questions such as the health part, by the National Center for statistics being compared were not problem or condition being treated with Complementary and Alternative significantly different.
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