CAM Use in America: Up Close
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How many adults in the United States use CAM? What are their characteristics, attitudes, and behaviors related to health? What CAM therapies do they use and for what purposes?
A large piece of this puzzle fell into place when NCCAM released, in May 2004, results from the largest (over 31,000 respondents) and most representative survey to date on Americans' use of CAM. The results were based on an NCCAM-supported CAM supplement to the Centers for Disease Control and Prevention's 2002 National Health Interview Survey (NHIS).
Since that time, NCCAM has been supporting studies to obtain more detailed information on CAM use—for example, by certain populations (such as women, racial/ethnic minorities, and older people) and for specific health problems or conditions. Findings have begun to appear in the peer-reviewed literature. This occasional column in CAM at the NIH will highlight selected findings.
Women
A team of seven authors led by Dawn Upchurch, Ph.D., of the University of California, Los Angeles, School of Public Health analyzed the NHIS responses of almost 17,300 women. About 75 percent of the women were White, and about 60 percent were under age 50. Among their findings about the respondents' use of CAM within the past 12 months:
- Forty percent used CAM.
- Having a higher level of education, being employed, and living in the West were among the factors connected to a higher rate of CAM use.
- Women aged 50 to 59 had the highest rate of CAM use, followed by women aged 40 to 49 and 30 to 39; women aged 70 and older had the lowest rate.
- The respondents used CAM for various conditions (see table below), especially for musculoskeletal conditions and chronic pain.
- Most often, they used CAM along with conventional medicine.
The authors analyzed which therapies were most used by looking at the major domains of CAM (for more, see nccam.nih.gov/health/whatiscam/), plus prayer for health. Among these choices, prayer, biologically based therapies, and mind-body practices (in that order) were the types of CAM most used. This study, the authors say, is a starting point and a portrayal of the general social context of CAM use by American women, but many aspects of the topic and of CAM in general remain to be explored.
| 1. | Back pain/problem | 15% |
| 2. | Head or chest cold | 10% |
| 3. | Neck pain/problem | 7% |
| 4. | Arthritis/gout/lupus/fibromyalgia | 6% |
| 5. | Anxiety/depression | 6% |
| 6. | Joint pain/stiffness | 5% |
| 7. | Stomach/intestinal problem | 4% |
| 8. | Severe headache/migraine | 4% |
| 9. | Insomnia/trouble sleeping | 3% |
| 10. | Recurring pain | 2% |
| 1 Percentages have been rounded. | ||
Robert Graham, M.D., and colleagues at the Osher Institute, Harvard Medical School, analyzed the survey data pertaining to CAM use by three racial/ethnic groups: Hispanics, non-Hispanic Blacks, and non-Hispanic Whites. They found that the rates of CAM use by non-Hispanic Blacks (26 percent) and Hispanics (27 percent) were "considerably less" than that of non-Hispanic Whites (36 percent). The CAM therapies these respondents used most were prayer, herbal medicine, relaxation techniques, and chiropractic. There were significant racial/ethnic differences in the use of certain therapies. Some factors associated with CAM use across racial/ethnic groups were being a woman, being age 35 to 54, having a higher level of education, having a higher level of income, having a usual source of medical care, and visiting a health professional within the past 6 months. Hispanics and non-Hispanic Blacks were less likely than non-Hispanic Whites to tell their health care provider that they used CAM. The authors make recommendations for future research, noting that this type of information could help health care providers deliver culturally sensitive care.
Older Adults Who Report Anxiety and DepressionMany adults over age 65 report higher levels of depressive symptoms, but very few of them are diagnosed with or receive conventional treatment for these problems. Joseph Grzywacz, Ph.D., and colleagues at Wake Forest University School of Medicine analyzed data on about 5,800 older adults who reported using CAM, including those who answered yes to a survey question on whether they had "been frequently depressed or anxious" in the preceding 12 months.
About 82 percent of those who reported symptoms of anxiety or depression (A/D) had used CAM (when prayer for health was included in the definition of CAM), compared with 65 percent of those who did not report these symptoms. When prayer was not included, the rates were about 35 percent and 27 percent, respectively. There were no racial/ethnic differences. The A/D group who used CAM mostly used mind-body therapies (especially spiritual practices), relaxation techniques, and nonvitamin/nonmineral/natural products. However, fewer than 20 percent used CAM for their mental health concerns. The authors suggest that this is likely not because these problems are underrecognized and undertreated, but because many older adults believe depressive feelings are a natural part of aging or, overall, have had less experience with "nonspiritual" forms of CAM than younger people have had. They note that their study has limitations (for example, more precise measures of mental illnesses are needed) but that future research could yield more insights on self-management practices for health purposes, including mental health.
References
Graham RE, Ahn AC, Davis RB, et al. Use of complementary and alternative medical therapies among racial and ethnic minority adults: results from the 2002 National Health Interview Survey. Journal of the National Medical Association. 2005;97(4):535-545.
Grzywacz JG, Suerken CK, Quandt SA, et al. Older adults' use of complementary and alternative medicine for mental health: findings from the 2002 National Health Interview Survey. Journal of Alternative and Complementary Medicine. 2006;12(5):467-473.
Upchurch DM, Chyu L, Greendale GA, et al. Complementary and alternative medicine use among American women: findings from the National Health Interview Survey, 2002. Journal of Women's Health. 2007;16(1):102-113.
For more on these and other papers based on the 2002 NHIS CAM data, consult the PubMed database or the NCCAM Clearinghouse.
