Skip to main content

Advertisement

Log in

Use of Complementary and Alternative Medicine and Self-Rated Health Status: Results from a National Survey

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Despite the absence of conclusive evidence of effectiveness, complementary and alternative medicine (CAM) is used by 4 of 10 adults in the US; little is known about the association between CAM use and health status.

Objective

To determine the relation between CAM use and self-reported health status and health improvement over time.

Design and Participants

We performed a secondary database analysis using data from the 2007 National Health Interview Survey of non-institutionalized US residents conducted by the National Center of Health Statistics of the Center for Disease Control. We identified CAM users and compared them to non-users. We used multivariable logistic regression to model the health status of respondents. We controlled for confounders including socio-demographic, clinical, and behavioral factors. The models were evaluated for discrimination and calibration.

Main Measures

The likelihood of respondents to report ‘Excellent’ current health and ‘Better’ health than in the prior year.

Key Results

Based on 23,393 respondents, we found 37% of U.S. adults used complementary and alternative medicine and 63% did not use any CAM. Compared to those who did not use CAM, CAM users were more likely to rate their health as ‘Excellent’ (adjusted-odds ratio (AOR) = 1.14, 95% CI = [1.03,1.26]). Similarly, CAM users were more likely to report their health as ‘Better’ than in the prior year (AOR = 1.64, 95% CI = [1.49,1.83]). The c-statistics for the two models were 0.755 and 0.616, respectively.

Conclusion

We found a significant association between CAM use and self-rated excellent health and health improvement over the prior year. Prospective trials are required to determine whether CAM use is causally related to excellent health status and better health than in the prior year.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993;328(4):246–52.

    Article  PubMed  CAS  Google Scholar 

  2. NCCAM. What is CAM? In: NCCAM Backgrounder; Feb 2007.

  3. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report 2008(12):1-23.

  4. Kaptchuk TJ, Eisenberg DM. The persuasive appeal of alternative medicine. Ann Intern Med. 1998;129(12):1061–5.

    PubMed  CAS  Google Scholar 

  5. Kaptchuk TJ. The web that has no weaver : understanding Chinese medicine. [Rev. ed. Chicago, Ill: Contemporary Books; 2000.

  6. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. Adv Data 2004(343):1-19.

  7. Mossey JM, Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health. 1982;72(8):800–8.

    Article  PubMed  CAS  Google Scholar 

  8. Goldstein MS, Siegel JM, Boyer R. Predicting changes in perceived health status. Am J Public Health. 1984;74(6):611–4.

    Article  PubMed  CAS  Google Scholar 

  9. DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med. 2006;21(3):267–75.

    Article  Google Scholar 

  10. Murata C, Kondo T, Tamakoshi K, Yatsuya H, Toyoshima H. Determinants of self-rated health: could health status explain the association between self-rated health and mortality? Arch Gerontol Geriatr. 2006;43(3):369–80.

    Article  PubMed  Google Scholar 

  11. Farkas J, Kosnik M, Flezar M, Suskovic S, Lainscak M. Self-rated health predicts acute exacerbations and hospitalizations in patients with COPD. Chest;138(2):323-30.

  12. Li CL, Chang HY, Wang HH, Bai YB. Diabetes, functional ability, and self-rated health independently predict hospital admission within one year among older adults: A population based cohort study. Arch Gerontol Geriatr.

  13. Trump DH. Self-rated health and health care utilization after military deployments. Mil Med. 2006;171(7):662–8.

    PubMed  Google Scholar 

  14. Trump DH, Brady J, Olsen CH. Self-rated health and subsequent health care use among military personnel returning from international deployments. Mil Med. 2004;169(2):128–33.

    PubMed  Google Scholar 

  15. Schoenfeld DE, Malmrose LC, Blazer DG, Gold DT, Seeman TE. Self-rated health and mortality in the high-functioning elderly–a closer look at healthy individuals: MacArthur field study of successful aging. J Gerontol. 1994;49(3):M109–15.

    PubMed  CAS  Google Scholar 

  16. Fylkesnes K. Determinants of health care utilization–visits and referrals. Scand J Soc Med. 1993;21(1):40–50.

    PubMed  CAS  Google Scholar 

  17. 2007 National Health Interview Survey (NHIS) Survey Description Document. June 2008. (Accessed Oct 4, 2010, at ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2007/srvydesc.pdf)

  18. Jonas WB, Kaptchuk TJ, Linde K. A critical overview of homeopathy. Ann Intern Med. 2003;138(5):393–9.

    PubMed  Google Scholar 

  19. Shen J, Wenger N, Glaspy J, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA. 2000;284(21):2755–61.

    Article  PubMed  CAS  Google Scholar 

  20. Cardini F, Weixin H. Moxibustion for correction of breech presentation: a randomized controlled trial. JAMA. 1998;280(18):1580–4.

    Article  PubMed  CAS  Google Scholar 

  21. Cherkin DC, Sherman KJ, Avins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169(9):858–66.

    Article  PubMed  Google Scholar 

  22. Singh RH. The holistic principles of Ayurvedic medicine. 1st ed. Delhi: Chaukhamba Sanskrit Pratishthan; 1998.

    Google Scholar 

  23. Esposito K, Marfella R, Ciotola M, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004;292(12):1440–6.

    Article  PubMed  CAS  Google Scholar 

  24. Baron M. The South Beach Diet. Health Care Food Nutr Focus 2004;21(10):10, 1.

  25. Foster GD, Wyatt HR, Hill JO, et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med;153(3):147-57.

  26. Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007;297(9):969–77.

    Article  PubMed  CAS  Google Scholar 

  27. Delichatsios HK, Welty FK. Influence of the DASH diet and other low-fat, high-carbohydrate diets on blood pressure. Curr Atheroscler Rep. 2005;7(6):446–54.

    Article  PubMed  CAS  Google Scholar 

  28. NCCAM. Biologically-based Practices: An Overview. In: NCCAM Backgrounder; 2004.

  29. Beavers DP, Beavers KM, Miller M, Stamey J. Messina MJ. Exposure to isoflavone-containing soy products and endothelial function: A Bayesian meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis; 2010.

    Google Scholar 

  30. Jenkins DJ, Kendall CW, Marchie A, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA. 2003;290(4):502–10.

    Article  PubMed  CAS  Google Scholar 

  31. Taubert D, Roesen R, Lehmann C, Jung N, Schomig E. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA. 2007;298(1):49–60.

    Article  PubMed  CAS  Google Scholar 

  32. Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy I, Lipsitz LA. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA. 1994;271(10):751–4.

    Article  PubMed  CAS  Google Scholar 

  33. NCCAM. Manipulative and Body-Based Practices: An Overview. In: NCCAM Backgrounder; 2004.

  34. Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cortisol decreases and serotonin and dopamine increase following massage therapy. Int J Neurosci. 2005;115(10):1397–413.

    Article  PubMed  CAS  Google Scholar 

  35. NCCAM. Mind-Body Medicine: An Overview. In: Backgrounder, ed.; 2009.

  36. Burke NJ, Jackson JC, Thai HC, et al. 'Honoring tradition, accepting new ways': development of a hepatitis B control intervention for Vietnamese immigrants. Ethn Health. 2004;9(2):153–69.

    Article  PubMed  Google Scholar 

  37. Hintz KJ, Yount GL, Kadar I, Schwartz G, Hammerschlag R, Lin S. Bioenergy definitions and research guidelines. Altern Ther Health Med. 2003;9(3 Suppl):A13–30.

    PubMed  Google Scholar 

  38. Chen KW, Turner FD. A case study of simultaneous recovery from multiple physical symptoms with medical qigong therapy. J Altern Complement Med. 2004;10(1):159–62.

    Article  PubMed  Google Scholar 

  39. vanderVaart S, Gijsen VM, de Wildt SN, Koren G. A systematic review of the therapeutic effects of Reiki. J Altern Complement Med. 2009;15(11):1157–1169.

    Article  PubMed  Google Scholar 

  40. NCCAM. Energy Medicine: An Overview. In: NCCAM Backgrounder; 2004.

  41. Kaptchuk TJ, Eisenberg DM. Varieties of healing. 2: a taxonomy of unconventional healing practices. Ann Intern Med. 2001;135(3):196–204.

    PubMed  CAS  Google Scholar 

  42. Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005;11(1):42–9.

    PubMed  Google Scholar 

  43. Tindle HA, Wolsko P, Davis RB, Eisenberg DM, Phillips RS, McCarthy EP. Factors associated with the use of mind body therapies among United States adults with musculoskeletal pain. Complement Ther Med. 2005;13(3):155–64.

    Article  PubMed  Google Scholar 

  44. Wolsko PM, Eisenberg DM, Davis RB, Phillips RS. Use of mind–body medical therapies. J Gen Intern Med. 2004;19(1):43–50.

    Article  PubMed  Google Scholar 

  45. McCaffrey AM, Eisenberg DM, Legedza AT, Davis RB, Phillips RS. Prayer for health concerns: results of a national survey on prevalence and patterns of use. Arch Intern Med. 2004;164(8):858–62.

    Article  PubMed  Google Scholar 

  46. 2007 National Health Interview Survey Questionnaire - Sample Adult & Adult CAM. US Center for Disease Control, National Center of Health Statistics, 2007. (Accessed Oct 4, 2010, at ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/2007/English/qalthealt.pdf.)

  47. Ware JE Jr. Keller SD, Gandek B, Brazier JE. Sullivan M. Evaluating translations of health status questionnaires. Methods from the IQOLA project. International Quality of Life Assessment. Int J Technol Assess Health Care. 1995;11(3):525–51.

    Google Scholar 

  48. McHorney CA, Ware JE Jr. Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32(1):40–66.

    Article  PubMed  CAS  Google Scholar 

  49. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–483.

    Article  PubMed  Google Scholar 

  50. Ware JE, Kosinski M. Interpreting SF-36 summary health measures: a response. Qual Life Res. 2001;10(5):405–413. Discussion 15-20.

    Article  PubMed  CAS  Google Scholar 

  51. Wagner AK, Gandek B, Aaronson NK, et al. Cross-cultural comparisons of the content of SF-36 translations across 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51(11):925–32.

    CAS  Google Scholar 

  52. Chaudhry S, Jin L, Meltzer D. Use of a self-report-generated Charlson Comorbidity Index for predicting mortality. Med Care. 2005;43(6):607–15.

    Article  PubMed  Google Scholar 

  53. Rius C, Perez G, Martinez JM, et al. An adaptation of Charlson comorbidity index predicted subsequent mortality in a health survey. J Clin Epidemiol. 2004;57(4):403–8.

    Article  PubMed  Google Scholar 

  54. Meissner HI, Tiro JA, Haggstrom D, Lu-Yao G, Breen N. Does patient health and hysterectomy status influence cervical cancer screening in older women? J Gen Intern Med. 2008;23(11):1822–8.

    Article  PubMed  Google Scholar 

  55. Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184–9.

    Article  PubMed  Google Scholar 

  56. Kushi LH, Fee RM, Folsom AR, Mink PJ, Anderson KE, Sellers TA. Physical activity and mortality in postmenopausal women. Jama. 1997;277(16):1287–92.

    Article  PubMed  CAS  Google Scholar 

  57. Bertisch SM, Wee CC, McCarthy EP. Use of complementary and alternative therapies by overweight and obese adults. Obesity (Silver Spring). 2008;16(7):1610–5.

    Article  Google Scholar 

  58. Wan TT. Predicting self-assessed health status: a multivariate approach. Health Serv Res. 1976;11(4):464–77.

    PubMed  CAS  Google Scholar 

  59. Bewick V, Cheek L, Ball J. Statistics review 14: Logistic regression. Crit Care. 2005;9(1):112–8.

    Article  PubMed  Google Scholar 

  60. Birdee GS, Legedza AT, Saper RB, Bertisch SM, Eisenberg DM, Phillips RS. Characteristics of yoga users: results of a national survey. J Gen Intern Med. 2008;23(10):1653–8.

    Article  PubMed  Google Scholar 

  61. Birdee GS, Wayne PM, Davis RB, Phillips RS, Yeh GY. T'ai chi and qigong for health: patterns of use in the United States. J Altern Complement Med. 2009;15(9):969–73.

    Article  PubMed  Google Scholar 

  62. Hosmer D. Lemeshow S. Applied Logistic Regression: New York: John Wiley and Sons, Inc.; 1989.

    Google Scholar 

  63. Bertisch SM, Wee CC, Phillips RS, McCarthy EP. Alternative mind–body therapies used by adults with medical conditions. J Psychosom Res. 2009;66(6):511–9.

    Article  PubMed  Google Scholar 

  64. Wolsko P, Ware L, Kutner J, et al. Alternative/complementary medicine: wider usage than generally appreciated. J Altern Complement Med. 2000;6(4):321–6.

    Article  PubMed  CAS  Google Scholar 

  65. Friedman A, Lahad A. Health behavior in a kibbutz population: correlations among different modalities of healthcare utilization. Isr Med Assoc J. 2001;3(12):898–902.

    PubMed  CAS  Google Scholar 

  66. Kaptchuk TJ. The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance? Ann Intern Med. 2002;136(11):817–25.

    PubMed  Google Scholar 

  67. Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev 2009(1):CD003120.

  68. Madsen MV, Gotzsche PC, Hrobjartsson A. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ. 2009;338:a3115.

    Article  PubMed  Google Scholar 

  69. Linde K AG, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. In: Cochrane Database of Systematic Reviews; 2009.

  70. Kelly RB. Acupuncture for pain. Am Fam Physician. 2009;80(5):481–4.

    PubMed  Google Scholar 

  71. Yeh GY, Wang C, Wayne PM, Phillips RS. The effect of tai chi exercise on blood pressure: a systematic review. Prev Cardiol. 2008;11(2):82–9.

    Article  PubMed  Google Scholar 

  72. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009(2):CD007146.

  73. Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):492–504.

    PubMed  Google Scholar 

  74. Shen YH, Nahas R. Complementary and alternative medicine for treatment of irritable bowel syndrome. Can Fam Physician. 2009;55(2):143–8.

    PubMed  Google Scholar 

  75. Fowler F. Improving Survey Questions: Design and Evaluation. Thousand Oaks: SAGE Publications; 1995.

    Google Scholar 

  76. Rains JC, Penzien DB. Behavioral research and the double-blind placebo-controlled methodology: challenges in applying the biomedical standard to behavioral headache research. Headache. 2005;45(5):479–86.

    Article  PubMed  Google Scholar 

  77. Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral headache treatment: history, review of the empirical literature, and methodological critique. Headache. 2005;45(Suppl 2):S92–109.

    Article  PubMed  Google Scholar 

  78. Bloom BS, Retbi A, Dahan S, Jonsson E. Evaluation of randomized controlled trials on complementary and alternative medicine. Int J Technol Assess Health Care. 2000;16(1):13–21.

    Article  PubMed  CAS  Google Scholar 

Download references

Author Contributions

Dr. Nguyen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Nguyen and Phillips were responsible for study concept and design as well as acquisition of data. Nguyen, Phillips, Davis, and Kaptchuk were responsible for analysis and interpretation of data and critical revision of the manuscript for important intellectual content. Nguyen, Phillips, and Kaptchuk drafted the manuscript. Nguyen and Davis carried out the statistical analysis, while Phillips obtained funding and supervised the study

Other Contributions

We would like to thank Dr. Helen Meissner for her communication on the calculation of the NHIS-comorbidity index and Patricia M. Barnes for her communication on the CAM prevalence calculation.

Conflicts of Interest

Dr. Nguyen was supported by an Institutional National Research Service Award (T32AT00051) from the National Institutes of Health (NIH). Prof. Ted Kaptchuk is supported by a Mid-Career Investigator Award from the National Center for Complementary and Alternative Medicine (NCCAM), NIH (K24 AT004095). Drs. Roger Davis and Russell Phillips are supported by a Mid-Career Investigator Award from the NCCAM, NIH (K24 –AT000589). The funding organizations had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of NCAAM or the NIH.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Long T. Nguyen PhD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nguyen, L.T., Davis, R.B., Kaptchuk, T.J. et al. Use of Complementary and Alternative Medicine and Self-Rated Health Status: Results from a National Survey. J GEN INTERN MED 26, 399–404 (2011). https://doi.org/10.1007/s11606-010-1542-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-010-1542-3

Key words

Navigation