The importance of wellness among users of complementary and alternative medicine: findings from the 2007 National Health Interview Survey

The effects of gender are contingent upon race and surprisingly, white women report the lowest percentage of wellness users while black and Asian men report some of the highest percentages. In fact, black men are over twice as likely as white women to be wellness users. Asian men and women are also more likely to be wellness users. And among combined users, only white and Hispanic men are less likely than white women. Few studies have examined gender-by-race interactions with regard to CAM use, let alone reasons for use. There is clearly non-random selection by gender and race with respect to use [2, 22, 34] as well as unobserved differences among users and non-users. One study, using the 2002 NHIS and analyzing only African Americans, found that users of CAM were more likely to be older, female, better educated, insured, and have higher income [35]. However, they also found that the “majority” used CAM for treatment rather than health promotion, although they did not provide statistical analysis for this conclusion. Importantly, the 2002 NHIS did not explicitly ask specific questions pertaining to health and wellness, only about treatment, thus potentially underestimating use for wellness. Also, it does not appear that black users are more likely than white users to utilize modalities that might be thought of as more “wellness focused” (e.g., relaxation techniques, yoga, supplements) [23]. Prayer for health was not included as a CAM modality in the 2007 NIHIS, and other research suggests it is commonly used among black men and women. The findings for Asian men and women are less surprising given the focus on prevention and wellness in Traditional East Asian Medicine and the commonality of practices such as tai chi and meditation in this population [36].

Unfortunately, the NHIS does not include information on specific motivations and beliefs known to be associated with use which may be useful in understanding these gender and racial/ethnic differences [5, 7, 37]. An early, high-quality national survey found that users of CAM were more likely to have unconventional religious beliefs and be in a category the author called “cultural creative” [37]. Users also had greater desire for control over their health. In a more recent systematic review of beliefs among CAM users [5], the authors summarized both quantitative and qualitative studies. In general, users viewed CAM as part of self-management for those with chronic health conditions, believed psychological factors had a role in the origins of illness and the promotion of health, and had a desire for holistic treatment [5]. Clearly, given the high prevalence of CAM use in the United States, the increasing integration of alternative and conventional medicine in health care settings, and the increasing consumer demand for insurance coverage for many CAM modalities, additional research on knowledge, motivations, and beliefs is a high priority.

Older users employ CAM to both manage existing health conditions and to promote wellness rather than use it for treatment alone. These findings reflect declines of health with aging, but also that older adults tend to be more health conscious than younger adults [38]. The effects of education are in the expected directions, with the most educated more likely to report wellness or combined use versus treatment alone. These findings are probably also due to the differences in beliefs according to education level, as described above [5, 37].

We find little support for net effects of enabling resources to distinguish reasons for use among CAM users. Other research documents that when comparing users to non-users, those with higher income and, in general, greater access to conventional medicine, are more likely to be users of CAM [2, 25‐27]. And, a recent study by Davis and colleagues [17] that focused on just CAM users, found that wellness users had greater access to and use of conventional medical care and concluded that these individuals are high users of all types of care. Thus, it may be that our operationalization of enabling resources did not capture all of the necessary dimensions of the domain to differentiate reasons for use among CAM users. It may also be useful to ask individuals directly if they used CAM instead of conventional care, and if so, to elaborate on the specific details.

As expected, users with poorer perceived or evaluated health are much less likely to report use for wellness alone when compared to treatment alone. Contrary to our expectations, those with poorer health are not more likely to use for both wellness and treatment versus treatment alone, net of other factors. However, the bivariate analysis revealed that higher percentages of those with poorer perceived or evaluated health reported using CAM for either combined user or for treatment alone. It is possible that in the multivariate model, part of the age effects described above are capturing this effect in the combined use group. Also, our model only captures clinically diagnosed health conditions and older persons may have several other health problems for which they use CAM for combined wellness and treatment. In other studies, use of CAM among those with chronic conditions is viewed as a form of self-management and a means to improve quality of life with these conditions [5, 7, 8]. Thus, our findings provide indirect support that those with health conditions are using CAM to improve wellness even when faced with health problems.

As expected, those users engaged in a greater number of healthy behaviors are more likely to be wellness and combined users versus use for treatment. Earlier studies have found healthy behaviors such as not smoking, drinking alcohol little or in moderation, having a normal BMI, and engaging in leisure-time physical activities are more common among CAM users versus non-users [2, 4, 22, 25, 39]. A more recent study [17] found that those engaging in these healthy lifestyles behaviors were more likely to be wellness users versus combined or treatment users. Our findings suggest those users engaging in multiple healthy lifestyle behaviors may be incorporating CAM practices as part of their “wellness lifestyle” [6]. These new results also shed light on the many prior studies that reported the rather contradictory findings that users of CAM versus non-users were more likely to have poorer health but also report healthier lifestyle behaviors [2‐4, 24, 25, 39]. It appears that those with existing health conditions tend to use CAM for treatment or to maintain and improve quality of life living with those health conditions. On the other hand, healthier users are inclined to engage in CAM practices to maintain positive health and wellness.