Predictors Of Complementary And Alternative Medicine Use Research Articles

POH07 Use of complementary and alternative medicine by patients attending a UK headache clinic

This study was undertaken in order to determine the extent of the use of complementary and alternative medicine (CAM) in a UK headache clinic. 92 patients attending a headache clinic...

Use of complementary and alternative medicine by those with a chronic disease and the general population - results of a national population based survey

BackgroundThe use of complementary and alternative medicine (CAM) is becoming more common, but population-based descriptions of its patterns of use are lacking. This study aimed to determine the prevalence of CAM use in the general population and for those with asthma, diabetes, epilepsy and migraine.MethodsData from cycles 1.1, 2.1 and 3.1 of the Canadian Community Health Survey (CCHS) were used for the study. The CCHS is a national cross-sectional survey administered to 400,055 Canadians aged ≥12 between 2001-2005. Self-reported information about professionally diagnosed health conditions was elicited. CCHS surveys use a multistage stratified cluster design to randomly select a representative sample of Canadian household residents. Descriptive data on the utilization of CAM services was calculated and logistic regression was used to determine what sociodemographic factors predict CAM use.ResultsWeighted estimates show that 12.4% (95% Confidence Interval (CI): 12.2-12.5) of Canadians visited a CAM practitioner in the year they were surveyed; this rate was significantly higher for those with asthma 15.1% (95% CI: 14.5-15.7) and migraine 19.0% (95% CI: 18.4-19.6), and significantly lower for those with diabetes 8.0% (95% CI: 7.4-8.6) while the rate in those with epilepsy (10.3%, 95% CI: 8.4-12.2) was not significantly different from the general population.ConclusionA large proportion of Canadians use CAM services. Physicians should be aware that their patients may be accessing other services and should be prepared to ask and answer questions about the risks and benefits of CAM services in conjunction with standard medical care.

Complementary and alternative medicine use in England: results from a national survey

In many countries, recent data on the use of complementary and alternative medicine (CAM) are available. However, in England, there is a paucity of such data. We sought to determine the prevalence and predictors of CAM use in England. Data were obtained from the Health Survey for England 2005, a national household survey that included questions on CAM use. We used binary logistic regression modelling to explore whether demographic, health and lifestyle factors predict CAM use. Data were available for 7630 respondents (household response rate 71%). Lifetime and 12-month prevalence of CAM use were 44.0% and 26.3% respectively; 12.1% had consulted a practitioner in the preceding 12 months. Massage, aromatherapy and acupuncture were the most commonly used therapies. Twenty-nine percent of respondents taking prescription drugs had used CAM in the last 12 months. Women (OR 0.491, 95% CI: 0.419, 0.577), university educated respondents (OR 1.296, 95% CI: 1.088, 1.544), those suffering from anxiety or depression (OR 1.341, 95% CI: 1.074, 1.674), people with poorer mental health (on GHQ: OR 1.062, 95% CI 1.026, 1.100) and lower levels of perceived social support (1.047, 95% CI: 1.008, 1.088), people consuming ≥ 5 portions of fruit and vegetables a day (OR 1.327, 95% CI: 1.124, 1.567) were significantly more likely to use CAM. Complementary and alternative medicine use in England remains substantial, even amongst those taking prescription drugs. These data serve as a valuable reminder to medical practitioners to ask patients about CAM use and should be routinely collected to facilitate prioritisation of the research agenda in CAM.

Complementary and Alternative Medicine Use Among Asian Indians in the United States: A National Study

Asian Americans use complementary and alternative medicine (CAM) at a higher rate than Americans. This national study on Asian Indians (AIs), the third largest Asian-American subgroup in the United States, examined the CAM use by gender and its association with acculturation, health behaviors, and access to health care. This was a cross-sectional survey. The subjects consisted of 1824 AI adults in six states with higher concentration of AIs. Mean age and years lived in the United States was 45.7 +/- 12.8 and 16.6 +/- 11.1 years, respectively. The respondent majority was male, immigrants, college graduates, and had access to care. Sixty three percent (63%) of AIs used at least one type of CAM; most common was a vegetarian diet, followed by use of dietary and herbal supplements and alternative medical systems. Females reported a significantly higher use of CAM, a vegetarian diet, and use of dietary and herbal supplements than AI males. Older age, female gender, having no access to care, and spirituality predicted CAM use in the logistic regression model. Older age, female gender, unmarried, and higher income was associated with use of dietary and herbal supplements; AIs who reported being vegetarian were more likely to be female, unmarried, spiritual, and self-reported their physical health to be fair or poor. This is the first national study of CAM use among AIs by gender and selected respondent characteristics. Results provide important information on health behaviors, beliefs, and patterns of CAM use in this ethnic subgroup to be factored into patient education.

Complementary and alternative medicine in the management of hypertension in an urban Nigerian community

BackgroundHypertension is a common non communicable condition worldwide. In developing countries (including Nigeria), the use of complementary and alternative medicine (CAM) is common. This study investigated the frequency and factors associated with use of CAM among hypertensive subjects in an urban Nigerian community. Perspectives about the management of hypertension were obtained from CAM practitioners in the community.MethodsFour hundred and forty hypertensive subjects in Idikan community, Ibadan, were interviewed using a semi-structured survey instrument. Association between categorical variables was tested using the chi-square test. Logistic regression analysis was done to identify independent predictor variables of CAM use, with CAM use as the outcome variable and the demographic and belief items as predictor variables. In-depth interviews were conducted with all known CAM practitioners in the community on issues relating to their beliefs, knowledge, practice and experiences in managing patients with hypertension in the community.ResultsIn the study sample, 29% used CAM in the management of their hypertension. Among those using CAM, the most common forms used were herbs (63%) and garlic (21%). Logistic regression analysis revealed that four variables were independent predictors of CAM use: being male (OR 2.58, p < 0.0001), belief in supernatural causes of hypertension (OR 2.11, p = 0.012), lack of belief that hypertension is preventable (OR 0.57, p = 0.014) and having a family history of hypertension (OR1.78, p = 0.042). Other factors such as age, educational level and occupation were not independent predictors of CAM use. Interviews with CAM practitioners revealed that they believed hypertension was caused by evil forces, stress or "too much blood in the body". They also thought they could cure hypertension but that reduced costs (compared to hospitals) was one of the reasons most of their clients consult them.ConclusionsThe use of CAM is common among hypertensive subjects in this urban Nigerian community. Men were more than twice as likely to use CAM and belief in supernatural causes of hypertension was the most notable belief predicting CAM use. Interviews with CAM practitioners yielded useful perspectives about the role they play in hypertension management in the community. This study adds to the small but growing literature about the use of CAM in hypertension in sub Saharan Africa. Further studies in hypertension and other non communicable disease are needed.

The use of complementary and alternative fertility treatment in couples seeking fertility care: data from a prospective cohort in the United States

To determine the prevalence of complementary and alternative medicine (CAM) use among couples seeking fertility care and to identify the predictors of CAM use in this population. Prospective cohort study. Eight community and academic infertility practices. A total of 428 couples presenting for an infertility evaluation. Interviews and questionnaires. Prevalence of complementary and alternative medicine therapy. After 18 months of observation, 29% of the couples had utilized a CAM modality for treatment of infertility; 22% had tried acupuncture, 17% herbal therapy, 5% a form of body work, and 1% meditation. An annual household income of > or = $200,000 (odds ratio 2.8, relative to couples earning <$100,000), not achieving a pregnancy (odds ratio 2.3), and a positive attitude toward CAM use at baseline were independently associated with CAM use. A substantial minority of infertile couples use CAM treatments. CAM was chosen most commonly by wealthier couples, those not achieving a pregnancy, and those with a baseline belief in the effectiveness of CAM treatments.

Use of complementary and alternative medicine during pregnancy and delivery

To assess the use of complementary and alternative medicine (CAM) during pregnancy and birth and the reasons behind it from the patient's perspective. In a prospective study, we assessed the use of CAM before and during pregnancy as well as during delivery in women by means of a self-report questionnaire. Some 205 patients completed the questionnaire at a response rate of 43.2% (205/475) and 104 women used CAM during pregnancy, especially homoeopathy, acupuncture, and phytotherapy. Stepwise regression analysis identified CAM use prior to pregnancy, greater income, and nationality as the most important predictors of CAM use. In accordance with earlier studies from Germany, we determined the most important methods used in the field of obstetrics. Interestingly, these are not evidence-based and those methods which are evidence-based are not now used. Also, the predictors of CAM use in pregnancy were similar to those in oncology. Future studies should focus on the safety and efficacy of CAM in pregnancy.

Complementary and Alternative Medicine among Singapore Cancer Patients

This study evaluates determinants, expectations, association with quality of life (QOL) and doctor's awareness of Complementary and Alternative Medicine (CAM) use in Singapore cancer patients. We interviewed 316 patients visiting the Cancer Centre of the National University Hospital on behaviour, attitudes and expectations towards CAM and assessed QOL via Euroqol Questionnaire (EQ-5D). Medical information was obtained from oncologists. One hundred and seventy-three patients (55%) reported CAM use after cancer diagnosis. Chinese ethnicity, tertiary education, age <65 years and previous CAM use were independent predictors of CAM use. Fifty-one per cent of CAM users informed their doctors about their use and 15% of doctors reported to be aware of CAM use in these patients. Thirty-seven per cent believed CAM to be equally or more effective than conventional cancer therapies and 78% expected at least basic knowledge about CAM from their oncologists. Twenty-fi ve per cent of patients reported concurrent use of oral CAM and chemotherapy, of which oncologists were unaware in 86% of cases. CAM users had higher EuroQol utility scores than non-CAM users (0.79 versus 0.73, respectively, P = 0.03), in particularly those aged >or=65 years and those with stage IV disease. Singapore cancer patients show high prevalence of CAM use, high expectations regarding its effectiveness and doctors' knowledge on CAM and many use it concurrently with chemotherapy or radiotherapy. Since oncologists are generally unaware of CAM use in their patients, doctor-patient communication on CAM use needs to be improved. The association of CAM use and higher QOL scores in some subgroups deserves further exploration.

Complementary and Alternative Medicine Use in Chronic Liver Disease Patients

To examine a wide range of sociodemographic and clinical characteristics as potential predictors of complementary and alternative medicine (CAM) use among chronic liver disease (CLD) patients, with a focus on CAM therapies with the greatest potential for hepatotoxicity and interactions with conventional treatments. There is some evidence that patients with CLD commonly use CAM to address general and CLD-specific health concerns. Patients enrolled in a population-based surveillance study of persons newly diagnosed with CLD between 1999 and 2001 were asked about current use of CAM specifically for CLD. Sociodemographic and clinical information was obtained from interviews and medical records. Predictors of CAM use were examined using univariate and multivariate logistic regression analysis. Of the 1040 participants, 284 (27.3%) reported current use of at least 1 of 3 CAM therapies of interest. Vitamins or other dietary supplements were the most commonly used therapy, reported by 188 (18.1%) patients. This was followed by herbal medicine (175 patients, 16.8%) and homeopathy (16 patients, 1.5%). Several characteristics were found to be independent correlates of CAM use: higher education and family income, certain CLD etiologies (alcohol, hepatitis C, hepatitis C and alcohol, and hepatitis B), and prior hospitalization for CLD. Use of CAM therapies that have the potential to interact with conventional treatments for CLD was quite common among this population-based sample of patients with CLD. There is a need for patient and practitioner education and communication regarding CAM use in the context of CLD.

The use of complementary and alternative medicine by patients with chronic hepatitis C

The use of complementary and alternative medicine (CAM) is expanding globally. However, prevalence of its use by patients with chronic hepatitis C (CHC) remains unclear. An exploratory, descriptive study was conducted using a questionnaire and interview to describe the use of CAM by patients with CHC attending a liver clinic in the United States. Eighty percent (n = 120) had used CAM in the last 12 months, most often prayer for health reasons (63%), multivitamins (56%) and herbal medicine (25%). A higher level of education (p < 0.005), poorer health status (p < 0.002) and prior use of anti-viral therapy (p < 0.02) were predictors of CAM use. Participants used CAM to promote general health, but herbal medicine was used to treat CHC symptoms and prevent liver disease. Use of CAM is common among patients with CHC. Failure to acknowledge the use of CAM as a management strategy may restrict the health provider's ability to provide optimal care.

Prevalence, socio-demographic and clinical predictors of post-diagnostic utilisation of different types of complementary and alternative medicine (CAM) in a nationwide cohort of Danish women treated for primary breast cancer

Aim This study investigated the prevalence and predictors of use of complementary and alternative medicine (CAM) in a nationwide inception cohort of Danish women treated for early-stage breast cancer as well as differences in user patterns for individual types of CAM. Methods Use of CAM since the time of diagnosis was assessed 12–16 weeks post-surgery for the 3343 women (age 18–70) included in the study (response rate: 68%). Socio-demographic and clinical variables were obtained from national longitudinal registries. Results 40.1% of the women had used one or more types of CAM. Users were younger than non-users. Age adjusted analyses showed that CAM users were characterised by absence of comorbidity, higher educational level, higher personal income, higher social status, being divorced/separated and living in the metropolitan area of Copenhagen. Multivariate analyses revealed that chemotherapy was the only clinical and treatment-related predictor of CAM use, and that CAM users were more likely to be of normal weight and non-smokers. Of CAM users, 33.7% believed that CAM would have a positive influence upon their breast cancer. Different characteristics distinguished users of individual types of CAM. Conclusion The results of this first nationwide study of utilisation of CAM in breast cancer show that CAM users are healthier and more likely to have higher socio-economic status than non-users. Different user patterns for individual types of CAM may be overlooked, when different types of CAM are treated as one homogeneous category.

Predictive factors for the use of complementary and alternative medicine (CAM) in radiation oncology

Introduction A multi-center study was performed to identify factors predicting the use of complementary and alternative medicine (CAM) in radiotherapy patients, giving patients the information and the support they request. Methodology A total of 1013 consecutive patients receiving radiotherapy for malignant diseases were interviewed using a structured questionnaire. Multivariate logistic stepwise backward regression was used to analyze the replies. Results A total of 59% of patients reported using CAM therapies. CAM use was more common in female patients, generally higher in advanced stages, and most common in breast cancer, followed by Hodgkin's disease, other gynecologic malignancies, renal cell carcinoma, rectal cancer, and prostate cancer. The most frequently reported CAM therapies were vitamins, mistletoe, selenium, and other trace elements. Multivariate logistic stepwise backward regression showed that age, gender, tumor type and stage, and smoking behavior were significant predictors of CAM use. The highest relative risk (RR) was calculated for breast cancer patients, while the lowest RR was calculated for head and neck cancer patients. Discussion This study represents the largest analysis of CAM use among radiotherapy cancer patients. More than half of the patients undergoing radiotherapy for cancer were using CAM. In general, the typical CAM user was a female patient suffering from breast cancer, a non-smoker and non-drinker, had an advanced stage of disease, and was treated with curative intentions.

Survey of complementary and alternative therapies used by children with specific learning difficulties (dyslexia)

Dyslexia is a common learning difficulty affecting up to 10% of British children that is associated with a wide range of cognitive, emotional and physical symptoms. In the absence of effective conventional treatment, it is likely that parents will seek complementary and alternative medicine (CAM) to try and help their children. However, little is known about the level of CAM use or the type of CAM used by dyslexic children. This study assessed: (1) the lifetime use of CAM by dyslexic children, (2) the role of socio-demographic factors in CAM use by dyslexic children, (3) parental attitudes towards CAM use in the treatment of dyslexia, and (4) how parents' understanding of dyslexia affects CAM use. A semi-structured questionnaire-based survey of parents of 148 dyslexic school children was undertaken. The children had been recruited to a university research programme investigating the effectiveness of a complementary therapy for the treatment of learning difficulties. Lifetime use of CAM was 55.4% (82 children). The most popular CAM approaches were nutritional supplements/special diets (63 children) followed by homeopathy (29 children) and osteopathy/chiropractic manipulation (29 children). Socio-demographic factors did not predict CAM use. In total, parents of 101 dyslexic children reported that an interest in CAM for the treatment of dyslexia was based on their preference for CAM for their families more generally. Parents who thought that dyslexia was a 'medical/health' disorder were more likely to have used CAM with their children (p<0.01) than other parents in this survey. Educational and health professionals should be aware that many dyslexic children use CAM. Parents of dyslexic children should be provided with evidence-based advice to help them make informed therapeutic choices.

Use of Complementary Medicine in Pediatric Patients With Inflammatory Bowel Disease: Results From a Multicenter Survey

We examined the use of complementary and alternative medicine (CAM) at 3 US pediatric medical centers, comparing a group of children with inflammatory bowel disease (IBD) with children presenting with chronic constipation. Surveys were administered by postal mail and at pediatric IBD centers in San Francisco, Houston, and Atlanta from 2001 to 2003. A comparison group consisting of pediatric patients with chronic constipation also was surveyed. Data were analyzed by t tests and by exact tests of contingency tables. In all, 236 surveys were collected from the IBD group; 126 surveys were collected from the chronic constipation comparison group. CAM therapies were used by 50% in the IBD group and 23% in the chronic constipation group. The overall regional breakdown of CAM use in IBD revealed no differences, although the types of CAM therapy used varied by site. The most commonly used CAM therapies in the IBD group were spiritual interventions (25%) and nutritional supplements (25%). Positive predictors for CAM use in IBD include the patient's self-reported overall health, an increase in the number of side effects associated with allopathic medications, white ethnicity, and parental education beyond high school. This is the first US study to characterize CAM use in pediatric patients with IBD with another chronic gastrointestinal disorder. CAM use was twice as common with the IBD group compared with the chronic constipation group. Regional variations exist with the types of CAM therapy used. Practitioners should know that half of their pediatric patients with IBD may be using CAM in conjunction with or as an alternative to other treatments and that certain predictors can help identify those using CAM therapies.

Predictors of the use of complementary and alternative medicine (CAM) by women at high risk for breast cancer

Background Few data exist regarding the use of complementary and alternative medicine (CAM) by unaffected women at high risk of breast cancer. Methods Self-reported CAM use by women from multiple-case breast cancer families was obtained by questionnaire. Factors associated with CAM use were assessed using multiple logistic regression. Results Of 892 women, 55% ( n = 489) used CAM, 6% ( n = 53) specifically to prevent cancer. CAM use was independently associated with tertiary education level (OR 2.56, 95% CI 1.83–3.58, p < 0.001), greater physical activity (OR 1.05 per hour of physical activity/week, 95% CI 1.00–1.10, p = 0.049), greater anxiety (OR 1.92, 95% CI 1.16–3.16, p = 0.01), not currently smoking (OR 0.64, 95% CI 0.42–0.97, p = 0.037) and lower perceived BC risk (OR 0.82 per 20 percentage points, 95% CI 0.72–0.94, p = 0.005). Conclusions The majority of high-risk women use CAM, but mostly for reasons other than cancer prevention. Most predictors of CAM use are consistent with the limited literature for women at high risk for cancer.

Comparative analysis of complementary and alternative medicine (CAM) use in the US cancer and noncancer populations

Significance/background Complementary and alternative medicine (CAM) therapies are often used with conventional medical treatments; hence healthcare providers need to understand factors influencing use and implications for patient care. Since estimates of use by cancer survivors vary widely (7–64%), population-level studies are needed to compare usage patterns. Purpose This study compares prevalence and patterns of CAM use in the US cancer population and the noncancer population. Factors that predict use of CAM providers, practices and products in relationship to symptom experience and purpose of use were identified. Methods A secondary analysis of the 2002 National Health Interview Survey data using STATA 9.2 software for population estimation was conducted. CAM use by cancer survivors ( N =2262; estimated cancer population=14.3 million) and individuals without cancer ( N =28,734; estimated population=191.5 million) was compared. Responses to 22 CAM use items in the NHIS Alternative Health Supplement were analyzed. Predisposing (gender, age, race, education, marital status), enabling (income, health insurance, provider-contact), and need factors (symptoms, co-morbidity, health status) in the CAM Healthcare Model were analyzed for ability to predict CAM use from a health service utilization perspective. Data analysis Binary and Multinomial Logistic Regression, the primary statistical models employed in the analysis, focused on between-subject differences in CAM use. A stepwise procedure was followed and potential predictor variables were excluded from the model if their p -value exceeded 0.10. Findings and implications Cancer and noncancer populations differ in their CAM use patterns, with cancer survivors more likely to use CAM. Predisposing, enabling and need factors were strong predictors of CAM use in both populations. Use was more prevalent among female, middle-aged, white, and well-educated people; women were specifically more likely to use CAM practices than men. A curvilinear relationship of use with age was noted suggesting a possible cohort effect. Higher income, private insurance, contact with conventional providers, pain and co-morbidity were strong predictors of CAM use. More than 39% of all cancer survivors used CAM, highlighting the need for oncology nurses and healthcare providers to assess use by their patients. Data will be compared with the soon to be released 2007 NHIS data set to determine trend patterns in CAM use over time.

Role of Religiosity and Spirituality in Complementary and Alternative Medicine Use Among Cancer Survivors in California

Cancer survivors often turn to religion, spirituality, and complementary and alternative medicine (CAM) because they perceive these areas as being more holistic and patient-centered than conventional medicine. Because increased religiosity and spirituality have been found to be associated with higher CAM use in the general population, it was hypothesized that these factors would be important predictors of CAM use in cancer survivors. The study included a subsample of 1844 people with cancer or a history of cancer from the 2003 California Health Interview Survey of CAM, a cross-sectional survey of a population-based sample of adults in California. Prevalence and predictors of religious/spiritual forms of CAM (R/S CAM) and nonreligious/nonspiritual forms of CAM (non-R/S CAM) were compared. Multivariate logistic regression was used to identify the predictors of R/S CAM and non-R/S CAM. Nearly two thirds of participants reported using at least 1 type of R/S CAM, and 85% reported ever using non-R/S CAM. The majority of cancer survivors reported that they were very/moderately religious or spiritual. Both religiosity and spirituality were strongly related to non-R/S CAM use, but in opposite directions. Very or moderately religious cancer survivors were less likely (odds ratio=0.30; 95% confidence interval, 0.12-0.40) than nonreligious cancer survivors to use non-R/S CAM. In contrast, very or moderately spiritual cancer survivors were more likely (odds ratio=2.42; 95% confidence interval, 1.16-6.02) than nonspiritual cancer survivors to use non-R/S CAM. The use of R/S CAM and non-R/S CAM is very high in cancer survivors. It may be helpful for clinicians to ascertain their patients' use of these types of CAM to integrate all forms of care used to managing their cancer.

Familial and Perceived Risk of Breast Cancer in Relation to Use of Complementary Medicine

To examine the use of complementary and alternative medicine (CAM) by women with varying levels of familial and perceived risk of breast cancer with the goal of preventing breast cancer. Cross-sectional data on CAM use were collected on 2,198 women (mean age, 63 years) personally unaffected by breast cancer in the Minnesota Breast Cancer Family Study. CAM use was compared across women at high, moderate, or average risk based on family history, as well as across categories of perceived risk of breast cancer. CAM use was also examined in relation to screening and general health behaviors, worry about breast cancer, and optimism. Half (49.5%) of the women reported using at least one CAM modality with the intent of preventing breast cancer. Univariate analyses indicated that greater overall CAM use was related to greater perceived risk (P = 0.018), more general health behaviors (P < 0.0001), more breast cancer screening behaviors (P = 0.0002), greater optimism (P = 0.0002), and higher educational attainment (P < 0.0001). Multivariate analysis revealed that general health behaviors (P < 0.0001), education (P = 0.0027), and optimism (P = 0.037) were significant predictors of CAM use when in the same model with perceived risk and breast cancer screening behaviors. Many women use CAM with the goal of preventing breast cancer. General health-promoting behaviors, education, and optimism predict CAM use. Evidence-based guidance is needed for the public and health care providers on the potential and limitations of specific CAM approaches to affect cancer risk.

Correlates of Complementary and Alternative Medicine Utilization in Depressed, Underserved African American and Hispanic Patients in Primary Care Settings

This study seeks to examine the correlates of complementary and alternative medicine (CAM) use in depressed underserved minority populations receiving medical care in primary care settings. A prospective study using interviewer-administered surveys and medical record reviews was conducted at 2 large outpatient primary care clinics providing care primarily to underserved African American and Hispanic individuals located in Los Angeles, California. A total of 2321 patients were screened for depression. Of these, 315 met the Patient Health Questionnaire-9 criteria for mild to severe depression. Over 57% of the sample reported using CAM sometimes or often (24%) and frequently (33%) for treatment of their depressive symptoms. Controlling for demographic characteristics, lack of health care coverage remained one of the strongest predictors of CAM use. Additionally, being moderately depressed, using psychotherapeutic prescription medications, and poorer self-reported health status were all associated with increased frequency of CAM utilization for treating depression. The underserved African American and Hispanic individuals meeting the diagnostic criteria for depression or subsyndromal depression use CAM extensively for symptoms of depression. CAM is used as a substitute for conventional care when access to care is not available or limited. Since CAM is used so extensively for depression, understanding domains, types, and correlates of such use is imperative. This knowledge could be used to design interventions aimed at improving care for depression.

Medical Pluralism among American Women: Results of a National Survey

Medical pluralism can be defined as the employment of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness. American women use a variety of health services and practices for women's health conditions, yet no national study has specifically characterized women's medical pluralism. Our objective was to describe medical pluralism among American women. A nationally representative telephone survey of 808 women >or=18 years of age was conducted in 2001. Cross-sectional observations of the use of 11 CAM domains and the use of an additional domain--spirituality, religion, or prayer for health--during the past year are reported. Women's health conditions, treatments used, reasons for use, and disclosure to conventional physicians are described, along with predictors of CAM use. Over half (53%) of respondents used CAM for health conditions, especially for those involving chronic pain. The majority of women disclosed such practices at clinical encounters with conventional providers. Biologically based CAM therapies, such as nutritional supplements and herbs, were commonly used with prescription and over-the-counter (OTC) pharmaceuticals for health conditions. Medical pluralism is common among women and should be accepted as a cultural norm. Although disclosure rates of CAM use to conventional providers were higher than in previous population-based studies, disclosure should be increased, especially for women who are pregnant and those with heart disease and cancer. The health risks and benefits of polypharmacy should be addressed at multiple levels of the public health system.