Comparative Analysis of Factors Affecting the Use of Comparative Analysis of Factors Affecting the Use of Complementary and Alternative Medicine and Prayer and Complementary and Alternative Medicine and Prayer and

Spiritual HealingSpiritual Healing

Comparative Analysis of Factors Affecting the Use of Comparative Analysis of Factors Affecting the Use of Complementary and Alternative Medicine and Prayer and Complementary and Alternative Medicine and Prayer and

Spiritual HealingSpiritual Healing

by by Catherine M. Simile, Patricia M. Barnes, Barbara J. Stussman,Catherine M. Simile, Patricia M. Barnes, Barbara J. Stussman,

Beth Taylor, and Catherine M. SimileBeth Taylor, and Catherine M. SimileNational Center for Health StatisticsNational Center for Health Statistics

Kim McFann and Richard L. NahinKim McFann and Richard L. NahinNational Center for Complementary and Alternative MedicineNational Center for Complementary and Alternative Medicine

by by Catherine M. Simile, Patricia M. Barnes, Barbara J. Stussman,Catherine M. Simile, Patricia M. Barnes, Barbara J. Stussman,

Beth Taylor, and Catherine M. SimileBeth Taylor, and Catherine M. SimileNational Center for Health StatisticsNational Center for Health Statistics

Kim McFann and Richard L. NahinKim McFann and Richard L. NahinNational Center for Complementary and Alternative MedicineNational Center for Complementary and Alternative Medicine

The findings and conclusions in The findings and conclusions in this presentation are those of the this presentation are those of the author(s) and do not necessarily author(s) and do not necessarily represent the views of the Centers represent the views of the Centers for Disease Control and for Disease Control and Prevention.Prevention.

The findings and conclusions in The findings and conclusions in this presentation are those of the this presentation are those of the author(s) and do not necessarily author(s) and do not necessarily represent the views of the Centers represent the views of the Centers for Disease Control and for Disease Control and Prevention.Prevention.

BackgroundBackgroundBackgroundBackground

• CAM – a group of diverse medical CAM – a group of diverse medical and health care systems , and health care systems , practices, and products that are practices, and products that are not presently considered to be part not presently considered to be part of conventional medicine.of conventional medicine.

• CAM – a group of diverse medical CAM – a group of diverse medical and health care systems , and health care systems , practices, and products that are practices, and products that are not presently considered to be part not presently considered to be part of conventional medicine.of conventional medicine.

MethodsMethodsMethodsMethods

• CAM supplement to the sample adult core of the 2002 National CAM supplement to the sample adult core of the 2002 National Health Interview Survey (NHIS)Health Interview Survey (NHIS)

– Administered to 31,044 sample adults (74.3% response rate)– Addressed 17 types of CAM therapies (including prayer and spiritual

healing)– Sponsored by the National Center for Complementary and Alternative

Medicine (NCCAM), National Institutes of Health (NIH)

• CAM supplement to the sample adult core of the 2002 National CAM supplement to the sample adult core of the 2002 National Health Interview Survey (NHIS)Health Interview Survey (NHIS)

– Administered to 31,044 sample adults (74.3% response rate)– Addressed 17 types of CAM therapies (including prayer and spiritual

healing)– Sponsored by the National Center for Complementary and Alternative

Medicine (NCCAM), National Institutes of Health (NIH)

Methods (cont’d)Methods (cont’d)Methods (cont’d)Methods (cont’d)

• Topical scope of NHIS allows inclusion of Topical scope of NHIS allows inclusion of previously unexplored and underutilized previously unexplored and underutilized concepts and measuresconcepts and measures

– respondent health behaviors– access to conventional medical services

• Logistic regression used to identify independent Logistic regression used to identify independent associations with CAM use and use of prayerassociations with CAM use and use of prayer

• Topical scope of NHIS allows inclusion of Topical scope of NHIS allows inclusion of previously unexplored and underutilized previously unexplored and underutilized concepts and measuresconcepts and measures

– respondent health behaviors– access to conventional medical services

• Logistic regression used to identify independent Logistic regression used to identify independent associations with CAM use and use of prayerassociations with CAM use and use of prayer

Dependent VariablesDependent VariablesDependent VariablesDependent Variables

CAM use -- use of any of the following in the past 12 months:CAM use -- use of any of the following in the past 12 months:

AcupunctureAcupuncture Chiropractic careChiropractic care MassageMassage Special dietsSpecial diets

AyurvedaAyurveda EHT-ReikiEHT-Reiki NaturopathyNaturopathy High dose/mega-High dose/mega-vitamin therapyvitamin therapy

BiofeedbackBiofeedback Folk medicineFolk medicine Natural herbsNatural herbs Yoga/Tai Chi/Qi Yoga/Tai Chi/Qi GongGong

Chelation Chelation therapytherapy HypnosisHypnosis Homeopathic Homeopathic

treatmenttreatmentRelaxation Relaxation techniquestechniques

Prayer/spiritual healing for health reasons -- any of the following in Prayer/spiritual healing for health reasons -- any of the following in the past 12 months:the past 12 months:

Prayed for your own healthPrayed for your own health Others prayed for your healthOthers prayed for your health

Participated in a prayer chain or Participated in a prayer chain or group for your own healthgroup for your own health

Had a healing ritual or sacrament Had a healing ritual or sacrament performed for your own healthperformed for your own health

Model Variables:Model Variables:Health Behaviors and StatusHealth Behaviors and Status

Model Variables:Model Variables:Health Behaviors and StatusHealth Behaviors and Status

• Health behaviors:Health behaviors:

– Physical activity (no exercise, some, regular)– Body weight status (underweight, normal weight, overweight, obese)– Drinking status (<12 drinks in lifetime, 0 drinks in past year, <1 per

week, 1-7 per week, 8-14 per week, 15+ per week)– Smoking status (never smoked, former smoker, current smoker)

• Health status:Health status:

– Number of health conditions (0, 1-2, 3-5, 6+)– Functional limitation (yes, no)– Health compared to 12 months ago (worse, same, better)

• Health behaviors:Health behaviors:

– Physical activity (no exercise, some, regular)– Body weight status (underweight, normal weight, overweight, obese)– Drinking status (<12 drinks in lifetime, 0 drinks in past year, <1 per

week, 1-7 per week, 8-14 per week, 15+ per week)– Smoking status (never smoked, former smoker, current smoker)

• Health status:Health status:

– Number of health conditions (0, 1-2, 3-5, 6+)– Functional limitation (yes, no)– Health compared to 12 months ago (worse, same, better)

Model Variables: Health CareModel Variables: Health CareModel Variables: Health CareModel Variables: Health Care

• Access to conventional care:Access to conventional care:

– Delayed care due to cost (yes, no)– Delayed care for reasons other than cost (yes, no)– Insurance status (uninsured, private coverage, public coverage)– Poverty status (at or below poverty line, 101-199%, 200-299%, 300-

399%, 400-499%, 500%+)

• Use of conventional medical services:Use of conventional medical services:

– Number of doctor visits in past 12 months (0, 1, 2-3, 4-9, 10+)– Used over-the-counter medications in past 12 months (yes, no)– Used prescription medications in past 12 months (yes, no)

• Access to conventional care:Access to conventional care:

– Delayed care due to cost (yes, no)– Delayed care for reasons other than cost (yes, no)– Insurance status (uninsured, private coverage, public coverage)– Poverty status (at or below poverty line, 101-199%, 200-299%, 300-

399%, 400-499%, 500%+)

• Use of conventional medical services:Use of conventional medical services:

– Number of doctor visits in past 12 months (0, 1, 2-3, 4-9, 10+)– Used over-the-counter medications in past 12 months (yes, no)– Used prescription medications in past 12 months (yes, no)

Model Variables: SociodemographicsModel Variables: SociodemographicsModel Variables: SociodemographicsModel Variables: Sociodemographics

– Gender (male, female)

– Employment status (not employed, private sector, public sector, self-employed/family business)

– Race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, non-Hispanic AIAN, non-Hispanic API)

– Region (Northeast, Midwest, South, West)

– Education (< than HS, HS grad/GED, some college/Associate’s, Bachelor’s, Master’s/Doctorate/Professional)

– Age (18-44, 45-64, 65+)

– Gender (male, female)

– Employment status (not employed, private sector, public sector, self-employed/family business)

– Race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, non-Hispanic AIAN, non-Hispanic API)

– Region (Northeast, Midwest, South, West)

– Education (< than HS, HS grad/GED, some college/Associate’s, Bachelor’s, Master’s/Doctorate/Professional)

– Age (18-44, 45-64, 65+)

ResultsResultsResultsResults

• Overall, 36.1% of adults used CAM Overall, 36.1% of adults used CAM (excluding prayer) and 45.1% used (excluding prayer) and 45.1% used prayer for health reasons in the past prayer for health reasons in the past 12 months12 months

• Overall, 36.1% of adults used CAM Overall, 36.1% of adults used CAM (excluding prayer) and 45.1% used (excluding prayer) and 45.1% used prayer for health reasons in the past prayer for health reasons in the past 12 months12 months

Results: Health BehaviorsResults: Health BehaviorsResults: Health BehaviorsResults: Health Behaviors

CAM (OR)CAM (OR) PRAYER (OR)PRAYER (OR)

ExerciseExercise

NoneNone refref refref

SomeSome 1.731.73 1.211.21

RegularRegular 2.382.38 1.311.31

Body Weight StatusBody Weight Status

UnderweightUnderweight ------ ------

Normal weightNormal weight refref refref

OverweightOverweight ------ ------

ObeseObese 0.830.83 ------

Results: Health BehaviorsResults: Health BehaviorsResults: Health BehaviorsResults: Health Behaviors

CAM (OR)CAM (OR) PRAYER (OR)PRAYER (OR)

Drinking StatusDrinking Status

< 12 drinks lifetime< 12 drinks lifetime refref refref

0 drinks past yr0 drinks past yr 1.211.21 ------

< 1 drink per week< 1 drink per week 1.431.43 0.760.76

1-7 drinks per week1-7 drinks per week 1.591.59 0.610.61

8-14 drinks per week8-14 drinks per week 1.501.50 0.480.48

15+ drinks per week15+ drinks per week ------ 0.500.50

Smoking StatusSmoking Status

Never smokedNever smoked refref refref

Former smokerFormer smoker 1.131.13 ------

Current smokerCurrent smoker ------ 0.790.79

Results: Health StatusResults: Health StatusResults: Health StatusResults: Health Status

CAM (OR)CAM (OR) PRAYER (OR)PRAYER (OR)

No. of Health ProblemsNo. of Health Problems

00 refref refref

1-21-2 1.551.55 1.251.25

3-53-5 2.292.29 1.591.59

6+6+ 3.343.34 2.132.13

Functional LimitationFunctional Limitation

YesYes 1.301.30 1.231.23

NoNo refref refref

Health Compared to 12 Health Compared to 12 Months AgoMonths Ago

WorseWorse ------ 1.481.48

SameSame refref refref

BetterBetter 1.391.39 1.321.32

Results: Access to Conventional CareResults: Access to Conventional CareResults: Access to Conventional CareResults: Access to Conventional Care

CAM (OR)CAM (OR) PRAYER (OR)PRAYER (OR)

Delayed Care Due to CostDelayed Care Due to Cost

YesYes 1.341.34 ------

NoNo refref refref

Delayed—Other Than CostDelayed—Other Than Cost

YesYes 1.511.51 1.171.17

NoNo refref refref

Insurance CoverageInsurance Coverage

UninsuredUninsured refref refref

PublicPublic 0.830.83 ------

PrivatePrivate ------ ------

Results: Access to Conventional CareResults: Access to Conventional CareResults: Access to Conventional CareResults: Access to Conventional Care

CAM (OR)CAM (OR) PRAYER (OR)PRAYER (OR)

Poverty StatusPoverty Status

At or belowAt or below refref refref

101-199%101-199% ------ ------

200-299%200-299% ------ ------

300-399%300-399% ------ ------

400-499%400-499% ------ ------

500% +500% + 1.301.30 0.700.70

Results: Use of Conventional CareResults: Use of Conventional CareResults: Use of Conventional CareResults: Use of Conventional Care

CAM (OR)CAM (OR) PRAYER (OR)PRAYER (OR)

No. of Doctor VisitsNo. of Doctor Visits

00 refref refref

11 ------ ------

2-32-3 1.211.21 ------

4-94-9 1.301.30 1.281.28

10+10+ 1.781.78 1.681.68

Used OTC MedsUsed OTC Meds

YesYes 1.231.23 1.271.27

NoNo refref refref

Used Prescription MedsUsed Prescription Meds

YesYes ------ 1.291.29

NoNo refref refref

Results: SociodemographicsResults: SociodemographicsResults: SociodemographicsResults: Sociodemographics

CAMCAM PRAYERPRAYER

GenderGender

FemaleFemale 1.551.55 1.531.53

MaleMale refref refref

Employment StatusEmployment Status

Not workingNot working refref refref

Private sectorPrivate sector ------ ------

Public sectorPublic sector ------ ------

Self-emp/fam businessSelf-emp/fam business 1.411.41 ------

Results: SociodemographicsResults: SociodemographicsResults: SociodemographicsResults: Sociodemographics

CAM (OR)CAM (OR) PRAYER (OR)PRAYER (OR)

Race/EthnicityRace/Ethnicity

HispanicHispanic ------ 1.891.89

Non-Hispanic whiteNon-Hispanic white refref refref

Non-Hispanic blackNon-Hispanic black ------ 2.612.61

Non-Hispanic AIANNon-Hispanic AIAN ------ ------

Non-Hispanic APINon-Hispanic API 1.561.56 ------

RegionRegion

SouthSouth refref refref

NortheastNortheast 1.121.12 0.570.57

MidwestMidwest 1.201.20 0.780.78

WestWest 1.581.58 0.620.62

Results: SociodemographicsResults: SociodemographicsResults: SociodemographicsResults: Sociodemographics

CAM (OR)CAM (OR) PRAYER (OR)PRAYER (OR)

AgeAge

18-4418-44 1.731.73 0.750.75

45-6445-64 1.641.64 ------

65+65+ refref refref

EducationEducation

< HS< HS refref refref

HS/G.E.D.HS/G.E.D. 1.371.37 ------

Some coll./AASome coll./AA 1.851.85 ------

BachelorsBachelors 2.402.40 ------

Master’s +Master’s + 2.792.79 ------

ConclusionsConclusionsConclusionsConclusions

• Different segments of population using CAM and Different segments of population using CAM and PRAYER; similar findings within these segmentsPRAYER; similar findings within these segments

• Cost and non-cost barriers to conventional care Cost and non-cost barriers to conventional care increase likelihood of CAM useincrease likelihood of CAM use

• Respondent health behaviors associated with both Respondent health behaviors associated with both CAM use and use of PRAYERCAM use and use of PRAYER

• Different segments of population using CAM and Different segments of population using CAM and PRAYER; similar findings within these segmentsPRAYER; similar findings within these segments

• Cost and non-cost barriers to conventional care Cost and non-cost barriers to conventional care increase likelihood of CAM useincrease likelihood of CAM use

• Respondent health behaviors associated with both Respondent health behaviors associated with both CAM use and use of PRAYERCAM use and use of PRAYER

Contact InformationContact InformationContact InformationContact Information

Catherine M. Simile, Ph.D.Catherine M. Simile, Ph.D.National Center for Health StatisticsNational Center for Health Statistics

Division of Health Interview StatisticsDivision of Health Interview Statistics3311 Toledo Road, Room 21153311 Toledo Road, Room 2115

Hyattsville, MD 20782Hyattsville, MD 20782Phone: (301) 458-4499Phone: (301) 458-4499Email: cus4@cdc.govEmail: cus4@cdc.gov

Catherine M. Simile, Ph.D.Catherine M. Simile, Ph.D.National Center for Health StatisticsNational Center for Health Statistics

Division of Health Interview StatisticsDivision of Health Interview Statistics3311 Toledo Road, Room 21153311 Toledo Road, Room 2115

Hyattsville, MD 20782Hyattsville, MD 20782Phone: (301) 458-4499Phone: (301) 458-4499Email: cus4@cdc.govEmail: cus4@cdc.gov