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Acupuncture Use in the United States: Who, Where, Why, and at What Price?


Abstract and Figures

Despite the increase in acupuncture uses and greater than ever before interest of funding agencies to fund biomedical research in acupuncture, little is known about the profile of acupuncture users. We examined who these individuals are, where they reside, why they use acupuncture, and what price they pay. The increased use and high costs associated with each acupuncture visit poses questions to health care insurers regarding its coverage. Profiling will help conventional providers identify the segment of the population who are more likely to use acupuncture and educate them on the possible risks and benefits of using it with conventional medicine.
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Acupuncture Use in the United States:
Who, Where, Why, and at What Price?
Shamly Austina, Zo Ramamonjiarivelob, Haiyan Quc & Gregory Ellis-
a Department of Critical Care Medicine, University of Pittsburgh,
Pittsburgh, Pennsylvania
b Department of Health Administration, Governors State University,
University Park, Illinois
c Department of Health Services Administration, University of
Alabama at Birmingham, Birmingham, Alabama
d Department of Public Health, Western Kentucky University,
Bowling Green, Kentucky
Published online: 15 Jun 2015.
To cite this article: Shamly Austin, Zo Ramamonjiarivelo, Haiyan Qu & Gregory Ellis-Griffith (2015)
Acupuncture Use in the United States: Who, Where, Why, and at What Price?, Health Marketing
Quarterly, 32:2, 113-128, DOI: 10.1080/07359683.2015.1033929
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Acupuncture Use in the United States: Who,
Where, Why, and at What Price?
Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
Department of Health Administration, Governors State University, University Park, Illinois
Department of Health Services Administration, University of Alabama at Birmingham,
Birmingham, Alabama
Department of Public Health, Western Kentucky University, Bowling Green, Kentucky
Despite the increase in acupuncture uses and greater than ever
before interest of funding agencies to fund biomedical research in
acupuncture, little is known about the profile of acupuncture users.
We examined who these individuals are, where they reside, why
they use acupuncture, and what price they pay. The increased use
and high costs associated with each acupuncture visit poses ques-
tions to health care insurers regarding its coverage. Profiling will
help conventional providers identify the segment of the population
who are more likely to use acupuncture and educate them on the
possible risks and benefits of using it with conventional medicine.
KEYWORDS alternative medicine, acupuncture, complementary
medicine, utilization, profiling
Over the years, there has been a steady increase in the use of complementary
and alternative medicine (CAM) among the U.S. population (Coulter & Willis,
2004). CAM includes diverse and abundant practices such as acupuncture,
Address correspondence to Shamly Austin, PhD, MHA, Research & Development
Solutions, Quality Improvement Department, Gateway Health, 444 Liberty Avenue, Pittsburgh,
PA 15222. E-mail:
Health Marketing Quarterly, 32:113–128, 2015
Copyright #Taylor & Francis Group, LLC
ISSN: 0735-9683 print=1545-0864 online
DOI: 10.1080/07359683.2015.1033929
Downloaded by [] at 15:10 15 June 2015
chiropractic care, naturopathy, ayurveda, and homeopathy. CAM therapies
are known as complementary medicine when used with conventional medi-
cine, and are known as alternative medicine when used alone (Floyd, 2006).
According to the 2007 National Health Interview Survey (NHIS), about 34%
of adults and 12%of children have used some form of CAM. An estimated
$33.9 billion out-of-pocket expenses per year are reported for CAM (U.S.
Department of Health and Human Services, 2008; National Certification
Commission for Acupuncture and Oriental Medicine, 2009).
One of the CAM therapies that have received particular attention during
the last decade is acupuncture. It is one of the fastest growing CAM therapies
in the United States (Burke, Upchurch, Claire, & Chyu, 2006) and has its
origin in traditional Chinese medicine (Kaptchuk, 2002; Vickers & Zollman,
1999). The National Certification Commission for Acupuncture and Oriental
Medicine reported a 32%increase in the number of visits to acupuncturists
between 2002 and 2007 (National Certification Commission for Acupuncture
and Oriental Medicine, 2009). The National Institutes of Health’s (NIH)
Research Portfolio Online Reporting Tools database lists about 73 federally
funded biomedical research studies in acupuncture (National Institutes of
Health, 2012). The NIH consensus panel has reported acupuncture as an
adjunct treatment or an acceptable alternative included in a comprehensive
management program for a variety of conditions (Burke et al., 2006; National
Institutes of Health, 1997). There is a growing body of literature on the
efficacy of acupuncture treatment for a variety of conditions, especially
musculoskeletal conditions, headaches, and asthma (Burke et al., 2006;
National Institutes of Health, 1997).
Despite the increase in acupuncture uses and greater than ever before
interest of funding agencies to fund biomedical research in acupuncture, little
is known about the profile of individuals who use acupuncture. Profiling,
defined as the ‘‘description of the salient characteristics of the best customers’’
(Ratner, 2011, p. 205), is a useful tool that can offer health care providers
information about the type of individuals they serve and consequently help
them focus on how to improve their services to better suit these types of
individuals. Given the pressure to provide integrative medicine and high
quality patient-centered care (Maizes, Rakel, & Niemiec, 2009), knowing the
profile of acupuncture users will guide acupuncturists to customize their skills
and services to meet the needs of users. Additionally, it will help allopathic
providers to identify the segment of the population that are more likely to
seek this kind of CAM therapy and educate them with the possible risks
and benefits of using acupuncture with conventional allopathic medicine.
Furthermore, getting a clear picture of acupuncture users might lead to better
and wider insurance coverage for acupuncture services.
Prior studies have profiled users of acupuncture in the United Kingdom
(McPheasron, Sinclair-Lian, & Thomas, 2006), minority and underserved
users of acupuncture in the United States (Highfield et al., 2012), U.S. women
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who have used acupuncture (Upchurch et al., 2008), and users of acupunc-
ture in the United States during the past 12 months based on data collected
prior to 2002 (Burke et al., 2006). The studies that analyzed samples from the
United States are limited due to the fact that they either focused on specific
groups from the U.S. population (Highfield et al., 2012; Upchurch et al.,
2008), or they studied people who used acupuncture over a limited time-
frame (Burke et al., 2006). As a result, we do not have a true picture of
acupuncture users in the United States. The primary purpose of this study
is to address these limitations by profiling all adults who have ever used acu-
puncture in their lifetime based on the 2012 NHIS. Specifically, we examined
who these individuals are, where they reside, why they use acupuncture, and
what price they pay to get this treatment. In a secondary analysis, we ident-
ified the aforementioned characteristics from a sample of individuals who
reported that they had used acupuncture in the past 12 months (recent users)
to see if these results were any different.
We used the behavioral model of health care utilization to identify the factors
associated with acupuncture utilization. This model has previously been used
to examine the correlates of CAM utilization as well as acupuncture (Brown,
Barner, Bohman, & Richards, 2009; Upchurch et al., 2008). Upchurch and
colleagues used the behavioral model of health care utilization to examine
acupuncture use among U.S. women, while Brown and colleagues examined
the utilization of CAM among African Americans. According to the model,
individuals’ health care utilization behavior is a function of their predisposing,
enabling, and need-related factors (Andersen, 1995). Factors such as age,
gender, race=ethnicity, and education level, which predispose individuals’
decision to use acupuncture, are known as predisposing factors. Enabling
factors are those that have the potential to facilitate an individual’s ability to
utilize acupuncture services. Factors such as annual income, having any
health insurance, having a personal physician, place of birth, marital status,
and region of residence are enabling factors. Finally, factors that determine
the need for acupuncture treatment such as health status or medical
conditions are need-related factors (Andersen, 1995). Overall, health status,
arthritis conditions, cardiovascular conditions, stroke, and depression=
anxiety are some of the need-related factors included in our model.
This is a retrospective cross-sectional study based on the 2012 NHIS, which
is a population-based random sample of noninstitutionalized population
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(The Centers for Disease Control and Prevention, 2012). Study respondents
are 18 years old or older. Data were collected using a computer-assisted per-
sonal interviewing method. The NHIS questionnaire has two parts: a core
section and a supplement section. The core section contains the household,
family, adult, and child components providing sociodemographic, health
care utilization, and behavior data. The questions in the supplement section
focus on topics such as CAM, and new and emerging health issues. The CAM
supplement collects information on acupuncture and other alternative treat-
ments. In 2012, the NHIS sample size for adults who responded to the CAM
supplement questionnaire consisted of approximately 34,525 noninstitu-
tionalized civilians residing in the United States (The Centers for Disease
Control and Prevention, 2012). We merged the adult CAM supplement
section with the person-level file from the NHIS family core questionnaire
to create a unique data set with information on adults’ acupuncture use
and their sociodemographic characteristics as well as their health conditions.
Our analysis included a final sample of 27,692 U.S. adults after we excluded
individuals with missing data related to the variables of interest.
Variables and Measures
The outcome variable acupuncture utilization was determined by assessing if
individuals ever utilized acupuncture services (yes=no). The explanatory vari-
ables were predisposing factors (i.e., age, race=ethnicity, gender, and education
level), enabling factors (i.e., income, health insurance, personal physician,
place of birth, marital status, and region of residence), and need-related factors
(i.e., overall health status and health conditions, including arthritis conditions,
cardiovascular conditions, stroke, hypertension, diabetes, cancer, breathing=
lung problems, depression=anxiety, and nervous system conditions).
Age groups were categorized as 18 to 44 years, 45 to 64 years, and 65
years or older. The variable race=ethnicity was categorized as White, African
American, Hispanic, Asian, and other (Native American, Alaskan, multiracial).
We included both genders (male and female) in our model. Education level
was categorized as those who had high school education or less, those who
had some college education, and those who had a bachelor’s degree or higher.
Income was categorized as individuals who made less than $55,000, those
who made $55,000 to $74,999, and those who made equal to or greater than
$75,000. About 45%of the sample had missing information on income. Hence,
we decided to include a fourth category as ‘‘undisclosed’’ for individuals who
did not disclose their annual income. Health insurance was categorized as the
presence of any type of health insurance and not having any health insurance.
Place of birth was categorized as U.S. born and non-U.S. born. Marital status
was categorized as married and others. The variable personal physician was
categorized as individuals who had one and those who did not have one.
Region of residence was categorized as Northeast, Midwest, South, and West.
116 S. Austin et al.
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Overall health status was categorized as good and poor. The health
conditions included in the model were arthritis conditions, cardiovascular
conditions, hypertension, diabetes, cancer, breathing=lung conditions,
depression=anxiety, and nervous system conditions. Health conditions were
dichotomized, indicating whether the respondents had each one of these
conditions or did not have one.
Data Analyses
The Statistical Package for the Social Sciences (IBM SPSS Inc., Chicago, IL)
version 19.0 for Windows was used for all statistical analyses and the sample
was weighted based on 2010 U.S. census data. As NHIS has a complex sam-
ple design, the final calculated weights that we used in our analysis were the
product of design weight and poststratification weights. Univariate analyses
were performed to explore the characteristics of the population who have
ever used acupuncture in their life. The independent variables were tested
for any multicollinearity using Cramer’s V correlation. We used multivariate
logistic regression models to examine the correlates of acupuncture utiliza-
tion. Further, we reported the reasons for acupuncture use and the average
price incurred.
Table 1shows the descriptive characteristics of the sample. Of the 27,692
adults in the sample, about 6.7%(12.7 million) have used acupuncture in their
lifetime. With respect to predisposing factors, 21%of the sample was age 65
and older, 55%were female, 70%were White, and 30%had a bachelor’s
degree or higher education. With respect to enabling factors, about 39%of
the respondents had an annual household income of less than $55,000,
10%did not have any health insurance, 81%had a personal physician, 15%
were born outside the United States, and 56%were married. The majority
(36%) of the respondents resided in the southern United States. With respect
to need factors, 14%of the sample reported poor health status, 4%reported
arthritis conditions, less than 1%reported cardiovascular conditions or cancer,
and slightly more than 2%individuals reported hypertension, diabetes, or
The correlation matrix in Table 2did not reveal any multicollinearity
problem. The minimum and maximum correlations observed among the
independent variables were 0 and 0.60, respectively.
Table 3shows the results from the weighted logistic regression identify-
ing the factors associated with acupuncture use. Adults in the 18 to 44 age
group were less likely (OR ¼0.53, p<.05) to use acupuncture compared to
older adults (65 years). Males were less likely to utilize acupuncture
Acupuncture Use in the United States 117
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TABLE 1 Sociodemographic Characteristics of Individuals From 2012 National Health
Interview Survey (N¼27,692)
Factors Variables Measures
Predisposing Factors Age (in years) 18–44 43.0
45–64 36.5
65 20.5
Gender Male 45.5
Female 54.5
Race White 70.2
African American 11.6
Hispanic 12.4
Asian 5.0
Other 0.8
Education High school 38.2
Some college 31.4
Bachelor’s degree or higher 30.2
Enabling Factors Annual income <$55,000 38.6
$55,000–$74,999 7.0
$75,000 9.2
Undisclosed 45.2
Health insurance Yes 90.4
No 9.6
Personal physician Have one 81.4
None 18.6
Place of birth U.S. born 84.9
Non-U.S. born 15.1
Marital status Married 55.8
Others 44.2
Region Northeast 19.5
Midwest 23.2
South 35.5
West 21.8
Health status Good 86.4
Poor 13.6
Arthritis conditions Yes 4.2
No 95.2
Cardiovascular Conditions Yes 0.6
No 99.4
Stroke Yes 1.0
No 99.0
Hypertension Yes 2.4
No 97.6
Diabetes Yes 2.3
No 97.7
Cancer Yes 0.8
No 99.2
Breathing=lung problems Yes 1.7
No 98.3
Depression=anxiety Yes 2.4
No 97.6
Nervous system conditions Yes 1.8
No 98.2
Note. Percentages weighted to U.S. population estimates.
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TABLE 2 Correlation Matrix (Cramer’s V Correlation Coefficient) for Independent Variables
Variables 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1 Age 1
2 Race .15 1
3 Gender .04 .04 1
4 Education .13 .23 .03 1
5 Income .44 .11 .17 .34 1
6 Health insurance .19 .16 00.13 .15 1
7 Place of birth .05 .60 .01 .10 .02 .11 1
8 Marital status .10 .16 .10 .11 .12 .06 .08 1
9 Personal physician .16 .13 .05 .06 .07 .20 .08 .06 1
10 Region .03 .34 .02 .07 .07 .06 .16 .02 .06 1
11 Health status .18 .11 .01.21 .24 .01 .00.07 .04 .06 1
12 Arthritis conditions .19 .06 .05 .10 .19 .04 .03 .08 .05 .03 .28 1
13 Cardio-vascular conditions .06 .01 00.03 .07 .01 .00.03 .01 .00.13 .17 1
14 Stroke .09 .03 .01.05 .10 .02 .01 .01 .02 .02 116 .10 .08 1
15 Hypertension .13 .08 .01 .09 .15 .02 .00.06 .03 .05 .27 .36 .21 .18 1
16 Diabetes .12 .04 .00.08 .14 .02 .00.03 .03 .04 .28 .25 .17 .14 .42 1
17 Cancer .07 .02 .00.02 .07 .02 .01 .01 .02 .00.14 .09 .08 .06 .13 .10 1
18 Breathing and lung problem .08 .03 .00.06 .12 .02 .03 .04 .02 .01 .22 .22 .14 .08 .24 .18 .08 1
19 Depression .06 .03 .02 .07 .12 .00.02 .08 .02 .01 .21 .19 .13 .06 .23 .16 .06 .20 1
20 Nervous system disorders .04 .02 .01 .04 .09 .01 .03 .03 .02 .00.17 .12 .14 .05 .13 .11 .06 .11 .16 1
Correlations not significant at p>.05.
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(OR ¼0.61, p<.05) than females. Compared to Whites, African Americans
were less likely (OR ¼0.58, p<.05) to use acupuncture. Individuals with
high school education or less (OR ¼0.33, p<.05) and with some college
(OR ¼0.61, p<.05) were less likely to use acupuncture than those who
had bachelors’ and higher degrees. Individuals who did not disclose their
income (OR ¼0.74, p<.05), those with an annual income of less than
$55,000 (OR ¼0.77, p<.05), and those with an annual income of $55,000
to $74,999 (OR ¼0.72, p<.05) were less likely to use acupuncture than indi-
viduals with annual income of $75,000 or higher. Compared to individuals
residing in the Western United States, individuals in other U.S. regions were
less likely to use acupuncture: Northeast (OR ¼0.61, p<.05), Midwest
(OR ¼0.49, p<.05), and South (OR ¼0.51, p<.05). Individuals with an over-
all poor health status (OR ¼0.76, p<.05) and diabetes (OR ¼0.50, p<.05)
were less likely to use acupuncture compared to individuals with an overall
TABLE 3 Results From the Weighted Logistic Regression for U.S. Individuals Who Ever Used
Acupuncture (N¼27,692)
Factors Variables (Reference category) Measures OR (95%CI)
Age (65 years) 18–44 0.53 (0.44–0.63)
45–64 0.96 (0.81–1.13)
Gender (Female) Male 0.61 (0.54–0.69)
Race (White) African American 0.58 (0.45–0.73)
Hispanic 0.84 (0.67–1.05)
Asian 1.17 (0.89–1.54)
Other 0.88 (0.45–1.73)
Education High school 0.33 (0.28–0.40)
(Bachelor’s degree or higher) Some college 0.61 (0.53–0.70)
Annual income <$55,000 0.77 (0.63–0.95)
($75,000) $55,000-$74,999 0.72 (0.56–0.93)
Undisclosed 0.74 (0.59–0.92)
Health insurance (No) Yes 1.02 (0.78–1.32)
Personal physician (No) Have one 1.14 (0.93–1.40)
Place of birth (Non-U.S. born) US born 0.94 (0.78–1.32)
Marital status (Others) Married 0.92 (0.78–1.14)
Region (West) Northeast 0.47 (0.39–0.56)
Midwest 0.45 (0.37–0.54)
South 0.33 (0.27–0.40)
Health status (Good) Poor 0.76 (0.60–0.97)
Arthritis conditions (No) Yes 1.56 (1.14–2.14)
Cardiovascular conditions (No) Yes 0.71 (0.35–1.42)
Stroke (No) Yes 1.68 (0.90–3.11)
Hypertension (No) Yes 0.69 (0.43–1.11)
Diabetes (No) Yes 0.50 (0.32–0.80)
Cancer (No) Yes 1.11 (0.62–1.99)
Breathing =lung problems (No) Yes 1.30 (0.63–2.69)
Depression=anxiety (No) Yes 1.25 (0.85–1.81)
Nervous system conditions (No) Yes 2.47 (1.68–3.63)
Note. Sample weighted to U.S. population estimates. OR ¼odds ratio; 95%CI denotes confidence interval.
120 S. Austin et al.
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good health status and those who did not have diabetes, respectively.
Individuals with arthritis conditions (OR ¼1.56, p<.05) and nervous system
conditions (OR ¼2.47, p<.05) were more likely to use acupuncture than
individuals who did not have these health conditions.
Further, we examined the reasons for acupuncture use. Of the 1,999
individuals who reported acupuncture use, 351 individuals responded to
the item on the reasons for acupuncture utilization. The major reason
identified for acupuncture use was conventional allopathic medical treatment
was not effective for the individuals’ specific health issue (33%). About 30%
used acupuncture for general health=wellness as well as disease prevention;
27%used it because friends and family members suggested the therapy; and
21%used it as their health care provider recommended it. About 7%reported
conventional medical treatment as too expensive. The average price per visit
was $94 and 67%of the sample visited an acupuncturist between 2 and 10
TABLE 4 Results From Weighted Logistic Regression for Recent Users of Acupuncture
Factors Variables (Reference category) Measures OR (95%CI)
Age (65 years) 18-44 0.73 (0.53–1.01)
45-64 0.82 (0.59–1.15)
Gender (Female) Male 0.48 (0.38–0.60)
Race (White) African American 0.62 (0.41–0.96)
Hispanic 0.77 (0.53–1.11)
Asian 1.33 (0.84–2.09)
Other 0.13 (0.01–1.09)
Education High school 0.31 (0.22–0.43)
(Bachelor’s degree or higher) Some college 0.58 (0.44–0.75)
Annual income <$55,000 0.64 (0.44–0.95)
($75,000) $55,000–$74,999 0.74 (0.46–1.18)
Undisclosed 0.51 (0.34–0.78)
Health insurance (No) Yes 0.77 (0.49–1.21)
Personal physician (No) Have one 1.60 (1.13–2.27)
Place of birth (Non-U.S. born) U.S. born 0.85 (0.60–1.22)
Marital status (Others) Married 0.91 (0.74–1.11)
Region (West) Northeast 0.51 (0.37–0.72)
Midwest 0.37 (0.28–0.50)
South 0.30 (0.22–0.42)
Health status (Good) Poor 0.64 (0.44–0.94)
Arthritis conditions (No) Yes 1.24 (0.72–2.10)
Cardiovascular conditions (No) Yes 0.33 (0.07–1.58)
Stroke (No) Yes 1.31 (0.52–3.25)
Hypertension (No) Yes 0.43 (0.21–0.90)
Diabetes (No) Yes 1.07 (0.46–2.47)
Cancer (No) Yes 1.39 (0.47–4.07)
Breathing=lung problems (No) Yes 0.66 (0.25–1.72)
Depression=anxiety (No) Yes 0.99 (0.52–1.90)
Nervous system conditions (No) Yes 3.10 (1.68–5.71)
Note. Sample weighted to U.S. population estimates. OR ¼odds ratio; 95%CI ¼confidence interval.
Acupuncture Use in the United States 121
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times. The majority obtained information about the therapy from the Internet
(17%); followed by 8%from scientific articles, magazines, and books; and
around 3%from television=radio or health food stores. Further, back pain
(23%) was reported as the major health condition for which individuals
sought acupuncture.
We conducted an additional logistic regression to investigate the deter-
minants of acupuncture use among individuals who used it during the past
12 months (recent users). The results of the analysis are summarized in
Table 4. About 3.1 million (1.6%) U.S. adults used acupuncture within the
12 months prior to the survey. The results with respect to age, having a per-
sonal physician and certain health conditions such as arthritis, hypertension,
and diabetes, were different from the sample of individuals who ever used
acupuncture. Our analysis indicated that those who had a personal physician
were more likely (OR ¼1.60, p<.05) to use acupuncture than individuals
who did not have one. The variables age, having arthritis, and having diabetes
were not significant predictors of acupuncture use.
We profiled acupuncture users in a sample of the U.S. adult population and
examined their reasons for using acupuncture. We found age, race, gender,
education, region of residence, overall health status, and having health con-
ditions such as arthritis, diabetes, and nervous system disorders to be predic-
tors of acupuncture use. The three major reasons for acupuncture use were:
first, conventional medical treatment was not effective for respondents’ specific
health problem; second, acupuncture was used for general health=wellness
and disease prevention; and finally, respondents used acupuncture based on
the recommendations from family and friends.
Individuals Who Used Acupuncture
We found that older adults use acupuncture more than their younger counter-
parts. This suggests that as individuals age, they tend to pay more attention
to issues related to their health care and place more value on their health
(Zanjani, Schaie, & Willis, 2006). In addition, elderly people have multiple
morbidities that require the use of several health services. Hence, they may
be more likely to utilize acupuncture services. On the contrary, among the
individuals who have used acupuncture within the last 12 months prior to
the survey, age is not a significant predictor of acupuncture use. An increase
in out-of-pocket expenses for conventional health care may have encouraged
individuals, irrespective of their age, to use acupuncture. Moreover, the
number of underinsured adults in the United States dramatically increased
to 25 million in 2007 (Schoen, Collins, Kriss, & Doty, 2008). As the number
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of underinsured adults increases, individuals in this group may be more
willing to use acupuncture or other alternative treatments as it may be
perceived as a more affordable option relative to conventional medicine.
In addition, prior studies have indicated that acupuncture utilization
varies by race=ethnicity (Barnes, Bloom, & Nahin, 2008; Burke et al., 2006).
However, we found that being Asian is not a significant predictor of acupunc-
ture use. This suggests that as immigrants gradually acculturate, they relinquish
cultural practices of their native countries and adopt the cultural practices of
their host countries. In a study by Lee and colleagues, Mexican- and Asian-
American individuals are less likely to use ethnic-specific CAM providers after
spending more time living in the United States (Lee, Goldstein, Brown, &
Ballard-Barbash, 2010). Further, we found that females were more likely to
utilize acupuncture services than males. Previous studies have reported that
women are increasingly incorporating CAM therapies into their health
and well-being practices (Eisenberg et al., 1998; Tindle, Davis, Phillips, &
Eisenberg, 2005). It is reported that more than 1.2 million U.S. women have
used acupuncture (Upchurch et al., 2008).
Our findings also suggest that the use of acupuncture is more prevalent
among individuals with a bachelor’s or higher degree. Higher educational
attainment may lead to the opportunity to enhance individual’s social,
psychological, and economic skills (Winkleby, Jatulis, Frank, & Fortmann,
1992). Acupuncture utilization is not a mainstream medical treatment in the
United States. As a result, one may have heightened awareness of possible
alternative treatments available; awareness is closely correlated with an
individual’s education level and income. Therefore, individuals with a higher
education level and annual income may be more likely to utilize acupuncture
therapy. In addition, our findings also indicate that having a personal phys-
ician is associated with acupuncture use during the last 12 months before
the survey. This suggests that physicians have become more comfortable
advising their patients to use acupuncture, or that higher out-of-pocket
expenses for their physician’s office visit motivated individuals to seek
alternative therapies such as acupuncture.
Where and Why Do They Use Acupuncture?
Our study suggests that individuals residing in the Western United States are
more likely to use acupuncture. The United States is a vast country with a
heterogeneous population and where one lives has a potential influence on
health care utilization (Wood, 1995). The Western region of the country has
a larger Asian immigrant population and immigrants bring with them
ethnic-specific cultural experiences (Burke et al., 2006). Our investigation also
identifies those individuals who report overall good health status to be more
likely to utilize acupuncture to maintain their health status. The Grossman
theory, which focuses on health as a consumption good, may help to explain
Acupuncture Use in the United States 123
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this occurrence. The theory indicates that health is similar to a capital good and
it needs proper attention and maintenance (Grossman, 1972). Acupuncture is
considered as a preventative wellness type of treatment. Thus, healthy indivi-
duals may be more willing to seek out unconventional therapies to maintain
their good health status. Further, our results show that individuals with
arthritis conditions and nervous system disorders are more likely to use the
services of acupuncturists. Acupuncture is considered effective in treating
conditions such as osteoarthritis, lower back, neck, shoulder, knee, and other
chronic pains (Berman et al., 2004; National Institutes of Health, 1997).
Reasons for Acupuncture Use and Cost Incurred
The major reason reported for acupuncture use is the ineffectiveness of
conventional medical treatment. Our findings support previous studies
conducted in the field of health care utilization. Individuals tend to look for
alternative types of treatment when they do not find relief from conventional
treatment (Astin, 1998; Burke et al., 2006). The second major reason for acu-
puncture use is overall health and disease prevention. As our results indicate
the educated individuals, high-income earners ($75,000) and those with
good health status are more likely to use acupuncture. These individuals have
the monetary resources to indulge in nonconventional therapies that target
overall health maintenance and disease prevention. The third major reason
reported for acupuncture use is recommendations from family and friends.
Individuals usually ask their relatives and friends for help and opinions on
health choices and, to a large extent, families and friends influence indivi-
duals’ choice of medical treatment (Boon & Kachan, 2008; Diefenbach et al.,
2002; Griffiths, 1995). The fourth major reason is nonaffordability of conven-
tional medical care. Conventional medical care has become less affordable
with the rise in health insurance premiums and out-of-pocket expenses. If
health care costs continue to increase faster than personal income, the
number of uninsured and underinsured will continue to grow and individuals
will seek comparatively less expensive alternative therapies of health care
(Pagan & Pauly, 2005).
The estimated average cost incurred among acupuncture users in our
study was $94 per visit and 67%individuals in this group visited acupunctur-
ists between 2 and 10 times. Even $94 per visit is a huge amount, especially
when multiple visits to the acupuncturists are taken into account. Currently,
Medicare does not cover acupuncture (Centers for Medicare and Medicaid Ser-
vices, 2012). However, some private health insurances such as Blue Cross and
Blue Shield and some health maintenance organizations such as Kaiser Perma-
nente cover acupuncture services (American Association of Acupuncture and
Oriental Medicine, 2012b). In addition, some states, such as Florida, Maine,
Montana, Nevada, Texas, Virginia, and Washington State among others,
mandate acupuncture coverage (California Health Benefits Review Program,
124 S. Austin et al.
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2011). California has been looking for scientific evidence on the effectiveness
of acupuncture before mandating its coverage (California Health Benefits
Review Program, 2011). Further, the Patient Protection and Affordable Care
Act (PPACA) does not specifically mandate acupuncture coverage. However,
the PPACA requires that plans should provide coverage of health services
included in the essential health benefits package (EHB). The EHB contains
a list of 10 categories of health services, including preventative services,
wellness services, and chronic disease managements. The American Associ-
ation of Acupuncture and Oriental Medicine is campaigning to convince the
Department of Health and Human Services that acupuncture meets the
inclusion criteria for EHB; hence, it deserves insurance coverage (American
Association of Acupuncture and Oriental Medicine, 2012a). The current trend
in increased acupuncture use and the high costs associated with each visit
to an acupuncturist poses questions to health care insurers regarding its
Limitations and Future Research
The results of our study should be considered in the light of certain limita-
tions. Because of the cross sectional nature of our design, we could not
capture an individual’s transition from conventional medicine to acupuncture
and vice-versa. However, this is the first study that examined the correlates of
acupuncture use among individuals who have ever used acupuncture. The
data did not have information on whether the individual used acupuncture
as an alternative therapy or complementary therapy. This study could only
analyze those reasons that were included in the 2012 NHIS questionnaire.
Additional reasons, such as cultural values and beliefs that we believe were
important to acupuncture utilization, were not included. In addition, the data
collected were based on self-reports; the use of self-reported data increases
the possibility of having internal validity threats such as response bias and
patient recall bias. The response rate for ‘‘Reasons for utilization’’ in the survey
was only 18%(n¼351) of the total 1,999 individuals who reported utilization.
Hence, the generalization of our results regarding reasons for utilization
may be limited. However, the NHIS is a highly reliable and valid data set,
which has a wide degree of generalizability to the broader U.S. population
(Boslaugh, 2007).
Over the years, acupuncture has matriculated from cultural curiosity to
one of the leading CAM therapies in the United States (Kaptchuk, 2002). The
rising cost of conventional medical care and its nonaffordability may have
resulted in an increasing number of people seeking CAM therapies such as
acupuncture. Future research should focus on longitudinal designs, which
would allow the opportunity to account for an individual’s transition from
conventional medicine to complementary or alternative therapies such as
acupuncture, and health insurance provision for acupuncture users.
Acupuncture Use in the United States 125
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... With the increasing global interest in TCM and CAIMs for various conditions, such as cancer [17] and insomnia [16], the nation has continued to conduct a number of clinical trials exploring the e cacy of TCMs and has recently launched the Action Plan of Regulatory Science which will aims to advance regulatory tools and standards used to evaluate TCM safety research [20]. Acupuncture has become increasingly popular in the United States over the years [21] as it is now the 11th most commonly used complementary health therapy [22]. ...
... Potential factors contributing to this trend include the increasing costs of conventional healthcare in the United States, continued research into the e cacy of acupuncture, and the inclusion of acupuncture in private health insurance plans [21]. Beginning in 2001, a series of German acupuncture trials investigating the cost-effectiveness, safety, and usefulness of acupuncture as a treatment for chronic back pain, osteoarthritis, migraine prophylaxis, and tension-type headache [23]. ...
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Introduction: Headache disorders are among one of the most common nervous system disorders affecting approximately 50% of adults worldwide. Acupuncture is a therapy originating from traditional Chinese medicine; some research has suggested that its use may relieve headache disorders. The objective of the present bibliometric analysis is to capture the characteristics of peer-reviewed publications at the intersection of headache and acupuncture research. Methods: Searches were run on July 08, 2021, and results were exported on the same day to prevent discrepancies between daily database updates. Trends associated with this subset of publications were identified and presented. Bibliometric networks were constructed and visualized using the software tool VOSviewer. Results: A total of 592 publications, published by 1482 authors were published in 231 journals from 1965 to 2021. An upward trend in the annual number of publications can be observed starting in the mid-1970s. The journal that published the largest number of publications was Deutsche Zeitschrift Fur Akupunktur. The most productive countries included China and Germany. Conclusions: The present study provides the characteristics of the literature at the intersection of headache disorders and acupuncture that allows understanding of the past, present, and future of research in this area.
... Acupuncture is often accompanied by Chinese herbal medicine, which according to 2018 systematic review [125] may produce similar results as traditional antidepressant medication. Although the use of acupuncture has increased in the United States in recent years [126], it continues to be considered complimentary medicine and is often not covered by most insurance [127], rendering it an unlikely option for those at financial disadvantage. ...
... In particular, complementary and alternative medicine includes diverse and abundant traditional practices, such as naturopathy, chiropractic care, acupuncture, Ayurveda, and homeopathy. Among these therapies, acupuncture has received significant attention, and is one of North America's fastest-growing complementary and alternative medicine therapies [8]. Acupuncture is a nonpharmacological and minimally invasive traditional Chinese medicine therapy that originated more than 2000 years ago, and has gradually spread and become quite popular in the West [9,10]. ...
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Acupuncture is one of the most extensively used complementary and alternative medicine therapies worldwide. In this study, we explore the use of near-infrared light-emitting diodes (LEDs) to provide acupuncture-like physical stimulus to the skin tissue, but in a completely non-invasive way. A computational modeling framework has been developed to investigate the light-tissue interaction within a three-dimensional multi-layer model of skin tissue. Finite element-based analysis has been conducted, to obtain the spatiotemporal temperature distribution within the skin tissue, by solving Pennes’ bioheat transfer equation, coupled with the Beer-Lambert law. The irradiation profile of the LED has been experimentally characterized and imposed in the numerical model. The experimental validation of the developed model has been conducted through comparing the numerical model predictions with those obtained experimentally on the agar phantom. The effects of the LED power, treatment duration, LED distance from the skin surface, and usage of multiple LEDs on the temperature distribution attained within the skin tissue have been systematically investigated, highlighting the safe operating power of the selected LEDs. The presented information about the spatiotemporal temperature distribution, and critical factors affecting it, would assist in better optimizing the desired thermal dosage, thereby enabling a safe and effective LED-based photothermal therapy.
... Many CIH approaches are not covered by insurance (33)(34)(35). Acupuncture has historically cost on average $94-$103 per visit (36,37), and more recent estimates indicate that the total annual amount paid for acupuncturist visits was a mean of $1022 (38). Further, research from the past 2 decades suggests that 75% of adults who used acupuncture had no insurance coverage for acupuncture (39), and the proportion of acupuncturist visits with any insurance coverage has increased marginally in recent years (38). ...
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Racial and ethnic disparities in pain management pose significant challenges to equitable cancer care delivery. These disparities are driven by complex interactions between patient-, provider-, and system-related factors that resist reductionistic solutions and require innovative, holistic approaches. On September 19, 2022, the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) published a joint guideline to provide evidence-based recommendations on integrative medicine for cancer pain management. Integrative medicine, which combines conventional treatments with complementary modalities from cultures and traditions around the world, are uniquely equipped to resonate with diverse cancer populations and fill existing gaps in pain management. While some complementary modalities, such as music therapy and yoga, lack sufficient evidence to make a specific recommendation, other modalities, such as acupuncture, massage, and hypnosis, demonstrated an intermediate level of evidence, resulting in moderate strength recommendations for their use in cancer pain management. However, several factors may hinder real-world implementation of the SIO-ASCO guideline and must be addressed to ensure equitable pain management for all communities. These barriers include, but are not limited to, the lack of insurance coverage for many complementary therapies, the limited diversity and availability of complementary therapy providers, the negative social norms surrounding complementary therapies, the under-representation of racial and ethnic subgroups in the clinical research of complementary therapies, and the paucity of culturally attuned interventions tailored to diverse individuals. This commentary examines both the challenges and the opportunities for addressing racial and ethnic disparities in cancer pain management through integrative medicine.
... The British Acupuncture Council (BAcC) is the main professional body for traditional acupuncturists in the UK and is on the PSA accredited register, representing over 2500 members. Acupuncture users report seeking treatment for disease prevention [12] and acupuncture use is associated with healthy behaviours [13]. Acupuncture use has been associated with greater physical activity in patients with breast and gynaecological cancer during oncology treatment [14]. ...
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Aims Complementary medicine therapists such as traditional acupuncturists are a large resource for supporting public health targets to improve health behaviours. Our objectives were to determine the prevalence and patterns of UK acupuncturists’ provision of lifestyle change support, test theory-based hypotheses about facilitators and barriers to supporting lifestyle changes and to explore associated characteristics and attitudes. Methods A mixed methods design in which British Acupuncture Council members (Sept 2019-April 2020) completed an online questionnaire assessing prevalence of lifestyle change support, typical patterns across patients and behaviours, Theory of Planned Behaviour constructs, practitioner characteristics and open-text responses regarding additional behaviours and clinical decisions to introduce lifestyle change. Results Three hundred fifty-two traditional acupuncturists participated (Mean age = 51.5 years, SD 9.9; 81.8% (n = 288) female). 57.7% (n = 203) reported offering support for lifestyle change during their most recent consultation. 91.7% (n = 323) reported supporting lifestyle change ‘always or most of the time’ for patients with chronic conditions and 67.9% (n = 239) reported this for patients with acute conditions. The pattern of typical support for different health behaviours ranged from 44.6% (n = 157) for smoking reduction (acute conditions) to 95.2% (n = 335) for diet support (chronic conditions). A linear regression model found that frequency of support for lifestyle change in acute patients was predicted by acupuncturists’ attitudes to both clinical role and importance of health behaviours, confidence in their ability to provide lifestyle change support and use of fewer behaviour change techniques. The decision to first offer lifestyle change support was guided by perceived patient receptiveness, whether presenting condition/diagnosis were likely to improve with lifestyle change and whether a strong therapeutic relationship was established. Conclusions Traditional acupuncturists’ reports suggest their work supports key public health targets for promoting healthy behaviours. Less frequent support for alcohol/smoking may reflect user characteristics but may suggest training needs for acupuncturists. Increase could be made for support in acute presentations, however the importance of patient receptiveness, linking advice to condition, and therapeutic alliance should be explored further. There may be important differences between acupuncture practice and mainstream healthcare (e.g. high level of contact, longer visits, holistic approach) which impact mechanisms of action of behaviour change.
... 33 On the patient demand side, having arthritic or neurological conditions are predictive of receiving acupuncture treatment, possibly to seek relief from pain symptoms. 34,35 Thus, there is growing recognition from researchers, providers, and patients that acupuncture can be used to treat pain. ...
Background: We examine the characteristics associated with the availability of therapeutic acupuncture in substance use disorder (SUD) treatment facilities in the United States (US). Methods: This study utilizes data from the 2018 National Survey of Substance Abuse Treatment Services (N-SSATS). Multivariable logistic regression was performed. Results: Only 5.5% (n = 814) of all SUD treatment facilities offered acupuncture therapy. Facilities operating an opioid treatment program (OTP) were 1.60 times more likely to offer therapeutic acupuncture than non-OTP facilities. Facilities that offered oral naltrexone pharmacotherapy or buprenorphine with naloxone pharmacotherapy were 1.63 and 1.37 times more likely to offer therapeutic acupuncture, respectively, compared to facilities that did not offer these pharmacotherapies. Federal government facilities were over four times more likely to offer acupuncture than those operated by state governments and had triple the odds of having acupuncture than private nonprofit organizations. Tribal facilities were over five times more likely than state government-operated facilities to offer acupuncture. Facilities located in the Western region of the US were 1.59, 1.39, and 1.30 times more likely than Northeastern, Midwestern, and Southern US regions, respectively, to offer acupuncture therapy. Conclusions: Although complementary and holistic approaches such as acupuncture are accepted adjunct methods to treat persons with SUD, the findings suggest that their utilization in SUD treatment facilities in the US is minimal. Results, however, highlight that facilities operated by tribal and federal governments, those that are located in the Western region of the US, and non-hospital facilities have the highest odds of incorporating therapeutic acupuncture as treatment for SUD.
... 8 According to the consensus panel report of the National Institutes of Health (NIH), acupuncture can effectively treat postoperative dental pain, 9 acupuncture has experienced significant growth in popularity and usage in the United States. 10 Electroacupuncture (EA), as a development of acupuncture, allows stimulation of a larger area around acupoints for a shorter time. Furthermore, it is quite easy to identify and quantify stimulation parameters such as intensity, duration, and frequency, 11 but the mechanisms underlying these effects remain to be clarified, EA may modulate inflammatory pain by affecting the entire nervous system, including the central nervous system (CNS), the peripheral nervous system (PNS), the immune system as well as endocrine system. ...
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Objective: To verify the efficacy of electroacupuncture (EA) on classical trigeminal neuralgia (CTN), and to observe the brain functional status of patients with CTN and the intervention effects of EA on brain function by resting-state functional magnetic resonance imaging (rs-fMRI). Methods and analysis: Thirty CTN patients will be randomly divided into EA combined with carbamazepine group and carbamazepine group in 2:1 ratio by using a random number table. Patients in EA combined with carbamazepine will receive EA treatment and carbamazepine for four weeks. The carbamazepine group will only receive carbamazepine treatment. VAS (visual analogue scale), HAMA (Hamilton Anxiety Scale), HAMD (Hamilton Depression Scale) and SF-36 (short form 36 health survey) will be performed before, after four-week treatments and at three-month follow-up in CTN patients. Six CTN patients will be randomly selected from EA combined with carbamazepine group and carbamazepine group, respectively, before treatment, and twelve paired healthy participants will be recruited at the same time. The twelve CTN patients will be scanned by rs-fMRI before and after treatment, and the healthy participants will be scanned by rs-fMRI only at baseline. Regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) analysis will be carried out to compare the dysfunctional brain regions between CTN patients and healthy participants, as well as the differences between two groups of patients with CTN after treatment. Trial registration: ChiCTR-1900027873.
Background: Evidence for acupuncture to treat pain is growing. Electrostimulation of acupuncture needles (electroacupuncture) is common for pain and is thought to augment the therapeutic effect. Objectives: To examine the association of pain outcomes after a single acupuncture session with electrostimulation included (EA) compared with no electrostimulation included (NEA). Methods: A retrospective observational study was conducted using electronic health records of acupuncture sessions for adults with acute pain under the care of an acute pain service. Paired t-test and linear regression were used to report pain intensity changes after a single acupuncture session and by including EA. Ordered logistic regression was used to report categorical pain relief. Logistic regression was used to explore the odds of adding EA and the patient's age, gender, and pretreatment pain. Results: From July 24, 2017, through November 9, 2020, 465 acupuncture sessions recorded EA (n = 194), or NEA (n = 271). Acupuncture, independent of EA status, reduced pain intensity by a mean 2.5 points. EA was associated with a mean 0.38-point reduction in pain intensity more than NEA (confidence interval [95% CI]: -0.75 to -0.01). Among sessions reporting categorical pain relief (n = 415), higher relief was more likely with EA (odds ratio = 2.16, 95% CI: 1.52-3.08). There was no association between EA and the patient's age, gender, and pretreatment pain intensity. Conclusions: After a single acupuncture session, both EA and NEA reduced pain intensity. Higher categorical pain relief was reported with EA, though the clinical meaning is uncertain. Future research should focus on well-defined populations for electroacupuncture and factors for including electrostimulation.
Background: Pain after traumatic brain injury (TBI) is common and can become chronic. Acupuncture is an increasingly popular non-pharmacologic option in the United States and is commonly used for pain. Objective: We explored demographics, injury characteristics, and pain characteristics of individuals who reported using acupuncture for chronic pain after TBI. Methods: We analyzed a subset of data collected as part of the Pain After Traumatic Brain Injury collaborative study and identified individuals reporting a history of acupuncture as part of management for chronic pain after TBI. We characterized and compared basic demographic data, pain treatment engagements, pain severity, pain interference, functional independence, and pain locations using descriptive and inferential statistics. Results: Our sample included 1,064 individuals. Acupuncture use (n = 208) was lower proportionally among females, Blacks/African Americans, Asians, less educated, and nonmilitary service members. Insurance type varied between acupuncture and non-acupuncture users. Functional and pain outcomes were similar, but acupuncture users reported a higher number of pain sites. Discussion: Acupuncture is one treatment utilized by individuals with TBI and chronic pain. Further investigation would be helpful to understand the barriers and facilitators of acupuncture use to inform clinical trials to examine the potential benefit of acupuncture on pain outcomes after TBI.
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A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990. To document trends in alternative medicine use in the United States between 1990 and 1997. Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively. A total of 1539 adults in 1991 and 2055 in 1997. Prevalence, estimated costs, and disclosure of alternative therapies to physicians. Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services. Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
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The objectives of this study were (1) to determine which Andersen Model variables [predisposing, enabling, and need (PEN)] are related to complementary and alternative medicine (CAM) use by African Americans in the past 12 months; and (2) to determine whether the addition of disease states to the Model will explain significant variation in CAM use in the past 12 months. The 2002 National Health Interview Survey was used with 4256 African American adults (n = 23,828,268 weighted) selected as the study population. The dependent variable, CAM Past 12 Months, represented participants' use of at least 1 of 17 CAM modalities during the past 12 months. The Andersen Model variables [predisposing (e.g., age); enabling (e.g., insurance); and need (e.g., medical conditions)] and prevalent disease states (> or =10%) comprised the independent variables. Logistic regression analyses, incorporating the sampling weights, were employed. Among predisposing factors, CAM use was associated with middle-aged to older, more educated, and female African Americans. Region (Northeast less likely than South) was the only significant enabling factor. Need factors had the most frequent relationships, with more medical conditions, more physician visits, better health status, prescription and over-the-counter medication use, more frequent exercise, and having activities of daily living limitations being associated with CAM use. After adjusting for PEN factors, the disease states of pain/aching joints, recurring pain, and migraine were related to CAM use. African American CAM users are middle-aged to older, female, educated, and have more medical conditions (especially pain-related). Users report higher utilization of "traditional" care (e.g., physician visits), indicating that CAM is likely a complement to conventional treatment in this population. Health care providers should use these factors as prompts for inquiring about CAM use in African American patients.
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This report presents selected estimates of complementary and alternative medicine (CAM) use among U.S. adults and children, using data from the 2007 National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). Trends in adult use were assessed by comparing data from the 2007 and 2002 NHIS. Estimates were derived from the Complementary and Alternative Medicine supplements and Core components of the 2007 and 2002 NHIS. Estimates were generated and comparisons conducted using the SUDAAN statistical package to account for the complex sample design. In 2007, almost 4 out of 10 adults had used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (17.7%) and deep breathing exercises (12.7%). American Indian or Alaska Native adults (50.3%) and white adults (43.1%) were more likely to use CAM than Asian adults (39.9%) or black adults (25.5%). Results from the 2007 NHIS found that approximately one in nine children (11.8%) used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (3.9%) and chiropractic or osteopathic manipulation (2.8%). Children whose parent used CAM were almost five times as likely (23.9%) to use CAM as children whose parent did not use CAM (5.1%). For both adults and children in 2007, when worry about cost delayed receipt of conventional care, individuals were more likely to use CAM than when the cost of conventional care was not a worry. Between 2002 and 2007 increased use was seen among adults for acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy, and yoga. CAM use for head or chest colds showed a marked decrease from 2002 to 2007 (9.5% to 2.0%).
Secondary data analysis plays an increasingly important role in epidemiology and public health research and practice, but many difficulties confront researchers and analysts who wish to use secondary data to address a research or policy question. This practical guide is the only book to provide both an introduction to secondary data analysis and a list of major sources of secondary data in the United States. Entries for each data source include the focus of the data, years available, data collection process used, and directions about how to access the data and supporting materials.
Context.— Research both in the United States and abroad suggests that significant numbers of people are involved with various forms of alternative medicine. However, the reasons for such use are, at present, poorly understood.Objective.— To investigate possible predictors of alternative health care use.Methods.— Three primary hypotheses were tested. People seek out these alternatives because (1) they are dissatisfied in some way with conventional treatment; (2) they see alternative treatments as offering more personal autonomy and control over health care decisions; and (3) the alternatives are seen as more compatible with the patients' values, worldview, or beliefs regarding the nature and meaning of health and illness. Additional predictor variables explored included demographics and health status.Design.— A written survey examining use of alternative health care, health status, values, and attitudes toward conventional medicine. Multiple logistic regression analyses were used in an effort to identify predictors of alternative health care use.Setting and Participants.— A total of 1035 individuals randomly selected from a panel who had agreed to participate in mail surveys and who live throughout the United States.Main Outcome Measure.— Use of alternative medicine within the previous year.Results.— The response rate was 69%.The following variables emerged as predictors of alternative health care use: more education (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3); poorer health status (OR, 1.3; 95% CI, 1.1-1.5); a holistic orientation to health (OR, 1.4; 95% CI, 1.1-1.9); having had a transformational experience that changed the person's worldview (OR, 1.8; 95% CI, 1.3-2.5); any of the following health problems: anxiety (OR, 3.1; 95% CI, 1.6-6.0); back problems (OR, 2.3; 95% CI, 1.7-3.2); chronic pain (OR, 2.0; 95% CI, 1.1-3.5); urinary tract problems (OR, 2.2; 95% CI, 1.3-3.5); and classification in a cultural group identifiable by their commitment to environmentalism, commitment to feminism, and interest in spirituality and personal growth psychology (OR, 2.0; 95% CI, 1.4-2.7). Dissatisfaction with conventional medicine did not predict use of alternative medicine. Only 4.4% of those surveyed reported relying primarily on alternative therapies.Conclusion.— Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life. IN 1993 Eisenberg and colleagues1 reported that 34% of adults in the United States used at least 1 unconventional form of health care (defined as those practices "neither taught widely in U.S. medical schools nor generally available in U.S. hospitals") during the previous year. The most frequently used alternatives to conventional medicine were relaxation techniques, chiropractic, and massage. Although educated, middle-class white persons between the ages of 25 and 49 years were the most likely ones to use alternative medicine, use was not confined to any particular segment of the population. These researchers estimated that Americans made 425 million visits to alternative health care providers in 1990, a figure that exceeded the number of visits to allopathic primary care physicians during the same period. Recent studies in the United States2 and abroad3- 4 support the prevalent use of alternative health care. For example, a 1994 survey of physicians from a wide array of medical specialties (in Washington State, New Mexico, and Israel) revealed that more than 60% recommended alternative therapies to their patients at least once in the preceding year, while 38% had done so in the previous month.2 Forty-seven percent of these physicians also reported using alternative therapies themselves, while 23% incorporated them into their practices. When faced with the apparent popularity of unconventional medical practices and the fact that people seem quite willing to pay out-of-pocket for these services,1 the question arises: What are the sociocultural and personal factors (health status, beliefs, attitudes, motivations) underlying a person's decision to use alternative therapies? At present, there is no clear or comprehensive theoretical model to account for the increasing use of alternative forms of health care. Accordingly, the goal of the present study was to develop some tentative explanatory models that might account for this phenomenon. Three theories that have been proposed to explain the use of alternative medicine were tested: Dissatisfaction: Patients are dissatisfied with conventional treatment because it has been ineffective,5- 6 has produced adverse effects,6- 7 or is seen as impersonal, too technologically oriented, and/or too costly.6- 15Need for personal control: Patients seek alternative therapies because they see them as less authoritarian16 and more empowering and as offering them more personal autonomy and control over their health care decisions.14,16- 19Philosophical congruence: Alternative therapies are attractive because they are seen as more compatible with patients' values, worldview, spiritual/religious philosophy, or beliefs regarding the nature and meaning of health and illness.19- 24 In addition to testing the validity of these 3 theoretical perspectives, this study also sought to determine on an exploratory basis how the decision to seek alternative therapies is affected by patients' health status and demographic factors.
Direct marketers typically attempt to improve the effectiveness of their campaigns by targeting their best customers. In the author's experience, many direct marketers are unaware that typical target methods develop a descriptive profile of their target customer — an approach that often results in less than successful campaigns. The purpose of this paper is to illustrate the inadequacy of the descriptive approach and to demonstrate the benefits of the correct predictive profiling approach. The predictive profiling approach is explained, and then the approach to look-alike profiling is expanded.Journal of Targeting, Measurement and Analysis for Marketing (2001) 10, 66-78; doi:10.1057/palgrave.jt.5740034
Acupuncture use remains common in the United States, yet little is known of its utilization by minority and underserved populations. Herein we report first visit data capturing patient profiles, types of conditions presented, and self-reports of their experience and satisfaction with acupuncture accessed at a free care clinic with in a large urban safety net hospital. Sixty-one adult, English-speaking acupuncture patients were given a 20 min survey after their first visit to a free care acupuncture clinic. Patients were from 12 different countries. Fifty-six percent of the participants were minorities. Sixty-five percent of respondents were female. Average age was 42.1. Eighty percent were acupuncture naïve. Patients' health complaints were similar to those of other surveyed mainstream patients with 57% reporting musculoskeletal conditions. Ninety-three percent would recommend a friend or family for acupuncture, 97% rating their overall experience with the acupuncture clinic as either very good or good. When made available to a diverse population of patients, acupuncture is utilized and perceived to be helpful. In this survey, patients sought treatment for musculoskeletal conditions and were satisfied with their first visit. Future research is warranted.
Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies. Additional competencies for primary health partners, including CAM and conventional medical providers, will need to be developed to foster successful integrative practices. Skills include learning to develop appropriate healthcare teams that function well in a medical home, developing an understanding of the diverse healing traditions, and enhancing communication skills. For integrative medicine to flourish in the United States, new providers, new provider models, and a realignment of incentives and a commitment to health promotion and disease management will be required.