The timing of initial use of CAM therapies in treating the current health problem is shown in Figure 2. In general, one third of all users of CAM therapies initiated treatment with one or more therapies before their initial visit to a primary care physician for the same clinical problem. Thirty-seven percent initiated use of CAM concurrent with (ie, within 2 weeks) of their initial visit to a primary care provider, and 1 in 5 (19%) initiated use of a CAM therapy after their initial primary care visit. One third (36%) of those using practitioner-based and self-care–based therapies and 46.2% of those using traditional folk remedies reported initiating therapy before a visit with a primary care provider. One third (36%) of the users of self-care–based therapies, 43% of users of practitioner-based therapies, and none of the users of traditional folk remedies reported using such a therapy concurrent with their initial clinic visit. One in 4 of the practitioner-based therapies (24.6%) and traditional folk remedies (23.1%) and 14% of users of self-care–based therapies reported initiating use after their initial visit to a primary care provider.
Approximately 1 in 4 patients reported using CAM to avoid side effects of regular treatment because a friend or coworker had recommended the treatment or because conventional treatment had failed to cure the problem Table 1. Between 10% and 15% of the patients reported using these therapies for philosophical reasons, because they preferred to deal with the problem by themselves, or because older family members had used these treatments for the same problem. Only 7 patients reported using therapies because they were unhappy with the attitude of family physicians. When examined by class of therapy, approximately 1 in 3 users of practitioner-based therapies reported using them to avoid the side effects of regular treatment, failure of regular treatment to cure their problem, and a recommendation from a friend or coworker. In addition to a preference for dealing with the problem by themselves, these 3 reasons (side effects, failure of regular treatment, and a recommendation from a friend) were also the primary reasons for use of self-care– based therapies. In contrast, use by parents and relatives for the same problem represented the primary reason for traditional folk remedies, accounting for slightly less than one third (30.8%) of the patients using them.
Predictors of CAM Use
A comparison of the social and demographic characteristics of users and nonusers of CAM is provided in Table 2. Use of CAM therapies was positively associated with level of education but inversely associated with level of acculturation. When examined by specific categories of CAM, women were significantly more likely than men to use herbal remedies (P <.05; data not shown) and other self-care– based forms of alternative medicine and traditional folk medicines. Level of education was positively associated with self-care–based forms of CAM in general and use of herbal (P <.001; data not shown) and dietary (P <.05; data not shown) remedies in particular. However, education was inversely associated with use of traditional folk remedies. Self-care-based therapies in general and herbal remedies in particular (P <.05; data not shown) were significantly associated with the level of household income. Use of traditional folk remedies was significantly associated with Hispanic ethnicity, place of birth, and low acculturation. Dietary remedies were positively associated with level of acculturation (P <.05; data not shown). Patients belonging to an health maintenance organization or possessing other forms of non-government-sponsored insurance were significantly more likely to use massage therapy (P <.05; data not shown) or herbal remedies (P <.05; data not shown).
The health status and quality of well-being of users and nonusers of CAM therapies and therapists is provided in Table 3. Users of CAM therapies reported significantly lower emotional role functioning and perceived general health compared with nonusers of the same age. Users of practitioner-based therapies reported significantly lower social functioning, physical and emotional role functioning, mental health, and perceived general health, and more pain than nonusers. Users of self-care–based therapies and traditional folk remedies reported significantly lower levels of general health than a year ago. Users of acupuncture (P=.03; data not shown) and chiropractors (P=.001; data not shown) reported significantly lower levels of general perceived health than nonusers (data not shown). Users of chiropractors also reported significantly higher levels of pain (P=.015; data not shown) than nonusers.
Musculoskeletal problems, usually back pain, were cited as the most common health problem associated with CAM use, followed by endocrine and metabolic diseases (primarily diabetes or obesity), diseases of the respiratory system (primarily asthma), and diseases of the genitourinary system Table 4. CAM users were approximately twice as likely as nonusers to have a musculoskeletal system disorder and 2.5 times as likely to have a genitourinary system disorder. Users of practitioner-based therapies were 2.7 times as likely to have a musculoskeletal system disorder as nonusers. Users of chiropractors were 3.7 times (P <.001; data not shown) and users of massage therapy were 2.2 times (P <.05; data not shown) as likely to have a musculoskeletal disorder as nonusers.