Number 79 n February 10, 2015

Trends in the Use of Complementary Health

Approaches Among Adults: United States, 2002–2012

by Tainya C. Clarke, Ph.D., M.P.H., Lindsey I. Black, M.P.H., National Center for Health Statistics;
 

Barbara J. Stussman, B.A., National Institutes of Health; Patricia M. Barnes, M.A., National Center for Health
 

Statistics; and Richard L. Nahin, Ph.D., M.P.H., National Institutes of Health
 

Abstract

Objective—This report presents national estimates of the use of

complementary health approaches among adults in the United States across three

time points. Trends in the use of selected complementary health approaches are

compared for 2002, 2007, and 2012, and differences by selected demographic

characteristics are also examined.

Methods—Combined data from 88,962 adults aged 18 and over collected as

part of the 2002, 2007, and 2012 National Health Interview Survey were

analyzed for this report. Sample data were weighted to produce national

estimates that are representative of the civilian noninstitutionalized U.S. adult

population. Differences between percentages were evaluated using two-sided

significance tests at the 0.05 level.

Results—Although the use of individual approaches varied across the three

time points, nonvitamin, nonmineral dietary supplements remained the most

popular complementary health approach used. The use of yoga, tai chi, and qi

gong increased linearly across the three time points; among these three

approaches, yoga accounted for approximately 80% of the prevalence. The use of

any complementary health approach also differed by selected sociodemographic

characteristics. The most notable observed differences in use were by age and

Hispanic or Latino origin and race.

Keywords: prevalence • nonvitamin, nonmineral dietary supplements • yoga

Introduction

Complementary health approaches

include an array of modalities and

products with a history of use or origins

outside of conventional Western

medicine. Previous studies have shown

that individuals often use

complementary health approaches to

improve health and wellbeing (1,2) or to

relieve symptoms associated with

chronic diseases or the side effects of

conventional medicine (3,4). In the

United States, most persons who use

complementary health approaches do so

to complement conventional care, rather

than as a replacement (5–7). Using data

from the 2002 National Health Interview

Survey (NHIS), Nahin et al. (8) found

that less than 5% of all U.S. adults used

complementary health approaches but

not conventional care. Previous research

has also shown differences in the use of

complementary health approaches by

demographic characteristics such as sex

and age (9,10). While knowledge of

various types of complementary health

approaches has increased among the

U.S. population, the use of individual

approaches has fluctuated across the

years (11).

To better understand the patterns of

use of complementary health

approaches, this report describes the

prevalence of adults using selected

complementary health approaches and

characterizes selected sociodemographic

characteristics of such users. Because

nonvitamin, nonmineral dietary

supplements are the most commonly

used complementary health approach

among U.S. adults, after vitamins and

prayer (12), individual supplements are

also examined.

Methods

Data source

Analyses in this report were based

on data collected from a combined

sample of 88,962 adults aged 18 and

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2 National Health Statistics Reports n Number 79 n February 10, 2015

over as part of the 2002, 2007, and

2012 Adult Alternative Medicine (ALT)

supplements to NHIS, with demographic

and other health information from the

Household, Sample Adult Core, and

Family Core components. NHIS is a

nationally representative, cross-sectional

household interview survey that is

fielded continuously by the Centers for

Disease Control and Prevention’s (CDC)

National Center for Health Statistics

(NCHS), and it produces annual

estimates of the health of the U.S.

civilian noninstitutionalized population.

Interviews are conducted in the home

using a computer-assisted personal

interview questionnaire, with telephone

follow-up permitted if necessary. A

detailed description of the NHIS sample

design and the survey questionnaires for

specific years are available elsewhere

(13–15).

The Household and Family Core of

NHIS collect health and

sociodemographic information on each

member of all families residing within a

sampled household. Within each family,

additional information is collected from

one randomly selected adult (the

‘‘sample adult’’) aged 18 and over with

the Sample Adult Core.

In 2002, 2007, and 2012, the ALT

supplement was administered to the

sample adult respondent. Sponsored by

the National Center for Complementary

and Integrative Health [(NCCIH)

formerly the National Center for

Complementary and Alternative

Medicine], part of the National Institutes

of Health (NIH), the ALT supplement

was implemented in order to provide a

national data source on complementary

medicine use. Since its inception in

2002, much of the content of the ALT

supplement has remained constant, but

modifications have been made in order

to accommodate emerging scientific

information, expert panel input, and

societal shifts. Although the approaches

included have varied slightly across

survey years, the following were

included in all three questionnaires:

acupuncture; Ayurveda; biofeedback;

chelation therapy; chiropractic care;

energy healing therapy; hypnosis;

massage; naturopathy; nonvitamin,

nonmineral dietary supplements;

homeopathic treatment; diet-based

therapies; yoga; tai chi; qi gong; and

meditation and other relaxation

techniques.

Detailed differences between the

three NHIS ALT supplement

questionnaires can be found elsewhere

(10,16). Briefly, use of a practitioner for

chiropractic care was asked about in

2002. In 2007, participants were asked

about use of a chiropractor or osteopath,

however no real specificity was gained,

as use of both types of manipulation

were grouped together. This question

was repeated in 2012, with the addition

of follow-up questions asking whether a

chiropractor, osteopath, or both were

seen. Also in 2007, a list of named

traditional healers replaced the more

general question of seeing a practitioner

of folk medicine, and questions about

the use of movement therapies were

added. In 2012, craniosacral therapy was

added to the questionnaire.

In order to provide greater detail on

meditation, in 2012 the type of

meditation practiced was specified as

mantra, mindfulness, or spiritual.

Combining the prevalence of all three

types of meditation may permit the

comparison of the general practice of

meditation across the three time points;

however, these comparisons may be

affected by the change in question

format on the 2012 supplement. Based

on cognitive testing and

recommendations from a NCCIH think

tank in 2012, information about the use

of deep-breathing exercises was not

asked as a stand-alone question but was

collected as part of other approaches,

including hypnosis, biofeedback,

meditation, guided imagery, progressive

relaxation, yoga, tai chi, and qi gong.

While this change reduced the

percentage of false-positive responses,

direct comparison to previous survey

years was lost. The list of nonvitamin,

nonmineral dietary supplements was

expanded from 35 in 2002, to 45 in

2007, and 119 in 2012. In addition, the

2002 questionnaire included a 12-month

recall period for use of named

nonvitamin, nonmineral dietary

supplements, whereas the 2007

questionnaire included a 30-day recall

period. As an improvement, the 2012

survey included both 30-day and

12-month recall periods for named

nonvitamin, nonmineral dietary

supplements. Comparisons of use in the

past 30 days were consequently

restricted to 2007 and 2012.

In order to compare overall use of

complementary health approaches across

all three time points, recalculation of

approaches that changed across years

was restricted to the narrowest definition

on any one questionnaire. Individual

approaches that were not directly

comparable across all three time points

were not included in trend analyses.

Measure of complementary

health approach use

For this report, the definition of any

complementary approach included the

use of one or more of the following

during the past 12 months: acupuncture;

Ayurveda; biofeedback; chelation

therapy; chiropractic care; energy

healing therapy; special diets (including

vegetarian and vegan, macrobiotic,

Atkins, Pritikin, and Ornish); folk

medicine or traditional healers; guided

imagery; homeopathic treatment;

hypnosis; naturopathy; nonvitamin,

nonmineral dietary supplements;

massage; meditation; progressive

relaxation; qi gong; tai chi; or yoga.

Due to the modifications in the three

questionnaires as outlined above, only

these approaches were asked about

consistently across the three time points.

Their use creates the most uniformed

definition to assess trends.

Demographic variables

Demographic characteristics of U.S.

adults presented in this report include

sex, age group, Hispanic or Latino

origin and race, educational attainment,

poverty status, and health insurance

coverage. All demographic

characteristics were measured at the

time of the interview.

Hispanic or Latino origin and race

were determined from two separate

questions, and individuals may have

identified as Hispanic or Latino origin

regardless of race. For conciseness, the

text and tables in this report use shorter
National Health Statistics Reports n Number 79 n February 10, 2015	 Page 3

versions of the 1997 Office of

Management and Budget terms for

Hispanic origin and race. For example,

the category ‘‘Non-Hispanic or nonLatino, black or African American,

single race’’ is referred to as ‘‘nonHispanic black.’’ Due to insufficient

sample size, ‘‘non-Hispanic Asian,’’

‘‘non-Hispanic Other Pacific Islander,’’

and ‘‘non-Hispanic American Indian

Alaska Native’’ were combined to form

the category ‘‘non-Hispanic other

races.’’

Educational attainment was

collected from all adults aged 18 and

over and was categorized in reference to

the highest degree completed at the date

of the interview. Household income was

also collected, and percentage of poverty

level was based on a comparison of

each respondent’s household income

with the poverty thresholds for the

family size, as defined by the U.S.

Census Bureau. Imputations for income

were not used.

Health insurance was categorized

into three mutually exclusive categories:

private, public, and uninsured. Persons

with more than one type of health

insurance were assigned to their primary

insurance category in the following

hierarchy: private, public, and uninsured.

A more detailed description of these

demographic variables can be found in

Technical Notes.

Statistical analyses

Estimates in this report were

calculated using the sample adult

sampling weights and are representative

of the noninstitutionalized population of

U.S. adults aged 18 and over. Data

weighting procedures are described in

more detail elsewhere (17,18). Point

estimates, and estimates of their

variances, were calculated using

SAS-callable SUDAAN version 11.0.0

(19), a software package that accounts

for the complex sample design of NHIS.

Estimates were age-adjusted using the

projected 2000 U.S. population as the

standard population in order to compare

various demographic subgroups that

have different age distributions (20,21).

Unless otherwise specified, the

denominator used was all adults aged 18

and over. Calculations excluded persons

with unknown information.

Estimates were compared using

two-sided t tests at the 0.05 level and

assuming independence. Terms such as

‘‘greater than’’ and ‘‘less than’’ indicate

a statistically significant difference.

Terms such as ‘‘not significantly

different’’ or ‘‘no difference’’ indicate

that there were no statistically detectable

differences between the estimates being

compared. Reliability of estimates was

evaluated using the relative standard

error (RSE), which is the standard error

divided by the point estimate. Estimates

with RSEs greater than 30% and less

than or equal to 50% are considered

unreliable and are preceded by a dagger

symbol (†) in Table 1.

The SAS procedure PROC

SURVEYLOGISTIC (22) with

orthogonal polynomial trend contrasts

was used to perform weighted linear or

quadratic regressions of the annual

design-adjusted rates for each variable

of interest. This procedure incorporates

the complex survey sample design of

NHIS, including stratification,

clustering, and unequal weighting. This

model tests the parallel-lines assumption

by simultaneously testing the equality of

separate slope parameters for each

variable. The variances of the regression

parameters were computed using the

Taylor series (linearization) method to

estimate the sampling errors of

estimators based on the complex sample

design. This method will be used for all

trend analyses in this report series.

Strengths and limitations of

data

A major strength of these analyses

is that the data are from a nationally

representative sample of U.S. adults,

allowing for population estimates. The

large sample size allows for estimation

of the use of complementary health

approaches by a wide variety of

population subgroups and other

self-reported health characteristics

collected in NHIS.

The data in this report also have

some limitations. NHIS is a crosssectional survey, and causal associations

cannot be made. Responses are

dependent on participants’ recall of

complementary health approaches that

they used in the past 12 months, as well

as their willingness to report their use

accurately. Additionally, in an effort to

improve the validity of the questions

asked and to meet NCCIH’s research

priorities, revisions to the content and

structure of some questions preclude

direct comparison across years, limiting

analysis of trends to approaches that

were asked about consistently on each

questionnaire.

Results

Adult use of selected

complementary health

approaches

Complementary health approaches

encompass a wide range of modalities.

Table 1 presents the prevalence of and

trends in the use of commonly used

complementary health approaches in

2002, 2007, and 2012. Although there

was consistency in the types of

approaches that were most popular,

there was variation in the trends across

time points.

+	 Nonvitamin, nonmineral dietary

supplements were the most

commonly used complementary

health approach at each of the three

time points: 18.9% in 2002 and

unchanged from 2007 to 2012

(17.7%).

+	 Whether used independently or as a

part of other approaches, deepbreathing exercises were the second

most commonly used complementary

health approach in 2002 (11.6%),

2007 (12.7%), and 2012 (10.9%).

+	 The use of yoga, tai chi, and qi gong

increased linearly over the three time

points, beginning at 5.8% in 2002,

6.7% in 2007, and 10.1% in 2012.

Yoga was the most commonly used

of these three approaches at all three

time points (Figure 1).

+	 There was a small but significant

linear increase in the use of

homeopathic treatment, acupuncture,

and naturopathy.

+	 The use of chiropractic care or

chiropractic and osteopathic
 

Page 4	 National Health Statistics Reports n Number 79 n February 10, 2015

 

Figure 1. Use of yoga, tai chi, and qi gong among adults in the past 12 months:

United States, 2002, 2007, and 2012

manipulation was the fourth most

commonly used approach in 2002

(7.5%), 2007 (8.6%), and 2012

(8.4%).

+	 Meditation was used by 7.6% of

adults in 2002, 9.4% in 2007, and

8.0% in 2012, keeping it among the

top five most commonly used

approaches for each time point.

+	 Ayurveda, biofeedback, guided

imagery hypnosis, and energy healing

therapy had a consistently low

prevalence and had no significant

changes across the three time points.

Overall use of

complementary health

approaches, by selected

characteristics

Among U.S. adults aged 18 and

over in 2002, 2007, and 2012, the

percentage who used any

complementary health approach in the

past 12 months ranged from 32.3% in

2002 to 35.5% in 2007 and was most

recently 33.2% in 2012. Table 2

highlights trends in the use of

complementary health approaches by

sex, age group, Hispanic or Latino

origin and race, education, poverty

status, and health insurance coverage.

+ There was a quadratic change in the

overall use of any complementary

health approach across the three time

points with a peak of 35.5% in 2007.

+ There was a significant quadratic

trend in the use of complementary

health approaches among both men

and women across the three time

points. The use of any

complementary health approach

increased by 3.5 percentage points

among men from 2002 to 2007 but

decreased by 2.5 percentage points

from 2007 to 2012. There was a

3.0 percentage point increase in use

among women from 2002 to 2007;

however, there were no further

significant differences between other

time points.

+	 There were no significant changes in

the prevalence of any complementary

health approach between each time

point for adults aged 18–44 (33.0% in

2002, 34.2% in 2007, and 32.2% in

2012). There was an increase from

36.5% in 2002 to 40.1% in 2007, and

then a decrease to 36.8% in 2012

among adults aged 45–64. The use of

any complementary health approach

also increased among adults aged 65

and over from 2002 to 2007, from

22.7% to 31.1%; but no significant

change was observed between 2007

and 2012 (31.1% to 29.4%).

+	 From 2002 to 2012, there was a

significant quadratic trend for

Hispanic adults (26.4% in 2002,

21.6% in 2007, and 22.0% in 2012)

and non-Hispanic white adults (34.4%

in 2002, 40.2% in 2007, and 37.9%

in 2012). However, a significant

linear trend was observed for

non-Hispanic black adults (22.9% in

2002 and 2007 and 19.3% in 2012)

and non-Hispanic other adults (41.5%

in 2002, 39.6% in 2007, and 37.3%

in 2012).

+	 There were significant quadratic

trends in the use of complementary

approaches among adults with less

than a high school diploma (18.6% in

2002, 18.9% in 2007, and 15.6% in

2012); adults with a high school

diploma or GED (General

Educational Development high school

equivalency diploma) (26.6% in

2002, 28.1% in 2007, and 24.4% in

2012); adults with some college

education (35.6% in 2002, 41.3% in

2007, and 36.5% in 2012); and those

with a college degree or higher

(42.1% in 2002, 46.7% in 2007, and

42.6% in 2012).

+	 There was a significant quadratic

trend in the use of complementary

approaches among poor adults (25.1%

in 2002, 26.6% in 2007, and 20.6%

in 2012) and not-poor adults (36.8%

in 2002, 40.3% in 2007, and 38.4%

in 2012); and a linear trend among

near-poor adults (27.7% in 2002,

27.9% in 2007, and 25.5% in 2012).

+	 There was a significant quadratic

trend in the use of any

complementary health approach

among all insured groups: those with
 

National Health Statistics Reports n Number 79 n February 10, 2015	 Page 5

 

Figure 2. Use of yoga among adults in the past 12 months, by age group: United States,

2002, 2007, and 2012

private insurance (34.6% in 2002,

39.0% in 2007, and 38.0% in 2012)

and public coverage (25.8% in 2002,

27.0% in 2007, and 24.8% in 2012)

as well as the uninsured (28.4% in

2002, 27.8% in 2007, and 22.9% in

2012).

Use of selected nonvitamin,

nonmineral dietary

supplements in 2007 and

2012

Although there was no change in

the percentage of overall use of

nonvitamin, nonmineral dietary

supplements among adults from 2007 to

2012, there was variability in the use of

specific types of supplements. Table 3

presents the prevalence of selected

nonvitamin, nonmineral dietary

supplements used in the past 30 days.

Estimates are limited to 2007 and 2012

because a 30-day supplement recall was

not included in the 2002 questionnaire.

+ Fish oil supplements and

glucosamine, chondroitin, or a

combination supplement were

consistently the two most common

nonvitamin, nonmineral dietary

supplements used in the past 30 days

in 2007 and 2012.

+ Fish oil use among adults increased

from 4.8% in 2007 to 7.8% in 2012.

Probiotic or prebiotic use was four

times as high in 2012 as it was in

2007 (1.6% and 0.4%, respectively),

rising to the third most commonly

used nonvitamin, nonmineral dietary

supplement in 2012.

+ The use of melatonin more than

doubled in use from 0.6% in 2007 to

1.3% in 2012.

+ There was a decrease in use of

glucosamine, chondroitin, or a

combination pill from 2007 to 2012,

from 3.2% to 2.6%.

+ From 2007 to 2012, there was also a

significant decline in the use of

echinacea (1.3 percentage points),

garlic (0.6), ginseng (0.8), ginkgo

biloba (0.6), methylsulfonylmethane

(MSM) (0.2), and saw palmetto (0.3).

Use of yoga by age group

and year

The most notable differences in the

use of any complementary health

approach were seen by age group. To

further understand age differences,

Figure 2 presents one of the most

commonly used approaches, yoga, by

age group for 2002, 2007, and 2012.

+	 While all age groups showed an

increased use of yoga over the

10-year period, the use of yoga

decreased with age (from 6.3% in

2002 to 11.2% in 2012 among those

aged 18–44; 5.2% in 2002 to 7.2% in

2012 among those 45–64; and 1.3%

in 2002 to 3.3% in 2012 among those

65 and over) (Figure 2).

+	 Adults aged 18–44 had the highest

prevalence of use across all three

time points. The increase in use of

yoga among this group from 2007 to

2012 (3.3 percentage points) was

more than twice the increase in use

between 2002 and 2007

(1.6 percentage points).

+	 There were no significant differences

observed in the use of yoga between

2002 and 2007 among adults aged

45–64 and those aged 65 and over;

however, there was an increase in the

use of yoga between 2007 and 2012

for both age groups (1.8 and

1.3 percentage points, respectively).

Use of yoga by Hispanic or

Latino origin and race and

year

The use of yoga varied by Hispanic

or Latino origin and race over the three

time points; Figure 3 presents these

changes.

+	 There was no significant change in

the use of yoga among Hispanic

adults between 2002 (2.8%) and 2007

(2.7%); however, the use of yoga

among this group almost doubled

between 2007 and 2012 (5.1%).

Non-Hispanic black adults
 

Page 6	 National Health Statistics Reports n Number 79 n February 10, 2015 Percent 

16 

14 

12 

10
 

8
 

6
 

4
 

2
 

0
 

Total 

95% confidence interval. 

 

Hispanic Non-Hispanic white Non-Hispanic black Non-Hispanic other 

1

Significantly different from 2007 and 2012 (p < 0.05).
 2

Significantly different from 2012 (p < 0.05).
 3

Significantly different from 2002 and 2007 (p < 0.05). 


NOTES: Estimates are age-adjusted using the projected 2000 U.S. population as the standard population and four age groups: 18–24, 25–44, 45–64, and 65 and over. Estimates are based on 


household interviews of a sample of the civilian noninstitutionalized population.
 

SOURCE: CDC/NCHS, National Health Interview Survey, 2002, 2007 and 2012.
 

Figure 3. Use of yoga among adults in the past 12 months, by Hispanic origin and race: United States, 2002, 2007, and 2012

demonstrated a similar pattern of use

across time (2.5% in 2002, 3.0% in

2007, and 5.6% in 2012) (Figure 3).

+	 Non-Hispanic white adults

demonstrated a consistent increase in

the use of yoga across the three time

points, from 5.8% in 2002 to 11.2%

in 2012.

+	 While there was no significant

difference in the use of yoga among

non-Hispanic other adults from 2002

(7.4%) to 2007 (8.9%), their use

increased by almost 30% from 2002

to 2012 (12.1%).

Discussion

In response to queries from

researchers, practitioners, and users of

complementary health approaches, this

report presents data from the 2002,

2007, and 2012 NHIS on the use of

complementary health approaches

among civilian noninstitutionalized U.S.

adults aged 18 and over. It focuses on

the prevalence and trends of selected

complementary health approaches used

in the past 12 months, selected

characteristics of adults who used any

complementary health approach, and the

use of selected nonvitamin, nonmineral

dietary supplements in the past 30 days.

The objective was to provide the most

current estimates of a wide range of

complementary health approaches that

are used by U.S. adults, to characterize

user demographics, and to monitor

changes over the three time points.

This report is one of the first to

estimate the prevalence of

complementary health approaches

among U.S. adults using the 2012

NHIS. Overall, 34% of adults used any

complementary health approach in 2012.

Despite the lack of a consistent

definition as to which approaches are

included in the measure of

complementary health approaches,

estimates of the overall use of any

complementary health approach

presented in this study are consistent

with previous research (9,10,23–25).

Estimates for the use of individual

approaches and demographic

characteristics are also consistent with

previous reports (9,10). Because a

narrower definition was used in this

report, it is not surprising that the

revised prevalence estimates for 2002

and 2007 were lower than those

published previously: 32.3% compared

with 35.0% for 2002 (9) and 35.5%

compared with 38.0% for 2007 (10).

Without taking into consideration which

complementary health approaches are

included in the definition of any

complementary health approach,

comparison of the prevalence may be

misleading across studies. This

confusion with definitions has led to an

effort to establish an internationally

accepted standard for what approaches

should be included in prevalence

surveys of complementary health

approaches (26).

Previous research using NHIS and

other surveys found that the use of any

complementary health approach has
National Health Statistics Reports n Number 79 n February 10, 2015	 Page 7

been increasing, and some reports

speculated that this increasing trend

would continue (23–25). However,

results from this report show that while

the overall use of complementary health

approaches displayed a slight increase

between 2002 and 2007, in 2012 use

among U.S. adults was not significantly

different from 2002. Distinct from the

trend in use of any complementary

health approaches, there have been

variations in the magnitude and

direction of the trends of individual

approaches. Nonvitamin, nonmineral

dietary supplements; deep-breathing

exercises; yoga, tai chi, and qi gong;

and chiropractic or osteopathic

manipulation were consistently popular

approaches over the three time points,

regardless of changes to some questions

across survey time points. Among these

approaches, yoga, tai chi, and qi gong

showed an increase, and deep-breathing

exercises and chiropractic or osteopathic

manipulation had no significant change

between 2002 and 2012. Although some

questions have been changed every

survey year, the estimates do not reflect

overly abundant increases or decreases

in any one approach.

In addition to comparing the

prevalence in use between time points,

further examination of selected

approaches revealed significant

differences among age and Hispanic or

Latino origin and race groups. The only

group of approaches to significantly

increase each year was the use of yoga,

tai chi, or qi gong. Given that all three

often incorporate low-intensity forms of

exercise that can be scaled to an

individual’s abilities, the increased

popularity across all ages and Hispanic

origin and race groups was expected.

Offered in a variety of settings ranging

from self-practice to specialized studios,

the yoga industry has experienced

growth in recent years, making it more

accessible to adults of all ages (27).

Previous research has noted

variations in use of complementary

health approaches by race and Hispanic

origin. This report found that Hispanic

and non-Hispanic black adults had a

decreasing pattern of use of any

complementary health approach while

non-Hispanic white adults had an

increasing pattern of use. Other studies

have examined how length of stay in the

United States and race and ethnicity

may help explain differences in the use

of complementary health

approaches (28).

The health benefits of nonvitamin,

nonmineral dietary supplements are

unclear. Despite this, such supplements

were consistently the most used

complementary health approach across

the three time points. Overall trends in

the prevalence of use of any nonvitamin,

nonmineral supplements need to be

qualified by the observations of a

significant increase in the use of certain

individual supplements: fish oil;

probiotics or prebiotics; and melatonin;

and decreases in the use of glucosamine,

chondroitin, or both; echinacea; garlic;

ginseng; ginkgo biloba; MSM; and saw

palmetto (Table 3).

Health advocates and physicians

have been recommending fish oil

supplementation (29,30), although its

benefits are not well understood.

Research has suggested that fish oil can

reduce blood pressure (31) and

inflammation (32), increase brain blood

flow (33), and provide structural

strength for neurons (34,35). The data

for this report showed a 60% increase in

the 30-day prevalence of using fish oils

between 2007 and 2012. The use of

other supplements such as melatonin

and probiotics or prebiotics also

increased. Consistent with the report’s

findings, market research indicates a

significant increase in sales of these

products over the past 5 years (36,37).

Although beyond the scope of this

report, the reasons for using

complementary health approaches may

help explain the differences in the trends

among demographic groups. The NHIS

ALT supplements were designed to help

guide the NIH research agenda, and they

have evolved to adapt to NCCIH’s

evolution in priorities from disease

treatment to a focus on symptom

management and the promotion of

optimal health (38,39). These

supplements provide the most

comprehensive source of information on

complementary health approaches used

by U.S. adults. Building upon previous

reports, this report is helpful for

monitoring changing patterns in

complementary health approach use.

Additionally, this report shows that

looking exclusively at the overall use of

complementary health approaches can

miss meaningful differences in the use

of individual approaches.

While substantial revisions to the

content and structure of the ALT

supplements since 2002 (16) preclude

direct comparisons of some approaches

across all three time points, it is still

possible to compare the prevalence of

some of these approaches between two

consecutive supplements. The

prevalence rates of complementary

health approaches will differ by survey

year and by publication without using

uniformed definitions. As such, data

users are advised to carefully define the

broad term of complementary health

approaches and recalculate specific

therapies, where possible, to facilitate

direct comparisons.

References

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Müllner M, Kundi M, Kaye AD. Use

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dietaryguidelines2010.pdf.

31. Fredman G, Serhan CN. Specialized

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anti-inflammatory and pro-resolution

lipid mediators. Nat Rev Immunol

8(5):349–61. 2008.

33. Jackson PA, Reay JL, Scholey AB,

Kennedy DO. DHA-rich oil

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34. Litman BJ, Niu SL, Polozova A,

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35. Mitchell DC, Niu SL, Litman BJ.

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Bluementhal M. Herb supplement

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11–7643, D458. 2011.
complementary health approaches during the past 12 months, by type of approach: United States, 2002, 2007, and 2012

Test for trend

2002 2007 2012 Percentage point change

Age-adjusted Age-adjusted Age-adjusted

percent1 percent1 percent1

Number (in (standard Number (in (standard Number (in (standard 2002– 2007– 2002–

thousands) error) thousands) error) thousands) error) 2007 2012 2012 Trend

. . .

......

...

...

...

...

38,183

23,457

11,766

15,22615,33610,052

6,765

18.9 (0.28)

11.6 (0.24)

5.8 (0.17)7.5 (0.19)7.6 (0.20)5.0 (0.16)3.3 (0.12)

38,797

27,79414,43618,74020,54118,068

6,040

17.7 (0.37)

12.7 (0.30)

6.7 (0.22)8.6 (0.27)9.4 (0.27)8.3 (0.23)2.8 (0.14)

40,579

24,21822,28119,36917,948

15,411

6,853

17.7 (0.37)

10.9 (0.26)10.1 (0.25)

8.4 (0.22)8.0 (0.21)6.9 (0.15)3.0 (0.13)

††

§1.1

0.9

††

§1.8

§3.3

0.1

0.0

††

§2.5

–0.2

††

§–1.6

§–0.6

††††

§3.4

††††

§1.9

–0.5

††††

*Linear

††††

*Quadratic

**Quadratic

...

...

3,4336,185

1.7 (0.09)3.0 (0.12)

3,9096,454

1.8 (0.11)

2.9 (0.15)

5,0464,766

2.2 (0.11)

2.1 (0.10)

0.1

–0.1

0.4 §–0.8 0.5 §–0.9

***Linear

*Linear

... 4,194 2.1 (0.10) 4,866 2.2 (0.16) 3,846 1.7 (0.10) 0.1 –0.5 –0.4 None

... 2,136 1.1 (0.07) 3,141 1.4 (0.10) 3,484 1.5 (0.08) 0.3 0.1 0.4 ***Linear

... 1,080 0.5 (0.05) 1,216 0.5 (0.06) 1,077 0.5 (0.05) 0.0 0.0 0.0 None

... 498 0.2 (0.03) 729 0.3 (0.04) 957 0.4 (0.04) 0.1 0.1 0.2 **Linear

... 505 0.2 (0.03) 561 0.2 (0.04) 347 0.1 (0.03) 0.0 –0.1 –0.1 None

... 278 0.1 (0.02) 362 0.2 (0.04) 281 0.1 (0.02) 0.1 –0.1 0.0 None

... 154 †0.1 (0.02) 214 †0.1 (0.03) 241 0.1 (0.02) 0.0 0.0 0.0 None

lative standard error greater than 30% and less than or equal to 50% and should be used with caution. 

ant at p < 0.05.

ges was all sample adults. 

athing exercises as part of hypnosis; biofeedback; Mantra meditation (including Transcendental Meditation, Relaxation Response, and Clinically Standardized Meditation); mindfulness meditation

ulness-based stress reduction, and mindfulness-based cognitive therapy); spiritual meditation (including centering prayer and contemplative meditation); guided imagery; progressive relaxation; yoga; tai

eathing exercises was asked broadly and not if used as part of other complementary health approaches. No trend analyses were conducted on the use of deep-breathing exercises. 

dly, and osteopathic approach was not specified on the survey. No trend analyses were conducted on the use of chiropractic or osteopathic manipulation. 

ding Transcendental Meditation, Relaxation Response, and Clinically Standardized Meditation); mindfulness meditation (including Vipassana, Zen Buddhist meditation, mindfulness-based stress

spiritual meditation (including centering prayer and contemplative meditation); and meditation used as a part of other practices (including yoga, tai chi, and qi gong). In 2002 and 2007, the use of

part of other complementary health approaches. 

for 2 weeks or more in the past 12 months. Special diets included vegetarian (including vegan), macrobiotic, Atkins, Pritikin, and Ornish diets. 

ht treatment from a homeopathic practitioner and those who self-medicated.

cted 2000 U.S. population as the standard population and using four age groups: 18–24, 25–44, 45–64, and 65 and over. The denominators for statistics shown exclude persons with unknown

Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.

vey, 2002, 2007, and 2012.

Page 10 National Health Statistics Reports n Number 79 n February 10, 2015
National Health Statistics Reports n Number 79 n February 10, 2015 Page 11

Table 2. Trends in the use of complementary health approaches among adults aged 18 and over, by selected characteristics:

United States, 2002, 2007, and 2012

2002 2007 2012 Percentage point change

Age-adjusted Age-adjusted

Age-adjusted percent1 percent1

Number (in percent1 Number (in (standard Number (in (standard 2002– 2007– 2002–

Selected characteristic thousands) (standard error) thousands) error) thousands) error) 2007 2012 2012 Trend

Total2

..................... 65,169 32.3 (0.37) 77,032 35.5 (0.48) 76,222 33.2 (0.42) †3.2 †–2.3 0.9 *Quadratic
 

Sex

Men ..................... 27,115 27.9 (0.49) 32,884 31.4 (0.61) 31,818 28.9 (0.54) †

3.5 †–2.5 1.0 **Quadratic

Women ................... 38,053 36.4 (0.48) 44,148 39.4 (0.61) 44,404 37.4 (0.54) †

3.0 –2.0 1.0 *Quadratic

Age group (years)

18–44 .................... 34,842 33.0 (0.48) 36,705 34.2 (0.63) 34,600 32.2 (0.57) 1.2 –2.0 –0.8 *Linear

45–64 .................... 23,041 36.5 (0.64) 29,507 40.1 (0.80) 29,048 36.8 (0.63) †

3.6 †–3.3 0.3 *Quadratic

65 and over................. 7,286 22.7 (0.64) 10,820 31.1 (0.92) 11,789 29.4 (0.73) †

8.4 –1.5 †6.9 *Quadratic

Hispanic or Latino origin and race
 

Hispanic ................... 5,626 26.4 (0.80) 6,162 21.6 (0.91) 7,525 22.0 (0.76) †

–4.8 0.4 †–4.4 *Quadratic
 

Non-Hispanic white ............ 50,219 34.4 (0.44) 59,814 40.2 (0.60) 57,008 37.9 (0.53) †

5.8 †–2.3 †3.5 ***Quadratic
 

Non-Hispanic black ............ 5,181 22.9 (0.66) 5,688 22.9 (0.90) 4,957 19.3 (0.75) 0.0 †

–3.6 †–3.6 *Linear
 

Non-Hispanic other3 ........... 4,142 41.5 (1.59) 5,368 39.6 (1.66) 5,946 37.3 (1.21) –1.9 –2.3 –4.2 ***Linear
 

Education

Less than high school diploma ..... 5,918 18.6 (0.68) 6,440 18.9 (0.85) 4,980 15.6 (0.72) –0.3 –2.0 †

–3.0 ***Quadratic

High school diploma or GED4

...... 15,777 26.6 (0.53) 17,457 28.1 (0.85) 14,744 24.4 (0.64) –1.5 †–3.7 †–2.2 ***Quadratic

Some college education ......... 14,244 35.6 (0.75) 23,189 41.3 (0.80) 16,762 36.5 (0.82) †

5.7 †–4.8 0.9 *Quadratic

College degree or higher ........ 28,953 42.1 (0.67) 29,743 46.7 (0.82) 39,586 42.6 (0.64) †

4.6 †–4.1 0.5 *Quadratic

Poverty status5

Poor ..................... 4,127 25.1 (0.99) 6,107 26.6 (1.02) 6,315 20.6 (0.76) 1.5 †–6.0 †–4.5 ***Quadratic
 

Near-poor .................. 6,961 27.7 (0.79) 8,380 27.9 (0.98) 9,283 25.5 (0.79) 0.2 –2.4 –2.2 ***Linear
 

Not-poor................... 41,962 36.8 (0.48) 55,953 40.3 (0.64) 55,490 38.4 (0.53) †

3.5 –1.9 1.6 ***Quadratic
 

Health insurance6

Private .................... 49,839 34.6 (0.42) 56,900 39.0 (0.59) 54,389 38.0 (0.50) †4.4 –1.0 †3.4 *Quadratic

Public .................... 6,402 25.8 (0.92) 9,401 27.0 (1.00) 11,387 24.8 (0.84) 1.2 –2.2 –1.0 **Quadratic

Uninsured .................. 8,730 28.4 (1.21) 10,382 27.8 (1.66) 9,505 22.9 (1.09) –0.6 †

–4.9 †–5.5 ***Quadratic

† Difference between both years is statistically significant at p < 0.05.

0.0 Quantity more than zero but less than 0.05.
 

* Significance of the chi-squared statistics is < 0.001.
 

** Significance of the chi-squared statistics is < 0.01.
 

*** Significance of the chi-squared statistics is < 0.05.
 1The denominator used in the calculation of percentages was all sample adults.
 2Total was defined by a ‘‘yes’’ response to use of one or more of the following in the past 12 months: acupuncture; Ayurveda; biofeedback; chelation therapy; chiropractic care; energy healing
 

therapy or Reiki; vegetarian and vegan, macrobiotic, Atkins, Pritikin, and Ornish diets; folk medicine; guided imagery; homeopathic treatment; hypnosis; naturopathy; nonvitamin, nonmineral, dietary
 

supplements; massage; meditation; progressive relaxation; qi gong; tai chi; or yoga. The use of prayer for health reasons, megavitamin supplements, and special diets not listed, was not included.
 

Respondents may have reported using more than one type of approach.
 3Non-Hispanic other and persons of multiple races is a very broad and varied category of persons from a variety of races and ethnicities. This group may be more diverse than the other racial and
 

ethnic groups.
 4GED is General Educational Development high school equivalency diploma.
 5Based on family income and family size using the U.S. Census Bureau’s poverty thresholds for the previous calendar year. Poor persons had a total annual income below the poverty threshold;
 

near-poor persons had incomes of 100% to less than 200% of the poverty threshold; not-poor persons had incomes that were 200% of the poverty threshold or greater.
 6Based on a hierarchy of mutually exclusive categories. Persons with more than one type of health insurance were assigned to the first appropriate category in the hierarchy. ‘‘Uninsured’’ includes
 

persons who had no coverage and those who had only Indian Health Service coverage or had only a private plan that paid for one type of service such as accidents or dental care.

NOTES: All estimates except age groups were age-adjusted using the projected 2000 U.S. population as the standard population and using four age groups: 18–24, 25–44, 45–64, and 65 and

over. Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.

SOURCE: CDC/NCHS, National Health Interview Survey, 2002, 2007, and 2012.
Page 12 National Health Statistics Reports n Number 79 n February 10, 2015

Table 3. Adults aged 18 and over who used selected types of nonvitamin, nonmineral dietary supplements during the past 30 days:

United States, 2007 and 2012

2007 2012

Dietary supplements1

Number (in

thousands)

Age-adjusted

percent2

(standard

error)

Number (in

thousands)

Age-adjusted

percent2

(standard

error)

p

value

Fish oil3 ............................... 10,923 4.8 (0.17) 18,848 7.8 (0.22) †

Glucosamine or chondroitin ................... 7,236 3.2 (0.14) 6,450 2.6 (0.11) †

Probiotics or prebiotics ...................... 865 0.4 (0.05) 3,857 1.6 (0.09) †

Melatonin ..............................

Coenzyme Q–10 (CoQ10)....................

1,296

2,691

0.6 (0.06)

1.2 (0.08)

3,065

3,265

1.3 (0.08)

1.3 (0.08)

†

††

Echinacea..............................

Cranberry (pills or capsules) ..................

4,848

1,560

2.2 (0.12)

0.7 (0.06)

2,261

1,934

0.9 (0.06)

0.8 (0.06)

†

††

Garlic supplements ........................ 3,278 1.4 (0.09) 1,927 0.8 (0.06) †

Ginseng ............................... 3,345 1.5 (0.10) 1,752 0.7 (0.06) †

Ginkgo biloba ...........................

Green tea pills (not brewed tea) or EGCG (pills)4 .....

2,977

1,528

1.3 (0.10)

0.7 (0.06)

1,619

1,503

0.7 (0.06)

0.6 (0.05)

†

††

Combination herb pill ....................... 3,446 1.5 (0.10) 1,463 0.6 (0.05) †

MSM (methylsulfonylmethane) .................

Milk thistle (silymarin). . . . . . . . . . . . . . . . . . . . . . .

1,312

1,001

0.6 (0.05)

0.4 (0.05)

1,051

988

0.4 (0.04)

0.4 (0.04)

†

††

Saw palmetto. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Valerian ...............................

1,682

877

0.7 (0.07)

0.4 (0.05)

988

801

0.4 (0.04)

0.3 (0.04)

†

††

† p < 0.05. ††Difference is not statistically significant. 1Respondents may have used more than one nonvitamin, nonmineral dietary supplement. 2The denominator used in the calculation of percentages was all sample adults. 3In 2007, fish oil was described as fish oil or omega 3 or DHA fatty acid. In 2012, fish oil was described as fish oil or omega 3 or DHA or EPA fatty acid. 4EGCG is epigallocatechin gallate.

NOTES: Estimates were age-adjusted using the projected 2000 U.S. population as the standard population and using four age groups: 18–24, 25–44, 45–64, and 65 and over. Estimates are

based on household interviews of a sample of the civilian noninstitutionalized population.

SOURCE: CDC/NCHS, National Health Interview Survey, 2007 and 2012.
National Health Statistics Reports n Number 79 n February 10, 2015 Page 13

Technical Notes

Response rate

In 2012, the National Health

Interview Survey (NHIS) interviewed

43,345 families living in 42,366

households. This yielded a sample size

of 108,131 persons, with a household

response rate of 77.6%. In 2007, NHIS

interviews were completed in 29,266

households, yielding 75,764 persons in

29,915 families and a household

response rate of 87.1%. In 2002, NHIS

interviews were completed in 36,161

households, yielding 93,386 persons in

36,831 families with a household

response rate of 89.6%. This report is

based on data from sample adults aged

18 and over who completed interviews.

The sample size and response rates

varied across supplements; in 2012, with

an overall response rate of 61.2%,

34,525 adults completed interviews. In

2007, 23,393 adults completed

interviews, yielding an overall response

rate of 67.8%. The overall response rate

in 2002 was 74.3%, with 31,044 adults

completing the NHIS interview.

Procedures used in calculating response

rates are described in detail in

Appendix I of the NHIS Survey

Description document for the respective

years (13–15).

Estimation procedures and

significance testing

The National Center for Health

Statistics (NCHS) creates survey

weights for each calendar quarter of the

NHIS sample. Estimates were calculated

using the NHIS data weighting

procedure previously described in detail

(17,18). Weights for 2002 and 2007

were derived from 2000 census-based

population estimates. Beginning with the

2012 NHIS, weights were derived from

2010 census-based population estimates.

Consecutive years of NHIS data

may be combined for a pooled analysis.

For this report, which spans two

different design periods, 1995–2005 and

2006–present, new design variables were

created, and the two design periods were

treated as statistically independent.

Point estimates and estimates of

their variances were calculated using

SUDAAN software (19) to account for

the complex sample design of NHIS. In

the tables, unknown values (responses

coded as ‘‘refused,’’ ‘‘not ascertained,’’

or ‘‘don’t know’’) were not counted in

the denominators when calculating

estimates. The Taylor series linearization

method was chosen for variance

estimation. Terms such as ‘‘greater

than’’ and ‘‘less than’’ indicate a

statistically significant difference. Terms

such as ‘‘not significantly different’’ or

‘‘no difference’’ indicate that the

statistics being compared were not

significantly different. Lack of comment

regarding the difference between any

two statistics does not mean that the

difference was tested and found to be

not significant.

Age adjustment

Percentages shown in this report

were age-adjusted using the projected

2000 U.S. population provided by the

U.S. Census Bureau as the standard

population (20,21). Age adjustment is

particularly important for demographic

characteristics such as race, ethnicity,

and poverty status, where there are often

differences in age structures. The

following age groups were used for age

adjustment: 18–24, 25–44, 45–64, and

65 and over. The SUDAAN procedure

PROC DESCRIPT was used to produce

age-adjusted percentages and their

standard errors.

Using different age groups for age

adjustment may result in slightly

different percentages. Consequently,

age-adjusted percentages for

complementary health approaches,

demographic characteristics, and

associated health conditions in this

report may not match age-adjusted

percentages for the same approaches,

health conditions, and demographic

characteristics in other reports.

Frequencies in this report are not

age-adjusted.

For more information on the

derivation of age-adjustment weights for

use with NCHS survey data, see Klein

and Schoenborn (21) (available through

NCHS from: http://www.cdc.gov/nchs/

data/statnt/statnt20.pdf).

Tests of significance

Statistical reliability and

hypothesis tests

Statistical tests performed to assess

the significance of differences between

annual estimates were two-tailed tests

with no adjustments made for multiple

comparisons. The critical value used for

two-sided tests at the 0.05 level of

significance was 1.96.

Definitions of selected terms

Health insurance coverage—NHIS

respondents were asked about health

insurance coverage for all members of

the family living in the household at the

time of the interview. Respondents

reported whether the sample adult was

covered by private insurance (obtained

through their employer or workplace,

purchased directly, or through a local or

community program); Medicare;

Medigap (supplemental Medicare

coverage); Medicaid; Indian Health

Service (IHS); military coverage

(including VA, TRICARE, or CHAMP–

VA); a state-sponsored health plan;

another government program; or any

single-service plans. This information

was used to form a health insurance

hierarchy that consisted of three

mutually exclusive categories.

Persons with more than one type of

health insurance were assigned to the

first appropriate category in the

following hierarchy: private coverage;

public coverage (includes persons with

Medicare, Medigap, Medicaid, military

coverage, a state-sponsored health plan,

or another government program); and

uninsured (includes persons who are

only covered by IHS or only have

single-service plans).

Hispanic or Latino origin and

race—Hispanic or Latino origin and

race are two distinct categories. Persons

of Hispanic or Latino origin may be of

any race. In NHIS, Hispanic or Latino

origin includes persons of Mexican,

Puerto Rican, Cuban, Central and South

American, or Spanish origin. Race is
Page 14 National Health Statistics Reports n Number 79 n February 10, 2015

based on the family respondent’s

description of his or her own race as

well as the race of other family

members. For conciseness, the text,

tables, and figures in this report use

shorter versions of the 1997 Office of

Management and Budget terms for

Hispanic or Latino origin and race. For

example, the category ‘‘not Hispanic or

Latino, black or African American,

single race’’ is referred to as ‘‘nonHispanic black’’ in the text, tables, and

figures. Estimates for non-Hispanic

persons of races other than white only

or black only are combined into the

‘‘non-Hispanic other’’ category.

Poverty status—Based on family

income and family size using the U.S.

Census Bureau’s poverty thresholds.

Persons who are categorized as ‘‘poor’’

have a family income strictly below

100% of the poverty threshold. ‘‘Near

poor’’ persons have family incomes of

100% to less than 200% of the poverty

threshold, and ‘‘not poor’’ persons have

family incomes that are 200% of the

poverty threshold or greater.

Terms related to complementary

health approaches

Acupuncture—A family of

procedures involving stimulation of

anatomical points on the body by a

variety of techniques. American

practices of acupuncture incorporate

medical traditions from China, Japan,

Korea, and other countries. The

acupuncture technique that has been

most scientifically studied involves

penetrating the skin with thin, solid,

metallic needles that are manipulated by

the hands or by electrical stimulation.

Atkins diet—Emphasizes a drastic

reduction in the daily intake of

carbohydrates (40 grams or fewer),

countered by an increase in protein and

fat.

Ayurveda—A medical system that

originated in India several thousand

years ago. Ayurveda is based on theories

of health and illness, and on ways to

prevent, manage, or treat health

problems. Ayurveda aims to integrate

and balance the body, mind, and spirit

(thus, some view it as ‘‘holistic’’). This

balance is believed to lead to

contentment and health and to help

prevent illness. A chief aim of

Ayurvedic practices is to cleanse the

body of substances that can cause

disease, and this is believed to help

reestablish harmony and balance.

Biofeedback—A technique that uses

simple electronic devices to teach clients

how to consciously regulate bodily

functions, such as breathing, heart rate,

and blood pressure, to improve overall

health. Biofeedback is used to reduce

stress, eliminate headaches, recondition

injured muscles, control asthma attacks,

and relieve pain.

Chiropractic manipulation—A form

of health care that focuses on the

relaionship between the body’s structure,

primarily the spine, and its function.

Deep-breathing exercises—An

active process that involves conscious

control over breathing in and out. This

may involve controlling the way in

which air is drawn in (for example,

through the mouth or nostrils), the rate

(for example, quickly or over a length

of time), the depth (for example,

shallow or deep), and the control of

other body parts (for example, relaxation

of the stomach).

Energy healing therapy—A

technique that involves channeling

healing energy through the hands of a

practitioner into the client’s body to

restore a normal energy balance and,

therefore, health. Energy healing therapy

has been used to treat a wide variety of

ailments and health problems, and it is

often used with other alternative and

conventional medical treatments.

Folk medicine—Systems of healing

(such as Curanderismo and Native

American healing) that have persisted

since the beginning of human culture

and flourished long before the

development of conventional medicine.

Folk healers usually participate in a

training regimen of observation and

imitation, with healing often considered

a gift passed down through several

family generations. Folk healers may

employ a range of remedies, including

prayer, healing touch or laying on of

hands, charms, herbal teas or tinctures,

and magic rituals, among other

techniques. Folk healers are found in all

cultures and operate under a variety of

names and labels.

Guided imagery—Used for healing

or health maintenance and involves a

series of relaxation techniques followed

by the visualization of detailed images,

usually calm and peaceful in nature. If

used for treatment, persons will

visualize their bodies free of the specific

problem or condition. Sessions are

typically 20 to 30 minutes in length and

may be practiced several times a week.

Homeopathic treatment—A system

of medical practices based on the theory

that any substance that can produce

symptoms of disease or illness in a

healthy person can cure those symptoms

in a sick person.

Hypnosis—An altered state of

consciousness characterized by increased

responsiveness to suggestion. This

hypnotic state is attained by first

relaxing the body, then shifting attention

toward a narrow range of objects or

ideas as suggested by the hypnotist or

hypnotherapist. The procedure is used to

effect positive changes and to treat

numerous health conditions including

ulcers, chronic pain, respiratory

ailments, stress, and headaches.

Macrobiotic diet—A diet low in fat

that emphasizes whole grains and

vegetables, and restricts the intake of

fluids. Of particular importance is the

consumption of fresh, nonprocessed

foods.

Meditation—A group of techniques,

most of which started in Eastern

religious or spiritual traditions. In

meditation, individuals learn to focus

their attention and suspend the stream of

thoughts that normally occupy the mind.

This practice is believed to result in a

state of greater physical relaxation,

mental calmness, and psychological

balance. Practicing meditation can

change how a person relates to the flow

of emotions and thoughts in the mind.

Mindfulness meditation—A type of

meditation based on the concept of

being mindful, or having increased

awareness, of the present. It uses

breathing methods, guided imagery, and

other practices to relax the body and

mind and help reduce stress. It is also

known as mindfulness relaxation and

mindfulness-based stress reduction.
National Health Statistics Reports

n Number 79n February 10, 2015 Page 15

Naturopathy—An alternative

medical approach based on the belief

that there isa healing power in the body

that establishes, maintains, and restores

health. Practitioners work with the

patient witha goal of supporting this

power through treatments such as

nutrition and lifestyle counseling,

dietary supplements, medicinal plants,

exercise, homeopathy, and treatments

from traditional Chinese medicine.

Nonvitamin, nonmineral dietary

supplements—Herbs or other nonvitamin

supplements such as pills, capsules,

tablets, or liquids that have been labeled

as dietary supplements. This category

did not include vitamin or mineral

supplements, homeopathic treatments, or

drinking herbal or green teas.

Ornish diet—A high-fiber, low-fat

vegetarian diet that promotes weight

loss and health by controlling what one

eats, not by restricting the intake of

calories. Fruits, beans, grains, and

vegetables can be eaten at all meals,

while nonfat dairy products such as

skim milk, nonfat cheeses, and egg

whites are to be eaten in moderation.

Products such as oils, avocados, nuts

and seeds, and meats of all kinds are

avoided.

Osteopathic manipulation—A

full-body system of hands-on techniques

to alleviate pain, restore function, and

promote health and wellbeing.

Pritikin diet—A low-fat diet that

emphasizes the consumption of foods

with large volumes of fiber and water,

including many vegetables; fruits; beans;

and natural, unprocessed grains. Meat is

allowed.

Progressive relaxation—A technique

used to relieve tension and stress by

systematically tensing and relaxing

successive muscle groups.

Qi gong—An ancient Chinese

discipline combining the use of gentle

physical movements, mental focus, and

deep-breathing directed toward specific

parts of the body. Performed in

repetitions, the exercises are normally

performed two times or morea week for

30 minutes ata time.

Spiritual meditation—May be

performed according to the practices of

one of the major religions or withina

spiritual tradition. The techniques used

may be the same as in other types of

meditation (for example, Transcendental

Meditation), but the focus is on

spirituality (such as repeatinga spiritual,

meditative phrase).

Tai chi—A mind-body practice that

originated in China asa martial art.

Individuals doing tai chi move their

bodies slowly and gently, while

breathing deeply and meditating (tai chi

is sometimes called moving meditation).

Many practitioners believe that tai chi

helps the flow throughout the body ofa

proposed vital energy called ‘‘qi.’’

Individuals practicing tai chi move their

bodies ina slow, relaxed, and graceful

series of movements. One can practice

alone or ina group. The movements

make up what are called forms (or

routines).

Traditional healer—Someone who

employs any one ofa number of ancient

medical practices that are based on

indigenous theories, beliefs, and

experiences handed down from

generation to generation, often orally.

The methods employed by each type of

traditional healer have evolved to reflect

the different philosophical backgrounds

and cultural origins of the healer.

Vegetarian diet—A diet that does

not include any meat. There are,

however, numerous variations on the

nonmeat theme. For example, some

vegetarian diets (called vegan diets) are

restricted to plant products only, while

others may include eggs and dairy

products. Another variation limits

consumption to raw fruit, sometimes

supplemented with nuts and vegetables.

Finally,a number of vegetarian diets

prohibit alcohol, sugar, caffeine, or

processed foods.

Yoga—A combination of breathing

exercises, physical postures, and

meditation used to calm the nervous

system and balance the body, mind, and

spirit.
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National Health Statistics Reports n Number 79 n February 10, 2015

Suggested citation

Clarke TC, Black LI, Stussman BJ, et al.

Trends in the use of complementary health

approaches among adults: United States,

2002–2012. National health statistics reports;

no 79. Hyattsville, MD: National Center for

Health Statistics. 2015.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate Director

for Science

Division of Health Interview Statistics

Marcie L. Cynamon, Acting Director

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