Number 78 n February 10, 2015

Use of Complementary Health Approaches Among
 

Children Aged 4–17 Years in the United States:
 

National Health Interview Survey, 2007–2012
 Lindsey I. Black, M.P.H., Tainya C. Clarke, Ph.D., M.P.H., Patricia M. Barnes, M.A., National Center for Health

Statistics; Barbara J. Stussman, B.A., 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 children aged 4–17 years in the

United States. Selected modalities are compared for 2007 and 2012 to examine

changes over time.

Methods—Data from the 2007 and 2012 National Health Interview Survey

(NHIS) were analyzed for this report. The combined sample included 17,321

interviews with knowledgeable adults about children aged 4–17 years. Point

estimates and estimates of their variances were calculated using SUDAAN

software to account for the complex sampling design of NHIS. Differences

between percentages were evaluated using two-sided significance tests at the 0.05

level.

Results—The use of complementary health approaches among children did

not change significantly since 2007 (from 12.0% in 2007 to 11.6% in 2012).

However, one approach, the use of traditional healers, showed a statistically

significant decrease in use, from 1.1% in 2007 to 0.1% in 2012. No other

significant decreases were identified. An increase in the use of yoga was

observed during this period (from 2.3% in 2007 to 3.1% in 2012). Nonvitamin,

nonmineral dietary supplements; chiropractic or osteopathic manipulation; and

yoga, tai chi, or qi gong were the most commonly used complementary health

approaches in both 2007 and 2012. Also consistent between 2007 and 2012 was

that complementary health approaches were most frequently used for back or

neck pain, head or chest cold, anxiety or stress, and other musculoskeletal

conditions.

Keywords: complementary and alternative medicine • chiropractic manipulation

• dietary supplements • fish oil

Introduction

Complementary health approaches

include a group of diverse medical and

health care interventions, practices,

products, and disciplines that are not

generally considered part of

conventional medicine (1). Use of

complementary health approaches in

children has not been studied

extensively at the national level.

However, the available data suggest

higher rates of use among children with

chronic health conditions, including

anxiety, musculoskeletal conditions, and

recurrent headaches compared with

those without these conditions (2–4).

This is similar to what is seen in adult

populations (5–7). Previous reports have

found that the specific sociodemographic

and health factors associated with

children’s use of complementary health

approaches—higher parental education,

higher family income, living in the

Western region, having more health

conditions, and having more doctor

visits in the past 12 months—mirror

those for adults (5,8). These similarities

may be partly explained by the fact that

parents are the gatekeepers of health

care for their children. Reflecting this

role, research has found that the

strongest predictor of the use of

complementary health approaches by

children is use by their parents (2,3,5).

Data from population-based surveys

on the use of complementary health

approaches in the United States now

span 20 years (5,9,10). The 2007

National Health Interview Survey

(NHIS) provided the first populationbased estimate of children’s use of

complementary health approaches.

Recognizing that factors such as

awareness and health insurance benefits

may change over time, this report aims

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 78 n February 10, 2015

to update the findings from 2007 to

provide the most current and

comprehensive picture of U.S. children’s

use of complementary health

approaches. In addition, estimates on the

use of complementary health approaches

by selected demographic characteristics

and the use of complementary health

approaches to treat selected conditions

are presented in this report.

Methods

Data source

Data in this report come primarily

from the 2007 and 2012 Child

Complementary and Alternative

Medicine (CAL) supplement of NHIS,

with demographic, family

characteristics, and other health

information from the Person, Sample

Child Core, and Family Core

components of NHIS. NHIS is a

household survey conducted

continuously throughout the year for the

Centers for Disease Control and

Prevention’s (CDC) National Center for

Health Statistics by interviewers from

the U.S. Census Bureau. Interviews are

primarily conducted in person, but

follow-ups to complete interviews may

be conducted over the telephone. NHIS

collects detailed health-related

information and some demographic

information from a sample of the

civilian noninstitutionalized U.S.

population.

The Sample Child Core obtains

additional information on the health of

one randomly selected child (the sample

child) in the family. For sample

children, information is provided by a

knowledgeable adult family member

residing in the household. In 2007, the

CAL supplement included all sample

children under age 18, while in 2012,

the supplement only included sample

children aged 4–17 years. To enable

comparisons, for this report 2007 data

were restricted to children aged 4–17

years, yielding final sample sizes of

7,103 children in 2007 and 10,218

children in 2012. A detailed description

of the NHIS sample design and the

survey questionnaires for specific years

are available from NHIS survey

description documents (11,12).

The processes used to develop the

CAL supplements have been previously

described (13). In brief, the

questionnaire content for both the 2007

and 2012 CAL supplements was based

on literature reviews, feedback from the

scientific community, expert input and

workshops, and cognitive testing.

Although specific modalities included in

the three questionnaires varied slightly

by year, the following practices were

asked about in both the 2007 and 2012

CAL supplements: acupuncture;

Ayurveda; biofeedback; chelation

therapy; chiropractic or osteopathic

manipulation; energy healing therapy;

hypnosis; massage; naturopathy;

nonvitamin, nonmineral dietary

supplements; homeopathy; diet-based

therapies; yoga; tai chi; qi gong;

meditation; and other relaxation

techniques. For both years, information

was collected on whether the sample

child used each modality in the past 12

months; whether the sample child had

seen a provider or practitioner for the

modality; whether the modality was

used to treat a specific health problem

or condition, and, if so, what health

problems or conditions were treated; and

whether the modality was used to

improve athletic or sports performance.

In 2012, the CAL supplement was

enhanced to collect further information

on lifetime use of the modality, the

number of times the sample child had

seen a practitioner for the modality, and

the costs related to modality use (13).

Although no changes were made in

how the survey was administered,

several modifications were made

between the 2007 and 2012 CAL

supplements. Noteworthy modifications

include: a) the restriction of the survey

to children aged 4–17 years; b) the

addition of items to determine whether

deep breathing or meditation was used

in conjunction with the practice of yoga,

tai chi, or qi gong and if a class was

taken or formal training was received; c)

meditation was categorized as mantra,

mindfulness, or spiritual; d) the number

of nonvitamin, nonmineral dietary

supplements included on the flashcard

was reduced from 44 products in 2007

to 21 products in 2012, although only

the 2012 survey allowed for the

inclusion of products not listed on the

flashcard; e) names of traditional healers

were modified and consolidated; f) Zone

and South Beach were eliminated from

the list of special diets; and g) deepbreathing exercise was removed as an

independent health practice for 2012,

but collected as a component of other

approaches. These changes likely

influenced the overall prevalence rates,

and the 2012 data were recoded to be

consistent with 2007 for the analysis

presented in this report. Given these

changes, results should be interpreted

with caution when comparing modalities

that are impacted by questionnaire

revisions.

Due to the lack of sufficient sample

sizes and the inability to compare

modalities across survey years, this

report only covers a selection of

complementary health approaches,

including: nonvitamin, nonmineral

dietary supplements; acupuncture;

naturopathy; homeopathy; chiropractic

or osteopathic manipulation;

biofeedback; massage therapy; special

diets (vegetarian or vegan, macrobiotic,

Atkins, Pritikin, and Ornish); traditional

healers (Curandero, Espiritista, Hierbero

or Yerbera, Shaman, Botanica, Native

American Healer or Medicine Man,

Sobador, Machi, Parchero, Yerbero,

Hierbista, and Huesero); movement

therapies (Feldenkrais, Alexander

technique, Pilates, and Trager

psychophysical integration); energy

healing therapy; and hypnosis.

Information presented in this report for

both 2007 and 2012 was obtained via a

knowledgeable adult proxy as part of

the in-person interview.

Demographic and other

variables used in the

analysis

Demographic characteristics of

children presented in this report include:

sex, age group, Hispanic or Latino

origin and race, parent’s highest level of

education, poverty status, and health

insurance coverage. All demographic

characteristics are based on the

knowledgeable adult’s report on behalf
National Health Statistics Reports n Number 78 n February 10, 2015 Page 3

of the child. Age groups of 4–11 and

12–17 years were assigned based on the

child’s age at the time of interview.

Hispanic or Latino origin and race are

determined based on two separate

questions. For this reason, a child may

have been identified as Hispanic or

Latino origin regardless of race. The

text and tables in this report use shorter

versions of the 1997 Office of

Management and Budget race and

Hispanic origin terms for conciseness.

For example, the category ‘‘Not

Hispanic or Latino, black or African

American, single race’’ is referred to as

‘‘non-Hispanic black.’’ Due to

insufficient sample size, Non-Hispanic

Asian, Non-Hispanic Other Pacific

Islander, and Non-Hispanic American

Indian or Alaska Native were combined

to form the category Non-Hispanic all

other races.

Parent’s education was defined as

the highest grade completed by the

child’s mother or father who was living

in the household, regardless of that

parent’s age. This measure did not take

into account a parent’s education if they

did not live in the same household as

the child.

Poverty status was based on the

family income and family size using the

U.S. Census Bureau’s poverty

thresholds. Children who are categorized

as ‘‘Poor’’ have a ratio less than 1.0;

that is, their family income was strictly

below the poverty threshold. ‘‘Near

poor’’ children have family incomes of

100% to less than 200% of the poverty

threshold, and ‘‘not poor’’ children have

family incomes that are 200% of the

poverty threshold or greater.

Respondents were asked about the

child’s health insurance coverage at the

time of the interview. Respondents

reported whether the child was covered

by private insurance (obtained through

the employer or workplace, purchased

directly, or through a local or

community program); Medicare;

Medigap (supplemental Medicare

coverage); Medicaid; State Children’s

Health Insurance Program (SCHIP);

Indian Health Service (IHS); military

coverage (including VA, TRICARE, and

CHAMP–VA); a state-sponsored health

plan; another government program; or

any single service plan. 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, SCHIP,

military coverage, a state-sponsored

health plan, or another government

program); and uninsured (also includes

persons who are only covered by IHS or

only have a single service plan).

The ‘‘any complementary health

approach use’’ category was defined as a

‘‘yes’’ response to any of the following:

chelation therapy; nonvitamin,

nonmineral dietary supplements; special

diet; acupuncture; Ayurveda;

homeopathic treatment; naturopathy;

traditional healer; chiropractic or

osteopathic manipulation; massage;

Feldenkrais; Alexander technique;

Pilates; Trager psychophysical

integration; biofeedback; mantra

meditation; Transcendental Meditation;

relaxation response; clinically standard

meditation; spiritual meditation; guided

imagery; progressive relaxation; yoga,

tai chi, or qi gong (with deep breathing);

hypnosis; or energy healing.

Statistical analysis

Estimates in this report were

calculated using weighted data and are

representative of the U.S.

noninstitutionalized population of

children aged 4–17 years. Data

weighting procedures are described in

more detail elsewhere (14). Point

estimates, and estimates of their

variances, were calculated using

SUDAAN software, version 10 (15), a

software package designed to account

for the complex sampling design of

NHIS. Estimates were age-adjusted and

weighted using the sample child weight.

Unless otherwise specified, the

denominator used was all children aged

4–17 years. Reliability of estimates was

evaluated using the relative standard

error (RSE), which is the standard error

divided by the point estimate. Estimates

were considered reliable if the RSE was

less than or equal to 30%; estimates that

were greater than 30% and less than or

equal to 50% were considered

unreliable. Estimates with RSEs of

greater than 50% are not shown.

Differences between estimates were

evaluated using two-tailed significance

tests at the 0.05 level. Terms such as

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

a statistically significant difference.

Terms such as ‘‘similar’’ or ‘‘no

difference’’ indicate that the estimates

being compared were not significantly

different. Due to the cross-sectional

nature of the data collected in NHIS, an

association between two variables does

not indicate a causal relationship.

Strengths and limitations of

the data

A major strength of the NHIS CAL

supplement data is that they were

collected for a nationally representative

sample of U.S. children, 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.

The large sample size also facilitates

investigation of the association between

complementary health approaches and a

wide range of other self-reported health

characteristics collected in NHIS.

NHIS data have several limitations.

First, estimates are based on responses

from a child’s knowledgeable adult and

therefore may be subject to recall bias.

Although considerable effort is made to

ensure accurate reporting, information

from the knowledgeable adult may be

inaccurate because the respondent is

unaware of relevant information, has

forgotten it, does not wish to reveal it to

an interviewer, or does not understand

the intended meaning of the question.

Lastly, although the overall sample size

was large, the number of children that

used many of the selected

complementary health approaches

presented in this report was low.

However, the findings reported here are

within the range of previous reports (5).
Page 4	 National Health Statistics Reports n Number 78 n February 10, 2015

Results

Children’s use of

complementary health

approaches during the past

12 months, 2007 and 2012

Complementary health approaches

encompass a wide range of modalities.

Table 1 breaks out selected modalities

used among all children aged 4–17

years for 2007 and 2012. The

percentages of individual modalities

range from 0.1%–4.9% of children

reporting use in the past 12 months.

+	 There was a statistically significant

decrease in the use of traditional

healers between 2007 (1.1%) and

2012 (0.1%). Due to questionnaire

modifications, this should be

interpreted with caution.

+	 Nonvitamin, nonmineral dietary

supplements were the most

commonly used modality in both

2007 and 2012.

+	 Any homeopathy was used by about

1.8% of children in 2012, while

practitioner-based homeopathy was

used by only 0.2% of children.

Yoga, tai chi, and qi gong are

movement therapies that are often

performed in classes with instructors.

Deep breathing and meditation are often

used with these movement therapies. For

the 2012 survey, respondents were asked

more detailed questions about the use of

yoga, tai chi, and qi gong such as if

deep-breathing exercises and meditation

were used with the practice and if

formal training was received or a class

was taken. Figure 1 illustrates the use of

yoga, tai chi, and qi gong among all

children in 2012 and differentiates the

percentage of children who use

breathing exercises and meditation as

part of their practice. Figure 2 provides

detailed information about children’s use

of different types of meditation.

+	 There was a statistically significant

increase in the use of any yoga, tai

chi, or qi gong between 2007 (2.5%)

and 2012 (3.2%). Most of this

increase can be attributed to the

increased use of yoga (2.3% to 3.1%)

(Table 1).

+ In 2012, 2.6% of children used yoga,

tai chi, or qi gong that included

deep-breathing exercises or

meditation in the past 12 months

(Figure 1).

+ In 2012, 1.2% of children took yoga

classes or received formal training

(Figure 1).

+ Spiritual, mindfulness, and mantra

meditation were each used by less

than 0.5% of children (Figure 2).

+ Meditation as part of yoga, tai chi, or

qi gong was used by about 1.3% of

children in 2012 (Table 1).

Overall use of any

complementary health

approaches, by selected

characteristics, 2007 and

2012

Table 2 shows the percentages of all

children aged 4–17 years in 2007 and in

2012 who had used any complementary

health approach in the past 12 months

by selected characteristics. Just as the

overall percentage of children aged 4–17

years using any complementary health

approaches remained stable from 2007

to 2012, use among subgroups of

Percent 

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

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

2.4 

2.5 

1.2 

1.2 

2.5 

2.6 

3.2 

0 1 2 3 4

Yoga, tai chi, or qi gong 

Yoga 

Including deep-breathing 

exercises or meditation 

Including deep-breathing 

exercises 

Took class or received 

formal training 

Any 

Figure 1. Age-adjusted percentages of children aged 4–17 years who used yoga, tai chi,

or qi gong during the past 12 months: United States, 2012

sociodemographic characteristics also

did not change for most groups.

+	 Overall, there was not a statistically

significant change in the prevalence

of any complementary health

approach between 2007 and 2012

(12.0% and 11.6%, respectively).

+	 In 2012, there was a statistically

significant decrease in the use of any

complementary health approach for

Hispanic children, and among

children whose parents had less than

a high school diploma.

+	 Similar to the pattern seen in 2007, in

2012, older children (aged 12–17)

were more likely to use any

complementary health approach

compared with younger children

(aged 4–11) (p < 0.001).

+	 In 2012, children whose parents had

more than a high school education

were seven times more likely to use

any complementary health approach

(15.0%) as children whose parents

had less than a high school diploma

(2.1%) (p < 0.001). This is similar to

2007, when 15.2% of children whose

parents were in the highest education

group and 4.1% of children whose

parents were in the lowest education
National Health Statistics Reports n Number 78 n February 10, 2015	 Page 5

Meditation

Any 

Spiritual 

Mindfulness 

Mantra 

As part of yoga, tai chi, 

or qi gong 

0.3 

0.2 

1.6 

0.5 

1.3 

0 0.5 1 1.5 2 2.5 

Percent 

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

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

Figure 2. Age-adjusted percentages of children aged 4–17 years who used selected

meditation techniques during the past 12 months: United States, 2012

Nonvitamin, nonmineral 

dietary supplements 

Chiropractic or osteopathic 

manipulation 

Yoga, tai chi, or qi gong 

Boys 

Girls 

5.2 

4.6 

2.9 

3.6 

4.2 

1

1.0 

0 1 2 3 4 5 6 7 

Percent 1

Significantly different from girls (p < 0.001). 

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

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

Figure 3. Age-adjusted percentages of children aged 4–17 years who used selected

complementary health approaches during the past 12 months, by sex: United States, 2012

group used any complementary health

approach (p < 0.01).

+ In both 2007 and 2012, children who

were not poor were two to three

times more likely to use any

complementary health approach

(14.9% and 14.8%, respectively) as

children who were poor (7.0% and

5.7%, respectively) (p < 0.001).

Use of selected

complementary health

approaches, by selected

characteristics, 2012

Differences in the percentages of

children who used nonvitamin,

nonmineral dietary supplements;

chiropractic or osteopathic manipulation;

and yoga, tai chi, or qi gong by sex,

race and ethnicity, and health insurance

status among all children aged 4–17

years for 2012 are presented in

Figures 3–5.

+	 In 2012, girls were more likely to use

yoga, tai chi, or qi gong in the past

12 months (4.2%) compared with

boys (1.0%). Sex did not have a

significant association with the use of

nonvitamin, nonmineral dietary

supplements and chiropractic or

osteopathic manipulation (Figure 3).

+	 Non-Hispanic white children were

more likely than Hispanic and

Non-Hispanic black children to use

nonvitamin, nonmineral dietary

supplements; chiropractic or

osteopathic manipulation; and yoga,

tai chi, or qi gong in the past 12

months (Figure 4).

+	 In 2012, the prevalence of

nonvitamin, nonmineral dietary

supplement and chiropractic or

osteopathic manipulation use in the

past 12 months was higher for

children with private health insurance

than for children with public

coverage. Insurance status had no

impact on the use of yoga, tai chi, or

qi gong (Figure 5).

Use of selected nonvitamin,

nonmineral dietary

supplements, 2007 and 2012

Little is known about the possible

benefits or adverse effects of

nonvitamin, nonmineral dietary

supplements in children. The use of

nonvitamin, nonmineral dietary

supplements was the most common

complementary health approach used in

both 2007 and 2012. Table 3 provides

greater detail on the specific types of

supplements used among all children in

the 30 days prior to the survey

interview. Overall, there was a change
Page 6	 National Health Statistics Reports n Number 78 n February 10, 2015

Percent 

*Estimates are considered unreliable. Data have a relative standard error greater than 30% and less than or equal to 50% 

and should be used with caution. 

1

Significantly different from Hispanic and non-Hispanic black persons (p < 0.001). 2

Significantly different from non-Hispanic all other races (p < 0.01). 3

Significantly different from Hispanic persons (p < 0.05). 

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

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

*2,30.5 

0 2 4 6 8 10

Hispanic 

Nonvitamin, nonmineral 

dietary supplements 

Chiropractic or osteopathic 

manipulation 

Yoga, tai chi, or qi gong 

Non-Hispanic white 

Non-Hispanic black 

Non-Hispanic all 

other races 

7.4 

2.5 

3.0 

1

3.2 

1

4.8 

1

6.2 

2.7 

2

2.0 

1.4 

1.4 

1.7 

Figure 4. Age-adjusted percentages of children aged 4–17 years who used selected

complementary health approaches during the past 12 months, by race and ethnicity:

United States, 2012

in the ranking of the top three

supplements used. Respondents could

report using more than one dietary

supplement.

+	 Echinacea was the most commonly

used supplement in 2007, while fish

oil was most commonly used in 2012.

+	 There was a significant increase in

the use of melatonin among children,

from 0.1% in 2007 to 0.7% in 2012.

+	 Use of combination herb pills

decreased from 0.5% in 2007 to 0.1%

in 2012.

+	 Fish oil and probiotics or prebiotics

were among the top three nonvitamin,

nonmineral dietary supplements used

in 2012. There was no statistical

difference between 2007 use and

2012 use.

+	 In 2012 and 2007, garlic

supplements, combination herb pills,

ginseng, cranberry, and glucosamine

or chondroitin were used by about

0.1% of children.

Reason for complementary

health approach use, 2007

and 2012

Respondents for children who used

or saw a practitioner for any

complementary health approach in the

past 12 months were asked if the

modality was used to treat a specific

health problem or condition. The

frequencies and percentages of children

who used selected complementary health

approaches to treat a specific health

problem or condition are shown in

Table 4.

+ Overall, among children who used

any complementary health approach,

44.2% used it to treat a specific

health problem or condition in 2007

and 45.6% in 2012.

+ Among children who used

nonvitamin, nonmineral dietary

supplements, the percentage using

these products to treat a specific

health condition decreased from

49.4% in 2007 to 35.5% in 2012. A

similar decrease was seen for

homeopathy (88.8% to 62.9%,

respectively).

+	 In 2012, acupuncture was the

modality that had the highest

percentage of users reporting use for

treatment of a condition (70.1%). In

2007, homeopathy was the modality

that had the highest percentage of

users reporting use for treatment of a

condition (88.8%).

Medical conditions treated

with complementary health

approaches, 2007 and 2012

Complementary health approaches

are often used to treat a specific health

problem or condition. Among children

who used any complementary health

approach, Table 5 presents selected

health problems and conditions for

which they were used.

+	 No statistically significant differences

were seen between 2007 and 2012 in

the proportion of individuals using

complementary health approaches to

treat or manage any of the conditions

queried.

+	 In 2007 and 2012, complementary

health approaches were most often

used for back or neck pain, head or

chest cold, other musculoskeletal

conditions, anxiety or stress, and

attention deficit hyperactivity disorder

(ADHD).

Conclusion

This report presents data from the

2007 and 2012 NHIS on the use of

complementary health approaches

among children aged 4–17 years in the

United States. It focuses on the use of

specific modalities in the past 12

months; the use of nonvitamin,

nonmineral dietary supplements in the

past 30 days; and complementary health

approaches used to treat health problems

or conditions. Further, it explores

characteristics of children who use

complementary health approaches and

makes comparisons between 2007 and

2012. Although prevalence rates for

overall use of complementary health

approaches in 2007 and 2012 are

presented, the 2012 questionnaire was

substantially different from the 2007

questionnaire (13). For instance, a lower

number of response options were
National Health Statistics Reports n Number 78 n February 10, 2015 Page 7

Percent 

*Estimates are considered unreliable. Data have a relative standard error greater than 30% and less than or equal to 50% 

and should be used with caution. 

1

Significantly different from public and uninsured (p < 0.001). 

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

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

0 2 4 6 8

Private 

Nonvitamin, nonmineral 

dietary supplements 

Chiropractic or osteopathic 

manipulation 

Yoga, tai chi, or qi gong 

Public 

Uninsured 

1

6.3 

2.9 

4.3 

1

4.7 

2.8 

2.4 

1.9 

1.0 

*2.3

Figure 5. Age-adjusted percentages of children aged 4–17 years who used selected

complementary health approaches during the past 12 months, by health insurance status:

United States, 2012

included on the flashcard for

nonvitamin, nonmineral dietary

supplements, two diet-based modalities

were eliminated, the list of traditional

healers was modified, and deepbreathing exercise was removed as an

independent health practice, all of which

likely influenced the overall prevalence

rate. Thus, while the prevalence of

children using any complementary

health approach did not change

significantly (from 12.0% in 2007 to

11.6% in 2012), this finding must be

viewed cautiously. When looking at

individual approaches, there was a

statistically significant decrease in the

use of traditional healers and a

significant increase in the use of yoga,

tai chi, or qi gong. However, the

decrease in the use of traditional healers

may be due, in part, to the modification

of the questionnaire (a decrease in the

types of traditional healers that could be

selected).

This report presents unique data

examining the practices of yoga,

meditation, and homeopathy in children.

Children, like adults, substantially

increased the practice of yoga between

2007 and 2012 (16). Within this same

5-year period, industry data suggest a

7.8% annual growth in the number of

yoga instructors (17). The low cost (18)

and the ability to practice in one’s own

home may contribute to yoga’s growing

popularity. Furthermore, public school

systems are beginning to incorporate

yoga into their fitness programs (19),

which may accelerate use by children in

the future.

Most children who practiced yoga

incorporated meditation, deep-breathing

exercises, or both into their practice;

that is, traditional forms of yoga were

practiced, not simply yoga as a type of

exercise (20). Only about one-third of

children who practiced yoga had taken a

class or received formal training in the

past 12 months. It is not clear what

proportion of the remaining children had

taken a class or received formal training

prior to the past 12 months.

More than 900,000 children used

meditation in 2012; of these, 760,000

(just over 80%) practiced meditation as

a part of yoga, tai chi, or qi gong. Only

about one-third of children who

meditated participated in mantra,

mindfulness, or spiritual meditation.

Thus, meditation as a part of movement

therapies is more common among

children than meditation alone (20).

Of those children who had received

homeopathic treatments, only a small

proportion had seen a practitioner of

homeopathy, suggesting that most use is

self-care. This self-care use of

homeopathy treatments is also reflected

in industry sales data that show steady

growth in the sales of homeopathic

products over the last 10 years, with

about 80% of sales occurring at retailers

such as big box stores, grocery stores,

and drug stores (21). To the best of the

authors’ knowledge, there are no data

assessing whether self-care with

homeopathic products is equivalent to

care from a trained homeopath.

However, the Food and Drug

Administration’s oversight of over-thecounter homeopathic products is far less

stringent than for pharmaceuticals, and

serious adverse events with the use of

homeopathic over-the-counter remedies

have been reported (22).

Similar to the results for adults (5),

the use of nonvitamin, nonmineral

dietary supplements; yoga, tai chi, or qi

gong; and chiropractic or osteopathic

manipulation varied considerably by

demographic characteristics (e.g., sex,

race and ethnicity, and insurance status).

Looking at individual approaches,

unique changes were seen over time in

the frequencies with which these

approaches were used to treat specific

health conditions. For instance, there

were large decreases in the percentage

of children who used either nonvitamin,

nonmineral dietary supplements or

homeopathy to treat a specific health

condition, but no changes for all other

approaches.

Consistent with previous reports (5),

the use of complementary health

approaches in children, both overall and

for individual modalities, is low

compared with that seen in adults (16).

For instance, while nonvitamin,

nonmineral dietary supplements are the

most common approach used by both

adults and children, the use by children

is almost one-quarter of the use by

adults (4.9% compared with 17.7%).

In 2007, the most common

nonvitamin, nonmineral dietary

supplements used by children in the past
Page 8	 National Health Statistics Reports n Number 78 n February 10, 2015

30 days were echinacea (0.8%), fish oil

(0.7%), and combination herb pills

(0.5%). There was a significant increase

in fish oil use from 0.7% in 2007 to

1.1% in 2012. However, the use of

echinacea and combination herb pills

decreased such that the top three

nonvitamin, nonmineral dietary

supplements shifted slightly in 2012 to

be fish oil (1.1%), melatonin (0.7%),

and probiotics or prebiotics (0.5%).

These changes in use patterns coincide

to some degree with the publication of

results from clinical trials. For instance,

since the mid-2000s, several welldesigned clinical trials have not seen

any benefit of taking echinacea to treat

or prevent the common cold (23,24).

During this same time period, data

supporting the use of fish oil for heart

health have been accumulating (25);

however, more recent work has been

published that questions the magnitude

of this effect (26). There is also some

evidence that omega-3 fatty acid

supplementation may have benefit for

the treatment of ADHD in children (27).

Between 2007 and 2012, there was

not much change in the top diseases or

conditions treated with complementary

health approaches. In fact, for both

years, the use of complementary health

approaches was most frequently reported

for back or neck pain, head or chest

cold, anxiety or stress, and other

musculoskeletal conditions. As shown

previously, back or neck pain is by far

the most prevalent condition for which

these approaches are used in

children (16). This high use may reflect

current best practice guidelines for the

treatment of back pain issued jointly by

the American College of Physicians and

the American Pain Society (28).

Taken together, the breadth and

depth of the 2012 NHIS child

supplement on complementary health

approaches provides the most

comprehensive snapshot of the use of

these approaches. The descriptive

statistics and highlights presented in this

report are the foundation for future

studies of complementary health

approaches. This report also reveals

interesting relationships between the use

of complementary health approaches in

children over the span of 5 years. The

expanded set of questions in the survey

addressing the reasons children use

these approaches, as well as perceived

outcomes associated with their use, may

help explain some of the observed

variation in the use of individual

approaches by population subgroups.

References

1.National Center for Complementary

and Alternative Medicine. Exploring

the science of complementary and

alternative medicine: Third strategic

plan: 2011–2015. Washington, DC:

U.S. Department of Health and

Human Services, National Institutes

of Health, National Center for

Complementary and Alternative

Medicine. NIH Publication number

11–7643, D458. 2011.

2.Birdee GS, Phillips RS, Davis RB,

Gardiner P. Factors associated with

pediatric use of complementary and

alternative medicine. Pediatrics

125(2):249–56. 2010.

3.Bethell C, Kemper KJ, Gombojav N,

Koch TK. Complementary and

conventional medicine use among

youth with recurrent headaches.

Pediatrics 132(5):e1173–83. 2013.

4.Simkin DR, Popper CW, eds.

Alternative and complementary

therapies for children with

psychiatric disorders, Part 1. Child

and Adolesc Psychiatr Clin N Am

22(3). 2013.

5.Barnes PM, Bloom B, Nahin RL.

Complementary and alternative

medicine use among adults and

children: United States, 2007.

National health statistics reports; no

12. Hyattsville, MD: National Center

for Health Statistics. 2008. Available

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

nhsr/nhsr012.pdf.

6.Wells RE, Bertisch SM, Buettner C,

Phillips RS, McCarthy EP.

Complementary and alternative

medicine use among adults with

migraines/severe headaches.

Headache 51(7):1087–97. 2011.

7.Quandt SA, Chen H, Grzywacz JG,

Bell RA, Lang W, Arcury TA. Use of

complementary and alternative

medicine by persons with arthritis:

Results of the National Health

Interview Survey. Arthritis Rheum

53(5):748–55. 2005.

8.Tindle HA, Davis RB, Phillips RS,

Eisenberg DM. Trends in use of

complementary and alternative

medicine by US adults: 1997–2002.

Altern Ther Health Med 11(1):42–9.

2005.

9.Astin JA. Why patients use

alternative medicine: Results of a

national study. JAMA 279(19):1548–

53. 1998.

10. Eisenberg DM, Davis RB, Ettner SL,

Appel S, Wilkey S, Van Rompay M,

Kessler RC. Trends in alternative

medicine use in the United States,

1990–1997: Results of a follow-up

national survey. JAMA

280(18):1569–75. 1998.

11. National Center for Health Statistics.

2007 National Health Interview

Survey (NHIS): Public use data

release. NHIS survey description.

2007. Available from: ftp://

ftp.cdc.gov/pub/Health_Statistics/

NCHS/Dataset_Documentation/NHIS/

2007/srvydesc.pdf.

12. National Center for Health Statistics.

2012 National Health Interview

Survey (NHIS): Public use data

release. NHIS survey description.

2012. Available from: ftp://

ftp.cdc.gov/pub/Health_Statistics/

NCHS/Dataset_Documentation/NHIS/

2012/srvydesc.pdf.

13. Stussman BJ, Bethell CD, Gray C,

Nahin RL. Development of the adult

and child complementary medicine

questionnaires fielded on the

National Health Interview Survey.

BMC Complement Altern Med

13:328. 2013.

14. Parsons VL, Moriarity C, Jonas K, et

al. Design and estimation for the

National Health Interview Survey,

2006–2015. National Center for

Health Statistics. Vital Health Stat

2(165). 2014.

15. RTI International. SUDAAN

(Release 11.0.0) [computer software].

2009.

16. 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.

17. Moldvay C. IBISWorld industry

report OD4185: Pilates & yoga

studios in the US. Los Angeles, CA:

IBISWorld, Inc. 2012.

18. Nahin RL, Barnes PM, Stussman BJ,

Bloom B. Costs of complementary

and alternative medicine (CAM) and
National Health Statistics Reports

n Number 78n February 10, 2015 Page9

frequency of visits to CAM

practitioners: United States, 2007.

National health statistics reports; no

18. Hyattsville, MD: National Center

for Health Statistics. 2009. Available

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

data/nhsr/nhsr018.pdf.

19. Abcarian R. Yoga in public schools

is exercise, not religion. Los Angeles

Times. July 1, 2013.

20. Ospina MB, Bond K, Karkhaneh M,

Tjosvold L, Vandermeer B, Liang Y,

et al. Meditation practices for health:

State of the research. Evid Rep

Technol Assess (Full Rep) 155:1–

263. 2007.

21. Nutrition Business Journal.

Supplement business report. Boulder,

CO: Penton Media, Inc. 2013.

22. Kuehn BM. Despite health claims by

manufacturers, little oversight for

homeopathic products. JAMA

302(15):1631–2. 2009.

23. Barrett B, Brown R, Rakel D, Mundt

M, Bone K, Barlow S, Ewers T.

Echinacea for treating the common

cold:A randomized trial. Ann Intern

Med 153(12):769–77. 2010.

24. Turner RB, Bauer R, Woelkart K,

Hulsey TC, Gangemi JD. An

evaluation of Echinacea angustifolia

in experimental rhinovirus infections. N Engl J Med 353(4):341–8. 2005.

25. Marik PE, Varon J. Omega-3 dietary

supplements and the risk of

cardiovascular events:A systematic

review. Clin Cardiol 32(7):365–72.

2009.

26. Kotwal S, Jun M, Sullivan D,

Perkovic V, Neal B. Omega-3 fatty

acids and cardiovascular outcomes:

Systematic review and meta-analysis.

Circ Cardiovasc Qual Outcomes

5(6):808–18. 2012.

27. Bloch MH, Qawasmi A. Omega-3

fatty acid supplementation for the

treatment of children with attentiondeficit/hyperactivity disorder

symptomology: Systematic review

and meta-analysis.J Am Acad Child

Adolesc Psychiatry 50(10):991–1000.

2011.

28. Chou R, Qaseem A, Snow V, Casey

D, Cross JT Jr, Shekelle P, et al.

Diagnosis and treatment of low back

pain:A joint clinical practice

guideline from the American College

of Physicians and the American Pain

Society. Ann Intern Med.

147(7):478–91. 2007.

29. Day JC. Population projections of the

United States by age, sex, race, and

Hispanic origin: 1995 to 2050. U.S.

Bureau of the Census, Current

Population Reports, P25–1130.

Washington, DC: U.S. Government

Printing Office. 1996.

30. Klein RJ, Schoenborn CA. Age

adjustment using the 2000 projected

U.S. population. Healthy People

Statistical Notes, no. 20. Hyattsville,

MD: National Center for Health

Statistics. 2001. Available from:

http://www.cdc.gov/nchs/data/statnt/

statnt20.pdf.

31. Office of Management and Budget.

Revisions to the standards for the

classification of federal data on race

and ethnicity. Fed Regist

62(210):58781–90. 1997.
Page 10 National Health Statistics Reports n Number 78 n February 10, 2015

Table 1. Frequencies and age-adjusted percentages of children aged 4–17 years who used or saw a practitioner, took a class, or

received formal training for selected complementary and alternative medicine modalities during the past 12 months, by type of therapy:

United States, 2007 and 2012

2007 2012

Age- Ageadjusted adjusted

percent percent

Number (in (standard Number (in (standard p

Therapy thousands) error) thousands) error) value1

Nonvitamin, nonmineral dietary supplements2 ........................... 2,452 4.3 (0.38) 2,753 4.9 (0.29) †

Chiropractic or osteopathic manipulation .............................. 1,742 3.0 (0.29) 1,854 3.3 (0.26) †

Yoga, tai chi, or qi gong (any)..................................... 1,414 2.5 (0.23) 1,820 3.2 (0.24) ¶

Yoga (any) ...............................................

Tai chi (any) ..............................................

Qi gong (any) .............................................

1,312

‡

113‡

2.3 (0.22) ‡

0.2 (0.06)‡

1,741

139

40

3.1 (0.23)

0.2 (0.05) ‡

0.1 (0.03)

¶

†

†

Deep-breathing exercises3 ....................................... 1,533 2.7 (0.28) 1,531 2.7 (0.21) †

Deep breathing as part of mantra, mindful, or spiritual meditation; guided imagery; or

progressive relaxation ....................................... --­ --­ 360 0.6 (0.09) --­

Deep breathing as part of yoga, tai chi, or qi gong ...................... --­ --­ 1,387 2.5 (0.21) --­

Homeopathy treatment4.................... .................... 686 1.2 (0.26) 1,007 1.8 (0.19) †

Homeopathy (practitioner based) ................................. --­ --­ 123 0.2 (0.06) --­

Meditation5 ................................................ 725 1.3 (0.16) 927 1.6 (0.16) †

Mantra, mindful, or spiritual meditation .............................. --­ --­ 323 0.6 (0.09) --­

Meditation as part of yoga, tai chi, or qi gong.......................... --­ --­ 760 1.3 (0.15) --­

Massage.................................................. 579 1.0 (0.14) 385 0.7 (0.10) †

Special diets6 ............................................... 404 0.7 (0.12) 419 0.7 (0.12) †

Progressive relaxation ......................................... 327 0.6 (0.11) 216 0.4 (0.07) †

Guided imagery ............................................. 293 0.5 (0.11) 239 0.4 (0.08) †

Movement therapies7 .......................................... 266 0.5 (0.08) 239 0.4 (0.09) †

Energy healing therapy .........................................

Naturopathy ................................................

Craniosacral therapy ..........................................

Acupuncture ...............................................

Traditional healers8 ...........................................

Biofeedback................................................

Hypnosis..................................................

Ayurveda .................................................

110

‡

158

--­

96

619

‡

73‡

34

0.2 (0.05) ‡

0.3 (0.10)

--­

0.2 (0.05)

1.1 (0.20) ‡

0.1 (0.04)‡

‡

0.1 (0.03)

102

‡

130

‡

95

‡

79

‡

69

‡

21‡

‡

0.2 (0.05)

0.2 (0.07) ‡

0.2 (0.07) ‡

0.1 (0.05) ‡

0.1 (0.05) ‡

0.0 (0.02)‡

‡

†

†

†

†

§

¶

†

†

† Difference is not statistically significant. ‡ Estimates are considered unreliable. Data have a relative standard error (RSE) greater than 30% and less than or equal to 50% and should be used with caution. Data not shown have an RSE

greater than 50%.

- - - Data not available. § p value less than 0.01.

0.0 Quantity more than zero but less than 0.05. ¶ p value less than 0.05. 1p value for differences across years. 2While questions were asked about nonvitamin, nonmineral dietary supplements in 2007 and 2012, the data should be interpreted with caution due to question order and the specific nonvitamin,

nonmineral dietary supplements covered.
 3Deep-breathing exercises in 2012 included deep-breathing exercises as part of hypnosis, biofeedback, mantra meditation (including Transcendental Meditation, relaxation response, and clinically
 

standardized meditation), mindfulness meditation (including vipassana, Zen Buddhist meditation, mindfulness-based stress reduction, and mindfulness-based cognitive therapy), spiritual meditation
 

(including centering prayer and contemplative meditation), guided imagery, progressive relaxation, yoga, tai chi, or qi gong, while deep-breathing exercises in 2007 asked broadly about the use of
 

deep breathing and did not distinguish between deep breathing used as part of other complementary health approach modalities.
 4Homeopathy questions in 2007 did not distinguish between practitioner based and self-care. Therefore, estimates presented in 2012 also do not take this into account.
 5Meditation in 2012 includes mantra meditation (including Transcendental Meditation, relaxation response, and clinically standardized meditation), mindfulness meditation (including vipassana, Zen
 

Buddhist meditation, mindfulness-based stress reduction, and mindfulness-based cognitive therapy), spiritual meditation (including centering prayer and contemplative meditation), and meditation
 

as part of yoga, tai chi, or qi gong. In 2007, meditation was asked broadly and did not specify subgroups of meditation.
 6Special diets in 2007 and 2012 include vegetarian (including vegan), macrobiotic, Atkins, Pritikin, and Ornish diets.
 7Movement therapies in 2007 and 2012 include Feldenkrais, Alexander technique, Pilates, and Trager psychophysical integration.
 8Traditional healers in 2007 include Curandero, Espiritista, Hierbero and Yerbera, Shaman, Botanica, Native American Healer or Medicine Man, and Sobador. Traditional healers in 2012 include
 

Curandero, Machi, or Parchero; Yerbero or Hierbista; Shaman; Native American Healer or Medicine Man; Sobador; and Huesero.
 

NOTES: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. Estimates were age-adjusted using the projected 2000 U.S. population as the
 

standard population and using two age groups: 4–11 and 12–17. The denominators for statistics shown exclude persons with unknown complementary health approach use information.
 

SOURCE: CDC/NCHS, National Health Interview Survey, 2007, 2012.
 
National Health Statistics Reports n Number 78 n February 10, 2015 Page 11

Table 2. Age-adjusted percentages of children aged 4–17 years who used any complementary health approaches during the past

12 months, by selected characteristics: United States, 2007 and 2012

Any complementary health approach use1

p value for

differences

Selected characteristic 2007 2012 across years

Age-adjusted

percent2 Age-adjusted

(standard percent2

error) (standard error)

Total .................................................. 12.0 (0.54) 11.6 (0.46)

Sex

Boys .................................................. 10.5 (0.77) 9.7 (0.56) †

Girls .................................................. 13.5 (0.69) 13.5 (0.67) †

Age (years)3

4–11 .................................................. 9.8 (0.67) 9.3 (0.53) †

12–17 ................................................. 15.0 (0.86) 14.7 (0.75) †

Hispanic origin and race

Hispanic................................................ 8.2 (0.87) 6.1 (0.54) ‡

Non-Hispanic white, single race ................................. 14.7 (0.82) 14.9 (0.70) †

Non-Hispanic black or African American, single race .................... 5.5 (0.84) 5.5 (0.77) †

Non-Hispanic all other races ................................... 13.6 (1.62) 14.2 (1.50) †

Parent’s education4

Less than high school diploma .................................. 4.1 (0.74) 2.1 (0.43) ‡

High school diploma or GED5 .................................. 8.1 (0.89) 6.9 (0.77) †

More than high school ....................................... 15.2 (0.76) 15.0 (0.62) †

Poverty status6

Poor .................................................. 7.0 (0.96) 5.7 (0.69) †

Near poor............................................... 8.5 (0.95) 9.1 (0.81) †

Not poor ............................................... 14.9 (0.80) 14.8 (0.67) †

Health insurance7

Private................................................. 14.1 (0.73) 14.6 (0.66) †

Public ................................................. 8.1 (0.76) 7.6 (0.55) †

Uninsured............................................... 10.4 (1.44) 8.4 (1.20) †

† Difference is not statistically significant. ‡ p value less than 0.01. 1Complementary health approach definition was a ‘‘yes’’ response to chelation therapy; nonvitamin, nonmineral dietary supplements; vegetarian or vegan diet; macrobiotic diet; Atkins diet; Pritikin

diet; Ornish diet; acupuncture; Ayurveda; homeopathic treatment; naturopathy; Native American or Medicine Man; Shaman; Curandero, Machi, or Parchero; Yerbero or Hierbista; Sobador; Huesero;

chiropractic or osteopathic manipulation; massage; Feldenkrais; Alexander technique; Pilates; Trager psychophysical integration; biofeedback; mantra meditation; Transcendental Meditation;
 

relaxation; clinically standard meditation; spiritual meditation; guided imagery; progressive relaxation; yoga, tai chi, or qi gong (with deep breathing); hypnosis; and energy healing.
 2The denominator used in the calculation of percentages was all sample children.
 3Estimates for age groups are not age-adjusted.
 4Refers to the education level of the parent with the higher level of education, regardless of that parent’s age.
 5GED is General Educational Development high school equivalency diploma.
 6Based on family income and family size using the U.S. Census Bureau’s poverty thresholds for the previous calendar year. ‘‘Poor’’ persons are defined as below the poverty threshold. ‘‘Near
 

poor’’ persons have incomes of 100% to less than 200% of the poverty threshold. ‘‘Not poor’’ persons have incomes that are 200% of the poverty threshold or greater.
 7Based on a hierarchy of mutually exclusive categories. Children with more than one type of health insurance were assigned to the first appropriate category in the hierarchy. ‘‘Uninsured’’ includes
 

children who had no coverage as well as 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: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. Estimates are age-adjusted using the projected 2000 U.S. population as the
 

standard population and using two age groups: 4–11 and 12–17.
 

SOURCE: CDC/NCHS, National Health Interview Survey, 2007, 2012.
 
Page 12 National Health Statistics Reports n Number 78 n February 10, 2015

Table 3. Frequencies and age-adjusted percentages of children aged 4–17 years who used selected types of nonvitamin, nonmineral

dietary supplements for health reasons in the past 30 days, by type of product used: United States, 2007 and 2012

Used selected nonvitamin, nonmineral dietary supplements1

2007 2012

Nonvitamin, nonmineral dietary supplements

Number (in

thousands)

Ageadjusted

percent2

(standard

error)

Number (in

thousands)

Ageadjusted

percent2

(standard error)

p

value

Fish oil3......................................... 394 0.7 (0.17) 664 1.1 (0.13) †

‡ ‡ §

Melatonin........................................ 87 0.1 (0.05) 419 0.7 (0.11)

Probiotics or prebiotics ............................... † ‡

0.3 (0.15) 294 0.5 (0.09) †

§

Echinacea ....................................... 434 0.8 (0.13) 205 0.4 (0.08)

Garlic supplements.................................. ‡

78 ‡0.1 (0.04) ‡80 ‡0.1 (0.04) †

‡ ‡ ‡ ‡

Combination herb pill ................................ 290 0.5 (0.15) 68 0.1 (0.04) ¶

Ginseng......................................... ‡ ‡ ‡63 ‡0.1 (0.05) †

Cranberry (pills, capsules) ............................. ‡33 ‡0.1 (0.03) ‡31 ‡0.1 (0.02) †

Glucosamine or chondroitin............................. ‡ ‡ ‡42 ‡0.1 (0.03) †

† Difference is not statistically significant. ‡

Estimates are considered unreliable. Data have a relative standard error (RSE) greater than 30% and less than or equal to 50% and should be used with caution. Data not shown have an RSE

greater than 50%. § p value less than 0.01. ¶ p value less than 0.05. 1Respondents may have used more than one nonvitamin, nonmineral dietary supplement. 2The denominator used in the calculation of percentages was all sample children. 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.

NOTES: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. Estimates were age-adjusted using the projected 2000 U.S. population as the

standard population and using two age groups: 4–11 and 12–17.

SOURCE: CDC/NCHS, National Health Interview Survey, 2007, 2012.
National Health Statistics Reports n Number 78 n February 10, 2015 Page 13

Table 4. Frequencies and age-adjusted percentages of children aged 4–17 years who used selected types of complementary health

approaches to treat a condition among those who used any complementary health approach in the past 12 months: United States, 2007

and 2012

2007 2012

Complementary health approach

Age-adjusted

percent

(standard

error)1

Age-adjusted

percent

(standard

error)1

p

value

Any complementary health approach ......................... 44.2 (2.66) 45.6 (2.16) †
 

Acupuncture ........................................ 53.9 (14.71) 70.1 (17.83) †
 

‡

Naturopathy ........................................ 50.0 (17.70) 66.0 (6.47) †
 

Homeopathy treatment .................................. 88.8 (4.07) 62.9 (5.26) §
 

Chiropractic or osteopathic manipulation ....................... 59.8 (5.21) 62.1 (3.86) †
 

‡ ‡

Biofeedback ........................................ 42.1 (16.36) 59.7 (21.93) †
 

Massage therapy ..................................... 40.0 (8.77) 42.6 (8.70) †
 

Nonvitamin, nonmineral dietary supplements .................... 49.4 (5.59) 35.5 (3.47) §
 

† Special diets2 ....................................... ‡

25.9 (7.36)
 † Traditional healers3 .................................... ‡

14.4 (4.61) ‡23.5 (8.85)
 

Movement therapies4 ................................... ‡ ‡

11.1 (3.98) †
 

Energy healing therapy.................................. 57.9 (13.44) ‡ †
 

‡

Hypnosis .......................................... 78.3 (19.11) †
 

† Difference is not statistically significant. ‡ Estimates are considered unreliable. Data have a relative standard error (RSE) greater than 30% and less than or equal to 50% and should be used with caution. Data not shown have an RSE

greater than 50%.

§ p value less than 0.001. 1The denominators used in the calculation of percentages were children who used each selected type of complementary health approach. 2Special diets include vegetarian (including vegan), macrobiotic, Atkins, Pritikin, and Ornish diets for both 2007 and 2012. 3Traditional healers in 2007 include Curandero, Espiritista, Hierbero or Yerbera, Shaman, Botanica, Native American Healer or Medicine Man, and Sobador. Traditional healers in 2012 include

Curandero, Machi, or Parchero; Yerbero or Hierbista; Shaman; Native American Healer or Medicine Man; Sobador; and Huesero. 4Movement therapies include Feldenkrais, Alexander technique, Pilates, and Trager psychophysical integration for both 2007 and 2012.

NOTES: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. Estimates are age-adjusted using the projected 2000 U.S. population as the

standard population and using two age groups: 4–11 and 12–17.

SOURCE: CDC/NCHS, National Health Interview Survey, 2007, 2012.
Page 14 National Health Statistics Reports n Number 78 n February 10, 2015

Table 5. Frequencies and age-adjusted percentages of children aged 4–17 years who used complementary health approaches in the past

12 months for specific conditions, among those who used complementary health approaches, by the condition for which it was used:

United States, 2007 and 2012

2007 2012

Disease or condition1

Number (in

thousands)

Age-adjusted

percentage2

(standard

error)

Number (in

thousands

Age-adjusted

percentage2

(standard

error)

p

value

Back or neck pain .................................. 686 8.8 (1.12) 602 8.9 (1.14) †

Head or chest cold .................................. 409 6.5 (1.38) 294 5.1 (0.92) †

Other musculoskeletal conditions ......................... 345 5.0 (0.99) 416 6.0 (0.98) †

Anxiety or stress ................................... 293 4.4 (0.94) 221 3.4 (0.72) †

ADHD or ADD3 .................. .................. 150 2.3 (0.52) 131 2.2 (0.59) †

Insomnia or trouble sleeping ............................

Constipation ......................................

Respiratory allergy ..................................

Sore throat other than strep or tonsillitis .....................

Sinusitis.........................................

Abdominal pain ....................................

Depression.......................................

Asthma .........................................

134‡

‡

68

‡

94 ‡

117

‡

66 ‡

178

112

2.0 (0.59)‡

‡

1.2 (0.53) ‡

1.4 (0.59) ‡

2.0 (0.78) ‡

1.0 (0.39) ‡

0.9 (0.28) ‡

1.8 (0.65)

110

‡

70

‡

69

‡

50

‡

45

‡

44

‡

41

‡

34

1.7 (0.43) ‡

1.2 (0.38) ‡

1.0 (0.39) ‡

0.9 (0.42) ‡

0.7 (0.31) ‡

0.6 (0.26) ‡

0.6 (0.23) ‡

0.5 (0.21)

†

†

†

†

†

†

†

†

† Difference is not statistically significant. ‡ Estimates are considered unreliable. Data have a relative standard error (RSE) greater than 30% and less than or equal to 50% and should be used with caution. Data not shown have an RSE

greater than 50%.
 1Respondents may have used more than one modality to treat a disease or condition, but were counted only once under each disease or condition treated. The questions about using a modality
 

to treat a disease or condition were only asked of respondents who had used the modality within the past 12 months. The exception to this is the questions about using nonvitamin, nonmineral
 

dietary supplements to treat a disease or condition, which were only asked of respondents who had used nonvitamin, nonmineral dietary supplements within the past 30 days.
 2The denominator used in the calculation of percentages was the number of children who used complementary health approaches within the past 12 months, excluding persons with unknown
 

information about whether a complementary health approach was used to treat the specified condition.
 3ADHD is attention deficit hyperactivity disorder and ADD is attention deficit disorder.
 

NOTES: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. Estimates are age-adjusted using the 2000 U.S. population as the standard
 

population and using two age groups: 4–11 and 12–17.
 

SOURCE: CDC/NCHS, National Health Interview Survey, 2007 and 2012.
 
National Health Statistics Reports n Number 78 n February 10, 2015 Page 15

Technical Notes

Sample design

The National Health Interview

Survey (NHIS) is a cross-sectional

household interview survey of the U.S.

civilian noninstitutionalized population.

Data are collected continuously

throughout the year in all 50 states and

the District of Columbia. NHIS uses a

multistage clustered sample design to

produce national estimates for a variety

of health indicators. Information on

basic health topics is collected for all

household members, if necessary by

proxy, from one adult family member.

Additional information is collected for

one randomly selected adult and one

randomly selected child in each family.

Self-response is required for the Sample

Adult questionnaire except in rare cases

where sample adults are physically or

mentally incapable of responding for

themselves. Interviews are conducted in

the home using computer-assisted

personal interview techniques, with

telephone interviewing permitted for

follow-up if necessary. Starting in 2006,

the sample design included Asian

persons in the oversampling of minority

populations in NHIS; previously, only

households with non-Hispanic black and

Hispanic persons were oversampled.

Response rate

In 2007, NHIS interviews were

completed in 29,266 households, which

yielded 75,764 persons in 29,914

families; the household response rate

was 87.1%. The Sample Child

questionnaire was completed for 9,417

children. The final response rate (which

takes into account household and family

nonresponse) for the 2007 sample child

files was 76.5% (11). In 2012, NHIS

interviews were completed in 42,366

households, which yielded 108,131

persons in 43,345 families; the

household response rate was 77.6%. The

Sample Child questionnaire was

completed for 12,275 children. The final

response rate (which takes into account

household and family nonresponse) for

the 2012 sample child files was 69.7%

(12).

Procedures used in calculating

response rates are described in detail in

Appendix I of the NHIS Survey

Description Document (11,12).

Age adjustment

Unless otherwise specified,

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 (29,30). Age adjustment was

used to allow comparison among

various population subgroups that have

different age structures. This is

particularly important for demographic

characteristics such as race, ethnicity,

and parent’s education. Age-adjusted

percentages should also be used when

assessing changes in prevalence over

time when the age distribution of the

population is changing. The following

age groups were used for age

adjustment: 4–11 and 12–17 years.

Estimates were calculated using

software for statistical analysis of

correlated data (SUDAAN) (15). 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. For this reason,

age-adjusted percentages for health

characteristics in this report may not

match age-adjusted percentages for the

same health 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 National Center for Health

Statistics survey data, see Klein and

Schoenborn (30).

Tests of significance

Statistical reliability and

hypothesis tests

Statistical tests performed to assess

the significance of year-to-year

differences in the estimates were

two-tailed tests with no adjustments

made for multiple comparisons. The test

statistic used to determine statistical

significance of the difference between

two percentages was

|X – X |

Z = a b , 2

√Sa

2 + Sb

where Xa and Xb are the two

percentages being compared, and Sa and

Sb are the SUDAAN-calculated standard

errors of those percentages. The critical

value used for two-sided tests at the

0.05 level of significance was 1.96.

Relative standard error

Standard errors, produced by using

the SUDAAN statistical package, are

shown for all percentages in the tables.

Estimates with a relative standard error

(RSE) greater than 30% and less than or

equal to 50% should be used with

caution as they do not meet standards of

reliability or precision. Estimates with

an RSE greater than 50% are not shown.

RSEs are calculated as:

RSE = (SE/Est)100

where SE is the standard error of the

estimate, and Est is the estimate

(percentage). The reliability of

frequencies and their corresponding

percentages is determined independently,

so it is possible for a particular

frequency to be reliable and its

associated percentage unreliable, and

vice versa. In most instances, however,

both estimates were reliable (or

unreliable).

Definition of 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.

Alexander technique—A practice

that uses guidance and education on

ways to improve posture and movement.
Page 16 National Health Statistics Reports n Number 78 n February 10, 2015

The intent is to teach a person how to

use muscles more efficiently to improve

the overall functioning of the body.

Examples of the Alexander technique as

a complementary health approach are

using it to treat low-back pain and the

symptoms of Parkinson’s disease.

Alternative provider or

practitioner—Someone who is

knowledgeable about a specific

alternative health practice. This person

provides care or gives advice about its

use and usually receives payment for his

or her services.

For some practices, the provider

may have received formal training and

been certified by a licensing board or

related professional association. For

example, a practitioner of biofeedback

(biofeedback therapist) has usually

received training in psychology and

physiology and may be certified by the

Biofeedback Certification International

Alliance (formerly the Biofeedback

Certification Institute of America).

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. In the United States,

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.

Botanica—A traditional healer who

supplies healing products, sometimes

associated with spiritual interventions.

Chelation therapy—A chemical

process in which a substance is used to

bind molecules, such as metals or

minerals, and hold them tightly so that

they can be removed from a system,

such as the body. In medicine, chelation

has been scientifically proven to rid the

body of excess or toxic metals. For

example, a person who has lead

poisoning may be given chelation

therapy to bind and remove excess lead

from the body before it can cause

damage.

Chiropractic manipulation—A form

of health care that focuses on the

relationship between the body’s

structure, primarily the spine, and its

function.

Craniosacral therapy—A bodybased practice in which practitioners use

light touch and manipulation focused on

the skull and spine, with the intent of

sensing and removing what they refer to

as blockages or imbalances that may be

contributing to a health condition.

Curandero, Machi, or

Parchero—Types of traditional folk

healers. Originally found in Latin

America, these healers specialize in

treating illness through the use of

supernatural forces, herbal remedies, and

other natural medicines.

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.

Espiritista—A traditional healer

who assesses a patient’s condition and

recommends herbs or religious amulets

to improve physical or mental health or

to help overcome a personal problem.

Feldenkrais—A method of

education in physical coordination and

movement. Practitioners use verbal

guidance and light touch to teach the

method through one-on-one lessons and

group classes. The intent is to help the

person become more aware of how the

body moves through space and to

improve physical functioning.

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, the individual will

visualize their body free of the specific

problem or condition. Sessions are

typically 20 to 30 minutes in length, and

may be practiced several times a week.

Hierbero, Yerbero, or Hierbista—A

practitioner with knowledge of the

medicinal qualities of plants.

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.

Huesero—A ‘‘bone setter’’ (in

Hispanic folk healing) who specializes

in bone ailments, mainly lesions and

fractures.

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.

Mantra meditation—A type of

meditation in which the meditator

focuses on a mantra (a specially chosen

word, sound, or phrase that is repeated

silently).
National Health Statistics Reports n Number 78 n February 10, 2015 Page 17

Massage—Therapists manipulate

muscle and connective tissue to enhance

function of those tissues and promote

relaxation and wellbeing.

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.

Native American Healer or

Medicine Man—A traditional healer

who uses information from the spirit

world to benefit the community. People

see Native American healers for a

variety of reasons, especially to find

relief from or a cure for illness or to

find spiritual guidance.

Naturopathy—An alternative

medical approach based on the belief

that there is a healing power in the body

that establishes, maintains, and restores

health. Practitioners work with the

patient with a 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—Taken by mouth and

contain a dietary ingredient intended to

supplement the diet other than vitamins

and minerals. Examples include herbs or

herbal medicine (as single herbs or

mixtures), other botanical products such

as soy or flax products, and dietary

substances such as enzymes and

glandulars. Among the most popular are

echinacea, ginkgo biloba, ginseng,

feverfew, garlic, kava kava, and saw

palmetto. Garlic, for example, has been

used to treat fevers, sore throats,

digestive ailments, hardening of the

arteries, and other health problems and

conditions.

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 kind are

avoided.

Osteopathic manipulation—A

full-body system of hands-on techniques

to alleviate pain, restore function, and

promote health and wellbeing.

Pilates—A method of physical

exercise used to strengthen and build

control of muscles, especially those used

for posture. Awareness of breathing and

precise control of movements are

integral components of Pilates. Special

equipment, if available, is often used.

Pritikin diet—A diet low in fat 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 more a week for

30 minutes at a time.

Shaman—Said to act as a medium

between the invisible spiritual world and

the physical world. Most gain

knowledge through contact with the

spiritual world and use the information

to perform tasks such as divination,

influencing natural events, and healing

the sick or injured.

Sobador—Uses massage and

rubbing techniques to treat patients.

Spiritual meditation—May be

performed according to the practices of

one of the major religions or within a

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 repeating a spiritual,

meditative phrase).

Tai chi—A mind-body practice that

originated in China as a 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 of a

proposed vital energy called ‘‘qi.’’

Individuals practicing tai chi move their

bodies in a slow, relaxed, and graceful

series of movements. One can practice

alone or in a group. The movements

make up what are called forms (or

routines).

Traditional healer—Someone who

employs any one of a 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.

Trager psychophysical

integration—A therapy in which

practitioners apply a series of gentle,

rhythmic rocking movements to the

joints. They also teach physical and

mental self-care exercises to reinforce

the proper movement of the body. The

intent is to release physical tension and

increase the body’s range of motion. An

example of Trager psychophysical

integration therapy is using it to treat

chronic headaches.

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.
Page 18 National Health Statistics Reports n Number 78 n February 10, 2015

Yoga—A combination of breathing

exercises, physical postures, and

meditation to calm the nervous system

and balance the body, mind, and spirit.
National Health Statistics Reports n Number 78 n February 10, 2015

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 5419

Hyattsville, MD 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

For more NCHS NHSRs, visit:

http://www.cdc.gov/nchs/products/nhsr.htm.

FIRST CLASS MAIL
 

POSTAGE & FEES PAID
 

CDC/NCHS
 

PERMIT NO. G-284
 

Suggested citation

Black LI, Clarke TC, Barnes PM, et al. Use of

complementary health approaches among

children aged 4–17 years in the United States:

National Health Interview Survey, 2007–2012.

National health statistics reports; no 78.

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

For e-mail updates on NCHS publication releases, subscribe online at: http://www.cdc.gov/nchs/govdelivery.htm.
 

For questions or general information about NCHS: Tel: 1–800–CDC–INFO (1–800–232–4636) • TTY: 1–888–232–6348
 

Internet: http://www.cdc.gov/nchs • Online request form: http://www.cdc.gov/info
 

DHHS Publication No. 2015–1250 • CS253703