Number 85 n November 4, 2015

Wellness-related Use of Common Complementary

Health Approaches Among Adults: United States, 2012

Barbara J. Stussman, B.A., National Institutes of Health; Lindsey I. Black, M.P.H., Patricia M. Barnes, M.A.,
 

and Tainya C. Clarke, Ph.D., M.P.H., 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 selected wellnessrelated reasons for the use of natural product supplements, yoga, and spinal

manipulation among U.S. adults in 2012. Self-reported perceived health

outcomes were also examined.

Methods—Data from 34,525 adults aged 18 and over collected as part of

the 2012 National Health Interview Survey were analyzed for this report.

In particular, whether adults who used selected complementary health approaches

did so to treat a specific health condition or for any of five wellness-related

reasons was examined, as well as whether these adults perceived that this use led

to any of nine health-related outcomes. Sampling weights were used to produce

national estimates that are representative of the civilian noninstitutionalized

U.S. adult population.

Results—Users of natural product supplements and yoga were more likely to

have reported using the approach for a wellness reason than for treatment of a

specific health condition, whereas more spinal manipulation users reported using

it for treatment rather than for wellness. The most common wellness-related

reason reported by users of each of the three approaches was for ‘‘general

wellness or disease prevention.’’ The majority of users of all three health

approaches reported that they perceived this use improved their overall health

and made them feel better. Yoga users perceived higher rates of all of the

self-reported wellness-related health outcomes than users of natural product

supplements or spinal manipulation.

Keywords: disease prevention • mind–body • nonvitamin, nonmineral dietary

supplements • National Health Interview Survey

Introduction

Complementary health approaches

include an array of health care systems,

therapies, and products with a history of

use or origins outside of mainstream

medicine. Examples include yoga,

chiropractic or osteopathic manipulation,

and acupuncture. Previous studies have

shown that many individuals use

complementary health approaches for

disease prevention and to improve

health and wellbeing (1,2), or to relieve

symptoms associated with chronic

diseases or the side effects of

conventional medicine(s) (3,4). Persons

who use complementary health

approaches often have a holistic health

philosophy, want greater control over

their own health, and practice a

‘‘wellness lifestyle’’ (5,6). Previous

studies have also shown that different

approaches are used for different

reasons (7–9). For example, Hawk et al.

2011 (7) found that nearly 60% of users

of massage therapy did so for reasons

other than treatment of a specific health

condition, whereas only 31% of

naturopathy users, 15% of acupuncture

users, and 18% of chiropractic or

osteopathic manipulation users sought

care for reasons other than to treat a

specific health condition.

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 85 n November 4, 2015

This report examines a range of

survey questions specifically developed

to capture wellness-related reasons and

perceived health outcomes reported by

individuals using selected complementary

health approaches. Previous qualitative

research conducted with persons who

use complementary health approaches

led to the development of new

questionnaire items that were included

in the 2012 National Health Interview

Survey (NHIS) (10). Respondents were

asked separately about health-related

reasons for using each complementary

health approach and whether they

perceived that this use resulted in

specified health outcomes. For the

current analyses, five questionnaire

items that captured wellness-related

reasons for using the approach, and nine

items that captured wellness-related

health outcomes for three commonly

used complementary approaches (natural

product supplements, yoga, and

chiropractic or osteopathic manipulation

[subsequently referred to in this report

as ‘spinal manipulation’ for the sake of

brevity]) among adults aged 18 and

over were examined (Table). These

three approaches were chosen for

analysis for two reasons: They were

among the most commonly used in

2012 (11) (17.7% of adults used natural

product supplements, 8.7% used yoga,

and 8.4% used spinal manipulation in

the previous 12 months); and they

represent three major types of

complementary health approaches:

natural products (natural product

supplements), mind–body approaches

(yoga), and practitioner-based

approaches (spinal manipulation).

Additionally, data on whether these

three approaches were used for

treatment purposes are presented. Other

reasons for using complementary health

approaches and outcomes from their use

were assessed in the 2012 survey but

are not considered wellness- or

treatment-related and, thus, are not

included in the current analyses.

This report builds on previous

research by examining an expanded list

of wellness-related reasons that

prompted individuals’ use of

complementary approaches, as well as

highlighting self-reported perceived

health outcomes. This analysis will

allow researchers and practitioners to

better understand not only wellness

and treatment reasons for using

complementary health approaches, but

also nuances in wellness-related use

across the three commonly used

approaches.

Methods

Data source

Data in this report come from the

2012 Adult Alternative Medicine

supplement to NHIS. NHIS is a

multipurpose health survey of the U.S.

civilian noninstitutionalized population.

It is conducted continuously for the

Centers for Disease Control and

Prevention’s National Center for Health

Statistics by trained interviewers from

the U.S. Census Bureau. Data are

collected in person at the respondent’s

home using computer-assisted personal

interviewing, but follow-ups to complete

interviews may be conducted over the

telephone.

The survey consists of both a core

set of questions that remain relatively

unchanged from year to year as well as

supplemental questions that are not

asked every year. The core consists of

four main components: Household

Composition Section, Family Core,

Sample Adult Core, and Sample Child

Core. The Household Composition

Section collects basic demographic and

relationship information about all

household members of all families

living in a household. The Family Core

Section collects sociodemographic and

basic health information about all family

members. For the Sample Adult Core,

one adult per family (the sample adult)

is randomly selected to respond to

detailed health questions. For the

Sample Child Core, a knowledgeable

adult (usually the parent) responds to

detailed health questions for one

randomly selected child per family

(the sample child). More information

on NHIS is available from:

http://www.cdc.gov/nchs/nhis.htm (12).

In 2012, NHIS fielded the Adult

Alternative Medicine supplement to

collect information on the use of

complementary health approaches in the

United States. This supplement followed

the Sample Adult questionnaire. All

sample adults were asked broadly about

the use of more than 20 different

complementary health approaches. For

persons who reported using a particular

approach, more detailed questions were

asked about this use, such as sources of

information about the approach and

disclosure to a conventional provider.

Respondents were also asked a series of

questions about reasons for use and

self-reported perceived health outcomes

resulting from the use of specific

approaches (Table). Respondents were

asked to respond yes or no to each

reason or outcome. Respondents with

missing data for a particular reason or

outcome were excluded from the

analysis of that item. Reasons were not

mutually exclusive and respondents

could report a wellness and a treatment

reason in addition to multiple wellness

reasons. In the event that adults used

more than three complementary health

approaches (3.2% of adults; 10.9% of

adults who used complementary health

approaches), they were first asked to

select the top three most important

approaches for their health, and then

asked to report reasons for the use of

these approaches only. The use of the

approaches analyzed in this report are

underestimated to the extent that adults

using more than three approaches did

not choose natural product supplements,

spinal manipulation, or yoga as most

important to health.

Wellness-related reasons analyzed

for this report include:

+ Treatment of a specific health

condition

+ General wellness or disease

prevention

+ Improve immune function

+ Improve energy

+ Focuses on the whole person—mind,

body, and spirit

+ Improve memory or concentration

The first self-reported perceived

health outcomes examined for this

report were whether respondents’ use of

the named complementary health
 	 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

	 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

National Health Statistics Reports n Number 85 n November 4, 2015	 Page 3

Table. Questionnaire items to capture wellness-related reasons for use and perceived health outcomes from use of complementary

health approaches: National Health Interview Survey, 2012

Reasons for and outcomes from using

complementary health approaches Survey question

General wellness or disease prevention Did you [see a practitioner for/use modality] for any of these reasons?

For general wellness or general disease prevention?

Improve immune function Did you [see a practitioner for/use modality] for any of these reasons?

To improve your immune function?

Improve energy Did you [see a practitioner for/use modality] for any of these reasons?

To improve your energy?

Focuses on the whole person—mind, body and

spirit

During the past 12 months, did you [see a practitioner for/use modality] for any of these reasons?

It focuses on the whole person—mind, body, and spirit?

Improve memory or concentration Did you [see a practitioner for/use modality] for any of these reasons?

To improve your memory or concentration?

Exercise more regularly Did [seeing a practitioner for/using modality] motivate you to exercise more regularly?

Eat healthier Did [seeing a practitioner for/using modality] motivate you to eat healthier?

Cut back or stop drinking alcohol Did [seeing a practitioner for/using modality] motivate you to cut back or stop drinking alcohol?

Cut back or stop smoking cigarettes Did [seeing a practitioner for/using modality] motivate you to cut back or stop smoking cigarettes?

Reduced stress or relaxation Did [seeing a practitioner for/using modality] lead to any of these outcomes?

Help to reduce your stress level or to relax?

Improved sleep Did [seeing a practitioner for/using modality] lead to any of these outcomes?

Help you to sleep better?

Felt better emotionally Did [seeing a practitioner for/using modality] lead to any of these outcomes?

Make you feel better emotionally?

Eased coping with health problems Did [seeing a practitioner for/using modality] lead to any of these outcomes?

Make it easier to cope with health problems?

Improved overall health and made you feel better Did [seeing a practitioner for/using modality] lead to any of these outcomes?

Improve your overall health and make you feel better?

NOTE: Response options for questionnaire items are yes or no.

approach motivated them to do any of

the following:

+ Exercise more regularly

+ Eat healthier

+ Cut back or stop drinking alcohol

+ Cut back or stop smoking cigarettes

The items on alcohol and smoking

were asked only of adults who reported

that they were current drinkers or

smokers in the Core questionnaire.

Other self-reported perceived health

outcomes examined in this report

include:

+ Reduced stress or relaxation

+ Improved sleep

+ Felt better emotionally

+ Eased coping with health problems

+	 Improved overall health and made

you feel better

Respondents were asked to say yes

or no to each item.

Analyses in this report were based

on data from 34,525 sample adults aged

18 and over, 4,400 of whom reported

that they had taken natural product

supplements in the past 30 days, 2,729

who reported practicing yoga in the past

12 months, and 2,785 who reported

seeing a practitioner for spinal

manipulation in the past 12 months. Use

of yoga was restricted to individuals

who had used deep breathing or

meditation as part of yoga. The

conditional response rate for the sample

adult questionnaire was 79.7% (the

number of completed sample adult

interviews divided by the total number

of eligible sample adults), and the final

response rate was 61.2% (the

conditional response rate multiplied by

the final family response rate).

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 (13). Point

estimates, and estimates of their

variances, were calculated using

SAS-callable SUDAAN version 11.0.0,

a software package that accounts for the

complex sample design of NHIS (14).

The denominators used in the

calculation of percentages for reasons

for use of complementary health

approaches were the number of adults

who reported use of the specific

complementary health approach as any

of their top three most important

approaches used for health reasons

within the past 12 months. Respondents
 	 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

	 

 

 

 

 

	 

 

 

 

 

 

 

 

 

	 

 

 

 

	 

 

 

Page 4	 National Health Statistics Reports n Number 85 n November 4, 2015

with missing data or unknown

information were excluded from the

analysis. Estimates presented are not

age-adjusted in order to capture the

actual prevalence of reasons persons

were using selected complementary

health approaches. Estimates were

compared using two-sided t tests at the

0.05 level. Terms such as ‘‘greater than’’

and ‘‘less than’’ indicate a statistically

significant difference. Terms such as

‘‘not significantly different’’ or ‘‘no

difference’’ indicate that no statistically

detectable differences were seen

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

less than or equal to 30% were

considered reliable.

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 reasons and outcomes for the use

of selected complementary health

approaches collected in NHIS.

Furthermore, it is unlikely that the

current data omit common reasons and

perceived outcomes given that the

questionnaire items were written based

on input from complementary approach

users (10).

There are several limitations to this

study. Pretesting of the questionnaire

revealed that some respondents did not

adhere to the 12-month time frame

stated in the question and reported on

their general use of the complementary

health approach. Although the items

were designed to differentiate between

reasons for beginning use and outcomes

from using complementary health

approaches, pretesting revealed that

some respondents interchanged these

concepts when answering. In addition,

this study is limited by the crosssectional nature of the survey, which

does not support conclusions from

causal associations. Responses are

dependent on participants’ recall of

complementary health approaches and

their willingness to report their use

accurately.

Results

Respondents who used or saw a

practitioner for any complementary

health approach in the previous

12 months were asked in separate survey

questions if the modality was used for

one or more wellness-related reasons,

and if it was used to treat a specific

health problem or condition. The

percentages of adults who used natural

product supplements, yoga, or spinal

manipulation for these reasons are

presented in Figure 1. Figures 2–4

present the wellness-related outcomes

for the use of natural product

supplements, yoga, and spinal

manipulation, respectively.

+ Natural product supplements and

yoga were used for wellness more

often than for treatment of a specific

health condition, whereas spinal Percent

 95% confidence interval. 

NOTES: “Any wellness reason” includes a positive response to one or more of the following: general wellness or 

general disease prevention; improve immune function; improve energy; focuses on the whole person—mind, body, 

and spirit; and improve memory or concentration. Respondents could select both "any wellness reason" and "to 

treat a specific health condition" or neither. 

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

44.9 

17.5 

67.1 

88.9 94.0 

53.4 

0 

20 

40 

60 

80 

100 

Natural product

 supplements 

Yoga Spinal manipulation 

To treat a specific health condition Any wellness reason 

Figure 1. Reasons for use of selected complementary health approaches, by approach,

among users aged 18 and over: United States, 2012

manipulation was used more often for

treatment (Figure 1).

+	 Users of natural product supplements

were almost twice as likely to take

these supplements for one or more

wellness-related reasons compared

with treatment of a health condition.

+	 Adults who used yoga were more

than five times more likely to report

wellness reasons than treatment of a

health condition. In contrast, more

than 60% of users of spinal

manipulation reported doing so to

treat a specific health condition, and

more than 50% did so for general

wellness or disease prevention.

+	 More than four out of five users of

natural product supplements reported

that they took these supplements for

general wellness or disease

prevention (Figure 2).

+	 More than 40% of persons who took

natural product supplements reported

that they did so to improve immune

function.
 

0 20 40 60 80 100

Improve 

memory or

 concentration 

Focuses on 

the whole 

person—mind, 

body, and spirit 

Improve

 energy 

Improve

 immune

 function 

General

 wellness or

 disease 

prevention 

22.2 

26.5 

31.0 

42.0 

83.3 

Percent

 95% confidence interval. 

NOTE: Respondents could select more than one reason. 

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

Figure 2. Wellness-related reasons for use of natural product supplements among users aged 18 and over: United States, 2012

 	 

	 

 

 

 

 

	 

 

 

 

 

	 

 

 

 

 

 

 

 

 

 

	 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

	 

 

 

National Health Statistics Reports n Number 85 n November 4, 2015	 Page 5

+	 More than one in every four

persons who used natural product

supplements did so because they

perceive it focuses on the whole

person—mind, body, and spirit.

+	 Compared with other wellness-related

reasons, relatively few natural product

supplement users cited improvement

of memory or concentration as a

reason (22.2%).

+	 Three of the five wellness-related

reasons were reported by the majority

of yoga users. Approximately four out

of five said that they use yoga for

general wellness or disease

prevention, and more than two-thirds

reported that they use yoga because

they perceive it focuses on the whole

person—mind, body, and spirit, or to

improve energy (Figure 3).

+	 Approximately 30% of persons who

used yoga reported that they did so

because they expected improved

immune function or improved

memory or concentration.

+ General wellness or disease

prevention was the most common

wellness-related reason chosen by

spinal manipulation users (43.2%)

(Figure 4).

+ One in four spinal manipulation users

selected ‘‘because it focuses on the

whole person—mind, body, and

spirit,’’ as a reason for using the

approach.

+ Less than 20% of spinal manipulation

users did so for the expectation of

improved energy, improved immune

function, or improved memory or

concentration.

Figure 5 shows estimates for

self-reported perceived health behavior

outcomes for users of natural product

supplements, yoga, and spinal

manipulation. Analyses regarding

alcohol and smoking use were restricted

to users of these complementary health

approaches who indicated earlier in the

survey that they currently drank alcohol

or smoked cigarettes. This restriction

was necessary due to how the data were

collected at the time of the interview.

Thus, users of these complementary

health approaches who were motivated

to quit drinking or smoking as a result

of the approach and were successful

doing so are not included in the

estimates.

Yoga users perceived higher rates of

each of the four health behavior

outcomes examined than did users of

natural product supplements or spinal

manipulation (for exercise more

regularly: 63.2% compared with 16.0%

and 21.7%, respectively; for eat

healthier: 42.6% compared with 21.9%

and 10.7%, respectively; for cut back or

stop drinking alcohol: 12.4% compared

with 4.6% and 2.7%, respectively; and

for cut back or stop smoking cigarettes:

25.2% compared with 5.6% and 6.5%,

respectively).

+	 More than 63% of yoga users

perceived that they were motivated to

exercise more regularly after using
 

31.2 

71.6 

67.4 

30.0 

79.9 

0 20 40 60 80 100 

Percent

 95% confidence interval. 

NOTE: Respondents could select more than one reason. 

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

Improve 

memory or

 concentration 

Focuses on 

the whole 

person—mind, 

body, and spirit 

Improve

 energy 

Improve

 immune

 function 

General

 wellness or

 disease 

prevention 

Figure 3. Wellness-related reasons for use of yoga among users aged 18 and over: United States, 2012

 	 

 

 

 

 

 

 

 

 

 

	 

 

 

 

	 

 

 

	 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 6	 National Health Statistics Reports n Number 85 n November 4, 2015

yoga. In contrast, only 16.0% of

natural product supplements users and

21.7% of spinal manipulation users

reported being motivated to exercise

more regularly.

Figure 6 presents five additional

wellness-related outcomes perceived by

respondents who used complementary

health approaches in the previous

12 months.

+	 More than two-thirds of users of all

three approaches reported improved

overall health and feeling better as a

result of using the approach

(Figure 6).

+	 More than 80% of yoga users

perceived reduced stress as a result of

using yoga.

+	 Fewer than one in four users of

natural product supplements

perceived reduced stress, better sleep,

or feeling better emotionally as a

result of using natural product

supplements.

+ Yoga users were more likely to report

feeling better emotionally as a result

of using the approach (67.2%) than

were users of natural product

supplements (21.4%) or spinal

manipulation (27.3%).

+ Approximately 4 in 10 users of spinal

manipulation perceived a reduced

level of stress, better sleep, or that it

was easier to cope with health

problems after using the approach.

Discussion

This report presents the most

comprehensive, nationally representative

data available describing wellnessrelated reasons and self-reported

perceived health outcomes for adults

using complementary health approaches.

This research confirms findings from

previous studies showing that reasons

for using complementary health

approaches vary by the type of

approach (15). Additionally, these

findings are in line with previous

research showing that yoga and natural

product supplements are primarily used

for wellness-related reasons, while

spinal manipulation is more commonly

used to treat a specific health

problem (8,9). The current findings shed

light on wellness-related reasons for

Americans’ use of these three

complementary health approaches and

highlight self-reported perceived health

outcomes that occur after such use.

The findings indicate some variation

in the reasons and self-reported

perceived health outcomes for users of

different complementary health

approaches. For yoga, the most common

reasons reported for use included

‘‘general wellness or disease

prevention,’’ ‘‘because it focuses on the

whole person—mind, body and spirit,’’

and ‘‘to improve energy.’’ The current

finding that more than 70% of yoga

users reported ‘‘because it focuses on

the whole person—mind, body, and

spirit’’ as a reason for practicing yoga is

in line with previous research revealing
 

 

5.3 

24.9 

16.2 

11.4 

43.2 

0 10 20 30 40 50

Percent

 95% confidence interval. 

NOTE: Respondents could select more than one reason. 

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

Improve 

memory or

 concentration 

Focuses on 

the whole 

person—mind, 

body, and spirit 

Improve

 energy 

Improve

 immune

 function 

General

 wellness or

 disease 

prevention 

Figure 4. Wellness-related reasons for use of spinal manipulation among users aged 18 and over: United States, 2012

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

National Health Statistics Reports n Number 85 n November 4, 2015 Page 7

a desire by yoga users for individualized

and holistic medical care that does not

regard health problems in isolation, but

connects the mind and body (16,17).

The most common self-reported

perceived health outcome by yoga

users in the current study was a

reduction in stress level, which confirms

previous research in smaller studies that

has found common reasons for using

yoga included general wellness, physical

exercise, and stress management

(8,17–20).

The most common reason

reported for using natural product

supplements—general wellness or

disease prevention—is also consistent

with small-scale and qualitative

studies (21,22). While natural product

supplement users were twice as likely to

report one or more wellness-related

reasons than they were to report

treatment of a specific health condition

as a reason for taking supplements,

specific positive health outcomes were

reported at relatively low rates. For

example, although 67.5% of natural

product supplements users reported that

the supplement ‘‘improved their overall

health and made them feel better,’’ the

remaining eight health outcomes were

reported by 25% or less of natural

product supplement users. This further

supports previous findings that natural

product supplements are commonly

taken for general wellness and

prevention of health problems rather

than specific outcomes (21).

A 2010 review of scientific

evidence on manual therapies found that

spinal manipulation may be helpful for a

range of conditions including back pain,

neck pain, and headaches (23).

Additionally, previous research has

demonstrated that individuals report

positive experiences and reduced pain as

a result of receiving chiropractic care

(spinal manipulation), and that a primary

reason for using the approach is overall

health (24,25). The current findings

support this prior research by finding

that users of spinal manipulation do so

to treat a health condition more often

than for wellness reasons, and that

‘‘improved overall health and made you

feel better’’ was the single most

commonly reported reason for or

outcome from using spinal

manipulation. Additionally, more than

one-third of spinal manipulation users

reported that this use reduced their

stress level, improved their sleep, or

helped them cope with health problems.

Previous smaller studies have found

associations between the use of

complementary approaches and positive

health behaviors (26,27). The current

analyses found that relatively few users

of natural product supplements or spinal

manipulation reported health behavior

outcomes. For instance, less than 25%

of each group said they were motivated
 

 

16.0 

21.9 

4.6 5.6 

63.2 

42.6 

12.4 

25.2 

21.7 

10.7 2.7 

6.5 

0 

20 

40 

60 

80 

Exercise more 

regularly 

Eat healthier Cut back or stop 

drinking alcohol 

Cut back or stop 

smoking cigarettes 

Percent

 95% confidence interval. 

NOTES: Respondents could select more than one outcome. The denominators for “Cut back or stop drinking alcohol” are users of each complementary health approach who indicated 

that they currently drink alcohol. The denominators for “Cut back or stop smoking cigarettes” are users of each complementary health approach who indicated that they currently smoke 

cigarettes. 

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

Natural product supplements Yoga Spinal manipulation 

Figure 5. Perceived health behavior outcomes from use of selected complementary health approaches among users aged 18 and over:

United States, 2012

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 8 National Health Statistics Reports n Number 85 n November 4, 2015

to exercise more regularly or eat

healthier, and less than 7% of these

users who were current smokers or

drinkers reported being motivated to cut

back on these behaviors—and those who

did say they were motivated were still

drinking or smoking at the time of the

interview. However, the findings were

more positive for adults who practiced

yoga. Nearly two-thirds of yoga users

reported that as a result of the approach,

they were motivated to exercise more

regularly, and 4 in 10 reported that they

were motivated to eat healthier. Yoga

has previously been shown in clinical

trials to be a safe way to improve

sleep (28). Yoga generally is not

considered aerobic exercise by

practitioners of yoga, but a form of

movement meditation and a way to

achieve a state of relaxation and balance

of mind, body, and spirit (28,29). The

definition of yoga employed in the

current study is consistent with this in

that the analysis was limited to

individuals who meditated or used

breathing exercises as part of their yoga

practice.

The current study found that yoga

users also perceive high levels of

emotional benefits from the practice.

More than two-thirds said that yoga

made them feel better emotionally or

reduced their stress level and made them

feel more relaxed. Clinical research has

shown that individuals who practice

yoga have reduced physiological

responses to stress compared with those

not using yoga or those new to

yoga (30). Findings related to perceived

emotional outcomes were more modest

for users of natural product supplements

and spinal manipulation. While

approximately 40% of spinal

manipulation users perceived that the

approach reduced their stress or helped

them to cope with health problems, only

25% or less of natural product

supplement users reported these benefits.

In conclusion, with the exception of

immune function, yoga users reported

higher rates of all of the wellnessrelated reasons and perceived health

outcomes compared with users of

natural product supplements or spinal

manipulation. Of note, while differences

exist across complementary health
 	 

 

 

 

 

 

 

 

 

 

	 

 

 

 

 

	 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

National Health Statistics Reports n Number 85 n November 4, 2015	 Page 9

approaches, the majority of users of all

three approaches perceived that use of a

particular complementary health

approach improved their overall health

and made them feel better. The findings

presented here highlight that reasons and

self-reported perceived health outcomes

vary by the type of complementary

health approach used.

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National Health Statistics Reportsn Number 85n November 4, 2015 Page 11

Technical Notes

Definitions of selected terms

Chiropractic manipulation—A

technique that usesa type of hands-on

therapy to adjust problems related to the

body’s structure, primarily the spine,

and its function.

Natural product supplements—

Include 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.

Osteopathic manipulation—A

full-body system of hands-on techniques

to alleviate pain, restore function, and

promote health and wellbeing.

Spinal manipulation—Use of either

chiropractic or osteopathic manipulation.

Yoga—Of Hindu origin,a

combination of breathing exercises,

meditation, and physical postures, used

to achievea state of relaxation and

balance of mind, body, and spirit.
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Suggested citation

Stussman BJ, Black LI, Barnes PM, et al.

Wellness-related use of common

complementary health approaches among

adults: United States, 2012. National health

statistics reports; no 85. Hyattsville, MD:

National Center for Health Statistics. 2015.

Copyright information

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public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

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, Director
 

Stephen J. Blumberg, Ph.D., Associate Director
 

for Science
 

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