NCHS Data Brief ■ No. 146 ■ April 2014

u.s. department of health and human services

centers for disease control and prevention

national center for health statistics

Regional Variation in Use of Complementary Health 

Approaches by U.S. Adults

Jennifer A. Peregoy, M.P.H.; Tainya C. Clarke, Ph.D., M.P.H.; Lindsey I. Jones, M.P.H.;

Barbara J. Stussman, B.A.; and Richard L. Nahin, Ph.D., M.P.H.

Complementary health approaches are defined as “a group of diverse medical 

and health care interventions, practices, products, or disciplines that are not

generally considered part of conventional medicine” (1). They range from 

practitioner-based approaches, such as chiropractic manipulation and massage 

therapy, to predominantly self-care approaches, such as nonvitamin, nonmineral 

dietary supplements, meditation, and yoga. This report presents estimates of 

the four most commonly used complementary health approaches among adults 

aged 18 and over in nine geographic regions, using data from the 2012 National 

Health Interview Survey adult alternative medicine supplement (2). 

Keywords: National Health Interview Survey • U.S. regions • chiropractic • 

dietary supplements

Nonvitamin, nonmineral dietary supplements, chiropractic or 

osteopathic manipulation, yoga, and massage therapy were 

the most common complementary health approaches used 

in 2012.

Key findings

Data from the National 

Health Interview Survey, 

2012

• Use of nonvitamin, 

nonmineral dietary supplements 

(17.9%) was greater than any 

other complementary health 

approach used by U.S. adults in 

2012.

• The use of practitioner-based 

chiropractic or osteopathic 

manipulation was nearly twice 

as high in the West North 

Central region as in the United 

States overall.

• Use of nonvitamin, 

nonmineral dietary supplements 

was highest in the Mountain, 

Pacific, and West North Central 

regions. 

• Use of yoga with deep 

breathing or meditation was 

approximately 40% higher 

in the Pacific and Mountain 

regions than in the United 

States overall.

Figure 1. Percentage of adults who used complementary health approaches in the past 12 

months, by type of approach: United States, 2012

NOTE: Not all complementary health approaches are presented in this figure. 

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

0

5

10

15

20

Nonvitamin,

nonmineral

dietary 

supplement

Chiropractic 

or

osteopathic

manipulation

17.9

8.5

Yoga

8.4

Massage

6.8

Meditation

4.1

Special

diets

3.0
NCHS Data Brief ■ No. 146 ■ April 2014

■  2  ■

• The use of nonvitamin, nonmineral dietary supplements (17.9%) was more than twice that 

of all other complementary health approaches (Figure 1).

• In 2012, chiropractic and osteopathic manipulation was used by 8.5% of U.S. adults, yoga 

by 8.4%, and massage by 6.8%.

• Other complementary health approaches commonly used by adults in 2012 include 

meditation (4.1%) and special diets (3.0%).

Use of practitioner-based chiropractic or osteopathic manipulation was 

twice as high in the West North Central region as in the United States 

overall.

• In 2012, 16.4% of adults in the West North Central region, and 11.4% of adults in the 

Mountain region, used practitioner-based chiropractic or osteopathic manipulation, both of 

which were higher than the national average (8.5%) (Figure 2). 

• Lower use of practitioner-based chiropractic or osteopathic manipulation was found in the 

East South Central (6.5%), South Atlantic (6.2%), and West South Central (5.9%) regions 

compared to the national average.

• The Pacific (9.3%) and East North Central (9.5%) regions had similar percentages of 

practitioner-based chiropractic or osteopathic manipulation use compared to the percentage 

for the nation as a whole.

Figure 2. Percentage of adults who saw a practitioner for chiropractic or osteopathic manipulation in the past 12 months, 

by region: United States, 2012

NOTES: SE is standard error. Significance is evaluated at the 0.05 level.

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

ND

SD

NE

KS MO

IA

MN

KY

TN

MS AL GA

FL

SC

NC

WV VA

WI

IL IN OH

MI

NY

PA

ME

VT NH

WA

OR

CA

TX

OK AR

LA

UT

MT

WY

NV

AZ

CO

NM

ID

MD

DE

NJ CT RI

MA

AK

HI

DC

West North Central

16.4% (SE 1.07) East North

Central

9.5% (SE 0.64) 

Middle Atlantic

7.2% (SE 0.49)

South

Atlantic

6.2% (SE 0.43)

East South

Central

6.5% (SE 0.96) 

West South

Central

5.9% (SE 0.50) 

New England

7.8% (SE 0.88)

Pacific

9.3% (SE 0.48)

Mountain

11.4% (SE 0.87)

National average: 8.5% (SE 0.21) 

Significantly lower

Not significantly different

Significantly higher
NCHS Data Brief ■ No. 146 ■ April 2014

■  3  ■

Adult use of nonvitamin, nonmineral dietary supplements was highest in 

the Mountain, Pacific, and West North Central regions.

• The Mountain (28.7%), Pacific (23.3%), and West North Central (23.1%) regions had the 

highest percentage of adults using nonvitamin, nonmineral dietary supplements (Figure 3). 

• The Middle Atlantic (13.6%), West South Central (13.6%), and South Atlantic (13.1%) 

regions had the lowest percentage of adults using nonvitamin, nonmineral dietary 

supplements.

• Use of nonvitamin, nonmineral dietary supplements in the East South Central (15.8%) and 

East North Central (19.5%) regions did not differ from the percentage for the nation as a 

whole (17.9%). 

Figure 3. Percentage of adults who used nonvitamin, nonmineral dietary supplements in the past 12 months, by region: 

United States, 2012

NOTES: SE is standard error. Significance is evaluated at the 0.05 level.

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

ND

SD

NE

KS MO

IA

MN

KY

TN

MS AL GA

FL

SC

NC

WV VA

WI

IL IN OH

MI

NY

PA

ME

VT NH

WA

OR

CA

TX

OK AR

LA

UT

MT

WY

NV

AZ

CO

NM

ID

MD

DE

NJ CT RI

MA

HI

DC

West North Central

 23.1% (SE 1.53) East North

Central

19.5% (SE 0.93)

Middle Atlantic

 13.6% (SE 0.82)

South

Atlantic

 13.1% (SE 0.83)

East South

Central

15.8% (SE 1.69)

West South

Central

 13.6% (SE 1.17)

New England

 15.2% (SE 1.08)

Pacific

 23.3% (SE 0.98)

 Mountain

 28.7% (SE 1.45)

AK

National average: 17.9% (SE 0.37) 

Significantly lower

Not significantly different

Significantly higher
NCHS Data Brief ■ No. 146 ■ April 2014

■  4  ■

The use of yoga with deep breathing or meditation was approximately 40% 

higher in the Pacific and Mountain regions than the national average.

• Yoga with deep breathing or meditation use in the East South Central (5.1%), West South 

Central (6.0%), South Atlantic (6.8%), and Middle Atlantic (7.1%) regions was lower than 

the percentage for the nation as a whole (Figure 4).

• When compared to the national average, no significant difference was observed in the 

percentage of adults who used yoga with deep breathing or meditation in the West North 

Central (8.7%) and East North Central (8.5%) regions.

Figure 4. Percentage of adults who practiced yoga with deep breathing or meditation in the past 12 months, by region: 

United States, 2012

NOTES: SE is standard error. Significance is evaluated at the 0.05 level.

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

ND

SD

NE

KS MO

IA

MN

KY

TN

MS AL GA

FL

SC

NC

WV VA

WI

IL IN OH

MI

NY

PA

ME

VT NH

WA

OR

CA

TX

OK AR

LA

UT

MT

WY

NV

AZ

CO

NM

ID

MD

DE

NJ CT RI

MA

HI

DC

West North Central

8.7% (SE 0.72) East North

Central

8.5% (SE 0.55)

Middle Atlantic

 7.1% (SE 0.54)

South Atlantic

 6.8% (SE 0.54)

East South

Central

 5.1% (SE 0.68)

West South

Central

 6.0% (SE 0.52)

New England

 10.8% (SE 1.14)

Pacific

 12.1% (SE 0.63)

 Mountain

11.5% (SE 0.83)

AK

National average: 8.4% (SE 0.22) 

Significantly lower

Not significantly different

Significantly higher
NCHS Data Brief ■ No. 146 ■ April 2014

■  5  ■

In 2012, adults living in the Pacific, Mountain, and West North Central 

regions were most likely to have used massage therapy during the past 12 

months.

• The percentage of adults using massage therapy was higher in the Pacific (9.4%), Mountain 

(9.4%), and West North Central (8.4%) regions than in the nation as a whole (6.8%)

(Figure 5). 

• No significant difference was found in the use of massage therapy in the West South Central 

(5.8%), East North Central (7.0%), and New England (7.3%) regions when compared to the 

national average. 

• Use of massage therapy in the East South Central (2.5%), South Atlantic (5.4%), and Middle 

Atlantic (5.6%) regions was lower than the national average.

Figure 5. Percentage of adults who used massage therapy in the past 12 months, by region: United States, 2012

NOTES: SE is standard error. Significance is evaluated at the 0.05 level.

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

ND

SD

NE

KS MO

IA

MN

KY

TN

MS AL GA

FL

SC

NC

WV VA

WI

IL IN OH

MI

NY

PA

ME

VT NH

WA

OR

CA

TX

OK AR

LA

UT

MT

WY

NV

AZ

CO

NM

ID

MD

DE

NJ CT RI

MA

HI

DC

West North Central

 8.4% (SE 0.68) East North

Central

7.0% (SE 0.49)

Middle Atlantic

 5.6% (SE 0.43)

South Atlantic

 5.4% (SE 0.39)

East South

Central

 2.5 % (SE 0.52)

West South

Central

5.8% (SE 0.55)

New England

 7.3% (SE 0.86)

Pacific

 9.4% (SE 0.53)

 Mountain

 9.4% (SE 0.84)

AK

National average: 6.8% (SE 0.18) 

Significantly lower

Not significantly different

Significantly higher

Summary

In 2012, nonvitamin, nonmineral dietary supplements (17.9%), practitioner-based chiropractic or 

osteopathic manipulation (8.5%), yoga with deep breathing or meditation (8.4%), and massage 

therapy (6.8%) were the most common complementary health approaches used by U.S. adults. 

Previous research demonstrated that regional differences exist in the use of complementary health 

approaches among adults in the United States (3,4), and this report reveals that those regional 

differences persist across a wide range of complementary health approaches. Environmental 

and cultural factors unique to towns, regions, and economic factors have long been linked to 

differences in health behaviors and general health measures in the U.S. population (5). Similar 

environmental and cultural factors may be related to the regional differences of complementary 

health approach uses that are presented in this report.
NCHS Data Brief ■ No. 146 ■ April 2014

■  6  ■

Definitions

Complementary health approaches: Include acupuncture, Ayurveda, biofeedback, chelation 

therapy, chiropractic or osteopathic manipulation, craniosacral therapy, energy healing therapy, 

guided imagery, herbs and other nonvitamin supplements, hypnosis, homeopathy, massage, 

meditation (mantra, mindfulness, and spiritual), Alexander technique, Feldenkreis, Pilates, 

Trager psychophysical integration, naturopathy, progressive relaxation, special diets, traditional 

healers, and yoga (with meditation or deep breathing), tai chi, and qi gong exercises. For more 

information about specific health approaches, refer to http://nccam.nih.gov/health/atoz.htm. 

Chiropractic manipulation: A technique that uses a type of hands-on therapy to adjust problems 

related to the body’s structure, primarily the spine, and its function. 

Massage: Manipulation of the body’s muscle and connective tissues to enhance the physical 

functioning of those tissues, and promote relaxation and well-being. It is usually performed by 

massage therapists. 

Meditation: A group of techniques with origins in Eastern religious or spiritual traditions. In 

meditation, a person learns to focus his or her 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. In 2012, meditation included mantra 

meditation (including Transcendental Meditation, relaxation response, and clinically standardized 

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

(including centering prayer and contemplative meditation). 

Nonvitamin, nonmineral dietary supplements: Include herbs and other nonvitamin supplements 

such as pills, capsules, tablets, or liquids that have been labeled as dietary supplements. This 

category does 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 well-being. 

Regions: Categories were slightly modified from the nine U.S. Census Bureau-designated 

divisions: New England—ME, VT, NH, MA, CT, RI; Middle Atlantic—NY, NJ, PA, DC, DE, 

MD; East North Central—OH, IL, IN, MI, WI; West North Central—MN, IA, MO, ND, SD, KS, 

NE; South Atlantic—WV, VA, NC, SC, GA, FL; East South Central—KY, TN, MS, AL; West 

South Central—LA, OK, AR, TX; Mountain—NV, NM, AZ, ID, UT, CO, MT, WY; and 

Pacific—WA, OR, CA, AK, HI.

Special diets: A variety of nutritional approaches ranging from a basic, healthy vegetablebased diet to adopting highly restrictive diets and supplement programs. Some diets are highly 

restrictive; examples of special diets include Zone, vegan, and Ornish diets.

Yoga: Of Hindu origin, a combination of breathing exercises, meditation, and physical postures 

used to achieve a state of relaxation and balance of mind, body, and spirit. Survey respondents 

were classified as having practiced yoga during the past 12 months only if they indicated they had 

practiced deep-breathing exercises or meditation as part of their yoga exercise.
NCHS Data Brief ■ No. 146 ■ April 2014

■  7  ■

Data source and methods

Data from the 2012 NHIS were used for this analysis. NHIS data are collected continuously 

throughout the year for the Centers for Disease Control and Prevention’s (CDC) National Center 

for Health Statistics (NCHS) by interviewers from the Census Bureau. NHIS collects information 

about the health and health care of the civilian noninstitutionalized U.S. population. Interviews 

are conducted in respondents’ homes, but follow-ups to complete interviews may be conducted 

over the telephone. 

In 2012, detailed health information was collected on a total of 34,525 persons aged 18 and over 

from the Sample Adult component of the survey. For further information about NHIS, including 

the questionnaire, visit the NHIS website: http://www.cdc.gov/nchs/nhis.htm. 

Questions on complementary health approaches were from the 2012 adult alternative medicine 

(ALT) supplement embedded in the Sample Adult component of the survey. The processes used 

to develop the 2012 ALT supplement, as well as those fielded in 2002 and 2007, have been 

previously described (6). The 2012 NHIS ALT supplement collected information from sample 

adults on their use of 18 complementary health approaches, which included 10 types of providerbased health therapies. NHIS participants were asked if they used or saw a practitioner for each of 

these approaches during the past 12 months.

Note that the 2012 questionnaire differed substantially from the 2007 questionnaire. Based on 

cognitive testing and input from expert panels (6), the definitions of certain modalities were 

modified to reduce false-positive responses. Data users should take these differences into account 

when conducting analyses and making comparisons between data from 2012 and previous survey 

years. 

The NHIS ALT data were weighted to produce national and regional estimates. Data weighting 

procedures are described in more detail elsewhere (7). Point estimates and estimates of their 

variances were calculated using SUDAAN software (8) to account for the complex sampling 

design of NHIS. The Taylor series linearization method was chosen for estimation of standard 

errors. Differences between percentages were evaluated using two-sided significance tests at the 

0.05 level. The estimated standard error of the difference between regional and national estimates 

accounted for nonindependence of regional and national estimates by incorporating their 

covariance.

About the authors

Jennifer A. Peregoy, Tainya C. Clarke, and Lindsey I. Jones are with CDC/NCHS, Division of 

Health Interview Statistics. Barbara J. Stussman and Richard L. Nahin are with the National 

Institutes of Health, National Center for Complementary and Alternative Medicine.

References

1. National Center for Complementary and Alternative Medicine, National Institutes of Health. 

Exploring the science of complementary and alternative medicine: Third strategic plan, 2011–

2015. NIH publication no 11–7643, D458. 2011.
NCHS Data Brief ■ No. 146 ■ April 2014

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2. National Health Interview Survey. Adult alternative medicine supplement. 

Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_

Documentation/NHIS/2012/althealt_layout.pdf.

3. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and 

alternative medicine use among adults: United States, 2002. Advance data 

from vital and health statistics; no 343. Hyattsville, MD: National Center for 

Health Statistics. 2004. 

4. 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.

5. Hartley D. Rural health disparities, population health, and rural culture. 

Am J Public Health 94(10):1675–8. 2004.

6. 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.

7. Botman SL, Moore TF, Moriarity CL, Parsons VL. Design and estimation 

for the National Health Interview Survey, 1995–2004. National Center for 

Health Statistics. Vital Health Stat 2(130). 2000.

8. RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citation

Peregoy JA, Clarke TC, Jones LI, et al. 

Regional variation in use of complementary 

health approaches by U.S. adults. NCHS 

data brief, no 146. Hyattsville, MD: National 

Center for Health Statistics. 2014.

Copyright information

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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

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Interview Statistics

Jane F. Gentleman, Ph.D., Director

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