Objective: To examine the reasons why office-based physicians do or do not recommend four selected complementary health approaches to their patients in the context of the Andersen Behavioral Model. Design: Descriptive estimates of physician-level data from the 2012 National Ambulatory Medical Care Survey (NAMCS) Physician Induction Interview, a nationally representative survey of office-based physicians (N = 5622, weighted response rate = 59.7%). Setting/Location: The United States. Outcome measures: Reasons for the recommendation or lack thereof to patients for: herbs and other non-vitamin supplements, chiropractic/osteopathic manipulation, acupuncture, and mind-body therapies (including meditation, guided imagery, and progressive relaxation). Differences by physician sex and medical specialty were described. Results: For each of the four complementary health approaches, more than half of the physicians who made recommendations indicated that they were influenced by scientific evidence in peer-reviewed journals (ranging from 52.0% for chiropractic/osteopathic manipulation [95% confidence interval, CI = 47.6-56.3] to 71.3% for herbs and other non-vitamin supplements [95% CI = 66.9-75.4]). More than 60% of all physicians recommended each of the four complementary health approaches because of patient requests. A higher percentage of female physicians reported evidence in peer-reviewed journals as a rationale for recommending herbs and non-vitamin supplements or chiropractic/osteopathic manipulation when compared with male physicians (herbs and non-vitamin supplements: 78.8% [95% CI = 72.4-84.3] vs. 66.6% [95% CI = 60.8-72.2]; chiropractic/osteopathic manipulation: 62.3% [95% CI = 54.7-69.4] vs. 47.5% [95% CI = 42.3-52.7]). For each of the four complementary health approaches, a lack of perceived benefit was the most frequently reported reason by both sexes for not recommending. Lack of information sources was reported more often by female versus male physicians as a reason to not recommend herbs and non-vitamin supplements (31.4% [95% CI = 26.8-36.3] vs. 23.4% [95% CI = 21.0-25.9]). Conclusions: There are limited nationally representative data on the reasons as to why office-based physicians decide to recommend complementary health approaches to patients. Developing a more nuanced understanding of influencing factors in physicians' decision making regarding complementary health approaches may better inform researchers and educators, and aid physicians in making evidence-based recommendations for patients.

Objective: There are no nationally representative studies using a probability sample that have been published examining whether physicians recommend complementary health approaches (CHAs) to their patients, as previous research has focused only on selected medical specialties or a particular U.S. region. This article fills a void in the current literature for robust data on recommendations for CHAs by office-based physicians in the United States. Design: Descriptive statistics and multivariable regression analyses of physician-level data were from the 2012 Physician Induction Interview of the National Ambulatory Medical Care Survey (NAMCS PII), a nationally representative survey of office-based physicians. Weighted response rate among eligible physicians sampled for the 2012 NAMCS PII was 59.7%. Setting/Location: United States. Outcome measures: Recommendations by physicians to their patients for any CHA, and individual CHAs: massage therapy, herbs/nonvitamin supplements, chiropractic/osteopathic manipulation, yoga, acupuncture, and mind-body therapies. Differences in recommendations by physician demographic characteristics were identified. Results: Massage therapy was the most commonly recommended CHA (30.4%), followed by chiropractic/osteopathic manipulation (27.1%), herbs/nonvitamin supplements (26.5%), yoga (25.6%), and acupuncture (22.4%). The most commonly recommended CHAs by general/family practice physicians were chiropractic/osteopathic manipulation (54.0%) and massage therapy (52.6%). Of all U.S. physicians, 53.1% recommended at least one CHA to patients during the previous 12 months. Multivariable analyses found physician's sex, race, specialty, and U.S. region to be significant predictors of CHA recommendations. Female physicians were more likely than male physicians to recommend massage therapy (adjusted odds ratio [aOR] = 1.76, 95% confidence interval [CI] = 1.40-2.20), herbs/nonvitamin supplements (aOR = 1.85, 95% CI = 1.46-2.35), yoga (aOR = 2.16, 95% CI = 1.70-2.75), acupuncture (aOR = 1.65, 95% CI = 1.27-2.13), and mind-body therapies (aOR = 2.63, 95% CI = 2.02-3.41) to patients. Psychiatrists (aOR = 0.13, 95% CI = 0.07-0.23), OB/GYNs (aOR = 0.38, 95% CI = 0.24-0.60), and pediatricians (aOR = 0.26, 95% CI = 0.18-0.38) were all less likely to recommend chiropractic/osteopathic manipulation than general and family practitioners. Conclusions: Overall, more than half of office-based physicians recommended at least one CHA to their patients. Female physicians recommended every individual CHA at a higher rate than male physicians except for chiropractic and osteopathic manipulation. These findings may enable consumers, physicians, and medical schools to better understand potential differences in use of CHAs with patients.

Purpose: Based on previous health behavior studies, we expected variation in use of individual complementary health approaches by geographic location. This analysis presents geographic comparisons of use of complementary health approaches among U.S. adults ≥18 years, using data from the 2012 National Health Interview Survey (NHIS). | Methods: Data from the Adult Complementary and Alternative Medicine supplement of the 2012 NHIS were examined to compare prevalence estimates of complementary health approaches among 9 geographic regions and the top 10 most populous states in the U.S. Differences between regional/state percentages and national averages were evaluated using two-sided significance tests at the 0.05 level. All analyses were conducted using SUDAAN to account for the complex NHIS sample design. | Results: Non-vitamin, non-mineral dietary supplements (NVNMDS) (17.9%), chiropractic and osteopathic manipulation (8.5%), and yoga (8.4%) were the top three approaches used in the U.S. The prevalence of adults who used any of the most popular approaches was consistently higher in the Mountain region and consistently lower in the South Atlantic region when compared to the national average. Adults in Michigan (24.6%) and Ohio (23.3%) were more likely to use NVNMDS. Fewer adults in Florida (6.2%) and Texas (5.9%) saw a practitioner for chiropractic or osteopathic manipulation. A greater proportion of adults in California (11.0%) and Illinois (11.0%) used yoga. Other complementary health approaches commonly used by adults in 2012 included massage (6.8%) and meditation (6.3%). | Conclusion: Prevalence of use of complementary health approaches was consistently higher in the Mountain region compared to the national average. States with the lowest prevalence were in the southern regions.

Purpose: The use of complementary health approaches such as mind-body therapies and natural products is popular among Americans. We investigated the specific reasons that complementary health approaches are used and individuals' perceived outcomes of utilizing a particular approach. | Methods: Using data from the 2012 National Health Interview Survey Complementary and Alternative Medicine Supplement we examined the reasons for use and reported outcomes of popular complementary health approaches among their individual users aged 18 and over. We report percentages and standard errors for each sub-group in this nationally representative cross-sectional study. | Results: Popular therapies used included, but were not limited to non-vitamin non-mineral dietary supplement (NVNMDS) use, chiropractic or osteopathic manipulation, yoga, massage therapy and meditation. Eighty-three percent of persons who used NVNMDs did so for general wellness or disease prevention while 42% used them to treat a specific condition. Sixty-six percent of persons who used chiropractic and osteopathic manipulation did so to treat a specific health condition, and 67% said it improved their overall health and made them feel better. Individuals using massage therapy reported a number of benefits including reduced stress (76%) and better sleep (54%). More than 80% of individuals using yoga or mindfulness meditation used these approaches for general wellness or disease prevention and said these approaches improved their overall health and made them feel better. Complementary health approaches were also perceived to be beneficial to social wellbeing, improving relationships and attendance at work/school. | Conclusion: The reasons Americans use complementary health approaches differ greatly by the approach, with some, such as NVNMDS used primarily for wellness or disease prevention, and others like chiropractic and osteopathic manipulation, used primarily to treat specific health conditions. The perceived outcomes associated with each therapy also varied considerably by approach.

Purpose: We examined changes between 2007 and 2012 in the use of selected modalities among children who used complementary health approaches. | Methods: Using the Child Complementary and Alternative Medicine supplements of the 2007 and 2012 National Health Interview Survey (NHIS), we calculated the percentage of children aged 4–17 years who used selected complementary health approach modalities among all children in that age range who used any complementary health approach. Point and standard error estimates were calculated using SUDAAN, accounting for the complex sample design of the NHIS. Percentages were age-adjusted to the projected 2000 U.S. standard population in order to make comparisons over time. Estimates were compared between years using two-tailed significance tests at the 0.05 level. | Results: The use of non-vitamin, non-mineral dietary supplements (NVNMDS) was the most common approach among children using any complementary health approach in both 2007 (33%) and 2012 (45%); however, the relative popularity of individual NVNMDS such as Echinacea, fish oils and melatonin changed substantially between years. In 2012, among those children who used any complementary health approach, 30% practiced yoga, tai chi or qi gong; this was a 50% increase from 2007. Conversely, use of acupuncture, progressive relaxation and special diets declined among children using complementary health approaches in 2007 and 2012. | Conclusion: We noted increased use of some individual approaches and decreased use of others. Children who used complementary health approaches in 2012 were more likely to take NVNMDS and participate in yoga, tai chi and qi gong compared to similar-aged children in 2007.

Purpose: Non-vitamin, non-mineral dietary supplements (NVNMDS) such as fish oils, melatonin and Echinacea are used by many Americans for improving health and wellbeing. Previous studies indicate a steady increase in overall use of NVNMDS over time, but none have documented changes in individual NVNMDS use. | Methods: We used data from the 2000, 2002, 2007 and 2012 National Health Interview Survey (NHIS), which are collected from representative samples of U.S. adults aged 18 and over. Point and standard error estimates of overall and selected NVNMDS use were calculated using SUDAAN, accounting for the complex sample design of the NHIS. For each year, the denominator was the estimated number of adults in the U.S. Data were age-adjusted to the projected 2000 U.S. standard. Estimates of NVNMDS use were compared between years using two-tailed significance tests at the 0.05 level. | Results: In 2000, 14% of adults aged 18 years and over used NVNMDS. Overall use has remained stable with an increase of over3 percentage points between 2000 and 2012, but little change was seen when comparing 2007 to 2012. However, during this same time period, there have been significant changes in the specific NVNMDS used. In 2002, Echinacea, ginseng and ginkgo biloba were the most common supplements used by adults. In 2007 and 2012, the use of these three supplements decreased, and they were no longer among the top 5 NVNMDS used in 2012. In 2007 and 2012 fish oil was the most common NVNMDS used among adults (4.8% and 7.8%, respectively). Between 2007 and 2012 the use of melatonin doubled, while probiotic/prebiotic use quadrupled. Conversely, there was a decrease in glucosamine/chondroitin use between 2007 and 2012. | Conclusion: While the overall use of NVNMDS has remained relatively stable over time, large increases and decreases in the use of individual NVNMDS have been noted.

OBJECTIVES: The aim of this study was to assess the construct validity of survey questions about the use of herbal and other nonvitamin/nonmineral dietary supplements. DESIGN: We conducted one-on-one, in-depth cognitive interviews with 32 respondents to test questions from the complementary and alternative medicine (CAM) supplement for the 2007 National Health Interview Survey. Respondents were sampled purposively according to their use of CAM. Interviewers probed respondents for their understanding of the questions, and analysis was guided by grounded theory, an approach that generates explanations of response error that are closely tied to the empirical data. RESULTS: We found two sources of misinterpretation of CAM questions. First, some respondents did not have any pre-established definition of what constitutes an herbal supplement while others had interpretations that did not match the intended definitions. These problems are common to many survey questions. However, a second finding is that misinterpretation also arose when respondents incorporated notions of self-concept into the act of taking "natural herbs," and answered based on their understanding of this image rather than on actual behavior. CONCLUSIONS: There are several sources of misinterpretation of CAM questions. One of the most important sources is whether or not the respondent has created a concept of self-image that includes the use of herbal supplements. Common questionnaire design techniques such as providing definitions to respondents will not help to eliminate misinterpretation due to self-image. We found that careful question wording that does not evoke definitions of self, combined with visual aids that narrow the focus of the questions, can lead to more accurate answers.