Complementary and Alternative Medicine Use for GI Conditions
Complementary and Alternative Medicine Use for GI Conditions
The NHIS is a cross-sectional, face-to-face survey conducted annually by the National Center for Health Statistics (NCHS) and the Centers for Disease Control (CDC) that gathers health-related data on the civilian, noninstitutionalized US population. The survey uses a complex, multistage sampling design and oversamples minorities to achieve population representation. Sampling weights are subsequently applied to the data to obtain statistically accurate estimates for the US population. Every 5 years, the survey includes questions about CAM use. The 2012 NHIS includes 34,525 US adults with a conditional response rate of 79.7%. The 2012 CAM supplement serially asked participants whether they had seen a practitioner for, or used, a given CAM modality within the past 12 months. Respondents were asked to rank their top three CAM modalities and state whether they used these modalities to address one or more symptoms or health conditions. For each of the top three CAM modalities, the survey also asked about disclosure to health-care providers, use of medical treatments, sources of information about CAM, and the reasons, motivations, perceived benefits, and perceived helpfulness of CAM use.
We defined adults with a GI condition as everyone who indicated the occurrence of one or more of the following on either the sample adult or CAM portions of the survey within the past 12 months: abdominal pain, acid reflux or heartburn, digestive allergy, liver condition, nausea and/or vomiting, ulcer, and stomach or intestinal illness. Each of these conditions was asked of all survey respondents except for the last category (stomach or intestinal illness), which was only asked of individuals using a CAM modality to address a health-related condition. We also identified a subpopulation of 407 adults who had used one or more of their top three CAM modalities specifically to address one or more of the GI conditions listed above.
The socio-demographic characteristics, which we examined, included sex, age, race, ethnicity, region of residence, education, marital status, income, and insurance status. We also examined perceived health status, body mass index, and health behaviors such as smoking status, alcohol use, and physical activity. For the comorbidity score, subjects were given a point for heart disease (coronary heart disease, ever had a heart attack, other heart condition), hypertension, pulmonary disease (emphysema, COPD, asthma, or chronic bronchitis), mental health concern in the last 12 months (depression, anxiety, other mental health disorder), neurological issues (recurring headache, memory loss, stroke, other neurological problem), weak/failing kidneys, or ever diagnosed with cancer, diabetes, or arthritis.
Use of a CAM modality was defined as a positive response to use of a specific modality and/or visit to a practitioner of that modality within the past 12 months. Modalities were categorized into one of the following groups: herbs and non-vitamin non-mineral supplements, manipulative therapies (chiropractic, osteopathic manipulation, massage, craniosacral therapy), mind body therapies (hypnosis, biofeedback, meditation, imagery, progressive relaxation, and mind body exercise (yoga, tai chi, qi gong), special diets (vegetarian or vegan, macrobiotic, Atkins diet, Pritikin diet, Ornish diet, or saw a practitioner for dietary counseling), movement therapies (Feldenkrais, Alexander technique, Pilates, Trager psychological integration), and other CAM modalities (acupuncture, ayurveda, chelation, energy healing, homeopathy, naturopathy, traditional healers). Use of vitamin and mineral supplements was excluded due to the high prevalence of use; teas were also not included. To sum the total number of CAM modalities used by each respondent we counted herb and supplement use only once—meditation, imagery, and progressive relaxation comprised a single category, mind body exercises were one category, and any special diets were counted only once.
We also assessed the reasons, motivations, perceived benefits, and perceived helpfulness of CAM use; disclosure to health-care providers; and sources of information about CAM among individuals using these modalities to specifically address a GI condition. To determine whether having a GI condition was independently associated with CAM use, we conducted a logistic regression analysis adjusting for all of the socio-demographic and health factors in Table 1.
We used SAS v9.2, proc surveyfreq, and the population weights provided by the NCHS to account for the complex sampling design of the survey and to obtain statistically accurate estimates of percentages for the civilian, noninstitutionalized US population. χ-tests for differences in proportions were conducted. Logistic regression analysis was performed using SAS-callable SUDAAN v11.0. Following the recommendations of the NCHS, estimates with relative standard errors greater than 30% were suppressed due to their likely unreliability. We conducted a sensitivity analysis excluding nausea and/or vomiting from our definition of GI condition as this was one of the largest categories of respondents and may represent an acute illness or be construed as more of a symptom than an actual condition. This study was reviewed and granted exempted status by the Beth Israel Deaconess Medical Center Committee on Clinical Investigations as all data were de-identified.
Methods
Data Source
The NHIS is a cross-sectional, face-to-face survey conducted annually by the National Center for Health Statistics (NCHS) and the Centers for Disease Control (CDC) that gathers health-related data on the civilian, noninstitutionalized US population. The survey uses a complex, multistage sampling design and oversamples minorities to achieve population representation. Sampling weights are subsequently applied to the data to obtain statistically accurate estimates for the US population. Every 5 years, the survey includes questions about CAM use. The 2012 NHIS includes 34,525 US adults with a conditional response rate of 79.7%. The 2012 CAM supplement serially asked participants whether they had seen a practitioner for, or used, a given CAM modality within the past 12 months. Respondents were asked to rank their top three CAM modalities and state whether they used these modalities to address one or more symptoms or health conditions. For each of the top three CAM modalities, the survey also asked about disclosure to health-care providers, use of medical treatments, sources of information about CAM, and the reasons, motivations, perceived benefits, and perceived helpfulness of CAM use.
Study Population
We defined adults with a GI condition as everyone who indicated the occurrence of one or more of the following on either the sample adult or CAM portions of the survey within the past 12 months: abdominal pain, acid reflux or heartburn, digestive allergy, liver condition, nausea and/or vomiting, ulcer, and stomach or intestinal illness. Each of these conditions was asked of all survey respondents except for the last category (stomach or intestinal illness), which was only asked of individuals using a CAM modality to address a health-related condition. We also identified a subpopulation of 407 adults who had used one or more of their top three CAM modalities specifically to address one or more of the GI conditions listed above.
Population Characteristics
The socio-demographic characteristics, which we examined, included sex, age, race, ethnicity, region of residence, education, marital status, income, and insurance status. We also examined perceived health status, body mass index, and health behaviors such as smoking status, alcohol use, and physical activity. For the comorbidity score, subjects were given a point for heart disease (coronary heart disease, ever had a heart attack, other heart condition), hypertension, pulmonary disease (emphysema, COPD, asthma, or chronic bronchitis), mental health concern in the last 12 months (depression, anxiety, other mental health disorder), neurological issues (recurring headache, memory loss, stroke, other neurological problem), weak/failing kidneys, or ever diagnosed with cancer, diabetes, or arthritis.
Outcomes
Use of a CAM modality was defined as a positive response to use of a specific modality and/or visit to a practitioner of that modality within the past 12 months. Modalities were categorized into one of the following groups: herbs and non-vitamin non-mineral supplements, manipulative therapies (chiropractic, osteopathic manipulation, massage, craniosacral therapy), mind body therapies (hypnosis, biofeedback, meditation, imagery, progressive relaxation, and mind body exercise (yoga, tai chi, qi gong), special diets (vegetarian or vegan, macrobiotic, Atkins diet, Pritikin diet, Ornish diet, or saw a practitioner for dietary counseling), movement therapies (Feldenkrais, Alexander technique, Pilates, Trager psychological integration), and other CAM modalities (acupuncture, ayurveda, chelation, energy healing, homeopathy, naturopathy, traditional healers). Use of vitamin and mineral supplements was excluded due to the high prevalence of use; teas were also not included. To sum the total number of CAM modalities used by each respondent we counted herb and supplement use only once—meditation, imagery, and progressive relaxation comprised a single category, mind body exercises were one category, and any special diets were counted only once.
We also assessed the reasons, motivations, perceived benefits, and perceived helpfulness of CAM use; disclosure to health-care providers; and sources of information about CAM among individuals using these modalities to specifically address a GI condition. To determine whether having a GI condition was independently associated with CAM use, we conducted a logistic regression analysis adjusting for all of the socio-demographic and health factors in Table 1.
Statistical Analyses
We used SAS v9.2, proc surveyfreq, and the population weights provided by the NCHS to account for the complex sampling design of the survey and to obtain statistically accurate estimates of percentages for the civilian, noninstitutionalized US population. χ-tests for differences in proportions were conducted. Logistic regression analysis was performed using SAS-callable SUDAAN v11.0. Following the recommendations of the NCHS, estimates with relative standard errors greater than 30% were suppressed due to their likely unreliability. We conducted a sensitivity analysis excluding nausea and/or vomiting from our definition of GI condition as this was one of the largest categories of respondents and may represent an acute illness or be construed as more of a symptom than an actual condition. This study was reviewed and granted exempted status by the Beth Israel Deaconess Medical Center Committee on Clinical Investigations as all data were de-identified.
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