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Nurses Physicians Dentists and Other Health Care Practitioners - Alternative Medicine Systems And Practitioners

This section considers two alternative medicine systems that originated in Western culture—homeopathy and naturopathic medicine—and two alternative medicine systems that developed in non-Western cultures—acupuncture and traditional Chinese medicine. It also describes some of the CAM practitioners who are providing care for Americans.

Homeopathic Medicine

Homeopathic medicine (also called homeopathy) is based on the belief that "like cures like" and uses very diluted amounts of natural substances to encourage the body's own self-healing mechanisms. Homeopathy was developed by a German physician, Dr. Samuel Hahnemann, in the 1790s. Dr. Hahnemann found that he could produce symptoms of particular diseases by injecting small doses of various herbal substances. This discovery inspired him to administer to sick people extremely diluted formulations of substances that would produce the same symptoms they suffered from in an effort to stimulate natural recovery and regeneration.

According to Dr. Kenneth Pelletier, a clinical professor of medicine at Stanford University School of Medicine and director of the NIH-funded Complementary and Alternative Medicine Program at Stanford, homeopathy has demonstrated effectiveness for a variety of ailments. In his book The Best of Alternative Medicine: What Works? What Does Not? (New York, NY: Simon & Schuster, 2000), Dr. Pelletier reports that clinical trials of homeopathy found it effective for the treatment of disorders such as seasonal allergies, asthma, childhood diarrhea, fibromyalgia, influenza, and rheumatoid arthritis.

Naturopathic Medicine

As its name suggests, naturopathic medicine (also called naturopathy) uses naturally occurring substances to prevent, diagnose, and treat disease. Although it is now considered an alternative medicine system, it is one of the oldest medicine systems and has its origins in Native American culture and also draws from Greek, Chinese, and East Indian ideas about health and illness.

The guiding principles of modern naturopathic medicine are "first, do no harm" and "nature has the power to heal." Naturopathy seeks to treat the whole person, since disease is seen as arising from many causes rather than a single cause. Naturopathic physicians are taught that "prevention is as important as cure" and to view creating and maintaining health as equally important as curing disease. They are instructed to identify and treat the causes of diseases rather than acting only to relieve symptoms.

Naturopathic treatment methods include nutritional counseling. Methods also include the use of dietary supplements, herbs, and vitamins; hydrotherapy (water-based therapies, usually involving whirlpool or other baths); exercise; manipulation; massage; heat therapy; and electrical stimulation. Since naturopathy draws on Chinese and Indian medical techniques, naturopathic physicians often use Chinese herbs, acupuncture, and East Indian medicines to treat disease.

Dr. Pelletier's research found studies demonstrating that naturopathy was effective for conditions such as asthma, atherosclerosis, back pain, some cancers, depression, diabetes, eczema (a skin condition), middle ear infections, migraine headaches, natural childbirth, and osteoarthritis. Further, Dr. Pelletier asserted that licensed naturopathic physicians are among the best trained CAM practitioners and he predicted that research would continue to confirm the benefits and efficacy of the safe, inexpensive, and lowrisk therapies they can provide.

Traditional Chinese Medicine

Traditional Chinese medicine (TCM) uses nutrition, acupuncture, massage, herbal medicine, and Qi Gong (exercises to improve the flow of vital energy through the body) to help people achieve balance and unity of their minds, bodies, and spirits. Practiced for more than three thousand years by about one quarter of the world's population, TCM has been adopted by naturopathic physicians, chiropractors, and other CAM practitioners in the United States.

TCM views balancing qi (pronounced "chee"), the vital life force that flows over the surface of the body and through internal organs, as central to health, wellness, disease prevention, and treatment. This vital force or energy is thought to flow through the human body in meridians, or channels. The Chinese believe that pain and disease develop when there is any sort of disturbance in the natural flow. TCM also seeks to balance the feminine and masculine qualities of yin and yang using other techniques such as moxibustion, which is the stimulation of acupuncture points with heat, and cupping, in which the practitioner increases circulation by putting a heated jar on the skin of a body part.

Herbal medicine is the most commonly prescribed treatment, and herbal preparations may be consumed as teas made from boiled fresh herbs or dried powders, or in combined formulations known as patent medicines. More than two hundred herbal preparations are used in TCM, and several (such as ginseng, ma huang, and ginger) have become popular in the United States. Ginseng is supposed to improve immunity and prevent illness; ma huang is a stimulant used to promote weight loss and relieve lung congestion; and ginger is prescribed to aid digestion, relieve nausea, reduce arthritic knee pain, and improve circulation. Many modern pharmaceutical drugs are derived from TCM herbal medicines. For example, ma huang components are used to make ephedrine and pseudoephedrine; GBE made from ginkgo biloba is used to treat cerebral insufficiency (lack of blood flow to the brain); and researchers have reported some encouraging findings about the use of ginkgo biloba to improve memory and slow the progression of dementia in some patients (Edward Ernst, "The Risk-Benefit Profile of Commonly Used Herbal Therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava," Annals of Internal Medicine, vol. 136, no. 1, January 2002).

Acupuncture

Acupuncture is a Chinese practice that dates back more than 5,000 years. Chinese medicine describes acupuncture—the insertion of extremely thin, sterile needles to any of 360 specific points on the body—as a way to balance qi. After a diagnosis of an imbalance in the flow of energy, the acupuncturist inserts needles at specific points along the meridians (pathways of energy flow throughout the body). Each point controls a different part of the body. Once the needles are in place, they are rotated gently or are briefly charged with a small electric current.

Traditional Western medicine explains the acknowledged effectiveness of acupuncture as the result of triggering the release of pain-relieving substances called endorphins that occur naturally in the body, as well as neurotransmitters and neuropeptides that influence brain chemistry. In addition to providing lasting pain relief, acupuncture has demonstrated success in helping people with substance abuse problems, relieving nausea, heightening immunity by increasing total white blood cells and T-cell production, and assisting patients to recover from stroke and other neurological impairments. Imaging techniques have confirmed that acupuncture acts to alter brain chemistry and function.

Chiropractic Physicians

Doctors of chiropractic (also known as chiropractors or DCs) treat patients whose health problems are associated mainly with the body's structural and neurological systems, especially the spine. These practitioners believe that interference with these systems can impair normal functions and lower resistance to disease. Chiropractic medicine asserts that misalignment or compression of the spinal nerves, for example, can alter many important body functions. According to the American Chiropractic Association (ACA), they "consider man as an integrated being and give special attention to the physiological and biochemical aspects including structural, spinal, musculoskeletal, neurological, vascular, nutritional, emotional, and environmental relationships." Doctors of chiropractic medicine do not use or prescribe pharmaceutical drugs or perform surgery. Instead, they rely on adjustment and manipulation of the musculoskeletal system, particularly the spinal column.

Many chiropractors use nutritional therapy and prescribe dietary supplements; some employ a technique known as applied kinesiology to diagnose and treat disease. Applied kinesiology is based on the belief that every organ problem is associated with weakness of a specific muscle. Chiropractors who use this technique claim they can accurately identify organ system dysfunction without any laboratory or other diagnostic tests.

In addition to manipulation, chiropractors also use a variety of other therapies to support healing and relax muscles before they make manual adjustments. These treatments include:

  • heat and cold therapy to relieve pain, speed healing, and reduce swelling
  • hydrotherapy to relax muscles and stimulate blood circulation
  • immobilization such as casts, wraps, traction, and splints to protect injured areas
  • electrotherapy to deliver deep tissue massage and boost circulation
  • ultrasound to relieve muscle spasms and reduce swelling.

According to the ACA, chiropractic is the third-largest group of health care professionals after medicine and dentistry. The ACA predicts that there will be nearly twice as many practicing doctors of chiropractic by 2010 as there were in 1999 when approximately 50 million patients sought care from slightly more than seventy thousand chiropractors. Visits to chiropractors are most often for treatment of lower back pain, neck pain, and headaches.

Critics of chiropractic are concerned about injuries resulting from powerful manual adjustments, and some physicians question chiropractors' abilities to establish medical diagnoses. Others worry that persons seeking chiropractic care instead of traditional allopathic medical care may be forgoing lifesaving diagnoses and treatment.

Alternative Medicine Is More Than a Fad

Researchers from the Harvard Medical School looked at long-term trends in the use of CAM therapies in the United States and published their findings in the August 21, 2001, issue of the Annals of Internal Medicine. The researchers conducted more than two thousand surveys and traced patterns of CAM utilization since the 1960s. They questioned survey respondents about twenty different CAM practices such as acupuncture, aromatherapy, biofeedback, energy healing, massage, and yoga.

The study found that over the past forty years nearly all of the twenty CAM therapies had increased in popularity, though interest surged during the 1960s and 1970s. The researchers observed that specific CAM therapies gained acceptance during each decade. In the 1960s Americans discovered diet programs, vitamins, and self-help support groups, and in the 1970s they turned to herbal medicine, biofeedback, and energy healing. The 1980s saw growing popularity of massage and naturopathy, and during the 1990s the appeal of massage increased along with interest in aromatherapy, energy healing, herbal medicine, and yoga.

Unlike the earlier studies that found CAM users to be mostly educated adults living in Western states, the Harvard researchers found the use of alternative therapies was unrelated to education, gender, or ethnicity. They observed that the increases in acceptance and use of CAM during the past fifty years suggest that demand for CAM therapies will continue in the future.

More recent research reveals that Americans' interest in and enthusiasm for CAM practices continues to grow. CDC researchers report that nearly two-thirds (62.1%) of American adults used some form of complementary or alternative medicine in the past year. (See Table 2.9.) The 2002 survey of thirty-one thousand U.S. adults asked about twenty-seven types of therapies such as acupuncture and chiropractic, the use of herbs or botanical products, yoga, meditation, special diets, and megavitamin therapy.

About 36% of survey respondents had used at least one form of complementary and alternative medicine. When prayer specifically for health reasons was included on the list of alternative approaches, the number of U.S. adults using some form of CAM in the past year rose to 62%. Researchers found that people most likely to use CAM therapies were women; those with higher education; and those who had been hospitalized within the past year. (See Table 2.10.) Former smokers were also more likely than current smokers or those who had never smoked to use CAM therapies. The survey also found that African-Americans were more likely than whites or Asians to use CAM when megavitamin therapy and prayer were included in the definition. (See Table 2.10.)

In "Complementary and Alternative Medicine Use among Adults: United States, 2002," the CDC reported that alternative approaches were most often used to treat back pain or problems (16.8%), colds (9.5%), neck pain or problems (6.6%), joint pain or stiffness (4.9%), and anxiety or depression (4.5%). When asked the reason they had sought or used CAM treatments, more than half (55%) of the survey respondents said they were most likely to use CAM because they believed that it would help them when combined with conventional medical treatments. Half of the respondents thought CAM would be interesting to try, 26% used CAM because a conventional medical professional suggested they try it, and 13% used CAM because they felt that conventional medicine was too expensive.

The CDC survey also found that within the past twelve months, 43% of adults reported that they had prayed for their own health, 24% prayed for someone

TABLE 2.9

Adults who used complementary and alternative medicine, by typeof therapy, 2002
Ever used Used during past 12 months
Therapy Number in thousands Percent Number in thousands Percent
1CAM includes acupuncture; ayurveda; homeopathic treatment; naturopathy; chelation therapy; folk medicine; nonvitamin, nonmineral, natural products; diet-based therapies; megavitamin therapy; chiropractic care; massage; biofeedback; meditation; guided imagery; progressive relaxation; deep breathing exercises; hypnosis; yoga; tai chi; qi gong; prayer for health reasons; and energy healing therapy/Reiki. Respondents may have reported using more than one type of therapy.
2The totals of the numbers and percents of the categories listed under "Diet-based therapies" are greater than the number and percent of "Diet-based therapies" because respondents could choose more than one diet-based therapy.
3The totals of the numbers and percents of the categories listed under "Prayer for health reasons" are greater than the number and percent of "Prayer for health reasons" because respondents could choose more than one method of prayer.
Notes: CAM is complementary and alternative medicine. The denominators for statistics shown exclude persons with unknown CAM information. Estimates were age adjusted to the year 2000 U.S. standard population using four age groups: 18–24 years, 25–44 years, 45–64 years, and 65 years and over.
SOURCE: Patricia M. Barnes, Eve Powell-Griner, Kim McFann, and Richard L. Nahin, "Table 1. Frequencies and Age-Adjusted Percents of Adults 18 Years and Over Who Used Complementary and Alternative Medicine, by Type of Therapy: United States, 2002," in "Complementary and Alternative Medicine Use among Adults: United States, 2002," in Advance Data from Vital and Health Statistics, no. 343, Centers for Disease Control and Prevention, National Center for Health Statistics, May 27, 2004, www.cdc.gov/nchs/data/ad/ad343.pdf (accessed June 7, 2004)
Any CAM1 use 149,271 74.6 123,606 62.1
Alternative medical systems
Acupuncture 8,188 4.0 2,136 1.1
Ayurveda 751 0.4 154 0.1
Homeopathic treatment 7,379 3.6 3,433 1.7
Naturopathy 1,795 0.9 498 0.2
Biologically based therapies
Chelation therapy 270 0.1 66 0.0
Folk medicine 1,393 0.7 233 0.1
Nonvitamin, nonmineral, natural products 50,613 25.0 38,183 18.9
Diet-based therapies2 13,799 6.8 7,099 3.5
Vegetarian diet 5,324 2.6 3,184 1.6
Macrobiotic diet 1,368 0.7 317 0.2
Atkins diet 7,312 3.6 3,417 1.7
Pritikin diet 580 0.3 137 0.1
Ornish diet 290 0.1 76 0.0
Zone diet 1,062 0.5 430 0.2
Megavitamin therapy 7,935 3.9 5,739 2.8
Manipulative and body-based therapies
Chiropractic care 40,242 19.9 15,226 7.5
Massage 18,899 9.3 10,052 5.0
Mind-body therapies
Biofeedback 1,986 1.0 278 0.1
Meditation 20,698 10.2 15,336 7.6
Guided imagery 6,067 3.0 4,194 2.1
Progressive relaxation 8,518 4.2 6,185 3.0
Deep breathing exercises 29,658 14.6 23,457 11.6
Hypnosis 3,733 1.8 505 0.2
Yoga 15,232 7.5 10,386 5.1
Tai chi 5,056 2.5 2,565 1.3
Qi gong 950 0.5 527 0.3
Prayer for health reasons3 110,012 55.3 89,624 45.2
Prayed for own health 103,662 52.1 85,432 43.0
Others ever prayed for your health 62,348 31.3 48,467 24.4
Participate in prayer group 25,167 23.0 18,984 9.6
Healing ritual for own health 9,230 4.6 4,045 2.0
Energy healing therapy/Reiki 2,264 1.1 1,080 0.5

else, 19% used products such as herbs, 12% practiced deep breathing, and 8% had meditated. Just about 12% of adults sought care from a licensed CAM practitioner—8% seek care from a chiropractor, 5% use massage therapeutically, and 4% use diet-based therapies for health.

CRITICS SAY ALTERNATIVE MEDICINE IS A WASTE OF TIME AND MONEY. Although complementary and alternative medicine practices are gaining in popularity throughout the United States and Europe, many allopathic physicians and scientists regard them with skepticism because they have not been rigorously tested or proven to be effective. In the May 15, 2002, issue of Time magazine, columnist Leon Jaroff asserted that the NCCAM budget of about $105 million per year is being misspent and that NCCAM is staffed with CAM practitioners and professionals who are biased in favor of CAM practices and unable to assess objectively their value to the American people.

Jaroff also contended that NCCAM monies are repeatedly given to the same alternative practitioners and researchers and that few of the results of NCCAM studies have been published. The Time columnist stated that NCCAM is always positive about CAM practices, and that he would like to see NCCAM publish at least one report that is critical or refutes the claims of CAM practitioners. Jaroff asserted that scientific repudiation of many CAM treatments would convince Americans that they are spending increasing sums of money on essentially worthless remedies and therapies.

Although detractors criticize the absence of scientific verification of the efficacy of CAM treatments, they also question whether some CAM approaches, which are generally not covered by health insurance and are paid for by the patient, exploit persons who are desperate, gullible, or otherwise vulnerable. Finally, critics of alternative medicine are concerned that CAM practices and practitioners are not adequately regulated. They point to variability of practitioners' training and expertise as well as the largely unregulated nature of the herbal and other remedies CAM practitioners may prescribe.

TABLE 2.10

Adults who used selected complementary and alternative medicine categories during the past year, by selected characteristics, 2002
Any use of —
Selected characteristic CAM including megavitamin therapy and prayer1 Biologically based therapies including megavitamin therapy2 Mind-body therapies including prayer3 CAM excluding megavitamin therapy and prayer4 Biologically based therapies excluding megavitamin therapy5 Mind-body therapies excluding prayer6 Alternative medical systems7 Energy therapies Manipulative and body-based therapies8
Total9,10 62.1 21.9 52.6 35.1 20.6 16.9 2.7 0.5 10.9
Sex10
Male 54.1 19.6 43.4 30.2 18.2 12.5 2.2 0.3 9.5
Female 69.3 24.1 61.1 39.7 22.9 21.1 3.2 0.7 12.2
Age
18–29 years 53.5 19.6 44.2 32.9 18.8 17.7 2.3 0.4 9.5
30–39 years 60.7 23.2 49.8 37.8 22.1 18.3 3.3 0.6 12.8
40–49 years 64.1 24.7 53.3 39.4 23.3 18.9 3.2 0.7 13.0
50–59 years 66.1 26.2 56.1 39.6 24.7 19.6 3.3 0.8 11.3
60–69 years 64.8 21.3 56.3 32.6 19.6 14.4 2.1 0.4 9.8
70–84 years 68.6 15.3 63.3 25.1 13.3 9.4 1.4 0.1 7.7
85 years and over 70.3 9.1 66.0 14.9 8.4 6.4 0.9 0.3 2.1
Race10
White, single race 60.4 22.3 50.1 35.9 20.9 17.0 2.8 0.5 12.0
Black or African American, single race 71.3 16.5 68.3 26.2 15.2 14.7 1.4 0.3 4.4
Asian, single race 61.7 29.5 48.1 43.1 28.9 20.9 4.5 0.6 7.2
Hispanic or Latino origin10,11
Hispanic or Latino 61.4 20.6 55.1 28.3 19.8 10.9 2.4 0.4 5.8
Not Hispanic or Latino 62.3 22.3 52.4 36.1 20.9 17.7 2.8 0.6 11.6
Education10
Less than high school 57.4 12.5 52.0 20.8 11.7 8.0 1.3 0.2 5.1
High school graduate/GED12 recipient 58.3 17.8 49.6 29.5 16.8 12.4 1.6 0.3 9.4
Some college—no degree 64.7 24.1 54.8 38.8 22.6 19.1 2.7 0.7 12.5
Associate of arts degree 64.1 24.6 53.8 39.8 23.1 20.2 3.0 0.5 12.6
Bachelor of arts or science degree 66.7 29.8 54.9 45.9 27.7 25.0 4.6 0.9 15.3
Masters, doctorate, professional degree 65.5 31.5 52.7 48.8 29.8 26.5 5.2 1.6 12.8
Family income10,13
Less than $20,000 64.9 18.9 58.8 29.6 18.0 14.8 2.4 0.4 6.7
$20,000 or more 61.6 23.1 51.2 37.0 21.6 17.9 2.9 0.6 12.1
$20,000–34,999 63.5 21.1 55.3 34.1 19.9 16.9 2.0 0.5 10.0
$35,000–54,999 62.8 22.6 52.8 36.6 21.2 17.9 2.9 0.6 11.8
$55,000–74,999 60.9 22.7 50.1 37.4 21.2 18.2 2.4 0.4 11.0
$75,000 or more 61.9 27.1 48.7 43.3 25.6 20.7 4.0 0.7 15.2
Poverty status10,14 Percents
Poor 65.5 17.9 60.8 28.2 17.0 14.1 2.0 0.3 5.9
Near poor 64.3 19.1 57.1 30.4 18.3 14.7 1.9 0.4 7.7
Not poor 62.6 24.7 51.2 39.8 23.2 19.5 3.2 0.6 13.1
Health insurance15
Under 65 years:
Private 61.4 24.6 50.0 39.4 23.2 19.3 3.0 0.6 13.1
Public 65.1 17.9 59.8 31.1 16.5 18.0 2.3 0.4 7.3
Uninsured 57.7 21.1 49.5 31.2 20.4 14.7 3.1 0.7 8.0
65 years and over:
Private 68.2 16.0 61.9 27.2 14.0 10.6 1.4 0.2 9.4
Public 65.9 14.6 61.1 21.3 13.4 8.4 1.3 0.1 4.5
Uninsured 74.4 18.2 73.2 19.7 18.2 3.0 0.7 0.7
Marital status10
Never married 60.2 21.0 52.0 33.0 19.7 18.0 2.6 0.7 9.4
Married 62.4 21.8 52.7 35.0 20.5 15.6 2.7 0.4 11.1
Cohabiting 59.4 25.9 47.7 37.9 24.6 20.4 2.9 1.3 11.1
Divorced or separated 65.4 23.5 57.5 38.8 22.2 22.1 2.6 0.6 11.1
Widowed 72.8 22.6 65.5 33.9 21.0 18.5 2.0 0.1 8.4

— Quantity zero.
1CAM including megavitamins and prayer includes acupuncture; ayurveda; homeopathic treatment; naturopathy; chelation therapy; folk medicine; nonvitamin, nonmineral, natural products; diet-based therapies; megavitamin therapy; chiropractic care; massage; biofeedback; meditation; guided imagery; progressive relaxation; deep breathing exercises; hypnosis; yoga; tai chi; qi gong; prayer for health reasons; and energy healing therapy/Reiki.
2Biologically based therapies including megavitamin therapy includes chelation therapy; folk medicine; nonvitamin, nonmineral, natural products; diet-based therapies; and megavitamin therapy.
3Mind body therapies including prayer includes biofeedback; meditation; guided imagery; progressive relaxation; deep breathing exercises; hypnosis; yoga; tai chi; qi gong; and prayer for health reasons.
4CAM excluding megavitamins and prayer includes acupuncture; ayurveda; homeopathic treatment; naturopathy; chelation therapy; folk medicine; nonvitamin, nonmineral, natural products; diet-based therapies; chiropractic care; massage; biofeedback; meditation; guided imagery; progressive relaxation; deep breathing exercises; hypnosis; yoga; tai chi; qi gong; and energy healing therapy/Reiki.
5Biologically based therapies excluding megavitamin therapy includes chelation therapy; folk medicine; nonvitamin, nonmineral natural products; diet-based therapies.
6Mind-body therapies excluding prayer includes biofeedback; meditation; guided imagery; progressive relaxation; deep breathing exercises; hypnosis; yoga; tai chi; qi gong.
7Alternative medical systems includes acupuncture; ayurveda; homeopathic treatment; and naturopathy.
8Manipulative and body-based therapies includes chiropratic care and massage.
9Total includes other races not shown separately and persons with unknown education, family income, poverty status, health insurance status, marital status, body weight status, lifetime smoking status, alcohol consumption status, and hospitalization status.
10Estimates were age adjusted to the year 2000 U.S. standard population using four age groups; 18–24 years, 25–44 years, 45–64 years, and 65 years and over.
11Persons of Hispanic or Latino origin may be of any race or combination of races. Similarly, the category "Not Hispanic or Latino" refers to all persons who are not of Hispanic or Latino origin, regardless of race.
12GED is General Education Development high school equivalency diploma.
13The categories "Less than $20,000" and "$20,000 or more" include both persons reporting dollar amounts and persons reporting only that their incomes were within one of these two categories. The indented categories include only those persons who reported dollar amounts.
14Poverty status is based on family income and family size using the Census Bureau's poverty thresholds for 2001. "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.
15Classification of health insurance coverage is based on a hierarchy of mutually exclusive categories. Persons with more than one type of health insurance were assigned to the first appropriate category in the hierarchy. Persons under age 65 years and those age 65 years and over were classified separately due to the prominence of Medicare coverage in the older population. The category "Uninsured" includes persons 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. Estimates are age-adjusted to the 2000 U.S. standard population using three age groups: 18–24 years, 25–44 years, and 45–64 years for persons under age 65, and two age groups: 65–74 years and 75 years and over for persons aged 65 years and over.
16MSA is metropolitan statistical area.
17Pacific states includes California, Oregon, Washington, Alaska, and Hawaii.
18Body weight status was based on Body Mass Index (BMI) using self-reported height and weight. The formula for BMI is kilograms/meters2. Underweight is defined as a BMI of less than 18.5; healthy weight is defined as a BMI of at least 18.5 and less than 25; overweight but not obese, is defined as a BMI of at least 25 and less than 30: and obese is defined as a BMI of 30 or more.
19Lifetime cigarette smoking status: Current smoker: smoked at least 100 cigarettes in lifetime and currently smoked cigarettes every day or some days; Former smoker: smoked at least 100 cigarettes in lifetime but did not currently smoke; Never smoker: never smoked at all or smoked at all or smoked less than 100 cigarettes in lifetime.
20Lifetime alcohol drinking status: Lifetime abstainer is less than 12 drinks in lifetime; former drinker is 12 or more drinks in lifetime, but no drinks in past year; current infrequent/light drinker is defined as at least 12 drinks in lifetime and 1–11 drinks in past year (infrequent) or 3 drinks or fewer per week, on average (light); current moderate/heavier is defined as at least 12 drinks in lifetime and more than 3 drinks per week up to 14 drinks per week, on average for men and more than 3 drinks per week up to 7 drinks per week on average for women (moderate) or more than 14 drinks per week on average for men and more than 7 drinks per week on average for women (heavier).
Note: CAM is complementary and alternative medicine. The denominators for statistics shown exclude persons with unknown CAM information.
SOURCE: Patricia M. Barnes, Eve Powell-Griner, Kim McFann, and Richard L. Nahin, "Table 4. Age-Adjusted Percents of Adults 18 Years and Over Who Used Selected Complementary and Alternative Medicine Categories during the Past 12 Months, by Selected Characteristics: United States, 2002," in "Complementary and Alternative Medicine Use among Adults: United States, 2002," in Advance Data from Vital and Health Statistics, no. 343, Centers for Disease Control and Prevention, National Center for Health Statistics, May 27, 2004, www.cdc.gov/nchs/data/ad/ad343.pdf (accessed June 7, 2004)
Urban/rural10
Urban 62.6 22.9 53.2 36.0 21.5 18.0 2.9 0.6 10.8
Rural 60.4 19.3 50.9 32.6 18.3 13.9 2.1 0.4 11.1
Place of residence10
MSA,16 Central City 63.5 22.5 55.3 34.9 21.1 18.3 3.1 0.6 9.9
MSA,16 not Central City 61.2 23.2 50.9 36.5 21.8 17.4 2.7 0.6 11.1
Not MSA16 62.1 18.2 53.1 31.9 17.2 13.9 2.1 0.3 11.6
Region10
Northeast 57.9 22.6 46.9 35.7 21.1 16.9 3.1 0.7 10.9
Midwest 61.4 20.9 52.0 37.0 19.7 18.2 2.2 0.5 13.2
South 64.6 19.3 57.2 29.9 18.0 14.0 1.9 0.3 7.9
West 62.1 27.7 50.3 42.2 26.4 21.1 4.6 0.8 13.8
Pacific states17 64.0 27.7 52.4 43.0 26.4 22.4 4.8 0.8 13.3
Body weight status10,18
Underweight 62.0 18.4 55.1 33.6 17.6 20.4 3.0 0.5 8.9
Healthy weigh 62.7 23.3 53.2 37.2 21.9 19.5 3.4 0.7 11.6
Overweight 60.1 21.9 49.6 34.8 20.6 15.8 2.6 0.5 11.2
Obese 64.6 21.1 56.3 33.4 19.8 15.3 1.9 0.4 10.3
Life time cigarette smoking status10,19 Percent
Current smoker 57.2 19.7 47.6 32.9 18.7 16.8 2.0 0.5 9.2
Former smoker 66.6 27.0 55.6 41.9 25.3 21.1 4.0 0.8 13.6
Never smoker 62.8 21.2 54.3 34.1 20.0 16.1 2.6 0.5 10.7
Lifetime alcohol drinking status10,20
Lifetime abstainer 61.6 14.9 56.9 24.3 14.0 10.8 1.5 0.2 6.1
Former drinker 69.2 20.5 62.3 33.4 19.0 16.6 2.3 0.5 9.4
Current infrequent/light drinker 62.2 24.3 51.6 39.7 23.0 19.6 3.1 0.7 13.3
Current moderate/heavier drinker 57.0 25.5 43.5 38.5 24.0 18.4 3.4 0.6 12.1
Hospitalized in the last year10
Yes 75.9 22.1 70.4 37.4 20.5 19.5 3.1 0.5 11.2
No 60.6 22.0 50.8 34.9 20.7 16.7 2.7 0.5 10.9

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