Determinants of Practitioner vs. Self Care Based CAM Use from the 2002 National Health Interview Survey

Despite recent reports of increase in CAM use, little is known about the types and determinants of CAM use. Question remains whether CAM use is practitioner (PR) or self-care (SC) driven. To address this, we analyzed the 2002 National Health Interview Survey's (NHIS) CAM use supplemental files to determine 1) differences in prevalence of PR and SC based CAM use by individuals with chronic morbidities, and 2) if there is a differential association between chronic disease and the above two types of CAM use. The NHIS utilized a stratified, multi-level, probability sampling, which included 31,044 respondents who provided information on past year uses of six PR and six SC based CAM. Seven chronic co-morbidities and eight socio-demographic covariates were used in the analysis.

Twenty three percent used SC-CAM, 5% used PR-CAM and 7% used a combination thereof. Among individuals reporting co-morbidity (N=15,051), 48.5% had at least one chronic disease, and 22.3% reported >=2 co-morbidities. More than a quarter (28.6%) with >=1 co-morbidity used SC-CAM modalities. Conversely, only 8% with >=1 co-morbidity used PR-CAM compared to those who did not have any co-morbidity (p<0.01). Using multinomial multiple regression models after adjusting for covariates, the odds of CAM use among individuals who used SC+PR was 1.86 (95%CI: 1.66;2.08), 1.54 (95%CI:1.45;1.63) for SC-CAM 1.37 (95%CI:1.20;1.57) for PR-CAM, when compared to CAM use by individuals who did not report having any of the analyzed chronic diseases (p<0.001). The model explained 33% of variance.

Study implications include CAM use promotion strategies for different population segments who may or may not prefer professional practitioners providing CAM.