Use of specific modalities grouped under the heading of “complementary and alternative medicine” (CAM) has become increasingly widespread in the United States, and better understood over the past 3 decades. Surveys of CAM use include such therapies as herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy,1
with increasing attention being given to different subpopulations in the United States. One of the modalities regularly included is acupuncture. Interest in acupuncture has increased over time, resulting in training programs, licensing, and credentialing procedures. Growing professionalization of acupuncturists has led to some of them working within mainstream medical settings.2
Acupuncture is one of the CAM therapies most positively viewed by physicians. Twenty-five (25) surveys conducted between 1982 and 1995 showed that acupuncture had the highest rate of physician referral (43%), leading among the top five preferred CAM therapies (chiropractic, homeopathy, herbal medicine, and massage).3
One (1) recent survey showed that 41% of primary care physician respondents would consider participating in acupuncture research.4
In a 2002 national survey of CAM use in adults, 4.1% of the 31,044 respondents reported using acupuncture at least once in their lifetime, and 1.1% (representing 2.13 million Americans) reported use of acupuncture within the previous year. Recent use was associated with female gender, higher education, more frequent visits to regular physicians, self-reported poor health, specific illness such as back or neck pain, and living in areas where there was greater access to CAM providers. Insurance reimbursement for visits was also a factor.5,6
A small but growing number of studies have focused on minority patient use of CAM in general, and of acupuncture in particular.7–14
Moreover, data suggest that primarily “Asian” patients use acupuncture, whereas African American and Latino/Latina patients reportedly prefer other CAM modalities. One study of CAM use by minority women, for example, showed that of 1026 Chinese American women, 7.8% used acupuncture as compared with 2.5% of non-Hispanic white women (n
= 747), 1.9% of Mexican Americans (n
= 1057), and 0.9% of African American women (n
= 1081). Multivariate models of CAM use indicate that ethnicity is independently associated with CAM modalities use, the use of CAM practitioners, and the health problems for which CAM is used.15
Even studies that do report on different minority groups generally do not focus on urban underserved patient populations. It is therefore not clear to what extent low acupuncture use by these populations represents a lack of familiarity, and/or the impact of actual barriers to access. According to an Institute of Medicine Report, minorities are less likely than whites to receive needed medical services.16
Disparities exist in specific disease areas and across a range of procedures. Moreover, to the extent that modalities such as acupuncture are not covered by insurance, but must be paid for out of pocket, cost can become a significant barrier.
There are even fewer data in relation to CAM use in pediatric populations, among whom the overall use of CAM has generally been studied in relation to specific illnesses17–23
and specific clinics.24
Predictors of CAM use by children include parental use, sociodemographics, the ability to pay out of pocket, and severity of illness.25
Insurance coverage can also be a factor.26
Such studies do not generally focus on the use of specific modalities such as acupuncture, although one study of patients referred by a pediatric pain service suggested that acupuncture is a reasonable addition to standard biomedical care, that it is tolerated by adolescents, and useful in helping to reduce pain and relieve anxiety.27
As in the case of adult underserved minority patients, the use of acupuncture by underserved pediatric populations has not been well studied.
For minority pediatric patients, barriers to accessing even conventional health care exist, and involve multiple risk factors such as race/ethnicity, poverty, parent education, insurance, and language.28
Parents have identified barriers such as not having the necessary skills and prerequisites for gaining access to the system, being alienated by front office experiences, and negative interactions with physicians.29
Against this backdrop, access to CAM therapies such as acupuncture for children may be further limited not only by financial barriers, but also by parents' lack of familiarity with acupuncture, lack of physician knowledge about appropriate use, and the absence of acupuncturists in hospital or clinic settings. To the best of our knowledge, the availability of acupuncture for pediatric populations, with some notable exceptions, is limited to private clinics, and is rarely if ever provided in urban hospitals and neighborhood health clinics—sites where underserved minority patients are more likely to seek care. We hypothesized that it would be possible to integrate acupuncture fully into clinical services provided by an urban hospital serving these minority and underserved adolescents and pediatric patients. In light of growing efforts to integrate CAM services into mainstream medical settings,30–32
we also hypothesized that, if acupuncture were made available and affordable to underserved minority patients from different age groups, it would be increasingly accepted and utilized as a CAM modality.