Our findings demonstrate that CAM use is frequently reported by midlife women. Overall, 46% of American women aged 40–59 years used any type of CAM in the past 12 months. Our findings are consistent with a recent national study of women aged 45–57 years using the same NHIS dataset,3
but we found lower prevalence than several other studies of midlife women.5,7,17
Recent findings for midlife women from SWAN indicated an overall prevalence of CAM use of 52.7%,5
which was a similar prevalence to that found in a Canadian study of women 45–65 years.18
In contrast, an Australian study of women aged 48–67 years reported a prevalence of recent CAM use of 82%.17
A study of women 45–65 years who were members of a Washington HMO also found a relatively high prevalence of CAM use (76%).7
These differences are due, in part, to the differences in the definitions of “any CAM use,” as well as sample variability. We found that >53% of midlife women said they used prayer for health reasons; this percentage is similar to that found in SWAN.5
We found that black and Hispanic women are more likely to use prayer for health, independent of other factors; this is also true for women of all ages and other samples of midlife women.1,5
Including prayer for health in studies of CAM use is clearly relevant and demonstrates important racial and ethnic differences that require additional investigation.19
Taken together, our findings suggest that for a substantial number of midlife women, CAM use and prayer appear to be important components of their overall health management.
Moreover, we found that women use a diversity of CAM therapies, and, importantly, the relations of many demographic, health, and behavioral factors to CAM use depended on the specific CAM type under consideration. For example, in the multivariate analyses, no racial or ethnic differences were observed in use of herbs or relaxation, but blacks were less likely than whites to use yoga/tai chi/qi gong, chiropractic care, and massage; blacks and Hispanics were more likely to use prayer for health. These racial and ethnic differences in specific types of CAM use are likely due to unmeasured group differences in knowledge, attitudes, and preferences about CAM use and health and health behaviors more generally. Being foreign born was positively associated with use of herbs, which may be because of continued adherence to traditional medicines of countries of origin.20
Except for chiropractic care, increases in education were associated with increases in use for each type of CAM and prayer. Increases in income had little independent effect on CAM use, except for massage. It may be that differences in knowledge and attitudes about CAM and health and wellness that arise from increased education are important.21
Although the effects of union status also depended on the specific type of CAM considered, explanations are somewhat more speculative but are consistent with other research.1
It may be, for example, that divorced women have fewer social supports than married women and, thus, are more likely to seek CAM therapies as coping strategies (e.g., relaxation techniques, yoga/tai chi/qi gong, massage).22
As expected, we found regional variability in CAM use, with women residing in the West more likely to use every type of CAM and less likely to use prayer than women residing in the South. These regional differences reflect the combined effects of availability of CAM therapies and services as well as regional normative differences in acceptability and utility of CAM.
Compared with studies that included women of all ages,1
the effect of self-reported health status on CAM use was less pronounced among midlife women. Only relaxation techniques and prayer showed increasing use with poorer health; it may be that these women are using these practices as part of their overall management of their poorer health. Self-reported health status, although a useful measure, captures only one aspect of women's overall health. Other studies of midlife women found that those with a greater number of chronic health conditions (e.g., heart disease, high blood pressure, arthritis, among others) were more likely to use flaxseed, glucosamine, and soy supplements,5
CAM types that were not explicitly considered here. The effects of smoking and alcohol use on CAM use have also been found by others,1,2
but testable explanations are still needed. For example, it may be that women who are former smokers have become more health conscious and, thus, more likely to use herbs, relaxation, and yoga/tai chi/qi gong as part of their health maintenance. Former drinkers may be using prayer as part of a sobriety program, which is commonly done in 12-step-type programs. In sum, our findings underscore the importance of analyzing individual CAM therapies separately because of the differences in the effects of demographic, health, and behavioral factors. Although “any use of CAM” is an important summary measure to assess overall prevalence, the exclusive use of this general measure masks important differences in the correlates of use of specific CAM types.
Our findings show substantial variability in the percentages of women who use a specific CAM type to treat a specific health condition vs. for general health and wellness. The highest percentage reported for treatment of specific health conditions was among women using chiropractic care, and the lowest was among women who used yoga/qi gong/tai chi and relaxation techniques. Herbs, massage, and prayer were used both for health conditions and for wellness. These findings also underscore the importance, particularly in the clinical setting, of asking women about their use of individual CAM therapies because reasons for use (curative vs. preventive) vary substantially by type of CAM. Moreover, for women who reported a health condition, substantial variability was observed in the particular health conditions mentioned across specific CAM types. For example, high percentages of women reported using relaxation techniques for stress-related conditions, whereas those using chiropractic care reported pain-related conditions. Importantly, only 14% of women who reported using herbs said they used herbs for menopausal symptoms; menopause was not a frequently mentioned condition for any other CAM therapy. This is significant because although the research is not very promising regarding the efficacy of various herbs and natural products for the treatment of one of the more bothersome menopausal symptoms, hot flashes,23
evidence is increasing that other CAM strategies, including relaxation techniques and deep breathing exercises, may ameliorate vasomotor symptoms.24
Thus, opportunities exist for education among menopausal women who might be interested in behavioral alternatives to hormone therapy for vasomotor symptoms.
Although the current study provides new information on the differences in specific types of CAM use among a nationally representative sample of midlife women, limitations must be acknowledged. The NHIS data used in the analysis are cross-sectional; therefore, the findings are limited to describing patterns of association between demographic, health, and behavioral characteristics and CAM. Few longitudinal datasets include the variables necessary to characterize women's patterns of use over time. A recent report using SWAN data is an exception13
and points to the need for additional longitudinal studies of CAM. Also, the NHIS data were collected in 2002, and although a recent trend analysis suggests some leveling off of annual prevalence rates of CAM use.8
The 2007 NHIS shows an increase of one to two percentage points in the CAM therapies we investigated.9
It is not clear what impact the Women's Health Initiative findings may have on midlife women's use of CAM, especially for management of menopausal symptoms. Additionally, although our findings suggest that some types of CAM tend to be used for treatment of health conditions and other types tend to be used for prevention and well-being, data limitations precluded any further analysis, such as evaluating reported effectiveness. Better understanding the ways in which midlife women make decisions about using CAM for treatment vs. prevention would provide a more comprehensive picture of their health management.