We found that 19.3% of adults (38.3 million) did not use conventional healthcare in the last 12 months despite that fact that 38.4% of these individuals had one or more health needs, with almost one-quarter having a serious chronic or acute medical condition. Instead of conventional care, 24.8% of these individuals used alternative medicine. Several striking differences were seen when comparing the characteristics of those who used alternative medicine to those who used neither alternative medicine nor conventional medicine. First, users of alternative medicine had poorer health. Second, users of alternative medicine were more likely to have more barriers to care as exemplified by their having to delay conventional care because of both cost and non-cost factors, with 1 in 5 having used alternative medicine because conventional care was too expensive. Finally, those who used only alternative medicine and those who used neither alternative medicine nor conventional medicine displayed distinctly different patterns of predisposing factors, as well as different patterns of personal health practices.
While the present data do not allow us to directly answer the question as to why the predisposing factors and personal health practices of alternative medicine users differed from non-users, they are consistent with the hypothesis that complementary medicine and alternative medicine users are more likely to have a wellness lifestyle than non-users [32
]. For instance, it has been proposed that higher education, a predisposing factor strongly associated with alternative medicine use in the present study, increases an individual's exposure to various types of complementary medicine and alternative medicine therapies [11
], perhaps through increased medical literacy and health information seeking activity [33
]. This seems especially true for the use of modern technologies like the internet [34
], which are increasingly used to access information on complementary medicine and alternative medicine [35
]. It may be that positive health behaviors associated with a wellness lifestyle [32
] cluster in alternative medicine users just as they do in females and those with higher education in the general population [36
]. Supporting this contention, it has been found that complementary medicine and alternative medicine are associated with a number of positive health behaviors that would be part of a wellness lifestyle [32
] including regular levels of exercise [37
], nonuse of tobacco [37
], nonuse or moderation in use of alcohol [37
], healthy diet choices [40
] and preventive screening [41
]. While the 2002 NHIS did not specifically ask participants if they used complementary medicine or alternative medicine for wellness, the 2007 NHIS did incorporate such a question. Future planned analysis of the 2007 dataset will allow direct assessment of whether those using only alternative medicine, do so for their overall wellness, as well as to treat specific diseases or conditions.
Our analyses are consistent with other national surveys [10
] showing that a relatively small proportion (1.7%-4.4%) of the population use alternative medicine but not conventional medicine. While predisposing factors (age, education, race and sex) were not predictors of relying primarily on alternative medicine in Astin's study [11
], education, race and sex were associated with the use of alternative medicine among those not using conventional care in the present study. Astin cautioned that his small sample size may have missed important predictors of using only alternative medicine. While, to our knowledge, no other studies besides Astin [11
] have specifically examined predictors of alternative medicine use, several studies have examined the predictors of complementary medicine and alternative medicine combined [11
]. Consistent with the present results, these earlier studies identify education, race and sex as predictors of use.
Contrary to earlier studies on complementary medicine and alternative medicine combined [43
], enabling factors appear to have little impact on the use of alternative medicine. Yet, cost issues seem to play some role in whether an individual uses alternative medicine versus neither complementary medicine nor conventional medicine in that even after accounting for insurance coverage and poverty status, those who delayed conventional care because of cost were more likely to use alternative medicine. It is, therefore, not surprising that individuals who used only alternative medicine predominately used lower cost self-care therapies such as dietary supplements and mind-body therapies. However, when faced with one or more health needs, individuals who used only alternative medicine were more likely to use practitioner-based therapies, especially manipulative and body based therapies.
While cost and other barriers to conventional care may be motivators of alternative medicine use, there also is an indication that some users of only alternative medicine do not find conventional medicine helpful (Table ). These data are consistent with observations suggesting that individuals who use only alternative medicine distrust the conventional care system and are generally dissatisfied with conventional care [11
]. In a similar vein, skepticism toward medical care is strongly associated with reduced use of conventional healthcare, even after controlling for predisposing, enabling and need factors [48
]. For these individuals, the value of conventional care for their health needs may not be appreciated.
Some users of only alternative medicine used alternative medicine because they felt conventional care was too expensive. It is possible this group would use conventional care if they could. Future research might assess whether this population is aware of public health insurance options and other failsafe measures to pay for conventional care. Finally, a substantial proportion of respondents who used only alternative medicine did so because they thought it would be interesting to try. Some of these individuals may be encountering non-cost barriers to conventional care, while, as mentioned earlier, others appear to be using alternative medicine as part of a healthy lifestyle choice [11
Our study has several limitations. First, the cross sectional nature of the study does not allow us to assess clinical outcomes in our two identified populations, those who use neither alternative medicine nor conventional healthcare and those who use only alternative medicine. Thus we cannot comment on the potential safety or efficacy of using only alternative medicine. Given that substantial numbers of both groups have one or more health needs, future prospective studies of these populations should investigate a number of possible outcomes such as avoidable hospitalization or premature death. Second, our measures were based on self-reported data that were not independently verified. Third, many other factors that may enable or impede healthcare utilization are not measured in this report but need to be considered. These factors include health beliefs, cultural practices, language barriers, social networks and contacts, and the availability of care in the community [15
]. Fourth, we limited our population for analysis to those individuals who did not report seeing a conventional provider in the preceding 12 months. There is always the potential for recall error in these types of questions. Finally, because our primary focus was to identify factors associated with the use, versus nonuse, of alternative medicine, a dichotomous dependent variable was utilized. By doing so, information on the number and type of alternative medicine therapies used and frequency of their use was lost. It may be that substantial differences exist between heavy and light users of alternative medicine or between the various, heterogeneous alternative medicine modalities.