The paper previously referenced by Brown et al. outlines the prevalence of CAM use in African Americans, analyzing data from the 2002 National Health Interview Survey (NHIS).1 The study concludes that a substantial number of African Americans use CAM; almost 70% of respondents report CAM use within the prior 12 months. Prayer for health reasons was the most common CAM modality, used by more than 60% of respondents, followed by herbals (14.2%) and relaxation (13.6%). Only 1.4% of CAM users surveyed had used an alternative medical system (acupuncture, Ayurveda, homeopathy, or naturopathy) in the past 12 months, and 3.6% reported having ever used one of these systems. The use of prayer was at least twice as high as any other CAM modality in this population.
With the inclusion of prayer in the definition of CAM, several papers have reported equal or higher levels of CAM use among African American populations compared to whites. At least four other studies report high CAM utilization rates in African American populations based on 2002 (National Health Interview Survey) NHIS data.2,4,16,17
Notably, Barnes et al. observed that 71% of African Americans reported the use of CAM. In this study, African American use of mind–body therapies dropped from 68.3% to 14.7% when prayer was excluded.2
Several other studies that have not used NHIS data have also reported that prayer is the most common alternative therapy used by African Americans.3,18–20
Research conducted in the United States suggests that some sociodemographic characteristics predict use of CAM. A frequently cited study by Eisenberg et al. that surveyed the use of 16 CAM therapies reports that CAM use is most common among women and college-educated people with incomes greater than $50,000 but is less common among African Americans.15
Interestingly, this study did not include prayer in its analysis. Suggesting a change in this disparity, more recent studies have included prayer in the definition of CAM, making it appear as though African American CAM use is increasing, when in actuality, prayer and spiritual healing have long been a part of African American culture.21
The plethora of data that report high CAM use in African American populations may provide the illusion that access to and knowledge of CAM services are equivalent across racial and ethnic groups in this country. Yet while we can find abundant information on “ethnic minority use of CAM” describing the use of prayer and home remedies, it appears that ethnic minority utilization of CAM practitioner-provided services is in fact quite low.1
It remains a challenge to find reports addressing apparent differential access to and knowledge of these services. Given the distinction between the use of CAM therapies—either including or excluding prayer—and the utilization of CAM services, further research is needed to improve our understanding of how CAM services are being utilized by communities of color. We suggest that this should be a focus of future study.