Complementary and alternative medicine
(CAM) refers to a variety of health practices considered to be outside the traditional domain of conventional Western medicine.1
Since the 1990s, rates of CAM use among Americans have increased steadily to the present rate of 38%.1–3
In 2007, it was estimated that Americans spent $33.9 billion on out-of-pocket CAM-related therapies, products, and classes.4
The extant research suggests that CAM use is associated with individual attempts to improve general health,5
treat specific health conditions such as back pain6
and complement conventional medical treatment of life-threatening illnesses such as cancer 8–9
and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).10–11
In the United States, common types of CAM therapies include natural products, mind–body medicine, manipulative and body-based practices, movement therapies, and whole medical systems.1
A myriad of factors have been shown to influence CAM usage, including demographic characteristics, such as age, gender, and race/ethnicity. Researchers find that CAM use may increase with age and that women tend to use CAM more frequently than men.12
Current statistics suggest that women between ages 30 and 69 are the primary consumers of CAM.2,5,12–14
Results from the 2007 National Health Interview Survey (NHIS) indicate that, among adults, native Americans or indigenous Alaskan people (50.3%) and whites (43.1%) reported higher rates of CAM use than Asians (39.9%) or African-Americans (25.5%).12
Among U.S. women who use CAM, reasons for using CAM may differ by race/ethnicity. A study by Chao et al. showed that, when asked what influenced their decision to use CAM, non-Hispanic white women noted personal beliefs, Mexican-American women cited the high cost of conventional medicine, and African-American women reported having read or heard something about CAM on the radio or television.15
Sexual orientation may also play a role in CAM use among women. The two published studies exploring the relationship between sexual orientation and CAM use suggest that sexual orientation may influence overall prevalence rates and motivation of CAM use.11,16
London et al. assessed past 6 month use of alternative therapists by sexual orientation among individuals with HIV/AIDS, and found that a combined sample of gay and lesbian patients had greater odds of having used CAM therapists than heterosexual patients (adjusted odds ratio [AOR]
1.95; 95% confidence interval [CI]
The data from this study are consistent with the extant literature suggesting higher rates of CAM use among medical populations and also indicate that sexual orientation may influence CAM use. However, it is unclear how these findings generalize to nonclinical samples and how use patterns may differ between gay men and lesbians. In a second study, Matthews and colleagues examined the relationship between sexual orientation and CAM use among a community sample of women. Information about rates and types of CAM modalities used was collected as part of a larger survey of lesbian and heterosexual women's health. Overall, 82% of the sample reported any lifetime CAM use. Even after controlling for age, education, race, and health status, lesbians were significantly more likely to have used CAM therapies, compared to their heterosexual counterparts (p
This study made an important contribution to the literature by demonstrating an association between sexual orientation and CAM use among a nonclinical sample of women. However, this study was limited to a narrow definition of CAM use.
Preliminary evidence suggests that CAM use may differ based on sexual orientation. A potential explanation for these findings is that lesbians may face barriers to accessing culturally competent and appropriate health care services. These barriers may include lower rates of health insurance coverage,17
lower average income levels, and higher rates of actual or perceived discrimination in health care settings.16,18
Lesbians may also have a higher prevalence of health-related conditions that have been associated with increased CAM use, such as depression and anxiety.19
In addition, research is needed to gain a better understanding of rates and correlates of CAM use among community samples of women and to identify how these factors may differ based on sexual orientation.
The overall objective of the current study was to estimate the prevalence and correlates of CAM use among a large community-based sample of women enrolled in a women's health research study, the ESTHER (Epidemiologic Study of HEalth Risk in Women) Project. Specific aims were to: (1) determine the prevalence of CAM use (lifetime, past 12-month, and past 12-month use of specific CAM modalities); (2) determine if the prevalence of CAM use differed between lesbian and heterosexual women; and (3) identify correlates of lifetime and past 12-month CAM use. To address these specific aims, secondary data analyses were performed on data collected as part of the ESTHER Project. Study findings have important implications for understanding how sexual minority status may affect CAM use among nonclinical samples of women.