In The News

Survey: 38% of Adults and 12% of Children Use Complementary and Alternative Medicine

Alternative Therapies in Health and Medicine Appoints New Editors

Older Adults Commonly Use Prescription and Over-the-counter Medications Together

Mediterranean Diet Plus Nuts May Be Helpful in Managing Metabolic Syndrome

Survey: 38% of Adults and 12% of Children Use Complementary and Alternative Medicine

Approximately 38% of adults in the United States aged 18 years and over and nearly 12% of US children aged 17 years and under use some form of complementary and alternative medicine (CAM), according to a new nationwide government survey. This survey marks the first time questions were included on children's use of CAM.

The survey, conducted as part of the 2007 National Health Interview Survey (NHIS), an annual study in which tens of thousands of Americans are interviewed about their health- and illness-related experiences, was developed by the National Center for Complementary and Alternative Medicine (NCCAM). It included questions on 36 types of CAM therapies commonly used in the United States—10 types of provider-based therapies, such as acupuncture and chiropractic, and 26 other therapies that do not require a provider, such as herbal supplementation and meditation.

The 2007 survey results, released in a National Health Statistics Report by the National Center for Health Statistics (NCHS), are based on data from more than 23 300 interviews with American adults and more than 9400 interviews with adults on behalf of a child in the household. The 2007 survey is the second conducted by NCCAM and NCHS; the first was done as part of the 2002 NHIS.

Comparison of the data from the 2002 and 2007 surveys suggests that overall use of CAM among adults has remained relatively steady, 36% in 2002 and 38% in 2007. However, there has been substantial variation in the use of some specific CAM therapies, such as deep breathing, meditation, massage therapy, and yoga, which all showed significant increases.

The most commonly used CAM therapies among US adults were

• nonvitamin, nonmineral, natural products (17.7%) Most common: fish oil/omega 3/DHA, glucosamine, echinacea, flaxseed oil or pills, and ginseng;
• deep breathing exercises (12.7%);
• meditation (9.4%);
• chiropractic or osteopathic manipulation (8.6%);
• massage (8.3%); and
• yoga (6.1%).

Adults used CAM most often to treat pain, including back pain or problems, neck pain or problems, joint pain or stiffness/other joint condition, arthritis, and other musculoskeletal conditions. Adult use of CAM therapies for head or chest colds showed a marked decrease from 2002 to 2007 (9.5% to 2.0%).

Consistent with results from the 2002 data, in 2007 CAM use among adults was greater among

• women (42.8%; compared to men, 33.5%);
• those aged 30 to 69 years (30-39 years: 39.6%; 40-49 years: 40.1%; 50-59 years: 44.1%; 60-69 years: 41.0%);
• those with higher levels of education (master’s, doctoral, or professional degrees: 55.4%);
• those who were not poor (poor: 28.9%; near poor: 30.9%; not poor: 43.3%);
• those living in the West (44.6%); and
• those who have quit smoking (48.1%).

Overall, nearly 12% of children use CAM. Children are 5 times more likely to use CAM if a parent or other relative uses CAM. Other characteristics of adult and child CAM users are similar; factors such as socioeconomic status, geographic region, the number of health conditions, the number of doctor visits in the last 12 months, and delaying or not receiving conventional care because of cost are all associated with CAM use.

Among children who used CAM in the past 12 months, CAM therapies were used most often for back or neck pain, head or chest colds, anxiety or stress, other musculoskeletal problems, and attention deficit/hyperactivity disorder (ADD/ADHD).

The most commonly used CAM therapies among children were nonvitamin, nonmineral, natural products (3.9%); chiropractic or osteopathic manipulation (2.8%); deep breathing exercises (2.2%); and yoga (2.1%).

For more information on the survey, visit http://nccam.nih.gov/news/camstats.htm.

Alternative Therapies in Health and Medicine Appoints New Editors

Effective with the Jan/Feb 2009 issue, 3 new editors—Christine L. Girard, ND; Jason Hao, DOM; and Michele Mittelman, RN, MPH—have been appointed to assist David Riley, MD, in his role as editor in chief of Alternative Therapies in Health and Medicine (ATHM), a peer-reviewed medical journal published by InnoVision Health Media.

“The new editors will play a vital role in reviewing content for the journal and are committed to using their knowledge and experience to enhance the high professional standards set by Alternative Therapies in Health and Medicine and helping to further its global mission,” Dr Riley said.

Christine L. Girard, ND, received her bachelor of arts degree from Goddard College and her naturopathic degree from the National College of Naturopathic Medicine, Portland, Oregon. She is the executive vice president of academic and clinical affairs for the Southwest College of Naturopathic Medicine in Tempe, Arizona, and serves on the board of directors of the American Association of Naturopathic Medicine. Dr Girard gives numerous lectures throughout the country on natural medicine, integrative oncology, and programs in postgraduate medical education.

Jason Hao, DOM, received his bachelor's and master's degrees from the Heilongjiang University of Chinese Medicine in China and received his master of business administration from the University of Phoenix. He is the president of the International Academy of Scalp Acupuncture, the chairman of the Acupuncture Committee at the National Certification Commission for Acupuncture and Oriental Medicine, and vice president of the Southwest Acupuncture College Board in Santa Fe, New Mexico. Dr Hao has been teaching, practicing, and researching acupuncture and treatment with Chinese herbs for 26 years at academic centers in the United States and China.

Michele Mittelman, RN, MPH, has a background in nursing from the University of Pennsylvania Hospital School of Nursing, Rutgers University, and is a member of Sigma Theta Tau International. She has worked as a registered nurse in intensive care, obtained a graduate degree in public health from Columbia University, and worked as a healthcare consultant with Ernst & Young. Ms Mittelman is an advocate for the nursing profession, focusing on integrative care. She has worked nationally to advance integrative medicine through strategic philanthropic initiatives and is also involved with the Dana Farber Cancer Institute in Boston.

“I am excited to have such talented, passionate professionals working with me on Alternative Therapies in Health and Medicine, and I believe the diversity of their backgrounds will bring the quality and reach of the journal to a new level,” Dr Riley said.

Now in its 15th year, Alternative Therapies in Health and Medicine is the definitive peer-reviewed journal in the field of integrative, cross-cultural, and alternative medicine. In both 2006 and 2007, ATHM had the highest impact factor ranking of any independently published peer-reviewed CAM journal in the United States—meaning that its research articles were cited more frequently than any other journal's in the field. ATHM regularly features original research, original articles, case reports, cross-disciplinary explorations, interviews, and more.

Older Adults Commonly Use Prescription and Over-the-counter Medications Together

A survey suggests that nearly half of older adults in the United States use prescription and over-the-counter medications together and that about 4% of older adults are potentially at risk of an adverse drug reaction because of an interaction between medications, according to a study in a recent issue of JAMA. The researchers also found that nearly 30% use at least 5 prescription medications.

Rates of prescription medication use have increased considerably over the last several decades, as have the rates of use of over-the-counter medications and dietary supplements. Older adults are the largest per capita consumers of prescription medications and the most at risk for medication-related adverse events.

Dima M. Qato, PharmD, MPH, of the University of Chicago and colleagues analyzed data from a survey to estimate the prevalence and patterns of medication use (including concurrent use) and major drug-drug interactions among older adults, aged 57 through 85 years. The survey included 3005 community-residing individuals who were drawn from a cross-sectional, nationally representative sample of the United States. In-home interviews, including medication logs, were administered between June 2005 and March 2006. Medication use was defined as prescription, over-the-counter, and dietary supplements used "on a regular schedule, like every day or every week." The survey response rate was about 75%.

During 2005 to 2006, 91% of older adults, corresponding to 50.5 million adults aged 57 to 85 years, regularly used at least 1 medication. Among all medication types, prescription medication use was the most prevalent, used by 81%, or an estimated 44.9 million older adults. The prevalence of prescription medication use was highest among the oldest age group, aged 75 to 85 years. Nearly one-half of older adults regularly used at least 1 over-the-counter medication or dietary supplement. Women were more likely to use prescription medications and dietary supplements than men, whereas use of over-the counter medications was similar among women and men.

More than half of older adults used 5 or more prescription medications, over-the-counter medications, or dietary supplements. For prescription medications, 29% of all respondents used more than 5 medications. The prevalence of the use of 5 or more prescription medications increased steadily with age for both men and women and was overall significantly higher among women.

Overall, 68% of older adults using prescription medications were concurrently using over-the-counter medications, dietary supplements, or both. The researchers also found that 1 in 25 (4%) older adults (approximately 2.2 million) were at risk for a major potential drug-drug interaction. The rate of any major medication interaction increased with age for both men and women but was higher among men compared with women across all age groups. More than half of these major interactions involved the use of nonprescription therapies. In addition, nearly half involved the use of anticoagulants (eg, warfarin) or antiplatelet agents (eg, aspirin).

Mediterranean Diet Plus Nuts May Be Helpful in Managing Metabolic Syndrome

A traditional Mediterranean diet with an additional daily serving of mixed nuts appears to be useful for managing some metabolic abnormalities in older adults at high risk for heart disease, according to a recent report in Archives of Internal Medicine.

The metabolic syndrome is a set of metabolic abnormalities that includes abdominal obesity, high cholesterol, high blood pressure, and high blood glucose levels, all of which are risk factors for cardiovascular disease, according to background information in the article. A traditional Mediterranean diet—characterized by a high intake of cereals, vegetables, fruits and olive oil; a moderate intake of fish and alcohol; and a low intake of dairy, meats, and sweets—has been associated with a lower risk for metabolic abnormalities.

Jordi Salas-Salvadó, MD, PhD, of the University of Rovira i Virgili, Spain, and colleagues assessed 1224 participants in the PREDIMED (Prevencion con Dieta Mediterranea) study who were aged 55 to 80 years and at high risk for cardiovascular disease. Participants were randomly assigned to 1 of 3 groups: 1 group received advice on a low-fat diet, and 2 received quarterly education about the Mediterranean diet. One of the Mediterranean diet groups was provided with 1 L per week of virgin olive oil, and the other received 30 g per day of mixed nuts.

At the beginning of the study, 61.4% of the participants met criteria for the metabolic syndrome. After one year, 409 participants in the Mediterranean diet plus olive oil group, 411 in the Mediterranean diet plus nuts group, and 404 in the control group of low-fat diet advice were available for evaluation. The prevalence of metabolic syndrome decreased by 13.7% among those in the nut group, 6.7% in the olive oil group, and 2% in the control group.

Participants’ weight did not change over the 1-year period. The number of individuals with large waist circumference, high triglycerides, or high blood pressure, however, significantly decreased in the Mediterranean diet plus nuts group compared with the control group. This suggests that components of the diet, principally the nuts, may have beneficial effects on pathophysiological characteristics of metabolic syndrome, such as oxygen-related cell damage, resistance to the effects of insulin, or chronic inflammation. The Mediterranean diet is high in unsaturated fatty acids; in addition, nuts contain beneficial nutrients such as fiber, arginine, potassium, calcium, and magnesium.