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Nonvitamin, nonmineral dietary supplements, chiropractic or osteopathic manipulation, yoga, and massage therapy were the most common complementary health approaches used in 2012. Use of practitioner-based chiropractic or osteopathic manipulation was twice as high in the West North Central region as in the United States overall. Adult use of nonvitamin, nonmineral dietary supplements was highest in the Mountain, Pacific, and West North Central regions. The use of yoga with deep breathing or meditation was approximately 40% higher in the Pacific and Mountain regions than the national average. In 2012, adults living in the Pacific, Mountain, and West North Central regions were most likely to have used massage therapy during the past 12 months. The use of practitioner-based chiropractic or osteopathic manipulation was nearly twice as high in the West North Central region as in the United States overall. Use of nonvitamin, nonmineral dietary supplements was highest in the Mountain, Pacific, and West North Central regions. Use of yoga with deep breathing or meditation was approximately 40% higher in the Pacific and Mountain regions than in the United States overall.
The use of nonvitamin, nonmineral dietary supplements (17.9%) was more than twice that of all other complementary health approaches (Figure 1). Complementary health approaches: Include acupuncture, Ayurveda, biofeedback, chelation therapy, chiropractic or osteopathic manipulation, craniosacral therapy, energy healing therapy, guided imagery, herbs and other nonvitamin supplements, hypnosis, homeopathy, massage, meditation (mantra, mindfulness, and spiritual), Alexander technique, Feldenkreis, Pilates, Trager psychophysical integration, naturopathy, progressive relaxation, special diets, traditional healers, and yoga (with meditation or deep breathing), tai chi, and qi gong exercises. Chiropractic manipulation: A technique that uses a type of hands-on therapy to adjust problems related to the body's structure, primarily the spine, and its function. Massage: Manipulation of the body's muscle and connective tissues to enhance the physical functioning of those tissues, and promote relaxation and well-being. Meditation: A group of techniques with origins in Eastern religious or spiritual traditions. Nonvitamin, nonmineral dietary supplements: Include herbs and other nonvitamin supplements such as pills, capsules, tablets, or liquids that have been labeled as dietary supplements. Osteopathic manipulation: A full-body system of hands-on techniques to alleviate pain, restore function, and promote health and well-being. Special diets: A variety of nutritional approaches ranging from a basic, healthy vegetable-based diet to adopting highly restrictive diets and supplement programs.

Yoga: Of Hindu origin, a combination of breathing exercises, meditation, and physical postures used to achieve a state of relaxation and balance of mind, body, and spirit.
In 2012, detailed health information was collected on a total of 34,525 persons aged 18 and over from the Sample Adult component of the survey. Questions on complementary health approaches were from the 2012 adult alternative medicine (ALT) supplement embedded in the Sample Adult component of the survey.
All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
They range from practitioner-based approaches, such as chiropractic manipulation and massage therapy, to predominantly self-care approaches, such as nonvitamin, nonmineral dietary supplements, meditation, and yoga. For more information about specific health approaches, refer to the National Center for Complementary and Alternative Medicine. In meditation, a person learns to focus his or her attention and suspend the stream of thoughts that normally occupy the mind. This category does not include vitamin or mineral supplements, homeopathic treatments, or drinking herbal or green teas.
Some diets are highly restrictive; examples of special diets include Zone, vegan, and Ornish diets.
Survey respondents were classified as having practiced yoga during the past 12 months only if they indicated they had practiced deep-breathing exercises or meditation as part of their yoga exercise.
NHIS data are collected continuously throughout the year for the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) by interviewers from the Census Bureau. The processes used to develop the 2012 ALT supplement, as well as those fielded in 2002 and 2007, have been previously described (6). Based on cognitive testing and input from expert panels (6), the definitions of certain modalities were modified to reduce false-positive responses.
Exploring the science of complementary and alternative medicine: Third strategic plan, 2011a€“2015. Development of the adult and child complementary medicine questionnaires fielded on the National Health Interview Survey.
This report presents estimates of the four most commonly used complementary health approaches among adults aged 18 and over in nine geographic regions, using data from the 2012 National Health Interview Survey adult alternative medicine supplement (2).

Previous research demonstrated that regional differences exist in the use of complementary health approaches among adults in the United States (3,4), and this report reveals that those regional differences persist across a wide range of complementary health approaches.
This practice is believed to result in a state of greater physical relaxation, mental calmness, and psychological balance.
NHIS collects information about the health and health care of the civilian noninstitutionalized U.S. The 2012 NHIS ALT supplement collected information from sample adults on their use of 18 complementary health approaches, which included 10 types of provider-based health therapies. Data users should take these differences into account when conducting analyses and making comparisons between data from 2012 and previous survey years.
Point estimates and estimates of their variances were calculated using SUDAAN software (8) to account for the complex sampling design of NHIS. Environmental and cultural factors unique to towns, regions, and economic factors have long been linked to differences in health behaviors and general health measures in the U.S. In 2012, meditation included mantra meditation (including Transcendental Meditation, relaxation response, and clinically standardized meditation), mindfulness meditation (including vipassana, Zen Buddhist meditation, mindfulness-based stress reduction, and mindfulness-based cognitive therapy), and spiritual meditation (including centering prayer and contemplative meditation).
NHIS participants were asked if they used or saw a practitioner for each of these approaches during the past 12 months.
Interviews are conducted in respondents' homes, but follow-ups to complete interviews may be conducted over the telephone. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. Similar environmental and cultural factors may be related to the regional differences of complementary health approach uses that are presented in this report. The estimated standard error of the difference between regional and national estimates accounted for nonindependence of regional and national estimates by incorporating their covariance. Nahin are with the National Institutes of Health, National Center for Complementary and Alternative Medicine.

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