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Knowledge about alternative medicine connected to education, income

People with lower educational levels and incomes are less likely to know about yoga, acupuncture, natural products and chiropractic medicine, according to a new study from San Francisco State University.

Studies on the use of complementary and alternative medicine (CAM) have typically focused on learning more about who use these types of practices and why. Less is known about trends among those who do not partake, which inspired new research by Professor of Health Education Adam Burke, published in PLOS ONE on June 17.

"It's very important to know why somebody is not doing a particular behavior," said Burke, who is also the director of SF State's Institute for Holistic Health Studies. "If your child isn't eating broccoli and you want him to, you need to know why. If it's just a matter of the pieces being too big, you can cut it up. But if you don't know why, the child will not eat the broccoli."

The research, based on the 2007 National Health Interview Survey, looked at data from more than 13,000 respondents who said they had never used acupuncture, chiropractic, natural products or yoga, four common CAM practices.

Lack of knowledge as a reason for non-use was strongly associated with lower education levels and income. Those who attended college were 58 percent less likely to indicate lack of knowledge as a reason for non-use, and individuals with higher incomes were 37 percent less likely.

"The implication of this study is that the lack of access to health knowledge is a root of health inequity," Burke said. "If you are poor, you have less access to health information for a variety of reasons."

Physical activity levels were also found to correlate with knowledge. People who described themselves as less physically active were significantly more likely to claim a lack of knowledge of all four complementary practices.

One finding of the study that surprised Burke was that the results held true for survey respondents who experienced lower back pain. Since back pain is the medical condition most commonly linked to use of complementary health treatments, Burke and his coauthors hypothesized that back-pain sufferers would have greater knowledge about these treatments even if they opted not to use them, as their pain would compel them to learn about a variety of remedies. But Burke found that the relationship between lower education levels and lack of knowledge remained -- in other words, back pain did not seem to be a significant enough motivator to seek out these common alternative treatments.

But it's especially important for people with back pain to know about CAM methods, Burke said. "Often, the solution for chronic pain is addictive prescription medications, which are problematic in all communities, especially in lower-income communities," Burke said. "Complementary methods have the potential to mitigate such addiction problems, and may help address the root problem rather than just managing the symptoms, which is a real benefit."

This study indicates a greater need among doctors to follow best-practice guidelines for sharing information about integrative practices, combining conventional western and CAM approaches, Burke said.

"It's highly likely that a lack of knowledge prevents some individuals from using these integrative approaches -- if they knew more, they would use them more," Burke said. "These are cost-effective treatments that have limited side effects and may actually help remediate people's problems. Especially in lower-income communities, it is important for health care providers to recommend them."

"Limited health knowledge as a reason for non-use of four common complementary health practices" by Adam Burke and co-authors Richard L. Nahin and Barbara J. Stussman of the National Center for Complementary and Integrative Health was published in PLOS.

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