acm%2E2014%2E0041

Original Article
Determining the Attitudes
and Use of Complementary, Alternative,
and Integrative Medicine Among Undergraduates
Michael A. Liu, BS,1
Ngoc-Tram Huynh, BS,1
Michael Broukhim, MS,2
Douglas H. Cheung, MS,3
Tonya L. Schuster, PhD,4
and Wadie Najm, MD1,5
Abstract
Objectives: To (1) determine the attitudes, perceptions, and use of complementary, alternative, and integrative
medicine among undergraduate students; (2) assess whether these students would benefit from more academic
exposure to complementary and alternative medicine (CAM) and promotion of integrative medicine (IM); and
(3) gauge the need and desire of undergraduates, particularly pre-health learners, to take courses about CAM/IM.
Methods: This cross-sectional electronic survey study was conducted on the campus of the University of
California (UC) Irvine. Selection criteria included being at least 18 years of age and a current undergraduate at
UC Irvine. All survey responses were collected between November 20, 2010, and June 1, 2011. The data were
analyzed by using Stata software, version 11-SE (Stata Corp., College Station, TX).
Results: Completed surveys were received from 2839 participants (mean age of respondents, 20.2 years).
Thirty-five percent had used CAM within the past 12 months, and 92.8% believed CAM to be at least somewhat
effective; however, only 31% had prior education on CAM. After adjustment for variables, familiarity and
belief in effectiveness were both highly linked to the use of CAM, with ascending odds ratios (ORs; 95%
confidence interval [CI]) of 3.9 (3.1–4.9), 8.1 (5.7–11.5), 13.4 (6.0–30.2), 2.1 (1.3–3.4), 4.9 (3.0–7.8), and 12.7
(6.9–23.4) among increasing categories (all p < 0.01). Sex (OR, 1.26 [95% CI, 1.01–1.56]; p < 0.05), Asian
ethnicity (1.46 [1.14–1.88]; p < 0.01), and prior education (1.26 [1.01–1.57]; p < 0.05) were also significantly
correlated to the use of CAM after adjustment. Most respondents indicated that they were likely to take a CAM
college course if it fulfilled a graduation requirement (63.6%) or was offered within their major (56.4%).
Conclusions: Overall, this large-scale study supports the ideas that education plays a pivotal factor in the
decision to use CAM and that there is a large demand for additional CAM knowledge among college students.
Introduction
Integrative Medicine refers to the holistic practice
focusing on health promotion and disease prevention
by combining evidence-based complementary and alternative
medicine (CAM) treatments with conventional, or Western,
treatments. CAM is the phrase used to define medical treatments
and techniques that are not part of conventional care. Alternative
medicine includes treatments that are used instead of conven-
tional therapies, while complementary medicine includes non-
conventional treatments that are used in conjunction with
conventional treatments.1
The range of CAM treatments in-
clude, but are not limited to, acupuncture, yoga, exercise, herbal
medicine, massage, chiropractic, mind–body modalities, and
homeopathy.2
A study conducted by the National Institutes of
Health in 2007 showed that 38.3% of adults had used some form
of CAM treatment in the past 12 months to treat conditions such
as back pain, headaches, colds, arthritis, anxiety, depression,
cholesterol problems, and reoccurring pain. Some of the major
reasons adults used CAM therapies included the following: the
potential for supplementary benefits of CAM alongside con-
ventional medicine, the potential to treat unique illnesses beyond
Presented in part at the 2012 IM and Health Consortium in Portland, Oregon.
1
Susan Samueli Center for Integrative Medicine, affiliated with School of Medicine, University of California, Irvine, Costa Mesa, CA.
2
Touro University College of Osteopathic Medicine, Vallejo, CA.
3
Department of Epidemiology, School of Public Health, Harvard University, Boston, MA.
4
Department of Sociology, University of California, Irvine, Irvine, CA.
5
Department of Family Medicine, School of Medicine, University of California, Irvine, Irvine, CA.
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 00, Number 0, 2014, pp. 1–9
ª Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2014.0041
1

the scope of conventional medicine, the avoidance of unwanted
side effects, and the lower relative costs of CAM therapies.3
CAM has become increasingly prevalent in both the
medical field and the general population in the United States;
this raises concerns for safety, information, and efficacy.4
Many medical, nursing, pharmacy, and public health schools
in the United States have responded to this growing con-
cern by providing CAM courses for health providers.4
Par-
ticularly, the number of U.S. medical schools reporting
inclusion of CAM into their curricula increased from 46 to
75 schools out of 125 between 1996 and 1999, respectively.5
Lack of CAM education in the undergraduate
curriculum and data on undergraduate
familiarity with CAM
Current undergraduate education on CAM is sparse. Only
five universities in the United States offer CAM degrees, and
research suggests that the overall percentage of college stu-
dents who have been exposed to any CAM subject material is
minimal in both undergraduate and professional school lev-
els.6
A study from San Francisco State University identified a
disparity between students’ high level of interest in CAM and
the low availability of CAM courses. Of the undergraduate
students surveyed, 97% favored the creation of a CAM major
because CAM courses were closely relevant to the students’
lives and helped them reduce their stress levels and because
the courses changed their dietary and exercise routines for the
better.6
Also of note, studies that reported close to 40% of
people who completed some college work had used some
form of CAM in the past 12 months despite the lack of
education on CAM at the undergraduate level.3
Because of
the applicable nature of CAM to health professional schools,
most research had focused on perception and attitude of CAM
in medical, pharmacy, nursing, and public health schools.
Currently there is a lack of research on the perceptions and
use of CAM among undergraduate college students.6
Reasons for CAM education
in the undergraduate curriculum
It has been suggested that CAM education in U.S. col-
leges would increase the effectiveness of the country’s
health practitioners.4
CAM education may be most benefi-
cial in the undergraduate curriculum because it may be too
late for students to gain sufficient understanding of CAM or
even develop an interest in CAM when first exposed to it at
the graduate level in pharmacy, nursing, or medical school.4
One likely reason for such a trend is that the compacted
curricula of schools for health professions prevent an in-
crease in the course load with topics on CAM. In addition,
even with the increased exposure to CAM education in
medical school, medical doctors were not found to report
increased CAM discussion with their patients.7
Perhaps
earlier exposure to CAM would encourage medical practi-
tioners to discuss CAM with their patients as an option. Pre-
health professionals and other undergraduates will also
benefit from education on CAM because the undergraduates
may develop healthier lifestyle habits and increase their
overall knowledge, self-worth, and well-being.6
To address these questions, this study sought to (1) deter-
mine the attitudes, perceptions, and use of complementary,
alternative, and integrative medicine among undergraduate
students; (2) assess whether they would benefit from more
academic exposure to CAM and promotion of integrative
medicine (IM); and (3) gauge the need and desire of under-
graduates, particularly pre-health learners, to take courses
about CAM/IM.
Materials and Methods
Participants and procedures
This cross-sectional electronic survey study was conducted
on the campus of the University of California (UC) Irvine in
southern California. The campus’s undergraduate population
consists of 21,976 students with an average age of 21 years.
The UC Irvine Institutional Review Board reviewed and
approved the study. The survey in this study collected so-
ciodemographic information, including age, sex, race, birth
status, years in the United States, college standing, major,
and career interests. Participants were asked about their past
and current use of CAM, perceptions of the effectiveness of
CAM, and their level of interest in CAM education. A free-
response question asked for the conditions that prompted
their use of CAM. Several questions labeled ‘‘multiple se-
lect’’ allowed students to select for multiple responses
among available choices. A definition of CAM derived from
the National Center for Complementary and Alternative
Medicine was provided, and responses were defined by self-
report: ‘‘CAM is the phrase used to define medical treatments
and techniques that are not part of conventional care. Com-
plementary and Alternative medicine includes treatments that
are used instead of or along with conventional therapies such
as synthetic/pharmaceutical drugs and surgery.’’ The range
of CAM treatments include but are not limited to acupunc-
ture, yoga, tai chi, herbal medicine, massage, chiropractics,
Ayurveda, homeopathy, and vitamins/minerals/supplements.
Several terms used in the current study, such as Traditional
Chinese Medicine and naturopathy, include multiple mo-
dalities. These are defined according to the National Center
for Complementary and Alternative Medicine. (See Appen-
dix for detailed survey information and definitions.)
The different schools within UC Irvine granted permission to
distribute the survey to their undergraduate students. Selection
criteria included being at least 18 years of age and a current
undergraduate at UC Irvine. Emails weresent to each individual
within their respective academic department, with a link di-
recting the participant to the survey on the university’s Elec-
tronic Educational Environment (EEE). EEE is a secure and
interactive platform that students use to access course materials
and conduct course evaluations, among other school-related
activities. Participation was voluntary, and 20 randomly se-
lected participants received a $20 gift card at the end of the
process as an incentive, indicated in the consent form. Students
were required to log in to their UC Irvine electronic account in
order to access the survey; however, the system only provided a
participation list, and responses were not linked to individuals.
EEE also automatically ensured that none of the students took
the survey more than once. All survey responses were collected
between November 20th 2010, and June 1, 2011.
Data analysis
Data were processed and analyzed by using Stata software,
version 11-SE (Stata Corp., College Station, TX). The data
2 LIU ET AL.

were summarized primarily through frequency values and
valid percentages, and measures of variability were reported
by using mean– standard deviation. The Pearson chi-squared
test was used to compare between pre-health and non–
pre-health students on their education preferences. Multi-
variable modeling procedures used a combination of forward
stepwise selection guided by a priori knowledge based on
literature review to assess factors associated with CAM use.
Level of significance was reported at a 5% a level. Non-
responses totaling < 5% were omitted from the data; other-
wise, the number of respondents are indicated in the tables.
Results
Characteristics of sample
Of a population of 21,976 undergraduates at UC Irvine
during the year 2010–2011, completed surveys were received
from 2839 participants with a mean sample age of 20.2 – 2.40
years. The study sample is representative of the overall UC
Irvine undergraduate population, with the exception of a
higher proportion of women (69% in study sample versus
53% overall) (Table 1). The majority of surveyed participants
were Asian (53.1%), reflecting UC Irvine’s student body, and
had at least some familiarity with CAM (64.3%); 92.8%
believed CAM to be at least somewhat effective, but only
31% had prior education on CAM (Table 2).
CAM use
Women were more prominent users of CAM than men,
and those familiar with CAM or with strong beliefs in its
effectiveness were much more likely to use CAM (Table 3).
A total of 1265 (45.2%) surveyed participants reported prior
use of some form of CAM in the past in response to a
general question (Table 2). However, given a list of CAM
treatments, 1806 (63.4%) respondents indicated using at
least one type of treatment. Of these respondents, the most
widespread treatments used were supplements (60.8%), mas-
sage (50.1%), body movement (38.5%), herbal medicine
(35.4%), and Traditional Chinese Medicine (30.1%). The least
commonly used treatments included Ayurveda (3.0%), hyp-
nosis (2.0%), and naturopathy (1.1%) (Table 4). Of the 1587
students who indicated reasons for using CAM, friend/relative
recommendation was the top justification (53.8%), followed
by efficiency/effectiveness of treatment (37.1%), curiosity
(36.2%), and personal philosophy (33.0%). The most major
reasons for not using CAM from the 1384 respondents were
having been healthy (55.8%), lack of familiarity (49.5%), and
lack of physician recommendation (37.1%) (Table 5).
In stepwise logistic regression analysis, sex (odds ratio
[OR], 1.26; 95% confidence interval [CI], 1.01–1.56; p< 0.05),
Asian ethnicity (OR, 1.46; 95% CI, 1.14–1.88; p< 0.01), and
prior education (OR, 1.26; 95% CI, 1.01–1.57; p< 0.05) were
significantly correlated to the use of CAM after adjustment for
variables in our study (Table 6). Being pre-health or a 5th-year
student was only significantly associated with use of CAM
Table 1. Sample Demographics Versus University
of California, Irvine Demographics
Characteristic
Total
responses
University of
California,
Irvine campus
Mean age – SD (y) 20.2 – 2.4
(n = 2788)
21 (n = 21,976)
Sex
Male 30 (852) 46.0 (10,067)
Female 68.6 (1948) 54.0 (11,766)
Declined to state 1.3 (39) 1.0 (143)
Ethnicity
Asian 53.1 (1497) 52.0 (11,412)
African American 2.1 (58) 2.3 (521)
Chicano/Latino 12.7 (357) 15.2 (3,348)
Native American 0.2 (6) 0.5 (107)
White/Caucasian 24.2 (682) 21.6 (4,750)
Missing/other/declined 7.8 (219) 5.5 (1,212)
International NA 2.8 (626)
College standing
Freshman 22.7 (638) 20 (4,298)
Sophomore 18.1 (510) 17 (3,804)
Junior 28.4 (800) 27 (6020)
Senior 26.3 (741) 36 (7941)
5+ years 4.5 (126) NA
School (multiple select)
Arts 3.9 (110) 4.0 (875)
Biological Sciences 23.8 (676) 20.0 (4456)
Business 4.6 (132) 2.0 (405)
Engineering 9.4 (268) 12.0 (2579)
Health Sciences 9.7 (276) 5.0 (1118)
Humanities 11.2 (318) 9.0 (2015)
Information/Computer
Science
2.6 (74) 4.0 (834)
Physical Sciences 6.9 (196) 5.0 (1167)
Social Ecology 15.1 (428) 10.0 (2135)
Social Sciences 26.2 (745) 25.0 (5464)
Undecided/Undeclared 2.5 (73) 4.0 (928)
Unless otherwise stated, values are the percentage (number).
SD, standard deviation; NA, not available.
Table 2. Sample Characteristics
Characteristic Total responses, % (n)
U.S. heritage
Born in United States. 82.2 (2311)
Born outside United States 17.8 (502)
Future profession
Health care related 44.4 (1240)
Non–health care related 55.6 (1551)
Used CAM
Yes (within lifetime) 45.2 (1265)
Yes (past 12 months) 35.1 (978)
Previous CAM education
Yes 31.0 (798)
Familiarity with CAM
Very familiar 2.8 (79)
Familiar 13.8 (383)
Somewhat familiar 47.7 (1327)
Not familiar 35.7 (995)
Belief in effectiveness of CAM
Very effective 9.8 (249)
Effective 37.8 (961)
Somewhat effective 45.2 (1149)
Not effective 7.2 (182)
CAM, complementary and alternative medicine.
UC IRVINE UNDERGRADUATES: CAM USE AND ATTITUDES 3

before adjustment. Familiarity and belief in effectiveness were
both highly linked to the use of CAM after adjustment, with
ascending ORs of 3.87 (95% CI, 3.08–4.88), 8.09 (95% CI,
5.69–11.48), 13.44 (95% CI, 5.99–30.17), 2.11 (95% CI, 1.32–
3.38), 4.87 (95% CI, 3.03–7.82), and 12.70 (95% CI, 6.91–
23.36), respectively, among increasing categories (p< 0.01).
CAM education
Among the respondents, 798 had prior education in CAM
modalities (Table 7). Most students attained education on
CAM through reading a book (61.2%), taking a college
course (33.2%), or attending a seminar (15.7%). Over half of
those with prior education cited an interest in further CAM use
(54.0%) or a future career involving CAM (52.0%). Among
those with prior education, pre-health students were signifi-
cantly more likely than non–pre-health students to pursue
further education (p<0.01), further CAM use (p<0.05), or a
future career involving CAM (p<0.01). Furthermore, most of
the 2783 respondents indicated that they were likely to take a
CAM college course if it fulfilled a graduation requirement
(63.6%) or was offered within their major (56.4%). Only
20.5% were not interested in taking a CAM course, with sig-
nificant differences (p<0.01) observed between pre-health
(9.1%) and non–pre-health students (29.6%). Almost one third
(36.5%) of surveyed students were interested in a CAM major,
also with a statistically significant difference (p<0.01) be-
tween pre-health (53.2%) and non–pre-health students (23.9%).
Discussion
To date, this is the largest comprehensive study of attitudes
and use of CAM of undergraduate students in the United
States. Our study population included approximately 35.1%
current CAM users, which is similar to the results described
by a recent undergraduate study in Houston (35.8%)8
and the
National Health Interview Survey of 2007 (38%).3
However,
other college studies reported high variations in use, from
58%9
to 78%,10
probably due to differences among CAM
Table 3. Current Uses of Complementary
and Alternative Medicine
Characteristic
Used CAM in the
past 12 months, % (n)
Sex
Male 27.7 (236)
Female 38.1 (742)
Ethnicity
African American 36.2 (21)
Native American 50.0 (3)
Asian 33.8 (507)
Chicano/Latino 38.2 (123)
White/Caucasian 34.5 (258)
Missing/other/declined 31.0 (68)
U.S. heritage
Born in United States. 35.4 (817)
Born outside United States. 33.1 (166)
College standing
Freshman 31.8 (203)
Sophomore 31.2 (159)
Junior 34.4 (275)
Senior 38.0 (282)
5+ years 50.8 (64)
Future profession
Health care related 36.9 (458)
Previous CAM education
Yes 51.4 (410)
Familiarity with CAM
Very familiar 75.9 (60)
Familiar 61.6 (236)
Somewhat familiar 40.8 (542)
Not familiar 15.1 (144)
Belief in effectiveness of CAM
Very effective 74.7 (183)
Effective 49.9 (480)
Somewhat effective 25.6 (294)
Not effective 10.4 (19)
Table 4. Use of Complementary
and Alternative Medicine
CAM Modalities (Multiple Select) Data (n = 18060)
n = 1806
Supplements 60.8 (1098)
Massage 50.1 (904)
Body movement 38.5 (695)
Herbal medicine 35.4 (639)
Traditional Chinese Medicine 30.1 (543)
Meditation 26.6 (480)
Dietary supplement 24.0 (434)
Chiropractic 23.1 (418)
Prayer for health reasons 19.3 (349)
Acupuncture 16.6 (300)
Energy medicine 8.1 (146)
Homeopathy 7.1 (129)
Biofeedback 3.2 (57)
Ayurveda 3.0 (55)
Hypnosis 2.6 (47)
Naturopathy 1.1 (20)
Other 0.6 (10)
Table 5. Reasons for Using/Not
Using Complementary and Alternative Medicine
Reasons
Total responses,
% (n)
For using CAM (multiple select) (n = 1587)
Friend/relative recommendation 53.8 (854)
Efficiency/effectiveness of treatment 37.1 (589)
Curiosity 36.2 (574)
Personal philosophy 33.0 (523)
Fewer side effects 24.5 (389)
Financially affordable 17.4 (276)
Recommended by a doctor 17.3 (275)
Conventional medicine did not help 16.3 (258)
Other 4.0 (64)
For not using CAM (multiple select) (n = 1384)
Have been healthy 55.8 (772)
Not familiar with CAM 49.5 (685)
Not recommended by doctor 37.1 (513)
More trust in conventional medicine 21.6 (299)
Other 1.5 (21)
4 LIU ET AL.

definitions/interpretations and limited samplings. Although
only 45.2% of the students in the current study stated ‘‘yes’’
to using CAM during their lifetime, 63.4% selected at least
one answer choice in a follow-up question for the specific
types of CAM modality they had used. This inconsistency
demonstrates the confusion among many students regarding
what constitutes CAM, despite being provided a general
definition.
Of the CAM treatments indicated in our study, the most
used therapies, consisting of supplements, massage, body
movement techniques, Traditional Chinese Medicine, herbal
medicine, and chiropractic, were consistent with the 2007
National Health Interview Survey data and other similar
studies.3,9–11
This may be due to the widespread commer-
cialization and marketing of these treatments and insurance
coverage of several of these therapies.12,13
Among the
findings was a disparity between the high use of herbal
medicine and the low use of naturopathy, which is inclusive
of herbal medicine, probably due to confusion over the term
naturopathy, which was not addressed in our survey. The
most commonly reported conditions for CAM included
cold/flu, musculoskeletal conditions, muscle pain, stress
and anxiety, and headaches/migraines, which paralleled the
current literature; however, participants did not report ar-
thritis or cholesterol problems, probably because college
students do not usually experience those symptoms.3,9
Stu-
dents’ most common reasons for using CAM stemmed from
friend/relative recommendations and beliefs in efficiency,
similar to those of the Houston undergraduate study,8
and
the high influence of a specific personal philosophy was
similar to the results of Astin’s national study.14
The current
study additionally found that curiosity contributed to the
decision to use CAM for many respondents. This study si-
multaneously examined the reasons students did not use
CAM, and good health and lack of knowledge were the most
cited causes. While good health was consistent with another
study targeting the disuse of CAM among a private Cali-
fornia institution, lack of knowledge was not a major factor
Table 6. Correlates of Reported Use of Complementary and Alternative Medicine
in Past 12 Months: Hierarchical Logistic Regression
Step 1 (n = 2670) Step 2 (n = 2435) Step 3 (n = 2182)
Variable OR (95% CI) p-Value OR (95% CI) p-Value OR (95% CI) p-Value
Sex
Male (Reference)
Female 1.41 (1.19–1.68) < 0.01 1.34 (1.12–1.61) < 0.01 1.26 (1.01–1.56) 0.04
Ethnicity
White (Reference)
African American 0.84 (0.47–1.48) 0.54 0.76 (0.41–1.39) 0.37 0.60 (0.30–1.21) 0.15
Asian 1.06 (0.88–1.29) 0.54 1.12 (0.92–1.38) 0.26 1.46 (1.14–1.88) < 0.01
Hispanic 0.89 (0.68–1.16) 0.38 0.89 (0.67–1.19) 0.43 0.87 (0.62–1.21) 0.40
Other 1.23 (0.84–1.81) 0.29 1.17 (0.78–1.75) 0.44 1.40 (0.85–2.29) 0.18
Born in United States
Yes (Reference)
No 0.95 (0.77–1.17) 0.61 1.00 (0.81–1.25) 0.96 1.05 (0.81–1.36) 0.72
Age 1.03 (0.99–1.07) 0.10 1.03 (0.99–1.08) 0.09 1.01 (0.97–1.06) 0.60
Pre-health track
No (Reference)
Yes 1.34 (1.15–1.58) < 0.01 1.24 (1.04–1.47) 0.01 1.07 (0.88–1.31) 0.49
Class standing
Freshman (Reference)
Sophomore 0.96 (0.75–1.23) 0.78 0.93 (0.72–1.21) 0.59 0.97 (0.71–1.32) 0.84
Junior 1.18 (0.94–1.49) 0.15 1.11 (0.87–1.42) 0.39 0.95 (0.71–1.28) 0.75
Senior 1.26 (0.99–1.60) 0.06 1.14 (0.88–1.48) 0.31 0.86 (0.63–1.17) 0.35
5+ years 1.94 (1.25–3.00) < 0.01 1.84 (1.15–2.95) 0.01 1.41 (0.80–2.49) 0.23
Prior education
No (Reference)
Yes 2.23 (1.86–2.68) < 0.01 1.26 (1.01–1.57) 0.04
Familiarity
Not familiar (Reference)
Somewhat familiar 3.87 (3.08–4.88) < 0.01
Familiar 8.09 (5.69–11.48) < 0.01
Very familiar 13.44 (5.99–30.17) < 0.01
Belief in effectiveness
Not effective (Reference)
Somewhat effective 2.11 (1.32–3.38) < 0.01
Effective 4.87 (3.03–7.82) < 0.01
Very effective 12.70 (6.91–23.36) < 0.01
OR, odds ratio; CI, confidence interval.

in that study; those participants instead attributed their disuse
of CAM primarily to the lack of provider support.15
This
suggests that people in different age groups may have dif-
fering values and reasons regarding their choice to use CAM.
Past findings have shown that those with higher education
are associated with higher uses of CAM;16
the current study
also found that prior familiarity was correlated with higher
CAM use. While Asians and whites typically have the
highest percentages of CAM use, studies have shown vari-
ation between the two groups. Some have shown Asians as
more likely users of CAM than whites,17,18
as equally like-
ly,19
or as less likely.3
In part, these differences may be
attributed to the heterogeneity within Asian subgroups with
regard to culture, lifestyle, and behavior.20
After adjustment
for demographic and educational factors, Asians in the cur-
rent study were the only ethnic group that significantly dif-
fered from whites and were more likely to use CAM.
However, whereas age has positively correlated with use of
CAM in other studies,8,9
this was not a major impact after
adjustment in the current study. This is probably due to the
inclusion of class standing as a covariate, which, while sig-
nificant initially, was no longer significant after adjustment
for education variables. Therefore, this study suggests that
the differences associated with age or increased class level
are primarily due to educational factors. Prior CAM educa-
tion was a strong predictor of CAM use, and it appears that at
least some of this relationship can be explained by increases
in familiarity and beliefs in effectiveness. Consistent with
other studies, women were more likely to use CAM than
were men.8,10,16
Enrollment in a pre-health track was sig-
nificantly associated with CAM use before adjustment of
education factors but was insignificant after adjustment, in-
dicating that pre-health students may be more likely to seek
knowledge of CAM. Overall, belief in effectiveness and
familiarity were the strongest predictors of CAM use.
This study has a few limitations. First, because the study
was cross-sectional, causation cannot be directly established.
Second, survey responses were based on self-reported data,
so recall bias may have affected the results. Additionally,
any potential confounders not included in the survey data
would not have been controlled for in this study. Because
this was a voluntary study, there may also have been re-
sponse bias from those who chose to participate in the sur-
vey. As discussed earlier, ambiguity over the definition of
CAM and its modalities among students may have influ-
enced the CAM use data; this reflects the lack of clarity in
the definitions/terms understood by undergraduates. The
strength of this study is the large sample representative of the
undergraduate population at this major university. Future
studies should consider a nationally representative sample of
undergraduates because there has not been such a study to
date. Additionally, studies may consider the timing and du-
ration of undergraduate CAM use as well as the specific
conditions prompting their use. Furthermore, future studies
should investigate the communication between undergradu-
ates and their physicians or CAM practitioners.
With such a substantial portion of the undergraduate
population using CAM therapies, it may be advantageous for
universities to provide more resources in health centers on
the proper use of these treatments. In addition, a substantial
portion of undergraduates who use CAM are entering the
healthcare field, and including CAM in undergraduate edu-
cation would provide a strong foundation given the lack of
appropriate CAM education in health professional schools.
Because many of these students will become future physi-
cians and healthcare providers and given the increased in-
terest and use of CAM among the general population,
providing a good foundation would allow for better re-
sponsiveness to patient’s interest and practice. If health
professional schools are not able to educate future health
Table 7. Responses to Education-Based Questions
Question Total responses Pre-health track Non–pre-health track
Education type (multiple select)
College course 33.2 (265) 39.4 (166)** 26.6 (97)
Certification course 5.4 (43) 6.9 (29)* 3.0 (11)
Online course 2.9 (23) 2.9 (12) 2.5 (9)
Reading book 61.2 (488) 56.8 (239)** 66.3 (242)
Seminar 15.7 (125) 17.8 (75) 12.9 (47)
Other 8.8 (70) 6.9 (29)* 11.2 (41)
Education sparks:
Interest in more education 57.0 (420) 68.4 (269)** 44.6 (148)
Interest in future CAM use 54.0 (396) 58.1 (227)* 50.3 (167)
Interest in future CAM career 52.0 (374) 69.7 (267)** 30.8 (100)
Interest in CAM college course if (multiple select)
Fulfilled requirement for graduation 63.6 (1770) 70.8 (865)** 57.7 (882)
Offered within major 56.4 (1570) 72.2 (882)** 44.0 (672)
Not offered within major 18.6 (517) 22.0 (269)** 15.7 (240)
Not interested 20.5 (571) 9.1 (111)** 29.6 (452)
Interest in major/minor in CAM
Yes 36.5 (1008) 53.2 (652)** 23.9 (367)
Some individuals did not associate as either pre-health or non–pre-health.
*p < 0.05 between pre-health and non–pre-health.
**p < 0.01 between pre-health and non–pre-health.
6 LIU ET AL.

professionals sufficiently on CAM, then it may be useful to
have more introductory courses on CAM at the undergrad-
uate level so that when these students enter professional/
graduate school, they can focus on the clinically applicable
aspects of CAM.
In conclusion, this large-scale study supports the idea that
education plays a pivotal factor in one’s decision to use
CAM, and that there is a large demand for additional CAM
knowledge among college students. Because many of the
findings reflect national adult CAM characteristics, the un-
dergraduate level may be the ideal source of implementation
to address these demands.
Author Disclosure Statement
No competing financial interests exist.
References
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what’s in a name? [homepage on the Internet].j Online
document at: http://nccam.nih.gov/health/whatiscam. Ac-
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6. Burke A. Characteristics of college students enrolled in an
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riers and cues to action for complementary and alternative
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3–22.
Address correspondence to:
Michael A. Liu, BA
Susan Samueli Clinic of Integrative Medicine
affiliated with School of Medicine
University of California, Irvine
1202 Bristol Street, 2nd Floor
Costa Mesa, CA 92626
E-mail: mauliu08@gmail.com
Appendix follows ƒƒƒƒƒƒƒƒƒƒƒƒ!

Appendix
1. Definition of Complementary and Alternative Medicine: CAM is the phrase used to define medical treatments and
techniques that are not part of conventional care. Complementary and alternative medicine includes treatments that are
used instead of or along with conventional therapies, such as synthetic/pharmaceutical drugs and surgery. The range of
CAM treatments include but are not limited to acupuncture, yoga, tai chi, herbal medicine, massage, chiropractic,
Ayurveda, homeopathy, and vitamins/minerals.
Did you read the definition of Complementary and Alternative Medicine above?
Yes __ No __
2. Age __
3. What is your gender?
Male __ Female __ Other __
4. What do you consider to be your primary ethnicity?
African American __ American Indian/Alaska Native __ Asian __ Hispanic/Latino __ Non-Hispanic White __ Pacific
Islander __ Other __
5. Were you born in the United States?
Yes __ No __
6. If not born in the United States, which country are you from? __ How long have you been in the United States? __
7. What is your college standing?
Freshman __ Sophomore __ Junior __ Senior __ 5 + years __
8. What is your school of discipline? (Check all that apply)
Arts __ Biological Sciences __ Business __ Engineering __ Health Sciences (includes Nursing and Public Health) __
Humanities __ Information and Computer Sciences __ Interdisciplinary Studies __ Physical Sciences __ Social Ecology
__ Social Sciences __
9. Are you planning on pursuing a healthcare-related career (i.e., medicine, nursing, pharmacy, hospital administration)?
Yes __ No __
10. Have you had any of the following forms of education on Complementary/Alternative Medicine?
College Course __ Certification Course __ Online Course __ Reading a book for your personal knowledge __ Seminar
__ N/A __ Other __
a. Did your education help spark an interest in undertaking further education on CAM?
Yes __ No __
b. Did your education on CAM help increase your use of CAM?
Yes __ No __
c. Did your education of CAM help spark an interest in incorporating any amount of CAM into your future career?
Yes __ No __
11. Would you enroll in a college course which incorporates CAM if the class: (Please check all that apply)
Fulfilled a requirement for graduation __ Was offered within your major __ Was not offered within your major __ Not
interested in taking a college course on CAM__
12. If offered at UCI, would you consider majoring/minoring in CAM?
Yes __ No __
13. How would you rate your familiarity with CAM?
Very familiar __ Familiar __ Somewhat familiar __ Not familiar __
14. Have you ever been personally treated with or used CAM?
Yes __ (If yes, please skip to question 16) No __
15. If no, why haven’t you considered using CAM in the past? (please check all that apply and afterwards skip to question 20)
Not recommended/referred by doctor__ Have been healthy__ More trust in conventional medicine__ Not familiar with
CAM__ N/A__ Other__
8 LIU ET AL.

16. What types of CAM have you been treated with or used for yourself? (Check all that apply)
Acupuncture_ Ayurveda __ Biofeedback __ Body Movement, Tai Chi, Yoga __ Chinese/ Oriental Medicine __
Chiropractic __ Dietary Supplement, Diet-Based Therapies __ Energy Healing, Energy Medicine, Reiki, Therapeutic
Touch __ Herbal Medicine __ Homeopathy __ Hypnosis __ Massage __ Meditation __ Naturopathy __ Prayer for
Health Reasons __ Vitamins/Minerals __ Other __
17. Have you been treated with or used CAM in the last 12 months?
Yes __ No __
18. What are your primary reasons for using CAM? (Please check all that apply)
Conventional medicine did not help __ Financially Affordable __ Curiosity_ Doctor/Practitioner Recommendation __
Efﬁciency/ Effectiveness __ Friend/Relative Recommendation __ Less side effects_ Personal philosophy_ N/A_ Other_
19. What illnesses/ conditions did you use CAM for in the past? __
20. How effective do you think CAM is in treating various conditions? Very effective __ Effective __ Somewhat effective
__ Not effective __
21. If there is any additional information regarding your use of, interest, or education in CAM, please provide it below: __
Deﬁnitions, quoted from National Center for Complementary and Alternative Medicine Web site:
Traditional Chinese Medicine – Traditional Chinese medicine (TCM) originated in ancient China and has evolved over
thousands of years. TCM practitioners use herbal medicines and various mind and body practices including Chinese herbal
medicine, Tai Chi, and Acupuncture.
Naturopathy – Naturopathy is a medical system guided by a philosophy that emphasizes the healing power of nature.
Treatments include: nutrition counseling, including dietary changes (such as eating more whole and unprocessed foods) and
use of vitamins, minerals, and other supplements; herbal medicines; homeopathy; hydrotherapy; physical medicine, such as
therapeutic massage and joint manipulation; exercise therapy; and lifestyle counseling.

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