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com
Original paper
1
Department of Sociology,
Research Center for Public
Health, Tsinghua University,
Beijing, China
2
Key Laboratory of Exercise
and Health Science, Ministry of
Education, Shanghai University
of Sport, Shanghai, China
Correspondence to
Dr Jun Jing, Room B405,
Medical School, 30 Shuangqing
Rd, Tsinghua University, Beijing
100084, P.R. China;
wangs@innomotion.biz
JC and SW contributed equally.
Accepted 24 December 2016
Published Online First
13 January 2017
To cite: Cui J, Wang S,
Ren J, et al. Acupunct Med
2017;35:200–207.
200
Use of acupuncture in the USA:
changes over a decade (2002–2012)
Jia Cui,1 Shaobai Wang,2 Jiehui Ren,1 Jun Zhang,1 Jun Jing1
ABSTRACT
Background The use of acupuncture has gained
popularity in the USA. The number of
acupuncture users and licensed acupuncturists
increased by 50% and 100%, respectively,
between 2002 and 2012, coinciding with
increasing acknowledgement of the importance
and efficacy of acupuncture over this time
period.
Methods This paper presents new findings from
the complementary health approaches section of
the 2012 National Health Interview Survey
(n=33 373 respondents). In particular, data on
the use of acupuncture and user characteristics
were compared against data collected from an
earlier survey in 2002. Statistical analyses
included weighted distribution, logistical
regression and Pearson’s χ2 tests.
Results The profile of the most common
acupuncture users comprised the following
sociodemographics age 41–65 years (47.4%);
female gender (69.6%); and non-Hispanic
(85.3%) and/or white (78.1%) ethnicity.
Respondents also tended to be US citizens
(92.1%) with some college education (57.1%)
and in very good to excellent health (60.8%).
The proportion of respondents using
acupuncture for treatment of a specific health
problem, as opposed to promotion of general
wellness, was 84.7% in 2002 and 55.3% in
2012.
Conclusions Our data suggest a growing
development of acupuncture in the USA. We
anticipate that the findings of our analysis of the
changes in acupuncture use over the 10-year
period from 2002 to 2012 will provide
information for users, acupuncturists, researchers
and the general public to help better understand
the status of acupuncture and reasons for its
usage, and to anticipate future trends for
acupuncture use in the USA.
INTRODUCTION
The use of complementary and alterna-
tive medicine (CAM) has gained popular-
ity in the USA. The National Health
Interview Survey (NHIS) administered
Cui J, et al. Acupunct Med 2017;35:200–207. doi:10.1136/acupmed-2016-011106
three complementary health approaches
sections, in 2002, 2007 and 2012, to
gather relevant information and explore
reasons and trends for the use of CAM.1
Acupuncture is one of the increasingly
prevalent CAM methods; it originated in
China, has over 2000 years of history,
and represents one of the key compo-
nents of Traditional Chinese Medicine.2
Acupuncture has gained increasing public
interest since the 1970s, when James
Reston, editor of the New York Times,
published a front page story the des-
cribing the pain relief derived from
acupuncture after his own emergency
appendectomy.3 Acupuncture gained
further notoriety after President Richard
Nixon’s visit to China in 1972. In the
USA, acupuncture is mainly used for
chronic pain.4 The Food and Drug
Administration (FDA) has classified acu-
puncture needles as class II medical
devices and the National Institutes of
Health (NIH) has supported hundreds of
projects on acupuncture to investigate its
efficacy and safety.5
Public data further support the obser-
vation of increased acceptance and use of
acupuncture in the USA. In 2002, 2007
and 2012, respectively, the NHIS
revealed that 4.2%, 6.3% and 6.4% of
US adults had used acupuncture, with
1.1%, 1.4% and 1.7% of US adults doing
so in the preceding 12 months.1 The
number of licensed acupuncturists
increased from over 12 000 in 2002 to
27 835 in 2012, marking a more than
twofold increase over 10 years.6 7 The
aim of this study was to explore the find-
ings of the 2012 NHIS sample on the use
of acupuncture and user characteristics
and compare these data with previous
NHIS surveys from 2002 and 2007,8–10
with the intention of providing useful
information for users, acupuncturists,
researchers and the general public to
better understand the status of acupunc-
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ture and reasons for its usage, as well as to anticipate
future trends for acupuncture use in the USA.
METHODS
Data sources
The primary data were derived from the NHIS survey
and CAM supplementary survey of 2012. NHIS is
conducted annually by the Centers for Disease
Control and Prevention (CDC) and the National
Center for Health Statistics (NCHS). The survey con-
tains core questionnaires on demographics, socioeco-
nomics and health, among other areas. The CAM
supplement was conducted in 2002, 2007 and 2012
to collect additional information on CAM modality
usage including acupuncture. Details of the core and
supplemental survey are available from the National
Health Statistic Report.11 This paper further utilises
the Integrated Health Interview Series (IHIS) database
open to the public.12 The IHIS is a harmonised set of
data and documentation based on material originally
included in the public use files of the NHIS and is dis-
tributed for free over the internet. IHIS variables are
given consistent codes and are thoroughly documen-
ted to facilitate longitudinal temporal comparisons.12
Measurement variables
General sociodemographic variables were selected and
analysed as follows: age (18–40 years, 41–64 years or
≥65 years); sex (male or female); Hispanic origin (yes
or no); race (white, black/African American, American
Indian/Alaskan or Asian); US citizenship (yes or no);
educational level (less than grade 9, some high school,
some college, or college and above); health status
(very good to excellent, or poor to good); region of
residence (Northeast, North Central/Midwest, South
or West); current marital status (married or single);
poverty threshold (above or below); personal annual
earnings (<$45 000, $45 000–$75 000, >$75 000);
chiropractor, acupuncturist or naturopath as personal
healthcare provider (yes or no); health insurance
coverage status (yes or no); having looked up informa-
tion on internet (yes or no); and having problems
paying or inability to pay medical bills (yes or no).
Acupuncture-related variables were selected and
analysed as follows: ever having had acupuncture (yes
or no); having had acupuncture in the past 12 months
(yes or no); number of times seeing practitioner for
acupuncture (numerical value); amount of money
paid per visit (numerical value); acupuncture costs
covered by insurance (yes or no); having bought a
self-help book or other materials to learn about acu-
puncture (yes or no); using acupuncture for specific
health problem (yes or no); reasons for use of acu-
puncture (multiple choice, detailed in Results);
medical care with acupuncture (multiple choice,
detailed in Results); importance of acupuncture use
(very important, somewhat important, slightly import-
ant or not at all important); and degree of help from
Cui J, et al. Acupunct Med 2017;35:200–207. doi:10.1136/acupmed-2016-011106
Original paper
acupuncture (a great deal, some, only a little or not at
all).
Sample size
In 2012, a total of 44 743 adults and children out of
108 131 NHIS respondents completed the CAM sup-
plemental questionnaire, yielding a participation rate
of 41.4%. The participants were divided into three
groups: non-users; past users; and current users. The
first analysis focused on sociodemographic variables
and compared all three groups. The second analysis
focused on the current user group to investigate indi-
vidual characteristic metrics such as number of visits,
cost, reason for use, etc, and benchmarked data with
historical values, where applicable.
Statistical analysis
The statistical analyses were completed in Stata V.12.0
(StataCorp LP, Texas, USA). All analyses used the IHIS
individual-level sample weights.13 χ2 and Fisher’s
exact tests were used to check whether there were
statistically significant differences between the groups
of users of acupuncture, and in the perceived import-
ance and degree of help from acupuncture. The socio-
demographic variables were analysed with respect to
the weighted distribution and prevalence of non-users,
past users and current users. Weighted logistical
regression was performed to check which sociodemo-
graphic variables were significantly related to past and
current use. User characteristic variables, such as
number of visits, cost and reason for use, were ana-
lysed by one-way or two-way tabulations. The
Pearson’s χ2 test was implemented for the independ-
ence of acupuncture user status (non-user, past-user
and current user) and other sociodemographic vari-
ables. Due to different sample sizes in 2002 and
2012, the results were normalised to a percentage
value of the whole sample for fair comparison
between years. Missing data (answers unknown, not
reported, refused, not ascertained, and ‘don’t know’)
were removed from the analysis. Statistical significance
was set at p<0.05. For age, mean and SD were also
calculated and one-way analysis of variance (ANOVA)
was used to examine for statistically significant differ-
ences between the three groups of acupuncture users.
RESULTS
Sample size and group
A total of 43 380 out of 44 743 people answered
whether or not they had ever had acupuncture, yielding
a useable sub-population of 97% of the whole sample
that took the CAM supplemental questionnaire. Only
adults (age ≥18 years old) were included in this study,
which further reduced the sample size to 33 373. Based
on data from two questions (firstly, if the user had ever
had acupuncture and, secondly, whether they had
received acupuncture in the preceding 12 months), the
sample was further divided into three groups: non-users
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Original paper

Table 1 Sociodemographic characteristics of acupuncture non-users, past users and current users (2012)
Sociodemographics Non-user (n=31 238) Past user (n=1563) Current user (n=572)
Age**++ 48.1±18.2 54.6±15.6 51.2±16.4
18–40 38.7 20.9 31.5
41–65 42.0 54.6 47.4
>65 19.3 24.6 21.2
Sex**+
Male 45.0 35.1 30.4
Female 55.0 64.9 69.6
Hispanic origin**+
No 82.6 89.1 85.3
Yes 17.4 10.9 14.7
Race**+
White 76.7 82.1 78.1
Black/African American 16.3 7.0 8.0
American Indian/Alaskan 1.0 1.1 1.1
Asian 6.1 9.8 12.9
US citizenship**
No 9.5 5.6 7.9
Yes 90.5 94.4 92.1
Educational level**
<Grade 9 6.2 2.5 3.9
Some high school 36.9 22.7 18.7
Some college 47.7 55.5 57.1
College and above 9.1 19.3 20.3
Health status
Very good to excellent 56.9 56.4 60.8
Poor to good 43.1 43.6 39.2
Region**
Northeast 16.7 16.7 17.5
North Central/Midwest 21.0 18.3 15.9
South 37.4 21.3 18.0
West 24.8 43.7 48.6
Current marital status
Married 43.4 45.8 45.9
Not married 56.6 54.2 54.1
Poverty threshold**
Above 80.6 88.6 89.3
Below 19.4 11.4 10.7
Personal earnings**
<$45 000 67.5 55.3 53.6
$45 000–$75 000 20.1 25.1 23.4
>$75 000 12.4 19.6 23.1
Personal healthcare provider is a chiropractor acupuncturist or naturopath**++
No 99.2 96.6 90.5
Yes 0.8 3.4 9.5
Health insurance coverage status**
Not covered 18.4 11.2 12.1
Covered 81.7 88.9 87.9
Looked up information on the internet in past 12 months**++
No 61.1 43.6 35.5
Yes 38.9 56.4 64.5
Problems paying or inability to pay medical bills
No 82.5 82.3 82.3
Yes 17.5 17.7 17.7
χ2 tests for non-user versus current user:
*p<0.05, **p<0.01, for past user versus current user: +p<0.05, ++p<0.01. Age is presented as mean±SD.

202 Cui J, et al. Acupunct Med 2017;35:200–207. doi:10.1136/acupmed-2016-011106

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Figure 1 Responses about importance of the use of acupuncture (A) and degree of help from acupuncture with respect to primary
condition (B) in the 2002 and 2012 National Health Interview Survey.
(31 238 (93.6%) who answered ‘no’ to ever having had
acupuncture); past users (1563 (4.7%) who answered
‘yes’ to ever having had acupuncture and answered ‘no’
to having had acupuncture in the preceding 12
months); and current users (572 (1.7%) who answered
‘yes’ to having had acupuncture in the past 12 months).
Changes in acupuncture usage
The proportion of current acupuncture users (ie, within
the preceding 12 months) increased from 1.1% to
1.7% in 2002 and 2012, respectively (p<0.05).
Similarly, the proportion of past users increased from
4.2% to 6.4% in 2002 and 2012, respectively
(p<0.05). Of note, in 2012, an additional answer item
showed 142 adults (0.3% of the 33 373 studied) had
used acupuncture, but never saw a licensed practitioner.
Among current users, there appeared to be a trend
towards an increasing belief in the importance of acu-
puncture, although none of these differences reached
formal statistical significance ( p>0.05). Nevertheless,
in 2012, >75% of users thought acupuncture was at
least somewhat important, compared with 66% in
2002 (table 1). Furthermore, >79% of users answered
in 2012 that acupuncture provided at least some help
with their primary condition, while only 70% of users
thought so back in 2002. Furthermore, in 2012, 55%
and 53% of users thought that acupuncture was very
important and provided a great deal of help with their
primary condition, respectively (figure 1), which
represents nearly a 10% increase over 2002 values.
Sociodemographic variables
According to 2012 data, the profile of the typical
current user tended to fall into a few key demographic
Cui J, et al. Acupunct Med 2017;35:200–207. doi:10.1136/acupmed-2016-011106
Original paper
categories, namely age 41–65 (47.4%), female gender
(69.6%) and non-Hispanic (85.3%) and/or white
(78.1%) ethnicity. Respondents falling into this group
also tended to be US citizens (92.1%) with some college
education (57.1%) who were in very good to excellent
health (60.8%). Compared to non-users, current users
in the 2012 survey tended to live in Western states
(48.6%, p<0.01) and above the poverty threshold
(89.3%, p<0.01). They also tended to earn more
(p<0.01). In addition, 9.5% of current users chose a
CAM provider as their primary personal healthcare pro-
vider and 64.5% looked up information on the internet
(table 1). Comparing data on current users between
2012 and 2002, we found a significant increase in age
(51.2±16.4 vs 45.7±15.6 years, p<0.01, respectively).
We also found significant differences in race, geograph-
ical region and personal earnings (table 2).
Multinomial regression
Table 3 details findings of the weighted multinomial
logistic regression analysis, revealing key variables signifi-
cantly related to acupuncture use compared to non-use.
For both past and current users, there were significant
influences of age, sex, race, geographical region, current
marital status, type of personal healthcare provider, and
whether or not respondents had searched for informa-
tion on the internet. Educational level and personal
earnings were only found to be significant variables for
past users and current users, respectively.
User characteristics
Visit frequency and cost
In 2012, 21.7% of current users saw an acupuncturist
only once per year, while 39.2%, 21.2% and 17.8%
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Table 2 Sociodemographic characteristics of current acupuncture Table 3 Weighted multinomial logistic regression analysis of
users (2002 vs 2012) past and current acupuncture users versus non-users
Sociodemographics 2002 (n=329) 2012 (n=572) Sociodemographics Relative risk ratio Relative risk ratio
(n=33 373) (95% CI) Past user (95% CI) Current user
Age** 45.7±15.6 51.2±16.4
18–40 41.6 31.5 Age (18–40)
41–65 46.2 47.4 41–65 2.2 (1.8 to 2.7)*** 1.0 (0.8 to 1.4)
>65 12.2 21.2 >65 2.6 (1.9 to 3.7)*** 1.8 (1.1 to 3.0)*
Sex Sex (male)
Male 36.0 33.9 Female 1.6 (1.4 to 2.0)*** 2.3 (1.7 to 3.1)***
Female 64.1 66.1 Hispanic origin (no)
Hispanic origin Yes 0.9 (0.7 to 1.2) 1.2 (0.8 to 1.9)
No 82.7 85.3 Race (white)
Yes 17.3 14.7 Black/African 0.3 (0.2 to 0.4)*** 0.8 (0.5 to 1.3)
American
Race*
American Indian/ 1.2 (0.5 to 2.7) 0.5 (0.1 to 3.7)
White 83.2 78.1 Alaskan
Black/African American 9.1 8.0 Asian 1.3 (0.9 to 1.7) 1.5 (1.0 to 2.4)
American Indian/Alaskan 0.3 1.1 US citizenship (no)
Asian 7.4 12.9 Yes 1.3 (0.8 to 2.1) 1.7 (0.8 to 3.6)
US citizenship Educational level (<grade 9)
No 9.2 7.9 Some high school 2.6 (0.8 to 8.5) 0.7 (0.2 to 2.4)
Yes 90.8 92.1 Some college 3.6 (1.1 to 11.8)* 1.2 (0.4 to 4.2)
Education level College and above 6.0 (1.8 to 19.7)** 1.4 (0.4 to 5.0)
<Grade 9 4.6 3.9 Health status (very good to excellent)
Some high school 22.0 18.7 Poor to good 1.0 (0.8 to 1.2) 1.1 (0.8 to 1.4)
Some college 57.6 57.1 Region (Northeast)
College and above 15.9 20.3 North Central/ 0.8 (0.6 to 1.0) 0.7 (0.4 to 1.0)
Health status Midwest
Very good to excellent 59.3 60.8 South 0.6 (0.4 to 0.8)*** 0.6 (0.4 to 0.9)*
Poor to good 40.7 39.2 West 1.8 (1.4 to 2.2)*** 1.6 (1.1 to 2.3)**
Region** Current marital status (married)
Northeast 23.7 17.5 Not married 1.3 (1.1 to 1.6)** 1.0 (0.8 to 1.4)
North Central/Midwest 17.0 15.9 Poverty threshold (above)
South 24.0 18.0 Below 0.9 (0.6 to 1.3) 0.5 (0.3 to 1.1)
West 35.3 48.6 Personal earnings (<$45 000)
Current marital status $45 000–$75 000 1.1 (0.9 to 1.4) 1.1 (0.8 to 1.6)
Married 48.5 45.9 >$75 000 1.2 (0.9 to 1.5) 2.0 (1.4 to 2.9)***
Not married 51.5 54.1 Personal healthcare provider is a chiropractor acupuncturist or naturopath
Poverty threshold (no)
Above 91.1 89.3 Yes 3.5 (2.3 to 5.5)*** 10.8 (6.9 to 16.8)***
Below 8.9 10.7 Health insurance coverage status (not covered)
Personal earnings* Covered 1.1 (0.8 to 1.6) 0.8 (0.5 to 1.2)
<$45 000 63.8 53.6 Looked up information on the internet in past 12 months (no)
$45 000–$75 000 21.1 23.4 Yes 1.6 (1.3 to 1.9)*** 2.1 (1.6 to 2.9)***
>$75 000 15.1 23.1 Problems paying or inability to pay medical bills (no)
Health insurance coverage status Yes 1.2 (1.0 to 1.6) 1.2 (0.9 to 1.8)
Not covered 16.1 12.1 Value listed in parentheses after each sociodemographic variable
represents base outcome for determination of relative risk ratio. *p<0.05,
Covered 83.9 87.9 **p< 0.01, ***p<0.001 vs non-users.
χ2 tests for 2002 vs 2012: *p<0.05, **p< 0.01. Age is presented as
mean±SD.

materials to learn more about acupuncture. The

visited two to five times, six to 10 times, and more
than 10 times annually, respectively (figure 2). In
2012, the average cost per visit was $58.40 and the
average total annual cost was $262.40. In addition,
2.7% of users bought self-help books or other reading
average amount paid for books or other reading mate-
rials was $73. It is also worth mentioning that 28% of
users in 2012 reported that the cost of their acupunc-
ture visits was covered by insurance, of which 13%
were completely covered and 15% were partially

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Figure 2 Distribution of acupuncture visit frequency in the 2002 and 2012 National Health Interview Survey.
covered. By comparison, 33% of users in 2002 had
full or partial insurance coverage when they sought
acupuncture treatment.
Reason for visit
The most common reason for acupuncture use was a
specific health problem (55.3% in 2012 and 84.7% in
2002; figure 3). Forty per cent of users had acupunc-
ture recommended by family or friends in 2012;
however this statistic was unavailable in 2002 for
comparison. Only 2.4% and 8.0% of users sought
acupuncture as an alternative because of expensive
medical treatment in 2012 and 2002, respectively.
Among specific health problems, acupuncture was
mostly used for pain: 30.9% for back pain or sore-
ness; 11.0% for joint pain or stiffness, or other joint
conditions; 6.9% for neck pain or problems; and
6.9% for arthritis.
Other medical care with acupuncture
Of the current acupuncture users in 2012, 4.8% also
received mental health counselling, 19.8% prescrip-
tion medication, 20.4% non-prescription medication,
17.1% physical therapy and 6.3% surgery. In 2012,
35.8% of users informed a conventional medical pro-
fessional about their use of acupuncture, versus
52.5% in 2007 (figure 4). No such data were available
in 2002 for comparison.
Figure 3 Reasons for the use of acupuncture in the 2002 and 2012 National Health Interview Survey.
Cui J, et al. Acupunct Med 2017;35:200–207. doi:10.1136/acupmed-2016-011106
Original paper
DISCUSSION
Consideration for users and cost
The proportion of respondents who disclosed a previ-
ous history of acupuncture treatment, including
current users, increased from 4.2% in 2002 to 6.4%
in 2012, while the proportion of those who had used
acupuncture in the preceding 12 months increased
from 1.1% to 1.7%, respectively. Although there was
a relative increase, the absolute figures are ultimately
still low. Most respondents in 2012 thought that acu-
puncture was at least somewhat important (75%) and
provided at least some help with their primary condi-
tion (79%). Insurance coverage for the costs of acu-
puncture treatment appeared to shrink from 33% in
2002 to 28% in 2012. In other words, relatively more
people paid out of pocket for their acupuncture treat-
ment in 2012. It is interesting to note that current
acupuncture users surveyed in 2012 earned more than
non-users and about 90% of them lived above the
poverty line. It was also uncommon (2.4%) for acu-
puncture users in 2012 to seek acupuncture as an
alternative medicine because of expensive medical
treatment. Based on these data, cost may not be a key
factor related to the use of acupuncture.
Sociodemographics
Compared with non-users, those who had used acu-
puncture displayed distinct social and demographic
characteristics worthy of further investigation. Of past
205
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Original paper
Figure 4 Medical care used alongside acupuncture in the 2012 and 2007 National Health Interview Survey.
and current users of acupuncture in the 2012 survey,
women constituted 70% (relative risk ratio 2.3 vs
male), which may reflect the fact that acupuncturists
commonly treat women’s health problems.14 About
half of past and current users resided in the Western
states, with a relative risk ratio of 1.6 compared to
those living in the Northeast. In the 2012 survey, it
was found that 74.8% and 77.4% of past and current
users, respectively, had a college education, while the
rate of college attendance among the non-users was
56.8%. In recent years, the NIH has supported more
than 400 research projects on CAM to investigate its
efficacy and safety.5 In addition, the fact that users of
acupuncture are more likely to look up information
on the internet than non-users (risk ratio 1.6 and 2.1
for past users and current users, respectively) indicates
that higher education may be associated with the
tendency to learn more about acupuncture online.
Comparison with previous years
The majority of sociodemographic characteristics of
users remained the same from 2002 to 2012, but
there were some changes noted in age, region and
personal earnings. In the 2012 survey, the propor-
tion of current acupuncture users ≥65 years of age
increased by 9%. The proportion of current acu-
puncture users living in the Western parts of the
USA increased by 13%, which may be a consequence
of relaxed regulations for the use of acupuncture in
those areas. Specifically, California is the only state
that has its own acupuncture licensing examin-
ation.15 Individuals can become licensed and practise
healthcare in California by taking written exams in
English, Chinese or Korean. In other words, one can
potentially get licensed and practise acupuncture
without understanding English, which may facilitate
broader use of the technique. In 2012, the propor-
tion of those earning >$75 000 increased by 8%
over 2002 values. However, it must be acknowl-
edged that personal earnings may naturally increase
over time and may not therefore solely relate to acu-
puncture use.
206
Limitations
Although the 2012 NIHS and supplementary CAM
survey had a greater number of responses than ever
before, the sample size is still relatively small (participa-
tion rate of 41.4%), so one should interpret the data with
caution. In contrast to the CAM supplement from 2007,
the 2002 and 2012 surveys discarded most questions that
related to why a past user stopped using acupuncture. As
mentioned earlier, we noted that the number of respon-
dents reporting acupuncture use tied to a specific health
problem dropped from 84.7% in 2002 to 55.3% in
2012. This dramatic drop may reflect a growing accept-
ance of acupuncture use to promote general wellness
rather than only to treat disease. However, it may also
reflect the fact that only four response items were avail-
able in 2002, thus limiting fair comparison.
CONCLUSION
In summary, the use and practice of acupuncture
increased between 2002 and 2012. Based on 2012
data, the typical profile of a current user is a 41- to
65-year-old female with some college education and
average to above-average earnings. The proportion of
users seeking acupuncture to treat specific diseases has
decreased, together with a growing trend for develop-
ment of acupuncture in the USA from 2002 to 2012.
However, the overall proportion of current acupunc-
ture users is still low (1.7%) and significant obstacles
remain, including limited insurance with only 28%
indicating coverage in 2012. We anticipate that our
findings will provide information for users, acupunc-
turists, researchers and the general public to help
them better understand the status of acupuncture and
reasons for its usage, and to anticipate future trends
for acupuncture use in the USA.
Contributors All authors made substantial contributions to the
conception and design of the work, acquisition, analysis, or
interpretation of the data, drafting of the manuscript and/or
critical revision for important intellectual content. All authors
approved the final version of the manuscript accepted for
publication and agree to be accountable for the integrity of all
aspects of the work.
Competing interests None declared.
Cui J, et al. Acupunct Med 2017;35:200–207. doi:10.1136/acupmed-2016-011106
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Provenance and peer review Not commissioned; externally
peer reviewed.
REFERENCES
1 National Center for Complementary and Alternative Medicine,
Statistics from the National Health Interview Survey. https://
nccih.nih.gov/research/statistics/NHIS
2 White A, Ernst E. A brief history of acupuncture.
Rheumatology 2004;43:662–3.
3 Reston J. Now, let me tell you about my appendectomy in
Peking. New York Times 1.6, 1971.
4 ter Riet G, Kleunen J, Knipschild P. Acupuncture and chronic
pain: a criteria-based meta-analysis. J Clin Epidemiol
1990;43:1191–9.
5 National Center for Complementary and Alternative Medicine,
Acupuncture: What you need to know. https://nccih.nih.gov/
health/acupuncture/introduction#hed5
6 Fabrey LJ, Cogdill KS, Kelley JA. A National Job Analysis:
Acupuncture and Oriental Medicine Profession (2003). National
Certification Commission for Acupuncture and Oriental
Medicine(NCCAOM). 2003. http://www.nccaom.org/wp-
content/uploads/pdf/NCCAOM_final_JA_Report_2003.pdf
7 NCCAOM®. Job Analysis, Number of Acupuncturists
Provided by State Licensing Boards, 2013. http://www.nccaom.
org/wp-content/uploads/pdf/NCCAOM_2013_JA_Report.pdf
8 Burke A, Upchurch DM, Dye C, et al. Acupuncture use in
the United States: findings from the National Health
Cui J, et al. Acupunct Med 2017;35:200–207. doi:10.1136/acupmed-2016-011106
Original paper
Interview Survey. J Altern Complement Med 2006;12:
639–48.
9 Zhang Y, Lao L, Chen H, et al. Acupuncture use among
American adults: what acupuncture practitioners can learn
from National Health Interview Survey 2007?. Evid Based
Complement Alternat Med 2012;2012:710750.
10 Tindle HA, Davis RB, Phillips RS, et al. Trends in use of
complementary and alternative medicine by US adults:
1997-2002. Altern Ther Health Med 2005;11:42–9.
11 National Center for Complementary and Alternative Medicine,
2012 NHIS Questionnaire—Adult CAM. Adult Alternative
Health/Complementary and Alternative Medicine”. http://ftp.
cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/
NHIS/2012/English/qalthealt.pdf
12 Integrated Health Interview Series. Harmonized data and
documentation for the U.S. National Health Interview Survey
(NHIS), http://www.ihis.us/ihis-action/faq#ques0
13 Minnesota Population Center and State Health Access Data
Assistance Center, Integrated Health Interview Series (IHIS):
Version 3.0, 2010. http://www.ihis.us/
14 Diehl DL, Kaplan G, Coulter I, et al. Use of acupuncture by
American physicians. J Alternat Complement Med
1997;3:119–26.
15 National Certification Commission for Acupuncture and
Oriental Medicine (NCCAOM®) Fact Sheet: Meeting National
Standards Through its Examinations and Certification Process,
http://www.nccaom.org/about/nccaom-national-standards/
207
 Downloaded from http://aim.bmj.com/ on December 4, 2017 - Published by group.bmj.com

Use of acupuncture in the USA: changes over

a decade (2002 −2012)
Jia Cui, Shaobai Wang, Jiehui Ren, Jun Zhang and Jun Jing

Acupunct Med 2017 35: 200-207 originally published online January 13,
2017
doi: 10.1136/acupmed-2016-011106

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