Index Terms: Alternative therapy, Health education, Student health services
Notes.
1. This manuscript was prepared and submitted to the Journal of
American College Health in July, 1999, which subsequently
declined to publish it.
2. All underlined text is linked to the specified item.
ABSTRACT
Although the use of alternative therapy (AT) is increasing in the
general population, a review of the literature resulted in no
evidence of research done among a college student population. A
convenience sample of 229 undergraduate students was surveyed about
their use of select forms of alternative therapy (AT) and certain
informational aspects surrounding their decision to use AT.
Sixty-three percent of the sample reported using some type of AT. The
three most frequently used AT modalities were vitamin/supplement,
herbal, and chiropractic. The vast majority of participants cited a
friend or family member as their initial AT information source.
Chi-square analysis revealed no significant differences among AT
users and non-users in gender, ethnicity or religion. However,
significant differences were found between the youngest students and
older students on the ability to locate information on AT and the
likely use of student health service-provided AT information.
Suggestions are given for student health service provision of
reliable AT information and future research.
The use of some type of alternative therapy (AT) has recently emerged as viable wellness option for millions of Americans and this use is increasing rapidly.1-3 A recent nationwide study estimated that in 1997, 83 million adult Americans had used some form of AT during the preceding 12 months.2 This estimate was an increase of over 20 million from an earlier 1990 study.3 Although it seems a valid assumption that U.S. college students' use of AT is also large and increasing, there is no research yet published to support this hypothesis.
AT can be defined as non-orthodox treatments whose therapeutic explanations usually lie outside the traditional Western biomedical model.2,4,5 The National Center for Complementary and Alternative Medicine (NCCAM) categorizes many common health practices as forms of AT. Included in the NCCAM taxonomy are chiropractic manipulation, massage, herbs and nutritional supplements.4 Despite the increasing public use of AT, very little scientific research has been done on the efficacy and safety of such practices.6-8
The decision on whether to use AT is generally self-motivated and self-prescribed. A person seeks out information about a particular therapy that he or she feels is reliable and valid. An informed choice is then made based upon the information gathered. Unfortunately, a large amount of the information available regarding AT is not peer-reviewed and has questionable reliability.6,8 In addition, scientists and physicians have begun to warn of potentially dangerous consequences that may arise from ill informed AT use.6, 8-11
Because of their relative unfamiliarity with medical science and health care matters, young college students form a particularly vulnerable group to the possible risks associated with misinformed AT use. In order to begin exploring this health issue, the purpose of this investigation was to:
METHOD
This descriptive correlational study was conducted at a four-year state college in the northwestern U.S. during the spring of 1999. Prior to its administration, the institution's review board approved the anonymous 11-item survey. Each survey had an affixed note that informed potential participants of the study's purpose, how their responses were going to be used, and that submission of a completed survey implied their informed consent.
The survey was administered to a purposive convenience sample of students attending various academic classes. The survey's first section consisted of four socio-demographic items (e.g., gender, ethnicity, etc.). The second section had seven items. It contained questions regarding participants' use of ten selected forms of AT. The selected therapies were acupressure, acupuncture, aroma, chiropractic, herbal, massage, magnetic, music, pet, and vitamin/supplement. The participants were asked to identify their initial sources of information on AT and whether they knew where to find additional information. Finally, the participants were asked which additional AT forms they were interested in, what delivery format of AT information they preferred, and whether they would use information on AT if it were provided by the college's student health services.
All data were analyzed using the commercial software application, Statistical Package for the Social Sciences 7.5 for Windows (SPSS, Inc., Chicago, Ill.). Two methods of analysis were performed on the data. First, all data underwent univariate descriptive statistical analysis to produce an overview of the sample's characteristics. Second, multiple chi-square tests for independence were done to determine whether relationships existed between a participant's demographics, use of AT and his or her perceived need for, and access to, AT information. During this phase of data analysis, a participant's age was converted to ordinal level data for use in the chi square statistic. An alpha level of .05 was used for all statistical tests.
RESULTS
Sample characteristics
The sample consisted of 229 respondents. This represented 7.6% of the college's Fall 1998 enrollment of 3,013. Of the 194 respondents who reported their age, the mean age was 24.4 years (SD = 7.91) and ranged from 18 to 57 years old.
Table 1 contrasts the socio-demographic data of the sample with the latest figures on total college enrollment from the U.S. Department of Education.12 Although the sample was substantially less ethnically varied, it generally resembled the nation's college student population on the other socio-demographic variables.
Two-thirds of the sample (n = 155) responded they were presently using some form of AT. The use of AT among the different age groups of the sample was:
The five most frequently used types of AT were vitamin/supplement, herbal, chiropractic, aroma, and music (see Figure 1). Figure 2 reflects the wide variety of initial information sources students used for their decisions on AT use. The bulk of the students said that either a friend or family member was their initial source of AT information.
Of the 212 students responding to the question asking if they knew where to look for additional AT information, nearly one-half (45.8%) said they did not. Among those who reported they knew where to look for additional information (54.2%), the five leading sources cited were the Internet, magazines or books, physicians, health food stores, and libraries (see Figure 3).
Only six out of ten respondents (n = 140) selected an AT they would like further information on. The most frequently mentioned therapy was massage, followed by aroma, acupuncture, herbal, and vitamins/supplements (see Figure 4).
Figure 5 illustrates that when the sample was asked to choose a format they preferred for AT information, the majority selected brochures. Workshops and a campus newspaper article were chosen second and third respectively.
Finally, as shown by Figure 6, 62% of the sample responded they would use AT information that was provided by student health services. Thirty-four percent of the sample said they would not use this service and 4% were unsure about their use. Six students did not respond to this question.
Chi-square analysis
To obtain a better picture of the AT informational dimensions of the sample, the results for the survey items involving the student's present AT use, ability to find further information, prospective use of student health service's information, and the ordinal age data were crosstabulated using the chi-square statistic.
Comparing participants who used AT with those who did not resulted in an absence of significant differences in gender, ethnicity or religion. However, differences were evident when the students' age, AT use and the informational variables were analyzed and are displayed in Table 2. Although no significant differences existed regarding AT use between the age groups, those in the youngest group (18-19 year olds) were distinctive. Despite their tendency to be less likely than the others to use AT, roughly 61% of these teenagers reported they did. As a group, eighteen and nineteen year-olds were significantly less likely to know where to find additional AT information than older students. In spite of their inability to locate additional AT information, these younger students were significantly less likely than older students to use AT information if it were provided by student health services. The influence of age was again evident when the 30-34 year-olds' responses revealed that these older students were more likely to report they knew where to locate additional information on AT than were other age groups.
When the sample was analyzed as a whole, students who were using some form of AT were more likely to report that they knew where to find additional information on AT. This differed significantly from those who did not use AT, as they were less likely to report knowing where to find further information (X2 = 30.7, p < .01).
A student's present use of AT also influenced his or her prospective use of information. If a student was using AT, he or she was more likely to use student health services' AT information versus someone who was not (X2 = 23.9, p < .01).
IMPLICATIONS
Empowering students to be able to make sound decisions regarding wellness behaviors is a fundamental goal of student health services. The results of this study suggest that a substantial number of college students use AT. In deciding whether to use AT, a large segment of participants obtained their initial information from a friend, family member, magazine article, health food store or media advertisement. Unfortunately, these are not authoritatively reliable sources upon which a student, especially a young student, can base an informed choice.
In this study, the youngest of college students (i.e., 18 and 19 year-olds) formed a particularly vulnerable group because of their reported inability in locating additional AT information. This is distressing since it appears that a large percentage of this group reported using some form of AT.
In its dual role as advocate and facilitator of student wellness, student health services can provide the reliable information and health education necessary to enable students to make informed choices on AT use. Methods for delivering this information are suggested by this study. Although, students selected brochures, workshops and campus newspaper articles as their preferred methods of information, they overwhelmingly choose the Internet as medium for acquiring additional AT information. Based on this finding, student health services could develop webpages on the college's Internet website which would provide such things as a listing of local AT providers, as well as links to reliable national websites focused on AT.
AT use among college students appears to reflect the rising nature of the AT phenomenon among the general population. It is important that college students of all ages have access to reliable information in order to make sound individual choices on AT use. Student health services can go a long way in providing this service both effectively and economically.
Suggestions for future research on this subject include replicating this study among a larger sample of college students and using a different sampling method to increase the power of the findings.
ACKNOWLEDGMENTS
I would like to thank the following people for their assistance in conducting this study: Junko Arai, BSN, RaNae Chandler, BSN, Clara Ellenberg, BSN, Grace Knight, BSN, Martha Waltman, BSN.
