Complementary Therapies in Medicine (2009) 17, 71—77 available at www.sciencedirect.com journal homepage: www.elsevierhealth.com/journals/ctim Definitions and patterns of CAM use by the lay public Dana Fennell a,* , Ana S.Q. Liberato b , Barbara Zsembik c a University of Southern Mississippi, Department of Anthropology and Sociology, 118 College Drive #5074, Hattiesburg, MS 39406-0001, United States b University of Kentucky, United States c University of Florida, United States Available online 20 November 2008 KEYWORDS CAM; Alternative medicine; Free listing; Methodology; Ethnicity Summary Introduction: CAM is a socially constructed concept, and the literature on CAM definitions and patterns of use illustrates problems centering on the conceptualization and operationalization of ‘‘CAM.’’ This renders it hard for researchers to truly understand CAM use patterns by the public. We use pilot data to explore lay conceptions of ‘‘CAM,’’ and methodological approaches to capturing CAM usage. Methods: Our pilot data come from surveys and journals of undergraduates, yielding direct and indirect measures of levels and patterns of CAM use. Results and conclusions: The free listing method is a way to methodologically get around cultural bias and other problems conceptualizing CAM. Our pilot data suggest the public may have trouble conceptualizing CAM, and that survey construction does affect the richness of data on CAM use. Asking respondents direct measures of CAM modalities through surveys yielded the richest data. © 2008 Elsevier Ltd. All rights reserved. Introduction Studies show complementary and alternative medicine (CAM) in the U.S. has grown substantially in recent decades. It was estimated that visits to CAM practitioners surpassed visits to primary physicians in the 1990s, 1 and expenditures on supplements were on the rise. 2,3 Lifetime prevalence of CAM use has been increasing since the 1950s, with yearly prevalence rates increasing moderately or holding steady from the late 1980s to 2002. 1,4—6 Levels and patterns of * Corresponding author. Tel.: +1 601 266 5355; fax: +1 601 266 6373. E-mail address: dana.fennell@usm.edu (D. Fennell). use, however, are difficult to estimate because of a lack of consensus on the definition and measurement of CAM. This is especially difficult among race/ethnic sub-populations because of cultural and lingual factors. Consequently, the variability in definitions, classifications, and measurements introduce thorny problems in fully documenting the preva- lence levels, social group differentials, and use patterns of CAM therapies. Many CAM users do not report CAM use to their pri- mary physicians. 2,7—10 Less is known about why this is happening, although physicians may ‘‘infrequently initiate discussions’’ of CAM use, 11 patients may not ‘‘know they should,’’ office visits may be too short, or patients may feel the doctor will lack knowledge of or be against the use of CAM. 10 Finally, if individuals define CAM in a way appreciably different from scientific definitions, this may 0965-2299/$ — see front matter © 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ctim.2008.09.002