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Although regional variation in CAM use exists (e.g., prevalence is highest in the Western states) (1, 6, 10), this variation is not entirely well-characterized in the literature.

While such variation in use could be attributed to differences in cultural norms and attitudes toward these modalities (11), an alternative explanation could be that CAM has been defined differently across studies.

Objectives: Few studies to date have examined the utilization of complementary and alternative medicine (CAM) in a local, ethnically diverse population in the United States (U. Fewer have addressed the differences in their use based on inclusion or exclusion of prayer as a modality.

Variable definitions of CAM are known to affect public health surveillance (i.e., continuous, systematic data collection, analysis, and interpretation) or benchmarking (i.e., identifying and comparing key indicators of health to inform community planning) related to this non-mainstream collection of health and wellness therapies. Design: Using population-weighted data from a cross-sectional Internet panel survey collected as part of a larger countywide population health survey, the study compared use of CAM based on whether prayer or no prayer was included in its definition.

The present study utilized data from the Los Angeles County DPH Clinical Services Survey, a cross-sectional Internet panel survey conducted during June–July, 2014.

This survey was commissioned by DPH to a national firm specializing in online panel surveys.

Results: Blacks were among the highest users of CAM when compared to Whites, especially when prayer was included as a CAM modality.

Both surveillance and benchmarking possess utility as a continuous quality improvement strategy which can be used to drive health and health-care decision-making (15, 16).

Because of this nexus between CAM and mainstream medicine, excluding prayer from the operational definition of CAM could lead to unintended consequences—e.g., health behaviors based on faith and spiritual values that are not disclosed to providers may impact patient adherence to recommended medical treatments.

Since the actual volume or impact of CAM utilization or substitute care in communities of color and/or other at-risk populations could be large, a less than robust surveillance and benchmarking of these patterns of use (and their potential consequences) may inadvertently lead to marginalization of the needs of these communities, thereby creating disparities.

Presently, there is no agreed upon definition of CAM or for its pattern of use.

Increasingly, even the term itself, “complementary and alternative medicine,” has been replaced by newer descriptors such as “complementary health approaches,” “integrative medicine,” or “integrative health” (12, 13).

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This, in turn, affects local planning of health and human services.

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