title: Use of conventional and complementary health care during the transition to menopause: longitudinal results from the Study of Women's Health Across the Nation (SWAN).
abstract: OBJECTIVE
  Women beginning the transition to menopause now have access to complementary and alternative therapies (CAM) that were not universally available in the past. Little is known about the association between CAM use and the use of conventional health care during menopause. We investigated the longitudinal association between use of CAM therapies and utilization of conventional health care in a large, multiethnic sample of midlife women who were enrolled in the cohort phase of the Study of Women's Health Across the Nation (SWAN).
  
  
  METHODS
  We used generalized estimating equations, repeated measures modeling to examine the association between CAM use and the yearly number of conventional health-care contacts, adjusting for relevant covariates, during a two-year period. CAM use was evaluated longitudinally as continuous, incident (no CAM use at baseline), sporadic, or no use during the study period.
  
  
  RESULTS
  Relative to nonusers, continuous CAM users had more conventional health-care contacts (beta 0.14, 95% CI 0.06, 0.21). Incident users and sporadic users also showed an excess in conventional health-care contacts (beta 0.14, CI 0.06, 0.22) and (beta 0.09, CI 0.01, 0.16), respectively. Ethnicity was independently associated with health-care contacts. Relative to white women, Japanese women had fewer contacts (beta -0.18, CI -0.31, -0.05).
  
  
  CONCLUSIONS
  Despite being a generally healthy, well-educated and high-income population with good access to health care, CAM users were using more of both conventional and alternative health-care resources than women who did not use CAM. These findings have practical implications for conventional health-care practitioners, allied health professionals and CAM practitioners.
authors.affiliation: Center for Health Services Research in Primary Care, University of California at Davis, 2103 Stockton Blvd, Suite 2224, Sacramento, CA 95817, USA. yabair@ucdavis.edu
authors.forename: Yali A
authors.initials: YA
authors.lastname: Bair
authors.forename: Ellen B
authors.initials: EB
authors.lastname: Gold
authors.forename: Rahman A
authors.initials: RA
authors.lastname: Azari
authors.forename: Gail
authors.initials: G
authors.lastname: Greendale
authors.forename: Barbara
authors.initials: B
authors.lastname: Sternfeld
authors.forename: Martha R
authors.initials: MR
authors.lastname: Harkey
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
mesh_terms: D000328:Adult; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008137:Longitudinal Studies; D008327:Mammography / Q000706:statistics & numerical data; D008593:Menopause / Q000502:physiology* / Q000523:psychology; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data; D011446:Prospective Studies; D044469:Racial Groups; D011795:Surveys and Questionnaires; D014626:Vaginal Smears / Q000706:statistics & numerical data