title: Utilization of complementary and alternative medicine (CAM) among children from a German birth cohort (GINIplus): patterns, costs, and trends of use.
abstract: BACKGROUND
  The use of complementary and alternative medicine (CAM) is widespread among children in Germany and other European countries. Only a few studies are available on trends in pediatric CAM use over time. The study's objective was to present updated results for prevalence, predictors, and costs of CAM use among German children and a comparison with findings from a previous follow-up of the same birth cohort.
  
  
  METHODS
  Data were collected for 3013 children on their utilization of medicinal products (during the last 4 weeks) and consultation with CAM providers (in the preceding year) from a German birth cohort study (GINIplus, 15-year follow-up) using a self-administered questionnaire. The reported medicinal CAMs were classified into six categories (homeopathy, herbal drugs, nutritionals, minerals and trace elements, microorganisms, further CAM). Drug prices were traced using pharmaceutical identification numbers (PZNs), or otherwise conservatively estimated. Finally, the results were compared with data obtained from the 10-year follow-up of the same birth cohort study by adopting the identical methodology.
  
  
  RESULTS
  In all, 26% of the reported 2489 drugs were medicinal CAM. The 4-week prevalence for homeopathy and herbal drug use was 7.5% and 5.6%, respectively. Some 13.9% of the children used at least one type of medicinal CAM in the preceding 4 weeks. The 1-year prevalence for consultation with CAM providers was 10.8%. From the drugs identified as CAM, 53.7% were homeopathic remedies, and 30.8% were herbal drugs. Factors associated with higher medicinal CAM use were female gender, residing in Munich, and higher maternal education. A homeopathy user utilized on average homeopathic remedies worth EUR 15.28. The corresponding figure for herbal drug users was EUR 16.02, and EUR 18.72 for overall medicinal CAM users. Compared with the 10-year follow-up, the prevalence of homeopathy use was more than halved (-52%) and dropped substantially for herbal drug use (-36%) and overall CAM use (-38%) as well.
  
  
  CONCLUSIONS
  CAM use among 15-year-old children in the GINIplus cohort is popular, but decreased noticeably compared with children from the same cohort at the age of 10 years. This is possibly mainly because German health legislation normally covers CAM for children younger than 12 years only.
authors.affiliation: Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. salvatore.italia@maastrichtuniversity.nl.|Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany. salvatore.italia@maastrichtuniversity.nl.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Italia
authors.affiliation: Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. helmut.brand@maastrichtuniversity.nl.
authors.forename: Helmut
authors.initials: H
authors.lastname: Brand
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany. heinrich@helmholtz-muenchen.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Heinrich
authors.affiliation: Marien-Hospital Wesel, Department of Pediatrics - Research Institute, Wesel, Germany. berdel.vonberg@t-online.de.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Berdel
authors.affiliation: Marien-Hospital Wesel, Department of Pediatrics - Research Institute, Wesel, Germany. avb.rodehorst@gmx.de.
authors.forename: Andrea
authors.initials: A
authors.lastname: von Berg
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany. wolfenstetter@helmholtz-muenchen.de.
authors.forename: Silke Britta
authors.initials: SB
authors.lastname: Wolfenstetter
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D015331:Cohort Studies; D000529:Complementary Therapies / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006705:Homeopathy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008419:Materia Medica / Q000627:therapeutic use; D009035:Mothers; D010342:Patient Acceptance of Health Care; D008517:Phytotherapy / Q000706:statistics & numerical data*; D028321:Plant Preparations / Q000627:therapeutic use; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D008419:Materia Medica; D028321:Plant Preparations