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Why Do Americans Use Dietary

Supplements?Motivations for Dietary Supplement Use

Johanna Dwyer, D.Sc,RDOffice of Dietary SupplementsNational Institutes of Health

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Agenda

USEHow do people vary in dietary supplement use?

MOTIVATIONSDo people think they are “deficient”?Do motivations for use vary by

person (demographics, health status, readiness)supplement (nutrient vs herbal/botanical)

Are some people more ready to use than others?

IMPLICATIONS for dietitians

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DemographicsDemographics

MotivationMotivation UseUse

AttitudesAttitudes

N=2002 nationally representativegrocery shoppers,in 2003

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MotivationsMotivations

AgeAgeSexSexIncomeIncomeEducationEducationEthnicityEthnicity

Concerns aboutConcerns aboutNutrient deficienciesNutrient deficiencies

Health statusHealth status

Readiness to engageReadiness to engageIn preventive behaviorsIn preventive behaviors

AttitudesAttitudesAttitudesAttitudes

DemographicsDemographics

UseUse

Nutrient vs NonNutrient vs Non--nutrientnutrientSpecific productsSpecific products

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Population

Representative sample Primary grocery shoppers/heads of household in USA, 2003 N=2002Surveyed by National Family Opinion for The Natural Marketing Institute (NMI)

16 page mail-home questionnaire of Health and WellnessSecondary data analysis funded by ODS, NIH

Results nationally projectable within 2%

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Methods

Motivations and useGeneralFor specific conditions/purposes

weight lossmanaging chronic conditions others

RespondentsDemographics

Age SexIncomeEducationEthnicity

Current health statusType of supplement used

nutrient vs nonnutrient

Readiness to use DS

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Methods

Respondent characteristics Demographics

Age SexIncomeEducationEthnicity

Current health statusDS useMotivations

Supplement characteristicsType (nutrient vs herbal and other) Category (MVM, single nutrient, condition-specific)

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How do people vary in DS use?

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Most Popular Nutrient DS 2003

0 20 40 60 80 100

MVM

Ca

E

C

B complex

Herbals

Mg

Antox

Folic

Glucosamine

% daily

Percent Using Daily

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Lately herbal DS decreasing andcondition-specific DS increasing!

Condition-SpecificCondition-Specific Condition-Specific Condition-Specific

Herbals HerbalsHerbals Herbals

Minerals MineralsMinerals Minerals

Vitamins Vitamins Vitamins Vitamins

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003

Condition-Specific Herbals Minerals Vitamins

Percent Used Last Year

Use past 12 months

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Factors affecting use

DemographicsMore with age especially if feeling poorlyF>MW> B or Hispanic

More with poor current health status

Supplement type and category also affect

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Use of some DS very common past year

0 20 40 60 80 100

Vitamins

Rx Drugs

OTC

Minerals

Herbals

Condition-Specific DS

Weight loss DS

HRT

Homeopathic Remedies

DS Other therapies

%

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People use DS in various ways

Use DS & alternativehealthcare first

Use combo DS,RX&OTC drugssimultaneouslyUse Rx drugs first

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Implications for Dietitians

With patients undergoing medical treatment

If prescription drugs are prescribed, encourage their use as directed first

Ask about DS use since it is common among the ill

Counsel to avoid possible adverse interactions

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Implications for Dietitians

People at special riskUse DS first for treatmentUse DS, conventional medical therapies and CAM all at the same time for disease treatment

Need to note to avoid interactions and failure to apply better tested treatments

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Herbals going down over time;condition-specific DS up!

0

20

40

60

80

100

2000 2001 2002 2003

Condition-Specific

Herbals

Minerals

Vitamins

Condition-Specific Herbals Minerals Vitamins

Use past 12 months

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Motivations

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Do people think they are “deficient”?

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Concerned about “deficiencies” in foods, ingredients, and nutrients

0

25

50

75

100

Soy p

roteinFiber

Soy I

soflav

ones

Whole Grains

Protein

PercentWhich do you consider deficient in your current diet?

%

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What are consumer perceptions of nutrient/food deficiencies ?

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Implications

Consumers mix up poor food choices and true nutrient deficiencies

Some think that eating less of a food than recommendations is “deficiency”

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Implications

Consumer and medical views of deficiency differ

Consumers interpret phrase as :“not getting enough in diet”

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Concerned about “deficiencies”

0 20 40 60 80 100

Antiox

C

K

Lutein

E

Folic acid

Mg

Protein

PercentWhich do you consider deficient in your current diet?

%

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Validity of dietary deficiency concerns varies

Some evidence for low intakes in subgroups in forSome nutrients: folic acid ,calcium , soy, fiber, potassiumSome foods: Whole grains

But little evidence for othersSoy protein and isoflavonesWaterOmega 3’s?

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Concerned about “deficiencies”

0 20 40 60 80 100

Calcium

Fiber

Omege 3

Water

Iron

PercentWhich do you consider deficient in your current diet?

%

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Implications

Sizable minority think they have nutrient deficiencies

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Those reporting feeling poorly reported more perceived nutrient deficiencies

However, perceived deficiencies of nutrients & foods not associated with use of DS

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Implications

People who report a “deficiency” more likely to also report health problems

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Why do people use supplements?

Depends on person’s characteristics

Also on type of supplement

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Personal characteristics

SexBig differences by sex on type of DS used

Poor reported health statusMore use of herbal, condition-specific DSLess of vitamin minerals

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Poor Reported Health StatusThose in poor physical, emotional or mental health used DS for specific health conditions more

ImplicationBe sure to check DS use in ill

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DemographicsWomen more mentions of

“MD recommended”“Good for me and family”

Implication: Women often traffic cops for DS use in families; enlist their help when DS needed

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Why Vitamin Mineral DS important to me

0 20 40 60 80 100

Overall health/wellness

Performance/energy

Px specific health problem

MD rec

good for me,family

nutrition

Tx specific health issue

lifestyle changes

Vitamins and Minerals

Many drivers

%

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Reasons for first using vitamin mineral DS

Percent

0

10

20

30

40

50

60

70

80

90

100

Overa

ll He

alth/

wellne

ssPe

rform

ance

/ene

rgy

Prev

ent

Doct

or R

xBe

tter f

or m

e& fa

milyNut

rition

al Co

nten

t

Trea

t

Lifes

tyle

Chan

geVitamin/Minerals

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Why Herbal DS are important to me

0 20 40 60 80 100

Overall health/wellness

Performance/energy

Px specific health problem

MD rec

good for me,family

nutrition

Tx specific health issue

lifestyle changes

Herbals

Many drivers

%

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Reasons for first using DSPercent

0

10

20

30

40

50

60

70

80

90

100

Overa

ll He

alth/

wellne

ssPe

rform

ance

/ene

rgy

Prev

ent

Doct

or R

xBe

tter f

or m

e& fa

milyNut

rition

al Co

nten

t

Trea

t

Lifes

tyle

Chan

geHerbals

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Why DS are important to me

0 20 40 60 80 100

Overall health/wellness

Performance/energy

Px specific health problem

MD rec

good for me,family

nutrition

Tx specific health issue

lifestyle changes

Vitamins and Minerals Herbals

Many drivers

%

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Reasons for first using DSPercent

0

10

20

30

40

50

60

70

80

90

100

Overa

ll He

alth/

wellne

ssPe

rform

ance

/ene

rgy

Prev

ent

Doct

or R

xBe

tter f

or m

e& fa

milyNut

rition

al Co

nten

t

Trea

t

Lifes

tyle

Chan

geVitamin/Minerals Herbals

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Implications

Many drivers for use

Differ only slightly by supplement type

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Why do people use dietary supplements???

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Authoritative Guidance

The Law:DSHEA 1995: DS are not for prevention or treatment of disease

ExpertsDS inappropriate as substitutes for evidence-based therapies prescribed by physicians

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Consumer view DS as helpful in Px and Tx of many conditions

0 20 40 60 80 100

arthritis

colds & flu

osteoporosis

lack energy

memory

cancer

TxPx

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Consmers view DS as helpful in Px and Tx of many conditions

0 20 40 60 80 100

hi BP

heart

vision

cholesterol

heartburn

stress

depression

TxPx

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0

10

20

30

40

50

60

70

80

Overall Health/wellness Prevention Treatment

Vitamin/Minerals Herbals

Agree that taking… is effective in …..(agree completely/somewhat)

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Consumers view DS as helpful in Px and Tx of many conditions

0 20 40 60 80 100

arthritiscolds & flu

osteoporosislack energy

memorycancer

hi BPheartvision

cholesterolheartburn

stress depression

obesitydiabetes

Chronic Fatigue

TxPx

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Implications

DS often used in ways differently than the law intends

Caution needed, especially if for treatment

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Are some people readier than others to use dietary supplements?

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Readiness for behavioral change

Prochaska: trans-theoretical model of readiness of behavioral change

Readiness varies by types of DS

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0

10

20

30

40

50

60

No Need Need haven'texplored

Explored for futureuse

Gatheredinformation and

evaluatingalternative

Useinfrequently<1yr

Use frequently>1yr

Vitamin/Minerals%

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0

10

20

30

40

50

60

No Need

Need haven't explored

Explored for future use

Gathered information and evaluating alternative

Use infrequently >1 yr

Use regularly,consistently >1 yr

Herbals

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0

10

20

30

40

50

60

No Need Need haven'texplored

Explored forfuture use

Gatheredinformation and

evaluatingalternative

Use regularlyconsistently 1

yr+

Useinfrequently>1

yr

Vitamin/Minerals Herbals

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How are motivations and use of DS related?

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Do motivations cause use?

Knowledge- Attitudes- Usemotivations

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Or do people develop motivations to justify use???

Use Attitudes-- Knowledgemotivations

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Are motivations the chicken ??

Motivations Use

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Or, are motivations the egg??

UseMotivations

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Implications for dietitians

Some people get in the habit and then find reasons for behavior

Often due to social influence

Others operate in a more deliberate manner

Consider both ways to influence behavior when collecting information about dietary supplement use!

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Case: Women in reproductive age group and folic acid DS

Some get into the habit of taking a folic acid supplement

Others use only after appealing to logic and attitudes

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Conclusions

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Conclusions

Motivations for dietary supplement use complex

Patterns of use vary depending on supplement

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Implications for dietitians

Many interactions between medications , drugs and dietary supplements

Check about interactions!

Put interactions in the chart!

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Implications for dietitians

Probe about dietary supplement use

To get total dietary intake must include nutrient containing dietary supplements!

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Acknowledgements

Funded by Office of Dietary Supplements, National Institutes of Health

http://Nutrition.govhttp://ods.od.nih.gov

DSID group

Thanks to Steve French and The Natural Marketing Institute (NMI) for analyses

www.NMIsolutions.com

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Conclusions

USEPeople vary greatly in dietary supplement use

MOTIVATIONSA substantial minority of people think they are “deficient”; either in foods or nutrients or bothMotivations for use vary by

person (demographics, health status, readiness)supplement (nutrient vs herbal/botanical)

Some people (nutrient supplement users) are more ready to use DS than others

IMPLICATIONS for dietitians:always ask about DS