Characteristics of Adults Who Used Mindfulness Meditation: United States,2012

Introduction

Mindfulness meditation involves increased awareness through focusing attention on direct, present-moment experience and observing changing sensory and mental phenomenon without interference. Much of the expansion of research and practice of mindfulness meditation in the United States stems from the work of Jon Kabat Zinn and the 8-week Mindfulness-Based Stress Reduction (MBSR) program. ¹ The original program was started in 1979. Since its introduction, it has become widespread and is now taught in many communities and medical centers. MBSR is commonly used for stress reduction but has also been implemented for a wide variety of medical conditions. Evidence for its health benefits to reduce stress, recurrent depression, anxiety, and pain has been demonstrated in clinical trials. ^{2 –4} Although the number and quality of randomized trials of MBSR and other forms of mindfulness meditation are expanding, few studies have investigated the prevalence and correlates of mindfulness meditation as a lifestyle choice in the U.S. population.

The National Health Interview Survey (NHIS) now collects data on mindfulness meditation as part of the Alternative and Complementary Medicine Supplement. The Supplement data were most recently collected in 2012. This data set provides the opportunity to investigate health characteristics among a representative sample of Americans who have endorsed practicing mindfulness in the past year. The goal of this study was to report estimates of the number of persons who had practiced mindfulness in the past year and describe their demographic and health characteristics compared with those who had not endorsed practicing mindfulness in the past year.

Materials and Methods

The NHIS is an annual survey collected on a representative sample of the U.S. population and is the principal source of information on the health of Americans. Thousands of households are interviewed about their health- and illness-related characteristics. It is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. The U.S. Census Bureau trained interviewers to visit 35,000–40,000 households yearly across the United States and collect data on 75,000–100,000 individuals. All data collected are self-report. In 2012, data were collected on 34,525 households (unconditional response rate, 61.2%). The current analysis is of the data from the 2012 Sample Adult survey as well as the 2012 Adult Complementary and Alternative Medicine Supplement of NHIS, developed by National Center for Health Statistics and the National Center for Alternative and Complementary Medicine (now the National Center for Complementary and Integrative Health). Administration of the Supplement began in 2002; it is given every 5 years. Details of the NHIS survey methods and procedures are published elsewhere. ^5,6

The 2012 Adult and Complementary and Alternative Medicine Supplement asks about mindfulness meditation. Because the authors were interested in individuals who actively practiced mindfulness meditation, this study analyzed the data from those who responded “yes” to the question “During the past 12 months, did you use mindfulness meditation, including Vipassana, Zen Buddhist meditation, Mindfulness-based Stress Reduction and Mindfulness-based Cognitive Therapy?” This group's characteristics were compared with those of persons who responded “no” to the question. The nonmeditator group included persons who endorsed other meditation methods, such as mantra meditation.

All data were analyzed by using SAS software, version 9.3, SURVEY procedures (SAS Institute, Cary, NC) to account for the complex, multistage sampling design involving stratification, clustering, and oversampling of specific population subgroups. ⁷ Data were weighted by using the sample adult weight provided by the NHIS.

The weights provided by the NHIS for analytic purposes have been adjusted in several ways to permit calculation of valid estimates for the U.S. population (civilians and noninstitutionalized). The two groups were first compared for demographic characteristics and health behaviors by using the Rao-Scott chi-square test for categorical variables and t-tests for continuous measures. Then, the two groups were compared for the presence of comorbidities, mental health problems, and occurrence of acute illnesses by using Rao-Scott chi-square tests. Note that respondents may have more than one health condition. All tests were two sided (α = 0.05). No adjustments for multiplicity were made because of the descriptive and exploratory nature of the analysis.

Results

According to the NHIS, an estimated 2,029,720 U.S. adults had practiced mindfulness meditation in the past 12 months in 2012. This represents 0.66% of the NHIS U.S. population estimates. Among mindfulness meditators, there were more women than men (61.2% vs. 38.8%; p < 0.0001). Compared with those who did not report mindfulness meditation, meditators were older on average (44 years vs. 37 years) and were more likely to be white and have a college degree or higher (Table 1). Income was evenly distributed at all levels and not significantly different between those who meditated and those who did not. Geographically, more persons practiced mindfulness meditation in the western United States and fewer did in the southern states (37.6% vs. 21.3% and 25.3% vs. 37.2%, respectively; p < 0.0001).

Regarding lifestyle habits, individuals who endorsed using mindfulness in the past year, as compared with those who did not, were more likely to smoke (every day/some days) (20.4% vs. 18.7%; p < 0.0001). More meditators also endorsed moderate exercise 1–10 times per week and less reported never exercising weekly (79.6% vs. 54.8% and 13.5% vs. 39.8%; p < 0.0001 respectively).

Regarding health characteristics, mindfulness meditators were overweight on average, whereas those who did not practice mindfulness were more likely to be obese (body–mass index, 27.3 vs. 30.6 kg/m²; p < 0.0001) (Tables 1 and 2). A greater number of meditators stated their health was better for the past 12 months (33.8% vs. 18.9%; p < 0.0001). Meditators also endorsed more muscle or bone pain, as well as other chronic pain, in the previous 12 months (36.9% vs. 23.4% and 24.4% vs. 12.1%, respectively; p<0.0001 respectively). Chronic pain conditions were more prevalent, including low back pain, neck pain, and headache (36.7% vs. 28.9 [p<0.0002]; 26.4% vs. 14.7 [p<0.0001]; 19.1% vs. 12.1% [p<0.0001]).

Chronic conditions, such as hypertension, coronary heart disease, diabetes, and chronic obstructive pulmonary disease (COPD), were significantly different between the groups; fewer mindfulness meditators reported having ever had these conditions (22.1% vs. 32.7%, 2.5% vs. 5.4%, 1.9% vs. 3.3%, 3.3% vs. 9.9%, respectively; p<0.0001 [p < 0.0488 for COPD). More meditators reported ever having been diagnosed with a mental health disorder (13.8% vs. 3.7%; p < 0.001), and more meditators than nonmeditators reported being nervous or feeling sad at least a little of the time (60.4% vs. 33.8% and 34.0% vs. 23.5%, respectively; p<0.0001).

Mindfulness meditation practitioners compared with nonmeditators reported more insomnia and being frequently stressed (35.9% vs. 20.1% and 56.4% vs. 29.0%, respectively; p<0.0001). Persons who had practiced mindfulness also reported more acute illness in the past year, such as a head/chest cold (61.2% vs. 42.3%; p<0.0001).

Discussion

An estimated 2,029,720 adults had practiced mindfulness meditation in the past year in 2012. They were predominantly white, female, and well educated but did not differ in socioeconomic status from those who did not practice mindfulness meditation. More meditators than nonmeditators exercised but also smoked tobacco. Although on average they were overweight, those who did not practice mindfulness meditation were more likely to be obese. Fewer meditators had common chronic diseases, such as hypertension, coronary heart disease, COPD, or diabetes. More meditators had muscle or bone pain or other chronic pain. They also reported more anxiety or depressive symptoms as compared with nonmeditators. Persons who had practiced mindfulness meditation also reported more acute illness in the past year. Yet compared with persons who did not meditate, more meditators reported being in better health than in the previous year.

By using the same NHIS dataset, Clarke et al. reported that 18 million people meditated in 2012. Their number is much larger because it also included adults who had endorsed mantra meditation, spiritual meditation, or meditation used as a part of other mind–body practices. The current study includes only individuals who practice mindfulness meditation. ⁸

More women than men reported practicing mindfulness meditation. Generally, the greater interest of U.S. women in integrative health and wellness has been consistently found in national surveys of complementary and integrative medicine. Why this is the case is not clear, and studies have not looked at this specific finding. However, it may indicate a greater willingness to engage in integrative health practices, including mind–body approaches. As mindfulness meditation continues to gain popularity and made easily accessible through classes, online resources, digital media, and books, the demographics of its uptake may change.

These results indicate that persons who practice mindfulness have more interest in pursuing a healthy lifestyle than those who do not meditate. This is suggested by the fact that more exercised moderately every week and were less likely to be obese. Yet more meditators also smoked tobacco, and this may reflect the greater amount of depressive and anxiety symptoms present. The practice of mindfulness meditation may be one of the several ways that these individuals cultivate well-being and stress reduction.

Both mental and physical health concerns were more prevalent in mindfulness meditators than in nonmeditators. To some extent this finding could be related to the aging process because meditators were on average older than nonmeditators. Meditators reported more chronic pain and had more low back or neck pain in the previous 3 months compared with nonmeditators. They also had more depressive and anxiety symptoms. They reported more stress. This profile of symptoms—pain, depressive/anxiety symptoms, and stress—makes up the most common reasons that people seek integrative medicine. They are also symptoms for which conventional treatment cannot provide satisfactory relief. Mindfulness meditation may provide an easily accessible method for learning to handle pain, depressive and anxiety symptoms, and stress. Clinical trials have shown the effectiveness of mindfulness meditation for depression, anxiety, and chronic pain. ^2,9,10 Practicing mindfulness may cause individuals to be more aware of their sensations, emotions, and thoughts, and this could result in the increased reporting of symptoms seen in the current study.

In this representative sample, persons who engaged in mindfulness in the past year were more likely to report an acute illness, such as a head/chest cold. This finding was also unexpected. Mindfulness meditation has stress-reducing effects. ^11,12 Increased stress has been associated with increased likelihood of a viral illness, such as the common cold. ¹³ Thus, a lower likelihood of having the common cold would have been anticipated. However, the study did not find this. Because half the population had stress (56.4%), that symptom could also partially explain the increased prevalence of the head/chest cold. The data do not include information on the length of time that people meditated or the consistency of their practice. It may be that to see sustained effects on immune function, the quantity and duration of meditation are important. Most studies have looked at short-term effects and did not evaluate a cohort over time or look at long-time practitioners of meditation.

The study is limited by lack of information on duration, quantity, and consistency of mindfulness meditation, which may affect health outcomes. Longer and/or more consistent practice may be associated with improved health outcomes, but currently this information is not known. Recall bias may have affected results because participants are being asked about illness in the previous year. As mindfulness teaches individuals to be more aware of the present moment and body sensation, persons practicing this form of meditation may be more likely to report physical and emotional symptoms. The extent to which this affected reporting is not known. Prayer research also has this paradox in that the more a person reports prayer, the more illness is present. ¹⁴ Participants in the no-mindfulness group may have had a mind–body practice and were not removed from analysis. We found differences between the two groups despite their inclusion in the nonmeditator sample. Another limitation of this study is the cross-sectional nature of the data set. Because the NHIS collects data at a single point in time, it is not possible to discern whether people with mental and physical health issues seek out meditation as a method for coping or whether meditators are more precisely aware of and able to recall and report on symptoms than those who do not meditate. The findings may reflect that people started meditating to cope with mental and physical health issues, but the data do not include this information. This study did not analyze data from NHIS questions about other meditation methods, such us mantra meditation; thus, how data from mindfulness meditators compare to data from other meditators is unknown. Such comparisons could be potential future research questions.

Conclusions

Mindfulness meditation has been practiced in the past year by an estimated 2,029,720 adults according to the 2012 NHIS dataset. Compared with nonmeditators, more meditators exercised but also reported more pain, stress, anxiety, or depressive symptoms, perhaps suggesting a reason for seeking out mindfulness meditation. Future research would benefit from more detailed information on the duration and regularity of mindfulness meditation practice.