PREVENTING CHRONIC DISEASE P U B L I C H E A L T H R E S E A R C H , P R A C T I C E , A N D P O LICY Volume 14, E01 JANUARY 2017 ORIGINAL RESEARCH Prevalence of Mindfulness Practices in the US Workforce: National Health Interview Survey Diana Kachan, PhD1; Henry Olano, MPH1; Stacey L. Tannenbaum, PhD2; Debra W. Annane, MA2; Ashwin Mehta, MD, MPH2; Kristopher L. Arheart, EdD1; Lora E. Fleming, MD, PhD3; Xuan Yang, MPH, MHS1; Laura A. McClure, MSPH2; David J. Lee, PhD1,2 Suggested citation for this article:K achan D, Olano H, Conclusion Tannenbaum SL, Annane DW, Mehta A, Arheart KL, et al. Worker groups with low rates of engagement in mindfulness prac- Prevalence of Mindfulness Practices in the US Workforce: tices could most benefit from workplace mindfulness interven- National Health Interview Survey. Prev Chronic Dis 2017; tions. Improving institutional factors limiting access to mindful- 14:160034. DOI: https://doi.org/10.5888/pcd14.160034. ness-based wellness programs and addressing existing beliefs about mindfulness practices among underrepresented worker groups could help eliminate barriers to these programs. PEER REVIEWED Abstract Introduction Over the last several decades, mindfulness-based interventions Introduction (MBIs) have gained wide recognition through such programs as Mindfulness-based practices can improve workers’ health and re- Mindfulness-Based Stress Reduction (1), Mindfulness-Based Cog- duce employers’ costs by ameliorating the negative effect of stress nitive Therapy (2), Mindfulness-Based Relapse Prevention (3), on workers’ health. We examined the prevalence of engagement in and others. The effectiveness of MBIs for the treatment of diffi- 4 mindfulness-based practices in the US workforce. cult and chronic clinical problems (eg, chronic pain, mood dis- orders, substance abuse) (4–6), as well as for stress in healthy pop- Methods ulations (7), has been well demonstrated. Mindfulness, the main We used 2002, 2007, and 2012 National Health Interview Survey therapeutic element of these programs, is defined as the intention- (NHIS) data for adults (aged ≥18 y, n = 85,004) to examine 12- al and nonjudgmental conscious awareness of the present moment month engagement in meditation, yoga, tai chi, and qigong among (1). This quality of mind is used and developed through varied different groups of workers. meditation techniques and through physical movements and mar- tial arts traditions such as yoga and tai chi. A typical MBI pro- Results gram incorporates a combination of mindfulness meditation and Reported yoga practice prevalence nearly doubled from 6.0% in mindful movement based primarily on yoga, with some inclusions 2002 to 11.0% in 2012 (P < .001); meditation rates increased from of other mindfulness-based practices such as tai chi or qigong. 8.0% in 2002 to 9.9% in 2007 (P < .001). In multivariable models, mindfulness practice was significantly lower among farm workers MBI implementation at the workplace takes many forms, ranging (odds ratio [OR] = 0.42; 95% confidence interval [CI], 0.21–0.83]) from employee wellness programs to leadership training. Grow- and blue-collar workers (OR = 0.63; 95% CI, 0.54–0.74) than ing evidence demonstrates the beneficial effects of mindfulness among white-collar workers. practices among workers, in terms of both physical symptoms (eg, pain) and mental well-being. For example, meditation interven- tions targeting workers are effective at reducing work-associated stress, depression, and anxiety among full-time Australian work- The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. www.cdc.gov/pcd/issues/2017/16_0034.htm • Centers for Disease Control and Prevention 1 PREVENTING CHRONIC DISEASE VOLUME 14, E01 PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY JANUARY 2017 ers (8). In health care providers, mindfulness training reduced Variables burnout, mood disturbances, and stress (9,10). Mindfulness train- Participants were dichotomized on each outcome based on wheth- ing also showed improvements in mood and sleep quality among er they reported engaging in each individual practice or any of the teachers (11). practices in the previous 12 months (yes/no). These were treated Workplace stress is associated with many poor health outcomes, separately as outcomes to create 5 outcome variables: meditation, both mental and physical (12,13); workplace stress is linked with yoga, tai chi, qigong, and any of the 4 practices. The assessment decreased productivity, increased occupational injury, and absent- question for meditation practice in 2002 and 2007 was altered sub- eeism (14,15), as well as with substantially higher medical ex- stantially for 2012. During 2002 and 2007, participants were penditures among highly stressed employees (16). By helping em- asked, “During the past 12 months, did you use meditation?” In ployees manage stress better, mindfulness-based practices, wheth- 2012, this question was replaced with 3 questions, each of which er formal or informal, can improve workers’ health, increase pro- asked “During the past 12 months, did you use . . . ” about the fol- ductivity, and reduce employers’ costs (17). lowing practices: 1) mantra meditation, including transcendental meditation, relaxation response, and clinically standardized medit- Rates of engagement in mindfulness-based practices among vary- ation; 2) mindfulness meditation, including Vipassana, Zen ing groups of workers are unknown. It is also unknown which Buddhist meditation, mindfulness-based stress reduction, and worker subgroups have better access to such practices or could be- mindfulness-based cognitive therapy; and 3) spiritual meditation nefit from improved access to them. In this study, we examined including centering prayer and contemplative meditation. As a res- the rates of engagement in common mindfulness-based practices ult, the 2012 meditation data are not comparable to those from in US workers and compared these rates for 4 major occupational 2002 and 2007; therefore, when modeling meditation or any of the categories. 4 practices, only data from 2002 and 2007 were used. Methods Employment was assessed for the week before the interview. Par- ticipants who worked during that week and those who reported Data having a job or business to return to if they did not work were classified as employed. Occupation was assessed with the ques- Since 1957, the National Center for Health Statistics has conduc- tion, “What kind of work were you doing?” referencing the job the ted the National Health Interview Survey (NHIS), a multipurpose person reported having in the last week. NHIS classifies occupa- and multistage probability survey of the US noninstitutionalized tion based on the Standard Occupational Classification System civilian population (www.cdc.gov/nchs/nhis). Information is col- Census codes (www.bls.gov/tus/iocodes.htm), which we col- lected yearly through the NHIS on its participants’ sociodemo- lapsed into 4 categories of workers: 1) white collar, 2) blue collar, graphic and health characteristics. In addition to the core compon- 3) service, and 4) farm (19). ents of NHIS, the Alternative Health/Complementary and Altern- ative Medicine Supplement was included in the survey during When comparing the odds of practice across occupations, the fol- 2002, 2007, and 2012. The supplement was administered to all lowing variables were included as potential confounders: educa- adult participants of NHIS, and it assessed lifetime and 12-month tional level (less than a high school diploma [reference], high use of various complementary and alternative health practices, in- school diploma, and more than a high school diploma), sex, race/ cluding such mindfulness-based techniques as meditation and ethnicity (non-Hispanic white [reference], non-Hispanic black, mind-body exercise activities containing a mindfulness element, Hispanic, Asian, other), age (continuous), and household income such as yoga, tai chi, and qigong. The final annual response rates (as a ratio of income to current poverty level, treated as a continu- for the Adult Alternative Health Supplement during the 3 years of ous variable). its administration averaged 66.5% (range, 59.4%–73.7%) (18). We used the available NHIS Alternative Health/Complementary and Statistical analysis Alternative Medicine Supplement data for adults (aged ≥18 y) to Prevalence and 95% confidence intervals (CIs) were calculated, examine workers’ 12-month engagement in the following mindful- and trends over survey years were assessed using χ2 tests. The pre- ness-based practices: 1) meditation, 2) yoga, 3) tai chi, 4) qigong, valence of mindfulness practices was compared among worker or 5) any of the 4 practices. groups using logistic regression. For each of the 5 study outcomes, 3 nested models were fitted; model 1 adjusted for survey year only; model 2 adjusted for survey year and adjusted for age, sex, and race/ethnicity; and Model 3 adjusted for the variables in mod- The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. 2 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2017/16_0034.htm PREVENTING CHRONIC DISEASE VOLUME 14, E01 PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY JANUARY 2017 el 2 and adjusted for income and education levels. Because of the vice workers (OR = 0.90; 95% CI, 0.79–1.03). In model 3, blue- complex sampling design, all estimates were adjusted for unequal collar workers were also significantly less likely than white-collar selection and clustering using sampling weights and stratification workers to engage in meditation (OR = 0.71; 95% CI, 0.59–0.85) variables available in NHIS. The sampling weights used were or yoga (OR = 0.46; 95% CI, 0.39–0.55); however, no significant those included in the adult core component of NHIS adjusted for differences were found for other types of workers for these prac- the use of combined survey years, as specified by Botman and tices. Jack (20). Discussion Results In this study, we examined the rates of 12-month engagement in 4 A total of 85,004 US adults aged 18 years or older, among whom common mindfulness-based practices (meditation, yoga, tai chi, 50,343 were employed (representing approximately 131 million and qigong) in US workers, and we compared these rates among US workers), answered questions about engaging in various mind- major occupational groups, using nationally representative data. fulness practices in the 3 survey periods. The characteristics of the To our knowledge, this is the first study to characterize the preval- study sample are presented in Table 1. ence of engagement in these practices in the workforce. We found that approximately 12% to 14% of workers and 9% to 12% of the The prevalence of practices in the overall worker population unemployed reported having engaged in at least 1 of these prac- ranged from 0.3% (qigong in 2002 and 2007) to 11.0% (yoga in tices within the past year. Over the decade of survey data avail- 2012) (Table 2). Across worker groups, between 2.2% (farm able, the rates of engagement in some practices (eg, yoga, medita- workers in 2002) and 18.2% (white-collar workers in 2007) repor- tion) increased; rates of yoga practice among workers rose almost ted engaging in at least 1 of the practices; approximately 9% to twofold between 2002 and 2012. However, the rates of engage- 12% of the unemployed did so. The prevalence of yoga practice ment in the lesser-known practices of tai chi and qigong did not increased significantly over the 3 survey years from 6.0% in 2002 substantially change during this period. The rates of engagement to 11.0% in 2012 (P < .001). From 2002 to 2007, the prevalence of in yoga in the general population have risen steadily during the engagement in meditation increased significantly, from 8.0% to past 2 decades (21), likely being driven by a combination of 9.9%, and prevalence of engagement in any of the 4 practices in- factors, including increased public awareness of health benefits creased significantly, from 11.7% to 14.3% (P < .001). (22,23), health care provider recommendations to their patients In Model 1, after adjustment for survey year, the unemployed and (23,24), and the growth in the number of yoga studios and other all other worker groups were significantly less likely to engage in classroom-based venues available for practice (21,23). Further- meditation, yoga, or any of the 4 practices than were white-collar more, the clinical success and dissemination of MBI programs, workers (Table 3). In 2002 and 2007, the odds of engaging in any such as Mindfulness-Based Stress Reduction and its derivatives, of the 4 practices ranged from 0.17 (95% CI, 0.09–0.32) for farm could explain some of the increase in the rates of meditation prac- workers to 0.67 (95% CI, 0.60–0.75) for service workers, com- tice engagement. pared with white-collar workers. These significant differences re- We found substantial variation in the rates of mindfulness prac- mained when additionally controlling for age, sex, and race/ethni- tice engagement across occupations. For example, white-collar city (model 2); service, farm, and blue-collar workers were signi- workers were more likely than all other workers to engage in yoga ficantly less likely than white-collar workers to engage in medita- or meditation, and they were more likely than blue-collar workers tion or yoga (Table 3). Blue-collar workers were also less likely to engage in tai chi or qigong. Most of these differences, however, than white-collar workers to practice tai chi (OR = 0.55; 95% CI, most likely can be attributed to differences in household income 0.41–0.75) or qigong (OR = 0.41; 95% CI, 0.22–0.77). and education level. After controlling for these 2 factors, blue-col- After additionally adjusting for education and income level (mod- lar workers were still less likely than white-collar workers to en- el 3), the odds of engaging in any of the 4 practices were signific- gage in meditation or yoga, and farm workers continued to be less antly lower in farm workers (OR = 0.42; 95% CI, 0.21–0.83) and likely to engage in any of the 4 practices. blue-collar workers (OR = 0.63; 95% CI, 0.54–0.74) than among Sociodemographic factors (eg, lower educational attainment, male white-collar workers; no significant difference was seen for ser- sex) may be a challenge to wider MBI implementation among US workers (25). Additionally, there seems to be a lack of engage- ment in mindfulness practices among blue-collar workers and farm workers beyond what can be explained by sociodemographic The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. www.cdc.gov/pcd/issues/2017/16_0034.htm • Centers for Disease Control and Prevention 3 PREVENTING CHRONIC DISEASE VOLUME 14, E01 PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY JANUARY 2017 factors. Moreover, lower rates of meditation or yoga engagement Our finding of high and increasing rates of exposure to mindful- among blue-collar workers, even after controlling for sociodemo- ness practices among US workers is encouraging. Approximately graphic factors, may indicate differences in beliefs about the value 1 in 7 workers report engagement in some form of mindfulness- of these practices among these workers (26). Additionally, more based activity, and these individuals can bring awareness of the leisure time, more access to workplace and other resources, and benefit of such practices into the workplace. Identifying workers more regular work schedules may provide more opportunity to who do engage in mindfulness activities and involving them in the practice mindfulness activities among white-collar workers relat- promotion of awareness about these in the workplace could in- ive to other worker groups. crease acceptance of MBIs among occupations that underrepresen- ted among mindfulness practitioners. Managers should take into One study limitation was that the location of mindfulness practice, account and identify such individuals when planning the imple- such as in the workplace itself, was not assessed. In recent years, mentation of MBIs in the workplace. Institutional factors, such as with the development of the National Institute for Occupational lack of funding or lack of work time for workplace opportunities, Safety and Health Total Worker Health (TWH) program that prevent equal access to various health-promotion measures as (www.cdc.gov/niosh/twh), the emphasis of workplace health pro- well as individual beliefs preventing engagement in mindfulness motion has been shifting toward work–life balance and overall practices should be addressed to make these practices available to worker well-being. The TWH program encourages measures that all workers. target both work-related and nonwork-related factors affecting worker health. Workplace MBIs can address this shift in emphasis. Although overall rates of engagement in mindfulness practices, A review of complementary therapies offered in the workplace such as yoga and meditation, are increasing in the workforce, vari- shows that mindfulness-based and meditation-based interventions ation in rates of engagement in mindfulness practices exists across were the most effective at improving workers’ psychological well- occupational groups. Mindfulness practice can address multiple being (27). workplace wellness needs, benefiting both employees and employ- ers. Development of workplace mindfulness programs should tar- MBIs are integrated into worksites in many different ways, includ- get occupational groups that have low rates of engagement in such ing web-based programs, yoga or meditation classes, and full practices (ie, blue-collar and farm workers), placing emphasis on mindfulness-based stress reduction programs (17,28). These MBIs men and on socioeconomically disadvantaged subgroups within each have their own challenges, which can include cost, time re- these occupations. This development should be done both by im- quired, expertise, and participant retention. Despite these chal- proving institutional factors that limit access to mindfulness-based lenges, MBIs offer substantial advantages, because they can wellness programs and addressing existing beliefs about mindful- provide workers with skills for coping with stress, whether or not ness practices among underrepresented worker groups. it is work-related, and for improving mood management and emo- tional regulation (29). Mindfulness practice can also increase Acknowledgments workers’ resilience, thereby enabling them to better deal with stress while preventing burnout, which is especially true for high- This research was supported by grants from the National Institute stress occupations. MBIs also have been effective in health beha- on Aging (grant no. F30AG040886), National Institute for Occu- vior modification, such as smoking cessation and substance abuse pational Safety and Health (grant no. R010H003915), the prevention measures (4,30). Reducing these risky behaviors re- European Regional Development Fund Programme 2007 to 2013, duces chronic health conditions, such as heart disease and cancer, and European Social Fund Convergence Programme for Cornwall resulting in an overall healthier workforce. Some other potential and the Isles of Scilly (University of Exeter Medical School). benefits of workplace MBIs are increased productivity, memory, creativity, focus, impulse control, and emotional intelligence (9). Author Information We could find no intervention studies in the literature which fo- Corresponding Author: Xuan Yang, MPH, MHS, Department of cused on blue-collar or farm workers. Given the low prevalence of Public Health Sciences, University of Miami, Miller School of these practices noted in this study, there is a pressing need for the Medicine, 1120 NW 14th St, Room 1027, Miami, FL 33136. development of interventions targeting these occupational groups. Telephone: 305-243-9028. E-mail: PREVENTING CHRONIC DISEASE VOLUME 14, E01 PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY JANUARY 2017 Author Affiliations: 1Department of Public Health Sciences, 11.Crain TL, Schonert-Reichl KA, Roeser RW. Cultivating University of Miami, Miller School of Medicine, Miami, Florida. teacher mindfulness: effects of a randomized controlled trial on 2Sylvester Comprehensive Cancer Center, University of Miami, work, home, and sleep outcomes. J Occup Health Psychol; Miller School of Medicine, Miami, Florida. 3European Centre for 2016. 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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. 6 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2017/16_0034.htm PREVENTING CHRONIC DISEASE VOLUME 14, E01 PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY JANUARY 2017 Tables Table 1. Characteristics of Adult Participants (Aged ≥18 y), National Health Interview Survey Alternative Medicine Supplement (N = 85,004), 2002, 2007, and 2012 Participants, % (SE) Unemployed White-Collar Worker Service Worker Farm Worker Blue-Collar Worker Characteristic N (n = 34,661) (n = 29,418) (n = 9,242) (n = 716) (n = 10,967) Education level <High school diploma 15,076 23.19 (0.33) 3.54 (0.13) 18.53 (0.57) 45.34 (2.32) 21.56 (0.55) High school diploma 23,278 31.54 (0.33) 18.24 (0.29) 32.27 (0.68) 30.85 (1.94) 42.51 (0.57) >High school diploma 46,135 45.27 (0.42) 78.22 (0.30) 49.20 (0.70) 23.81 (1.67) 35.93 (0.60) Race/ethnicity Hispanic 14,659 12.41 (0.28) 8.98 (0.23) 20.27 (0.57) 40.67 (2.71) 19.49 (0.52) Non-Hispanic white 53,099 70.26 (0.41) 75.46 (0.36) 57.70 (0.67) 54.01 (2.57) 65.28 (0.58) Non-Hispanic black 12,430 12.16 (0.27) 9.58 (0.24) 16.36 (0.47) 3.82 (0.42) 11.48 (0.37) Non-Hispanic Asian 4,007 4.16 (0.15) 5.37 (0.17) 4.21 (0.24) 1.02 (0.36) 2.77 (0.20) Other 809 1.01 (0.13) 0.61 (0.05) 1.47 (0.21) 0.48 (0.26) 0.98 (0.13) Sex Male 37,343 39.29 (0.36) 44.08 (0.39) 41.91 (0.66) 82.02 (1.35) 84.88 (0.41) Female 47,661 60.71 (0.36) 55.92 (0.39) 58.09 (0.66) 17.98 (1.35) 15.12 (0.41) Survey year 2002 29,878 30.10 (0.42) 32.52 (0.47) 25.45 (0.57) 54.12 (2.56) 34.20 (0.65) 2007 22,054 32.23 (0.46) 33.65 (0.49) 35.51 (0.73) 20.32 (2.31) 34.38 (0.70) 2012 33,072 37.67 (0.40) 33.83 (0.37) 39.04 (0.74) 25.57 (2.37) 31.43 (0.62) Agea — 54.06 (0.19) 41.77 (0.11) 39.04 (0.21) 38.98 (0.56) 40.80 (0.17) Abbreviation: —, not applicable. a Mean (SE) age was 46 (0.11) years. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. www.cdc.gov/pcd/issues/2017/16_0034.htm • Centers for Disease Control and Prevention 7 PREVENTING CHRONIC DISEASE VOLUME 14, E01 PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY JANUARY 2017 Table 2. Prevalence of 12-Month Engagement in Mindfulness-Based Practices Among Adults (Aged ≥18 y), by Employment Status and Occupation, National Health Interview Survey Alternative Medicine Supplement, 2002, 2007, and 2012 2002 2007 2012a Practice/Occupation Status % (Standard Error) Yoga Unemployed 3.71 (0.20) 4.75 (0.29) 6.59 (0.30) All workers 5.95 (0.21) 6.85 (0.29) 11.00 (0.34) White-collar workers 8.26 (0.32) 9.33 (0.41) 14.22 (0.48) Service workers 4.53 (0.47) 6.29 (0.60) 10.67 (0.66) Farm workers 1.50 (0.70) — 2.33 (1.69) Blue-collar workers 1.72 (0.18) 1.39 (0.26) 3.07 (0.33) Meditation Unemployed 6.89 (0.30) 8.76 (0.41) 3.64 (0.22) All workers 8.01 (0.25) 9.93 (0.32) 4.41 (0.21) White-collar workers 9.79 (0.34) 12.25 (0.48) 5.22 (0.29) Service workers 7.65 (0.60) 9.27 (0.65) 5.36 (0.51) Farm workers 1.59 (0.79) 5.79 (2.46) 0.19 (0.19) Blue-collar workers 4.91 (0.38) 5.67 (0.61) 1.70 (0.25) Tai chi Unemployed 1.35 (0.14) 0.99 (0.15) 1.03 (0.10) All workers 1.23 (0.10) 1.08 (0.10) 1.21 (0.10) White-collar workers 1.55 (0.14) 1.23 (0.15) 1.38 (0.15) Service workers 1.22 (0.23) 1.17 (0.24) 1.21 (0.22) Farm workers — Blue-collar workers 0.56 (0.13) 0.72 (0.17) 0.86 (0.18) Qigong Unemployed 0.25 (0.05) 0.34 (0.09) 0.28 (0.05) All workers 0.27 (0.04) 0.26 (0.05) 0.39 (0.05) White-collar workers 0.36 (0.07) 0.28 (0.06) 0.49 (0.08) Service workers 0.08 (0.05) 0.30 (0.12) 0.43 (0.10) Farm workers — Blue-collar workers 0.16 (0.07) 0.14 (0.08) 0.12 (0.06) Any of the 4 practicesb Unemployed 9.48 (0.32) 11.74 (0.46) 9.32 (0.35) All workers 11.68 (0.31) 14.34 (0.37) 13.64 (0.37) White-collar workers 15.05 (0.44) 18.16 (0.53) 17.21 (0.51) Service workers 10.05 (0.69) 13.47 (0.80) 13.74 (0.79) Farm workers 2.20 (0.90) 5.73 (2.43) 2.42 (1.71) Blue-collar workers 5.83 (0.39) 6.72 (0.63) 4.52 (0.40) Abbreviation: —, data not available. a 2012 Prevalences of meditation and all 4 practices are not comparable to previous years because of substantial changes in the meditation questions. b Yoga, meditation, tai chi, or qigong. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. 8 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2017/16_0034.htm PREVENTING CHRONIC DISEASE VOLUME 14, E01 PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY JANUARY 2017 Table 3. Multivariable Logistic Regression Results, Odds of 12-Month Engagement in Mindfulness-Based Practices Among Adult (Aged ≥18 y) Worker Subgroups, National Health Interview Survey Alternative Medicine Supplement, 2002, 2007, and 2012a Model 1 Model 2 Model 3 Characteristic Odds Ratio (95% Confidence Interval) Meditation in Previous 12 Months (2002 and 2007 Data Only) Employment/occupation White-collar worker 1 [Reference] Unemployed 0.69 (0.63–0.75) 0.75 (0.68–0.83) 1.00 (0.89–1.13) Service worker 0.81 (0.65–0.85) 0.76 (0.67–0.87) 0.95 (0.81–1.11) Farm worker 0.21 (0.12–0.40) 0.30 (0.15–0.58) 0.54 (0.26–1.09) Blue-collar worker 0.43 (0.39–0.53) 0.52 (0.44–0.60) 0.71 (0.59–0.85) Age 0.99 (0.99–1.00) 1.00 (0.99–1.00) Sex Female 1 [Reference] Male 0.80 (0.74–0.86) 0.77 (0.71–0.84) Race/ethnicity Non-Hispanic white 1 [Reference] Hispanic 0.58 (0.50–0.67) 0.71 (0.60–0.85) Non-Hispanic black 0.93 (0.83–1.05) 0.98 (0.86–1.11) Asian 1.03 (0.86–1.24) 1.00 (0.81–1.23) Other 1.52 (1.03–2.25) 1.55 (1.00–2.40) Education level <High school diploma 1 [Reference] High school diploma 1.61 (1.31–1.98) >High school diploma 3.58 (2.97–4.31) Income-to-poverty ratiob 1.01 (1.00–1.02) Yoga in Previous 12 Months Employment/occupation White-collar worker 1 [Reference] Unemployed 0.44 (0.41–0.48) 0.56 (0.51–0.60) 0.86 (0.77–0.95) Service worker 0.66 (0.59–0.74) 0.66 (0.60–0.74) 0.94 (0.83–1.06) Farm worker 0.13 (0.06–0.29) 0.21 (0.09–0.48) 0.39 (0.14–1.03) Blue-collar worker 0.18 (0.15–0.21) 0.29 (0.25–0.34) 0.46 (0.39–0.55) Age 0.97 (0.97–0.98) 0.97 (0.97–0.98) Sex Female 1 [Reference] a Model 1 adjusted for survey year only; Model 2 adjusted for survey year, age, sex, and race/ethnicity; and Model 3 adjusted for survey year, age, sex, race/ethni- city, income, and education level. b 14 Ordinal categories. c Data not presented because of small sample size. d Yoga, meditation, tai chi, or qigong. (continued on next page) The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. www.cdc.gov/pcd/issues/2017/16_0034.htm • Centers for Disease Control and Prevention 9 PREVENTING CHRONIC DISEASE VOLUME 14, E01 PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY JANUARY 2017 (continued) Table 3. Multivariable Logistic Regression Results, Odds of 12-Month Engagement in Mindfulness-Based Practices Among Adult (Aged ≥18 y) Worker Subgroups, National Health Interview Survey Alternative Medicine Supplement, 2002, 2007, and 2012a Model 1 Model 2 Model 3 Characteristic Odds Ratio (95% Confidence Interval) Male 0.36 (0.33–0.39) 0.34 (0.31–0.38) Race/ethnicity Non-Hispanic white 1 [Reference] Hispanic 0.45 (0.40–0.50) 0.65 (0.57–0.74) Non-Hispanic black 0.44 (0.40–0.49) 0.55 (0.49–0.62) Asian 1.19 (1.03–1.36) 1.17 (1.00–1.36) Other 0.92 (0.65–1.30) 1.04 (0.73–1.48) Education level <High school diploma 1 [Reference] High school diploma 1.67 (1.30–2.14) >High school diploma 4.51 (3.53–5.77) Income-to-poverty ratiob 1.06 (1.05–1.07) Tai Chi in Previous 12 Months Employment/occupation White-collar worker 1 [Reference] Unemployed 0.80 (0.67–0.97) 0.80 (0.65–0.98) 1.12 (0.87–1.43) Service worker 0.88 (0.67–1.14) 0.92 (0.71–1.20) 1.20 (0.91–1.58) Farm worker —c Blue-collar worker 0.51 (0.38–0.68) 0.55 (0.41–0.75) 0.88 (0.63–1.22) Age 1.00 (1.00–1.01) 1.01 (1.00–1.01) Sex Female 1 [Reference] Male 0.97 (0.83–1.13) 0.94 (0.79–1.12) Race/ethnicity Non-Hispanic white 1 [Reference] Hispanic 0.62 (0.48–0.79) 0.76 (0.58–1.00) Non-Hispanic black 0.99 (0.79–1.24) 1.06 (0.84–1.35) Asian 2.43 (1.87–3.15) 2.28 (1.72–3.04) Other 2.36 (1.40–3.98) 2.91 (1.72–4.91) Education level <High school diploma 1 [Reference] High school diploma 1.64 (1.04–2.59) a Model 1 adjusted for survey year only; Model 2 adjusted for survey year, age, sex, and race/ethnicity; and Model 3 adjusted for survey year, age, sex, race/ethni- city, income, and education level. b 14 Ordinal categories. c Data not presented because of small sample size. d Yoga, meditation, tai chi, or qigong. (continued on next page) The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. 10 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2017/16_0034.htm