The Role of Complementary and Alternative Medicine in the Socioeconomic Status-Health Relationship: Measurement, Mediation, and Moderation

Abstract

This dissertation examines whether complementary and alternative medicines (CAMs) form an alternative health lifestyle that contributes to socioeconomic disparities in health. This research contributes a systematic measurement of alternative health lifestyles to the field of health lifestyles research by examining patterns of CAM use, a subset of health behaviors used by a substantial portion of the population. Exploratory and confirmatory factor analyses on data from the Midlife in the United States (MIDUS) survey reveal four distinct dimensions of alternative health lifestyle: Mind-Body Medicine, Alternative Medical Systems, Physical and Nutritional Approaches, and Manipulative Treatments. These findings indicate that CAM use, like other health behaviors, is patterned. Drawing on Health Lifestyles Theory, I examine associations between socioeconomic status (SES) and alternative health lifestyles using generalized linear mixed modeling. Results reveal a strong, consistent association with education but not income. This finding supports Health Lifestyles Theory's assertion that members of the same status group tend to share similar health lifestyles. Health lifestyles are based on choices available according to opportunities and resources. Members of the same status group tend to share similar opportunities and resources. Additionally, similarities in socialization and experience shape perceptions, beliefs, and attitudes, including toward matters of health, shaping health lifestyle choices. Health Lifestyles Theory focuses largely on education's role as a structural variable, however these findings also support Human Capital Theory. Human Capital Theory emphasizes education's impact on health lifestyle through its ability to increase effective agency. Higher education increases both learned effectiveness and sense of personal control, enabling the construction of a healthier lifestyle. People with higher SES are more likely to engage in alternative health lifestyles. The next question examined by this dissertation is whether greater use of CAMs contributes to better health among high SES compared to lower SES individuals. Results from structural equation models show that alternative health lifestyle does not contribute to socioeconomic disparities in health. These results support the assertion of Fundamental Causes Theory that SES is a fundamental social cause of health, meaning the relationship between SES and health is enduring, maintained by the multiplicity of mechanisms generated by the social conditions associated with SES. Results also show that worse health is associated with greater CAM use, indicating that people tend to use CAMs to address poor health rather than to prevent disease. Finally, I examine SES as a moderator of the relationship between change in health status and change in CAM use. A change in health status, such as the development of a new chronic condition, represents a crucial point in predicting future health and wellness. Differences in response to a change in health status by SES may contribute to socioeconomic disparities in health and wellness across the lifespan as people develop chronic conditions. Results show that economic constraints and resources associated with education do not shape access to CAMs for the chronically ill. In fact, members of low and high education groups who develop new chronic conditions tend to adopt CAMs at the same rate. This indicates that CAMs are accessible to the chronically ill with lower education, and something other than the health-related knowledge, skills, and psychosocial resources associated with higher education influence CAM use.