Religion, health, and psychological well-being in older adults: findings from three national surveys

What's God Got to Do with It? How Religiosity Predicts Atheists' Health

The relationship between atheism and health is poorly understood within the Religion/Spirituality-health literature. While the extant literature promotes the idea that Attendance, Prayer, and Religiosity are connected to positive health outcomes, these relationships have not been established when controlling for whether a person is an atheist. Data from the 2008-2012 American General Social Survey (n = 3210) were used to investigate this relationship. Results indicated that atheists experienced Religiosity more negatively than non-atheists. Additionally, results demonstrated that non-belief in God was not related to better or worse perceived global health, suggesting that belief in God is not inherently linked to better reported health.

Is religiosity associated with cancer screening? Results from a national survey

This study examined the following: (1) relationships between religiosity-as measured by religious service attendance-and screening for breast, cervical, and colorectal cancers; (2) the potential mediating role of social support; and (3) the potential moderating effect of race/ethnicity. Statistical analyses showed that religiosity was associated with greater utilization of breast, cervical, and colorectal cancer screening. Social support fully mediated the relationship between religiosity and Pap screening, and partially mediated the relationship between religiosity and colorectal screening, but had no effect on the relationship between religiosity and mammography screening. Race/ethnicity moderated the relationship between religiosity and social support in the cervical cancer screening model, such that the positive association between religiosity and social support was stronger for non-Hispanic Blacks than it was for non-Hispanic Whites. These findings have implications for the role of social networks in health promotion and can inform cancer screening interventions in faith-based settings.

Belief in life after death, salivary 3-methoxy-4-hydroxyphenylglycol, and well-being among older people without cognitive impairment dwelling in rural Japan

OBJECTIVES

Research has found that spirituality/religiosity has a salutary association with mental/physical health. However, the association of belief in life after death with well-being has rarely been studied, and the same is true of its association with biological indices, such as monoamine transmitters. Therefore, we examined the associations between well-being and religiosity, salivary 3-methoxy-4-hydroxyphenylglycol (sMHPG), and demographic characteristics.

METHODS

The participants were 346 community-dwelling people, aged 65 years or older, without cognitive or mental deficits, in rural Japan. Measures of religiosity consisted of belief in life after death, attachment to life, and experiences related to death and religion. The measures were assessed by scales specifically suited for Japanese religious orientations. Participants' well-being was assessed by a life satisfaction scale containing two subscales. We also measured sMHPG, a major metabolite of noradrenaline that is thought to reflect certain psychological states, such as psychomotor retardation and effortful attention.

RESULTS

One subscale of life satisfaction was positively associated with belief in life after death and sMHPG, and the other life satisfaction subscale was positively associated with education and death/religion-related experiences (e.g., visiting family graves or loss of a friend). Gender differences were found in afterlife beliefs and each life satisfaction subscale.

CONCLUSIONS

These results suggest that religiosity, including belief in life after death and death/religion-related experiences, is salubriously associated with mental health among older people, especially women, living in rural Japan. The basal level of sMHPG was positively associated with life satisfaction, but not with belief in life after death.

Differences in life satisfaction among older community-dwelling Hispanics and non-Hispanic Whites

OBJECTIVES

Hispanics are the fastest growing ethnic/racial group of the older adult population in the United States, yet little is known about positive mental health in this group. We examined differences in life satisfaction between demographically matched groups of older Hispanics and non-Hispanic Whites, and sought to identify specific factors associated with these differences

METHODS

Participants included 126 community-dwelling English-speaking Hispanics aged 50 and older, and 126 age-, gender-, and education-matched non-Hispanic Whites. Participants completed standardized measures of life satisfaction and postulated correlates, including physical, cognitive, emotional and social functioning, as well as positive psychological traits and religiosity/spirituality.

RESULTS

Hispanics reported greater life satisfaction than non-Hispanic Whites (p < 0.001). Ethnic groups were comparable on most postulated correlates of life satisfaction, except that Hispanics had lower levels of cognitive performance, and higher levels of daily spiritual experiences, private religious practices and compassion (ps < 0.001). Among these factors, spiritual experiences, religious practices, and compassion were significantly associated with life satisfaction in the overall sample. Multivariable analyses testing the influence of these three factors on the association between ethnicity and life satisfaction showed that higher spirituality among Hispanics accounted for ethnic differences in life satisfaction.

CONCLUSION

English-speaking Hispanics aged 50 and older appeared to be more satisfied with their lives than their non-Hispanic White counterparts, and these differences were primarily driven by higher spirituality among Hispanics. Future studies should examine positive mental health among various Hispanic subgroups, including Spanish speakers, as an important step toward development of culturally sensitive prevention and intervention programs aimed at promoting positive mental health.

Religiosity and well-being of older adults in Chennai, India

OBJECTIVES

Using the theory of religious effects (Journal for the Scientific Study of Religion, 42, 17-30 ( 2003 )), the current study examined the relationship among religiosity, psychosocial resources (social support and mastery) and psychological distress.

METHOD

Through face-to-face interviewing, data were collected from 321 randomly selected older adults in Chennai, India. Structural equation modelling (SEM) was conducted to test the direct-effect and the mediation models. The direct-effect model posited a direct inverse relation between religiosity and psychological distress. The mediation model posited that psychosocial resources mediate the influence of religiosity on psychological distress.

RESULTS

The fit indices supported a partial mediation model. Psychosocial resources partially mediated the influence of religiosity on psychological distress.

CONCLUSION

These findings suggest the crucial role of religiosity in influencing the well-being of older adults. The need to integrate religiosity in interventions for older Indian adults is discussed.

Inflammation and Coagulation as Mediators in the Relationships Between Religious Attendance and Functional Limitations in Older Adults

OBJECTIVE

The aim of this study was to examine inflammation and coagulation, which are positively linked to disability and inversely linked to increased religious attendance, as mediators in the cross-sectional relationships between religious attendance and functional status.

METHOD

Frequency of attendance and limitations in basic activities of daily living (ADLs), instrumental activities (IADLs), and mobility were assessed in 1,423 elders.

RESULTS

More frequent attendance was associated with fewer ADL, IADL, and mobility limitations, and with lower levels of inflammation and coagulation including interleukin-6, soluble vascular cell adhesion molecule, and D-dimer. Inflammation and coagulation partially mediated the associations between attendance and function. Eight percent of the effect of attendance on ADL (p = .014), 5% of the effect on IADL (p = .003), and 8% of the effect on mobility (p = .001) limitations were due to inflammation and coagulation.

DISCUSSION

Relationships between attendance and function may be due in part to lower levels of inflammation and coagulation among elders who attend services.

Spiritual/religious coping in patients with epilepsy: relationship with sociodemographic and clinical aspects and quality of life

One hundred and ten patients with epilepsy with a mean age of 45.9 were assessed by a clinical-neurological evaluation, Quality of Life in Epilepsy Inventory-31 (QOLIE-31), and the Spiritual/Religious Coping (SRCOPE) Scale. The objective of this study was to evaluate if patients with epilepsy used positive and/or negative spiritual/religious coping and the relationships between this type of coping and the sociodemographic and clinical aspects of epilepsy and the QOLIE-31. A greater use of positive coping (3.0±0.7) than negative coping (2.3±0.7) was found. The use of the positive factor was greater in mesial temporal lobe epilepsy (MTLE) than in other types of epilepsy. The ratio of negative/positive coping was associated with lower scores in the QOLIE-31 (-0.222; p=0.036). Patients with epilepsy appear to use spiritual/religious coping, especially those with MTLE, and a predominance of negative coping was associated with a reduced quality of life. Future studies should evaluate interventions considering the knowledge of spiritual/religious strategies by the patients.

Psychosocial and cognitive health differences by caregiver status among older Mexican Americans

This study identifies the risk and protective factors associated with informal caregiving by older (≥70 years) Mexican Americans and profiles caregiving arrangements. Overall, a greater number of informal caregivers (n = 92) were married and female. They also had higher physical functioning and better cognition than non-caregivers (n = 1,888) but fewer visited a physician regularly. Informal caregivers also showed an increased risk of depressive symptoms. A third of caregivers spent more than 20 h/day caregiving and the majority (84%) of care recipients were family members. In order to support the efforts of this disproportionately burdened caregiver group, increased social support and healthcare services are needed.

Two years after cancer diagnosis, what is the relationship between health-related quality of life, coping strategies and spirituality?

This study aimed to analyze the relationship between spirituality, coping strategies and health-related quality of life (HRQL) among a large representative sample of patients two years after cancer diagnosis. Using a cross-sectional design, medical and self-reported data were collected by physicians and a patient telephone interview, respectively. Among 4270 participants, 54.6% reported that spirituality was not a source of comfort at all during the disease, 23.4% stated that it was a source of moderate comfort and 22.5% a source of great comfort. After adjustment for age, gender, educational level and living in a couple, a multivariate analysis showed that a lower mental HRQL score was independently associated with finding moderate comfort in spirituality when compared with finding no comfort at all. After multiple adjustment, a lower score of physical HRQL and a higher score of fighting spirit were independently associated with having found great comfort in spirituality when compared with those who found no comfort at all. This study aimed to understand the dynamics of religious beliefs among cancer patients over the disease duration and to understand how these beliefs could be considered and utilized by patients as a source of comfort and support. The results highlight not only the role spirituality may play in disease management and the extent to which it may be a valuable source of comfort during the follow-up of cancer patients, but also its role in the evaluation of the different dimensions of HRQL.

Religious attendance and loneliness in later life

PURPOSE OF THE STUDY

Studies show that loneliness is a major risk factor for health issues in later life. Although research suggests that religious involvement can protect against loneliness, explanations for this general pattern are underdeveloped and undertested. In this paper, we propose and test a theoretical model, which suggests that social integration and social support are key mechanisms that link religious attendance and loneliness.

DESIGN AND METHODS

To formally test our theoretical model, we use data from the National Social Life Health and Aging Project (2005/2006), a large national probability sample of older adults aged 57-85 years.

RESULTS

We find that religious attendance is associated with higher levels of social integration and social support and that social integration and social support are associated with lower levels of loneliness. A series of mediation tests confirm our theoretical model.

IMPLICATIONS

Taken together, our results suggest that involvement in religious institutions may protect against loneliness in later life by integrating older adults into larger and more supportive social networks. Future research should test whether these processes are valid across theoretically relevant subgroups.

Spirituality and severity of menopausal symptoms in a sample of religious women

Menopause represents an important life change, particularly for religious women whose identity is significantly related to family. Two competing hypotheses are examined: one, because religious women have their identity focused on family and child rearing, spirituality will be related to increased menopausal symptoms because menopause represents a loss of identity and purpose; and two, because spirituality can provide strength and comfort during difficult times, it will, therefore, be related to decreased menopausal symptoms. To test these competing hypotheses, questionnaires were administered to 218 women (average age 55, 35% premenopausal, 26% peri-menopausal, 39% postmenopausal) who were members of the Church of Jesus Christ of Latter Day Saints. Regression analyses indicated that higher levels of spiritual strength were related to decreased levels of reported menopausal symptoms. Spiritual strength was also related to increased benefit finding during menopause, decreased concern with body appearance, and increased use of adaptive coping strategies. We conclude that finding strength in spirituality may help religious women cope better with the life changes associated with menopause.

Theory in religion, aging, and health: an overview

This paper provides an overview of theory in religion, aging, and health. It offers both a primer on theory and a roadmap for researchers. Four "tenses" of theory are described--distinct ways that theory comes into play in this field: grand theory, mid-range theory, use of theoretical models, and positing of constructs which mediate or moderate putative religious effects. Examples are given of both explicit and implicit uses of theory. Sources of theory for this field are then identified, emphasizing perspectives of sociologists and psychologists, and discussion is given to limitations of theory. Finally, reflections are offered as to why theory matters.

Sociodemographic predictors of elderly's psychological well-being in Malaysia

BACKGROUND AND OBJECTIVE

Psychological well-being as one of the most important indicators of successful aging has received substantial attention in the gerontological literature. Prior studies show that sociodemographic factors influencing elderly's psychological well-being are multiple and differ across cultures. The aim of this study was to identify significant sociodemographic predictors of psychological well-being among Malay elders.

METHODOLOGY

The study included 1415 older Malays (60-100 years, 722 women), randomly selected through a multistage stratified random method from Peninsular Malaysia. WHO-Five well-being index was used to measure psychological well-being. Data analysis was conducted using the Statistical Package for Social Sciences (SPSS) version 13.0.

RESULTS

Using multiple regression analysis a significant model emerged (F(7, 1407) = 20.14, p ≤ 0.001), where age, sex, marital status, and household income were significant predictor variables of psychological well-being among Malay elders. However, level of education, employment status, and place of residence failed to predict psychological well-being.

CONCLUSION

This study showed that the oldest old, elderly women, unmarried, and the poor elderly people are at risk for experiencing low psychological well-being. Therefore, they need special attention from family, policy makers, and those who work with elderly people.

The influence of religiosity on health

The relationship between religion and health has been a subject of interest in the past and in the latest years becoming increasingly visible in the social, behavioral, and health sciences. Among several approaches to be considered, the present work provides a briefly discuss concerning the bond between health and religiosity in the cure process and diseases treatment. Several investigations show that religious participation is related with better outcomes for persons who are recovering from physical and mental illness, also the psychology science have committed special issues to positive correlations between religious belief and practice, mental and physical health and longevity. On the other hand, religion may also be associated with negative outcomes and the inappropriate use of health services as fanaticism, asceticism, mortifications and oppressive traditionalism. The potential for both positive and negative effects of spirituality on health, combined with the high levels of engagement with spirituality suggests that this area is ripe for future sustained research. Independent of the possible mechanisms, if individuals receive health profits by the religion; those should be motivated, respecting the individual faith of each one.

A Descriptive Analysis of Religious Involvement Among Older Adults In Japan

The purpose of this study was to conduct a descriptive analysis of multiple dimensions of religion with data provided by a nationwide sample of older people in Japan. Six dimensions of religion were evaluated: Religious affiliation, involvement in formal religious organizations, private religious practices, the functions of prayer, belief in punishment by supernatural forces, and beliefs about the afterlife. In addition to describing these facets of religion for the sample as a whole, tests were also performed to see if they vary by age, sex, marital status, education, and whether older Japanese people live in rural or urban areas. The findings suggest that even though older people in Japan are not highly involved in formal religious institutions, they frequently engage in private religious practices. Moreover, the data reveal that while older people in Japan do not often endorse some religious beliefs (e.g., beliefs about the quality of the afterlife), they strongly adhere to others (e.g., beliefs about punishment by supernatural forces). Significant and fairly consistent variations by gender and rural versus urban residence were also observed across the measures of religiousness.

Resiliency in the face of disadvantage: do Hispanic cultural characteristics protect health outcomes?

Hispanics living in the United States may face substantial adversity, given stresses of immigration and acculturation, low incomes, poor educational and occupational opportunities, inadequate access to health care, and exposure to discrimination. Despite these disadvantages, the Hispanic population often shows equal or better health outcomes when compared to non-Hispanic Whites, a trend that has puzzled researchers and has been referred to as the "Hispanic Paradox." Hispanics with non-U.S. nativity also tend to show better health than those born in the United States, although this advantage dissipates with increasing time spent in the United States. The current article discusses the Reserve Capacity Model (L.C. Gallo & K. A. Matthews, 2003) as a potential framework for understanding how psychosocial risk and resilient factors may contribute to health disparities associated with broad sociocultural factors, such as low socioeconomic status or minority ethnicity. In addition, we examine theory concerning features of the Hispanic culture that may enhance resilience (e.g., social resources, familism, religiousness; G. Marin & B. V. Marin, 1991) in the face of adverse circumstances. We summarize some of our recent work that has empirically tested effects of risk and resilient factors in Hispanic health in the contexts of prostate cancer and cardiovascular disease. We conclude by discussing future directions and opportunities for researchers interested in culture-specific resiliency factors in relation to health outcomes.

Spirituality, depression, living alone, and perceived health among Korean older adults in the community

Both theoretical and empirical studies have documented the protective effect of religiosity and spirituality on general health in older adults in community and hospital settings; however, no study has documented the relationship between spirituality and depression among older adults living alone in communities in Korea. We tested two hypotheses: Hypothesis 1: Korean older adults living alone would be more depressed and less healthy than older adults living with family, and Hypothesis 2: Individuals who are more religious and spiritual would report a lower level of depression and a higher level of general health even when other demographic and living status variables are controlled. A descriptive, comparative, and correlational design with a convenience sampling method was conducted among community-dwelling Korean older adults in Chounbook Providence, South Korea. This study included 152 men and women older than 65 years old. Hypothesis 1 was supported as Korean older adults living alone were significantly more depressed than were older adults living with family (P<.01). However, for Hypotheses 2, only spirituality activities and Spirituality Index of Well-Being scores were significantly associated with general health and/or depression (P<.01), but there were no relationships between the variables of attendance and importance of religion with general health and depression.

Care partner responses to the onset of mild cognitive impairment

PURPOSE

We examined characteristics, responses, and psychological well-being of care partners who support and assist older adults recently diagnosed with mild cognitive impairment (MCI).

DESIGN AND METHODS

Based on a sample of 106 care partners of community residents diagnosed with MCI at memory clinics, we conducted face-to-face interviews including scales and open-ended questions. Measures tapped elements of the caregiver stress process model advanced by Pearlin and associates (1990, Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30, 583-594), including background characteristics, knowledge and attitude resources, stressors, strains, and protective conditions. The outcome was psychological well-being as indexed by depressive symptoms.

RESULTS

Care partners' depressive symptoms were higher in the context of poorer health, lower perceived importance of religion, less knowledge about dementia, being more bothered by the older adult's MCI symptoms, having a lower sense of environmental mastery, more perceived burden, more frequent use of coping strategies, and more social support. Narratives revealed multiple dimensions of stress, strain, and frustration, regardless of the level of depressive symptoms.

IMPLICATIONS

Assisting a relative with MCI presents new and complex challenges, even though it is an early caregiving role. Care partners likely would benefit from strategies aimed at reducing self-blame, enhancing coping skills, sustaining their sense of mastery, managing their health, seeking and accepting respite, and communicating effectively with the person with MCI and significant others.

Análise empírica do senso de controle: buscando entender o excesso de confiança

No emergente campo das finanças comportamentais, em cujo contexto são abordados detalhes do comportamento humano, relativos à tomada de decisões financeiras, estes detalhes são considerados implicações da psicologia cognitiva e da sociologia. Desse modo, a ainda pequena, porém crescente, produção científica acerca dessa temática no âmbito nacional, tem considerado essencialmente as conseqüências dos vieses cognitivos dos agentes, que podem comprometer a validade de julgamentos realizados. Alguns dos vieses cognitivos, como o excesso de confiança e a procrastinação, considerados na literatura, sofrem influência do senso de controle que cada indivíduo possui. Desse modo, o objetivo deste artigo é verificar associações entre idade e senso de controle, analisando os efeitos mediadores de outras características pessoais sobre essa associação. O estudo é conduzido a partir de dados coletados no primeiro trimestre de 2006, em 421 indivíduos residentes no Brasil. Os principais resultados sugerem uma associação quadrática significativa, do tipo U invertido, entre idade e senso de controle, estando essa relação sob a influência da educação e da percepção de saúde geral do indivíduo. Assim, parece que as pessoas têm a evolução de seu senso de controle ao longo da vida mediada pela sua educação, como também por sua saúde.

Development and Validation of Instruments to Assess Potential Religion-Health Mechanisms in an African American Population

The health disparities that negatively affect African Americans are well-documented; however, there are also many sociocultural factors that may play a protective role in health outcomes. Religious involvement is noted to be important in the African American community and to have a positive association with health outcomes. However, few studies have explained why this relationship exists. This article reports on the development and validation of instruments to assess two proposed mediators of the relationship between religiosity and health for an African American population; perceived religious influence on health behaviors and illness as punishment from a higher power. We used a systematic iterative process, including interviews and questionnaire data from African Americans who provided feedback on item wording. We also solicited input from African American pastors. In a sample of 55 African Americans, the instruments appeared to have strong internal reliability (alpha = .74 and .91, respectively) as well as test-retest reliability (r = .65, .84, respectively, p < .001). Evidence far construct validity is also discussed, as are recommendations for health disparities research using these instruments.

Hitting the target: why existing measures of "religiousness" are really reverse-scored measures of "secularism"

Over 100 measures of religiousness and spirituality are used in research investigating the associations between religion and health. These measures are often used to assess "religiousness in general," but this approach lumps together widely divergent worldviews in ways that can distort religion beyond recognition. The authors suggest that the existing measures of religiousness are perhaps better understood as reverse-coded measures of "secularism." This argument suggests that the existing data regarding religiousness and health might be best interpreted as demonstrating a small, robust health liability associated with a deliberately secular worldview. If true, this conclusion might change the direction of future research, and it would imply that meaningful inferences about the health associations of religious practice will depend on developing tools that measure specific religions in their particularity.

Religiousness/spirituality and mental health among older male inmates

PURPOSE

With the rapid growth in the older inmate population, emerging issues regarding physical and mental health require greater research and clinical attention. We examined the relation of religiousness/spirituality; demographic characteristics such as age, race, and type of crime; and physical and mental health among 73 older male inmates in the state of Alabama.

DESIGN AND METHODS

Inmates older than age 50 who passed a cognitive screening completed face-to-face interviews lasting between 30 and 60 min. Due to the low literacy rates of the participants, we administered all measures orally with response cards to facilitate understanding.

RESULTS

Nearly 70% of the inmates were incarcerated for murder or sexual crimes. There were no racial/ethnic differences in reported religiousness/spirituality, demographic characteristics, or mental health. We found an association between self-reported years of incarceration and experienced forgiveness. Three regression models examined whether inmates' self-reported religiousness/spirituality influenced anxiety, depression, and desire for hastened death. We found that having a greater number of daily spiritual experiences and not feeling abandoned by God were associated with better emotional health.

IMPLICATIONS

Future studies, perhaps using longitudinal or case-control methodology, should examine whether increased daily spiritual experiences and decreased feelings of abandonment by God foster better mental health among older inmates.

The role of coping humor in the physical and mental health of older adults

OBJECTIVES

This study examined the associations among coping humor, other personal/social factors and the health status of community-dwelling older adults.

METHOD

Survey questionnaires were completed with 73 community-dwelling older adults. Included were measures of coping humor, spirituality, self-efficacy, social support and physical and mental health status.

RESULTS

Correlations across all variables showed coping humor to be significantly associated with social support, self-efficacy, depression and anxiety. Forward stepwise regression analyses showed that coping humor and self-efficacy contributed to outcome variance in measures of mental health status. Contrary to expectation, neither social support nor spirituality contributed to the total outcome variance on any of the dependent measures.

CONCLUSION

The importance of social support, self-efficacy and spirituality in determining the quality of life of older adults is well supported in the literature. Coping humor as a mechanism for managing the inevitable health stresses of aging has received less attention. This study shows that coping humor and self efficacy are important factors for explaining health status in older adults. Correlations among coping humor, self efficacy and social support suggest that a sense of humor may play an important role in reinforcing self-efficacious approaches to the management of health issues.

Personality, Negative Interactions, and Mental Health

Research suggests that an individual's personality traits may mediate the relationship between social support and mental health. This study uses two national data sets to test a conceptual model that integrates personality, social support, negative interactions, and psychological distress. Results suggest that, beyond the influence of personality, social support is negatively associated with psychological distress, and negative interactions are positively associated with such distress. The findings also suggest that personality has direct and indirect effects, through social support and negative interactions, on psychological distress. Findings specify how positive and negative facets of relationships and personality influence mental health outcomes.

Spirituality and autonomic cardiac control

BACKGROUND

Spirituality has been suggested to be associated with positive health, but potential biological mediators have not been well characterized.

PURPOSE AND METHODS

The present study examined, in a population-based sample of middle-aged and older adults, the potential relationship between spirituality and patterns of cardiac autonomic control, which may have health significance. Measures of parasympathetic (high-frequency heart rate variability) and sympathetic (pre-ejection period) cardiac control were obtained from a representative sample of 229 participants. Participants completed questionnaires to assess spirituality (closeness to and satisfactory relationship with God). Personality, demographic, anthropometric, health behavior, and health status information was also obtained. A series of hierarchical regression models was used to examine the relations between spirituality, the autonomic measures, and two derived indexes--cardiac autonomic balance (CAB, reflecting parasympathetic to sympathetic balance) and cardiac autonomic regulation (CAR, reflecting total autonomic control).

RESULTS

Spirituality, net of demographics, or other variables were found to be associated with enhanced parasympathetic as well as sympathetic cardiac control (yielding a higher CAR) but was not associated with CAB. Although the number of cases was small (N = 11), both spirituality and CAR were significant negative predictors of the prior occurrence of a myocardial infarction.

CONCLUSIONS

In a population-based sample, spirituality appears to be associated with a specific pattern of CAR, characterized by a high level of cardiac autonomic control, irrespective of the relative contribution of the two autonomic branches. This pattern of autonomic control may have health significance.

Perceptions of the religion--health connection among African Americans in the southeastern United States: sex, age, and urban/rural differences

Extensive literature reviews suggest that religiousness is positively associated with health. Much less understood is the particular nature of the religion-health connection. Religion and the church play a central role in the lives of many African Americans. This study used a mixed-methods approach to examine perceptions of the religion-health connection among African Americans in urban and rural areas. Four hundred participants were randomly selected and interviewed by telephone, answering open-ended questions about their perceptions of the role of religiousness in their health. Data were analyzed using an open-coding technique. Codes were arranged into families involving the role of a higher power, health behavior, physical factors, social support, mental health, and contextual factors in determining physical health, as well as the potential negative role of religiousness. Quantitative analysis revealed the stronger presence of themes among women, older participants, and those in rural counties. Applications for theory and health promotion are discussed.

The impact of religiousness, spirituality, and social support on psychological well-being among older adults in rural areas

This paper presents the results of a study on the impact of spirituality, religiousness, and social support on the psychological well-being among rural elderly. With a rural community sample of 215 older adults, hierarchical regression analyses found significant associations between dimensions of spirituality/religiousness, social support, and psychological well-being, with spirituality/religiousness inversely related to depression and social support, positively related to life satisfaction. Findings of this study suggest that practitioners need to develop programs or services that are congruent with religious/spiritual beliefs and practices in order to better enhance the psychosocial well-being and improve the quality of life among older persons in rural areas.

Saúde mental, qualidade de vida e religião em idosos de um Programa de Saúde da Família

OBJETIVO: Avaliar as relações entre as dimensões da vida sociocultural, como rede social de apoio e religião, saúde mental e qualidade de vida (QV) em idosos de um Programa de Saúde da Família (PSF). MÉTODOS: Avaliou-se uma amostra de 82 idosos (> 60 anos), cadastrados em um PSF. Foram descritos o perfil de saúde física e mental, a capacidade funcional e a qualidade de vida, assim como fatores demográficos, socioeconômicos e culturais associados a essas dimensões. Foram utilizados os seguintes instrumentos: Inventário Sociodemográfico, Clínico e de Religiosidade, MINI, WHOQOL-bref e o Índice de Barthel. RESULTADOS: Dos 82 idosos, 47 (57%) eram mulheres e 35 (43%) homens, porquanto 42 (51%) com de idade de 60 a 69 anos e 40 (49%) com idade de 70 anos ou mais. Por meio de modelos multivariados, identificou-se que a presença de transtornos mentais associa-se a morar só ou com apenas uma pessoa. Apresentaram uma pior QV os idosos que não recebem aposentadoria e que fizeram uso de benzodiazepínicos no último ano. A religião revelou-se dimensão importante associada à QV; em todos os domínios da WHOQOL-bref os idosos membros de igrejas evangélicas apresentaram piores escores. CONCLUSÕES: O presente estudo evidencia que idosos com menores escolaridade e renda tendem a ter pior QV e saúde.

The rural context and women's self-management of chronic health conditions

OBJECTIVE

To examine the rural context and describe its influence on the self-management of chronic illness by women living in a rural setting.

METHODS

The Women to Women (WTW) project is a research-based computer intervention that provides health education and peer support to rural women with chronic health conditions. Messages posted to the online support and health education chat rooms were examined to determine the characteristics of the rural context in relation to the women's illness self-management.

RESULTS

'Distance' was the overarching characteristic of the rural context that influenced the women's ability to self-manage their chronic health problems. The effect of distance was woven throughout each of the four predominant themes that emerged from the data as having influence - physical setting, social/cultural/economic environment, nature of women's work, and accessibility/quality of healthcare. These influences affected the women's self-management abilities both negatively and positively.

DISCUSSION

The rural context profoundly influenced the ability of rural women to self-manage their chronic conditions. From the data, health professionals and policy-makers can glean information about the barriers to healthcare faced by rural women who are trying to manage their chronic health problems in comparative isolation.

Religion, spirituality and the well-being of informal caregivers: a review, critique, and research prospectus

The purpose of this article is to review and critique the published literature examining the relationships between religion/spirituality and caregiver well-being and to provide directions for future research. A systematic search was conducted using bibliographic databases, reference sections of articles, and by contacting experts in the field. Articles were reviewed for measurement, theoretical, and design limitations. Eighty-three studies were retrieved. Research on religion/spirituality and caregiver well-being is a burgeoning area of investigation; 37% of the articles were published in the last five years. Evidence for the effects of religion/spirituality were unclear; the preponderance (n = 71, 86%) of studies found no or a mixed association (i.e., a combination of positive, negative, or non-significant results) between religion/spirituality and well-being. These ambiguous results are a reflection of the multidimensionality of religion/spirituality and the diversity of well-being outcomes examined. They also partially reflect the frequent use of unrefined measures of religion/spirituality and of atheoretical approaches to studying this topic. Investigators have a fairly large number of studies on religion/spirituality and caregiver well-being on which to build. Future studies should be theory driven and utilize psychometrically sound measures of religion/spirituality. Suggestions are provided to help guide future work.

Health behaviors and breast cancer: experiences of urban African American women

Breast-cancer survival rates are lower among African American women compared to White women. Obesity may contribute to this disparity. More than 77% of African American women are overweight or obese. Adopting health behaviors that promote a healthy weight status may be beneficial because obesity increases risk for recurrence. Studies among White breast-cancer survivors indicate that many make health behavior changes after diagnosis. This cross-sectional pilot study collected quantitative and qualitative data on the attitudes, beliefs, barriers, and facilitators related to health behavior changes in 27 overweight/obese African American breast-cancer survivors. Results indicated that most participants reported making dietary changes since their diagnosis, and some had increased their physical activity. Focus groups provided rich details on the barriers and facilitators for behavior change. These results begin to address the significant gap in our knowledge of African American breast-cancer survivors' health behaviors and underscore the need for culturally competent health behavior interventions.

Religiousness and mental health: a review

OBJECTIVE: The relationship between religiosity and mental health has been a perennial source of controversy. This paper reviews the scientific evidence available for the relationship between religion and mental health. METHOD: The authors present the main studies and conclusions of a larger systematic review of 850 studies on the religion-mental health relationship published during the 20th Century identified through several databases. The present paper also includes an update on the papers published since 2000, including researches performed in Brazil and a brief historical and methodological background. DISCUSSION: The majority of well-conducted studies found that higher levels of religious involvement are positively associated with indicators of psychological well-being (life satisfaction, happiness, positive affect, and higher morale) and with less depression, suicidal thoughts and behavior, drug/alcohol use/abuse. Usually the positive impact of religious involvement on mental health is more robust among people under stressful circumstances (the elderly, and those with disability and medical illness). Theoretical pathways of the religiousness-mental health connection and clinical implications of these findings are also discussed. CONCLUSIONS: There is evidence that religious involvement is usually associated with better mental health. We need to improve our understanding of the mediating factors of this association and its use in clinical practice.

Challenges to the reproductive-health needs of African women: on religion and maternal health utilization in Ghana

How relevant is religion to our understanding of maternal health (MH) service utilization in sub-Saharan Africa? We ask this question mainly because while the effect of religion on some aspects of reproductive behavior (e.g., fertility, contraception) has not gone unnoticed in the region, very few studies have examined the possible link with MH service utilization. Understanding this link in the context of sub-Saharan Africa is particularly relevant given the overriding influence of religion on the social fabric of Africans and the unacceptably high levels of maternal mortality in the region. As African countries struggle to achieve their stipulated reductions in maternal and child mortality levels by two-thirds by 2015 as part of the Millennium Development Goals, the need to examine the complex set of macro- and micro-factors that affect maternal and child health in the region cannot be underestimated. Using data from the 2003 Ghana Demographic Survey, we found religion (measured by denominational affiliation) to be a significant factor in MH use. This is true even after we had controlled for socio-economic variables. In general, Moslem and traditional women were less likely to use such services compared with Christians. The findings are discussed with reference to our theoretical framework and some policy issues are highlighted.

Religious Influences on Preventive Health Care Use in a Nationally Representative Sample of Middle-Age Women

Despite the many benefits of preventive services, they are often underutilized. Social factors, such as religion, can figure prominently in these discrepancies by either creating barriers or facilitating use. Using data from the Health and Retirement Survey (HRS, 1992-1996), the current study examines the relationship between religious attendance, religious salience, and denomination and three types of female preventive services in a sample of middle-age women (N = 4253). Findings indicate that women who attend religious services more frequently use more mammograms, Pap smears, and self-breast exams. In addition, women belonging to Mainline Protestant or Jewish denominations use certain preventive services more than Evangelical Protestants. Finally, women with higher levels of religious salience are more likely to conduct self-breast exams. These findings add important information to the public health literature concerning factors that influence preventive service use. They also add to the growing field of religion and health research where preventive health care use is emerging as a possible mechanism linking religion to a wide variety of physical health outcomes.

Active coping mediates the association between religion/spirituality and quality of life in ovarian cancer

OBJECTIVES

This study investigated the role of religion/spirituality (R/S) and coping in quality of life (QOL) in 129 women immediately prior to a course of adjuvant chemotherapy for ovarian cancer.

METHODS

Participants completed the COPE, the Functional Assessment of Cancer Therapy-Ovarian (FACT-O), and the Systems of Belief Inventory-15R (SBI-15R). Women averaged 58.9 years of age (SD = 11.5) and were primarily Caucasian (86%), married (74%), and had received at least some college education (67%). Eighty-five percent of the participants had stage III or IV ovarian cancer at study entry.

RESULTS

Correlational analyses revealed that R/S was associated with active coping (r = 0.23, P = 0.022), overall QOL (r = 0.25, P = 0.012), emotional and functional well-being (r = 0.24, P = 0.014 and r = 0.28, P = 0.004), and fewer ovarian cancer-specific concerns (r = 0.27, P = 0.006). In addition, active coping was related to overall QOL (r = 0.22, P = 0.029) and social and functional well-being (r = 0.20, P = 0.042 and r = 0.33, P = 0.001). Tests of mediation between these variables suggested that the positive associations between R/S and functional well-being and R/S and overall QOL were mediated through the use of active coping.

CONCLUSION

Future studies are needed to better understand the complex relationships between R/S, coping, and QOL throughout the ovarian cancer treatment experience.

Methodologic Issues in Research on Religion and Health

This study examines several methodologic issues in research on religion and health, including the measurement of the concept of religion, research designs, sampling, and statistical controls for assessing the "net" effects of religion on health outcomes. It briefly discusses differences in analytical perspectives that have contributed to the debate about the effects of religion on health. The authors review some of the methodologic problems of past research in this area of study and address what needs to be done to enhance the quality of the research. The authors conclude that the research methodology used in studies of religion and health has improved over time and that it continues to do so.

Resources Predicting Positive and Negative Affect During the Experience of Stress: A Study of Older Asian Indian Immigrants in the United States

PURPOSE

Using the life stress model of psychological well-being, in this study we examined risks and resources predicting the occurrence of both positive and negative affect among older Asian Indian immigrants who experienced stressful life events.

DESIGN AND METHODS

We collected data through a telephone survey of 226 respondents (aged 50 years and older) in the Southeastern United States. We used hierarchical, negative binomial regression analyses to examine correlates of positive and negative affect.

RESULTS

Different coping resources influenced positive and negative affect when stressful life events were controlled for. Being female was a common risk factor for poorer positive and increased negative affect. Satisfaction with friendships and a cultural or ethnic identity that is either bicultural or more American were predictive of greater positive affect. Greater religiosity and increased mastery were resources predicting less negative affect.

IMPLICATIONS

Cognitive and structural interventions that increase opportunities for social integration, increasing mastery, and addressing spiritual concerns are discussed as ways of coping with stress to improve the well-being of individuals in this immigrant community.