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Woodard N, Butler J, Ghosh D, Green KM, Knott CL. The Association between State-Level Structural Racism and Alcohol and Tobacco Use Behaviors among a National Probability Sample of Black Americans. Cancer Epidemiol Biomarkers Prev 2024; 33:261-269. [PMID: 38032218 PMCID: PMC10872984 DOI: 10.1158/1055-9965.epi-23-0873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/24/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Structural racism is how society maintains and promotes racial hierarchy and discrimination through established and interconnected systems. Structural racism is theorized to promote alcohol and tobacco use, which are risk factors for adverse health and cancer-health outcomes. The current study assesses the association between measures of state-level structural racism and alcohol and tobacco use among a national sample of 1,946 Black Americans. METHODS An existing composite index of state-level structural racism including five dimensions (subscales; i.e., residential segregation and employment, economic, incarceration, and educational inequities) was merged with individual-level data from a national sample dataset. Hierarchical linear and logistic regression models, accounting for participant clustering at the state level, assessed associations between structural racism and frequency of alcohol use, frequency of binge drinking, smoking status, and smoking frequency. Two models were estimated for each behavioral outcome, one using the composite structural racism index and one modeling dimensions of structural racism in lieu of the composite measure, each controlling for individual-level covariates. RESULTS Results indicated positive associations between the incarceration dimension of the structural racism index and binge drinking frequency, smoking status, and smoking frequency. An inverse association was detected between the education dimension and smoking status. CONCLUSIONS Results suggest that state-level structural racism expressed in incarceration disparities, is positively associated with alcohol and tobacco use among Black Americans. IMPACT Addressing structural racism, particularly in incarceration practices, through multilevel policy and intervention may help to reduce population-wide alcohol and tobacco use behaviors and improve the health outcomes of Black populations.
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Affiliation(s)
- Nathaniel Woodard
- Cancer Care Quality Training Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Butler
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Debarchana Ghosh
- Department of Geography, University of Connecticut, University of Connecticut, Storrs, CT, USA
| | - Kerry M. Green
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Cheryl L. Knott
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
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Cohen D, Bhushan B, Hanks R, Yoon DP, Johnstone B, Holliday G, Grover A. Examining Cultural, Ethnic, and Religious Differences with the Brief Multidimensional Measure of Religiousness and Spirituality in the U.S. and India. JOURNAL OF RELIGION & HEALTH 2021; 61:3492-3506. [PMID: 34599709 DOI: 10.1007/s10943-021-01433-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 02/08/2023]
Abstract
The Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) is regularly used to measure spirituality and religiosity in U.S. Christian populations, although it has not been used for making comparisons with non-Western groups. This study compared BMMRS results for 109 individuals (60 in the U.S. and 49 in India) with traumatic brain injury (TBI) from different cultures (U.S., India), ethnic groups (African American, Caucasian, South Asian), and religions (Christian, Hindu, Muslim). In general, the results indicated that U.S. African Americans and Christians reported being the most spiritual, South Asians and Hindus the least. Groups differed significantly in self-reported spiritual experiences, but less in frequency of religious activities. Results suggest using caution when applying Western-based measures of religion and spirituality in non-Western, non-Christian populations.
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Affiliation(s)
- Daniel Cohen
- Department of Classics, Archeology, and Religion, University of Missouri, 205 Swallow Hall, Columbia, MO, 65211, USA.
| | - Braj Bhushan
- Department of Humanities and Social Sciences, Indian Institute of Technology Kanpur, Kanpur, India
| | - Robin Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, USA
| | - Dong Pil Yoon
- School of Social Work, University of Missouri, Columbia, USA
| | - Brick Johnstone
- Department of Health Psychology, University of Missouri, Columbia, USA
| | - Greyson Holliday
- Department of Health Psychology, University of Missouri, Columbia, USA
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Identifying Protective Factors in the Association Between Peer Victimization and Internalizing Symptoms of African American Adolescents in Four Chicago’s Southside Neighborhoods. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09433-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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4
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Hong JS, Valido A, Rivas-Koehl MM, Wade RM, Espelage DL, Voisin DR. Bullying victimization, psychosocial functioning, and protective factors: Comparing African American heterosexual and sexual minority adolescents in Chicago's Southside. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:1358-1375. [PMID: 33608898 DOI: 10.1002/jcop.22521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/13/2021] [Indexed: 05/26/2023]
Abstract
African American heterosexual and sexual minority (SM) adolescents report widespread bullying victimization (BV), which is associated with poorer psychosocial functioning. However, studies examining potential protective factors that moderate this association are limited. Using data from a cross-sectional study conducted in Chicago, we examined the association between BV and psychosocial functioning among a sample of heterosexual (n = 475) and SM (n = 105) African American adolescents and examined whether four empirically-supported protective factors moderated these associations. Among SM adolescents, having close parents was protective against psychosomatic symptoms for those who reported high BV and having caring teachers was protective against substance use for those who reported both high and low BV. Among heterosexual adolescents, having close parents was protective against substance use for those who reported high BV but having high neighborhood support exacerbated the risk of developing psychosomatic symptoms for those who reported high BV. Implications for school and parental-based interventions are discussed.
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Affiliation(s)
- Jun Sung Hong
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Alberto Valido
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Ryan M Wade
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Dorothy L Espelage
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dexter R Voisin
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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5
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Jordan A, Babuscio T, Nich C, Carroll KM. A feasibility study providing substance use treatment in the Black church. J Subst Abuse Treat 2020; 124:108218. [PMID: 33771290 DOI: 10.1016/j.jsat.2020.108218] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 10/02/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Black adults with substance use disorders (SUDs) experience health care disparities, including access to and retention in treatment. The Black church is a trusted institution in the Black community and could be a novel setting for providing SUD treatment. METHOD We conducted a nonrandomized feasibility study evaluating (1) whether it was possible to conduct a clinical trial of SUD treatment in this setting, (2) whether an adequate number of individuals with SUDs would participate in technology-based treatment in this setting, and (3) whether an adequate number of individuals would be retained in this setting. We evaluated computer-based training for cognitive behavioral therapy (CBT4CBT), with modifications that the church-based health advisors (CHAs), who delivered the intervention within the church, made. RESULTS Participants were 40 Black adults, all of whom met DSM-5 criteria for a current SUD, (55% severe). The mean number of sessions completed was 6.8 and 31 completed all 7 sessions of CBT4CBT. Both self-reports and weekly urine toxicology screens indicated reduction in substance use over time. CONCLUSION We demonstrated feasibility, as we were able to (1) collect weekly data and protect participant confidentiality, (2) recruit an adequate number of individuals with SUD, with (3) high uptake and retention of an adapted CBT4CBT in the Black church. If demonstrated to be effective in a future randomized clinical trial, delivery of technology-based treatments in the Black church may prove a promising, easily disseminable strategy to provide evidence-based interventions to an underserved and undertreated population.
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Affiliation(s)
- Ayana Jordan
- Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA.
| | - Theresa Babuscio
- Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA.
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA.
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA.
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6
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Knott CL, Ghosh D, Williams BR, Park C, Schulz E, Williams RM, He X, Stewart K, Bell C, Clark EM. Do neighborhood characteristics contribute beyond individual demographics to cancer control behaviors among African American adults? Cancer Epidemiol 2019; 64:101666. [PMID: 31896040 DOI: 10.1016/j.canep.2019.101666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Recent years have seen increased interest in the role of neighborhood factors in chronic diseases such as cancers. Less is known about the role of neighborhood factors beyond individual demographics such as age or education. It is particularly important to examine neighborhood effects on health among African American men and women, considering the disproportionate impact of cancer on this group. This study evaluated the unique contribution of neighborhood characteristics (e.g., racial/ethnic diversity, income) beyond individual demographics, to cancer control behaviors in African American men and women. METHODS Individual-level data were drawn from a national survey (N = 2,222). Participants' home addresses were geocoded and merged with neighborhood data from the American Community Survey. Multi-level regressions examined the unique contribution of neighborhood characteristics beyond individual demographics, to a variety of cancer risk, prevention, and screening behaviors. RESULTS Neighborhood racial/ethnic diversity, median income, and percentage of home ownership made modest significant contributions beyond individual factors, in particular to smoking status where these factors were associated with lower likelihood of smoking (ps < .05). Men living in neighborhoods with older residents, and greater income and home ownership were significantly more likely to report prostate specific antigen testing (ps < .05). Regional analyses suggested different neighborhood factors were associated with smoking status depending on the region. CONCLUSION Findings provide a more nuanced understanding of the interplay of social determinants of health and neighborhood social environment among African American men and women, with implications for cancer control interventions to eliminate cancer disparities.
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Affiliation(s)
- Cheryl L Knott
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, 1234W School of Public Health Bldg., College Park, MD 20742, USA.
| | - Debarchana Ghosh
- University of Connecticut, Department of Geography, Austin Bldg, Rm. 438, 215 Glenbrook Rd, U-4148 Storrs, CT 06269-4148, USA.
| | - Beverly Rosa Williams
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology/Geriatrics/Palliative Care, CH19 218K, Community Health Svc Bldg-19th, Birmingham AL 35294-2041, USA.
| | - Crystal Park
- University of Connecticut, Department of Psychological Sciences, Bousfield Psychology Building, 406 Babbidge Rd, Unit 2010, Storrs, CT 06269, USA.
| | - Emily Schulz
- Northern Arizona University - Phoenix Biomedical Campus, Department of Occupational Therapy, 435N 5th St, Phoenix, AZ 85004, USA.
| | - Randi M Williams
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, 1234W School of Public Health Bldg., College Park, MD 20742, USA
| | - Xin He
- University of Maryland, School of Public Health, Department of Epidemiology and Biostatistics, 2234H School of Public Health Bldg., College Park, MD 20742, USA.
| | - Kathleen Stewart
- University of Maryland, School of Public Health, Department of Geographical Sciences, 1125 LeFrak Hall, College Park, MD 20742, USA.
| | - Caryn Bell
- University of Maryland, School of Public Health, Department of African American Studies, 1119 Taliaferro Hall, 4280 Chapel Lane, College Park, MD 20742, USA.
| | - Eddie M Clark
- Saint Louis University, Department of Psychology, Morrissey Hall, 3700 Lindell Blvd., Room 2819, St. Louis, MO, 63108, USA.
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Clark EM, Williams BR, Huang J, Roth DL, Holt CL. A Longitudinal Study of Religiosity, Spiritual Health Locus of Control, and Health Behaviors in a National Sample of African Americans. JOURNAL OF RELIGION AND HEALTH 2018; 57:2258-2278. [PMID: 29322285 PMCID: PMC6039282 DOI: 10.1007/s10943-017-0548-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present longitudinal study examined religious beliefs and behaviors, spiritual health locus of control (SHLOC), and selected health-related behaviors and outcomes in a national sample of 766 African American adults. Participants were interviewed by telephone three times over a 5-year period. Results indicated that stronger religious beliefs and religious behaviors were associated with greater changes in active SHLOC. There was some evidence of direct effects of religious beliefs and behaviors on changes in health behaviors. Religious behaviors were related to greater passive SHLOC over time across some health outcomes. Passive SHLOC was associated with some less desirable health outcomes over time.
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Affiliation(s)
- Eddie M. Clark
- Department of Psychology, Saint Louis University, Morrissey Hall, 3700 Lindell Blvd., St. Louis, MO 63108, USA. . Phone: (314) 977-2272
| | - Beverly Rosa Williams
- UAB Comprehensive Center for Healthy Aging, CH19 218K, 1720 2nd Ave S, Birmingham, AL 35294-1304, USA. . Phone: (205) 789-5814
| | - Jin Huang
- Center on Aging and Health, Johns Hopkins University, Baltimore MD, 21205, USA. . Phone: (410) 502-6635
| | - David L. Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore MD, 21205, USA. . Phone: (410) 955-0491
| | - Cheryl L. Holt
- Department of Behavioral and Community Health, 1234W School of Public Health Bldg. (255), 422 Valley Drive, School of Public Health, University of Maryland, College Park, MD 20742, USA. . Phone: (301) 405-6659
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8
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Park CL, Holt CL, Le D, Christie J, Williams BR. Positive and Negative Religious Coping Styles as Prospective Predictors of Well-Being in African Americans. PSYCHOLOGY OF RELIGION AND SPIRITUALITY 2018; 10:318-326. [PMID: 30505376 PMCID: PMC6261495 DOI: 10.1037/rel0000124] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Research on religious coping has proliferated in recent years, but many key questions remain, including the independent effects of positive and negative religious coping styles on well-being over time. Further, little research on religious coping styles has been conducted with African Americans in spite of their documented importance in this population. The present study examined the independent prospective effects on well-being of positive and negative religious coping styles over the subsequent 2.5 years in a national sample of African American community-dwelling adults. Well-being indicators included depressive symptoms and positive and negative affect as well as self-esteem and meaning in life. Results indicated that when considering positive and negative religious coping styles together, baseline positive religious coping consistently and positively predicted the well-being indicators 2.5 years later, while negative religious coping consistently and negatively predicted the well-being indicators 2.5 years later. These effects remained when examining change in well-being levels over time, although they attenuated in magnitude. Finally, negative religious coping more strongly predicted the negative aspects of well-being (e.g., depressive symptoms, negative affect) 2.5 years later than did positive religious coping, an effect that also remained but was attenuated when controlling for baseline levels of well-being. These results highlight the nuanced relationships between both positive and negative religious coping styles and positive and negative aspects of well-being over time among African Americans. Future research might usefully examine how to minimize negative effects and capitalize on the salutary effects of positive religious coping.
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Affiliation(s)
- Crystal L Park
- Department of Psychological Sciences, University of Connecticut
| | - Cheryl L Holt
- Behavioral and Community Health, University of Maryland, College Park
| | - Daisy Le
- Behavioral and Community Health, University of Maryland, College Park
| | - Juliette Christie
- Behavioral and Community Health, University of Maryland, College Park
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9
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Le D, Holt CL. CervixCheck: A Spiritually-Based Text Messaging Intervention to Promote Cervical Cancer Awareness and Pap Test Screening Intention among African-American Women. JOURNAL OF HEALTH COMMUNICATION 2018; 23:842-853. [PMID: 30300091 PMCID: PMC9159894 DOI: 10.1080/10810730.2018.1528317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND/PURPOSE On a national level, African-American women have a 34% higher incidence of cervical cancer and are twice as likely to die of the disease when compared to White women. In response to the need to improve cervical cancer prevention and Pap test screening knowledge and utilization, we developed and pilot tested a 16-day SMS text message-based intervention. The CervixCheck study was designed to develop, pilot test, and evaluate the feasibility, acceptability, and initial efficacy of a spiritually-based SMS text messaging intervention aimed at increasing cervical cancer awareness and Pap test screening intention in church-attending African-American women ages 21-65. Methods/Approach: The Theory of Planned Behavior guided the development of the CervixCheck intervention. This intervention utilized a non-experimental one-group pretest-posttest design. In this article, we present findings from the pilot testing phase. Of the 52 participants at baseline, 46 completed the post-program survey. RESULTS/FINDINGS The current study provides evidence for the early feasibility, high acceptability, and some initial efficacy of the CervixCheck intervention. There was a significant pre-post increase observed for knowledge about cervical cancer and the Pap test (p = .001) and subjective norms (p = .006). Findings post-intervention also revealed that 83% of participants reported being either "satisfied" or "very satisfied" with the CervixCheck intervention and 85% found the SMS text messages either "useful" or "very useful". CONCLUSIONS/SIGNIFICANCE A spiritually-based SMS text messaging intervention could be a culturally-appropriate and cost-effective method of promoting cervical cancer early detection information to church-attending African-American women.
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Affiliation(s)
- Daisy Le
- a Department of Behavioral and Community Health (DL, CH) , University of Maryland, School of Public Health , College Park , MD , USA
| | - Cheryl L Holt
- a Department of Behavioral and Community Health (DL, CH) , University of Maryland, School of Public Health , College Park , MD , USA
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Yoo J. The Effect of Religious Involvement on Life Satisfaction among Korean Christians: Focused on the Mediating Effect of Spiritual Well-Being and Self-Esteem. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2017; 71:257-266. [PMID: 29224523 DOI: 10.1177/1542305017743432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present study examined the relationship between two categories of religious involvement, namely religious belief and religious behavior, and life satisfaction among Korean Christians (N = 278) with spiritual well-being and self-esteem as potential mediators in this relationship by using structural equation modeling (SEM). The results supported the full mediated structural model and indicated that religious belief had a significant indirect effect on life satisfaction through the mediators, spiritual well-being and self-esteem. Religious behavior did not have an indirect or direct effect on life satisfaction among Korean Christians. The significance, implications, and limitations of the study were discussed.
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Affiliation(s)
- Jieun Yoo
- 65423 Anyang University , Anyang, Republic of Korea
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11
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Clark EM, Huang J, Roth DL, Schulz E, Williams BR, Holt CL. The relationship between religious beliefs and behaviors and changes in spiritual health locus of control over time in a national sample of African Americans. Ment Health Relig Cult 2017; 20:449-463. [PMID: 29398951 DOI: 10.1080/13674676.2017.1356274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Using data from a sample of African Americans, the present study examined the role of religious beliefs and behaviors in predicting changes in spiritual health locus of control (SHLOC), or beliefs about the role that God plays in a person's health. A national sample of African American adults was recruited using a telephone survey and re-contacted 2.5 years later. Overall, results indicated that both higher religious beliefs and behaviors predicted increases in active SHLOC, or the view that one collaboratively works with God to maintain one's health. However, only religious behaviors predicted increases in passive SHLOC, or the view that because God is in complete control of health that one's own behaviors are unnecessary. Among men, religious beliefs predicted strengthening active SHLOC beliefs, while religious behaviors predicted growing passive SHLOC beliefs. Among women, religious behaviors predicted strengthening active and passive SHLOC beliefs.
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Affiliation(s)
- Eddie M Clark
- Department of Psychology, Saint Louis University, Morrissey Hall, 3700 Lindell Blvd., St. Louis, MO 63108, USA.
| | - Jin Huang
- Center on Aging and Health, Johns Hopkins University, Baltimore MD, 21205, USA.
| | - David L Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore MD, 21205, USA.
| | - Emily Schulz
- Department of Occupational Therapy, A.T. Still University, Arizona School of Health Sciences, 5850 E. Still Circle, Mesa, AZ 85206, USA.
| | - Beverly Rosa Williams
- UAB Comprehensive Center for Healthy Aging, CH19 218K, 1720 2nd Ave S, Birmingham, AL 35294-1304, USA.
| | - Cheryl L Holt
- Department of Behavioral and Community Health, 2369 School of Public Health Bldg. (255), 422 Valley Drive, School of Public Health, University of Maryland, College Park, MD 20742, USA.
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12
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Holt CL, Roth DL, Huang J, Clark EM. Role of religious social support in longitudinal relationships between religiosity and health-related outcomes in African Americans. J Behav Med 2017; 41:62-73. [PMID: 28776192 DOI: 10.1007/s10865-017-9877-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/22/2017] [Indexed: 12/27/2022]
Abstract
This study tested a longitudinal model of religious social support as a potential mediator of the relationship between religious beliefs and behaviors, and multiple health-related outcomes (e.g., depressive symptoms, functioning, diet, alcohol use, cancer screening). A national probability sample of African Americans enrolled in the religion and health in African Americans study completed three waves of telephone interviews over a 5-year period (N = 766). Longitudinal structural equation models indicated that religious behaviors, but not beliefs, predicted the slowing of a modest overall decline in positive religious social support, while negative interactions with congregational members were stable. Positive religious support was associated with lower depressive symptoms and heavy drinking over time, while negative interaction predicted increases in depressive symptoms and decreases in emotional functioning. Positive religious support mediated the relationship between religious behaviors and depressive symptoms and heavy drinking. Findings have implications for mental health interventions in faith-based settings.
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Affiliation(s)
- Cheryl L Holt
- School of Public Health, Department of Behavioral and Community Health, University of Maryland, 1234W School of Public Health Building (255), College Park, MD, 20742, USA.
| | - David L Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jin Huang
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eddie M Clark
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
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13
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Holt CL, Roth DL, Huang J, Park CL, Clark EM. Longitudinal effects of religious involvement on religious coping and health behaviors in a national sample of African Americans. Soc Sci Med 2017. [PMID: 28645040 DOI: 10.1016/j.socscimed.2017.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Many studies have examined associations between religious involvement and health, linking various dimensions of religion with a range of physical health outcomes and often hypothesizing influences on health behaviors. However, far fewer studies have examined explanatory mechanisms of the religion-health connection, and most have overwhelmingly relied on cross-sectional analyses. Given the relatively high levels of religious involvement among African Americans and the important role that religious coping styles may play in health, the present study tested a longitudinal model of religious coping as a potential mediator of a multidimensional religious involvement construct (beliefs; behaviors) on multiple health behaviors (e.g., diet, physical activity, alcohol use, cancer screening). A national probability sample of African Americans was enrolled in the RHIAA (Religion and Health In African Americans) study and three waves of telephone interviews were conducted over a 5-year period (N = 565). Measurement models were fit followed by longitudinal structural models. Positive religious coping decreased modestly over time in the sample, but these reductions were attenuated for participants with stronger religious beliefs and behaviors. Decreases in negative religious coping were negligible and were not associated with either religious beliefs or religious behaviors. Religious coping was not associated with change in any of the health behaviors over time, precluding the possibility of a longitudinal mediational effect. Thus, mediation observed in previous cross-sectional analyses was not confirmed in this more rigorous longitudinal model over a 5-year period. However, findings do point to the role that religious beliefs have in protecting against declines in positive religious coping over time, which may have implications for pastoral counseling and other faith-based interventions.
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Affiliation(s)
- Cheryl L Holt
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, United States.
| | - David L Roth
- Johns Hopkins University, Center on Aging and Health, United States
| | - Jin Huang
- Johns Hopkins University, Center on Aging and Health, United States
| | - Crystal L Park
- University of Connecticut, Department of Psychological Sciences, United States
| | - Eddie M Clark
- Saint Louis University, Department of Psychology, United States
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14
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Le D, Holt CL, Hosack DP, Huang J, Clark EM. Religious Participation is Associated with Increases in Religious Social Support in a National Longitudinal Study of African Americans. JOURNAL OF RELIGION AND HEALTH 2016; 55:1449-60. [PMID: 26493343 PMCID: PMC4841759 DOI: 10.1007/s10943-015-0143-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study reports on the association between religious beliefs and behaviors and the change in both general and religious social support using two waves of data from a national sample of African Americans. The Religion and Health in African Americans (RHIAA) study is a longitudinal telephone survey designed to examine relationships between various aspects of religious involvement and psychosocial factors over time. RHIAA participants were 3173 African American men (1281) and women (1892). A total of 1251 men (456) and women (795) participated in wave 2 of data collection. Baseline religious behaviors were associated with increased overall religious social support from baseline to wave 2 (p < .001) and with increased religious social support from baseline to wave 2 in each of the following religious social support subscales: emotional support received (p < .001), emotional support provided (p < .001), negative interaction (p < .001), and anticipated support (p < .001). Religious beliefs did not predict change in any type of support, and neither beliefs nor behaviors predicted change in general social support. African Americans who are active in faith communities showed increases in all types of religious social support, even the negative aspects, over a relatively modest longitudinal study period. This illustrates the strength of the church as a social network and the role that it plays in people's lives.
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Affiliation(s)
- Daisy Le
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, 20742, USA.
| | - Cheryl L Holt
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, 20742, USA
| | - Dominic P Hosack
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, 20742, USA
| | - Jin Huang
- Center on Aging and Health, Johns Hopkins University, 2024 E. Monument St. Suite 2-700, Baltimore, MD, 21205, USA
| | - Eddie M Clark
- Department of Psychology, Saint Louis University, Morrissey Hall, 3700 Lindell Blvd., St. Louis, MO, 63108, USA
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Meng J, McLaughlin M, Pariera K, Murphy S. A Comparison Between Caucasians and African Americans in Willingness to Participate in Cancer Clinical Trials: The Roles of Knowledge, Distrust, Information Sources, and Religiosity. JOURNAL OF HEALTH COMMUNICATION 2016; 21:669-677. [PMID: 27175604 DOI: 10.1080/10810730.2016.1153760] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study aims to (a) examine the roles of knowledge, distrust in medical professionals, information sources, and 2 dimensions of religiosity (i.e., religious activity and religious belief) in influencing willingness to participate (WTP) in cancer clinical trials and to (b) compare the results for Caucasians and African Americans in order to inform future recruitment. An online survey was fielded via a Knowledge Networks panel with a nationally representative sample including 478 Caucasians and 173 African Americans. The results showed that distrust in medical professionals was a strong barrier to WTP for both ethnic groups, whereas factual knowledge about trial procedures was not associated with WTP for either ethnic group. Seeking trial information from doctors was positively associated with WTP for Caucasians; seeking trial information from hospitals was positively associated with WTP for African Americans. More interestingly, levels of religious activity negatively predicted WTP for Caucasians but positively predicted WTP for African Americans. Self-reported religious belief was not associated with WTP for either ethnic group. In sum, although distrust is a common barrier to WTP, the influence of preferred information sources and religious activity on WTP varies as a function of ethnicity.
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Affiliation(s)
- Jingbo Meng
- a Department of Communication , Michigan State University , East Lansing , Michigan , USA
| | - Margaret McLaughlin
- b Annenberg School for Communication and Journalism , University of Southern California , Los Angeles , California , USA
| | - Katrina Pariera
- c Department of Organizational Sciences and Communication , The George Washington University , Washington , DC , USA
| | - Sheila Murphy
- b Annenberg School for Communication and Journalism , University of Southern California , Los Angeles , California , USA
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Roth DL, Usher T, Clark EM, Holt CL. Religious Involvement and Health over Time: Predictive Effects in a National Sample of African Americans. JOURNAL FOR THE SCIENTIFIC STUDY OF RELIGION 2016; 55:417-424. [PMID: 28502992 PMCID: PMC5423663 DOI: 10.1111/jssr.12269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this study, two telephone interviews that assessed both religious involvement and health-related quality of life were conducted approximately 2.5 years apart in a national sample of 290 African Americans. Religious involvement was assessed with an instrument that measured both personal religious beliefs (e.g., having a personal relationship with God) and more public religious behaviors (e.g., attending church services). Health-related quality of life was measured with version 2 of the Medical Outcomes Study 12-item short form (SF-12v2). Structural equation models indicated that higher religious beliefs at baseline predicted better physical and mental health 2.5 years later. Higher religious behaviors at baseline contributed smaller, complementary suppression effects. Physical and mental health indicators from the SF-12v2 at baseline did not predict changes in either religious beliefs or religious behaviors over time. These findings indicate that, for African Americans, personal religious beliefs lead to beneficial health effects over time, whereas individual differences in health do not appear to predict changes in religious involvement.
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Affiliation(s)
- David L Roth
- Center on Aging and Health, Johns Hopkins University
| | - Therri Usher
- Center on Aging and Health, Johns Hopkins University
| | | | - Cheryl L Holt
- Department of Behavioral and Community Health, University of Maryland
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17
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Holt CL, Roth DL, Huang J, Clark EM. Gender differences in the roles of religion and locus of control on alcohol use and smoking among African Americans. J Stud Alcohol Drugs 2016; 76:482-92. [PMID: 25978836 DOI: 10.15288/jsad.2015.76.482] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Spiritual health locus of control reflects a person's beliefs about the role of a higher power in one's health and can take an active or a passive perspective. The purpose of this study was to examine the moderating role of active and passive spiritual health locus of control beliefs on select health risk behaviors--alcohol use and smoking--in a national sample of African Americans. METHOD A national U.S. probability sample of study participants (N = 2,370; 906 men; 1,464 women) completed a telephone survey assessing religious involvement, active and passive spiritual health locus of control beliefs, and alcohol consumption and smoking status. Because of previous research suggesting gender-specific associations among these variables, moderation analyses were conducted separately for men and women. RESULTS For women, higher religious behaviors were associated with less alcohol use, and this effect was more pronounced among those high in active spiritual health locus of control. For men, the combination of lower religious beliefs and higher passive spiritual health locus of control was associated with more alcohol consumption and more days of consuming five or more alcoholic drinks. No moderation effects were found for smoking. CONCLUSIONS This study identified unique patterns of religious involvement and spiritual health locus of control beliefs that are associated with alcohol use, including heavy drinking, among African Americans. These findings have implications for pastoral counseling and other faith-based approaches for addressing heavy drinking in African Americans.
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Affiliation(s)
- Cheryl L Holt
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland
| | - David L Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Jin Huang
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Eddie M Clark
- Department of Psychology, Saint Louis University, St. Louis, Missouri
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18
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Range LM, Brazda GF. How Organ Donors are Different from Non-donors: Responsibility, Barriers, and Religious Involvement. JOURNAL OF RELIGION AND HEALTH 2015; 54:2286-2291. [PMID: 25524413 DOI: 10.1007/s10943-014-9982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
To see if religious involvement, previously linked to various health behaviors, was linked to organ donation, 143 ethnically diverse undergraduates stated whether they were registered donors (53% were), and completed measures of organ donation attitudes and religious involvement. Compared with non-donors, donors reported fewer barriers, more family responsibility, and more willingness to receive donor organs, but were not different in religious involvement. Even in 2014, when being a "good Samaritan" by agreeing to organ donation is as easy as checking one box on a driver's license application, religious involvement does not seem to be a factor in checking this box.
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Affiliation(s)
- Lillian M Range
- Department of Counseling and Behavioral Sciences, Our Lady of Holy Cross College, 4123 Woodland Drive, New Orleans, LA, 70131, USA.
| | - Geoffrey F Brazda
- Department of Counseling and Behavioral Sciences, Our Lady of Holy Cross College, 4123 Woodland Drive, New Orleans, LA, 70131, USA
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Bailey ZD, Slopen N, Albert M, Williams DR. Multidimensional religious involvement and tobacco smoking patterns over 9-10 years: A prospective study of middle-aged adults in the United States. Soc Sci Med 2015; 138:128-35. [PMID: 26093070 DOI: 10.1016/j.socscimed.2015.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the relationship between multiple dimensions of religious involvement and transitions of tobacco smoking abstinence, persistence, cessation and relapse over 9-10 years of follow-up in a national sample of adults in the United States. Using data provided at baseline and follow-up, participants were categorized as non-smokers, persistent smokers, ex-smokers, and relapsed smokers. Religious involvement over the two time points were categorized into combinations of "high" and "low" involvement within the domains of (a) religious attendance, (b) religious importance, (c) spiritual importance, (d) religious/spiritual comfort seeking, and (e) religious/spiritual decision-making. High levels of religious involvement across five dimensions (religious attendance, religious importance, spiritual importance, religious/spiritual comfort-seeking, and religious/spiritual decision-making) were associated with lower odds of being a persistent smoker or ex-smoker. Religious involvement was not associated with smoking cessation among smokers at baseline. Interventions to increase smoking abstinence may be more effective if they draw on ties to religious and spiritual organizations and beliefs. Meanwhile, religious involvement is unlikely to affect smoking cessation effectiveness.
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Affiliation(s)
- Zinzi D Bailey
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Montreal Health Equity Research Consortium, Institute of Health and Social Policy, McGill University, Montreal, QC, Canada.
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA
| | - Michelle Albert
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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20
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Holt CL, Le D, Calvanelli J, Huang J, Clark EM, Roth DL, Williams B, Schulz E. Participant Retention in a Longitudinal National Telephone Survey of African American Men and Women. Ethn Dis 2015; 25:187-92. [PMID: 26118147 PMCID: PMC4593062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE The purpose of this article is to describe participant demographic factors related to retention, and to report on retention strategies in a national study of African Americans re-contacted 2.5 years after an initial baseline telephone interview. DESIGN & SETTING The Religion and Health in African Americans (RHIAA) study was originally developed as a cross-sectional telephone survey to examine relationships between religious involvement and health-related factors in a national sample of African Americans. The cohort was re-contacted on average of 2.5 years later for a follow-up interview. PARTICIPANTS RHIAA participants were 2,803 African American men (1,202) and women (1,601). INTERVENTIONS RHIAA used retention strategies consistent with recommendations from Hunt and White. Participants also received a lay summary of project findings. MAIN OUTCOME MEASURES Retention at the follow-up interview. RESULTS Retention rates ranged from 39%- 41%. Retained participants tended to be older and female. In age- and sex-adjusted analyses, retained participants were more educated, single, and in better health status than those not retained. There was no difference in religious involvement in adjusted analyses. CONCLUSIONS Although overall retention rates are lower than comparable longitudinal studies, RHIAA was not originally designed as a longitudinal study and so lacked a number of structures associated with long-term studies. However, this project illustrates the feasibility of conducting lengthy cold call telephone interviews with an African American population and helps to identify some participant factors related to retention and study strategies that may aid in retention.
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Holt CL, Clark EM, Debnam KJ, Roth DL. Religion and health in African Americans: the role of religious coping. Am J Health Behav 2014; 38:190-9. [PMID: 24629548 PMCID: PMC4096932 DOI: 10.5993/ajhb.38.2.4] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To test a model of the religion-health connection to determine whether religious coping plays a mediating role in health behaviors in a national sample of African Americans. METHODS Participants completed a telephone survey (N = 2370) assessing religious involvement, religious coping, health behaviors, and demographics. RESULTS Religious beliefs were associated with greater vegetable consumption, which may be due to the role of positive and negative religious coping. Negative religious coping played a role in the relationship between religious beliefs and alcohol consumption. There was no evidence of mediation for fruit consumption, alcohol use in the past 30 days, or smoking. CONCLUSIONS Findings have implications for theory and health promotion activities for African Americans.
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Affiliation(s)
- Cheryl L Holt
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, USA.
| | - Eddie M Clark
- Saint Louis University, Department of Psychology, Saint Louis, MO, USA
| | - Katrina J Debnam
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA
| | - David L Roth
- Johns Hopkins University, Center on Aging and Health, Baltimore, MD, USA
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22
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Holt CL, Clark EM, Wang MQ, Williams BR, Schulz E. The Religion-Health Connection Among African Americans: What Is the Role of Social Capital? JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2014. [DOI: 10.1002/casp.2191] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Cheryl L. Holt
- School of Public Health, Department of Behavioral and Community Health; University of Maryland; 2369 Public Health Building (255) College Park MD 20742 USA
| | - Eddie M. Clark
- Department of Psychology; Saint Louis University; 214 Shannon Hall Saint Louis MO 63013 USA
| | - Min Qi Wang
- School of Public Health, Department of Behavioral and Community Health; University of Maryland; 2369 Public Health Building (255) College Park MD 20742 USA
| | - Beverly Rosa Williams
- Department of Medicine, Division of Gerontology/Geriatrics/Palliative Care; University of Alabama at Birmingham; CH19 218K; 1530 3rd Ave. S Birmingham AL 35294-2041 USA
| | - Emily Schulz
- Arizona School of Health Sciences, Department of Occupational Therapy; A.T. Still University; 5850 E. Still Circle Mesa AZ 85206 USA
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Holt CL, Roth DL, Clark EM, Debnam K. Positive self-perceptions as a mediator of religious involvement and health behaviors in a national sample of African Americans. J Behav Med 2014; 37:102-12. [PMID: 23143382 PMCID: PMC3587037 DOI: 10.1007/s10865-012-9472-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 11/03/2012] [Indexed: 10/27/2022]
Abstract
Self-esteem and self-efficacy are theorized to serve as mediators of the relationship between religious involvement and health outcomes. Studies confirming these relationships have produced mixed evidence. This study examined whether self-esteem and self-efficacy mediate the relationship between religious involvement (beliefs, behaviors) and a set of modifiable health behaviors in a national probability sample of African Americans. African Americans, in general, are relatively high in religious involvement and have higher than average rates of chronic disease. Participants were interviewed by telephone, and a Religion-Health Mediational Model was tested using structural equation modeling. Results suggest that self-esteem and self-efficacy at least in part mediate the relationship between religious beliefs (e.g., relationship with God) and greater fruit and vegetable consumption, and lower alcohol consumption. Religious behaviors (e.g., service attendance) were found to have direct, unmediated effects on health behaviors. Findings have implications for church-based health promotion in African American communities such as education or support groups.
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Affiliation(s)
- Cheryl L Holt
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 2369 Public Health Building (255), College Park, MD, USA,
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Owolabi MO. Consistent determinants of post-stroke health-related quality of life across diverse cultures: Berlin-Ibadan study. Acta Neurol Scand 2013; 128:311-20. [PMID: 23509863 DOI: 10.1111/ane.12126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Discovery of consistent determinants of post-stroke health-related quality of life (HRQOL) across different cultures is essential for the development of widely applicable therapeutic models for maximizing HRQOL in stroke patients. The objective of this study was to identify variables with consistent effect on post-stroke HRQOL across disparate cultures. PATIENTS AND METHODS Detailed socio-demographic and clinical data were obtained from successive stroke patients (≥1 month post-stroke) from Ibadan, Nigeria (n = 100) and Berlin, Germany (n = 103). Stroke severity was assessed using the National Institute of Health Stroke Scale and stroke levity score, while disability was graded with modified Rankin Scale. HRQOL was measured with the psychometrically robust holistic HRQOL in stroke patients (HRQOLISP) instrument. Variables with significant univariate or bivariate relationships to HRQOL were included in the multiple forward stepwise regression analysis at P = 0.05. RESULTS In disparate cultures, marital status (0.091 < P < 0.902) and stroke type (0.357 < P < 0.975) had no significant relationship to HRQOL. In regression models explaining up to 86% of the HRQOL variance in Ibadan and 70% of the HRQOL variance in Berlin; stroke severity, disability, emotional disorder, and sense of purpose in life were the key predictors of HRQOL after stroke (P < 0.0001 to P < 0.04). CONCLUSIONS Based on these consistent determinants, the stroke recovery cycle, a novel therapeutic model aimed at improving sense of purpose and meaning in life after stroke while promoting emotional and physical well-being, is proposed for further exploration.
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Affiliation(s)
- M. O. Owolabi
- Department of Medicine; University of Ibadan; Nigeria
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25
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Holt CL, Clark EM, Roth DL. Positive and Negative Religious Beliefs Explaining the Religion-Health Connection Among African Americans. THE INTERNATIONAL JOURNAL FOR THE PSYCHOLOGY OF RELIGION 2013; 24:311-331. [PMID: 28546736 PMCID: PMC5441393 DOI: 10.1080/10508619.2013.828993] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Theory and literature suggests that the reason religiously-involved people tend to have good health outcomes is because they have healthy lifestyles and behaviors in accord with religious beliefs. Other literature suggests that religious involvement may play a negative role in health outcomes due to beliefs about illness originating as punishment for sins. These ideas were tested as part of a theoretical model of the religion-health connection, in a national sample of African Americans. Outcomes included a variety of health-related behaviors. Study participants (N=2,370) randomly selected from a US national call list completed a telephone survey assessing religious involvement, health behaviors, and demographic characteristics. Structural equation modeling was used to analyze study data. Findings indicate that perceived religious influence on health behavior mediated the relationship between religious beliefs and behaviors and higher fruit consumption, and lower alcohol use and smoking. Belief that illness is the result of punishment for sin mediated the relationship between 1) religious beliefs and higher vegetable consumption and lower binge drinking; and 2) religious behaviors and lower vegetable consumption and higher binge drinking. These findings could be applied to health education activities conducted in African American faith-based organizations such as health ministries, in the effort to eliminate health disparities.
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Affiliation(s)
- Cheryl L Holt
- University of Maryland, School of Public Health, Department of Behavioral and Community Health
| | | | - David L Roth
- Johns Hopkins University, Center on Aging and Health
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