Health benefits of religion among Black and White older adults? Race, religiosity, and C-reactive protein

Racial Discrimination, Religious Coping, and Cardiovascular Disease Risk Among African American Women and Men

OBJECTIVE

This cross-sectional study examined whether religious coping buffered the associations between racial discrimination and several modifiable cardiovascular disease (CVD) risk factors-systolic and diastolic blood pressure (BP), glycated hemoglobin (HbA1c), body mass index (BMI), and cholesterol-in a sample of African American women and men.

METHODS

Participant data were taken from the Healthy Aging in Neighborhoods of Diversity Across the Life Span study (N = 815; 55.2% women; 30-64 years old). Racial discrimination and religious coping were self-reported. CVD risk factors were clinically assessed.

RESULTS

In sex-stratified hierarchical regression analyses adjusted for age, socioeconomic status, and medication use, findings revealed several significant interactive associations and opposite effects by sex. Among men who experienced racial discrimination, religious coping was negatively related to systolic BP and HbA1c. However, in men reporting no prior discrimination, religious coping was positively related to most risk factors. Among women who had experienced racial discrimination, greater religious coping was associated with higher HbA1c and BMI. The lowest levels of CVD risk were observed among women who seldom used religious coping but experienced discrimination.

CONCLUSION

Religious coping might mitigate the effects of racial discrimination on CVD risk for African American men but not women. Additional work is needed to understand whether reinforcing these coping strategies only benefits those who have experienced discrimination. It is also possible that religion may not buffer the effects of other psychosocial stressors linked with elevated CVD risk.

Absent Relations of Religious Coping to Telomere Length in African American and White Women and Men

OBJECTIVES

This study investigated whether race and sex moderated the relations of religious coping to telomere length (TL), a biomarker of cellular aging implicated in race-related health disparities.

METHODS

Participant data were drawn from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, which included 252 socioeconomically diverse African American and White men and women aged (30-64 years old). Cross-sectional multivariable regression analyses examined interactive associations of religious coping, race, and sex to TL, adjusting for other sociodemographic characteristics.

RESULTS

Religious coping was unrelated to TL in this sample (p's > .05). There were no notable race or sex differences. Post hoc exploratory analyses similarly found that neither secular social support coping use nor substance use coping was associated with TL.

CONCLUSION

There was no evidence to support that religious coping use provided protective effects to TL in this sample of African American and White women and men. Nevertheless, future studies should use more comprehensive assessments of religious coping and intersectional identities to provide an in-depth examination of religiosity/spirituality as a potential culturally salient protective factor in cellular aging among African Americans in the context of specific chronic stressors such as discrimination.

Daily spiritual experiences and allostatic load trajectories: a longitudinal study of midlife African American women

OBJECTIVE

This study aimed to evaluate the association between daily spiritual experiences and allostatic load (AL) trajectories in midlife African American women.

METHODS

A longitudinal analysis of public-use data from 727 African American women in the Study of Women's Health Across the Nation (SWAN) was performed. We included African American women who completed the Daily Spiritual Experiences Scale at SWAN visit 4 (2000-2001) and had AL data at three or more study visits over 7 years. AL was calculated at each visit using 10 biomarkers: systolic and diastolic blood pressure, body mass index, C-reactive protein, high-density lipoprotein cholesterol, total cholesterol, waist-to-hip ratio, fasting serum glucose, triglycerides, and dehydroepiandrosterone. Group-based trajectory modeling identified women with similar patterns of AL. We used multinomial logistic regression to estimate associations between daily spiritual experiences (some days or less, most days, daily, many times a day) and AL trajectories.

FINDINGS

Our sample had a mean ± SD age of 49.9 ± 2.66 years, 47% were early perimenopausal, and 17% earned <$19,999 annually. The mean ± SD AL score was 2.52 ± 1.68. Three AL trajectories were identified: low (35.1%), moderate (44.7%), and high (20.2%). In age-adjusted models, women who reported daily comfort in religion and spirituality were less likely to follow a high AL trajectory (odds ratio, 0.41; 95% CI, 0.18-0.93); the association was attenuated when controlling for depressive symptoms (odds ratio, 0.48; 95% CI, 0.19-1.21).

CONCLUSIONS

Findings from this study do not support an independent association between spirituality in African American women and AL trajectories in midlife. Studies with a larger sample and additional measures of spirituality are warranted in this population.

The association between religious beliefs and values with inflammation among Middle-age and older adults

Objectives: Dimensions of religion and spirituality are associated with better emotional, physical, and cognitive health. However, the underlying physiological mechanisms are not well known. We investigated the relationship between dimensions of religion and spirituality with levels of C-reactive protein (CRP), a biomarker of systematic inflammation, in middle-aged and older adults in the United States.Methods: In this descriptive longitudinal study using secondary data, we used proportional odds models of the generalized estimating equation (GEE) to assess the association between religious beliefs and values and religious service attendance with CRP levels from respondents (n = 2,385) aged 50 years and older in the Health and Retirement Study from 2006 to 2014.Results: Middle-aged to older adults who reported higher religious beliefs and values had lower levels of CRP, controlling for age, sex, education, marital status, race, household income, and health, such as hypertension, diabetes, cancer, and body mass index (BMI).Conclusion: Religious beliefs and values are associated with lower CRP levels among middle-aged and older adults in the U.S. This study adds to the understanding of biological processes underlying the relationship between dimensions of religion and spirituality with better cognitive and physical health, potentially through inflammation.

Associations Between Religiosity and Medical Mistrust: An Age-Stratified Analysis of Survey Data from Black Adults in Chicago

Medical mistrust is associated with poor health outcomes, ineffective disease management, lower utilization of preventive care, and lack of engagement in research. Mistrust of healthcare systems, providers, and institutions may be driven by previous negative experiences and discrimination, especially among communities of color, but religiosity may also influence the degree to which individuals develop trust with the healthcare system. The Black community has a particularly deep history of strong religious communities, and has been shown to have a stronger relationship with religion than any other racial or ethnic group. In order to address poor health outcomes in communities of color, it is important to understand the drivers of medical mistrust, which may include one's sense of religiosity. The current study used data from a cross-sectional survey of 537 Black individuals living in Chicago to understand the relationship between religiosity and medical mistrust, and how this differs by age group. Descriptive statistics were used to summarize data for our sample. Adjusted stratified linear regressions, including an interaction variable for age group and religiosity, were used to model the association between religiosity and medical mistrust for younger and older people. The results show a statistically significant relationship for younger individuals. Our findings provide evidence for the central role the faith-based community may play in shaping young peoples' perceptions of medical institutions.

Religious Involvement and Allostatic Resilience: Findings from a Community Study of Black and White Americans

Wide inequities in stress and health have been documented between Black and White women and men in the United States. This study asks: How does religion factor into these inequities? We approach this open question from a biopsychosocial perspective, developing three hypotheses for the stress-coping effects of religiosity between groups. We then test our hypotheses with survey and biomarker data from the Nashville Stress and Health Study (2011-2014), a probability sample of Black and White women and men from Davidson County, Tennessee. We find that Black women score the highest on all indicators of religiosity, followed by Black men, White women, and White men. We also find that increased divine control and religious coping predict higher levels of resiliency biomarkers for Black women only and lower levels for White respondents, especially White men. We discuss how our findings inform broader population health inequities and outline several avenues for future research.

Matters of the Heart: Childhood Maltreatment, Religious Transitions, and Cardiovascular-Related Problems over the Life Course

Objectives:

Childhood maltreatment is associated with a higher risk of cardiovascular-related problems, the leading cause of death in the United States. Drawing from cumulative inequality theory, this study considers whether transitions in religious attendance moderate the deleterious impact of childhood maltreatment on long-term cardiovascular risk.

Methods:

We utilize over 35 years of prospective panel data from the National Longitudinal Study of Youth from the United States (1979–2015).

Results:

Our findings suggest that decreases in religious attendance between adolescence and adulthood (from high to low, and high to moderate attendance) were associated with elevated cardiovascular-related risk for those abused as children. Neither stable high attendance nor increases in attendance buffered against the impact of childhood abuse on cardiovascular-related problems.

Discussion:

We illustrate the importance of incorporating the role of stability and change in religious attendance across the life course and suggest directions for future research.

"Agape love is justice": Black clergies' public and theological support of Black gay men

This study explored how 60 Black clergy came to publicly and theologically support Black gay men. They participated in three 90-minute life history interviews to address the study aims. Open, axial and selective coding were used to understand and order themes within their accounts while addressing specific aims. Life events, purpose-driven theological training and a commitment to justice provide the basis for theological and public support of Black gay men. Clergies' understanding of justice is an expression of agape love. Such love inspires both the support and advocacy of stigmatised, marginalised and overly burdened populations. Study findings question monolithic understandings of both Black clergy and the Black church as homophobic and heteronormative. The informants' data reveal agape love as a key motivation of ministerial holistic support for marginalised and oppressed populations, including Black gay men. Finally, these data assert that agape love is inconsistent with heteronomative and homophobic scriptural interpretation.

Social Relationships and Adaptation in Later Life

Social relations encompass a complex and dynamic set of characteristics that have been shown to distinctly affect health and quality of life across the lifespan and especially in older adulthood. In this chapter we begin with a brief review of several prominent theories of social relations. Next, we consider how social relations can be understood based on the resource they provide (e.g., contact frequency, social support), the relationship they stem from (e.g., friends, family), the strength of the tie (e.g., strong, weak) as well as the means of communication (e.g., offline, online). We briefly summarize how these characteristics have been shown to uniquely influence health and quality of life in older adulthood. Finally, we contemplate potential clinical applications, provide recommendations for the future and offer final concluding comments.

Denominational and Gender Differences in Hypertension Among African American Christian Young Adults

Hypertension, a major cardiovascular disease risk factor, is disproportionately prevalent among African American young adults. Religion and spirituality (R/S) have been studied for their potential effect on blood pressure (BP) outcomes. Despite their disproportionate hypertension risk and high levels of R/S engagement, limited research explores BP differences among religious African Americans. This study investigates whether denominational affiliation predicts within-group differences in odds of having hypertension among African American Christian young adults. Data from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were used to examine hypertension differences between 1932 African American young adults based on self-reported religious denomination. Gender-separated logistic regressions included religious service attendance and coping measures, as well as personal characteristics and health behaviors to adjust for potential effects on BP. The odds of having hypertension were higher for Pentecostal women compared to Baptist and Catholic women. Hypertension odds for women who reported attending services more than once weekly were lower than those who never attended church. For women, frequent use of religious coping predicted higher odds of having hypertension than seldom or never using religious coping. R/S variables did not predict significant differences among men. The health benefits of R/S do not appear to be consistent within African American Christian young adults. Religion may be viewed as a source of BP risk and resilience, especially among African American young women.

Identifying neighbourhood and individual resilience profiles for cardiovascular health: a cross-sectional study of blacks living in the Atlanta metropolitan area

OBJECTIVE

To simultaneously examine multiple individual-level neighbourhood perceptions and psychosocial characteristics and their relationships with cardiovascular health (CVH) among blacks.

DESIGN

Cross-sectional study.

SETTING

Subjects were recruited between 2016 and 2018 via convenience sampling.

PARTICIPANTS

385 Black men and women, age 30-70 living in the Atlanta metropolitan area (Georgia, USA).

PRIMARY OUTCOME MEASURE

Individual's CVH was summarised as a composite score using American Heart Association's Life's Simple 7 (LS7) metrics.

METHODS

We implemented unsupervised learning (k-means) and supervised learning (Bayesian Dirichlet process clustering) to identify clusters based on 11 self-reported neighbourhood perception and psychosocial characteristics. We also performed principal component analysis to summarise neighbourhood perceptions and psychosocial variables and assess their associations with LS7 scores.

RESULTS

K-means and Bayesian clustering resulted in 4 and 5 clusters, respectively. Based on the posterior distributions, higher LS7 scores were associated with better neighbourhood perceptions and psychosocial characteristics, including neighbourhood safety, social cohesion, activities with neighbours, environmental mastery, purpose in life, resilient coping and no depression. Taken together, the first principal components of neighbourhood perceptions and psychosocial characteristics were associated with an increase of 0.07 (95% CI -0.17 to 0.31) and 0.31 (95% CI 0.06 to 0.55) in LS7 score, respectively, after accounting for age, sex, household income and education level.

CONCLUSION

Both neighbourhood perception and psychosocial domains were related to CVH, but individual psychosocial characteristics appeared to contribute to CVH most. Approaches that acknowledge the importance of factors in both domains may prove most beneficial for enhancing resilience and promoting CVH among black communities.

Hopelessness Among Middle-Aged and Older Blacks: The Negative Impact of Discrimination and Protecting Power of Social and Religious Resources

Background and Objectives

Hopelessness—a state of despair characterized by a negative outlook towards the future and a belief in insurmountable challenges—is a risk factor for major depression, cardiovascular disease, and all-cause mortality among older adults. It is also an understudied consequence of discrimination. Older blacks disproportionately report experiencing discrimination and, as a result, may be at greater risk of feeling hopeless. However, social and religious resources may protect against the adverse effects of discrimination. The current study examines whether social support, social engagement, religious attendance, and religiosity buffer the effects of self-reported everyday discrimination on hopelessness among a nationally representative sample of blacks.

Research Design and Methods

Using data from the 2010/2012 psychosocial assessment of the Health and Retirement Study, we regressed hopelessness on everyday discrimination, stratifying by 2 age groups, ages 51–64, representing middle-age (n = 1,302), and age 65 and older, representing old age (n = 887). Interaction terms tested whether each resource moderated the discrimination–hopelessness relationship controlling for depressive symptoms, socioeconomic status, and demographic characteristics.

Results

Greater reports of everyday discrimination were associated with higher levels of hopelessness for middle-aged and older blacks. For middle-aged blacks, the resources did not moderate the discrimination–hopelessness relationship; rather, higher levels of support (b = −0.294, p < .01), religiosity (b = −0.297, p < .001), religious attendance (b = −0.218, p < .05) were independently and inversely associated with hopelessness. For older blacks, higher levels of religiosity moderated the discrimination–hopelessness relationship (b = −0.208, p < .05) and higher levels of support (b = −0.304, p < .05) and social engagement (b = −0.236, p < .05) were independently and inversely associated with hopelessness.

Discussion and Implications

Findings suggest that self-reported everyday discrimination increases hopelessness among middle-aged and older blacks but social and religious resources may counterbalance its effects, in age-specific ways, to protect against hopelessness. Religiosity may be especially important for older blacks as a buffer against the negative consequences of discrimination on hopelessness.

Doing biocultural anthropology: Continuity and change

Biocultural anthropology has long represented an important approach in the study of human biology. However, despite demonstrated utility, its somewhat amorphous identity leaves some scholars questioning just what it means to be biocultural. In this article, rather than providing proscriptive doctrine, we contribute to these conversations about the nature of biocultural anthropology by considering what biocultural research does. We begin with a consideration of some of the foundational themes of biocultural work including recognition of the dialectical nature of sociocultural and biological forces, interest in inequality, and incorporation of both evolutionary and political economic perspectives. To emphasize the consistency of biocultural work over time, we also trace these themes from originating work to their appearance in current research. We then identify some of the key actions of the biocultural approach, noting that biocultural work can execute any number though rarely all of these actions simultaneously. We then offer brief introductions to the articles that make up this special issue, highlighting the ways in which each piece undertakes key biocultural actions. Following these introductions, we provide a discussion of some of the types of biocultural work that are not present in this special issue, recognizing the breadth of biocultural research across multiple subfields of anthropology. Finally, we point to some potentially fruitful directions for future biocultural research. In the end, we conclude that while biocultural anthropology may not have a cohesive or set agenda, it does have a clear and recognizable form of content and methodology illuminated by its actions.

Do religious and spiritual identity confer risk for hypertension via psychosocial and lifestyle factors?

The total and indirect effect of hostility on systolic and diastolic blood pressure was compared as a function of religious and spirituality identity in a nationally representative sample of 2971 adults aged 46.44 years. Structural equation modeling uncovered an indirect path from hostility to diastolic blood pressure via unhealthy behaviors and hostility to unhealthy behaviors via social isolation. Compared to a non-religious/non-spiritual reference group, the effect for unhealthy behaviors on diastolic blood pressure was greater for those endorsing some form of religious identity. However, the direction of the effect for hostility on social isolation and social isolation on unhealthy behaviors was reversed in those endorsing spiritual and religious identity.

Perceived racism, affectivity, and C-reactive protein in healthy African Americans: Do religiosity and racial identity provide complementary protection?

Perceived racism contributes to cardiovascular disease (CVD) disparities among African Americans. Psychosocial factors that protect against the effects of perceived racism therefore may be reflected by indicators of CVD risk, including C-reactive protein (CRP). The current cross-sectional study examined whether CRP is linked to religiosity and racial identity-two culturally-enshrined individual differences that can protect against the harmful effects of racism. Healthy African Americans completed self-report measures of everyday racism, religious intensity (a measure of the importance of religion/spirituality), and racial centrality (a measure of racial identity strength). We measured positive and negative affectivity as outcomes (N = 534), and we collected a dried bloodspot measure of CRP (N = 118). Religious intensity and racial centrality were independently associated with greater positive affectivity, and interactively associated with negative affectivity and CRP-when perceived racism was high, strongly identified African Americans had significantly higher CRP, but lower negative affectivity, when they were also low in religious intensity. Results highlight that religiosity and racial identity may interactively protect against the effects of racism and may play a role in CVD disparities.

Individual differences in personality predict the use and perceived effectiveness of essential oils

Essential oil (EO) use is growing in popularity and ostensibly used for treating or preventing various ailments or conditions. Despite the increase in use, there is a paucity of research on psychosocial predictors of EO use and their perceived effectiveness. However, several psychosocial characteristics are associated with health-promoting behavior and a tendency to believe in homeopathic cures. In the current study, we examined a variety of individual differences in the use and perceived effectiveness of essential oils in a sample of 1,202 participants (Mage = 31.33, SD = 13.77; 61.7% women, 75.6% Caucasian). We found that receptivity to pseudo-profound fabricated statements and religiosity were the most consistent predictors of greater use of, perceived effectiveness of, and a willingness to spend more money on EOs.

Death Anxiety, Religious Doubt, and Depressive Symptoms across Race in Older Adults

The purpose of this study is to investigate the direct and indirect relationships among death anxiety, religious doubt, and depressive symptoms in older adults. This study also investigates race as a moderator for these relationships. This study used data from the Religion, Aging, and Health Survey. Participants identified as Christian, identified as Black or White, lived in a non-institutionalized household within the U.S., were retired, and spoke English. Using PROCESS, results revealed that religious doubt partially mediated the relationship between death anxiety and depressive symptoms. Furthermore, moderated mediation models revealed that race moderated the relationship between religious doubt and depressive symptoms. Specifically, there was significant, positive relationship between religious doubt and depressive symptoms for participants who identified as Black but not White. Results highlight how religious doubt can influence depressive outcomes among the geriatric communities of color. Limitations and future directions are also discussed.

Religious Attendance and Biological Risk: A National Longitudinal Study of Older Adults

Although several studies suggest that religious involvement is associated with healthier biological functioning in later life, most of this work is cross-sectional. We extend previous research by employing a longitudinal design. Our analysis of Health and Retirement Study (2006/2010) data suggests that older adults who attended religious services weekly or more in 2006 tend to exhibit fewer high-risk biomarkers in 2010 and greater reductions in allostatic load over the 4-year study period than respondents who attended yearly or not at all. These patterns persisted with adjustments for baseline allostatic load and a range of background variables.

Inflammation mediates the effect of discrimination, religiosity, and friendship network on expression of the Tp53 cancer suppressor gene

Objective

Chronic inflammation and expression of the TP53 gene are two biomarkers that have been identified as particularly important in the etiology and progression of cancer. While much is known about the determinants of inflammation, there is currently little information regarding the causes of variation in the functioning of TP53, even though it has been recognized for 40 years as the most potent of the cancer suppressor genes. The current paper explores the interrelationship between these two biomarkers and investigates the extent to which they are influenced by the social environment.

Methods

Using structural equation modeling (SEM) and longitudinal observational data from a sample of several hundred African Americans, we tested the hypothesis that adversity – operationalized as racial discrimination- and coping resources – operationalized as religiosity and black friends - influence expression of TP53, for better or worse, through their impact on inflammation.

Results

Correlational analysis showed inflammation and TP53 to be inversely related. Further, discrimination was positively related to inflammation and negatively related to TP53 expression, whereas religiosity and black friends were both negatively related to inflammation and positively related to TP53 expression. Finally, SEM indicated that the effect of the social environmental variables on TP53 expression was indirect through level of inflammation.

Conclusions

In addition to its established contribution to cancer through DNA damage and cell proliferation, inflammation likely increases cancer risk indirectly by inhibiting expression of the TP53 cancer suppressor gene. Hence environmental and stress management interventions may do more than reduce inflammation's cell damaging effects; they may also lessen the chances of cancer by increasing expression of TP53.

•

Discrimination, religiosity, and black friends showed significant associations with inflammation and TP53.

•

The effect of discrimination, religiosity, and black friends on TP53 was indirect through level of inflammation.

•

Inflammation likely increases cancer risk indirectly by suppressing the TP53 cancer suppressor gene.

•

Environmental and stress management interventions may lessen the chances of cancer by increasing expression of TP53.

Religious Attendance and Body Mass: An Examination of Variations by Race and Gender

Studies of the association between religious attendance and body mass have yielded mixed results. In this paper, we consider intersectional variations by race and gender to advance our understanding of these inconsistencies. We use data from the 2006-2008 Health and Retirement Study to examine the association between religious attendance and three indicators of body mass: overall body mass index, waist circumference, and waist-to-height ratio (n = 11,457). For White women, attendance is either protective or unrelated to body mass. For Black women, attendance is consistently associated with increased body mass. We find that religious attendance is not associated with body mass among the men.

Buddhist Activities related to Sedentary behavior and Hypertension in Tibetan monks

Previous studies suggest sedentary behavior (SB) is a risk factor for hypertension. However, buddhist activities related to SB in Tibetan monks is quite different from common SB. Meditation, chanting, and buddhist teaching are the main features during sitting. There is no study to examine the association between buddhist activities related to sitting and hypertension. There were 594 Tibetan monks included for analysis. Buddhist activities related to SB involve hours of meditation, chanting, and buddhist teaching for a typical weekday and weekend day. After controlling potential risk factors, compared with Tibetan monks who has the sedentary time < 8 h/d, those with 10 h/d ≤ sedentary time < 11 h/d was associated with about 80% decrease in the risk of hypertension (OR = 0.22;95% CI = 0.07-0.71), and about 90% decrease (OR = 0.11; 95% CI = 0.03-0.40) in those with sedentary time ≥ 11 h/d. In hypertension subgroup, buddhist activities related to SB is associated with a decrease in BP during linear regression analysis (standard β = -0.355; P = 0.004 for SBP; standard β = -0.345; P = 0.013 for DBP). We conclude that sitting might not simply represent the extremely low energy expenditure of the physical activity continuum. Psychosocial activities may play an important role in SB.

Building Capacity Among Laity: A Faith-Based Health Ministry Initiative

A systematic review of topic-specific faith-based health programs determined that health outcomes can be improved though faith-based health interventions. A university research team, in partnership with the Kansas United Methodist Church and a United Methodist philanthropy, facilitated planning and development of a statewide initiative to increase the capacity of laity-led health ministry teams. The purpose of this paper is to describe the processes utilized to design and implement an initiative to increase capacity for laity-led comprehensive health ministry among Kansas United Methodist Church congregations and to share the key elements of the initiative.

The Relationship Between Religious and Psychospiritual Measures and an Inflammation Marker (CRP) in Older Adults Experiencing Life Event Stress

Inflammation, often measured by C-reactive protein (CRP), is thought to be related to a number of debilitating illnesses as we age, including cardiovascular disease, cancer and diabetes. Stress has also been implicated in these processes. This study examines potential protective effects of spirituality and religion in older adults who have experienced stressful life events. As part of the nationwide Landmark Study of Spirituality and Health, a subsample of 643 middle-aged and older adults (age ≥ 50) who were at or above the median in number of life stressors (≥ 2) was included in this analysis. Psychospiritual and religious (PS/R) variables included: religious service attendance, prayer, religious meaning, religious hope, general meaning, general hope and sense of peace. Control variables included: age, gender, education, BMI, smoking, alcohol use, social support. Only church attendance predicted significantly lower CRP after controlling for covariates, even above the other PS/R variables (standardized β = - 0.14, t = - 3.23 p = 0.001). Those with frequent religious service attendance were 38% less likely to have clinically elevated CRP than those who attend rarely or never. Religious service attendance may confer protection in older adults experiencing stressful events as it was significantly associated with lower CRP, an inflammatory marker associated with illness.

Religiosity and Health: A Holistic Biopsychosocial Perspective

The resurgence of interest in the influence of religion and spirituality on health is examined within the context of the holistic paradigm and historical connection between nursing and spirituality. While nursing and spirituality often intersect with end-of-life considerations, this article presents findings from studies that demonstrate that religious involvement favors health and longevity across the life course. Examples include protective associations with stress, depression, self-rated health, and infant birth weight. Theoretical and empirical explanations for this relationship are offered, such as social and psychological resources and healthy behaviors. The effects of religion on biological functioning, including allostatic load and telomere length, are also discussed, although this area is understudied. Considerations for the "dark-side" of religious involvement are also offered. Suggestions for nurses wishing to protect and promote the health of their patients using a holistic approach include expanding knowledge of research on religion and health and advocating for patients' spiritual needs by conducting a comprehensive spiritual assessment in primary, secondary, and tertiary clinical settings.

Religiosity and faith in relation to time to metabolic syndrome for Hispanic women in a multiethnic cohort of women-Findings from the Study of Women's Health Across the Nation (SWAN)

OBJECTIVES

We investigated whether faith was associated with a difference in time to incident metabolic syndrome (MetS) among midlife Hispanic women vs women of other ethnicities.

STUDY DESIGN

The Study of Women's Health Across the Nation (SWAN) is a community-based, longitudinal study of a cohort of midlife women. Social, demographic, psychosocial, anthropometric, medical, and physiological measures, and incident MetS were assessed in near-annual intervals using questionnaires and assays. Each participant answered key questions related to religion and meaning in her life. Differences in time to MetS were modeled by Hispanic ethnicity (vs. otherwise) among women reporting low and high levels of faith.

MAIN OUTCOME MEASURE

Incident MetS in the 7 years after the SWAN baseline assessment.

RESULTS

Among 2371 women, average baseline age 46, Hispanic women (n = 168) were more likely to have higher perceived stress and financial strain than non-Hispanic women (n = 2203). Nevertheless, Hispanic women were far more likely than non-Hispanic women to report that faith brought them strength and comfort in times of adversity, that they prayed often, and that their faith was sustaining for them. Hispanic women had the highest incidence rate of MetS of any racial/ethnic group. However, among women with high levels of faith, the incidence rate of MetS was similar in the Hispanic and non-Hispanic groups. Conversely, among women with low levels of faith, Hispanic women had a faster progression to MetS than did non-Hispanic women.

CONCLUSIONS

Faith might be associated with a different risk of MetS among women of Hispanic vs other ethnicities. Among women who are not part of a faith community, Hispanic ethnicity might be a risk factor for MetS.

Adverse Childhood Experiences among a Community of Resilient Centenarians and Seniors: Implications for a Chronic Disease Prevention Framework

CONTEXT

Research has linked adverse childhood experiences (ACEs) with chronic disease in adults and diminished life span. Adverse biological embedding of ACEs potentially occurs through inflammatory mechanisms; inflammatory marker alterations are identified as candidate biomarkers for mediating health consequences. Lifestyle practices of residents of California's Loma Linda Blue Zone, one of five worldwide longevity hotspots, may provide insight into inflammation remediation and chronic disease prevention. Little research has been done on centenarians' early-life experiences or on ACEs in a longevity community.

OBJECTIVE

To interview centenarians and seniors in this region regarding their childhood experiences to inform chronic disease prevention frameworks.

DESIGN

Qualitative study of Loma Linda Blue Zone community members. Childhood exposures and practices were assessed using focus groups and semistructured key informant interviews, with open-ended questions on general hardships and ACEs and supplemented with lifestyle and resiliency factor questions. Data were audiorecorded and transcribed. Integrative grounded theory methods guided coding and theming.

MAIN OUTCOME MEASURES

Exposure to ACEs and practice of resiliency factors.

RESULTS

Participants (7 centenarians and 29 seniors) reported exposure to multiple ACEs (domains: Economic deprivation, family dysfunction, and community violence). Community members reported practicing resiliency factors, each with anti-inflammatory properties suggesting mitigation of ACE-related toxic stress.

CONCLUSION

This is one of the first studies of its kind to identify a community of resilient members despite their tremendous burden of ACEs. Embedding the identified resiliency factors into chronic disease prevention frameworks has potential for mitigating systemic inflammation, alleviating chronic disease burden, and promoting a culture of health.

Religious Participation and Biological Functioning in Mexico

OBJECTIVE

Although several studies suggest that religious involvement tends to favor healthy biological functioning, most of this work has been conducted in the United States. This study explores the association between religious participation and biological functioning in Mexico.

METHOD

The data are drawn from two waves of the Mexican Health and Aging Study (2003-2012) to assess continuous and categorical biomarker specifications.

RESULTS

Across specifications, religious participation in 2003 is associated with lower levels of waist-to-hip ratio, total cholesterol, pulse rate, and overall allostatic load in 2012. Respondents who increased their participation over the study period also exhibit a concurrent reduction in pulse rate. Depending on the specification, participation is also associated with lower levels of diastolic blood pressure and C-reactive protein. Participation is generally unrelated to body mass index, glycosylated hemoglobin, and systolic blood pressure.

DISCUSSION

Our results confirm that religious participation is associated with healthier biological functioning in Mexico.

Church attendance, allostatic load and mortality in middle aged adults

IMPORTANCE

Religiosity has been associated with positive health outcomes. Hypothesized pathways for this association include religious practices, such as church attendance, that result in reduced stress.

OBJECTIVE

The objective of this study was to examine the relationship between religiosity (church attendance), allostatic load (AL) (a physiologic measure of stress) and all-cause mortality in middle-aged adults.

DESIGN, SETTING AND PARTICIPANTS

Data for this study are from NHANES III (1988-1994). The analytic sample (n = 5449) was restricted to adult participants, who were between 40-65 years of age at the time of interview, had values for at least 9 out of 10 clinical/biologic markers used to derive AL, and had complete information on church attendance.

MAIN OUTCOMES AND MEASURES

The primary outcomes were AL and mortality. AL was derived from values for metabolic, cardiovascular, and nutritional/inflammatory clinical/biologic markers. Mortality was derived from a probabilistic algorithm matching the NHANES III Linked Mortality File to the National Death Index through December 31, 2006, providing up to 18 years follow-up. The primary predictor variable was baseline report of church attendance over the past 12 months. Cox proportional hazard logistic regression models contained key covariates including socioeconomic status, self-rated health, co-morbid medical conditions, social support, healthy eating, physical activity, and alcohol intake.

RESULTS

Churchgoers (at least once a year) comprised 64.0% of the study cohort (n = 3782). Non-churchgoers had significantly higher overall mean AL scores and higher prevalence of high-risk values for 3 of the 10 markers of AL than did churchgoers. In bivariate analyses non-churchgoers, compared to churchgoers, had higher odds of an AL score 2-3 (OR 1.24; 95% CI 1.01, 1.50) or ≥4 (OR 1.38; 95% CI 1.11, 1.71) compared to AL score of 0-1. More frequent churchgoers (more than once a week) had a 55% reduction of all-cause mortality risk compared with non-churchgoers. (HR 0.45, CI 0.24-0.85) in the fully adjusted model that included AL.

CONCLUSIONS AND RELEVANCE

We found a significant association between church attendance and mortality among middle-aged adults after full adjustments. AL, a measure of stress, only partially explained differences in mortality between church and non-church attendees. These findings suggest a potential independent effect of church attendance on mortality.

Processes Linking Religious Involvement and Telomere Length

Although numerous studies suggest that religious involvement is associated with better health and longer life expectancies, it is unclear whether these general patterns extend to cellular aging. The mechanisms linking indicators of religious involvement with indicators of cellular aging are also undefined. We employed longitudinal data from the 2004 and 2008 Health and Retirement Study, a national probability sample of Americans aged 50 and older, to test whether average telomere length varied according to level of religious attendance. We also tested several potential mechanisms. Our results showed that respondents who attended religious services more frequently in 2004 also exhibited fewer stressful events, lower rates of smoking, fewer symptoms of depression, and lower levels of C-reactive protein in 2008. Respondents who increased their level of attendance from 2004 to 2008 also exhibited lower rates of smoking in 2008. Although religious attendance was not directly associated with telomere length, our mediation analyses revealed significant indirect effects through depression and smoking, but not stressful events or C-reactive protein. We conclude that religious attendance may promote telomere length indirectly by reducing symptoms of depression and the risk of smoking. There was no evidence to support stressful events or C-reactive protein as mechanisms of religious attendance.

Religious Involvement and Health over Time: Predictive Effects in a National Sample of African Americans

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.

Dimensions of religious involvement and leukocyte telomere length

Although numerous studies suggest that religious involvement is associated with a wide range of favorable health outcomes, it is unclear whether this general pattern extends to cellular aging. In this paper, we tested whether leukocyte telomere length varies according to several dimensions of religious involvement. We used cross-sectional data from the Nashville Stress and Health Study (2011-2014), a large probability sample of 1252 black and white adults aged 22 to 69 living in Davidson County, TN, USA. Leukocyte telomere length was measured using the monochrome multiplex quantitative polymerase chain reaction method with albumin as the single-copy reference sequence. Dimensions of religious involvement included religiosity, religious support, and religious coping. Our multivariate analyses showed that religiosity (an index of religious attendance, prayer frequency, and religious identity) was positively associated with leukocyte telomere length, even with adjustments for religious support, religious coping, age, gender, race, education, employment status, income, financial strain, stressful life events, marital status, family support, friend support, depressive symptoms, smoking, heavy drinking, and allostatic load. Unlike religiosity, religious support and religious coping were unrelated to leukocyte telomere length across models. Depressive symptoms, smoking, heavy drinking, and allostatic load failed to explain any of the association between religiosity and telomere length. To our knowledge, this is the first population-based study to link religious involvement and cellular aging. Although our data suggest that adults who frequently attend religious services, pray with regularity, and consider themselves to be religious tend to exhibit longer telomeres than those who attend and pray less frequently and do not consider themselves to be religious, additional research is needed to establish the mechanisms underlying this association.

Lifetime Trauma, Praying for Others, and C-Reactive Protein

Research indicates that praying for others may offset the effects of stress on self-rated health and psychological well-being. The purpose of the current study is to extend this literature by seeing whether praying for others moderates the effects of exposure to lifetime trauma on a key marker of inflammation: C-reactive protein. The data come from a recent nationwide survey of adults of all ages (N = 1,589). Levels of C-reactive protein were obtained from assays of blood spots drawn from a capillary fingerstick. The findings suggest that the magnitude of the relationship between lifetime trauma and C-reactive protein is completely offset for study participants who frequently pray for others. The theoretical implications of this research are discussed.

Spirituality, Religiosity, and Weight Management Among African American Adolescent Males: The Jackson Heart KIDS Pilot Study

Spirituality and religion have been identified as important determinants of health for adults; however, the impact of faith-oriented factors on health behaviors and outcomes among African American adolescent males has not been well studied. The purpose of this study is to examine the relationship between religiosity and spirituality and obesity-related behaviors among 12-19 year old African American males (N = 105) in the Jackson Heart KIDS Pilot Study. Key variables of interest are church attendance, prayer, daily spirituality, weight status, attempts to lose weight, nutrition, physical activity, and stress. Daily spirituality is associated with whether an individual attempts to lose weight. The results from logistic regression models suggest that daily spirituality increases the odds that African American male adolescents attempt to lose weight (OR = 1.22, CI: 1.07-1.41) and have a history of diet-focused weight management (OR = 1.13, CI: 1.02-1.26). Future studies are needed to further explore the association between religion, spirituality, and obesity-related behaviors.

Ethnic/racial differences in the association between social support and levels of C-reactive proteins in the North Texas Heart Study

Perceived social support has been reliably related to lower rates of morbidity and mortality. However, studies modeling C-reactive protein (CRP) as an important biological pathway linking social support to health have produced inconsistent results. Given purported ethnic/racial differences in sensitivity to social resources, the present study tested if ethnicity/race moderated the link between perceived support and CRP in a diverse community sample of 300 participants from the North Texas Heart Study. Consistent with prior research, there was no overall link between social support and CRP levels. However, the association between social support and high sensitivity (hs)-CRP levels was moderated by ethnicity/race as perceived support predicted lower hs-CRP levels primarily in African Americans. These results suggest the importance of considering how ethnicity/race may inform models on the complex biological mechanisms linking social support to health.