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

Placing the US Federal Investment in Religion, Spirituality, and Health Research in Context: A Systematic Review and Comparison with Social Support and Optimism Funding Levels

Religion and spirituality (R/S) have been linked to better physical and mental health. The US government has funded several research studies that include a focus on R/S but the amount of support over the last several years appears to be declining. To better understand these funding trends for R/S and health research, we chose relevant comparisons from projects that include a focus on social support and optimism. We identified total amount of funding, change in funding patterns over time, and characteristics of funded projects from a large database of US research projects (Federal RePORTER). We reviewed 5093 projects for social support and 6030 projects for optimism before narrowing the number of eligible studies to 170 and 13, respectively. Social support projects received the largest investment of $205 million dollars. Funded awards for social support and optimism remained stable over time while R/S decreased (p = 0.01), intervention research was more characteristic and studies of African-American/Black participants were less characteristic of funded projects in social support than of R/S (ps < 0.001). Future research for R/S and health would likely benefit from continued focus on minority communities and on identifying and developing appropriate interventions to support individual and community health and well-being.

Converting qualitative data into quantitative values using a matched mixed-methods design: A new methodological approach

BACKGROUND

Quantifying qualitative data as part of mixed-methods research (MMR) can add to the study results' analysis. Comparable results may reinforce the conclusions, while differences hold an opportunity for an in-depth discussion. To date, there is little guidance for researchers seeking to quantify their qualitative data.

OBJECTIVES

Describing conversion of qualitative data to quantitative values, comparison with matched questionnaire results, discussing the benefits of this process and the matched MMR design.

METHODS

We describe in detail how qualitative data from 46 interviews were converted into quantitative values (i.e., quantitative-qualitative values, QQVs) using MMR design, enabling a comparison of results from interviews and questionnaires obtained from the same participants. This process was embedded in a larger MMR study on family-caregivers caring for people-with-end-stage-dementia conducted between the years 2020-2021.

RESULTS

A QQV was generated for three main themes and compared to the questionnaires' scores regarding the same topics. There were no significant differences between the scores regarding 'satisfaction with nurses and physicians care', and 'discussion with nurses and physicians about end-of-life care'. However, for 'burden', the QQV score was significantly higher than the questionnaires' score.

DISCUSSION

We described how to use a matched MMR design to produce and compare QQV from interviews with questionnaire scores. This methodology may allow further valuable discussion if the results are either similar or not, and for better integration and easier presentation of the results. Comparable results can reinforce the conclusions from both parts of the MMR study, while differences hold an opportunity for an in-depth discussion regarding their meaning and context. Although we claim that this methodology can be embedded in the MMR structure and contribute significantly to the discussion's depth, it by no means replaces the traditional MMR design.

PATIENT AND PUBLIC CONTRIBUTION

No patient or public contribution.

Prevalence of Cardiovascular Disease Risk Factors by Key Demographic Variables Among Mid-South Church Leaders from 2012 to 2017

Cardiovascular disease (CVD) risk factors were examined among church leaders (n = 2309) who attended Mid-South United Methodist Church annual meetings between 2012 and 2017 using repeated cross-sectional data. There was a significant increase in body mass index (BMI) (b = 0.24, p = 0.001) and significant decreases in blood pressure (systolic: b = - 1.08, p < 0.001; diastolic: b = - 0.41, p = 0.002), total cholesterol (b = - 1.76, p = 0.001), and blood sugar (b = - 1.78, p = 0.001) over time. Compared to Whites, a significant increase was seen in BMI (b = 1.14, p = 0.008) among participants who self-identified as "Other," and a significant increase was seen in blood pressure (systolic: b = 1.36, p = 0.010; diastolic: b = 1.01, p = 0.004) among African Americans over time. Results indicate BMI and blood pressure are important CVD risk factors to monitor and address among church leaders, especially among race/ethnic minority church leaders.

Rural-Urban Differences in the Factors Affecting Depressive Symptoms among Older Adults of Two Regions in Myanmar

The aim of the study was to investigate rural–urban differences in depressive symptoms in terms of the risk factors among older adults of two regions in Myanmar to provide appropriate intervention for depression depending on local characteristics. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from the two regions, for face-to-face interviews. Depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (GDS). Depressive symptoms were positively associated with living in rural areas (B = 0.42; 95% confidence interval (CI): 0.12,0.72), female (B = 0.55; 95% CI: 0.31,0.79), illness during the preceding year (B = 0.68; 95% CI: 0.45,0.91) and non-Buddhist religion (B = 0.57; 95% CI: 0.001,1.15) and protectively associated with education to middle school level or higher (B = −0.61; 95% CI: −0.94, −0.28) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.30, −0.10). In women in urban areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.78; 95% CI: 0.36, 1.20) and protectively associated with education to middle school level or higher (B = −0.67; 95% CI: −1.23, −0.11), middle or high wealth index (B = −0.92; 95% CI: −1.59, −0.25) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.38, −0.03). In men in rural areas, illness during the preceding year was positively associated with depressive symptoms (B = 0.87; 95% CI: 0.33, 1.42). In women in rural areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.83; 95% CI: 0.36, 1.30) and protectively associated with primary education (B = −0.62; 95% CI: −1.12, −0.12) and the frequency of visits to religious facilities (B = −0.44; 95% CI: −0.68, −0.21). Religion and wealth could have different levels of association with depression between older adults in the urban and rural areas and men and women. Interventions for depression in older adults should consider regional and gender differences in the roles of religion and wealth in Myanmar.

"I Struggle with Breast Cancer and I Struggle with God": Insights from African American Breast Cancer Survivors

PURPOSE

Recognizing that spiritual and religious beliefs are personal and vary within communities, the purpose of this qualitative study was to explore the influence of these beliefs on experiences with breast cancer care and social support among African American Christian breast cancer survivors.

METHODS

Forty-seven African American breast cancer survivors participated in focus groups (n = 7) in three northeastern urban cities. We used thematic analyses to identify major themes.

RESULTS

Three themes emerged relating to how spirituality influenced participants' cancer journeys: (1) struggling with God, (2) reclaiming my power, and (3) needing religious social support. Participants described the rhythmic flow of their spiritual beliefs as they navigated their lived experiences during diagnosis, treatment, and post-treatment. Spirituality was intimately intertwined with their illness experience as they grappled with their health and well-being.

CONCLUSIONS

Participants used spirituality as an avenue to cope and navigate through their diagnosis and treatment. These spiritual relationships created "church families" and provided the survivors' access to cancer support groups, financial support, and therapeutic support. Our findings support faith-based approaches to health promotion and call for more studies to understand the influence of religion on health.

Association between depressive symptoms and objective/subjective socioeconomic status among older adults of two regions in Myanmar

Low objective socioeconomic status (SES) has been correlated with poor physical and mental health among older adults. Some studies suggest that subjective SES is also important for ensuring sound physical and mental health among older adults. However, few studies have been conducted on the impact of both objective and subjective SES on mental health among older adults. This study examines whether objective or subjective SES is associated with depressive symptoms in older adults in Myanmar. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from two regions of Myanmar, for face-to-face interviews. The Geriatric Depression Scale (GDS) was used to evaluate the depressive symptoms. Participants were classified as having no depressive symptom (GDS score <5) and having depressive symptoms (GDS score ≥5). Objective and subjective SES were assessed using the wealth index and asking participants a multiple-choice question about their current financial situation, respectively. The relationship between objective/subjective SES and depressive symptoms was examined using a multivariable logistic regression analysis. The mean age of the 1,186 participants aged 60 years and above was 69.7 (SD: 7.3), and 706 (59.5%) were female. Among them, 265 (22.3%) had depressive symptoms. After adjusting for objective SES and other covariates, only low subjective SES was positively associated with depressive symptoms (adjusted odds ratio, AOR: 4.18, 95% confidence interval, CI: 2.98-5.87). This association was stronger among participants in the rural areas (urban areas, AOR: 2.10, 95% CI: 1.08-4.05; rural areas, AOR: 5.65, 95% CI: 3.69-8.64). Subjective SES has a stronger association with depressive symptoms than objective SES, among older adults of the two regions in Myanmar, especially in the rural areas. Interventions for depression in older adults should consider regional differences in the context of subjective SES by reducing socioeconomic disparities among the communities.

Destroying God's Temple? Physical Inactivity, Poor Diet, Obesity, and Other "Sin" Behaviors

On average, our participants (N = 112), who self-proclaimed to be Christians, believed that physically inactive lifestyles, unhealthy eating, overeating, and being obese destroy the body, God's temple. However, these beliefs were less definitive, than those of other common "sin" behaviors, such as drug use, smoking, and excessive drinking of alcohol. In addition, destroying the body with physical inactivity or poor diet was not necessarily viewed as sinful. Subsequently, these beliefs did not relate to self-reported physical activity, dietary behavior, or body mass index. It is possible that inactivity, poor dietary habits, and obesity are not internalized into the spiritual perspective as destroying the body, God's temple, in the same way as other "sin" behaviors.

Race, ethnicity, religious affiliation, and education are associated with gay and bisexual men's religious and spiritual participation and beliefs: Results from the One Thousand Strong cohort

OBJECTIVES

This study examined the rates of spirituality, religiosity, religious coping, and religious service attendance in addition to the sociodemographic correlates of those factors in a U.S. national cohort of 1,071 racially and ethnically diverse HIV-negative gay and bisexual men.

METHOD

Descriptive statistics were used to assess levels of spirituality, religiosity, religious coping, and religious service attendance. Multivariable regressions were used to determine the associations between sociodemographic characteristics, religious affiliation, and race/ethnicity with four outcome variables: (1) spirituality, (2) religiosity, (3) religious coping, and (4) current religious service attendance.

RESULTS

Overall, participants endorsed low levels of spirituality, religiosity, and religious coping, as well as current religious service attendance. Education, religious affiliation, and race/ethnicity were associated with differences in endorsement of spirituality and religious beliefs and behaviors among gay and bisexual men. Men without a 4-year college education had significantly higher levels of religiosity and religious coping as well as higher odds of attending religious services than those with a 4-year college education. Gay and bisexual men who endorsed being religiously affiliated had higher levels of spirituality, religiosity, and religious coping as well as higher odds of religious service attendance than those who endorsed being atheist/agnostic. White men had significantly lower levels of spirituality, religiosity, and religious coping compared to Black men. Latino men also endorsed using religious coping significantly less than Black men.

CONCLUSIONS

The implications of these findings for future research and psychological interventions with gay and bisexual men are discussed. (PsycINFO Database Record

Role of religious social support in longitudinal relationships between religiosity and health-related outcomes in African Americans

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.

Exploring the Relationship of Religiosity, Religious Support, and Social Support Among African American Women in a Physical Activity Intervention Program

Religious belief has been linked to a variety of positive mental and physical health outcomes. This exploratory study will address the relationship between religious involvement and social connectedness among African American women. Results from a physical activity intervention research project (N = 465) found that total religious support and social support were significantly negatively correlated with total religiosity, while total general social support was significantly positively correlated with total religious support. Overall, the study indicates that more research is needed on ways to encourage interaction between the positive dimensions of both religiosity and social support to bring about healthy behaviors.

Characterizing Change in Religious and Spiritual Identity among a National Sample of African American Adults

We explore changes in self-reported religious/spiritual identity in 313 African American adults over an average period of 2.5 years. Changes in religious and spiritual identity were reported by half of the participants and were associated with age, education, and income. The least stability was observed among respondents identifying as religious/not spiritual at baseline but shifting to religious and spiritual at follow-up. This trend was significant for respondents age 55 and over. Faith-based interventions for African Americans should consider viewing religious and spiritual identity as a fluid rather than fixed characteristic assessing changes in spiritual and religious attributes over time.

Word on the Street: Engaging Local Leaders in a Dialogue About Prostate Cancer Among African Americans

African American men face the highest rates of prostate cancer, yet with no consensus for screening and treatment, making informed health care decisions is difficult. This study aimed to identify approaches to empowering African American men as proactive participants in prostate cancer decision making using an established community-campus partnership employing elements of community-based participatory research methods. Community stakeholders with an interest in, and knowledge about, health care in two local African American communities were recruited and completed key informant interviews (N = 39). Grounded theory coding identified common themes related to prostate cancer knowledge, beliefs, attitudes, and responses to them. Common barriers such as gender roles, fear, and fatalism were identified as barriers to work-up and treatment, and both communities' inadequate and inaccurate prostate cancer information described as the key problem. To build on community strengths, participants said the change must come from inside these communities, not be imposed from the outside. To accomplish this, they suggested reaching men through women, connecting men to doctors they can trust, making men's cancer education part of broader health education initiatives designed as fun and inexpensive family entertainment events, and having churches bring community members in to speak on their experiences with cancer. This study demonstrated the success of community engagement to identify not only barriers but also local strengths and facilitators to prostate cancer care in two suburban/rural African American communities. Building collaboratively on community strengths may improve prostate cancer care specifically and health care in general.

NEW AND EMERGING PROFESSIONALS: Does Race Moderate Social Support and Psychological Distress Among Rural Older Adults?

Greater social support is associated with decreased psychological distress among older adults. Researchers have found racial differences in psychological distress. Might race moderate social support and psychological distress? The authors hypothesized African American collectivistic values could increase the importance of social support. Participants were rural adults aged 60 and older (N = 100). Multiple regression analyses controlled for health, income, education, and sex. Race moderated satisfaction with social support and psychological distress. However, greater satisfaction predicted less psychological distress among Caucasians while it was not associated with African Americans' distress in this sample. Achieving satisfaction with social support may be particularly important for Caucasians receiving therapy. Interventions may also address strategies to improve physical health, emotional support, and quality of social support, which significantly predicted psychological distress for both groups.

Black megachurch websites: an assessment of health content for congregations and communities

This study examines the health-related content of Black megachurch websites in the southeastern United States. Data collection resulted in the identification of qualitative themes and frequencies of references to general health, specific health conditions, and corresponding general and specific health ministries. The most salient qualitative themes included holistic definitions of health, attention to racial health disparities, belief in divine health and protection from illness, emphasis on individual health responsibility, and belief in a religion-health connection. Nearly all websites referred to general health, and 74% mentioned a general health ministry. The most frequent references to specific health conditions included addiction, cancer, and HIV/AIDS, roughly corresponding to the top mentioned specific health ministries. This study provides baseline data on Black megachurch efforts to convey health information to their virtual congregations and communities. Findings support recent initiatives to involve megachurches in the provision of health messages within cultural frames to reach African Americans.

The psychological well-being of people living with HIV/AIDS and the role of religious coping and social support

OBJECTIVE

This study examined correlates of depressive symptoms, particularly the role of religious coping (RCOPE), among people living with HIV/AIDS (PLWHA). The study also examined social support as a possible mediator of the proposed association between religious coping and depressive symptoms and the impact of depressive symptomatology on health outcomes such as HIV medication adherence, immune function, and health-related quality of life (HRQOL) among PLWHA.

METHOD

A convenience sample of 292 PLWHA were recruited from an out-patient infectious disease clinic and AIDS-service organizations in the Southeastern United States.

RESULTS

56.7% reported depressive symptoms. PLWHA with depressive symptomatology reported significantly poorer health outcomes, including poorer HIV medication adherence, lower CD4 cell count, and poorer HRQOL. The odds of being depressed was significantly associated with birth sex (female: OR = 0.43, 95% CI = .23-.80), sexual orientation (gay/bisexual: OR = 1.95, 95% CI = 1.04-3.65), marital status (single: OR = .52, 95% CI = .27-.99), social support satisfaction (OR = 0.65, 95% CI = .49-.86), and negative RCOPE (OR = 1.22, 95% CI = 1.14-1.31). Social support partially mediated the relationship between religious coping and depressive symptoms.

CONCLUSIONS

High rates of depressive symptoms are present in PLWHA, which negatively impact health outcomes. Religious coping, perceived stress, and social support satisfaction serve an important role in depressive symptomatology among PLWHA. These findings underscore the need for healthcare providers to regularly screen PLWHA for and adequately treat depression and collaborate with mental health providers, social workers, and pastoral care counselors to address PLWHA's mental, social, and spiritual needs and optimize their HIV-related outcomes.

Positive self-perceptions as a mediator of religious involvement and health behaviors in a national sample of African Americans

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.

C-reactive protein levels in African Americans: a diet and lifestyle randomized community trial

BACKGROUND

Chronic inflammation is linked to poor lifestyle behaviors and a variety of chronic diseases that are prevalent among African Americans, especially in the southeastern U.S.

PURPOSE

The goal of the study was to test the effect of a community-based diet, physical activity, and stress reduction intervention conducted in 2009-2012 on reducing serum C-reactive protein (CRP) in overweight and obese African-American adults.

METHODS

An RCT intervention was designed jointly by members of African-American churches and academic researchers. In late 2012, regression (i.e., mixed) models were fit that included both intention-to-treat and post hoc analyses conducted to identify important predictors of intervention success. Outcomes were assessed at 3 months and 1 year.

RESULTS

At baseline, the 159 individuals who were recruited in 13 churches and had evaluable outcome data were, on average, obese (BMI=33.1 [±7.1]) and had a mean CRP level of 3.7 (±3.9) mg/L. Reductions were observed in waist-to-hip ratio at 3 months (2%, p=0.03) and 1 year (5%, p<0.01). In female participants attending ≥60% of intervention classes, there was a significant decrease in CRP at 3 months of 0.8 mg/L (p=0.05), but no change after 1 year. No differences were noted in BMI or interleukin-6.

CONCLUSIONS

In overweight/obese, but otherwise "healthy," African-American church members with very high baseline CRP levels, this intervention produced significant reductions in CRP at 3 and 12 months, and in waist-to-hip ratio, which is an important anthropometric predictor of overall risk of inflammation and downstream health effects.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01760902.

Positive and Negative Religious Beliefs Explaining the Religion-Health Connection Among African Americans

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.

Religious involvement and physical and emotional functioning among African Americans: the mediating role of religious support

OBJECTIVES

Religious social support may in part account for the relationship between religious involvement and health-related outcomes. African Americans, on average, tend to have relatively high levels of religious involvement, and suffer a higher burden of health conditions than other groups. This study aimed to examine whether religious social support played a mediating role between religious involvement and physical and emotional functioning, and depressive symptoms.

DESIGN

The study used a cross sectional telephone survey among a national probability sample of African Americans (n = 803). Study participants completed telephone interviews and data were analysed using structural equation modelling.

MAIN OUTCOME MEASURES

Physical and emotional functioning and depressive symptoms served as study outcomes.

RESULTS

In both the emotional functioning and depressive symptoms models, the indirect effect test from religious behaviours to emotional religious support indicated evidence for mediation. There was no mediation for the physical functioning model.

CONCLUSION

Implications for faith-based health promotion interventions are discussed.

Medication adherence and spiritual perspectives among african american older women with hypertension. A qualitative study

The purpose of this qualitative study was to explore how African American older adults use spirituality to adhere to their antihypertensive medications. Data collection included in-depth individual interviews with 21 older African American women. Content analysis revealed five themes: The Lord Helps Those Who Help Themselves; Staying in the Lord for Guidance; God Is My Rock; Guardian Angels and Saints; and Brings Me Peace, Ease of Burdens, and Ability to Cope. Findings of this study suggest that spirituality is perceived as a positive resource that helps study participants adhere to their antihypertensive medication regimen. Possible faith-based interventions for nurses and other health care professionals to use with their patients are discussed.

EXPLORING SPIRITUAL WELL-BEING AMONG SURVIVORS OF COLORECTAL AND LUNG CANCER

This descriptive, exploratory study is part of a larger observational study of the quality of cancer care delivered to population-based cohorts of newly-diagnosed patients with lung and colorectal cancer. The current study explores the role of spiritual well-being in adjustment to life after the cancer diagnosis, utilizing the Functional Assessment of Chronic Illness Therapy - Spiritual Well-being - Expanded (FACIT-Sp-Ex) Scale. Survey data collected from 304 newly-diagnosed cancer survivors were analyzed to explore important aspects of spirituality, such as sense of meaning in one's life, harmony, peacefulness, and a sense of strength and comfort from one's faith. Spiritual well-being scores, particularly meaning/peace, were statistically significant for African Americans, women and colorectal cancer survivors. These findings amplify a need for oncology social workers and other practitioners to assess spiritual well-being in cancer survivors in an effort to strengthen psychosocial treatment plans. Implications for social work practice and research are discussed.