Religious attendance and mortality: implications for the black-white mortality crossover

The Relationship between Religion, Substance Misuse, and Mental Health among Black Youth

Studies suggest that religion is a protective factor for substance misuse and mental health concerns among Black/African American youth despite reported declines in their religious involvement. However, few studies have investigated the associations among religion, substance misuse, and mental health among Black youth. Informed by Critical Race Theory, we evaluated the correlations between gender, depression, substance misuse, and unprotected sex on mental health. Using multiple linear regression, we assessed self-reported measures of drug use and sex, condom use, belief in God, and religiosity on mental health among a sample of Black youth (N = 638) living in a large midwestern city. Results indicated drug use, and sex while on drugs and alcohol, were significant and positively associated with mental health symptoms. Belief in God was negatively associated with having sex while on drugs and alcohol. The study's findings suggest that despite the many structural inequalities that Black youth face, religion continues to be protective for Black youth against a myriad of prevalent problem behaviors.

Black and white differences in subjective survival expectations: An evaluation of competing mechanisms

While black-white inequality in longevity is well documented in the United States, little is known about how individuals from different race/ethnic groups form their own personal survival expectations. Prior research has found that despite having higher mortality, blacks on average report higher survival expectations relative to whites. Using data from the Health and Retirement Study, we examined racial differences in subjective survival expectations across birth cohorts and provide explanatory mechanisms. We find that blacks-men in particular-were overly optimistic about their survival, but this effect had waned with successive birth cohorts. Furthermore, whereas subjective survival expectations and actual survival were correlated among white men, among black men the most optimistic fared worst. Blacks and whites differed not only in their response patterns, but also in how they weighed the different factors (socioeconomic, psychosocial, health, parental longevity) associated with expected survival. Importantly, those who estimated their survival probability with certainty had positive psychosocial characteristics, irrespective of race, but only whites had better health. These findings underscore the importance of group differences in subjective survival expectations as another potential form of inequality. Racial differences in how long individual expect to live may account for differences in social and economic behavior and outcomes, irrespective of actual longevity differentials.

Does Religious Participation Predict Future Expectations About Health? Using a Life Course Framework to Test Multiple Mechanisms

Though an impressive array of health outcomes has been studied, research within the field of religion and health has not yet considered how religious involvement may affect future expectations about health. This is a significant shortcoming because the teachings of many religions direct adherent's focus to the distant future, and future self-ratings of health are a known predictor of subjective life expectancy and eventual mortality risk. Recognizing the need for a life course approach to conceptualizing patterns of religious involvement, we assess how stability or change in religious attendance from childhood to adulthood structures individual expectations of future health. Drawing on data from the 2017 Values and Beliefs of the American Public Study (Baylor Religion Survey Wave 5), we find that stable high (weekly) attendance between childhood and adulthood is associated with higher future health expectations. Parametric mediation analyses conducted in the counterfactual framework suggest that this association is explained by the tendency of frequent stable attenders to have (a) higher levels of beliefs in the sense of divine control and (b) a lower likelihood of engaging in harmful health behaviors (smoking).

Religious Participation and Mortality Risk in Mexico

OBJECTIVES

Although research suggests that religious involvement tends to favor longevity, most of this work has been conducted in the United States. This article explores the association between religious participation and all-cause mortality risk in Mexico.

METHODS

We used data from the 2003-2015 Mexican Health and Aging Study (n = 14,743) and Cox proportional hazard regression models to assess the association between religious participation and all-cause mortality risk.

RESULTS

Our key finding is that older Mexicans who participate once or more per week in religious activities tend to exhibit a 19% reduction in the risk of all-cause mortality than those who never participate. This estimate persisted with adjustments for health selection (chronic disease burden, activities of daily living, instrumental activities of daily living, cognitive functioning, and depressive symptoms), several potential mediators (social support, smoking, and drinking), and a range of sociodemographic characteristics. Although we observed considerable health selection due to physical health and cognitive functioning, we found no evidence of mediation.

DISCUSSION

Our results confirm that religious participation is associated with lower all-cause mortality risk among older adults in Mexico. Our analyses contribute to previous research by replicating and extending the external validity of studies conducted in the United States, Israel, Denmark, Finland, and Taiwan.

Religion, Life Expectancy, and Disability-Free Life Expectancy Among Older Women and Men in the United States

OBJECTIVES

Existing literature shows religion is associated with health and survival separately. We extend this literature by considering health and survival together using a multistate life table approach to estimate total, disability-free, and disabled life expectancy (LE), separately for women and men, for 2 disability measures, and by 2 indicators of religion.

METHOD

Data come from the Health and Retirement Study (1998-2014 waves). Predictors include importance of religion and attendance at religious services. The disability measures are defined by ADLs and IADLs. Models control for sociodemographic and health covariates.

RESULTS

Attendance at religious services shows a strong and consistent association with life and health expectancy. Men and women who attend services at least once a week (compared with those who attend less frequently or never) have between 1.1 and 5.1 years longer total LE and between 1.0 and 4.3 years longer ADL disability-free LE. Findings for IADL disability are similar. Importance of religion is related to total and disabled LE (both ADL and IADL), but the differentials are smaller and less consistent. Controlling for sociodemographic and health factors does not explain these associations.

DISCUSSION

By estimating total, disability-free, and disabled LE, we are able to quantify the advantage of religion for health. Results are consistent with previous studies that have focused on health and mortality separately.

The effect of religious belief on Chinese elderly health

BACKGROUND

With the accelerated ageing of the population in China, the health problems of elderly people have attracted much attention. Although religious belief has been shown to be a key way to improve the health of elderly people in various studies, little is known about the causal relationship between these variables in China. This paper explores the effect of religious belief on the health of elderly people in China, which will provide an important reference for China to achieve healthy ageing.

METHODS

Balanced panel data collected between 2012 and 2016 from the China Family Panel Studies (CFPS) were used. Health was assessed using self-rated health, and religious belief was measured by whether the respondents believed in a religion. The DID+PSM method was employed to solve the endogeneity problem caused by self-selection and omitted variables. In addition, the CESD score (replacing self-rated health) and different matching methods (the method of PSM after DID method) were used to perform the robustness test.

RESULTS

The results show that religious belief has no significant effect on the health of elderly people. With the application of different matching methods (one-to-one matching, K-nearest neighbour matching, radius matching and kernel matching) and replacing the health indicator (the CESD score) with the above matching methods, the results are still robust.

CONCLUSION

In China, religious belief plays a limited role in promoting "healthy ageing", and it is difficult to improve the health of elderly people only via religious belief. Therefore, except for focusing on the guidance of religion with regard to healthy lifestyles, multiple measures need to be taken to improve the health of elderly people.

Multidimensional Mortality Selection: Why Individual Dimensions of Frailty Don't Act Like Frailty

Theoretical models of mortality selection have great utility in explaining otherwise puzzling phenomena. The most famous example may be the Black-White mortality crossover: at old ages, Blacks outlive Whites, presumably because few frail Blacks survive to old ages while some frail Whites do. Yet theoretical models of unidimensional heterogeneity, or frailty, do not speak to the most common empirical situation for mortality researchers: the case in which some important population heterogeneity is observed and some is not. I show that, when one dimension of heterogeneity is observed and another is unobserved, neither the observed nor the unobserved dimension need behave as classic frailty models predict. For example, in a multidimensional model, mortality selection can increase the proportion of survivors who are disadvantaged, or "frail," and can lead Black survivors to be more frail than Whites, along some dimensions of disadvantage. Transferring theoretical results about unidimensional heterogeneity to settings with both observed and unobserved heterogeneity produces misleading inferences about mortality disparities. The unusually flexible behavior of individual dimensions of multidimensional heterogeneity creates previously unrecognized challenges for empirically testing selection models of disparities, such as models of mortality crossovers.

Does religious involvement affect mortality in low-income Americans? A prospective cohort study

OBJECTIVE

This study aimed to evaluate the impacts of various forms of religious involvement, beyond individual socioeconomic status, lifestyle factors, emotional well-being and social support, on all-cause and cause-specific mortality in socioeconomic disadvantaged neighbourhoods.

DESIGN

This is a prospective cohort study conducted from 2002 through 2015.

SETTINGS

This study included underserved populations in the Southeastern USA.

PARTICIPANTS

A total of nearly 85 000 participants, primarily low-income American adults, were enrolled. Eligible participants were aged 40-79 years at enrolment, spoke English and were not under treatment for cancer within the prior year.

RESULTS

We found that those who attended religious service attendance >1/week had 8% reduction in all-cause death and 15% reduction in cancer death relative to those who never attended. This association was substantially attenuated by depression score, social support, and socioeconomic and lifestyle covariates, and further attenuated by other forms of religious involvement. This association with all-cause mortality was found being stronger among those with higher socioeconomic status or healthier lifestyle behaviours.

CONCLUSION

Our results indicate that the association between religious services attendance >1/week and lower mortality was moderate but robust, and could be attenuated and modified by socioeconomic or lifestyle factors in this large prospective cohort study of underserved populations in the Southeastern USA.

Religiosity Dimensions and Disability-Free Life Expectancy in Taiwan

Objectives: Eight years of panel data are used to investigate the association between three dimensions of religiosity and total and disability-free life expectancy (TLE/DFLE) in Taiwan. Method: Data come from the 1999 "Taiwan Longitudinal Study on Aging" (TLSA; N = 4,440; Age 55+). Dimensions of religiosity are public, private, belief, and coping. Mortality is linked to a national database. Disability is activities of daily living (ADLs). TLE/DFLE estimates use the Stochastic Population Analysis for Complex Events (SPACE) software. Results: Those who engage in public and private religiosity live longer and more years disability-free than others, but proportion of life disability-free does not differ across levels of religiosity. Coping is less associated with TLE and DFLE. Coping however associates with more years disabled among men. Findings are robust to model specifications. Discussion: The way in which religiosity associates with health depends upon the definition. When it does associate, religiosity increases TLE and DFLE proportionately.

Associations of Religious Upbringing With Subsequent Health and Well-Being From Adolescence to Young Adulthood: An Outcome-Wide Analysis

In the present study, we prospectively examined the associations of religious involvement in adolescence (including religious service attendance and prayer or meditation) with a wide array of psychological well-being, mental health, health behavior, physical health, and character strength outcomes in young adulthood. Longitudinal data from the Growing Up Today Study were analyzed using generalized estimating equations. Sample sizes ranged from 5,681 to 7,458, depending on outcome; the mean baseline age was 14.74 years, and there were 8–14 years of follow-up (1999 to either 2007, 2010, or 2013). Bonferroni correction was used to correct for multiple testing. All models were controlled for sociodemographic characteristics, maternal health, and prior values of the outcome variables whenever data were available. Compared with no attendance, at least weekly attendance of religious services was associated with greater life satisfaction and positive affect, a number of character strengths, lower probabilities of marijuana use and early sexual initiation, and fewer lifetime sexual partners. Analyses of prayer or meditation yielded similar results. Although decisions about religion are not shaped principally by health, encouraging service attendance and private practices in adolescents who already hold religious beliefs may be meaningful avenues of development and support, possibly leading to better health and well-being.

The Methuselah Effect: The Pernicious Impact of Unreported Deaths on Old-Age Mortality Estimates

We examine inferences about old-age mortality that arise when researchers use survey data matched to death records. We show that even small rates of failure to match respondents can lead to substantial bias in the measurement of mortality rates at older ages. This type of measurement error is consequential for three strands in the demographic literature: (1) the deceleration in mortality rates at old ages; (2) the black-white mortality crossover; and (3) the relatively low rate of old-age mortality among Hispanics, often called the "Hispanic paradox." Using the National Longitudinal Survey of Older Men matched to death records in both the U.S. Vital Statistics system and the Social Security Death Index, we demonstrate that even small rates of missing mortality matching plausibly lead to an appearance of mortality deceleration when none exists and can generate a spurious black-white mortality crossover. We confirm these findings using data from the National Health Interview Survey matched to the U.S. Vital Statistics system, a data set known as the "gold standard" (Cowper et al. 2002) for estimating age-specific mortality. Moreover, with these data, we show that the Hispanic paradox is also plausibly explained by a similar undercount.

Social integration and age-related decline in lung function

OBJECTIVES

We tested the hypothesis that social integration, measured as number of social roles, is associated with less age-related loss of lung function, an important marker of health and longevity. We also investigated possible psychological factors through which social integration might influence lung health.

METHODS

Data were analyzed from the Health and Retirement Study (ages 52-94, n = 4,224).

RESULTS AND CONCLUSIONS

Each additional social role reported at baseline was associated with less of a decline in lung function between baseline and the follow-up assessment four years later. The association withstood controls for demographics, weight, and height and was mediated by more positive and less negative affect and lower rates of cigarette smoking and more physical activity. Roles were mostly substitutable, with both high (spouse, parent, friends, relatives) and low (employee, religious service attendee, volunteer, members of other groups) intimacy roles independently contributing to less age-related decline in lung function. (PsycINFO Database Record

Perceived Stress in Black and Latino Male Firefighters: Associations with Risk and Protective Factors

Objective

To compare the prevalence of work-related protective and risk factors among Black and Latino male firefighters and to examine the association of these factors to perceived stress among both ethnic groups.

Design Setting Participants

Participants included 1,036 male, career firefighters who self-identified as Black (n=477) or Latino (n=559) from a large fire department in a major metropolitan city in the southwestern United States. As part of a department-wide suicide prevention program conducted in 2008, participants completed an anonymous and voluntary mental health needs survey.

Measures

The needs survey included questions regarding prevalence of work-related protective and risk factors, the RAPS-4 to assess substance abuse problems, and the 10-item Perceived Stress Scale.

Results

Results of regression analyses indicated that for both Black and Latino male firefighters, alcohol abuse (β =.13, β =.22), self-reported good health (β = -.23, β =-.24) and a positive partner/spouse relationship (β =-.14, β = -.15) were related to perceived stress. In addition, having a second job (β = .12) and a sense of life calling (β =-.10) were related to perceived stress only among Latino firefighters. All associations were in the expected direction as indicated by the signs of the standardized beta coefficients (β).

Conclusion

Black and Latino male firefighters reported relatively high levels of perceived stress. However, there were both differences and similarities in the factors associated to perceived stress among the ethnic groups. Therefore, interventions to help firefighters reduce or manage stress need to take into account that factors associated with perceived stress may vary by ethnic group.

Whites but Not Blacks Gain Life Expectancy from Social Contacts

Background. Recent research suggests that the health gain from economic resources and psychological assets may be systematically larger for Whites than Blacks. Aim. This study aimed to assess whether the life expectancy gain associated with social contacts over a long follow up differs for Blacks and Whites. Methods. Data came from the Americans’ Changing Lives (ACL) Study, 1986–2011. The sample was a nationally representative sample of American adults 25 and older, who were followed for up to 25 years (n = 3361). Outcome was all-cause mortality. The main predictor was social contacts defined as number of regular visits with friends, relatives, and neighbors. Baseline demographics (age and gender), socioeconomic status (education, income, and employment), health behaviors (smoking and drinking), and health (chronic medical conditions, obesity, and depressive symptoms) were controlled. Race was the focal moderator. Cox proportional hazard models were used in the pooled sample and based on race. Results. More social contacts predicted higher life expectancy in the pooled sample. A significant interaction was found between race and social contacts, suggesting that the protective effect of more social contacts is smaller for Blacks than Whites. In stratified models, more social contacts predicted an increased life expectancy for Whites but not Blacks. Conclusion. Social contacts increase life expectancy for White but not Black Americans. This study introduces social contacts as another social resource that differentially affects health of Whites and Blacks.

The Intellectual Disability Mortality Disadvantage: Diminishing With Age?

On average, adults with intellectual disability (ID) have higher mortality risk than their peers in the general population. However, the effect of age on this mortality disadvantage has received minimal attention. Using data from the 1986-2011 National Health Interview Survey-Linked Mortality Files (NHIS-LMF), discrete time hazard models were used to compare mortality risk for adults with and without ID by age and gender. Increased mortality risk was present for all adults with ID, but was most pronounced among younger age females. The mortality differential between those with and without ID diminished with increased age for both females and males. Findings support the argument that heterogeneity of frailty may explain differences in mortality risk between those with and without ID.

Association of Religious Service Attendance With Mortality Among Women

IMPORTANCE

Studies on the association between attendance at religious services and mortality often have been limited by inadequate methods for reverse causation, inability to assess effects over time, and limited information on mediators and cause-specific mortality.

OBJECTIVE

To evaluate associations between attendance at religious services and subsequent mortality in women.

DESIGN, SETTING, AND PARTICIPANTS

Attendance at religious services was assessed from the first questionnaire in 1992 through June 2012, by a self-reported question asked of 74 534 women in the Nurses' Health Study who were free of cardiovascular disease and cancer at baseline. Data analysis was conducted from return of the 1996 questionnaire through June 2012.

MAIN OUTCOMES AND MEASURES

Cox proportional hazards regression model and marginal structural models with time-varying covariates were used to examine the association of attendance at religious services with all-cause and cause-specific mortality. We adjusted for a wide range of demographic covariates, lifestyle factors, and medical history measured repeatedly during the follow-up, and performed sensitivity analyses to examine the influence of potential unmeasured and residual confounding.

RESULTS

Among the 74 534 women participants, there were 13 537 deaths, including 2721 owing to cardiovascular deaths and 4479 owing to cancer deaths. After multivariable adjustment for major lifestyle factors, risk factors, and attendance at religious services in 1992, attending a religious service more than once per week was associated with 33% lower all-cause mortality compared with women who had never attended religious services (hazard ratio, 0.67; 95% CI, 0.62-0.71; P < .001 for trend). Comparing women who attended religious services more than once per week with those who never attend, the hazard ratio for cardiovascular mortality was 0.73 (95% CI, 0.62-0.85; P < .001 for trend) and for cancer mortality was 0.79 (95% CI, 0.70-0.89; P < .001 for trend). Results were robust in sensitivity analysis. Depressive symptoms, smoking, social support, and optimism were potentially important mediators, although the overall proportion of the association between attendance at religious services and mortality was moderate (eg, social support explained 23% of the effect [P = .003], depressive symptoms explained 11% [P < .001], smoking explained 22% [P < .001], and optimism explained 9% [P < .001]).

CONCLUSIONS AND RELEVANCE

Frequent attendance at religious services was associated with significantly lower risk of all-cause, cardiovascular, and cancer mortality among women. Religion and spirituality may be an underappreciated resource that physicians could explore with their patients, as appropriate.

Spirituality, religiosity, aging and health in global perspective: A review

Persistent population aging worldwide is focusing attention on modifiable factors that can improve later life health. There is evidence that religiosity and spirituality are among such factors. Older people tend to have high rates of involvement in religious and/or spiritual endeavors and it is possible that population aging will be associated with increasing prevalence of religious and spiritual activity worldwide. Despite increasing research on religiosity, spirituality and health among older persons, population aging worldwide suggests the need for a globally integrated approach. As a step toward this, we review a subset of the literature on the impact of religiosity and spirituality on health in later life. We find that much of this has looked at the relationship between religiosity/spirituality and longevity as well as physical and mental health. Mechanisms include social support, health behaviors, stress and psychosocial factors. We identify a number of gaps in current knowledge. Many previous studies have taken place in the U.S. and Europe. Much data is cross-sectional, limiting ability to make causal inference. Religiosity and spirituality can be difficult to define and distinguish and the two concepts are often considered together, though on balance religiosity has received more attention than spirituality. The latter may however be equally important. Although there is evidence that religiosity is associated with longer life and better physical and mental health, these outcomes have been investigated separately rather than together such as in measures of health expectancy. In conclusion, there is a need for a unified and nuanced approach to understanding how religiosity and spirituality impact on health and longevity within a context of global aging, in particular whether they result in longer healthy life rather than just longer life.

Leaving my religion: Understanding the relationship between religious disaffiliation, health, and well-being

Religious disaffiliation-leaving the religious tradition in which one was raised for no religious affiliation in adulthood-has become more common in recent years, though few studies have examined its consequences for the health and well-being of individuals. We use an innovative approach, comparing the health and subjective well-being of religious disaffiliates to those who remain affiliated using pooled General Social Survey samples from 1973 through 2012. We find that religious disaffiliates experience poorer health and lower well-being than those consistently affiliated and those who are consistently unaffiliated. We also demonstrate that the disadvantage for those who leave religious traditions is completely mediated by the frequency of church attendance, as disaffiliates attend church less often. Our results point to the importance of the social processes surrounding religious disaffiliation and emphasize the role of dynamics in the relationship between religious affiliation and health.

Role of stress in low birthweight disparities between black and white women: a population-based study

AIM

This study examines the role of stress in low birthweight (LBW) risk in Black and White women in the United States.

METHODS

Data from the 1998-2000 Fragile Family and Child Wellbeing Study were used (n = 3869). We included several self-reported conditions which we categorised as stressors (i.e. socio-economic conditions, health behaviours, access to quality care and cultural factors), then we used logistic regression models to analyse the role of stressors in explaining the health disparities in LBW.

RESULTS

Most women were unmarried (59% for White women and 87% for Black women). Among unmarried White women, the only stressor associated with a higher likelihood of LBW was smoking (odds ratio (OR) = 2.0, 95% confidence interval (CI) (1.2, 3.3)). Among unmarried Black women, smoking (OR = 1.7, 95% CI (1.2, 2.3)), drug use (OR = 1.7, 95% CI (1.0, 2.6)), paying for the baby's birth with government resources (OR = 1.6, 95% CI (1.1, 2.4)) and religious affiliation (OR = 1.6, 95% CI (1.0, 2.5)) were associated with higher likelihood of LBW. Among married White women, older age (OR = 1.1, 95% CI (1.0, 1.2)), smoking (OR = 5.2, 95% CI (1.7, 15.5)), using governmental resources to pay for birth (OR = 3.6, 95% CI (1.0, 12.4)) and living in governmental housing (OR = 9.1, 95% CI (2.0, 41.1)) were associated with higher likelihood of LBW. No stressors were statistically significant for married Black women.

CONCLUSION

We analysed a large number of stressors at the individual, household and societal levels and found differences on the stressors among Black and White women. However, the stressors included in the analyses did not fully explain the racial disparities in LBW.

Mortality deceleration and mortality selection: three unexpected implications of a simple model

Unobserved heterogeneity in mortality risk is pervasive and consequential. Mortality deceleration-the slowing of mortality's rise with age-has been considered an important window into heterogeneity that otherwise might be impossible to explore. In this article, I argue that deceleration patterns may reveal surprisingly little about the heterogeneity that putatively produces them. I show that even in a very simple model-one that is composed of just two subpopulations with Gompertz mortality-(1) aggregate mortality can decelerate even while a majority of the cohort is frail; (2) multiple decelerations are possible; and (3) mortality selection can produce acceleration as well as deceleration. Simulations show that these patterns are plausible in model cohorts that in the aggregate resemble cohorts in the Human Mortality Database. I argue that these results challenge some conventional heuristics for understanding the relationship between selection and deceleration; undermine certain inferences from deceleration timing to patterns of social inequality; and imply that standard parametric models, assumed to plateau at most once, may sometimes badly misestimate deceleration timing-even by decades.

An examination of black/white differences in the rate of age-related mortality increase

BACKGROUND

The rate of mortality increase with age among adults is typically used as a measure of the rate of functional decline associated with aging or senescence. While black and white populations differ in the level of mortality, mortality also rises less rapidly with age for blacks than for whites, leading to the well-known black/white mortality “crossover”.

OBJECTIVE

This paper investigates black/white differences in the rate of mortality increase with age for major causes of death in order to examine the factors responsible for the black/white crossover.

METHODS

The analysis considers two explanations for the crossover: selective survival and age misreporting. Mortality is modeled using a Gompertz model for 11 causes of death from ages 50–84 among blacks and whites by sex.

RESULTS

Mortality increases more rapidly with age for whites than for blacks for nearly all causes of death considered. The all-cause mortality rate of mortality increase is nearly two percentage points higher for whites. The analysis finds evidence for both selective survival and age misreporting, although age misreporting is a more prominent explanation among women.

CONCLUSIONS

The black/white mortality crossover reflects large differences in the rate of age-related mortality increase. Instead of reflecting the impact of specific causes of death, this pattern exists across many disparate disease conditions, indicating the need for a broad explanation.

HEALTHIER, WEALTHIER, AND WISER: A DEMONSTRATION OF COMPOSITIONAL CHANGES IN AGING COHORTS DUE TO SELECTIVE MORTALITY

The gradual changes in cohort composition that occur as a result of selective mortality processes are of interest to all aging research. We present the first illustration of changes in the distribution of specific cohort characteristics that arise purely as a result of selective mortality. We use data on health, wealth, education, and other covariates from two cohorts (the AHEAD cohort, born 1900-23 and the HRS cohort, born 1931-41) included in the Health and Retirement Survey, a nationally representative panel study of older Americans spanning nearly two decades (N=14,466). We calculate sample statistics for the surviving cohort at each wave. Repeatedly using only baseline information for these calculations so that there are no changes at the individual level (what changes is the set of surviving respondents at each specific wave), we obtain a demonstration of the impact of mortality selection on the cohort characteristics. We find substantial changes in the distribution of all examined characteristics across the nine survey waves. For instance, the median wealth increases from about $90,000 to $130,000 and the number of chronic conditions declines from 1.5 to 1 in the AHEAD cohort. We discuss factors that influence the rate of change in various characteristics. The mortality selection process changes the composition of older cohorts considerably, such that researchers focusing on the oldest old need to be aware of the highly select groups they are observing, and interpret their conclusions accordingly.

Religion, spirituality, and health: the research and clinical implications

This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.

Socioeconomic status and the Black-White mortality crossover

OBJECTIVES

We investigated associations among age, race, socioeconomic status (SES), and mortality in older persons and whether low SES contributes to the Black-White mortality crossover (when elevated age-specific mortality rates invert).

METHODS

We used panel data from the North Carolina Established Populations for Epidemiologic Studies of the Elderly to test the main and interactive effects of SES on mortality.

RESULTS

Discrete-time hazard models showed that the association between low education and mortality did not vary by race or age and was only significant for men. For women, the effect of low income diminished with age and had little impact on the crossover. For men, low income varied by race and age, altering the Black-White crossover and producing low-high income crossovers at advanced ages.

CONCLUSIONS

Low education and income were associated with increased mortality risk for older adults, but only low income had a differential impact on the Black-White mortality crossover. A primary route to reducing mortality differentials in later life is to prevent the disproportionate selective mortality of Blacks and the poor earlier in the life course.

Examining the Racial Crossover in Mortality between African American and White Older Adults: A Multilevel Survival Analysis of Race, Individual Socioeconomic Status, and Neighborhood Socioeconomic Context

We examine whether individual and neighborhood socioeconomic context contributes to black/white disparities in mortality among USA older adults. Using national longitudinal data from the Americans' Changing Lives study, along with census tract information for each respondent, we conduct multilevel survival analyses. Results show that black older adults are disadvantaged in mortality in younger old age, but older black adults have lower mortality risk than whites after about age 80. Both individual SES and neighborhood socioeconomic disadvantage contribute to the mortality risk of older adults but do not completely explain race differences in mortality. The racial mortality crossover persists even after controlling for multilevel SES, suggesting that black older adults experience selective survival at very old ages. Addressing the individual and neighborhood socioeconomic disadvantage of blacks is necessary to reduce mortality disparities that culminate in older adulthood.

The effects of childhood, adult, and community socioeconomic conditions on health and mortality among older adults in China

Using a large, nationally representative longitudinal sample of Chinese aged 65 and older, this study examines the effects of childhood, adult, and community socioeconomic conditions on mortality and several major health outcomes. The role of social mobility is also tested. We find that childhood socioeconomic conditions exert long-term effects on functional limitations, cognitive impairment, self-rated health, and mortality independent of adult and community socioeconomic conditions. Achieved conditions matter for most outcomes as well, considering that adult and community socioeconomic conditions have additional impacts on health among Chinese elders. The majority of the effects of childhood conditions are not mediated by adult and community conditions. The results also show that social mobility and health in later life are linked in complex ways and that psychosocial factors have marginal explanatory power for the effects of socioeconomic conditions. Overall, this study provides new longitudinal evidence from China to support the notion that health and mortality at older ages are influenced by long-term and dynamic processes structured by the social stratification system. We discuss our findings in the context of the life course and ecological perspective, emphasizing that human development is influenced by a nexus of social experiences that impact individuals throughout life.

Exceptions to the Rule: Exceptional Health Among the Disadvantaged

Countless studies show that socioeconomic status (SES) is strongly related to morbidity and mortality. However, few studies consider the substantial variability in health within socioeconomic strata. In this article, the authors examine the incompatibility between stratification-based theories of health inequality and empirical patterns of exceptional health among the socially disadvantaged. Using panel data from the Health and Retirement Survey (1992-2008), the authors test the mediating and moderating effects of various predictors of exceptional health (no chronic diseases or physical limitations) for middle-aged and older adults with and without a high school education. Results suggest that a combination of demographic characteristics, family and religious factors, socioeconomic resources, health behaviors, psychological makeup, and biological attributes play differing roles in protecting the health of disadvantaged men and women. The findings underscore the complex associations among SES, protective mechanisms, and health and offer new insight into how disadvantaged adults defy their odds of poor health.

Association of Religious Participation With Mortality Among Chinese Old Adults

This research examines the association of religious participation with mortality using a longitudinal data set collected from 9,017 oldest-old aged 85+ and 6,956 younger elders aged 65 to 84 in China in 2002 and 2005 and hazard models. Results show that adjusted for demographics, family/social support, and health practices, risk of dying was 24% (p < 0.001) and 12% (p < 0.01) lower among frequent and infrequent religious participants than among nonparticipants for all elders aged 65+. After baseline health was adjusted, the corresponding risk of dying declined to 21% (p < 0.001) and 6% (not significant), respectively. The authors also conducted hazard models analysis for men versus women and for young-old versus oldest-old, respectively, adjusted for single-year age; the authors found that gender differentials of association of religious participation with mortality among all elderly aged 65+ were not significant; association among young-old men was significantly stronger than among oldest-old men, but no such significant young-old versus oldest-old differentials in women were found.

Reexamining the Dominance of Birth Cohort Effects on Mortality

The association between birth cohort and subsequent mortality has been of interest especially following publication of studies around 1930 of cohorts born up to the latter part of the nineteenth century, particularly for England and Wales. Updated results are presented for this population, together with those for two other cohorts, twentieth-century Japanese and British populations born about 1930, which have been identified as having particularly clear-cut birth cohort patterns, and which are used to underpin incorporation of cohort effects in both British official and actuarial mortality forecasts. Graphical methods used to identify cohort patterns are discussed. A number of limitations and difficulties are identified that mean that the conclusions about the predominance of cohort effects are less robust than often assumed. It is argued that alternative explanations should be considered and that the concentration on birth cohorts with particularly advantaged patterns may distort research priorities.

The Black-White difference in age trajectories of functional health over the life course

This study examines whether the racial disparity in functional health grows unabated over the adult life course--the cumulative disadvantage hypothesis--or shrinks among the oldest old---the age-as-leveler hypothesis. Special emphasis is placed on the role of socioeconomic status (SES), which is highly associated with race. The analysis uses latent growth-curve modeling to examine differences in age trajectories of functional health between Black and White Americans and is based on nationally representative panel data of 3497 adults. Results cautiously support the age-as-leveler hypothesis. Net of functional health at baseline, Black adults experience a growing disadvantage in functional health over time until the oldest ages, when the gap in functional health begins to shrink. Results indicate that the potential leveling mechanisms of age may be specific to women. SES including financial assets explains the divergence in functional health across young and middle-aged Black and White adults, but not the later-life convergence. This study reveals the life-course pattern of racial disparity in functional health and suggests that more theoretical development is needed in this field to explain why the age-as-leveler and cumulative disadvantage processes are different for functional health than for other outcomes.

Looking Inside the Black Box of "Attendance at Services": New Measures for Exploring an Old Dimension in Religion and Health Research

Research in religion and health has spurred new interest in measuring religiousness. Measurement efforts have focused on subjective facets of religiousness such as spirituality and beliefs, and less attention has been paid to congregate aspects, beyond the single item measuring attendance at services. We evaluate some new measures for religious experiences occurring during congregational worship services. Respondents (N=576) were religiously-diverse community-dwelling adults interviewed prior to cardiac surgery. Exploratory factor analysis of the new items with a pool of standard items yielded a readily interpretable solution, involving seven correlated but distinct factors and one index variable, with high levels of internal consistency. We describe religious affiliation and demographic differences in these measures. Attendance at religious services provides multifaceted physical, emotional, social, and spiritual experiences that may promote physical health through multiple pathways.

Causes of death and mortality crossovers by race

The phenomenon of "mortality crossovers," the intersection of age curves of mortality at older ages, has been observed in comparisons of various populations for some time. Some researchers have argued that crossovers are an artifact of deficient reporting of age that is greater for some populations than others. Other researchers attribute crossovers to selective processes by age that vary by group. We use mortality data from the National Center for Health Statistics for the U.S. at ages 55 and over, supplemented by comparable data from matched records of the National Health Interview Survey and National Death Index, to reexamine causes of death linked to mortality crossovers for Whites and Blacks in the U.S. Findings portray a more elaborate set of influences of causes of death than has been discovered heretofore; however, the major finding is that the mortality crossover for Whites and Blacks in the U.S. is real and, although observed for several causes of death, operates principally through varying trajectories of heart disease mortality.