Matrix attachment regions increase the efficiency and stability of RNA-mediated resistance to tomato spotted wilt virus in transgenic tobacco

Matrix attachment regions (MARs) are DNA elements that can increase and stabilize transgene expression. We investigated the effect of the RB7 MAR on transgenic virus resistance. Constructs for resistance to tomato spotted wilt virus (TSWV) with and without flanking RB7 MARs were used to transform tobacco and produce homozygous lines. The population with the MAR construct had a significantly higher percentage of TSWV resistant plants in the R1 generation than the nonMAR population. Each resistant line was advanced to the R4 generation, and significantly fewer MAR lines lost resistance over generations compared to the nonMAR population. Lines with TSWV resistance in growth chamber tests were also resistant in field trials. Two lines that were resistant in the R1 generation and susceptible in the R4 were examined in more detail in order to determine if transcriptional silencing of the transgene was occurring in the later generation. Short interfering 21-25 nt RNAs from the transgene that are characteristic of post-transcriptional gene silencing (PTGS) were present in the resistant R1 plants, but not the susceptible R4 plants, indicating that virus resistance was associated with PTGS of the transgene. Loss of resistance was accompanied by an increase in promoter methylation in both lines. In line M41, the transgene was fully silenced at the transcriptional level in the R4 as shown by nuclear run-on assays. In line NM13, transgene transcription and RNA accumulation was still present in the R4 generation, but the level of transcription was not sufficient to trigger PTGS, suggesting that this line may have partial transcriptional silencing. These results are consistent with the concept that MARs may prevent transcriptional silencing.

Mental health services in faith communities: the role of clergy in black churches

A small but growing literature recognizes the varied roles that clergy play in identifying and addressing mental health needs in their congregations. Although the role of the clergy in mental health services delivery has not been studied extensively, a few investigations have attempted a systematic examination of this area. This article examines the research, highlighting available information with regard to the process by which mental health needs are identified and addressed by faith communities. Areas and issues where additional information is needed also are discussed. Other topics addressed include client characteristics and factors associated with the use of ministers for personal problems, the role of ministers in mental health services delivery, factors related to the development of church-based programs and service delivery systems, and models that link churches and formal services agencies. A concluding section describes barriers to and constraints against effective partnerships between churches, formal services agencies, and the broader practice of social work.

Talar neck fractures and rates of avascular necrosis

Talar neck fractures are unique and potentially debilitating injuries. Their successful treatment requires an understanding of talar anatomy and arterial blood supply, as well as knowledge of the sequelae of these injuries, particularly avascular necrosis of the talar body. Presented is an extensive literature review on talar neck fractures and Hawkins' classification, with special emphasis on the rates of avascular necrosis as determined by selected researchers on the topic.

The religion-health connection: evidence, theory, and future directions

The volume and quality of research on what we term the religion-health connection have increased markedly in recent years. This interest in the complex relationships between religion and mental and physical health is being fueled by energetic and innovative research programs in several fields, including sociology, psychology, health behavior and health education, psychiatry, gerontology, and social epidemiology. This article has three main objectives: (1) to briefly review the medical and epidemiologic research on religious factors and both physical health and mental health; (2) to identify the most promising explanatory mechanisms for religious effects on health, giving particular attention to the relationships between religious factors and the central constructs of the life stress paradigm, which guides most current social and behavioral research on health outcomes; and (3) to critique previous work on religion and health, pointing out limitations and promising new research directions.

Public health and health education in faith communities

This special issue of Health Education & Behavior is devoted to broadly examining the interconnections among public health, health education, and faith-based communities. In addition to a focus on questions related to the practice of public health and health education within religious settings (e.g., program development, implementation, and evaluation), the articles in this issue examine a broad range of both substantive and methodological questions and concerns. These articles include contributions that address (1) various theoretical and conceptual issues and frameworks explaining the relationships between religious involvement and health; (2) substantive reviews of current research in the area; (3) individual empirical studies exploring the associations between religious involvement and health attitudes, beliefs, and behaviors; (4) evaluations of health education programs in faith communities; and (5) religious institutions and their contributions to the development of health policy. The articles comprising the issue are selective in their coverage of the field and provide different and complementary perspectives on the connections between religious involvement and health. It is hoped that this approach will appeal to a broad audience of researchers, practitioners, policy makers, and others from health education, public health, and related social and behavioral science disciplines.

Is religiousness a correlate of absorption? Implications for psychophysiology, coping, and morbidity

CONTEXT

Evidence synthesized from social epidemiology, psychophysiology, and behavioral medicine suggests that religiousness may represent a significant correlate of absorption, a construct for which few if any psychosocial determinants have been identified.

OBJECTIVE

To examine the association between absorption and intrinsic and extrinsic religiousness.

PARTICIPANTS

83 respondents of a self-administered survey of adult survivors of cancer or other life-threatening diseases, recruited from participants in a pilot study of psychosocial factors related to recovery from illness.

MAIN MEASURES

Tellegen Absorption Scale and Religious Orientation Scale.

RESULTS

Absorption, as assessed by the Tellegen Absorption Scale, was positively and significantly associated with intrinsic religiousness, as measured by the Religious Orientation Scale. Predominantly intrinsic subjects had absorption scores at least 20% higher than did predominantly extrinsic, proreligious, or nonreligious subjects.

DISCUSSION

Prior research has found that absorption and hypnotizability have psychophysiological correlates, and that religiousness shows protective effects against morbidity and mortality. In light of this work, the present findings suggest that certain religious cognitions, emotions, or experiences may generate an internally focused state that enhances health and attenuates disease through self-soothing psychophysiological mechanisms.

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

This study examines the impact of religious involvement on health status and psychological well-being using data on older adults from three national probability surveys: the Myth and Reality of Aging (N = 2,797), the Quality of American Life (N = 1,209), and Americans' Changing Lives (N = 1,669) studies. Constructs are measured by single items and indices that vary across data sets. A proposed theoretical model specifies direct effects of religiosity on health and well-being and indirect effects on well-being through health. Analyses consist of structural-equation modeling of confirmed measurement models using weighted least squares estimation in LISREL 8.03. The model is analyzed first as specified and is then rerun controlling for the effects of six exogenous constructs: age, gender, race, marital status, education, and geographical region. Findings reveal excellent overall fit in all three samples and the presence of statistically significant religious effects, notably positive net effects of organizational religiosity, in all three samples. These results build on those of prior studies based mostly on samples limited regionally or methodologically or to particular racial or ethnic groups. This study also underscores the value of replicated secondary data analysis as a strategy for gerontologists seeking to confirm or examine a given structural model. Finally, an agenda is proposed for future research in this area.

Quantitative methods in research on complementary and alternative medicine. A methodological manifesto. NIH Office of Alternative Medicine

OBJECTIVES

This article summarizes the deliberations of the Quantitative Methods Working Group convened by the National Institutes of Health (NIH) in support of the NIH Office of Alternative Medicine.

METHODS

The working group was charged with identifying methods of study design and data analysis that can be applied to empirical research on complementary and alternative medicine. This charge was broad and inclusive and addressed the evaluation of alternative therapies, the investigation of the basic science of complementary medical systems, studies of health promotion and disease prevention, and health services research.

RESULTS

The working group produced a "methodological manifesto," a summary list of seven recommended methodological guidelines for research on alternative medicine. These recommendations emphasize the robustness of existing research methods and analytic procedures despite the substantive unconventionality of alternative medicine.

CONCLUSIONS

Contrary to the assertions of many researchers and alternative practitioners, established methodologies (eg, experimental trials, observational epidemiology, social survey research) and data-analytic procedures (eg, analysis of variance, logistic regression, multivariate modeling techniques) are quite satisfactory for addressing the majority of study questions related to alternative medicine, from clinical research on therapeutic efficacy to basic science research on mechanisms of pathogenesis and recovery.

Age differences in patterns and correlates of the frequency of prayer

This study examines differences by age cohort in (a) the frequency of prayer, (b) racial and gender variation in prayer, and (c) religious and sociodemographic correlates of prayer. Analyses are conducted across four age cohorts (18-30, 31-40, 41-60, > or = 61) using data from the 1988 National Opinion Research Center (NORC) General Social Survey (N = 1,481). Findings reveal that prayer is frequently practiced at all ages, but more frequently in successively older cohorts. In addition, females and, to a lesser extent, African Americans pray more frequently than males and Whites, respectively. Further, hierarchical multiple regression analyses reveal statistically significant associations across age cohorts between prayer and key measures of religious behavior, feeling, belief, and experience.

How religion influences morbidity and health: reflections on natural history, salutogenesis and host resistance

This paper surveys the field that has come to be known as the epidemiology of religion. Epidemiologic study of the impact of religious involvement, broadly defined, has become increasingly popular in recent years, although the existence, meaning and implications of an apparently salutary religious effect on health have not yet been interpreted in an epidemiologic context. This paper attempts to remedy this situation by putting the "epidemiology" into the epidemiology of religion through discussion of existing empirical findings in terms of several substantive epidemiologic concepts. After first providing an overview of key research findings and prior reviews of this field, the summary finding of a protective religious effect on morbidity is examined in terms of three important epidemiologic concepts: the natural history of disease, salutogenesis and host resistance. In addition to describing a theoretical basis for interpreting a religion-health association, this paper provides an enumeration of common misinterpretations of epidemiologic findings for religious involvement, as well as an outline of hypothesized pathways, mediating factors, and salutogenic mechanisms for respective religious dimensions. It is hoped that these reflections will serve both to elevate the status of religion as a construct worthy of social-epidemiologic research and to reinvigorate the field of social epidemiology.

"Song of ourselves": a quantitative history of American autobiographies

This article highlights the major descriptive findings of an exploratory, quantitative study of American autobiographies published before 1945. Of particular importance for gerontology, age-cohort distributions of autobiographers are graphed, demonstrating that the genre itself has been created predominantly by men and women aged 55 and over. This study suggests that these writers offer scholars a virtually untapped resource for the historical phenomenology of aging.

Religious attendance and psychological well-being in Mexican Americans: a panel analysis of three-generations data

This study examined the effects of religious attendance on three dimensions of psychological well-being using panel data from a three-generations study of Mexican Americans from Texas (N = 624). Well-being dimensions included life satisfaction (the 13-item LSIA), and respective seven- and four-item depressed and positive affect subscales of the CES-D. Two-wave path analyses revealed a cross-sectional association between religious attendance and life satisfaction in the two oldest generations, and a salutary longitudinal effect of religious attendance on subsequent depressed affect in the youngest generation. Findings for life satisfaction and depressed affect withstood controlling for health and five sociodemographic correlates of religious attendance and well-being.

How prayer heals: a theoretical model

This article presents a theoretical model that outlines various possible explanations for the healing effects of prayer. Four classes of mechanisms are defined on the basis of whether healing has naturalistic or supernatural origins and whether it operates locally or nonlocally. Through this framework, most of the currently proposed hypotheses for understanding absent healing and other related phenomena-hypotheses that invoke such concepts as subtle energy, psi, consciousness, morphic fields, and extended mind-are shown to be no less naturalistic than the Newtonian, mechanistic forces of allopathic biomedicine so often derided for their materialism. In proposing that prayer may heal through nonlocal means according to mechanisms and theories proposed by the new physics, Dossey is almost alone among medical scholars in suggesting the possible limitations and inadequacies of hypotheses based on energies, forces, and fields. Yet even such nonlocal effects can be conceived of as naturalistic; that is, they are explained by physical laws that may be unbelievable or unfamiliar to most physicians but that are nonetheless becoming recognized as operant laws of the natural universe. The concept of the supernatural, however, is something altogether different, and is, by definition, outside of or beyond nature. Herein may reside an either wholly or partly transcendent Creator-God who is believed by many to heal through means that transcend the laws of the created universe, both its local and nonlocal elements, and that are thus inherently inaccessible to and unknowable by science. Such an explanation for the effects of prayer merits consideration and, despite its unprovability by medical science, should not be dismissed out of hand.

Religious effects on health status and life satisfaction among black Americans

This study tests a theoretical model linking religiosity, health status, and life satisfaction using data from the National Survey of Black Americans, a nationally representative sample of Blacks at least 18 years old. Findings reveal statistically significant effects for organizational religiosity on both health and life satisfaction, for nonorganizational religiosity on health, and for subjective religiosity on life satisfaction. Analyses of structural invariance reveal a good overall fit for the model across three age cohorts (< or = 30, 31-54, > or = 55) and confirm that assuming age-invariance of structural parameters does not significantly detract from overall fit. In addition, after controlling for the effects of several sociodemographic correlates of religiosity, health, and well-being, organizational religiosity maintains a strong, significant effect on life satisfaction. These findings suggest that the association between religion and well-being is consistent over the life course and not simply an artifact of the confounding of measures of organizational religiosity and health status.

Religion and health: is there an association, is it valid, and is it causal?

This paper reviews evidence for a relationship between religion and health. Hundreds of epidemiologic studies have reported statistically significant, salutary effects of religious indicators on morbidity and mortality. However, this does not necessarily imply that religion influences health; three questions must first be answered: "Is there an association?", "Is it valid?", and, "Is it causal?" Evidence presented in this paper suggests that the answers to these respective questions are "yes," "probably," and "maybe." In answering these questions, several issues are addressed. First, key reviews and studies are discussed. Second, the problems of chance, bias, and confounding are examined. Third, alternative explanations for observed associations between religion and health are described. Fourth, these issues are carefully explored in the context of Hill's well-known features of a causal relationship. Despite the inconclusiveness of empirical evidence and the controversial and epistemologically complex nature of religion as an epidemiologic construct, this area is worthy of additional investigation. Further research can help to clarify these provocative findings.

Race and gender differences in religiosity among older adults: findings from four national surveys

Using data from four national surveys, this article presents findings on racial and gender differences in religiosity among older adults. Surveys include the second Quality of American Life study, the Myth and Reality of Aging study, wave one of Americans' Changing Lives, and the 1987 sample of the General Social Survey. These four data sources collectively include a broad range of items which tap the constructs of organizational, nonorganizational, and subjective religiosity. In all four studies, and for most indicators, results revealed significant racial and gender differences which consistently withstood controlling for sociodemographic effects, including age, education, marital status, family income, region, urbanicity, and subjective health.

Immediate internal fixation of low-velocity gunshot-related femoral fractures

Fractures caused by gunshots are increasingly common in urban hospitals and trauma centers. The rising incidence and complexity of these injuries present difficult management problems and health care burdens. In a 3-year period, from 1989 through 1991, 21 patients with femoral shaft fractures from low-velocity bullets were treated with intramedullary fixation within 15 hours of admission. Eighteen patients were available for follow-up. The fractures had healed in all patients. Average hospitalization for an isolated injury was 7 days. There were no complications related to immediate internal fixation. Immediate internal fixation of femoral shaft fractures caused by low-velocity gunshots can be performed in an efficient and cost effective manner.

Effect of sleep quality on symptoms of irritable bowel syndrome

A prospective, one-month diary study was conducted with 23 adult irritable bowel syndrome (IBS) patients in order to determine the relationship between IBS and the quality of sleep. Subjects were screened through history and diagnostic studies. Accepted patients then completed a daily diary of IBS symptoms and sleep quality. At baseline, most subjects (74%) characterized themselves as "poor sleepers." Using pooled time series analysis, the study found a significant correlation between morning IBS symptoms and the quality of the prior night's sleep (P < 0.001), a finding not previously reported in the literature. A less strong but still significant correlation (P < 0.05) was found between end of day IBS symptoms and the quality of sleep during the prior evening. Morning IBS symptoms seem to rise or fall in close association with the prior night's quality of sleep. The study supports the hypothesis that IBS symptoms are related to a disturbance in sleep.

Prayer and health during pregnancy: findings from the Galveston Low Birthweight Survey

In this study we examined the relationship between praying for one's baby during pregnancy and self-ratings of health. Data were collected from a biethnic (black and Hispanic) sample of postpartum mothers in Galveston, Tex, from 1986 to 1987. This sample is representative of the annual biethnic population of live births in Galveston. Subjective health was assessed for the periods both before and during pregnancy with self-ratings of global or overall health, worry over health, and functional health or lack of disability. Analyses controlled for the effects of the mother's age, marital status, gravidity, education, and self-rated religiosity. Findings revealed that all three prepregnancy health measures were associated with prayer. Subjectively unhealthier mothers prayed more for their baby during pregnancy regardless of their perceived health during pregnancy, and subjectively healthier mothers prayed less for their baby regardless of their self-reported religiosity. Additional analyses revealed that the effect of poor health on the frequency of prayer was not simply an outcome of the mother's worry over her own health.

Age differences in mystical experience

Age differences are examined in reports of deja vu, ESP, clairvoyance, spiritualism, and numinous experience. According to the 1988 General Social Survey (N = 1481), these mystical experiences are somewhat more common now than in 1973, and deja vu, clairvoyance, and a composite mysticism score have increased with successively younger age cohorts. Further, private and subjective religiosity are positively related to overall mystical experience, while organizational religiosity is inversely related.

Gender and age differences in religiosity among black Americans

Gender and age differences were examined in over a dozen religious indicators using cross-sectional data from the National Survey of Black Americans (N = 2,107). Although both genders manifested moderate to high levels of organizational, nonorganizational, and subjective religiosity, black women significantly exceeded black men in levels of religiosity at all ages, even when controlling for the effects of education, marital and employment status, region, urbanicity, and health satisfaction.

Antecedents and dimensions of religious involvement among older black adults

This study proposed and tested a measurement model of religiosity among a sample of older (55 years of age and above) Black Americans. This model incorporates three correlated dimensions of religious involvement, termed organizational, nonorganizational, and subjective religiosity. Findings indicate that the proposed model provides a good fit to the data, is preferable to other alternative models, and exhibits convergent validity with respect to exogenous or antecedent variables (age, gender, marital status, income, education, urbanicity, and region) known to predict religious involvement. In addition, these antecedents exhibit stronger effects on subjective religiosity than on the two more behavioral dimensions of religiosity. Interpretation of these status-group differences in religiosity focuses on socialization experiences and social environment factors which may promote a religious world-view.

Ethnic differences in patient requests for pregnancy testing

This study identifies a black-white difference in pregnancy test requests and in factors predicting such requests among 324 women tested at an academic family practice in 1986. Data were obtained from encounter sheets filled out by clinicians at the time tests were ordered. Analysis of variance revealed that blacks requested fewer pregnancy tests than whites, and that this finding remained significant (P less than .01) after controlling for the effects of gestational status and other clinical and sociodemographic factors. Blacks were less likely to be married or possess health insurance, but more likely to have been pregnant before. Logistic regressions indicated that factors predicting test requests differed by ethnicity, with symptoms and age predicting test requests among whites, and pregnancy the only significant predictor among blacks. Explanations consistent with these findings include possible ethnic differences in reactions to symptoms and economic factors. Further refinement of these hypotheses and consideration of other alternatives will advance understanding of ethnicity as a factor in test-requesting behavior, and enable clinicians to communicate with and care for black women more effectively.

The factor structure of the pregnancy anxiety scale

This paper presents a measurement model of a ten-item scale of maternal anxiety during pregnancy. Using confirmatory factor analysis, its reliability and validity are examined in a hospital sample of mothers (N = 266) surveyed postpartum in Galveston, Texas. According to several indices of overall fit as well as individual parameter estimates, a latent internal structure of three interrelated dimensions is confirmed for the scale items. These first-order constructs are anxiety about being pregnant, childbirth, and hospitalization. This model exhibits a considerably better fit than both a no-factors model and a model in which the dimensions are uncorrelated. Finally, several exogenous constructs expected to be associated with pregnancy anxiety--age, marital status, and worry over health--exert significant effects on dimensions of the model or on a second-order factor.

Triethnic differences in pregnancy outcomes: findings from the GLOWBS study

Findings are presented from the Galveston Low Birthweight Survey (GLOWBS), conducted at The University of Texas Medical Branch from 1986 through 1987. One full year of delivery logbook data were abstracted on all live, single births (N = 3904) to Anglo (n = 2114), black (n = 902), and Hispanic (n = 888) mothers. Analyses include triethnic comparisons of pregnancy outcomes and maternal characteristics through analysis of variance and both crude and adjusted logistic regression for deleterious pregnancy outcomes in blacks relative to non-blacks. The most striking finding is a consistent black disadvantage that withstands controlling for parity, age, and marital status. Blacks have a significantly lower mean birthweight, shorter mean gestation, lower 1-minute and 5-minute Apgar scores, and a higher incidence of both low birthweight (RR = 1.89) and prematurity (RR = 1.57) than either Anglos or Hispanics, between whom no differences are found.

Laboratory differences in cervical cytology

This prospective study was designed to determine if there is a difference in reporting endocervical cells in Papanicolaou smears among laboratories used by an urban, academic family practice. A review of the literature found no studies comparing Papanicolaou smear results among laboratories with respect to the presence of endocervical cells. In this study, three laboratories evaluated a total of 140 Papanicolaou smears from women aged 16 to 83 (mean = 33.8) for endocervical cells. The presence of endocervical cells was reported for 88 smears (62.9%) ranging from 42/83 (50.6%) to 21/23 (91.3%) among laboratories. Results of an analysis of variance revealed a statistically significant difference in the frequency of reporting endocervical cells (p less than .001) among the laboratories. Analysis of covariance controlling for effects of several factors known to influence the outcome of Papanicolaou smears (age, days since last menstrual period, method used to obtain smear, and experience of clinician obtaining smear) failed to explain this difference.

Symptom reporting in wanted and unwanted pregnancies

This study examined the association between unwanted pregnancy and the reporting of pregnancy symptoms in a sample of 99 pregnant women drawn from an urban, medical school based family practice residency. Of these women, 51 had unwanted pregnancies, and 48 had wanted pregnancies. Women with wanted pregnancies were more likely than women with unwanted pregnancies to report three pregnancy symptoms (amenorrhea, breast tenderness, and morning sickness). This association of symptoms with a wanted pregnancy persisted after controlling for age, race, marital status, contraceptive use, menstrual irregularity, and days since last menses through multiple logistic regression. Findings suggest that symptoms may be underreported by women with unwanted pregnancies.

Religion and medicine: How are they related?

This paper provides a comprehensive and dynamic profile of religion-medicine interrelationships. This profile is drawn from the respective characteristics of religion and medicine, as well as from historic and contemporary literature regarding their interconnections. Six symbiotic functions are identified and discussed with respect to their bearing on clinical practice, medical education, and research.

Dimensions of the OARS mental health measures

A measurement model of mental health for the Older Americans Resources and Services (OARS) questionnaire is described. Using confirmatory factor analysis on noninstitutionalized elderly from Cleveland (N = 1834) and Virginia (N = 2146), the 21 OARS mental health items were fit to a 15-item model. In addition to the second-order construct of mental health, there were four first-order dimensions: life satisfaction, psychosomatic symptomatology, alienation, and cognitive deficit. Analyses were further replicated by splitting both samples in half. The model fit well and compared favorably to other alternative specifications. In addition to this analysis of internal structure, the model was also examined in relation to several exogenous factors including age, sex, race, education, and physical health. While the model again fit well, a model with cognitive deficit separate from the other factors seemed more reasonable.

What does gerontology mean?

Despite growth in the field of gerontological research over the past 50 years, no consensus has emerged on either the definition of gerontology or on its scope and boundaries. This confusion is rooted historically in developments involving the origins and adoption of the term. These include the divergent agendas and world views of particular disciplines and gerontological institutions, as well as conflicts over both ideology and turf among major gerontologists. Speculation is offered on the potential, as well as the costs, of developing consensus-in the future.

Exploring the persistent black risk of low birthweight: findings from the GLOWBS Study

Results are presented from the Galveston Low Birthweight Survey (GLOWBS) Study, a tri-ethnic survey (N = 1,179) of live, single births, conducted in Galveston, Texas, from 1986 to 1987. Four principal findings emerged pointing to a persistent black risk for low birthweight (less than 2,500g). First, black infants (2,997g) have significantly lower mean birthweight than either Anglos (3,281g) or Hispanics (3,270g). Second, blacks are at significantly higher risk of low birthweight than nonblacks (risk ratio = 1.71). Third, despite controlling for a variety of pregnancy- and health-related, psychosocial, socioeconomic, and health services factors (including even gestational length), being black still exerts a significant, inverse effect on birthweight (beta = -0.137). Fourth, of the above factors only gestational length (R2 = 0.39) accounts for more than a negligible amount of the total variance in birthweight among blacks. These findings are discussed, and several lines of follow-up research are proposed.

Is religion therapeutically significant for hypertension?

Epidemiologic studies of the effects of religion on blood pressure suggest that religious commitment is inversely associated with blood pressure and that several religious denominations or groups have relatively low rates of hypertension-related morbidity and mortality. In this review, we examine the implication that certain characteristics and functions of religion account for this association, and we posit 12 possible explanations for this finding. We propose that a salutary effect of religion on blood pressure can be explained by some combination of the following correlates or sequelae of religion: the promotion of health-related behavior; hereditary predispositions in particular groups; the healthful psychosocial effects of religious practice; and, the beneficial psychodynamics of belief systems, religious rites, and faith. Since past epidemiologic studies may have been methodologically limited or flawed, possible explanations for the findings of these studies also include epistemological confusion, measurement problems, and analytical errors. Finally, for the sake of completeness, two more speculative hypotheses are identified: superempirical and supernatural influences or pathways.

Religion, Type A behavior, and health

In a study of air traffic controllers, religious differences are found in the way Type A behavior is associated with several health status indicators. Associations between the Jenkins Activity Survey (JAS) and physical illness incidence, health-promotive behavior, diastolic and systolic blood pressure, subjective distress and impulse control problems, and alcohol consumption are examined by religious attendance, religious affiliation, and change in affiliation. Findings confirm that Type A does not vary significantly by religion. However, there are several significant findings between Type A and various health indicators. Type A is associated with illness incidence, overall and more strongly in several religion, subgroups. Type A and alcohol consumption are related positively in Protestants and converts, and negatively in churchgoing Catholics. Type A is related to impulse control problems in churchgoing Protestants and to subjective distress in churchgoing Catholics. Finally, in individuals with weak or no religious ties, Type A is associated with lower blood pressure. This last finding suggests that in some people (for example, the irreligious or unchurched), the coronary-prone behavior pattern may have cardiovascular effects which are salutary in at least one respect.

Attitudes toward hospital evangelism: a comparison of pastors and chaplains

The attitudes toward hospital evangelism of a random sample of Baptist ministers from Texas are analyzed, with special reference to significant differences between pastors and chaplains. Findings reveal that these two groups hold divergent views on the central mission of hospital evangelism. In general, Baptist pastors tend toward a more idealized view focused on soul-winning than Baptist chaplains, who seem somewhat more attentive to the special circumstances of the hospital patient. The implications of these findings are discussed.

Is there a religious factor in health care utilization?: A review

This paper reviews more than 30 studies of health care utilization in which the effects of religion variables are examined, an area previously unreviewed. The authors found that over three-quarters of these studies reported significant religious differences in rates of utilization. The most common operationalization of religion was religious affiliation (typically Protestant vs Catholic vs Jewish), although the effects of religious attendance and religiosity were occasionally examined. Most major areas of health care use are represented in this literature, including psychiatric care, maternal and child health services, dental care, and physician and hospital utilization. Despite the preponderance of significant findings, it is difficult to isolate any consistent trends, although low-order analyses seem to suggest that Jews are higher utilizers than non-Jews. New findings presented from a study in Appalachia were inconclusive. The authors discuss the conceptual limitations inherent in ways in which health services researchers typically investigate the effects of religion. Drawing on recent work in the epidemiology of religion, several recommendations are offered regarding the prospect of future research in this area.

Is there a religious factor in health?

This paper reviews epidemiologic studies employing religion as an independent construct, and finds that most epidemiologists have an extremely limited appreciation of religion. After a historical overview of empirical religion and health research, some theoretical considerations are offered, followed by clarification of several operational and methodological issues. Next, well over 200 studies are reviewed from nine health-related areas: cardiovascular disease, hypertension and stroke, colitis and enteritis, general health status, general mortality, cancer of the uterine corpus and cervix, all other non-uterine cancers, morbidity and mortality in the clergy, and cancer in India. Finally, an agenda for further research is proposed.

Is frequent religious attendance really conducive to better health? Toward an epidemiology of religion

Although hundreds of published studies have addressed the effects of religion on morbidity and mortality, many investigators may be unaware of this literature. This paper begins with an analysis of an important subset of these studies--those 27 which operationalize 'religiosity' as religious attendance--and which, taken as a whole, point to a consistent salutary effect for frequent attendance. Upon identifying several pervasive epistemological, methodological, and analytical problems with these studies, however, this paper shows that there is insufficient evidence to conclude that religious attendance is positively and significantly related to health. Nevertheless, the authors present a theoretical basis for expecting such associations. This framework is included in a brief primer on religion for epidemiologists and other sociomedical scientists interested in exploring the health-related effects of religious factors. Finally, a possible scenario for the development of an epidemiology of religion is discussed.

'New age' healing in the U.S

This paper provides a conceptual overview of the 'New Age' phenomenon and of 'New age healing,' concepts which have gone virtually unaddressed in social science research, health-related or otherwise. First, drawing upon diverse sources, the authors attempt to define 'New age,' after which they discuss those medical, spiritual, and sociocultural developments which help account for the rise of new age healing in the U.S. Next, a comprehensive review of over a dozen schemata of healing, healers, and medical systems fails to provide a satisfactory classification of new age healing. Finally, by analyzing data derived from primary and secondary source materials on 81 healing systems or techniques identifying themselves with the new age, a typology of new age healing itself is inductively generated. Three general modes are found: mental or physical self-betterment, esoteric teachings, and contemplative practice. These types of new age healing place primary emphasis, respectively, on body, mind and soul.

The social identity of the chronic schizophrenic

Using ethnographic research methods in a sample of institutionalized male schizophrenics, an emic typology of patient social identities was derived. Interview and observational data yielded three general status classes comprising thirteen associated identities: killer, fighter, assaultive person, fag, rapist, doper, drunk, victim, con, nut, weirdo, snitch, and disoriented. An individual's social identity varied depending upon his current setting within the hospital (official, private, patient-staff interaction, or outside). This emic-derived typology is contrasted with the etic typologies which dominate the literature (e.g. Goffman, Salisbury and Henry), and the importance of ethnographic study in social psychiatry is highlighted.

Life style--an emergent concept in the sociomedical sciences

The concept of life style recently has gained prominence in sociomedical research; yet the term remains poorly defined. This paper traces the evolution of the life style concept from its origins in sociological and personality studies to its current use in reference to behavioral risk factors for disease. Particular attention is given to the changes in meaning that have taken place over the past few decades. Similarities between the notion of life style and concepts of cultural integration are noted, and the various uses of life style are categorized along an idealist-materialist continuum. Finally, the authors fault medicalized notions of life style for failing to acknowledge the importance of the context and meaning of health-related behavior.

Determinants of physician utilization among Mexican-Americans. A three-generations study

Determinants of physician utilization were examined using a three-generational sample of Mexican-Americans in San Antonio. A typical version of Andersen's causal behavioral model was moderately successful in predicting physician utilization in the middle and older generations and less successful in the younger generation. Consistent with the literature, need factors (health indicators) tended to affect utilization most directly. The authors also examined whether acculturation into the larger society positively influenced utilization regardless of need, as the literature suggested. While three separate measures of acculturation had no independent effects on physician utilization, acculturation did affect utilization indirectly via the need variables in the middle generation, although these effects were not consistently in the direction of greater utilization. Generational differences in determinants of physician utilization are discussed particularly in relation to the model's greater relevance for the middle and older generations.

Religion and health in Mexican Americans

The relationship between religion and health was investigated using data from a three-generation study of mexican Americans. Two measures of religion-religious institution attendance and self-rated religiosity-were correlated with a number of functional health indicators, including self-rated health, activity restriction owing to health, bed disability days, physician utilization, worry over health, a physical symptoms scale, and a depression scale. In addition, prevalence rates were calculated for several major chronic diseases. Many significant associations obtained, as well as an inverse relationship between self-rated religiosity and hypertension. These findings are interpreted in light of the literature on religious attendance and health and on religion and aging.

The role of the black church in community medicine

Historically, the black church has been the preserver and the perpetuator of the black ethos, the radix from which its defining values and norms have been generated, and the autonomous social institution that has provided order and meaning to the black experience in the United States. The traditional ethic of community-oriented service in the black ethos is highly compatible with the communitarian ethic of community medicine. Given this congruence and the much-documented fact that black Americans are an at-risk and under-served group regarding health status indicators and the provision of preventive health care, respectively, the black church is an extremely relevant locus for the practice of community medicine. A number of health programs based in or affiliated with the black church have operated throughout the United States, and these programs, along with the corpus of literature comprising conceptual articles favorable toward such a role for the black church, are reviewed within four areas of community medicine: primary care delivery, community mental health, health promotion and disease prevention, and health policy.

Is self-care a social movement?

Historically, social movements in health have often exerted considerable influence over health policy, public expectation in regards to health services, the structure of health professions and institutions and personal health practices. Self-care has been widely assumed to be a social movement by authors writing in the health arena. The validity of this assumption is questioned by (1) positing criteria and characteristics of social movements and (2) comparing the self-care phenomenon to four examples in the area of health (Temperance, Christian Science, Psychedelia, and Feminist Health) which appear to fit the thoroughly reviewed. It is concluded that self-care does not presently warrant consideration as a social movement. Several factors which include the rapid pace of technological innovation in medical care, the erosion of the traditional doctor/patient relationship and the increasing degree of the medicalization of previously non-medical aspects of social life are seen as contributory to the forming of preconditions of a potential self-care social movement.