American Public Health Association Annual Meeting 2014 – November 15 to 19, 2014
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PANEL DISCUSSION:
Religion
and Spirituality as
Neglected Causal Factors in Health:
Epidemiologic Evidence
4030.0 - SCI: Tuesday, November 18,
2014:
8:30 AM-10:00 AM,
Hilton: Exhibition Center C
8:32 Religion and Spirituality as Social Determinants of Health Over the Life Course
Ellen L. Idler, PhD
In this presentation we review the evidence for including religion among the social determinants of health, now the dominant paradigm in public health. It is widely accepted that social, economic, and political conditions are the fundamental influences on population health indicators such as morbidity and mortality. We contend that the social determinants literature has been limited by its exclusion of the social sphere of religion, to which most world populations have wide exposure. This oversight is ironic because one of the key insights of the social determinants approach is that early life influences often have lifelong consequences on health. Many rituals and practices of the world's leading faith traditions map directly onto daily, weekly, annual, and life course transition events that are encountered as individuals age.
We review the population-based research literature on religion/spirituality and health outcomes using a life course approach. We summarize findings from available studies of mortality and identify gaps in the literature. There are extremely few studies of the effects of religion on the health of infants and children. Most research on religion/spirituality and health has been limited to surveys; the inclusion of (non-self-report) infant and child outcomes is an important area for future research. For adolescents, there are many more studies, but physical health outcomes are still relatively rare; such research more frequently examines mental health outcomes and health practices. Most of the thousands of studies of religion/spirituality and health outcomes have been performed with adults and elderly persons; we summarize the mortality findings from these studies with a graphical approach, differentiating group-level from individual-level studies, and public religious involvement measures from private/subjective measures. We conclude that a) the evidence for an association between religion/spirituality and health is incomplete; b) the available evidence suggests that public/social but not private/subjective religiousness is related to lower mortality risks in adulthood; and c) a life course approach is necessary for future research on religion/spirituality and health outcomes. Overall, the evidence suggests that religious involvement represents a social influence, or determinant, of health that should be included in the framework of the social determinants of health.
8:50 What 100+ Meta-Analyses and Systematic Reviews Reveal about the Effects of Religion/Spirituality on Health: Implications for Causality
Doug Oman, PhD
More than 3000 empirical studies have examined relations between religion, spirituality, and a variety of health outcomes. Religion and spirituality (R/S) have been theorized to causally influence health through mechanisms including social connections, health behaviors, mental health, and religious methods of coping. Yet many social scientists and health professionals remain unaware or skeptical of this literature. I report preliminary findings from a systematic review more than 100 peer-reviewed meta-analyses and other systematic reviews (SRs) of R/S and health-related variables. Topics were classed as substantive and closely health-focused (n=78), secondarily health-focused (n=16), or methodological (n=35). Closely health-focused reviews appeared in 65 distinct journals from 239 collective authors, each reviewing a median of about 25 studies. Updating Levin (1994), we evaluate relevance to applying Hill’s (1965) nine perspectives for establishing causality, finding that many are now supported by one or more SRs. Implications are discussed for public health and related fields.
REFERENCES
Hill, A. B. (1965). The Environment and Disease: Association or Causation? Proceedings of the Royal Society of Medicine, 58, 1217-1219.
Levin, J. S. (1994). Religion and health: is there an association, is it valid, and is it causal? Social Science and Medicine, 38(11), 1475-1482. doi: 10.1016/0277-9536(94)90109-0
9:08 Religious Attendance and the Mobility Trajectories of Older Mexican Americans
Terrence D. Hill, PhD
Disability, dependency, and related comorbidity are major public health concerns with extensive social, psychological, and economic consequences. Although most studies have emphasized the factors that elevate the risk of disability, far fewer studies have focused on the identification of potential protective factors. Numerous studies have shown that religious attendance is associated with lower rates of morbidity and mortality in the general population. To this point, however, it is unclear whether religious attendance is in some way protective against disability. While some studies have shown that religious attendance is associated with favorable disability outcomes, other studies have reported null associations between religious attendance and disability.
Previous research is also limited by (1) an over-emphasis on non-Hispanic white and black populations, (2) self-reported disability data, (3) health selection into religious activities, (4) confounding with social ties and social support, and (5) a lack of precision concerning underlying disability trajectories. Building on previous research, we examine the association between religious attendance and disability among older Mexican Americans--the largest segment of the growing Hispanic population. We employ performance-based assessments of mobility. We include comprehensive adjustments for health selection, social ties, and social support. We also predict membership in multiple classes of disability trajectories in the population. Employing seven waves of data collected from the original cohort of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE), we used growth mixture modeling (GMM) to estimate latent classes of mobility trajectories. We then estimated a series of multinomial logistic regression models to predict the odds of membership in the mobility trajectory classes. Our GMM results suggest that multiple disability trajectories characterize the older Mexican American population. Specifically, we observed three significant mobility trajectories: (1) High initial functioning followed by decline, (2) Moderate initial functioning followed by decline, and (3) Low initial functioning followed by no change or slight improvement. Our multinomial logistic regression results indicate that respondents who attend religious services exhibit greater odds of being classified in the high mobility class than the low mobility class. Level of religious attendance did not distinguish between the moderate and low mobility classes. Our regression results confirm that religious attendance is associated with favorable mobility trajectories among older Mexican Americans. Our results apply to performance-based assessments of functional ability, not self-reports. Our key regression results persist with comprehensive adjustments for health selection, social ties, and social support. Future research is needed to answer several questions: (1) What about other Hispanic subgroups? (2) Is religious attendance more protective for certain groups? (3) If religious attendance slows the rate of functional decline, why does it?
9:26 Methodology and Causality in Religion and Health Research
Tyler VanderWeele, PhD
The talk will survey some of the methodological challenges in assessing causality in religion and health research. While the field has seen increasing use of better longitudinal designs in assessing the relationship between religion and health, for certain questions considerable methodological challenges remain. For example, while it is the case that religious participation is longitudinally associated with less depression, it is also the case that those who become depressed are more likely to cease attending religious services. Such feedback, with causality in both directions, renders cross-section data useless, and requires causal modeling techniques, such as marginal structural models, to adequately assess the extent of the effects in both directions. Analyses using marginal structural models with the Nurses' Health Study data will be presented in studying this feedback between religious service attendance and depression. Another set of methodological challenges arises when interest lies in studying mechanisms governing the relationship between religious participation and health outcomes. The relevance of the literature on causal mediation analysis to religion and health research will be discussed generally, and analyses will be presented examining the mechanisms for the religion-mortality relationship in the Nurses' Health Study data.
More than 3000 empirical studies have now examined relations between religion, spirituality, and a variety of health-related outcomes, as documented in the two editions of the Handbook of Religion and Health (Koenig et al, 2001, 2012). Religion and spirituality (R/S) have been theorized to causally influence health through a variety of mechanisms, including social connections, health behaviors, mental health, and religious methods of coping with stress. Public Health epidemiologic research, in the form of large population-based prospective studies, appears to have played an important role in prompting the recent interdisciplinary upsurge in interest in R/S and health relations (e.g., Strawbridge &c, 1997; Oman & Reed, 1998), spanning medicine, psychology, social work, and other fields. Studies have repeatedly linked R/S factors to different and usually more favorable profiles of health behavior and other modifiable risk factors that are often targeted in public health interventions. Ironically, however, R/S factors and evidence for their importance are often neglected in contemporary public health research, teaching, and practice, with many public health professionals remaining unaware of this literature or skeptical about the strength of the evidence.
In order to encourage greater awareness of R/S factors, this session will offer a set of inter-related presentations to familiarize attendees with this field. The session will present major conceptual models for how R/S factors may causally affect health, such as social ecological and life course perspectives, along with descriptions of supporting evidence. It will also review and summarize findings from the large number of systematic reviews that have now been conducted on R/S factors that relate to health variables. As an illustrative example, the session will present an (unpublished) 7-wave investigation of the relation between religious involvement and disability. The session will also describe a variety of methodological tools, challenges, and findings in assessing causality. The session will conclude with a panel discussion of possible implications for research, teaching, and practice.
References:
Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of Religion and Health. New York: Oxford University Press.
Koenig, H. G., King, D. E., & Carson, V. B. (2012). Handbook of religion and health (2nd ed.). Oxford ; New York: Oxford University Press.
Oman, D., & Reed, D. (1998). Religion and Mortality Among the Community-Dwelling Elderly. American Journal of Public Health, 88(10), 1469-1475.
Strawbridge, W. J., Cohen, R. D., Shema, S. J., & Kaplan, G. A. (1997). Frequent Attendance at Religious Services and Mortality over 28 Years. American Journal of Public Health, 87(6), 957-961.
90 Minutes Total: 2 minutes for introduction; 18 minutes per speaker, 16 minutes for panel discussion
8:30 Introduction and Welcome:
Doug Oman, PhD
8:32 Religion and Spirituality as Social Determinants of Health Over the Life Course
Ellen L. Idler, PhD
8:50 100+ Systematic Reviews of Religion/Spirituality and Health Now Published
Doug Oman, PhD
9:08 Religious Attendance and the Mobility Trajectories of Older Mexican Americans
Terrence D. Hill, PhD
9:26 Methodology and Causality in Religion and Health Research
Tyler VanderWeele, PhD
9:44 Panel Discussion: Possible Implications for Research, Teaching, and Practice
Moderator: Doug Oman
10:00 End of Session!