The Influence of Religion on Health
Finally, a line of studies that can be seen as encompassing the research presented above, too, is the one that related religious practices to protection against death. Two of the studies already presented (Hummers et al., 1999; Oman et al., 2002) have looked at associations between frequent attendance of religious services and major types of cause-specific mortality: circulatory, respiratory, digestive, cancer and external causes (Oman et al., 2002), or circulatory, respiratory, infectious, cancer, diabetes, external and residual (Hummer et al., 1999). Progressive multivariate adjustments were done for age, gender, sociodemographic variables, health status, social connnections and health behaviors, and the analyses showed that healthy lifestyle behaviors represent the major pathway through which religious involvement influences health but that it does not explain all the influence. Thus, religious involvement may offer protection against death from various diseases beyond the one offered through healthy behaviors (Oman et al., 2002) and social associations (Hummer et al., 1999). Musik, House and Williams (2004) analyzed the data from a large sample of adults followed for 28 years in order to investigate the effect of religious services attendance on mortality. In order to do this, they regressed the date of death on the predictor variables in a Cox proportional hazard model. Variables such as age, gender, race, service attendance, sociodemographics and SES, health status, health behaviors, social integration and support, other religious factors (e.g., volunteering for church, subjective religiosity/comfort, private religious activities) and beliefs (e.g., negative justice, fatalism) were entered in the model and the results showed that service attendance has a significant and sizable protective effect on mortality, such that mortality is reduced by 30-35 percent, and that healthy behaviors (particularly moderate physical activity) seem to mediate approximately 30 percent of that protective effect and social integration and support marginally mediating the protective effect (Musik et al., 2004). Lastly, two studies provided additional proof for the protecting effect of religiosity from mortality. One is a meta-analysis of 42 studies that found that religious involvement was significantly associated with lower mortality, although some of this associated can be accounted for by mediating factors such as demographics, psychosocial and health-related variables, (McCullough, Hoyt, Larson, Koenig & Thorensen, 2000). Another finding was that the relationship was stronger for women than for men. The other study revealed this association only for women, such that women with lowest religiousness through adulthood lives less than women who were more religious, but this association was found to be attributable to variables like personality traits, social ties, health behaviors and mental and physical health (McCullough, Friedman, Enders & Martin, 2009).
Another set of studies looked at the relationship between religion and mortality in elderly adults. One of these used a sample of community-dwelling elderly (Oman & Reed, 1998). Again, progressive multivariate adjustments were done for age, gender, demographics, health status, physical functioning, health habits, social functioning and support, and psychological state., religious attendance did protect against mortality and the level of protectiveness grew when social support was involved, as well, showing a complementary trend between the two variables. Similar results on a sample of elderly showed that religious services attendance protected against disability for both men and women and private religious involvement protected against depression for recently disabled men (Idler & Kasl, 1992). A very interesting result was that religious group membership protected both Christians and Jews against mortality in the month before their respective major holidays. The authors considered health behaviors, social support and optimism among the major factors that can explain part of these associations, along with religious services attendance and the finding of a meaning in life (Idler & Kasl, 1992).
However, studies that looked at the relationship between religion and mortality in elderly patients did not yield as optimistic results as the ones yielded by the studies on adults and elderly adults (Kutner, Lin, Fielding, Brogan & Hall, 1992; Pargament, Koenig, Tarakeshwar & Hahn, 2001). One study investigated whether social and/or psychologic factors help to predict older dialysis patients' continued survival. A stratified (by race and sex) random sample of elderly patients, receiving chronic dialysis, was interviewed about demographic, dialysis, health status, social situation, and psychological outlook variables. When a Cox proportional hazard model was fit to the data, with continued survival from the time of the interview as the dependent variable, no other psychosocial variable was a significant predictor of mortality, except the functional status (Kutner et al., 1992). The other study followed a sample of elderly patients for two years in order to assess the influence of religious coping and struggle on mortality (Pargament et al., 2001). With demographic, physical and mental health variable controlled, the analyses showed that religious struggle (e.g. high ratings of spiritual discontent, such as feelings that God has abandoned the person or does not love the person) actually increases mortality.
Conclusion and Areas for Future Study
The literature reviewed above is not only extensive but goes in great depth into the relationships between spirituality, religion, and health. Associations between spirituality and Eastern religious practices and lower blood pressure, lower levels of stress hormones and lower oxidative stress have been found (Seeman et al., 2003). Moreover, associations between Judeo, Christian, and Islamic religious practices and lower blood pressure, protective effect against cardiovascular disease, increased immune function, lipid levels and protective effect against all-cause mortality were found (Seeman et al., 2003; Powell, 2003). Nonetheless, little research has been done on certain populations and on certain associations between religion and health (e.g. lipids, immunity, other physiological measures, different types of causes for mortality). Moreover, little research has expanded the notion of religiousness or religious commitment. Many of the studies presented above measure religiousness as attendance to religious services (in all three major religions) (Colantonio et al., 1992; Koenig et al., 1997; Oman & Reed, 1998; Hummer et al., 1999; Sephton et al., 2001; Oman et al., 2002; Musik et al., 2004), and sometimes included also private practices such as prayer and reading religious literature (Idler & Kasl, 1992; Hixon et al., 1998; Koenig et al., 1998; Woods et al., 1999; McCullough et al., 2000; Steffen et al., 2001; Al-Kandari, 2003; McCullough et al., 2009). Only a few studies looked at fasting and other religious diet consideratons or included this among their measures of religiousness (Friedlander et al., 1985; Friedlander et al., 1987; Asgary, 2000; Al-Kandari, 2003; Sarri, 2003). Finally, only very few studies took into consideration the multiple dimensions of religion (Al-Kandari, 2003; Musik et al. 2004).
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