Linking Multi-Dimensional Religiosity in Childhood and Later Adulthood: Implications for Later Life Health.

This study examines religiosity patterns across childhood and later adulthood and their associations with later-life health using an experimental module from the 2016 Health and Retirement Study (N = 1649; Mean Age = 64.0). Latent class analysis is used to categorize individuals by commonalities in religious attendance, religious identity, and spiritual identity. Cross-sectional and longitudinal associations are then explored using probable depression, disability, and mortality as health indicators. Results reveal complex patterns, often characterized by declining attendance and fluctuating identity. Relationships with health appear stronger in cross-sectional analyses, suggesting that some associations may be non-causal. Individuals with consistently strong religiosity show significantly better psychological health compared to their relatively non-religious counterparts. Moreover, the absence of religiosity in later adulthood is associated with an increased risk of mortality. Overall, the findings support the promotion of religiosity whilst acknowledging individual variations and highlighting the need for more individualistic approaches to the study of religion and health.

Data quality and response distributions in a mixed-mode survey.

Longitudinal surveys traditionally conducted by interviewers are facing increasing pressures to explore alternatives such as sequential mixed-mode designs, which start with a cheaper self-administered mode (online) then follow up using more expensive methods such as telephone or face-to-face interviewing. Using a designed experiment conducted as part of the 2018 wave of the Health and Retirement Study (HRS) in the US, we compare a sequential mixed-mode design (web then telephone) with the standard telephone-only protocol. Using an intent-to-treat analysis, we focus on response quality and response distributions for several domains key to HRS: physical and psychological health, financial status, expectations and family composition. Respondents assigned to the sequential mixed-mode (web) had slightly higher missing data rates and more focal responses than those assigned to telephone-only. However, we find no evidence of differential quality in verifying and updating roster information. We find slightly lower rates of asset ownership reported by those assigned to the web mode. Conditional on ownership, we find no detectable mode effects on the value of assets. We find more negative (pessimistic) expectations for those assigned to the web mode. We find little evidence of poorer health reported by those assigned to the web mode. We find that effects of mode assignment on measurement are present, but for most indicators the effects are small. Finding ways to remediate the differences in item-missing data and focal values should help reduce mode effects in mixed-mode surveys or those transitioning from interviewer- to self-administration.

Defining Childlessness Among Middle-Aged and Older Americans: A Research Note.

Measuring childlessness is complicated by the increasing complexity of family structure. Using data from the 2014 Health and Retirement Study, in this research note we compared three definitions of childlessness: (1) respondent never fathered/gave birth to a child, (2) respondent had no children who were living and in contact, and (3) respondent and spouse/partner had no children or stepchildren who were living and in contact. Results showed that the prevalence of childlessness among Americans aged 55 or older ranged from 9.2% to 13.6% depending on which definition was used. The association between select individual characteristics (gender and marital status) and the likelihood of childlessness, as well as the association between childlessness and loneliness and living arrangements, also varied depending on how childlessness was defined. Therefore, how we define childlessness can affect our understanding of its prevalence, correlates, and relationships with well-being. Future research on childlessness should carefully consider the choice of definition and its implications for research and policy discussions.

Later-Life Living Arrangements of Americans With and Without Children: A Life Table Approach.

OBJECTIVES: This study describes living arrangement-specific life expectancy for older Americans with and without children, by sex and race/ethnicity. METHOD: We use life tables from the Human Mortality Database and data from the Health and Retirement Study over a 17-year period (2000-2016) to calculate living arrangement-specific life expectancy at age 65 using Sullivan's method. Results describe the lives of older Americans aged 65 and older with and without children in terms of the number of expected years of life in different living arrangements. RESULTS: With the exception of Hispanic men, older Americans without children spend over half of their remaining life living alone. Among the childless, it is White women and Black men who spend the largest percent of remaining life living alone (65% and 57%, respectively). Relative to parents, childless older Americans have an overall life expectancy at age 65 that is 1 year lower and spend 5-6 years more living alone and fewer years living with a spouse (8 years less for men and 5 years less for women). Childless older Americans spend more time in nursing homes, but average expected duration in this living arrangement is short and differences between those with and without children are small. DISCUSSION: This descriptive analysis demonstrates the fundamental ways in which children shape the lives of older Americans by showing that later-life living arrangements of childless Americans differ markedly from their counterparts with children. These results provide a valuable empirical foundation for broader efforts to understand relationships between childlessness, living arrangements, and well-being at older ages.

Are Religiosity and Spirituality Related to Self-Reported Health Expectancy? An Analysis of the European Values Survey.

Research on religiosity and health has generally focussed on the United States, and outcomes of health or mortality but not both. Using the European Values Survey 2008, we examined cross-sectional associations between four dimensions of religiosity/spirituality: attendance, private prayer, importance of religion, belief in God; and healthy life expectancy (HLE) based on self-reported health across 47 European countries (n = 65,303 individuals). Greater levels of private prayer, importance of religion and belief in God, at a country level, were associated with lower HLE at age 20, after adjustment for confounders, but only in women. The findings may explain HLE inequalities between European countries.

Multigenerational Households During Childhood and Trajectories of Cognitive Functioning Among U.S. Older Adults.

OBJECTIVES: Family structure in childhood influences early brain development and cognitive performance in adulthood. Much less is known about its long-term impact on later-life cognitive functioning. We extend the two-generation family structure approach to investigate the potential contribution of living with grandparents in multigenerational households to differences in cognitive functioning at older ages. METHODS: Data were drawn from 9 waves of the Health and Retirement Study (1998-2014) merged with newly collected childhood family history data. Five types of family structure were assessed: two-parent households, two-parent households with grandparents, single-parent households, single-parent households with grandparents, and grandparent-headed households. Growth curve models were used to estimate trajectories of cognitive functioning over time. RESULTS: Childhood family structure was significantly associated with level of cognitive functioning, but not to rate of cognitive decline. Relative to those from two-parent households, individuals who grew up in multigenerational households showed higher levels of cognitive functioning, including those living with a single parent and grandparents. Those who lived with a single parent alone were the most disadvantaged. The effects of these multigenerational households persisted net of childhood and adulthood socioeconomic status and health outcomes. DISCUSSION: Grandparent coresidence may cultivate a socially enriched home environment, providing resources and protection for early cognitive development that could persist throughout life. Multigenerational living arrangements are likely to increase as the contemporary population ages. More research needs to be done to understand the impact of these living arrangements on future generations' brain health and cognitive aging.

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.

Does Religious Activity Distinguish the Mortality Experiences of Older Taiwanese? An Analysis Using Eighteen Years of Follow-Up Data.

This paper extends investigation of religiosity and longevity to Taiwan using a 1989 survey: N = 3849, aged 60+, with 18 years of follow-up. Religious activity is measured as worship and performance of rituals. A Gompertz regression, adjusted and non-adjusted for covariates and mediating factors, shows the hazard of dying is lower for the religiously active versus the non-active. Transformed into life table functions, a 60-year-old religiously active Taiwanese female lives more than 1 year longer than her non-religious counterpart, ceteris paribus. Mainland Chinese migrants are examined carefully because of unique religious and health characteristics. They live longer, but the religiosity gap is similar.

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.

Religiosity and health: A global comparative study.

The objective of this paper is to understand global connections between indicators of religiosity and health and how these differ cross-nationally. Data are from World Values Surveys (93 countries, N=121,770). Health is based on a self-assessed question about overall health. First, country-specific regressions are examined to determine the association separately in each country. Next, country-level variables and cross-level interactions are added to multilevel models to assess whether and how context affects health and religiosity slopes. Results indicate enormous variation in associations between religiosity and health across countries and religiosity indicators. Significant positive associations between all religiosity measures and health exist in only three countries (Georgia, South Africa, and USA); negative associations in only two (Slovenia and Tunisia). Macro-level variables explain some of this divergence. Greater participation in religious activity relates to better health in countries characterized as being religiously diverse. The importance in god and pondering life's meaning is more likely associated with better health in countries with low levels of the Human Development Index. Pondering life's meaning more likely associates with better health in countries that place more stringent restrictions on religious practice. Religiosity is less likely to be related to good health in communist and former communist countries of Asia and Eastern Europe. In conclusion, the association between religiosity and health is complex, being partly shaped by geopolitical and macro psychosocial contexts.

Estimation of Mode Effects in the Health and Retirement Study Using Measurement Models.

Using multiple modes to collect data is becoming a standard practice in survey agencies. While this should lower costs and reduce non-response error it may have detrimental effects on measurement quality. This is of special concern in panel surveys where a key focus is on measuring change over time and where changing modes may have an effect on key measures. In this paper we use a quasi-experimental design from the Health and Retirement Study to compare the measurement quality of two scales between face-to-face, telephone and Web modes. Panel members were randomly assigned to receive a telephone survey or enhanced face-to-face survey in the 2010 core wave, while this was reversed in the 2012 core wave. In 2011, panelists with Internet access completed a Web survey containing selected questions from the core waves. We examine the responses from 3251 respondents who participated in all three waves, using latent models to identify measurement mode effects. The two scales, depression and physical activity, show systematic differences between interviewer administered modes (i.e., face-to-face and telephone) and the self-administered one (i.e., Web). Possible explanations are discussed.

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.

Does Sequence Matter in Multi-Mode Surveys: Results from an Experiment.

Interest in a multi-mode approach to surveys has grown substantially in recent years, in part due to increased costs of face-to-face interviewing and the emergence of the internet as a survey mode. Yet, there is little systematic evidence of the impact of a multimode approach on survey costs and errors. This paper reports the results of an experiment designed to evaluate whether a mixed-mode approach to a large screening survey would produce comparable response rates at a lower cost than a face-to-face screening effort. The experiment was carried out in the Health and Retirement Study (HRS), an ongoing panel study of Americans over age 50. In 2010, HRS conducted a household screening survey to recruit new sample members to supplement the existing sample. The experiment varied the sequence of modes with which the screening interview was delivered. One treatment offered mail first, followed by face-to-face interviewing; the other started with face-to-face and then mail. A control group was offered only face-to-face interviewing. Results suggest that the mixed mode options reduced costs without reducing response rates to the screening interview. There is some evidence, however, that the sequence of modes offered may impact the response rate for a follow-up in-depth interview.

Cohort Profile: the Health and Retirement Study (HRS).

The Health and Retirement Study (HRS) is a nationally representative longitudinal survey of more than 37 000 individuals over age 50 in 23 000 households in the USA. The survey, which has been fielded every 2 years since 1992, was established to provide a national resource for data on the changing health and economic circumstances associated with ageing at both individual and population levels. Its multidisciplinary approach is focused on four broad topics-income and wealth; health, cognition and use of healthcare services; work and retirement; and family connections. HRS data are also linked at the individual level to administrative records from Social Security and Medicare, Veteran's Administration, the National Death Index and employer-provided pension plan information. Since 2006, data collection has expanded to include biomarkers and genetics as well as much greater depth in psychology and social context. This blend of economic, health and psychosocial information provides unprecedented potential to study increasingly complex questions about ageing and retirement. The HRS has been a leading force for rapid release of data while simultaneously protecting the confidentiality of respondents. Three categories of data-public, sensitive and restricted-can be accessed through procedures described on the HRS website (hrsonline.isr.umich.edu).

The association between socioeconomic status and cardiovascular risk factors among middle-aged and older men and women.

Studies of gender differences in the association between socioeconomic status (SES) and cardiovascular risk factors have produced mixed findings. The purpose of this research was to examine whether the association between SES and cardiovascular risk factors differed between older men and women. Using data on physical measures and biomarkers from the 2006 Health and Retirement Study (N = 2,502 men; N = 3,474 women), linear regression models were used to estimate the association between SES and seven cardiovascular risk factors. Interactions between gender and SES were tested. For all seven risks assessed, we observed significant associations of selected SES factors to cardiovascular risk for men and/or women. In all of these cases, lower SES was associated with higher cardiovascular risk. However, for six of the factors, we also observed gender differences in the association between SES and cardiovascular risk, such that lower SES was associated with higher cardiovascular risk for women but not for men. These findings suggest that the association between SES and cardiovascular risk is more pronounced for women than for men. Implementing interventions to reduce cardiovascular risk factors, particularly among older women with lower SES, might, over time, reduce cardiovascular disease in women and improve quality of life.

ENCOURAGING RECORD USE FOR FINANCIAL ASSET QUESTIONS IN AWEB SURVEY.

We report on two experiments to encourage record use by respondents in an Internet survey. The experiments were conducted in the 2009 Health and Retirement Study (HRS) Internet Survey, administered to those in the HRS panel with Internet access, and in the 2011 HRS Internet Survey. Encouraging respondents to consult records at the relevant point in the questionnaire significantly increased reported record use (from 39 percent to 47 percent), but was insufficient to produce significant changes in the precision (amount of rounding) of the information reported. Including the encouragement in the mailed invitation to the Web survey in 2011 resulted in a lower response rate (77 percent with encouragement, 80 percent without), but increased reported record use among respondents (from 46 percent to 55 percent). In neither case was the increase in reported record use large enough to produce significant differences in the precision of the information reported between the groups with and without encouragement.

LINKING SURVEY AND ADMINISTRATIVE RECORDS: MECHANISMS OF CONSENT.

Survey records are increasingly being linked to administrative databases to enhance the survey data and increase research opportunities for data users. A necessary prerequisite to linking survey and administrative records is obtaining informed consent from respondents. Obtaining consent from all respondents is a difficult challenge and one that faces significant resistance. Consequently, data linkage consent rates vary widely from study-to-study. Several studies have found significant differences between consenters and non-consenters on socio-demographic variables, but no study has investigated the underlying mechanisms of consent from a theory-driven perspective. In this study, we describe and test several hypotheses related to respondents' willingness to consent to an earnings and benefit data linkage request based on mechanisms related to financial uncertainty, privacy concerns, resistance towards the survey interview, level of attentiveness during the interview, the respondents' preexisting relationship with the administrative data agency, and matching respondents and interviewers on observable characteristics. The results point to several implications for survey practice and suggestions for future research.

Diabetes-related change in physical disability from midlife to older adulthood: evidence from 1996-2003 Survey of Health and Living Status of the Elderly in Taiwan.

One in five older adults in Taiwan have been diagnosed with diabetes. This study drew on disability data for 5121 nationally representative middle-aged and older adults from the 1996-2003 Survey of Health and Living Status of the Elderly in Taiwan (SHLSET). By employing cohort sequential design and multilevel models, it combined cross-sectional and longitudinal evidence to characterize the age trajectory of physical disability from midlife to older adulthood and to discern the extent to which diabetes contributes to the variation in that trajectory. The main effects of diabetes and diabetes × age interaction in the fully controlled model provide evidence that diabetes independently and consistently changes physical functioning over and above natural aging processes in Taiwanese adults. In addition, while adding diabetes in the age trajectory of physical disability explained 3.2% and 1.6% of the variance in levels of and linear changes in physical disability trajectory, respectively, further adding follow-up status, sociodemographic factors and comorbidities altogether explained 40.5% and 29.1% of the variance in levels of and linear changes in that trajectory. These results imply that preventing the incidence of diabetes-related comorbidities may reduce the deterioration in both levels of and rates of change in physical disability.

A comparison of response rates in the English Longitudinal Study of Ageing and the Health and Retirement Study.

Survey response rates are an important measure of the quality of a survey; this is true for both longitudinal and cross-sectional surveys. However, the concept of a response rate in the context of a panel survey is more complex than is the case for a cross-sectional survey. There are typically many different response rates that can be calculated for a panel survey, each of which may be relevant for a specific purpose. The main objective of our paper is to document and compare response rates for two long-term panel studies of ageing, the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) in the United States. To guide our selection and calculation of response rates for the two studies, we use a framework that was developed by Peter Lynn (2005) and present several different types of longitudinal response rates for the two surveys. We discuss similarities and differences in the study designs and protocols and how some of the differences affect comparisons of response rates across the two studies.

Characteristics of physical measurement consent in a population-based survey of older adults.

BACKGROUND: Collecting physical measurements in population-based health surveys has increased in recent years, yet little is known about the characteristics of those who consent to these measurements. OBJECTIVE: To examine the characteristics of persons who consent to physical measurements across several domains, including one's demographic background, health status, resistance behavior toward the survey interview, and interviewer characteristics. RESEARCH DESIGN, SUBJECTS, AND MEASURES: We conducted a secondary data analysis of the 2006 Health and Retirement Study, a nationally-representative panel survey of older adults aged 51 and older. We performed multilevel logistic regressions on a sample of 7457 respondents who were eligible for physical measurements. The primary outcome measure was consent to all physical measurements. RESULTS: Seventy-nine percent (unweighted) of eligible respondents consented to all physical measurements. In weighted multilevel logistic regressions controlling for respondent demographics, current health status, survey resistance indicators, and interviewer characteristics, the propensity to consent was significantly greater among Hispanic respondents matched with bilingual Hispanic interviewers, patients with diabetes, and those who visited a doctor in the past 2 years. The propensity to consent was significantly lower among younger respondents, those who have several Nagi functional limitations and infrequently participate in "mildly vigorous" activities, and those interviewed by black interviewers. Survey resistance indicators, such as number of contact attempts and interviewer observations of resistant behavior in prior wave iterations of the Health and Retirement Study were also negatively associated with physical measurement consent. The propensity to consent was unrelated to prior medical diagnoses, including high blood pressure, cancer (excluding skin), lung disease, heart abnormalities, stroke, and arthritis, and matching of interviewer and respondent on race and gender. CONCLUSIONS: Physical measurement consent is not strongly associated with one's health status, though the findings are somewhat mixed. We recommend that physical measurement results be adjusted for characteristics associated with the likelihood of consent, particularly functional limitations, to reduce potential bias. Otherwise, health researchers should exercise caution when generalizing physical measurement results to the population at large, including persons with functional limitations that may affect their participation.