Is Secularization an Age-Related Process?

Secularization has been studied for decades by sociologists of religion. Long-running surveys in the United States and Europe show steady generational decline in religious affiliation and participation, and yet this trend has largely been ignored by gerontologists and life course researchers. We examined data from the Health and Retirement Study, hypothesizing between-cohort declines in religious participation. Based on data from a sample stratified by 10-year birth cohorts, we identified variation in patterns of religious involvement from 2004 to 2016. Measures of attending religious services, feeling religion is very important, and having good friends in the congregation show age-graded patterns; older cohorts have a higher level of religiosity than those following them, with only minor exceptions. For all three measures, differences by cohort within waves of data are statistically significant. We confirm, with longitudinal data, the findings of repeated cross-sectional surveys in the United States showing a generational pattern of decline in religiousness. The consequences of this loss of a common social tie for future older cohorts are unknown, since current older cohorts still maintain a high level of religious participation. However, future generations of older adults are likely to be less familiar with social support from religious institutions, and those institutions may be less available to provide such support as the apparently inexorable processes of secularization continue.

The benefits of being a senior mentor: Cultivating resilience through the mentorship of health professions students.

Senior Mentor Programs (SMPs) pair community-dwelling older adults with health professions students to facilitate knowledge, improve communication skills, and promote positive attitudes regarding the aging process. Although evidence exists that SMPs meet these goals, the programs' psychosocial impact on the senior mentors remains unexplored. The current study assessed 101 mostly female (64.4%) senior mentors (M age = 77.6) pre- and postprogram. Although mentors had no change in the amount of perceived ageism experienced or expectation of experiencing ageism, their concern/anxiety over ageism significantly decreased from pre- (M = 21.58) to posttest (M = 20.19). Qualitative thematic analysis indicated meaningfulness of program and scheduling difficulties as prevalent themes. Mentors who reported less concern about ageism following the program were more likely to have experienced ageism in the year prior to the program and to attend religious services more often, another potential intergenerational contact. These results highlight possible benefits of mentor service for older adults.

Transcending differences to study the transcendent: an exploratory study of researchers' and chaplains' reflections on interdisciplinary spiritual care research collaboration.

BACKGROUND: Despite recognition of the centrality of professional board-certified chaplains (BCC) in palliative care, the discipline has little research to guide its practices. To help address this limitation, HealthCare Chaplaincy Network funded six proposals in which BCCs worked collaboratively with established researchers. Recognizing the importance of interdisciplinary collaboration in the development of a new field, this paper reports on an exploratory study of project members' reflections over time on the benefits and challenges of conducting inter-disciplinary spiritual care research. METHODS: Data collection occurred in two stages. Stage 1 entailed two independent, self-reflective focus groups, organized by professional discipline, mid-way through the site projects. Stage 2 entailed end-of-project site reports and a conference questionnaire. RESULTS: Eighteen professionals participated in the group discussions. Stage 1: researchers perceived chaplains as eager workers passionately committed to their patients and to research, and identified challenges faced by chaplains in learning to conduct research. Chaplains perceived researchers as passionate about their work, were concerned research might uncover negative findings for their profession, and sensed they used a dissimilar paradigm from their research colleagues regarding the 'ways of relating' to knowledge and understanding. Stage 2: researchers and chaplains noted important changes they ascribed to the interdisciplinary collaboration that were classified into six domains of cultural and philosophical understanding: respect; learning; discovery; creativity; fruitful partnerships; and learning needs. CONCLUSIONS: Chaplains and researchers initially expressed divergent perspectives on the research collaborations. During the projects' lifespans, these differences were acknowledged and addressed. Mutual appreciation for each discipline's strengths and contributions to inter-professional dialogue emerged.

Spirituality As A Determinant Of Health: Emerging Policies, Practices, And Systems.

Reimagining public health's future should include explicitly considering spirituality as a social determinant of health that is linked to human goods and is deeply valued by people and their communities. Spirituality includes a sense of ultimate meaning, purpose, transcendence, and connectedness. With that end in mind, we assessed how recommendations recently issued by an expert panel for integrating spiritual factors into public health and medicine are being adopted in current practice in the United States. These recommendations emerged from a systematic review of empirical evidence on spirituality, serious illness, and population health published between 2000 and 2022. For each recommendation, we reviewed current federal, state, and local policies and practices recognizing spiritual factors, and we considered the ways in which they reflected the panel's recommendations. In this article, we highlight opportunities for broader application and scale while also noting the potential harms and benefits associated with incorporating these recommendations in various contexts. This analysis, while respecting the spiritual and religious diversity of the US population, identifies promising approaches for strengthening US public health by integrating spiritual considerations to inform person- and community-centered policy and practice.

Narratives and counter-narratives in religious responses to COVID-19: A computational text analysis.

Religious responses to COVID-19 as portrayed in a major news source raise the issue of conflict or cooperation between religious bodies and public health authorities. We compared articles in the New York Times relating to religion and COVID-19 with the COVID-19 statements posted on 63 faith-based organizations' web sites, and with the guidance documents published by the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) specifically for religious bodies. We used computational text analysis to identify and compare sentiments and topics in the three bodies of text. Sentiment analysis showed consistent positive values for faith-based organizations' texts throughout the period. The initial negative sentiment of religion-COVID-19 coverage in the New York Times rose over the period and eventually converged with the consistently positive sentiment of faith-based documents. In our topic modelling analysis, rank order and regression analysis showed that topic prevalence was similar in the faith-based and public health sources, and both showed statistically significant differences from the New York Times. We conclude that there is evidence of both narratives and counter-narratives, and that these showed demonstrable shifts over time. Text analysis of public documents shows alignment of the interests of public health and religious bodies, which can be discerned for the benefit of communities if parties are trusted and religious messages are consistent with public health communications.

The prevalence, grouping, and distribution of stressors and their association with anxiety among hospitalized patients.

Anxiety is prevalent among hospital inpatients and it has harmful effects on patient well-being and clinical outcomes. We aimed to characterize the sources of hospital distress and their relationship to anxiety. We conducted a cross-sectional study of inpatients (n = 271) throughout two Southeastern U.S. metropolitan hospitals. Participants completed a survey to identify which of 38 stressors they were experiencing. They also completed the State Trait Anxiety Inventory six-item scale. We evaluated the prevalence of stressors, their distribution, and crude association with anxiety. We then used multivariate logistic regression to estimate the association between stressors and clinically relevant anxiety, with and without adjusting for demographic variables. We used factor analysis to describe the interrelationships among stressors and to examine whether groups of stressors tend to be endorsed together. The following stressors were highly endorsed across all unit types: pain, being unable to sleep, feelings of frustration, being overwhelmed, and fear of the unknown. Stressors relating to isolation/meaninglessness and fear/frustration tend to be endorsed together. Stressors were more frequently endorsed by younger, female, and uninsured or Medicaid-insured patients and being female and uninsured was associated with anxiety in bivariate analysis. After controlling for the sources of distress in multivariate linear analysis, gender and insurance status no longer predicted anxiety. Feelings of isolation, lack of meaning, frustration, fear, or a loss of control were predictive. Study results suggest that multiple stressors are prevalent among hospital inpatients and relatively consistent across hospital unit and disease type. Interventions for anxiety or emotional/spiritual burden may be best targeted to stressors that are frequently endorsed or associated with anxiety, especially among young and female patients.

Understanding recent changes in suicide rates among the middle-aged: period or cohort effects?

OBJECTIVE: We examined trends in suicide rates for U.S. residents aged 40 to 59 years from 1979 to 2005 and explored alternative explanations for the notable increase in such deaths from 1999 to 2005. METHODS: We obtained information on suicide deaths from the National Center for Health Statistics and population data from the U.S. Census Bureau. Age- and gender-specific suicide rates were computed and trends therein analyzed using linear regression techniques. RESULTS: Following a period of stability or decline, suicide rates have climbed since 1988 for males aged 40-49 years, and since 1999 for females aged 40-59 years and males aged 50-59 years. A crossover in rates for 40- to 49-year-old vs. 50- to 59-year-old males and females occurred in the early 1990s, and the younger groups now have higher suicide rates. The post-1999 increase has been particularly dramatic for those who are unmarried and those without a college degree. CONCLUSIONS: The timing of the post-1999 increase coincides with the complete replacement of the U.S. population's middle-age strata by the postwar baby boom cohorts, whose youngest members turned 40 years of age by 2005. These cohorts, born between 1945 and 1964, also had notably high suicide rates during their adolescent years. Cohort replacement may explain the crossover in rates among the younger and older middle-aged groups. However, there is evidence for a period effect operating between 1999 and 2005, one that was apparently specific to less-protected members of the baby boom cohort.

Promoting advance care planning in African American faith communities: literature review and assessment of church-based programs.

Advance care planning is under-used among Black Americans, often because of experiences of racism in the health care system, resulting in a lower quality of care at the end of life. African American faith communities are trusted institutions where such sensitive conversations may take place safely. Our search of the literature identified five articles describing faith-based advance care planning education initiatives for Black Americans that have been implemented in local communities. We conducted a content analysis to identify key themes related to the success of a program's implementation and sustainability. Our analysis showed that successful implementation of advance care planning programs in Black American congregations reflected themes of building capacity, using existing ministries, involving faith leadership, exhibiting cultural competency, preserving a spiritual/Biblical context, addressing health disparities, building trust, selectively using technology, and fostering sustainability. We then evaluated five sets of well-known advance care planning education program materials that are frequently used by pastors, family caregivers, nurse's aides, nurses, physicians, social workers, and chaplains from a variety of religious traditions. We suggest ways these materials may be tailored specifically for Black American faith communities, based on the key themes identified in the literature on local faith-based advance care planning initiatives for Black churches. Overall, the goal is to achieve better alignment of advance care planning education materials with the African American faith community and to increase implementation and success of advance care planning education initiatives for all groups.

Psychosocial factors in heart surgery: presurgical vulnerability and postsurgical recovery.

OBJECTIVE: Distress and low perceived social support were examined as indicators of psychosocial vulnerability in patients about to undergo heart surgery. DESIGN: A total of 550 study patients underwent heart surgeries, including bypass grafting and valve procedures. Psychosocial interviews were conducted about five days before surgery, and biomedical data were obtained from hospital records. MAIN OUTCOME MEASURES: Sociodemographic, personality, religious, and biomedical factors were evaluated as predictors of psychosocial vulnerability, and all five sets of variables were evaluated as contributors to hospital length of stay (LOS). RESULTS: Patients scoring higher on one or more indicator of presurgical psychosocial vulnerability were younger, more likely to be female, less likely to be married, less well educated, lower in dispositional optimism, higher in trait anger, and lower in religiousness. Older age, depression, low support, and low trait anger each showed an independent, prospective association with greater LOS, and several other predictors had prospective relationships with LOS that were statistically mediated by depression or perceived support. CONCLUSION: Evidence that multiple psychosocial factors may influence adaptation to heart surgery has implications for understanding and ameliorating presurgical distress and for improving postsurgical recovery.

Psychological factors influencing self-assessments of health: toward an understanding of the mechanisms underlying how people rate their own health.

BACKGROUND: Research in the past 20 years has shown that self-assessed health (SAH) is a consistent and reliable predictor of health outcomes. However, it is still unclear what factors are responsible for the association of SAH with mortality and other objective health indicators. PURPOSE: This study examined the impact of trait positive affect, trait negative affect, and functional limitations (FL) on SAH cross-sectionally and longitudinally. We hypothesized that changes in SAH ratings would be mainly influenced by FL, whereas affective information would have a biasing effect on SAH ratings cross-sectionally. METHODS: We analyzed longitudinal data obtained from five successive annual interviews conducted with over 800 elderly respondents (mean age = 73 years) using latent growth curve modeling. RESULTS: Results revealed that SAH judgments were related to FL and to trait affects in each of the five waves (cross-sectional data), but only changes in FL were related to changes in SAH over time. These data also showed that changes in SAH were predictive of mortality above and beyond its initial levels. CONCLUSIONS: The results suggest that the temporal trajectory of FL is a source of information that allows an individual's SAH to predict objective health measures of both morbidity and mortality.

What Do We Rate When We Rate Our Health? Decomposing Age-related Contributions to Self-rated Health.

Self-ratings of health (SRH) indicate current health-related quality of life and independently predict mortality. Studies show the SRH of older adults appears less influenced by physical health than the SRH of younger adults. But if physical health accounts less for the SRH of older adults, what factors take its place? To understand the relative contributions of social, emotional, and physical states to SRH by age, we analyzed data from the National Health Interview Survey 2006 to 2011 ( N = 153,341). In age-stratified regressions, physical health and functional limitations declined as correlates of SRH for older age strata, while social factors, such as gender and race, increased in importance. Oaxaca-Blinder decomposition showed that if younger respondents had similar health conditions, they would rate their health more poorly than current cohorts of older adults do. The declining influence of physical health on SRH in old age appears to be due in part to displacement by social factors.

Religion, a social determinant of mortality? A 10-year follow-up of the Health and Retirement Study.

The social determinants of health framework has brought a recognition of the primary importance of social forces in determining population health. Research using this framework to understand the health and mortality impact of social, economic, and political conditions, however, has rarely included religious institutions and ties. We investigate a well-measured set of social and economic determinants along with several measures of religious participation as predictors of adult mortality. Respondents (N = 18,370) aged 50 and older to the Health and Retirement Study were interviewed in 2004 and followed for all-cause mortality to 2014. Exposure variables were religious attendance, importance, and affiliation. Other social determinants of health included gender, race/ethnicity, education, household income, and net worth measured at baseline. Confounders included physical and mental health. Health behaviors and social ties were included as potential explanatory variables. Cox proportional hazards regressions were adjusted for complex sample design. After adjustment for confounders, attendance at religious services had a dose-response relationship with mortality, such that respondents who attended frequently had a 40% lower hazard of mortality (HR = 0.60, 95% CI 0.53-0.68) compared with those who never attended. Those for whom religion was "very important" had a 4% higher hazard (HR = 1.04, 95% CI 1.01-1.07); religious affiliation was not associated with risk of mortality. Higher income and net worth were associated with a reduced hazard of mortality as were female gender, Latino ethnicity, and native birth. Religious participation is multi-faceted and shows both lower and higher hazards of mortality in an adult US sample in the context of a comprehensive set of other social and economic determinants of health.

Course of depressive symptoms in patients undergoing heart surgery: confirmatory analysis of the factor pattern and latent mean structure of the Center for Epidemiologic Studies Depression Scale.

OBJECTIVE: The purpose of this study was to examine the dimensionality, stability, and course of depressive symptoms over the 12-month period beginning approximately 1 week before heart surgery. METHODS: The Center for Epidemiological Studies Depression Scale (CES-D) was administered to 570 patients before heart surgery and 1, 3.5, 6.5, and 12.5 months later. RESULTS: Confirmatory factor analysis rejected a four-factor model as a result of small variances for two interpersonal items. With their elimination, a three-factor solution (negative affect, low positive affect, somatic/vegetative symptoms) showed good psychometric properties. Except for the somatic/vegetative factor at the 1-month follow up, there was a high degree of stability in the factor pattern over a 12-month period beginning approximately 1 week before heart surgery. Latent mean structure analysis indicated that, apart from elevations in several somatic/vegetative symptoms during the month after surgery, means for all three depressive symptoms declined over time. The recovery of positive affect showed a steeper trajectory toward the end of the follow-up period by comparison with the rates of decline for depressed affect and somatic/vegetative symptoms. CONCLUSIONS: These findings support using 18 CES-D items to measure three depressive symptom dimensions in heart patients and may reflect a normative pattern of adjustment to heart surgery.

Quality of life following cardiac surgery: impact of the severity and course of depressive symptoms.

OBJECTIVES: The purpose of this study was to examine the impact of the severity and course of depressive symptoms on change in quality of life (QOL) 6 months after cardiac surgery. METHODS: Ninety patients were interviewed before heart surgery and 2 and 6 months after surgery. Depressive symptoms were assessed using the Beck Depression Inventory, and QOL was assessed using physical and psychosocial functioning indices derived from the Medical Outcomes Study instrument. Multiple regression examined the effects of the severity and course of depressive symptoms on QOL adjusting for demographic and biomedical predictors. RESULTS: Higher levels of presurgical depressive symptoms predicted poorer physical functioning after cardiac surgery. A similar effect on psychosocial functioning fell short of significance. An increase in depressive symptoms 2 months after surgery was significantly predictive of poorer physical and psychosocial functioning at 6 months. The effect of increased depressive symptoms on psychosocial functioning was significantly stronger in patients with high presurgical Beck Depression Inventory scores. CONCLUSIONS: Both preoperative depressive symptoms and postoperative increases in depressive symptoms seem associated with poorer QOL 6 months after cardiac surgery. Further examination of these associations and the mechanisms they reflect may provide a basis for guiding treatment decisions before and after coronary artery bypass graft surgery.

Why not find out whether religious beliefs predict surgical outcomes? If they do, why not find out why? Reply to Freedland (2004).

In this reply to K. E. Freedland's (see record 2004-13299-002) comments on R. J. Contrada et al. (see record 2004-13299-001), it is shown that the statistical issues he raised, and his preferred interpretation of the findings, were adequately addressed in the original article. It is argued that methodological limitations also were fully characterized and do not differ in kind from those of biomedical studies. Other issues discussed include the merits of focusing on distal versus proximal causation, plausibility of explanatory mechanisms for health effects of religious involvement, and potential practical applications that do not require manipulation of religious involvement. The article is concluded by commenting on subtle aspects of discourse that may unnecessarily polarize discussions of possible physical health effects of religious involvement.