29 Apr-5 May

Q: Why during the past decade has there been a development of scientific study of the influence of religion on health?

ABSTRACT

An obvious by-product of the ever-increasing range of life expectancy is the myriad of problems that range from chemical and medical debilitation to emotional and mental problems, such as depression, loneliness, anxiety, and fear among the elderly. The lack of purpose and meaning and a feeling of uselessness is a major problem of this demographic segment.

While rigorous scientific research has clearly identified salutary effects of religion on health, and well-thought-out hypotheses describe the mechanisms believed to impart these effects, a tremendous chasm remains-the gap between empirical findings and post hoc explanations.

Using an experimental design, we are proposing research based on informal programs and studies initiated by the Lubavitcher Rebbe, under the aegis "School for the Elderly," that successfully overcome much of the aforementioned dysfunction. Through reacclimation to languages and lifestyles of their youth, the inner spirituality of elderly Jews surfaces.

A decade ago reviews of historical investigations provided the impetus for the serious scientific study of religion. Reviews by Bergin (1983), Witter, Stock, Okun, and Haring (1985), Levin and Schiller (1987), and Schiller and Levin (1988) concluded salutary effects of religion on physical health, mental health, and health care utilization. While the investigations reviewed had not set out to explore religion and health particularly, serendipitously, religion simply stood out among other psychosocial indicators in relationship to various health measures.

These early investigations operationalized 'religion' crudely. Nonetheless, in the overwhelming majority of studies utilizing these measures, 'religion' was found to influence health, including "…cardiovascular disease, hypertension and stroke, uterine and other cancers, colitis and enteritis, mental health, general mortality…mental health, general well-being…health care utilization,…and overall health status" (Schiller and Levin, 1985; p. 1369). The illumination of the scope of and beneficial relationship between religion and health in hundreds of historical investigations advanced the study of religion and health from marginal science to mainstream, scholarly, and important work.

A brief review of the early empirical findings clearly illustrates both the initial simplicity of the conceptualization of religion, and the scope of documented effects. Religious affiliation (usually operationalized as Protestant versus Catholic versus Jewish) was the most widely used indicator. In a small number of research designs participation frequency was collected. Measurement of aspects of religion other than group affiliation or participation frequency did not occur. Yet, even with this crude operationalization of religion, differences emerged.

Denominational differences in utilization were found, including: frequency of medical, dental, psychiatric, and, preventive care visits (Strole and Langner, 1962; Yeracaris, 1962; Segal, 1965; Wan and Yates, 1965; Scheff, 1966; Tessler and Mechanic, 1978); likelihood of childhood immunizations (Johnson, Jenkins, and Northcutt, 1962; Schonfield, Schmidt, and Sternfeld, 1963); willingness to travel for treatment (Cauffman, Peterson and Emrick, 1967); and likelihood of prenatal and postpartum visits (Collver, Ten Have, and Speare, 1967; Notzon, 1973). Denominational differences in morbidity and mortality were documented in the hundreds of studies cited by Levin and Schiller (1987), Schiller and Levin (1988), and Jarvis and Northcutt (1987), including cardiovascular disease, hypertension and stroke, uterine and other cancers, colitis and enteritis, mental health, general mortality, and overall health status. Participation frequency (observational and/or social) was also found to be related to health.

However, the simplistic operationalizations of religion in these early studies constituted methodological oversimplification. The nominal categories of religious affiliation (Protestant, Catholic, Jewish) included, without distinction, the most orthodox and the most liberal. Frequency of participation often included attendance at both devotional services and social functions. A more important shortcoming of these early studies was a lack of any theoretically coherent rationale for the inclusion of the religion indicators in the studies at all. The early researchers did not first consider whether there should there be any relationship between religion and health. They did not propose and then set out to develop and test theoretical models.

The theoretical void pervading the earlier works has now been replaced by psychosocial theory and epistemological paradigms. Investigations of the relationship between religion and health appear in the most prestigious peer-reviewed journals. Longitudinal designs, exhaustive controls, and state-of-the-art statistical methodologies have replaced the simple cross-sectional designs and descriptive analysis utilized in earlier studies.

During the past decade, rigorous research has documented many aspects of the relationship between religion and health, including morbidity, mortality, subjective health, and psychological constructs of well-being. Koenig, Moberg, and Kvale (1988), using an eighty-eight item questionnaire to assess the religious activities and attitudes of older adults, found that religion is a powerful force in the lives of older persons, and is integrally related to both mental and physical health. Idler and Kasl (1992) report that community-dwelling older adults may actually postpone the timing of their death until the conclusion of major religious holidays. Oxman, Freeman and Manheimer (1995) have reported that lack of religious strength and comfort are risk factors following cardiac surgery, finding both post-procedure complication and six-month mortality rates significantly lower for the more religious patients. Kark, Shemi, Friedlander, Martin, Manor, and Blondheim (1995), reporting on a sixteen-year historical prospective study of mortality in eleven matched religious and secular Israeli kibbutsim (collective settlements), documented statistically lower mortality rates in the religious kibbutsim. The magnitude of the difference in mortality rates they documented is exemplified by nullification of the usual female mortality advantage (remarkably, in these matched kibbutsim, secular women did not live longer than religious men). Likewise, Strawbridge, Cohen, Shema, and Kaplan (1997), found a decreased risk of mortality for those attending religious services, theoretically linking this finding to social ties and health behaviors. Similarly, Hummer, Rogers, Nam, and Ellison (1999), found strong effects of religious attendance on mortality. Morbidity studies have documented the salutary effect of religiosity on coronary heart disease (Kark and Kaufmann, 1985), plasm lipids, and lipoproteins (Friedlander, Kark, and Stein, 1987), blood pressure (Hixson, Gruchow, and Morgan; 1998), and, immune status in symptomatic HIV infected gay men (Woods, Antoni, Ironson, and Kling, 1999).

A number of researchers have documented relationships between religion and psychological well-being. Religious involvement has been shown to be positively associated with happiness (Poloma and Pendelton, 1990); coping (Pargament, Ensing, Falgout, Olsen, Riley, Hairsma, and Warren, 1990); self-esteem and mastery (Krause and Tran, 1989); and life satisfaction (Anson, Antovsky, and Sagy, 1990). Religiosity has been shown to provide protective effects against psychological illnesses, such as depression (Strawbridge, Shema, Cohen, Roberts, and Kaplan, 1998) and chronic anxiety (Koenig, Moberg, and Kvale, 1998), and to exert beneficial effects on subjective health and functionality (Levin and Markides, 1986; Idler and Kasl, 1992, 1997).

BIO
Pamela Elfenbein completed an MSW at Barry College in Miami and a PhD in medical sociology at the University of Miami in Coral Gables. Since 1978 she has been involved in social work for the elderly in the Miami area. In 1999 she was appointed director of education and training for the Southeast Florida Center on Aging of Florida International University. Dr. Elfenbein is applying her professional experience and knowledge to initiate a pioneering Torah study and prayer program for the elderly in conjunction with The Shul of Bal Harbour in Miami, where she and her family are active congregants.

Elfenbp@fiu.edu

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