Building Capacity to Adequately Measure the Influence of Religion and Spirituality on Health in the U.S.: Build it and They Will Come?
Moderator -
Alexandra Shields, PhD., Associate Professor of Medicine, Harvard Medical School, Director, Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Associate Member, Broad Institute of MIT and Harvard
Panelists -
Tracy Balboni, M.D., MPH, Clinical Director, Supportive and Palliative Radiation Oncology Service, Dana-Farber/Brigham and Women's Cancer Center
Associate Professor, Radiation Oncology, Harvard Medical School
Yvette C. Cozier, M.D., Assistant Professor of Epidemiology, Boston University School of Public Health, Epidemiologist, Slone Epidemiology Center, Boston University
Tyler J. VanderWeele, PhD., Professor of Epidemiology, Harvard T.H. Chan School of Public Health
New Research and a Discussion with Investigators from the National Consortium on Psychosocial Stress, Spirituality, and Health
A plethora of studies have documented associations of various measures of religiosity and spirituality (R/S) and diverse health outcomes over the years, yet the field of R/S research has been hampered by the lack of robust, adequately powered studies including nationally representative samples; the lack of prospective research designs that are able to make causal inferences; and the lack of consensus in the field regarding which R/S measures are most important to collect or how best to assess the robustness of potential R/S measures. The newly-formed National Consortium on Psychosocial Stress, Spirituality, and Health has taken on the challenge of rigorously assessing the biological resonance of more than 80 R/S items in investigations of the etiology of several high priority health conditions. These analyses will be used to prioritize R/S measures for recommendation for inclusion in U.S. prospective cohort studies in data collection going forward. Working towards a consensus on common metrics across cohorts is an essential step in building the data assets needed to ask and answer key questions regarding the role of R/S in human health. We are building on the most powerful epidemiological data assets in our nation, representing billions of dollars of investment over decades of clinical, demographic, epidemiological and environmental data collected by cohorts tracking diverse subpopulations and diverse clinical phenotypes.
This panel presents new work from this research team. Papers will be presented by lead investigators of the Consortium, who will then lead a discussion of this new initiative.
• How Important are Religion and Spirituality to understanding Human Health? Perspectives of Leading U.S. Cohort Principal Investigators.
The current lack of consistent, high quality religious and spirituality (R/S) measures available within U.S. prospective cohort studies has prevented the consideration of R/S as influences in the highest quality epidemiological studies conducted to investigate factors associated with risk and/or protection against high priority diseases. We conducted a national interview study of Principal Investigators of leading national prospective studies to address PIs’ perspectives regarding the importance of religiosity and spirituality in understanding the etiology of human disease; their assessment of the quality of extant R/S research; their decisions to include or not include R/S measures in their cohorts’ data collection efforts to date; and the kinds of evidence they would need to see before investing substantial effort in expanding their R/S data collection in the future. A list of key informant Principal Investigators of leading national prospective studies was identified using the NIH RePORT database and PubMed, and compiled via NIH Consortia websites. Cohorts were prioritized to include diverse racial/ethnic populations, and national cohorts were prioritized over regional cohorts. PIs were recruited sequentially until 20 PIs agreed to be interviewed. PIs were consented and participated in a one-hour interview, conducted by Dr. Shields and/or Balboni. An interview guide was developed and used to ensure consistent coverage of major themes. Interviews were digitally recorded, transcribed, and analyzed using standard qualitative methods.
• Religious and Spiritual Predictors of All-Cause Mortality in the Black Women’s Health Study
Previous longitudinal studies have consistently shown an association between religious service attendance and lower all-cause mortality, but the literature on associations between other measures of religion and spirituality (R/S) and mortality is limited. We followed 36,613 respondents from the Black Women’s Health Study from 2005 through 2013 to assess the associations between R/S and all-cause mortality using proportional hazard models. Attending services several times a week was associated with substantially lower mortality (MRR=0.64; 95% CI: 0.51,0.80) relative to never attending services. Prayer several times per day was not associated with mortality after control for demographic and health covariates, but trended towards higher mortality when control was made for other R/S variables (MRR=1.28; 95% CI: 0.99,1.67 for >2 times/day relative to ≤once a week; p-trend<0.01). Religious coping and self-identification as a very religious/spiritual person were associated with lower mortality when adjustment was made only for age, but the association was attenuated when control was made for demographic and health covariates. The results indicate that service attendance was the strongest R/S predictor of mortality in this cohort.
• Religious and Spiritual Coping and Risk of Incident Hypertension in the Black Women’s Health Study
Stress has been associated with increased risk of hypertension. Few studies have assessed the effect of religion or spirituality (R/S) on hypertension risk, with conflicting results. We prospectively assessed the relationship between R/S and incident hypertension within the Black Women’s Health Study (BWHS), a cohort study initiated in 1995 that follows participants through biennial questionnaires. During 8 years of follow-up (2005-2013), 4,235 incident cases of hypertension were identified. High involvement of R/S in coping with stressful situations was associated with reduced risk of hypertension (IRR: 0.85; 95% CI: 0.73, 1.00) compared with no involvement of R/S in coping. This association was strongest among women reporting greater levels of perceived stress (IRR: 0.70; 95% CI: 0.54, 0.91; P interaction=0.01). Service attendance, frequency of prayer, and self-identification as a religious/spiritual person were not consistently associated with incidence of hypertension. R/S coping was associated with a decreased risk of hypertension after controlling for known risk factors, especially among those reporting higher levels of stress.
• Spirituality—A Missing Link Between Low Pharmacotherapy Use Among Black Smokers and Lung Cancer Disparities?
Use of approved smoking cessation medications continue to be underutilized, particularly among Blacks, although reasons for low pharmacotherapy use are poorly understood. We conducted a survey of 2,400 self-identified white and Black Americans from 2008-2014 and conducted 12 focus groups and 12 one-on-one interviews to assess lay beliefs about what most influences smokers’ ability to quit, how spirituality may play a role, and how these beliefs differ among smokers versus nonsmokers. 50% of Blacks, regardless of smoking status, expressed that “God’s help” was the greatest influence on smokers’ ability to quit, controlling for a wide range of covariates (OR: 4.71; 95% CI: 2.50-8.89). In focus groups and interviews, Black religious smokers who never used pharmacotherapy described using medication in a quit attempt as in conflict with their faith. Spirituality is an undervalued factor in understanding the dynamics of pharmacotherapy use among Blacks and other smokers. Understanding low pharmacotherpay use is essential to address, particularly given that the clinical benefit of emerging pharmacogenomics treatment strategies depends entirely on smokers’ willingness to use medication in a quit attempt.
Alexandra Shields, PhD., Associate Professor of Medicine, Harvard Medical School, Director, Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Associate Member, Broad Institute of MIT and Harvard
Panelists -
Tracy Balboni, M.D., MPH, Clinical Director, Supportive and Palliative Radiation Oncology Service, Dana-Farber/Brigham and Women's Cancer Center
Associate Professor, Radiation Oncology, Harvard Medical School
Yvette C. Cozier, M.D., Assistant Professor of Epidemiology, Boston University School of Public Health, Epidemiologist, Slone Epidemiology Center, Boston University
Tyler J. VanderWeele, PhD., Professor of Epidemiology, Harvard T.H. Chan School of Public Health
New Research and a Discussion with Investigators from the National Consortium on Psychosocial Stress, Spirituality, and Health
A plethora of studies have documented associations of various measures of religiosity and spirituality (R/S) and diverse health outcomes over the years, yet the field of R/S research has been hampered by the lack of robust, adequately powered studies including nationally representative samples; the lack of prospective research designs that are able to make causal inferences; and the lack of consensus in the field regarding which R/S measures are most important to collect or how best to assess the robustness of potential R/S measures. The newly-formed National Consortium on Psychosocial Stress, Spirituality, and Health has taken on the challenge of rigorously assessing the biological resonance of more than 80 R/S items in investigations of the etiology of several high priority health conditions. These analyses will be used to prioritize R/S measures for recommendation for inclusion in U.S. prospective cohort studies in data collection going forward. Working towards a consensus on common metrics across cohorts is an essential step in building the data assets needed to ask and answer key questions regarding the role of R/S in human health. We are building on the most powerful epidemiological data assets in our nation, representing billions of dollars of investment over decades of clinical, demographic, epidemiological and environmental data collected by cohorts tracking diverse subpopulations and diverse clinical phenotypes.
This panel presents new work from this research team. Papers will be presented by lead investigators of the Consortium, who will then lead a discussion of this new initiative.
• How Important are Religion and Spirituality to understanding Human Health? Perspectives of Leading U.S. Cohort Principal Investigators.
The current lack of consistent, high quality religious and spirituality (R/S) measures available within U.S. prospective cohort studies has prevented the consideration of R/S as influences in the highest quality epidemiological studies conducted to investigate factors associated with risk and/or protection against high priority diseases. We conducted a national interview study of Principal Investigators of leading national prospective studies to address PIs’ perspectives regarding the importance of religiosity and spirituality in understanding the etiology of human disease; their assessment of the quality of extant R/S research; their decisions to include or not include R/S measures in their cohorts’ data collection efforts to date; and the kinds of evidence they would need to see before investing substantial effort in expanding their R/S data collection in the future. A list of key informant Principal Investigators of leading national prospective studies was identified using the NIH RePORT database and PubMed, and compiled via NIH Consortia websites. Cohorts were prioritized to include diverse racial/ethnic populations, and national cohorts were prioritized over regional cohorts. PIs were recruited sequentially until 20 PIs agreed to be interviewed. PIs were consented and participated in a one-hour interview, conducted by Dr. Shields and/or Balboni. An interview guide was developed and used to ensure consistent coverage of major themes. Interviews were digitally recorded, transcribed, and analyzed using standard qualitative methods.
• Religious and Spiritual Predictors of All-Cause Mortality in the Black Women’s Health Study
Previous longitudinal studies have consistently shown an association between religious service attendance and lower all-cause mortality, but the literature on associations between other measures of religion and spirituality (R/S) and mortality is limited. We followed 36,613 respondents from the Black Women’s Health Study from 2005 through 2013 to assess the associations between R/S and all-cause mortality using proportional hazard models. Attending services several times a week was associated with substantially lower mortality (MRR=0.64; 95% CI: 0.51,0.80) relative to never attending services. Prayer several times per day was not associated with mortality after control for demographic and health covariates, but trended towards higher mortality when control was made for other R/S variables (MRR=1.28; 95% CI: 0.99,1.67 for >2 times/day relative to ≤once a week; p-trend<0.01). Religious coping and self-identification as a very religious/spiritual person were associated with lower mortality when adjustment was made only for age, but the association was attenuated when control was made for demographic and health covariates. The results indicate that service attendance was the strongest R/S predictor of mortality in this cohort.
• Religious and Spiritual Coping and Risk of Incident Hypertension in the Black Women’s Health Study
Stress has been associated with increased risk of hypertension. Few studies have assessed the effect of religion or spirituality (R/S) on hypertension risk, with conflicting results. We prospectively assessed the relationship between R/S and incident hypertension within the Black Women’s Health Study (BWHS), a cohort study initiated in 1995 that follows participants through biennial questionnaires. During 8 years of follow-up (2005-2013), 4,235 incident cases of hypertension were identified. High involvement of R/S in coping with stressful situations was associated with reduced risk of hypertension (IRR: 0.85; 95% CI: 0.73, 1.00) compared with no involvement of R/S in coping. This association was strongest among women reporting greater levels of perceived stress (IRR: 0.70; 95% CI: 0.54, 0.91; P interaction=0.01). Service attendance, frequency of prayer, and self-identification as a religious/spiritual person were not consistently associated with incidence of hypertension. R/S coping was associated with a decreased risk of hypertension after controlling for known risk factors, especially among those reporting higher levels of stress.
• Spirituality—A Missing Link Between Low Pharmacotherapy Use Among Black Smokers and Lung Cancer Disparities?
Use of approved smoking cessation medications continue to be underutilized, particularly among Blacks, although reasons for low pharmacotherapy use are poorly understood. We conducted a survey of 2,400 self-identified white and Black Americans from 2008-2014 and conducted 12 focus groups and 12 one-on-one interviews to assess lay beliefs about what most influences smokers’ ability to quit, how spirituality may play a role, and how these beliefs differ among smokers versus nonsmokers. 50% of Blacks, regardless of smoking status, expressed that “God’s help” was the greatest influence on smokers’ ability to quit, controlling for a wide range of covariates (OR: 4.71; 95% CI: 2.50-8.89). In focus groups and interviews, Black religious smokers who never used pharmacotherapy described using medication in a quit attempt as in conflict with their faith. Spirituality is an undervalued factor in understanding the dynamics of pharmacotherapy use among Blacks and other smokers. Understanding low pharmacotherpay use is essential to address, particularly given that the clinical benefit of emerging pharmacogenomics treatment strategies depends entirely on smokers’ willingness to use medication in a quit attempt.