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Religion and Subjective Health Among Black and White Elders
Musick, Marc A., 1996. Journal of Health and Social Behavior,
37(3):221–237. †
Recent research has shown that subjective health has a substantial impact on life
satisfaction and is a significant predictor of mortality among the healthy elderly. It is less clear what
role social and demographic factors have in shaping perceptions of health. This study focuses on the effect
of religion on self–reported health in a sample of Black and White elderly adults.
Previous studies have documented the beneficial effects of religion on well–being.
The author reviews and critiques the current literature linking religion and subjective health. In an attempt
to better specify the effects of religion than in earlier studies, the author uses a data set that is rich
in measures of health and social resources collected over two waves.
The study uses data from the Duke Established Populations for Epidemiologic Studies of
the Elderly. The data were collected from five contiguous counties in north central North Carolina. Although
four of the counties were rural, approximately half the participants were from the urban county. Blacks were
oversampled, such that 55% of the population were black. Data were collected in four waves in each year from
1986 to 1989. Data from the first and fourth waves are used in this study as identical methods of data
collection were used.
The study aimed to determine the impact that Personal Religious Devotion, Public
Religious Activity, Health Behaviors, Conservative Religious Worldviews and Racial Differences could have on
subjective health. The racial difference is considered important, as there are racial variations in religious
activity and physical health. The potential effects of each of these factors and the likely causes of these
effects are discussed in detail in the paper.
It is hypothesized that higher levels of private religious activity would predict high
levels of subjective health and that although impaired health would reduce subjective health, it would
increase religious devotion. In a similar manner, higher levels of church attendance were expected to predict
greater perceived health with social interaction being linked to higher subjective health and mediating the
effects of religious health but again, physical health would moderate the relationship between religious
activity and subjective health. The author suggested that the absence of the unhealthy behaviors of smoking
and alcohol consumption would be linked to religious observance and lead to higher perceived health, thus
mediating the effects of health and religion. It was suggested that conservative religious worldviews, held
by certain Protestant denominations, would reduce perceived health. Finally, it was hypothesized that the
effects of religious activity on subjective health would be greater for Blacks than for Whites.
Subjective health was measured as excellent, good, fair or poor and chronic health
conditions were measured according to ratings for five conditions: heart problems, hypertension, diabetes,
stroke and cancer. Functional impairment was measured according to whether the respondent could do heavy
work, walk up a flight of stairs and walk half a mile. Higher values indicated greater impairment. Cigarette
smoking was measured as currently smokes or does not currently smokes and alcohol consumption was measured as
those who consumed alcohol and those who did not. Social interaction was measured according to the number of
their children, relatives or friends which respondents saw during one month and how often they talked on
the phone. Respondents were also asked to rate how satisfied they were with the amount of time they see
friends and relatives. Church attendance was measured in six frequency categories ranging from never to
more than once a week. Religious devotion was measured according to the frequency of private religious
activities and used five classes, from rarely/never to daily or more often. Respondents were also classed
as conservative Protestant or otherwise. The study also controlled for the demographic variables of sex,
marital status, education, age and urban residence.
In the study, Blacks reported worse subjective health and functional impairment than
Whites, but did not differ in chronic conditions. Whites reported more social interaction than Blacks, but
Blacks showed higher satisfaction with interaction. Blacks attended church more, but reported the same level
of devotional activities. As expected, those with more chronic conditions or greater functional impairment
reported worse subjective health.
Church attendance was the only religion indicator that was found to be a significant
predictor of subjective health. It had a positive effect for Blacks and Whites. However, when functional
impairment or chronic conditions were considered, church attendance became insignificant while private
religious devotion increased to significance. This indicated that those with the highest levels of functional
impairment engaged in more private religious activity than those who were less impaired. It was also shown
that private religious activities have a positive effect subjective health for Blacks and Whites
highlighting that those who engage in prayer and Bible study perceive their health in more positive terms.
However the effect for Whites was only marginally significant. The positive effects of religious devotion
were found to be somewhat offset by the negative effect of functional impairment. Therefore, there is the
implication that failure to control for health status would conceal the effects of these activities.
As the effects of religious devotion were moderated by functional impairments, religion
had the greatest effect for those who faced difficulties. Blacks did not benefit from this to the same extent
as Whites. However, for Whites, church attendance had little effect on subjective health for those with low
levels of functional impairment. The author tentatively attributes these differences to Blacks having lived
a life of greater adversity in terms of both health and socioeconomic status and therefore being better
prepared to face limitations in later life, whereas Whites will rely on religion in times of difficulty.
It was expected that the effects of church attendance on subjective health would be
partially mediated by social interaction. However, the social interaction and satisfaction from social
interaction variables did not mediate this relationship for either race. In addition, although religiousness
was found to be associated with lower levels of unhealthy behaviors, these behaviors did not mediate the
relationship between religion and self–rated health for either race. It was also found that the
conservative religious worldviews hypothesis was not supported for Blacks or Whites.
In comparing differences between Blacks and Whites, in the final regression model, none
of the effects for religion, health, health behavior or social interaction variables were different.
In conclusion, the study found that religious activity has modest main and interactive
effects on subjective health but that there was little difference between the races in terms of religion and
subjective health. These results are consistent with previous research.
The author considers the lack of racial differences surprising, but highlights that
actual health status is shown to be an important component and therefore future examination of the link
between religion and subjective health should incorporate measures of functional health. The effects of
religion on subjective health were greatest for those suffering from physical health problems, emphasizes the
comfort role of religion suggested by other researchers. The author states that the lack of strong findings
in this study question the existence of a relationship between religion and subjective health, but suggests
this is due to the high level of religiosity in the sample. It is considered that a more heterogeneous
sample would find stronger results.
The study does not establish a causal pathway between religion and subjective health. The
author concludes that there is a complex relationship between religion, physical health, social interaction
and subjective aspects of health and suggests that future research should consider the mechanisms that
underlie this relationship.
† This study is based on data from the United States.