The Influence of Religious Attendance on Smoking Among Black Men

A Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FAITH-CORE): Protocol for a Community Participatory Development Study

BACKGROUND

Tobacco smoking remains the leading cause of preventable morbidity and mortality in the United States, with significant rural-urban disparities. Adults who live in rural areas of the United States have among the highest tobacco smoking rates in the nation and experience a higher prevalence of smoking-related deaths and deaths due to chronic diseases for which smoking is a causal risk factor. Barriers to accessing tobacco use cessation treatments are a major contributing factor to these disparities. Adults living in rural areas experience difficulty accessing tobacco cessation services due to geographical challenges, lack of insurance coverage, and lack of health care providers who treat tobacco use disorders. The use of digital technology could be a practical answer to these barriers.

OBJECTIVE

This report describes a protocol for a study whose main objectives are to develop and beta test an innovative intervention that uses a private, moderated Facebook group platform to deliver peer support and faith-based cessation messaging to enhance the reach and uptake of existing evidence-based smoking cessation treatment (EBCT) resources (eg, state quitline coaching programs) for rural adults who smoke.

METHODS

We will use the Integrated Theory of Health Behavior Change, surface or deep structure frameworks to guide intervention development, and the community-based participatory research (CBPR) approach to identify and engage with community stakeholders. The initial content library of moderator postings (videos and text or image postings) will be developed using existing EBCT material from the Centers for Disease Control and Prevention Tips from Former Smokers Campaign. The content library will feature topics related to quitting smoking, such as coping with cravings and withdrawal and using EBCTs with faith-based message integration (eg, Bible quotes). A community advisory board and a community engagement studio will provide feedback to refine the content library. We will also conduct a beta test of the intervention with 15 rural adults who smoke to assess the recruitment feasibility and preliminary intervention uptake such as engagement, ease of use, usefulness, and satisfaction to further refine the intervention based on participant feedback.

RESULTS

The result of this study will create an intervention prototype that will be used for a future randomized controlled trial.

CONCLUSIONS

Our CBPR project will create a prototype of a Facebook-delivered faith-based messaging and peer support intervention that may assist rural adults who smoke to use EBCT. This study is crucial in establishing a self-sufficient smoking cessation program for the rural community. The project is unique in using a moderated social media platform providing peer support and culturally relevant faith-based content to encourage adult people who smoke to seek treatment and quit smoking.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/52398.

Religious service attendance and mortality among older Black men

Religious institutions have been responsive to the needs of Black men and other marginalized populations. Religious service attendance is a common practice that has been associated with stress management and extended longevity. The objective of this study was to examine the relationship between religious service attendance and all-cause mortality among Black men 50 years of age and older. Data for this study were from NHANES III (1988–1994). The analytic sample (n = 839) was restricted to participants at least 50 years of age at the time of interview who self-identified as Black and male. Mortality was the primary outcome for this study and the NHANES III Linked Mortality File was used to estimate race-specific, non-injury-related death rates using a probabilistic matching algorithm, linked to the National Death Index through December 31, 2015, providing up to 27 years follow-up. The primary independent variable was religious service attendance, a categorical variable indicating that participants attended religious services at least weekly, three or fewer times per month, or not at all. The mean age of participants was 63.6±0.3 years and 36.4% of sample members reported that they attended religious services one or more times per week, exceeding those attending three or fewer times per month (31.7%), or not at all (31.9%). Cox proportional hazard logistic regression models were estimated to determine the association between religious service attendance and mortality. Participants with the most frequent religious service attendance had a 47% reduction of all-cause mortality risk compared their peer who did not attend religious services at all (HR 0.53, CI 0.35–0.79) in the fully adjusted model including socioeconomic status, non-cardiovascular medical conditions, health behaviors, social support and allostatic load. Our findings underscore the potential salience of religiosity and spirituality for health in Black men, an understudied group where elevated risk factors are often present.

When Resilience Becomes Risk: A Latent Class Analysis of Psychosocial Resources and Allostatic Load Among African American Men

There is a well-established link between psychosocial risks and psychological health among African American (AA) men. Yet, the psychosocial sources and physical health consequences of resilience (i.e., the ability to maintain good health despite adversity) remain underexplored. Using data from 283 AA men in the Nashville Stress and Health Study, the present study investigated the links between psychosocial resilience and allostatic load (AL), a biological indicator of physiological dysregulation. Latent class analysis (LCA) identified distinct resilience profiles comprising eight psychosocial resources across four categories: coping strategies, sense of control, racial identity, and social support. Analysis of variance (ANOVA) tests determined significant class differences in men’s AL scores. LCA results confirm a four-class model was the best fit: Class 1 (high resources, 32%), Class 2 (high coping but low control, 13%), Class 3 (low resources but high racial identity, 20%), and Class 4 (low resources but high mastery, 34%). Results reveal lower AL (better health) among Classes 1 (m = 0.35) and 4 (m = 0.31) and higher AL (worse health) among Classes 2 (m = 0.44) and 3 (m = 0.44). Findings indicate that the “quality” rather than the “quantity” of psychosocial resources matters for physical health among AA men, as positive health outcomes were observed among both low- and high-resource classes. Results suggest different resource combinations produce distinct patterns of resilience among AA men and underscore the need to further elucidate complex resilience processes among this population.

A Comparative Analysis of Smoking Rates by Sex and Socioeconomic Status Among Ultra-Orthodox City Residents and Non-Ultra-Orthodox City Residents in Israel

The aim of this cross-sectional study is to examine the differences in smoking rates between ultra-Orthodox Jews and non-ultra-Orthodox Jews and to understand the role of sex and socioeconomic status (SES) in predicting smoking among the two populations. The study population included all Maccabi Healthcare Services members aged 50 or older (N = 30,170) who lived in two cities in the center of Israel: Bnei Brak-a city with a high concentration of ultra-Orthodox, and Ramat Gan-a non-ultra-Orthodox city. After adjusting for age, sex, and SES, the prevalence of smoking in the ultra-Orthodox city was significantly lower than that in the non-ultra-Orthodox city. A significant interaction was found between sex and degree of religiosity in predicting smoking. The smoking differences between men and women in the ultra-Orthodox city were high compared with those in the non-ultra-Orthodox city. Similarly, a significant interaction was found between SES and degree of religiosity in predicting smoking. These results in the effects of sex and SES in predicting smoking between ultra-Orthodox Jews and non-ultra-Orthodox Jews require further research to better understand these differences and plan intervention programs tailored to different populations accordingly.

Religious service attendance typologies and African American substance use: a longitudinal study of the protective effects among young adult men and women

PURPOSE

This study sought to identify variation by gender in the associations between religious service attendance from adolescence to young adulthood and seven measures of lifetime and short-term substance use.

METHODS

To conduct this nationally representative study, data from the Add Health Surveys was abstracted from Waves I and IV (N = 3,223) to construct four types of service attendance (non-attenders, attenders only as adolescents, attenders only in young adulthood, and consistent attenders). A series of logistic regressions were conducted to identify the independent effects of each pattern of service attendance on each substance among all black young adults, as well as male and female sub-samples.

RESULTS

Analysis revealed consistent attenders were generally less likely to use substances, with the effects being strongest among females. Among young adult only attenders, males recorded lower odds across all three short-term measures whereas females reported lower odds only for monthly cigarette use.

CONCLUSION

The protective effects of religious service attendance are more robust for African Americans who consistently attend in adolescence and young adulthood, especially among females.

Trauma exposure, PTSD symptoms, and tobacco use: Does church attendance buffer negative effects?

Traumatic stress and posttraumatic stress disorder (PTSD) are overrepresented in urban African American communities, and associated with health risk behaviors such as tobacco use. Support and resources provided by churches may reduce trauma-related health risks. In the current study, we assessed weekly church attendance as a moderator of relations between (a) traumatic event exposure and probable PTSD, and (b) probable PTSD and tobacco use. Data were drawn from a health surveillance study conducted in seven churches located in Chicago's West Side. Participants (N = 1015) were adults from churches as well as the surrounding community. Trauma exposure was reported by 62% of participants, with 25% of those who experienced trauma reporting probable PTSD. Overall, more than one-third of participants (37.2%) reported current tobacco use. As compared with non-weekly church attendance, weekly church attendance was associated with a lower likelihood of PTSD (odds ratio [OR] = 0.41; 95% confidence interval [CI] = 0.26-0.62; p < .0001) and lower tobacco use overall (OR = 0.22; 95% CI = 0.16-0.30; p < .0001), but did not moderate the effect of trauma exposure on risk of PTSD, or the effect of PTSD on tobacco use. Findings support church attendance as a potential buffer of trauma-related stress.

Smoking and Religion: Untangling Associations Using English Survey Data

While factors affecting smoking are well documented, the role of religion has received little attention. This national study aims to assess the extent to which religious affiliation is associated with current-smoking and ever-smoking, controlling for age, sex, ethnicity and socio-economic status. Variations between adult and youth populations are examined using secondary analysis of individual-level data from 5 years of the Health Survey for England for adult (aged >20, n = 39,837) and youth (aged 16-20, n = 2355) samples. Crude prevalence statistics are contrasted with binary logistic models for current-smoking and ever-smoking in the adult and youth samples. Analyses suggest that Muslims smoke substantially less than Christians. Highest levels of smoking characterise people not professing any religion. Associations between smoking and the Muslim religion attenuate to statistical insignificance in the face of ethnic and socio-economic factors. An association between smoking and the absence of a religious affiliation is sustained. An understanding of the association between smoking and religion is essential to the development of tobacco control programmes.

The Effectiveness of Cigarette Pack Health Warning Labels with Religious Messages in an Urban Setting in Indonesia: A Cross-Sectional Study

This study sought to assess the effectiveness of religious cigarette health warning labels (HWLs) in Indonesia, a country with a high public health burden from tobacco use. The study tested different religious and nonreligious messages related to suicide, secondhand smoke (SHS) and gangrene. Participants were smokers and non-smokers from Surabaya, Indonesia (n = 817). Participants rated each HWL for its effectiveness on a scale of 1 to 10 (1 = “not at all”, 10 = “extremely”) with respect to 10 items. Nonreligious HWLs were marginally superior for SHS and suicide while religious HWLs were marginally superior for gangrene. Given the close rating scores between religious and nonreligious HWLs, they were functionally equal in effectiveness. With proper assessment of potential unintended consequences, the implementation of religious HWLs could be considered for a proportion of HWLs.

"Thou Shalt not Smoke": Religion and smoking in a natural experiment of history

We provide a new identification strategy to analyse the implications of religious affiliation on unhealthful behaviour by focusing on the link between religiousness and smoking. Our quasi-experimental research design exploits the exogenous dramatic fall in religious affiliation that took place in East Germany after the post-war separation. Our conditional difference-in-differences estimates on data from the German Socio-Economic Panel (SOEP) for the period 1998-2006 indicate that individuals who are not affiliated to any religious denomination are consistently 13-19 percentage points more likely to smoke than are religious individuals. We interpret our results on the basis of a restraining effect of religious ethics on unhealthy behaviour, confirming the view that religion is a far-reaching vehicle for the enforcement of social norms.

Does religious involvement affect mortality in low-income Americans? A prospective cohort study

OBJECTIVE

This study aimed to evaluate the impacts of various forms of religious involvement, beyond individual socioeconomic status, lifestyle factors, emotional well-being and social support, on all-cause and cause-specific mortality in socioeconomic disadvantaged neighbourhoods.

DESIGN

This is a prospective cohort study conducted from 2002 through 2015.

SETTINGS

This study included underserved populations in the Southeastern USA.

PARTICIPANTS

A total of nearly 85 000 participants, primarily low-income American adults, were enrolled. Eligible participants were aged 40-79 years at enrolment, spoke English and were not under treatment for cancer within the prior year.

RESULTS

We found that those who attended religious service attendance >1/week had 8% reduction in all-cause death and 15% reduction in cancer death relative to those who never attended. This association was substantially attenuated by depression score, social support, and socioeconomic and lifestyle covariates, and further attenuated by other forms of religious involvement. This association with all-cause mortality was found being stronger among those with higher socioeconomic status or healthier lifestyle behaviours.

CONCLUSION

Our results indicate that the association between religious services attendance >1/week and lower mortality was moderate but robust, and could be attenuated and modified by socioeconomic or lifestyle factors in this large prospective cohort study of underserved populations in the Southeastern USA.

Religious Affiliation, Informal Participation, and Network Support Associated With Substance Use: Differences Across Age Groups

Background. Associations between religious involvement and substance use are well established. However, limited research examines the effects of religious affiliation, informal participation, and network support on substance use among two distinct age cohorts. Objectives. This study aims to examine whether religious affiliation, informal participation, and network support are associated with alcohol, tobacco, and marijuana use among young and late middle-age adults. Method. The UC Berkeley Social Networks Study (Wave 1, 2015) offers novel cohort data on young (21-30 years old, n = 483) and late middle-age (50-70 years old, n = 673) adults. Poisson regression models were used to predict alcohol use, while logistic regression models were used to predict odds of smoking and marijuana use. Results. Among young adults, membership in a religious organization was associated with less alcohol, tobacco, and marijuana use. Conversely, participating in informal organizations was associated with more alcohol and marijuana use. Desiring more people to talk to and get together with were associated with more smoking and drinking, respectively. However, wishing more people to ask for help was associated with less substance use altogether. In a similar pattern, among older adults, religious involvement was associated with less alcohol and marijuana use. Desiring more people to ask for help was also related to less marijuana use. Conclusion. Younger adult participation in informal groups serves to encourage social substance use. In contrast, older people are more involved in religious groups, which support social behaviors that do not include substance use.