VanderWeele et al. Respond to "Church Attendance and Mortality"

Perceptions of Accountability to God and Psychological Well-Being Among US Adults

This study examines whether accountability to God is positively associated with four measures of psychological well-being-happiness, mattering to others, dignity, and meaning-among US adults. It also tests the possibility that prayer moderates these associations. Data from the 2017 Values and Beliefs of the American Public Survey (n = 1251) were analyzed using multivariate regression. Findings provided support for an association between accountability to God and mattering to others, dignity, and meaning in fully controlled models, and for happiness when religious controls were excluded. They also showed that these relationships were stronger among those who prayed frequently compared with those who did not. Overall, these findings shed light on a new concept-accountability to God-including its association with psychological well-being.

Antecedents of Purpose in Life: Evidence from A Lagged Exposure-Wide Analysis

Potential antecedents to having a sense of purpose in life remain understudied. As researchers begin contemplating purpose as a promising target of public health intervention, it is critical to identify its antecedents. Using prospective data from the Nurses' Health Study II (2009-2016; N ranged from 3,905 to 4,189), this study evaluated a wide range of potential antecedents of purpose, including: psychosocial well-being, psychological distress, employment characteristics, lifestyle, and physical health factors. In separate regression models we regressed purpose in life on each candidate antecedent. In each model, we adjusted for the prior value of purpose, prior values of all exposure variables, and various other covariates simultaneously. Bonferroni correction was used to correct for multiple testing. The results suggested that positive affect and the number of close relatives were each associated with higher purpose (e.g., β=0.14, 95% CI: 0.11, 0.17 for positive affect). Several psychological distress indicators were inversely associated with purpose, including depressive symptoms, anxiety symptoms, loneliness, and hopelessness (e.g., β=-0.16, 95% CI: -0.19, -0.13 for depressive symptoms). There was also some evidence suggesting that fewer close friends, living alone, and unemployment/retirement were associated with lower purpose. There was, however, little evidence that health behaviors or physical health were associated with subsequent purpose. This study extends the literature by providing longitudinal evidence with rigorous analytic methodologies, and by considering a wide range of potential antecedents of purpose including some that have seldom been examined previously.

Religion, Spirituality, and Health: New Considerations for Epidemiology

Religion and spirituality are important social determinants that drive public health practice. The field of epidemiology has played a vital role in answering long-standing questions about whether religion is causally associated with health and mortality. As epidemiologists spark new conversations (e.g., see Kawachi (Am J Epidemiol. (https://doi.org/10.1093/aje/kwz204)) and Chen and VanderWeele (Am J Epidemiol. 2018;187(11):2355-2364)) about methods (e.g., outcomes-wide analysis) used to establish causal inference between religion and health, epidemiologists need to engage with other aspects of the issue, such as emerging trends and historical predictors. Epidemiologists will need to address 2 key aspects. The first is changing patterns in religious and spiritual identification. Specifically, how do traditional mechanisms (e.g., social support) hold up as explanations for religion-health associations now that more people identify as spiritual but not religious and more people are not attending religious services in physical buildings? The second is incorporation of place into causal inference designs. Specifically, how do we establish causal inference for associations between area-level constructs of the religious environment (e.g., denomination-specific church membership/adherence rates) and individual- and population-level health outcomes?