ReadChen & VanderWeele, (2018)article and answerthe following questions (below) in an essay format (Note: You won't be able to view your peers' posts until you have posted your original post.).
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oup_ajepid_kwy142 2355..2364 ++ American Journal of Epidemiology © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
[email protected]. Vol. 187, No. 11 DOI: 10.1093/aje/kwy142 Advance Access publication: September 10, 2018 Original Contribution Associations of Religious UpbringingWith Subsequent Health andWell-Being FromAdolescence to YoungAdulthood: AnOutcome-Wide Analysis Ying Chen and Tyler J. VanderWeele* *Correspondence to Dr. Tyler J. VanderWeele, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Kresge Building, 677 Huntington Avenue, Boston, MA 02115 (e-mail:
[email protected]). Initially submitted November 14, 2017; accepted for publication June 29, 2018. In the present study, we prospectively examined the associations of religious involvement in adolescence (includ- ing religious service attendance and prayer or meditation) with a wide array of psychological well-being, mental health, health behavior, physical health, and character strength outcomes in young adulthood. Longitudinal data from the Growing Up Today Study were analyzed using generalized estimating equations. Sample sizes ranged from 5,681 to 7,458, depending on outcome; the mean baseline age was 14.74 years, and there were 8–14 years of follow-up (1999 to either 2007, 2010, or 2013). Bonferroni correction was used to correct for multiple testing. All models were controlled for sociodemographic characteristics, maternal health, and prior values of the outcome vari- ables whenever data were available. Compared with no attendance, at least weekly attendance of religious services was associated with greater life satisfaction and positive affect, a number of character strengths, lower probabilities of marijuana use and early sexual initiation, and fewer lifetime sexual partners. Analyses of prayer or meditation yielded similar results. Although decisions about religion are not shaped principally by health, encouraging service attendance and private practices in adolescents who already hold religious beliefs may be meaningful avenues of development and support, possibly leading to better health and well-being. health; lifecourse; outcome-wide analysis; prayer or meditation; religious service attendance; religious upbringing; well-being Abbreviations: GUTS, Growing Up Today Study; NHSII, Nurses’Health Study II; STI, sexually transmitted infection. America is highly religious (1, 2). Religious beliefs and prac- tices are likely shaped by a number of factors, the most promi- nent of which may be religious upbringing in early life (3, 4). It is a common practice for parents to raise their children based on their own religious beliefs (5). There has, however, been a con- tinuing decline in religiosity for decades, for the most part due to lower rates in younger generations (6, 7). Despite the general trends of declining religious participation, there is still consider- able intergenerational religious continuity in the United States (4). For instance, recent estimates of the rates of intergenera- tional transmission of religious affiliation were 82% in Jews, 85% inMuslims, 62% in Evangelical Protestants, and 43% in Catholics, and 59% of parents who attended religious ser- vices at least weekly had children who reported frequent ser- vice attendance (4). Empirical research suggests that religion is associated with better health and well-being in adults (8). For instance, there is a gradient relationship between frequent religious service attendance and lower mortality risk, even in the most rigorous studies (9–14). In other studies, religious involvement has also been linked to a wide range of other outcomes, such as greater psychological well-being, character strengths, reduced mental illness, and healthier behaviors (8, 15, 16). Religious teachings often concern practices related to living a healthy lifestyle and also sometimes explicitly consider character or respect for the body as an integral part of the beliefs (15). Individuals engage in religion in a variety of ways, such as public participation, religious affiliation and identity, private practices, and religious coping (15). There have only been a limited number of studies in which investigators have com- pared the health associations of multiple forms of religious participation within the same study. Results from studies in adults generally suggest that religious attendance shows the strongest health associations in community samples, whereas 2355 Am J Epidemiol. 2018;187(11):2355–2364 D ow nloaded from https://academ ic.oup.com /aje/article/187/11/2355/5094534 by guest on 01 O ctober 2020 http://creativecommons.org/licenses/by-nc/4.0 http://creativecommons.org/licenses/by-nc/4.0 religious coping is a prominent predictor for recovery and sur- vival in clinically ill populations (13, 15, 17). To date, prior studies have mostly been conducted in adults. However, research has increasingly suggested that religion may confer lifecourse influences and that religion may have even more profound health effects at younger ages (18, 19). Existing evidence in adolescents suggests that religious involvement may protect against certain behaviors and promote positive practices (20–23). These studies are, however, subject to certain limita- tions. Specifically, much of the prior work is cross-sectional. There is often limited control for baseline characteristics, and reverse causation often cannot be ruled out. For example, an observed inverse association between service attendance and depression may be confounded by prior depression status, because depression may affect subsequent service attendance (24). In addition, different aspects of religious involvement are often examined in separate studies and a limited number of outcomes are investigated, so that existing evidence re- mains scattered across studies. It may be important to exam- ine multiple health and well-being outcomes simultaneously within the same study (25, 26). To provide additional insights into the role of religious upbring- ing, we used an outcome-wide analytic approach (26) to prospec- tively examine the associations of religious involvement in adolescence with a wide array of psychological, mental, behav- ioral, physical health, and character strengths outcomes in young adulthood. The 2 aspects of religious participation that were examined were frequency of religious service atten- dance (a form of public participation) and frequency of prayer or meditation (a form of private practice). The inde- pendent associations of service attendance and prayer or meditation across outcomes were also examined in a second- ary analysis. We hypothesized that both frequent service attendance and prayer or meditation are each associated with greater psychological, mental, behavioral, and physical health and character strengths outcomes. Drawing upon prior literature in adults (13, 15, 17), we expected that service attendance would have stronger associations with various outcomes than would prayer or meditation. METHODS We used longitudinal data from the Nurses’ Health Study II (NHSII) and the Growing Up Today Study (GUTS). NHSII was initiated in 1989, and it enrolled 116,430 nurses aged 25–42 years. In 1996, NHSII participants with children between 9 and 14 years of age were invited to have their children participate in another cohort of GUTS. A total of 16,882 children completed the questionnaires about their health. NHSII and GUTS partici- pants continue to be followed up with mailed or Web-based questionnaires annually or biennially (27, 28). This study was approved by the Brigham and Women’s Hospital Institutional ReviewBoards. Religious participation was first assessed in the GUTS 1999 questionnaire wave; therefore, this year was considered as base- line for the present study. The outcome variables were assessed in themost recent waves, either the 2010wave (for participants aged 23–30 years) or the 2013 or 2007wave (if data were not available in the 2010 wave). Of respondents to the 1999 questionnaire (n= 12,410), those with missing data on the exposure (n = 1,597 on religious service attendance and n = 1,621 on prayer or medi- tation) or the outcome variable (n ranged from 3,355 to 5,124 for analyses on service attendance and from 3,341 to 5,108 for analy- ses on prayer or meditation, depending on the outcome) were removed from each analysis involving those variables. Missing data on the covariates were imputed from the previous ques- tionnaire year; if no such data were available, the mean values (for continuous variables) or values of the largest category (for categorical variables) of the nonmissing data were used for imputation. This yielded samples of 5,689–7,458 indivi- duals (up to 1,329 were siblings) for analyses on service atten- dance and 5,681–7,448 individuals (up to 1,325 were siblings) for analyses on prayer or meditation, depending on the out- come. Compared with participants who were lost to follow-up in the 2010 questionnaire wave, those who remained in the cohort were older and healthier, had a higher socioeconomic status, and were more likely to report frequent religious partici- pation at baseline; in addition, a higher percentage was female (Web Table 1, available at https://academic.oup.com/aje). Web Table 2 shows the timing of the assessment of all vari- ables. The exposure variables (service attendance and prayer or meditation) were assessed in the GUTS 1999 questionnaire wave (participants aged 12–19 years). To reduce the possibil- ity of reverse causation, prior values of the outcome variables assessed in wave 1998 or 1999 were used as a covariate when- ever available. Exposure assessment Religious service attendance. Frequency of religious service attendance (1999 wave) was measured using the question, “How often do you go to religious meetings or services?”Response op- tions ranged from 1 (never) to 5 (more than once per week). Re- sponses were grouped into 3 categories: never, less than once per week, and at least once per week (29). Prayer or meditation. Frequency of prayer or meditation (1999wave) was assessedwith the question, “How often do you pray or meditate?”Response categories ranged from 1 (never) to 4 (once per day or more). Outcome assessment A wide array of psychological well-being (life satisfaction, positive affect, self-esteem, emotional processing, and emotional expression), character strengths (frequency of volunteering, sense of mission, forgiveness of others, and being registered to vote), physical health (number of physical health problems and overweight/obesity), mental health (depression, anxiety, and probable posttraumatic stress disorder), and health behavioral (cigarette smoking, frequent binge drinking, marijuana use, other illicit drug use, prescription drug misuse, number of life- time sexual partners, early sexual initiation, history of sexually transmitted Infections (STIs), teen pregnancy, abnormal Pap test results) outcomes were assessed (waves 2010, 2013, or 2007). See Web Table 3 and the Web Appendix for details on eachmeasurement. Am J Epidemiol. 2018;187(11):2355–2364 2356 Chen and VanderWeele D ow nloaded from https://academ ic.oup.com /aje/article/187/11/2355/5094534 by guest on 01 O ctober 2020 https://academic.oup.com/aje Covariates assessment Sociodemographic characteristics. Sociodemographic co- variates included participant age (in years), sex (female or male), race (white or nonwhite), and geographic region (West, Mid- west, South, or Northeast) (GUTS 1999). Maternal covariates included maternal age (in years; NHSII 1999), race (white or nonwhite; NHSII 1999), marital status (NHSII 1997), subjec- tive socioeconomic status in the United States and in the com- munity (both