NIH Public Access Author Manuscript Int J Religion Spiritual Soc. Author manuscript; available in PMC 2014 November 03.
NIH-PA Author Manuscript
Published in final edited form as: Int J Religion Spiritual Soc. 2012 ; 2(3): 129–144.
Religiousness, Physical Activity and Obesity among Older Cancer Survivors: Results from the Health and Retirement Study 2000–2010 Sophia Lyn Nathenson and Oregon Institute of Technology, University of Utah, USA Ming Wen University of Utah, USA
Abstract NIH-PA Author Manuscript NIH-PA Author Manuscript
The health behaviors of cancer survivors are an important research agenda in light of mounting evidence that aspects of health such as diet and exercise have salutary effects both mentally and physically for cancer survivors, a rapidly growing population in the United States and elsewhere. This paper analyzes data from the Health and Retirement Study 2000–2010 to determine if religious salience impacts the likelihood of obesity, changes in body mass index, and weekly vigorous activity. Two theories propose different hypotheses about the relationship. The health belief model would suggest the more religious may have the perception that healthy behaviors are positive and will be more likely to have a healthy body weight and get exercise. Conversely, high religious salience may signify a God locus of health control, leading to lesser likelihood of engagement in preventive health behaviors. Using logistic and regression analysis controlling for health behaviors at baseline (2000), these theories are tested, in addition to the explanatory power of lifestyle as a potential mechanism in the relationship of religiousness to body weight. Results show that high levels of religious salience may correspond to greater likelihood of obesity and lesser likelihood of getting regular exercise. Policy implications may include a greater emphasis on diet and physical activity in religious settings that may instead stress other health behaviors such as abstinence from smoking and alcohol.
Keywords Health Behavior; Cancer Survivorship; Obesity; Religion; Physical Activity; God Locus of Health Control; Health Belief Model; Medical Sociology
© Common Ground, Sophia Lyn Nathenson, Ming Wen, All Rights Reserved Sophia Lyn Nathenson: Sophia Lyn Nathenson, Ph.D. is an Assistant Professor of Sociology at the Oregon Institute of Technology. She is currently developing a Medical Sociology program for future health professionals. Dr. Nathenson's research focuses on the social and behavioral factors that contribute to well being, including the use of spirituality and alternative medicines for health. Ming Wen: University of Utah, USA
Nathenson and Wen
Page 2
INTRODUCTION NIH-PA Author Manuscript
Cancer is the second leading cause of death and a prevalent condition among older adults in the United States (Center for Disease Control and Prevention 2012). Thanks to medical and epidemiological advancement in cancer prevention and treatment, survivor rates of many cancers have tremendously increased in recent years leading to a rapidly growing number of cancer survivors chronically living in the ‘remission’ society. How cancer survivors fare and what social and behavioral factors are contributory to their health and well-being have thus become increasingly important research questions drawing a great deal of attention across disciplines (Park et al. 2008).
NIH-PA Author Manuscript
Among a myriad of social factors, religiousness and spirituality have been widely studied for their impacts on coping with cancer with evidence pointing to beneficial effects both mentally and physically (Koenig 2001). Meanwhile, healthy behaviors such as physical activity and maintaining normal weight are highlighted as protective factors promoting quality of life among cancer survivors (Courneya & Friedenreich 1997). Most recent evidence on this topic is based on case-control and intervention studies that do not allow for generalizable conclusions about this unique population. This study takes advantage of a rich large, nationally representative dataset to examine the extent to which importance of religion (religious salience) to cancer survivors predicts physical activity and obesity. Specifically, the research questions in this study are: 1.
Are more religious cancer survivors more or less likely to be obese?
2.
Are more religious cancer survivors more or less likely to get regular vigorous physical activity?
3.
Can differences be attributed to more religious persons adopting a healthy lifestyle?
In the following sections, background is given on the link between religion and health behavior of cancer survivors, the theoretical and methodological approach of this study, followed by results and policy implications. Health Behavior of Cancer Survivors
NIH-PA Author Manuscript
While cancer accounts for nearly 23% of total deaths in America, a growing number of those diagnosed will survive. Currently, one in every twenty Americans is a cancer survivor (Center for Disease Control and Prevention 2012). Cancer survivorship, and particularly the mental and physical health status of survivors, is of utmost importance considering these figures. It becomes a public health priority to investigate the extent to which social factors alter additional health risks specific this population of survivors, who are at increased risk of other chronic conditions including other cancers, heart disease, arthritis, obesity, diabetes (Demark-Wahnefried 2000). Increasingly, lifestyle factors such as diet and physical activity are attributed as preventive and even causative factors in cancer diagnosis and reoccurrence (Anand et al. 2008). Many social demographers and medical sociologists have debated whether the rapidly growing aging population that is most affected by cancer is living longer, healthier lives or longer lives with more chronic illness (Jagger 2006; Nusselder 2003; Myers & Manton 1984). Lifestyle is one route to disease prevention that may have a greater impact on the lives of survivors than mere biomedical treatment focused more on Int J Religion Spiritual Soc. Author manuscript; available in PMC 2014 November 03.
Nathenson and Wen
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NIH-PA Author Manuscript
eradicating than preventing the disease. Evidence has shown cancer survivors may adopt negative health behaviors, perhaps as poor coping mechanisms (Blanchard et al. 2003). Yet other studies note positive behaviors post-diagnosis (Andrykowski 2005; Pinto & Tunzo 2005), due in part to perceptions of lifestyle being part of cancer's etiology. While survivors undergo significant distress, this distress may serve as a motivating factor in health seeking behavior (Patterson et al 2003; McBride et al. 2000; Demark-Wahnefried et al. 2000), and cancer survivors may strive for a healthier diet and more exercise (Pinto, Eakin & Maruyama 2000; Pinto et al. 1998; Nordevang, Callmer, Holm 1992; Gritz 1991). Religion and Health Behaviors
NIH-PA Author Manuscript
The religion and health literature, which spans disciplines of sociology, medicine, psychology, gerontology, psychiatry and anthropology, is a vast research base that investigates a variety of religious measures and health outcomes. Although some researchers have used the words religion and spirituality as synonymous, social scientists have identified important distinctions between the two concepts (Nelson et al. 2009). Religion is typically connected to an organizational or institutional religion and is thus measured by aspects such as church attendance or religious salience (the importance of religion to an individual). Within this religious domain, early scholars of religion such as Allport (1950) have acknowledged further distinctions of extrinsic and intrinsic religiousness, as well as public and private practices. Extrinsic religion refers to the more external or social aspects of religion such as church attendance, while intrinsic religiousness refers to practices of personal devotion to God such as prayer or reading scriptures. This study specifically examines religious salience, which captures the importance of religion to an individual while signifying an affiliation with a religious institution.
NIH-PA Author Manuscript
Is there a role for religion in preventive health behaviors of cancer survivors? This question has led to significant tensions in the religion and health literature, due to theoretical debates and conflicting empirical evidence. One the one hand, extrinsic measures of religiousness such as church service attendance have been positively related to participation in preventive screenings for cancer (Fox, Pitkin, Paul, Carson & Duan 1998). Studies of older adults have demonstrated that belief in God as a support system in life can enhance one's ability to cope and adapt to stress (Pargament et al. 1998) and that “life meaning” is linked to positive health behavior in survivors (Park et al. 2008). These results confirm that a belief in God can be a supportive, positive force in one's life that can empower individuals to take better care of themselves. On the other hand, belief in God as having control over one's health may be a hindrance to health seeking behavior. For example, Kinney and colleagues found that women with a high level of belief in God as the controlling source of health were less likely to get breast cancer screenings (Kinney et al. 2002). While those with an internal health locus of control believe they have the power to influence their health situation, those with an external or God Locus of Health Control (GLHC) believe their outcomes to be the result of external influence. Studies specific to cancer survivors suggest that a relationship to God may also serve as a hindrance in disease prevention in the absence of other social support that may encourage preventive health behaviors (Gullatte, Brawley, Kinney et al. 2010).
Int J Religion Spiritual Soc. Author manuscript; available in PMC 2014 November 03.
Nathenson and Wen
Page 4
NIH-PA Author Manuscript
A key finding from the religion and health literature, which has exploded since the 1990s, is that many religious groups have lower rates of cancer and other chronic diseases (Fraser et al. 1991, Levin 2001). An important explanation for this advantage is the healthier behavior pattern of the religious. Many religious doctrines emphasize healthy behaviors and the importance of a pure mind and body (Ellison 1991). Thus, religion can influence health by the promotion of a healthy lifestyle (Levin 2001). Empirical evidence shows that religious persons tend to have lower rates of negative health behaviors such as smoking and alcohol use (Koenig 2011). These relationships have been found across age groups, including older adults. For example, in a series of studies, Benjamins (2004, 2005, 2006) found that among older adults religious attendance and religious salience were related to better physical health and better preventive health measures and that weekly church attendance was related to fewer functional limitations. This study focuses on religious salience, or the importance of religion in one's life, in relation to obesity and physical activity in cancer survivors due to the lack of variation in religious affiliation in the Health and Retirement Study1 and to be consistent with other studies on this topic drawing on the same dataset (Benjamins 2004). Obesity and Physical Activity
NIH-PA Author Manuscript NIH-PA Author Manuscript
Two health behaviors that are often examined in cancer survivors are a healthy diet and exercise, due to the negative health consequences of obesity and the positive impact of exercise on quality of life. Obesity has reached an epidemic level in the United States, where thirty percent of the adult population has a BMI of over 30 and therefore defined as clinically obese (Flegal et al. 2002). Furthermore, a third of the population is overweight by the clinical definition (BMI 25>= and
NIH-PA Author Manuscript
Published in final edited form as: Int J Religion Spiritual Soc. 2012 ; 2(3): 129–144.
Religiousness, Physical Activity and Obesity among Older Cancer Survivors: Results from the Health and Retirement Study 2000–2010 Sophia Lyn Nathenson and Oregon Institute of Technology, University of Utah, USA Ming Wen University of Utah, USA
Abstract NIH-PA Author Manuscript NIH-PA Author Manuscript
The health behaviors of cancer survivors are an important research agenda in light of mounting evidence that aspects of health such as diet and exercise have salutary effects both mentally and physically for cancer survivors, a rapidly growing population in the United States and elsewhere. This paper analyzes data from the Health and Retirement Study 2000–2010 to determine if religious salience impacts the likelihood of obesity, changes in body mass index, and weekly vigorous activity. Two theories propose different hypotheses about the relationship. The health belief model would suggest the more religious may have the perception that healthy behaviors are positive and will be more likely to have a healthy body weight and get exercise. Conversely, high religious salience may signify a God locus of health control, leading to lesser likelihood of engagement in preventive health behaviors. Using logistic and regression analysis controlling for health behaviors at baseline (2000), these theories are tested, in addition to the explanatory power of lifestyle as a potential mechanism in the relationship of religiousness to body weight. Results show that high levels of religious salience may correspond to greater likelihood of obesity and lesser likelihood of getting regular exercise. Policy implications may include a greater emphasis on diet and physical activity in religious settings that may instead stress other health behaviors such as abstinence from smoking and alcohol.
Keywords Health Behavior; Cancer Survivorship; Obesity; Religion; Physical Activity; God Locus of Health Control; Health Belief Model; Medical Sociology
© Common Ground, Sophia Lyn Nathenson, Ming Wen, All Rights Reserved Sophia Lyn Nathenson: Sophia Lyn Nathenson, Ph.D. is an Assistant Professor of Sociology at the Oregon Institute of Technology. She is currently developing a Medical Sociology program for future health professionals. Dr. Nathenson's research focuses on the social and behavioral factors that contribute to well being, including the use of spirituality and alternative medicines for health. Ming Wen: University of Utah, USA
Nathenson and Wen
Page 2
INTRODUCTION NIH-PA Author Manuscript
Cancer is the second leading cause of death and a prevalent condition among older adults in the United States (Center for Disease Control and Prevention 2012). Thanks to medical and epidemiological advancement in cancer prevention and treatment, survivor rates of many cancers have tremendously increased in recent years leading to a rapidly growing number of cancer survivors chronically living in the ‘remission’ society. How cancer survivors fare and what social and behavioral factors are contributory to their health and well-being have thus become increasingly important research questions drawing a great deal of attention across disciplines (Park et al. 2008).
NIH-PA Author Manuscript
Among a myriad of social factors, religiousness and spirituality have been widely studied for their impacts on coping with cancer with evidence pointing to beneficial effects both mentally and physically (Koenig 2001). Meanwhile, healthy behaviors such as physical activity and maintaining normal weight are highlighted as protective factors promoting quality of life among cancer survivors (Courneya & Friedenreich 1997). Most recent evidence on this topic is based on case-control and intervention studies that do not allow for generalizable conclusions about this unique population. This study takes advantage of a rich large, nationally representative dataset to examine the extent to which importance of religion (religious salience) to cancer survivors predicts physical activity and obesity. Specifically, the research questions in this study are: 1.
Are more religious cancer survivors more or less likely to be obese?
2.
Are more religious cancer survivors more or less likely to get regular vigorous physical activity?
3.
Can differences be attributed to more religious persons adopting a healthy lifestyle?
In the following sections, background is given on the link between religion and health behavior of cancer survivors, the theoretical and methodological approach of this study, followed by results and policy implications. Health Behavior of Cancer Survivors
NIH-PA Author Manuscript
While cancer accounts for nearly 23% of total deaths in America, a growing number of those diagnosed will survive. Currently, one in every twenty Americans is a cancer survivor (Center for Disease Control and Prevention 2012). Cancer survivorship, and particularly the mental and physical health status of survivors, is of utmost importance considering these figures. It becomes a public health priority to investigate the extent to which social factors alter additional health risks specific this population of survivors, who are at increased risk of other chronic conditions including other cancers, heart disease, arthritis, obesity, diabetes (Demark-Wahnefried 2000). Increasingly, lifestyle factors such as diet and physical activity are attributed as preventive and even causative factors in cancer diagnosis and reoccurrence (Anand et al. 2008). Many social demographers and medical sociologists have debated whether the rapidly growing aging population that is most affected by cancer is living longer, healthier lives or longer lives with more chronic illness (Jagger 2006; Nusselder 2003; Myers & Manton 1984). Lifestyle is one route to disease prevention that may have a greater impact on the lives of survivors than mere biomedical treatment focused more on Int J Religion Spiritual Soc. Author manuscript; available in PMC 2014 November 03.
Nathenson and Wen
Page 3
NIH-PA Author Manuscript
eradicating than preventing the disease. Evidence has shown cancer survivors may adopt negative health behaviors, perhaps as poor coping mechanisms (Blanchard et al. 2003). Yet other studies note positive behaviors post-diagnosis (Andrykowski 2005; Pinto & Tunzo 2005), due in part to perceptions of lifestyle being part of cancer's etiology. While survivors undergo significant distress, this distress may serve as a motivating factor in health seeking behavior (Patterson et al 2003; McBride et al. 2000; Demark-Wahnefried et al. 2000), and cancer survivors may strive for a healthier diet and more exercise (Pinto, Eakin & Maruyama 2000; Pinto et al. 1998; Nordevang, Callmer, Holm 1992; Gritz 1991). Religion and Health Behaviors
NIH-PA Author Manuscript
The religion and health literature, which spans disciplines of sociology, medicine, psychology, gerontology, psychiatry and anthropology, is a vast research base that investigates a variety of religious measures and health outcomes. Although some researchers have used the words religion and spirituality as synonymous, social scientists have identified important distinctions between the two concepts (Nelson et al. 2009). Religion is typically connected to an organizational or institutional religion and is thus measured by aspects such as church attendance or religious salience (the importance of religion to an individual). Within this religious domain, early scholars of religion such as Allport (1950) have acknowledged further distinctions of extrinsic and intrinsic religiousness, as well as public and private practices. Extrinsic religion refers to the more external or social aspects of religion such as church attendance, while intrinsic religiousness refers to practices of personal devotion to God such as prayer or reading scriptures. This study specifically examines religious salience, which captures the importance of religion to an individual while signifying an affiliation with a religious institution.
NIH-PA Author Manuscript
Is there a role for religion in preventive health behaviors of cancer survivors? This question has led to significant tensions in the religion and health literature, due to theoretical debates and conflicting empirical evidence. One the one hand, extrinsic measures of religiousness such as church service attendance have been positively related to participation in preventive screenings for cancer (Fox, Pitkin, Paul, Carson & Duan 1998). Studies of older adults have demonstrated that belief in God as a support system in life can enhance one's ability to cope and adapt to stress (Pargament et al. 1998) and that “life meaning” is linked to positive health behavior in survivors (Park et al. 2008). These results confirm that a belief in God can be a supportive, positive force in one's life that can empower individuals to take better care of themselves. On the other hand, belief in God as having control over one's health may be a hindrance to health seeking behavior. For example, Kinney and colleagues found that women with a high level of belief in God as the controlling source of health were less likely to get breast cancer screenings (Kinney et al. 2002). While those with an internal health locus of control believe they have the power to influence their health situation, those with an external or God Locus of Health Control (GLHC) believe their outcomes to be the result of external influence. Studies specific to cancer survivors suggest that a relationship to God may also serve as a hindrance in disease prevention in the absence of other social support that may encourage preventive health behaviors (Gullatte, Brawley, Kinney et al. 2010).
Int J Religion Spiritual Soc. Author manuscript; available in PMC 2014 November 03.
Nathenson and Wen
Page 4
NIH-PA Author Manuscript
A key finding from the religion and health literature, which has exploded since the 1990s, is that many religious groups have lower rates of cancer and other chronic diseases (Fraser et al. 1991, Levin 2001). An important explanation for this advantage is the healthier behavior pattern of the religious. Many religious doctrines emphasize healthy behaviors and the importance of a pure mind and body (Ellison 1991). Thus, religion can influence health by the promotion of a healthy lifestyle (Levin 2001). Empirical evidence shows that religious persons tend to have lower rates of negative health behaviors such as smoking and alcohol use (Koenig 2011). These relationships have been found across age groups, including older adults. For example, in a series of studies, Benjamins (2004, 2005, 2006) found that among older adults religious attendance and religious salience were related to better physical health and better preventive health measures and that weekly church attendance was related to fewer functional limitations. This study focuses on religious salience, or the importance of religion in one's life, in relation to obesity and physical activity in cancer survivors due to the lack of variation in religious affiliation in the Health and Retirement Study1 and to be consistent with other studies on this topic drawing on the same dataset (Benjamins 2004). Obesity and Physical Activity
NIH-PA Author Manuscript NIH-PA Author Manuscript
Two health behaviors that are often examined in cancer survivors are a healthy diet and exercise, due to the negative health consequences of obesity and the positive impact of exercise on quality of life. Obesity has reached an epidemic level in the United States, where thirty percent of the adult population has a BMI of over 30 and therefore defined as clinically obese (Flegal et al. 2002). Furthermore, a third of the population is overweight by the clinical definition (BMI 25>= and
