Religion and Health-Impacting Behaviours

1. Religion and Health-Impacting Behaviours Drawn from: Handbook of Religion and Health Koenig, McCullough, Larson

2. Religion and Health Behaviours • Contemporary Health Care Scene • Both Canada and the US face rising public health care costs with the aging of the baby boomer population • e.g., in the USA the number of severely disabled persons over 65 will rise from circa 3 million to 12 million in next 35 years • With this looming, it is not surprising that along with talk of increasing health care rationalization, there is also increasing emphasis on prevention and healthy lifestyle promotion as a way of offsetting rising health care costs. • Raises the intriguing question—how do various religious beliefs or behaviours coincide positively or negatively with behaviours that affect health for good or for ill?

3. Religion and Health Behaviours • We will begin with a quick survey of behaviours that we know are linked to health outcomes…

4. Religion and Health Behaviours • Diet, Weight Control, and Exercise • Diet is considered a factor in the development of coronary heart disease, some cancers, hypertension, stroke, diabetes, and atherosclerosis • These are the leading causes of death in North America • The typical North American diet is rich in fat (36% of carbohydrate intake on average), low in complex carbs and dietary fiber (as compared to a healthy diet which is characterized by low fat, saturated fat, and cholesterol and high intake of vegetables, fruits and grains.

5. Religion and Health Behaviours • Diet, Weight Control, and Exercise • Obesity (20% over ideal body weight) is also a major health cost • It is implicated in development of diabetes mellitus, endometrial cancer, breast cancer, colon cancer, gallbladder disease, hypertension, osteoarthritis, and coronary heart disease.

6. Religion and Health Behaviours • Diet, Weight Control, and Exercise • Regular physical exercise is associated with lower rates of colon cancer, stroke, and back injury, prevention/management of heart disease, hypertension, diabetes, osteoporosis, obesity, depression, and anxiety. • Physically inactive are about twice as likely to develop coronary artery disease (about same level of risk as smokers or people with high blood pressure)

7. Religion and Health Behaviours • Cigarette Smoking • Responsible for 15-20% of deaths in USA • 21% of coronary heart disease deaths • 87% of lung cancer deaths • 30% of cancer deaths in general • Nearly 100% of deaths from chronic bronchitis and emphysema • Ten years ago, 25% of American population smoked regularly—these numbers are dropping in older adult population, rising somewhat in younger adults since then.

8. Religion and Health Behaviours • Drugs and Alcohol • Affects health care costs directly, but also indirectly • Alcohol is involved in nearly 50% of all deaths in motor vehicle accidents, suicides, and homicides • Circa 25% of adolescents suffer negative effects of alcohol and drug abuse • Frequently contribute to school failure and unwanted pregnancies • Increase risk of… • Transmitting HIV infection • Likelihood of birth defects • Cirrhosis

9. Religion and Health Behaviours • Sexual Practices • Adolescent Girls Age 15-19 who have had sexual intercourse • 1970—30% • 1988—50% • By age 20, 75% of women have had sexual intercourse • Unmarried motherhood (of which adolescent pregnancies make up a high proportion) is linked to higher infant mortality rates • 12 million cases of STD’s occur each year in USA (gonorrhea, syphilis, genital herpes, chlamydia, cytomegalovirus, chancroid, Hepatitis B, human papillomavirus [linked to cervical cancer]), HIV/AIDS)

10. Religion and Health Behaviours • Sexual Practices • STD risks rise with increasing numbers of sexual partners • Sexually active adolescent women ages 15-19 • 60% have had 2+ partners • 7% have had 10+ partners • Surveys suggest 50-82% men have at least one extramarital sexual affair; 26-70% of women • At risk are not just partner having affair but unsuspecting partners • 25% of sexually active teenagers are infected with one or more STD

11. Religion and Health Behaviours • Safe Driving and Avoiding Risk • “unintentional injuries”—4th leading cause of death in US • Approx. ½ are vehicle accidents • Other causes, in order, falls, poisoning, drowning, fire • Also short term and permanent disabilities arise from injuries

12. Religion and Health Behaviours • Sleep Patterns • Prolonged sleep deprivation leads to disorganization, hallucinations, delusions, cognitive impairment • Short periods of sleep deprivation leads to daytime fatigue and irritability • Both psychological and physiological problems are likely to result if the normal sleep-wake cycle is broken (typically 6-9 hours/night)

13. Religion and Health Behaviours • If these are well known and well documented health related behaviours, then we can raise some interesting research on the relationship between religion and these behaviours. • Some areas have been researched, some have not and we are left with speculation.

14. Religion and Health Behaviours • Diet • Certain religious groups have dietary codes as part of their religious observance • E.g., • Seventh-Day Adventists: not allowed alcohol, tabacco, caffeinated beverages, pork (basically observe Jewish kosher laws), frequently avoid hot spices and highly refined foods • Mormons: not allowed alcohol, cigarettes, caffeinated beverages, habit-forming drugs; also have a higher rate of making their own bread from whole grains and their own canned preserves (required to keep 1 yr stock of food on hand)

15. Religion and Health Behaviours • Diet • E.g., • Jews: More conservative and orthodox Jews avoid pork and other aspects of kosher diet, typically encourage temperate use of alcohol • Buddhists: Some follow a vegetarian diet that is high in carbohydrates, high ratio of polyunsaturated to saturated fatty acids, and moderate fat content; rice and soybean are the primary sources of protein. (A diet such as this leaves cholesterol, glucose and uric acid at lower levels)

16. Religion and Health Behaviours • Diet • Studies on cholesterol levels have produced results that indicate that religious influences on diet may at times account for differing levels of serum cholesterol (and as such, may impact diseases associated with high levels of serum cholesterol)

17. Religion and Health Behaviours • Serum Cholesterol Studies and Religion • e.g., several studies have found higher serum cholesterol levels among Jews than non-Jews • 250 men, 250 women consecutively admitted to Mt. Sinai Hospital in NYC • 21% Jews had hypercholesterolemia • 9% non-Jews had hypercholesterolemia • 250 men, 166 women in garment factory in 1956 • Compared Jewish and Italian workers • Caloric intake m/w: Jewish (2188/1782); Italian (2312/1962) • But higher proportion of fats from animal sources for Jewish segment m/w: Jewish (80%/78%) Italian (78%/63%) • Jewish group had higher prevalence of hypercholesterolemia and higher rate of coronary heart disease

18. Religion and Health Behaviours • Serum Cholesterol Studies and Religion • Given genetic factors play a role in determining cholesterol levels, religious groups with higher rates of in-breeding can show interesting cholesterol results as well (i.e., small group where only marriage to in-group members is encouraged/permitted, e.g., certain Jewish or Christian subgroups) • e.g., in South African Study they followed 26 families with hypercholesterolemia and compared these with general population • It turned out 20 of 26 families were with Dutch Reformed Church despite the DRC being only 5% of South African population • Study’s authors attribute this to cases of genetic inbreeding

19. Religion and Health Behaviours • Serum Cholesterol Studies and Religion • Comparison among residents of Jerusalem in 1987 to determine relationship between religious observance and plasma lipids and lipoproteins in 673 17 year olds. • Plasma cholesterol, triglycerides, and LDL levels were higher in youth from secular families than in youth from orthodox Jewish families even when factors such as sex, origin, social class, body mass index were accounted for • Dietary factors most likely at play

20. Religion and Health Behaviours • Serum Cholesterol Studies and Religion • Trappists vs. Benedictine Monks • Trappist community lacto-ovo-vegetarian diet, very low in fat content (26% of cal. from fat) • Benedictine community nearly identical except for diet (45% of cal. from fat) • Trappists had lower average serum cholesterol levels (205 mg% vs. 236 mg% for Benedictine) • However, another study has suggested that, in fact, Trappist monks have a higher rate of arterial hypertension than men of the same age in the general American population, suggesting diet itself is not sufficient to offset the development of atherosclerotic vascular disease

21. Religion and Health Behaviours • Serum Cholesterol Studies and Religion • Seventh Day Adventists • 1964 Study compared 145 SDA’s in California with 433 non-SDA’s in New York • SDA Men averaged 13% lower levels than non-SDA’s • SDA Women averaged 21% lower levels than non-SDA’s • Given they were age-matched, researches attributed differences to SDA diet • 1968 Study surveyed 3260 SDA’s in Washington, DC • Matched vegetarian SDA’s and non-veg. SDA’s as well as 4244 persons in NYC • Serum cholesterol levels in SDA vegetarians was 185; non-veg. SDA’s was 196; both of these were signficantly lower than the age-matched cholesterol levels of the non-SDA NYC population sample

22. Religion and Health Behaviours • Weight Control • 1984 phone survey of 3025 persons between 20-64; 552 eliminated because of poor health • Examined 5 health related practices (smoking, exercising, alcohol use, weight maintenance, and sleep habits) along with variables that included income, education, age, life events, and social network. • The two social network indicators that were significantly related to health practices were church attendance and marriage • Church attenders were more likely to be non-smokers and have lower alcohol consumption • Among males, former smokers were more likely to be church attenders • Among females, unfavourable weight was more common with church attenders

23. Religion and Health Behaviours • Weight Control • Other studies have continued to make this correlation between religiosity and being overweight • 1981-1984 study of some 5000 persons in Pawtucket, Rhode Island • Church members 20% more likely to be overweight than non-church members (even when age, sex, and ethnicity are controlled) • 1998 Survey of 3500 Americans which measured religious practice, religious identity, religious coping, and affiliation • States with higher proportion of persons with no religious affiliation had lower rates of obesity • Percentage of Baptists in states was positively associated with obesity • Highest body weight among Pietistic and Fundamentalist Protestants; Jews and non-Christians had the lowest weight

24. Religion and Health Behaviours • Weight Control • 1998 Survey of 3500 Americans which measured religious practice, religious identity, religious coping, and affiliation • HOWEVER • Body weight difference by religious affiliation disappeared when demographic characteristics were controlled • But, obesity was also associated with higher levels of religious practice, with underweight persons scoring lower on religious practice (even with covariates controlled) • Religious activity moderated the effect of obesity on depression • Obese persons more depressed than others, religious obese persons were significantly less likely to be depressed than nonreligious obese persons.

25. Religion and Health Behaviours • Weight Control • 1998 survey of 1931 persons over age 55 in Marin County, California • Persons who attended religious services weekly or more were more likely to be overweight but less likely to be depressed than frequent attenders • Frequent attenders, despite being overweight, were significantly less likely to die during the five-year follow-up.