Mental health services in faith communities: the role of clergy in black churches.

A small but growing literature recognizes the varied roles that clergy play in identifying and addressing mental health needs in their congregations. Although the role of the clergy in mental health services delivery has not been studied extensively, a few investigations have attempted a systematic examination of this area. This article examines the research, highlighting available information with regard to the process by which mental health needs are identified and addressed by faith communities. Areas and issues where additional information is needed also are discussed. Other topics addressed include client characteristics and factors associated with the use of ministers for personal problems, the role of ministers in mental health services delivery, factors related to the development of church-based programs and service delivery systems, and models that link churches and formal services agencies. A concluding section describes barriers to and constraints against effective partnerships between churches, formal services agencies, and the broader practice of social work.

Talar neck fractures and rates of avascular necrosis.

Talar neck fractures are unique and potentially debilitating injuries. Their successful treatment requires an understanding of talar anatomy and arterial blood supply, as well as knowledge of the sequelae of these injuries, particularly avascular necrosis of the talar body. Presented is an extensive literature review on talar neck fractures and Hawkins' classification, with special emphasis on the rates of avascular necrosis as determined by selected researchers on the topic.

Public health and health education in faith communities.

This special issue of Health Education & Behavior is devoted to broadly examining the interconnections among public health, health education, and faith-based communities. In addition to a focus on questions related to the practice of public health and health education within religious settings (e.g., program development, implementation, and evaluation), the articles in this issue examine a broad range of both substantive and methodological questions and concerns. These articles include contributions that address (1) various theoretical and conceptual issues and frameworks explaining the relationships between religious involvement and health; (2) substantive reviews of current research in the area; (3) individual empirical studies exploring the associations between religious involvement and health attitudes, beliefs, and behaviors; (4) evaluations of health education programs in faith communities; and (5) religious institutions and their contributions to the development of health policy. The articles comprising the issue are selective in their coverage of the field and provide different and complementary perspectives on the connections between religious involvement and health. It is hoped that this approach will appeal to a broad audience of researchers, practitioners, policy makers, and others from health education, public health, and related social and behavioral science disciplines.

The religion-health connection: evidence, theory, and future directions.

The volume and quality of research on what we term the religion-health connection have increased markedly in recent years. This interest in the complex relationships between religion and mental and physical health is being fueled by energetic and innovative research programs in several fields, including sociology, psychology, health behavior and health education, psychiatry, gerontology, and social epidemiology. This article has three main objectives: (1) to briefly review the medical and epidemiologic research on religious factors and both physical health and mental health; (2) to identify the most promising explanatory mechanisms for religious effects on health, giving particular attention to the relationships between religious factors and the central constructs of the life stress paradigm, which guides most current social and behavioral research on health outcomes; and (3) to critique previous work on religion and health, pointing out limitations and promising new research directions.

Is religiousness a correlate of absorption? Implications for psychophysiology, coping, and morbidity.

CONTEXT: Evidence synthesized from social epidemiology, psychophysiology, and behavioral medicine suggests that religiousness may represent a significant correlate of absorption, a construct for which few if any psychosocial determinants have been identified. OBJECTIVE: To examine the association between absorption and intrinsic and extrinsic religiousness. PARTICIPANTS: 83 respondents of a self-administered survey of adult survivors of cancer or other life-threatening diseases, recruited from participants in a pilot study of psychosocial factors related to recovery from illness. MAIN MEASURES: Tellegen Absorption Scale and Religious Orientation Scale. RESULTS: Absorption, as assessed by the Tellegen Absorption Scale, was positively and significantly associated with intrinsic religiousness, as measured by the Religious Orientation Scale. Predominantly intrinsic subjects had absorption scores at least 20% higher than did predominantly extrinsic, proreligious, or nonreligious subjects. DISCUSSION: Prior research has found that absorption and hypnotizability have psychophysiological correlates, and that religiousness shows protective effects against morbidity and mortality. In light of this work, the present findings suggest that certain religious cognitions, emotions, or experiences may generate an internally focused state that enhances health and attenuates disease through self-soothing psychophysiological mechanisms.

Religion, health, and psychological well-being in older adults: findings from three national surveys.

This study examines the impact of religious involvement on health status and psychological well-being using data on older adults from three national probability surveys: the Myth and Reality of Aging (N = 2,797), the Quality of American Life (N = 1,209), and Americans' Changing Lives (N = 1,669) studies. Constructs are measured by single items and indices that vary across data sets. A proposed theoretical model specifies direct effects of religiosity on health and well-being and indirect effects on well-being through health. Analyses consist of structural-equation modeling of confirmed measurement models using weighted least squares estimation in LISREL 8.03. The model is analyzed first as specified and is then rerun controlling for the effects of six exogenous constructs: age, gender, race, marital status, education, and geographical region. Findings reveal excellent overall fit in all three samples and the presence of statistically significant religious effects, notably positive net effects of organizational religiosity, in all three samples. These results build on those of prior studies based mostly on samples limited regionally or methodologically or to particular racial or ethnic groups. This study also underscores the value of replicated secondary data analysis as a strategy for gerontologists seeking to confirm or examine a given structural model. Finally, an agenda is proposed for future research in this area.

Quantitative methods in research on complementary and alternative medicine. A methodological manifesto. NIH Office of Alternative Medicine.

OBJECTIVES: This article summarizes the deliberations of the Quantitative Methods Working Group convened by the National Institutes of Health (NIH) in support of the NIH Office of Alternative Medicine. METHODS: The working group was charged with identifying methods of study design and data analysis that can be applied to empirical research on complementary and alternative medicine. This charge was broad and inclusive and addressed the evaluation of alternative therapies, the investigation of the basic science of complementary medical systems, studies of health promotion and disease prevention, and health services research. RESULTS: The working group produced a "methodological manifesto," a summary list of seven recommended methodological guidelines for research on alternative medicine. These recommendations emphasize the robustness of existing research methods and analytic procedures despite the substantive unconventionality of alternative medicine. CONCLUSIONS: Contrary to the assertions of many researchers and alternative practitioners, established methodologies (eg, experimental trials, observational epidemiology, social survey research) and data-analytic procedures (eg, analysis of variance, logistic regression, multivariate modeling techniques) are quite satisfactory for addressing the majority of study questions related to alternative medicine, from clinical research on therapeutic efficacy to basic science research on mechanisms of pathogenesis and recovery.

Age differences in patterns and correlates of the frequency of prayer.

This study examines differences by age cohort in (a) the frequency of prayer, (b) racial and gender variation in prayer, and (c) religious and sociodemographic correlates of prayer. Analyses are conducted across four age cohorts (18-30, 31-40, 41-60, > or = 61) using data from the 1988 National Opinion Research Center (NORC) General Social Survey (N = 1,481). Findings reveal that prayer is frequently practiced at all ages, but more frequently in successively older cohorts. In addition, females and, to a lesser extent, African Americans pray more frequently than males and Whites, respectively. Further, hierarchical multiple regression analyses reveal statistically significant associations across age cohorts between prayer and key measures of religious behavior, feeling, belief, and experience.

How religion influences morbidity and health: reflections on natural history, salutogenesis and host resistance.

This paper surveys the field that has come to be known as the epidemiology of religion. Epidemiologic study of the impact of religious involvement, broadly defined, has become increasingly popular in recent years, although the existence, meaning and implications of an apparently salutary religious effect on health have not yet been interpreted in an epidemiologic context. This paper attempts to remedy this situation by putting the "epidemiology" into the epidemiology of religion through discussion of existing empirical findings in terms of several substantive epidemiologic concepts. After first providing an overview of key research findings and prior reviews of this field, the summary finding of a protective religious effect on morbidity is examined in terms of three important epidemiologic concepts: the natural history of disease, salutogenesis and host resistance. In addition to describing a theoretical basis for interpreting a religion-health association, this paper provides an enumeration of common misinterpretations of epidemiologic findings for religious involvement, as well as an outline of hypothesized pathways, mediating factors, and salutogenic mechanisms for respective religious dimensions. It is hoped that these reflections will serve both to elevate the status of religion as a construct worthy of social-epidemiologic research and to reinvigorate the field of social epidemiology.

"Song of ourselves": a quantitative history of American autobiographies.

This article highlights the major descriptive findings of an exploratory, quantitative study of American autobiographies published before 1945. Of particular importance for gerontology, age-cohort distributions of autobiographers are graphed, demonstrating that the genre itself has been created predominantly by men and women aged 55 and over. This study suggests that these writers offer scholars a virtually untapped resource for the historical phenomenology of aging.

Religious attendance and psychological well-being in Mexican Americans: a panel analysis of three-generations data.

This study examined the effects of religious attendance on three dimensions of psychological well-being using panel data from a three-generations study of Mexican Americans from Texas (N = 624). Well-being dimensions included life satisfaction (the 13-item LSIA), and respective seven- and four-item depressed and positive affect subscales of the CES-D. Two-wave path analyses revealed a cross-sectional association between religious attendance and life satisfaction in the two oldest generations, and a salutary longitudinal effect of religious attendance on subsequent depressed affect in the youngest generation. Findings for life satisfaction and depressed affect withstood controlling for health and five sociodemographic correlates of religious attendance and well-being.

How prayer heals: a theoretical model.

This article presents a theoretical model that outlines various possible explanations for the healing effects of prayer. Four classes of mechanisms are defined on the basis of whether healing has naturalistic or supernatural origins and whether it operates locally or nonlocally. Through this framework, most of the currently proposed hypotheses for understanding absent healing and other related phenomena-hypotheses that invoke such concepts as subtle energy, psi, consciousness, morphic fields, and extended mind-are shown to be no less naturalistic than the Newtonian, mechanistic forces of allopathic biomedicine so often derided for their materialism. In proposing that prayer may heal through nonlocal means according to mechanisms and theories proposed by the new physics, Dossey is almost alone among medical scholars in suggesting the possible limitations and inadequacies of hypotheses based on energies, forces, and fields. Yet even such nonlocal effects can be conceived of as naturalistic; that is, they are explained by physical laws that may be unbelievable or unfamiliar to most physicians but that are nonetheless becoming recognized as operant laws of the natural universe. The concept of the supernatural, however, is something altogether different, and is, by definition, outside of or beyond nature. Herein may reside an either wholly or partly transcendent Creator-God who is believed by many to heal through means that transcend the laws of the created universe, both its local and nonlocal elements, and that are thus inherently inaccessible to and unknowable by science. Such an explanation for the effects of prayer merits consideration and, despite its unprovability by medical science, should not be dismissed out of hand.

Religious effects on health status and life satisfaction among black Americans.

This study tests a theoretical model linking religiosity, health status, and life satisfaction using data from the National Survey of Black Americans, a nationally representative sample of Blacks at least 18 years old. Findings reveal statistically significant effects for organizational religiosity on both health and life satisfaction, for nonorganizational religiosity on health, and for subjective religiosity on life satisfaction. Analyses of structural invariance reveal a good overall fit for the model across three age cohorts (< or = 30, 31-54, > or = 55) and confirm that assuming age-invariance of structural parameters does not significantly detract from overall fit. In addition, after controlling for the effects of several sociodemographic correlates of religiosity, health, and well-being, organizational religiosity maintains a strong, significant effect on life satisfaction. These findings suggest that the association between religion and well-being is consistent over the life course and not simply an artifact of the confounding of measures of organizational religiosity and health status.

Religion and health: is there an association, is it valid, and is it causal?

This paper reviews evidence for a relationship between religion and health. Hundreds of epidemiologic studies have reported statistically significant, salutary effects of religious indicators on morbidity and mortality. However, this does not necessarily imply that religion influences health; three questions must first be answered: "Is there an association?", "Is it valid?", and, "Is it causal?" Evidence presented in this paper suggests that the answers to these respective questions are "yes," "probably," and "maybe." In answering these questions, several issues are addressed. First, key reviews and studies are discussed. Second, the problems of chance, bias, and confounding are examined. Third, alternative explanations for observed associations between religion and health are described. Fourth, these issues are carefully explored in the context of Hill's well-known features of a causal relationship. Despite the inconclusiveness of empirical evidence and the controversial and epistemologically complex nature of religion as an epidemiologic construct, this area is worthy of additional investigation. Further research can help to clarify these provocative findings.

Race and gender differences in religiosity among older adults: findings from four national surveys.

Using data from four national surveys, this article presents findings on racial and gender differences in religiosity among older adults. Surveys include the second Quality of American Life study, the Myth and Reality of Aging study, wave one of Americans' Changing Lives, and the 1987 sample of the General Social Survey. These four data sources collectively include a broad range of items which tap the constructs of organizational, nonorganizational, and subjective religiosity. In all four studies, and for most indicators, results revealed significant racial and gender differences which consistently withstood controlling for sociodemographic effects, including age, education, marital status, family income, region, urbanicity, and subjective health.

Immediate internal fixation of low-velocity gunshot-related femoral fractures.

Fractures caused by gunshots are increasingly common in urban hospitals and trauma centers. The rising incidence and complexity of these injuries present difficult management problems and health care burdens. In a 3-year period, from 1989 through 1991, 21 patients with femoral shaft fractures from low-velocity bullets were treated with intramedullary fixation within 15 hours of admission. Eighteen patients were available for follow-up. The fractures had healed in all patients. Average hospitalization for an isolated injury was 7 days. There were no complications related to immediate internal fixation. Immediate internal fixation of femoral shaft fractures caused by low-velocity gunshots can be performed in an efficient and cost effective manner.

Effect of sleep quality on symptoms of irritable bowel syndrome.

A prospective, one-month diary study was conducted with 23 adult irritable bowel syndrome (IBS) patients in order to determine the relationship between IBS and the quality of sleep. Subjects were screened through history and diagnostic studies. Accepted patients then completed a daily diary of IBS symptoms and sleep quality. At baseline, most subjects (74%) characterized themselves as "poor sleepers." Using pooled time series analysis, the study found a significant correlation between morning IBS symptoms and the quality of the prior night's sleep (P < 0.001), a finding not previously reported in the literature. A less strong but still significant correlation (P < 0.05) was found between end of day IBS symptoms and the quality of sleep during the prior evening. Morning IBS symptoms seem to rise or fall in close association with the prior night's quality of sleep. The study supports the hypothesis that IBS symptoms are related to a disturbance in sleep.

Prayer and health during pregnancy: findings from the Galveston Low Birthweight Survey.

In this study we examined the relationship between praying for one's baby during pregnancy and self-ratings of health. Data were collected from a biethnic (black and Hispanic) sample of postpartum mothers in Galveston, Tex, from 1986 to 1987. This sample is representative of the annual biethnic population of live births in Galveston. Subjective health was assessed for the periods both before and during pregnancy with self-ratings of global or overall health, worry over health, and functional health or lack of disability. Analyses controlled for the effects of the mother's age, marital status, gravidity, education, and self-rated religiosity. Findings revealed that all three prepregnancy health measures were associated with prayer. Subjectively unhealthier mothers prayed more for their baby during pregnancy regardless of their perceived health during pregnancy, and subjectively healthier mothers prayed less for their baby regardless of their self-reported religiosity. Additional analyses revealed that the effect of poor health on the frequency of prayer was not simply an outcome of the mother's worry over her own health.