Religious Involvement and Sleep Among Older African Americans

Abstract

Objective: This study sought to determine whether religious involvement is associated with sleep quality in a nationally representative sample of older African Americans. Methods: The analytic sample included African American respondents aged 55+ from the National Survey of American Life-Reinterview (N = 459). Religious involvement variables included service attendance, reading religious texts, watching religious television programs, listening to religious radio programs, prayer, and subjective religiosity. Sleep outcomes were restless sleep and sleep satisfaction. Multiple linear regression analysis was used. Results: Watching religious television programs was associated with more restless sleep. Respondents who attended religious services less than once a year, at least once a week, or nearly every day reported greater sleep satisfaction than respondents who never attended religious services. Subjective religiosity was associated with lower sleep satisfaction. Discussion: The findings demonstrate the importance of examining a variety of religious involvement domains, which could point to different explanatory pathways between religious involvement and sleep.

Keywords

sleep quality African Americans religiosity minority aging

Sleep is a health imperative and is vital for biological and cognitive functioning (Luyster et al., 2012). Poor sleep can lead to a range of physical and mental health problems (Baglioni et al., 2016; Buxton & Marcelli, 2010; Luyster et al., 2012). For example, poor sleep is a risk factor for depression, anxiety disorders, obesity, diabetes, hypertension, cardiovascular disease, and cancer (Baglioni et al., 2016; Buxton & Marcelli, 2010; Lincoln et al., 2019). Insufficient sleep can also result in cognitive and motor impairments that are equivalent to impairments caused by alcohol consumption at or above the legal limit for driving (Luyster et al., 2012). Consequently, insufficient sleep is associated with increased risk of motor vehicle accidents, work-related injuries, and fatal workplace accidents (Tucker et al., 2016) and is predictive of all-cause and disease-specific mortality (Grandner et al., 2010). Particularly relevant to older adults, poor sleep is associated with cognitive decline, dementia, and increased risk for falls (Noh et al., 2017; Scullin & Bliwise, 2015).

Our current understanding of sleep problems among older African Americans is fairly limited. What we can glean from available studies, however, is that African American older adults might have higher risk for sleep problems compared to their younger and White counterparts. For example, a growing body of studies document racial differences in sleep quality. Findings from cohort and epidemiological studies indicate that African Americans have poorer sleep quality than Whites (Grandner et al., 2016; Ruiter et al., 2011). Although the majority of these studies focus on younger populations, they provide evidence of sleep inequalities by race. With respect to age, findings from studies of the general population of older adults indicate that sleep problems are highly prevalent in this population. For example, about 9%–12% of the general population may be diagnosed with sleep disorder (Morin & Jarrin, 2013), whereas the prevalence is 25%–40% among older adults (Morin & Jarrin, 2013). Moreover, sleep disorders are under-recognized and under-treated issues, especially in older adults (Kamel & Gammack, 2006). Thus, it is likely that reported rates of sleep problems among older adults are underestimated. Despite the dearth of sleep studies focused on older African Americans, findings from available studies are consistent with those based on younger populations. One cohort study of older African Americans and Whites found that older African Americans had poorer sleep quality than older Whites (Turner et al., 2016). Findings from a study using a convenience sample of African American older adults found that a significant proportion of respondents had sleep problems (Bazargan et al., 2019). This study also identified risk factors for sleep problems that are disproportionately present among older African Americans, including chronic health conditions and financial difficulty. Collectively, these findings suggest that African American older adults might have greater risk for poor sleep quality compared to other age and racial groups. Unfortunately, very few studies examine sleep quality in this population which limits our understanding of the evaluation of sleep among older African Americans and potential mitigating factors that could disrupt the relationship between poor sleep and poor health outcomes in this population.

A small body of literature identifies religious involvement as a protective factor against poor sleep (Hill et al., 2018; Kent de Grey et al., 2018). Religious involvement may be an especially relevant protective factor for older African Americans, given the high rates of religious involvement in this population. Older African Americans have higher rates of religious involvement (e.g., religious service attendance, church membership, subjective religiosity) than their younger counterparts and non-Hispanic Whites of any age (Chatters et al., 2014; Nguyen, 2020; Taylor & Chatters, 2011; Taylor et al., 2007, 2014). High religious involvement among older African Americans can be attributed to the central role of the Black church, both historically and contemporaneously, in the lives of many African Americans. In addition to serving as a religious institution, the Black church has political, social, cultural, educational, and civic functions in African American communities (Lincoln & Mamiya, 1990). Given that religion holds important meaning and significance for older African Americans, it is expected that religious involvement may play an important role in the sleep of older African Americans as it does in the general older adult population (Blanc et al., 2020). The purpose of this study was to determine whether religious involvement is associated with better sleep quality in a nationally representative sample of older African Americans.

Religion and Sleep

Religion is a multidimensional construct. Research has examined the relationship between various dimensions of religious involvement and sleep quality. Included among these are nonorganizational (e.g., prayer, reading religious texts), organizational (e.g., service attendance), and subjective (e.g., attitudes, beliefs, experiences, self-perceptions, and attributions related to religion or spirituality) religious involvement.

Nonorganizational Religious Involvement

Research indicates that nonorganizational religious involvement is associated with a range of sleep outcomes. Findings from a cross-sectional study of sleep among women with breast cancer who were undergoing chemotherapy and recruited from chemotherapy clinics demonstrated that higher levels of religious activity were associated with longer sleep latency and a greater likelihood of sleep medication use (Khoramirad et al., 2015). This is consistent with another cross-sectional study’s finding indicating that religious involvement is associated with lower sleep quality (Bélanger et al., 2020). These findings suggest reverse causality in the relationship between religious involvement and sleep. That is, the study respondents may have been experiencing sleep problems and engaged in religious activities as a means to cope with their sleep problems. In contrast, some evidence indicates that nonorganizational religious involvement predicts better sleep quality (Brewer-Smyth et al., 2020). Yet, there is also evidence indicating that participation in nonorganizational religious activities is unrelated to subjective sleep quality, global sleep quality, sleep duration, sleep disturbances, or daytime dysfunction (Ellison et al., 2019; Khoramirad et al., 2015).

Organizational Religious Involvement

The bulk of the research on organizational religious involvement and sleep has focused on religious service attendance. There is a small but contradictory body of literature that indicates that religious service attendance is not associated with sleep. These studies tested the relationship between service attendance and a range of sleep outcomes (e.g., sleep quality, short sleep duration, poor sleep, sleep disorder) and were unable to identify statistically significant associations among these variables (Ellison et al., 2019; Gillum, 2013; Krause & Ironson, 2017). Null findings from these investigations may be a result of discrepancies in the measurement of service attendances (i.e., categorical vs. continuous variable), sleep quality, and/or the differences in the study samples (i.e., nationally representative samples vs. regional and local samples; racially/ethnically diverse samples vs. predominately non-Hispanic White samples).

A number of studies indicate that religious service attendance is associated with better sleep outcomes. More specifically, these studies demonstrate that more frequent service attendance is predictive of better sleep quality (Brewer-Smyth et al., 2020; Hill et al., 2006, 2020; Khoramirad et al., 2015) and less frequent sleep disturbances (Hill et al., 2020; White et al., 2018). For example, Hill et al.’s (2006) investigation of religion and sleep among adults found that respondents who attended religious services more than once a week reported higher sleep quality than respondents who either never attended religious services or attended services once a year. A study on sleep among women living in a faith-based homeless mission reported similar findings (Brewer-Smyth et al., 2020). The findings from this study showed that women who attended services more frequently were more likely to have higher quality sleep. Evidence concerning middle-aged and older adults also demonstrates the protective qualities of service attendance. Research by Hill et al. (2020), which used data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE), revealed that among Mexican Americans aged 65 and older, more frequent service attendance was predictive of less frequent sleep disturbances.

Subjective Religious Involvement

Regarding subjective religious involvement, a number of studies have identified the beneficial impacts of multiple indicators of subjective religious involvement on sleep. Some studies indicate that greater salience of one’s religious beliefs is associated with less daytime dysfunction (as a result of sleep disturbances) and less frequent sleep disturbances (White et al., 2018; Yang et al., 2008), while other studies indicate that greater religious salience is associated with more severe sleep disturbances (Yang et al., 2008). Although religious well-being was not associated with sleep quality in a study of religion and sleep among adults living with HIV, spiritual well-being was associated with higher sleep quality (Phillips et al., 2006). Evidence concerning perceptions of attachment to God reveals that secure attachment to God is predictive of better sleep quality (Brewer-Smyth et al., 2020).

Taken together, this body of evidence concerning the connection between religious involvement and sleep is inconclusive. Despite the strong evidence indicating that religious involvement functions as either a protective factor against poor sleep outcomes or a coping resource for people with sleep problems, several studies were unable to identify relationships between a number of religious involvement indicators and sleep. These equivocal findings limit our understanding of the role of religious involvement in sleep. Further investigation is critical to address this knowledge gap.

In our review of the extant literature on the connection between religion and sleep, we identified several knowledge gaps. First, many of the studies in this area used regional or convenience samples, which limits the generalizability of the study findings. Additionally, research that examines the effects of religious involvement on sleep mainly focused on service attendance and few have examined religious involvement behaviors at the nonorganizational level. Another limitation of the current religion-sleep research is that very few studies have focused on racially/ethnically diverse samples, and studies on older African Americans are exceedingly rare. Information regarding the psychosocial factors associated with sleep specific to older African Americans is particularly important, as African Americans are two to three times more likely than non-Hispanic Whites to experience poor sleep, including insufficient sleep (Whinnery et al., 2014).

Focus of the Present Study

To address these knowledge gaps, the current study sought to determine whether nonorganizational, organizational, and subjective religious involvement are associated with sleep quality in a nationally representative sample of older African Americans. We expected that higher levels of nonorganizational, organizational, and subjective religious involvement would be associated with better sleep quality. Sleep quality was assessed with measures of restless sleep and sleep satisfaction. These two sleep measures were selected because restless sleep is a commonly used indicator of sleep quality (Ohayon et al., 2017) and a prevalent sleep complaint among adults in the U.S., affecting 30%–40% of the American adult population (Dopheide, 2020). Sleep satisfaction, a person’s perception of their sleep quality, taps into the subjective dimension of sleep quality and is highly correlated with other indicators of sleep quality, such as restless sleep and daytime dysfunction (Yi et al., 2006).

Methods

Sample

The African American sample for the current analysis was drawn from the National Survey of American Life: Coping with Stress in the 21st Century-Reinterview (NSAL-RIW). The original NSAL and NSAL-RIW were collected by the Program for Research on Black Americans at the University of Michigan’s Institute for Social Research using a national multistage probability design. The African American sample is the core sample of the NSAL. The core sample consists of 64 primary sampling units (PSUs), of which 56 overlap substantially with existing Survey Research Center National Sample primary areas. The remaining eight primary areas were chosen from the South to ensure the sample represented African Americans in the proportion in which they are distributed nationally. The African American sample is a nationally representative sample of households located in the 48 coterminous states with at least one Black adult aged 18 years or older who did not identify ancestral ties in the Caribbean. The data collection was conducted from February 2001 to June 2003. Respondents were compensated for their time. The overall response rate was 72.3%. Final response rates for the NSAL two-phase sample designs were computed using the American Association of Public Opinion Research (AAPOR) guidelines (for Response Rate 3 samples) (AAPOR, 2006) (see Jackson et al., 2004 for a more detailed discussion of the NSAL sample).

Self-administered follow-up questionnaires were mailed to all respondents after the original interviews were completed. The NSAL-RIW included measures that were not in the original survey, such as sleep measures. Of the 3570 African American respondents who completed the NSAL, a total of 2137 completed the NSAL-RIW, which yielded a response rate of 60%. The NSAL and NSAL-RIW data collections were approved by the University of Michigan Institutional Review Board. The analytic sample for this study featured 459 African American respondents aged 55 or older.

Measures

Religious Involvement

Measures of nonorganizational, organizational, and subjective religious involvement were included in the analyses. Nonorganizational religious involvement measures included reading religious books or other religious material, watching religious television programs, listening to religious radio programs, and praying. Respondents were asked the frequency with which then engaged in each of these activities, and response categories included never (1), a few times a year (2), at least once a month (3), a few times a month (4), at least once a week (5), and nearly everyday (6). Organizational religious involvement was assessed by religious service attendance. This variable was derived by combining two variables. A variable that assessed whether or not respondents attended religious services—“Other than for weddings or funerals, have you attended services at a church or other place of worship since you were 18 years old?”—was combined with a variable that assessed frequency of service attendance. The resulting service attendance variable had six categories: never, less than once a year, a few times a year, a few times a month, at least once a week, and nearly everyday. Prior research indicates that the relationship between service attendance and health is nonlinear (Taylor et al., 2012), and preliminary analyses confirmed that the associations between service attendance and sleep outcomes were also nonlinear. Consequently, we treated service attendance as a categorical variable in the multivariate analyses, and the reference category for this variable was “never.” Subjective religious involvement was assessed by this item: “How religious would you say you are – very religious, fairly religious, not too religious, or not religious at all?” Higher values on this measure represented higher subjective religiosity.

Sleep Quality Indicators

Restless sleep was measured using an item from the Center for Epidemiological Studies-Depression Scale (CES-D) (Radloff, 1977). This CES-D item asked respondents how often their sleep was restless during the past week. Response categories ranged from 0 (rarely or none of the time) to 3 (most or all of the time). Sleep satisfaction was measured with the question, “How satisfied are you with your sleep?” Possible response categories ranged from very dissatisfied (1) to very satisfied (4).

Covariates

The multivariate analysis accounted for several sociodemographic, health, and health behavior factors that are associated with sleep and religious involvement, including age, education, family income, gender, marital status, region, chronic physical health conditions, body mass index (BMI), physical activity, and depressive symptoms. Age and education were treated as continuous variables. Age was assessed in years, and education was assessed in years of completed formal schooling. Family income was also assessed continuously and coded in dollars. Due to its skewed distribution, family income was log transformed for all multivariate analyses. Missing data for family income and education were imputed using an iterative regression-based multiple imputation approach incorporating information about age, gender, region, race, employment status, marital status, home ownership, and nativity of household residents. Gender was coded as a binary variable (men = 1, women = 2), and men were set as the reference group. Marital status differentiated between respondents who were married or cohabiting and respondents who were separated, divorced, widowed, or never married (reference group). Region was coded to distinguish between respondents who resided in the Northeast, North Central, South (reference group), and West. Chronic physical health conditions represented a count of self-reported, physician-diagnosed physical health conditions. BMI was treated as a continuous variable and calculated as: BMI=703*weight (lbs.)/height (ins.)². Physical activity was assessed using a three-item index. The items asked, “How often do you: (a) work in the garden or the yard; (b) engage in active sports or exercise; (c) take walks? Would you say often (4), sometimes (3), rarely (2), or never (1)?” A mean physical activity score was derived from these three items. Depressive symptoms were measured using the 12-item CES-D Scale. This scale assessed the extent to which in the last 30 days respondents had restless sleep, had trouble keeping their mind on tasks, enjoyed life, had crying spells, could not get going, felt depressed, hopeful, happy, as good as other people, that everything was an effort, that people were unfriendly, and that people disliked them. Positive valence items were reverse coded. A continuous depressive symptoms score was derived from computing a mean score from all items of the scale except for the “restless sleep” item (Cronbach’s alpha = .76). The “restless sleep” item was omitted from the depressive symptoms score because this item was used as a sleep outcome.

Analysis Strategy

Multiple linear regression analyses were performed to estimate the effects of religious involvement on sleep satisfaction and restless sleep outcomes. All multivariate analyses took into account the complex multistage clustered design of the NSAL-RIW sample, unequal probabilities of selection, nonresponse, and poststratification. All analyses were conducted in Stata 15.1.

Results

Table 1 presents the distribution of the study variables. More than half of respondents were women (59%), and the mean age of respondents was 66 years. Almost two out of five respondents were married or cohabiting (42%). Slightly over half of respondents resided in the South (56%), and approximately one out of five respondents lived in the Midwest (21%). More than two out of five respondents attended religious services at least once a week (43%), and close to one quarter of respondents (24%) attended religious services a few times a month. On average, respondents had about 12 years of education and the annual family income was $30,530. Regarding health measures, respondents reported 2.68 chronic health conditions on average and low levels of depressive symptoms, with a mean score of .43 (range 0–3). The mean BMI was 29.13, and the mean score for physical activity was 2.62 (range 1–4). Respondents reported moderate to high levels of religious involvement related to reading religious materials, watching religious television programs, and listening to religious radio programs. Overall, praying and subjective religiosity were endorsed at relatively high levels. Respondents indicated high levels of sleep satisfaction and low levels of restless sleep.

Table 1.

Demographic Characteristics of the Sample and Distribution of Study Variables.

	N (%)	Mean (S.D.)	Min	Max
Read religious materials		4.71 (1.51)	1	6
Watch religious television		4.49 (1.49)	1	6
Listen to religious radio		3.78 (2.05)	1	6
Pray		5.72 (1.00)	1	6
Religious service attendance
Never	13 (3.30%)
Less than once a year	46 (11.21%)
A few times a year	54 (12.22%)
A few times a month	118 (24.41%)
At least once a week	198 (43.41%)
Nearly everyday	30 (5.45%)
Subjective religiosity		3.43 (.70)	1	4
Restless sleep		.60 (.95)	0	3
Sleep satisfaction		3.17 (.84)	1	4
Gender
Men	149 (40.56%)
Women	310 (59.44%)
Marital status
Separated/divorced/widowed/never married	311 (57.64%)
Married/cohabiting	147 (42.36%)
Region
Northeast	66 (15.88%)
Midwest	96 (20.68%)
South	271 (55.64%)
West	26 (7.80%)
Age		65.97 (8.19)	55	90
Education		11.82 (3.27)	0	17
Family income		30530.32 (32568.01)	0	250,000
Chronic health conditions		2.68 (1.92)	0	11
Depressive symptoms		.43 (.47)	0	2.73
BMI		29.13 (5.75)	16.44	51.37
Physical activity		2.62 (.85)	1	4

Notes. Percents and N are presented for categorical variables and Means and Standard Deviations are presented for continuous variables. Percentages are weighted and frequencies are un-weighted.

Findings from the multivariate analysis indicated that watching religious television programs was positively associated with restless sleep (Table 2). That is, respondents who more frequently watched religious television programs also reported experiencing restlessness during sleep more frequently. Religious service attendance was associated with sleep satisfaction (Table 2). More specifically, compared to respondents who never attended services, respondents who attended services less than once a year, at least once a week, or nearly everyday reported higher levels of satisfaction with their sleep. Also, subjective religiosity was inversely associated with sleep satisfaction, such that more religious respondents reported lower levels of sleep satisfaction.

Table 2.

Regression Analyses of Sleep Outcomes Among Older African Americans.

	B (SE)
	Restless Sleep	Sleep Satisfaction
Read religious materials	−.05 (.04)	−.02 (.03)
Watch religious television	.08 (.03)*	−.01 (.04)
Listen to religious radio	−.01 (.02)	.03 (.03)
Pray	−.08 (.07)	.09 (.06)
Religious service attendance
Never^a	0	0
Less than once a year	.29 (.26)	.68 (.31)*
A few times a year	.37 (.27)	.58 (.31)
A few times a month	.23 (.26)	.55 (.33)
At least once a week	.20 (.25)	.67 (.29)*
Nearly everyday	.03 (.27)	.75 (.26)**
Subjective religiosity	.06 (.08)	−.20 (.07)*
Gender
Men^a	0	0
Women	.08 (.10)	−.22 (.10)*
Age	.00 (.01)	.01 (.01)
Marital status
Separated/divorced/widowed/never married^a	0	0
Married/cohabiting	−.06 (.11)	.18 (.10)
Region
South^a	0	0
Northeast	.21 (.12)	−.27 (.20)
Midwest	.00 (.10)	−.18 (.17)
West	−.06 (.14)	.03 (.19)
Education	.01 (.01)	.01 (.01)
Family income	.06 (.06)	−.18 (.06)**
Chronic health conditions	.04 (.02)	−.07 (.03)*
Depressive symptoms	.91 (.11)***	−.43 (.13)**
BMI	−.00 (.01)	.01 (.01)
Physical activity	−.02 (.04)	−.02 (.04)
Intercept	−.92 (.89)	4.13 (.67)***
N	418	415

B = regression coefficient; SE = standard error.

*p < .05. **p < .01. ***p < .001.

^aReference category.

Discussion

This study investigated the relationship between religious involvement and sleep among older African Americans. There is a paucity of research on the psychosocial determinants of sleep among older African Americans, which represents an important knowledge gap in the sleep literature. This study makes a significant contribution to the sleep literature by bridging this knowledge gap. The current analysis found that overall, older African Americans reported high levels of religious involvement at the nonorganizational and organizational levels, with praying and religious service attendance being among some of the most frequently engaged religious activities. Respondents’ sleep quality was relatively good based on their self-reports of restless sleep and satisfaction with sleep. The multivariate analyses revealed that several religious involvement indicators across multiple dimensions (i.e., nonorganizational, organizational, and subjective involvement) were related to restless sleep and sleep satisfaction.

The findings revealed that some religious involvement indicators were associated with poor sleep outcomes. For example, older African Americans who indicated that they watched religious television programs more frequently also experienced restless sleep more frequently. Additionally, respondents who had higher levels of subjective religiosity reported lower levels of sleep satisfaction. These findings seem negative and counterintuitive; however, we believe that religious involvement can also function as a coping resource for persons experiencing sleep problems, which will promote better sleep. For example, respondents who were struggling with restless sleep may have believed that watching religious television programs could help soothe them and bring about a sense of calm and serenity, which would aid in their sleep. Consequently, older African Americans who had problems with restless sleep may have increased their consumption of religious television programs to help them cope with this sleep problem. Similarly, respondents who were dissatisfied with their sleep may have been turning to religion or God to cope with their poor sleep and therefore may view themselves as more religious. These results are in accordance with other studies reporting inverse relationships between religious involvement and sleep (Bélanger et al., 2020; Khoramirad et al., 2015). Research in this area shows that people who have higher levels of religious involvement are more likely to report sleep medication use, longer sleep latency, and poorer sleep quality (Bélanger et al., 2020; Khoramirad et al., 2015). These findings are also concordant with evidence in the broader literature regarding the religion-health connection, which finds that, in some instances, individuals with mental or physical health struggles will become more religiously involved in reaction to their declining health (Chatters, 2000; Nguyen, 2020; Taylor et al., 2012).

Interestingly, most of the nonorganizational religious involvement indicators (i.e., listening to religious radio programs, reading religious texts, and praying) were unassociated with both sleep outcomes. While these religious practices have not fully been investigated in sleep research, this finding contrasts with evidence indicating that praying and reading religious texts are associated with a range of mental health outcomes (Himle et al., 2012; Nguyen, 2020; Taylor et al., 2011). Past research demonstrates that service attendance is one of the strongest and most reliable religious involvement determinants of health. We postulate that the inclusion of service attendance in the current analysis accounted for a large proportion of the variance in sleep outcomes. This may have resulted in null effects for some of the nonorganizational religious involvement variables.

We found that religious service attendance was associated with sleep satisfaction. Older African Americans who either attended religious services less than once a year, at least once a week, or nearly everyday reported higher levels of satisfaction with their sleep than older African Americans who never attended religious services. This finding demonstrated that not all categories of service attendance frequency were associated with sleep satisfaction. For example, there were no differences in levels of sleep satisfaction between those who attended religious services a few times a year or a few times a month and those who never attended. This pattern of findings suggests that the effect of service attendance on sleep satisfaction is not linear, which is consistent with research on service attendance and other indicators of health (Sternthal et al., 2010; Taylor et al., 2013). Given the nonlinear nature of the association between service attendance and sleep satisfaction, previous sleep studies that treated service attendance as a continuous or dichotomous (i.e., attends, does not attend) measure may have misspecified the functional form of the association between service attendance and sleep. This may have contributed to some of the null findings related to service attendance and sleep in the extant literature.

The curvilinear relationship between service attendance and sleep satisfaction indicates that among older African Americans who attend church, frequent and infrequent attendees benefit the most from going to church. The finding that frequent churchgoers were more satisfied with their sleep is in line with a large body of research indicating a positive relationship between service attendance and health (Chatters, 2000; Nguyen, 2020). People who attend religious services weekly or multiple times a week are more likely to be socially integrated within their congregational networks. People who are well integrated within their congregational networks tend to receive more support from church members. The higher levels of church support that frequent service attendees receive could help them better cope with major and minor life stressors and mitigate the negative effects of these stressors on sleep. Moreover, frequent church attendees are likely to have closer relationships with other church members, and through social influence, church members can encourage, support, and help these individuals to adopt or maintain health behaviors that promote sleep health (e.g., regular physical activity) and minimize or abstain from negative health behaviors that disrupt sleep, such as nicotine use and heavy alcohol consumption (Hill et al., 2018).

However, our findings indicating that infrequent churchgoers (i.e., respondents who attended services less than once a year) benefitted with respect to sleep satisfaction while moderately frequent churchgoers (i.e., respondents who attended services a few times a year or a few times a month) received no benefit from attending church is counterintuitive. Ancillary analyses indicated that men predominated the “less than once a year” attendance category, and women predominated the “a few times a month” attendance category. Bivariate analyses (part of the ancillary analyses) indicated that the difference in gender composition between these two service attendance categories was statistically significant; thus, these gender differences may have canceled out the effects of moderate service attendance and contributed to the counterintuitive pattern of findings. Evidence regarding sleep quality and sleep disturbances indicates that men tend to have higher quality sleep and fewer sleep disturbances (Gamaldo et al., 2014; Grandner et al., 2013; McCrae et al., 2008). Therefore, service attendance among infrequent attendees may have predicted greater sleep satisfaction because this group was comprised largely of men, who tend to have better sleep outcomes than women. In contrast, service attendance among respondents who attended services a few times a month may have been unrelated to sleep satisfaction, as this group was comprised largely of women, who tend to have poorer sleep outcomes than men. Additionally, it is possible that older African Americans who attended religious services with moderate frequency may have also engaged in other religious activities that could influence sleep but were not accounted for in the analysis, which could have contributed to the null findings for service attendance in these two groups of respondents.

It is important to note that livestreaming of religious services have become increasingly common, especially during the coronavirus pandemic (Pew Research Center, 2020). Livestreaming expands access to religious services, particularly for older adults. In-person religious services can be difficult to attend for older adults who lack transportation to and from church or have functional limitations or chronic or severe health conditions. Thus, online services provide a more accessible way to attend religious services for these individuals. This shifting pattern of religious service attendance suggests that online service attendance may also play a role in the sleep of older African Americans. Future research should distinguish between in-person and online service attendance and determine whether online service attendance is associated with sleep quality. Additionally, future investigations should explore whether the effects of online service attendance on sleep quality differs from that of in-person service attendance.

Strengths and Limitations

There are three key strengths of our study. To our knowledge, this is the first study to examine the influence of religious involvement on sleep among African American older adults. While research on the religion and health connection has examined a broad range of health outcomes, sleep has been infrequently investigated as a health outcome in this area of research. Furthermore, most investigations of sleep and religious participation predominately focus on the non-Hispanic White population, and little is known about the relationship between religion and sleep among racial or ethnic minority populations. This study contributes to the literature by examining the function of multiple dimensions of religious involvement in the sleep quality of older African Americans. A second strength of this study is the use of the NSAL-RIW data set, which featured a nationally representative sample of older African Americans. Many previous studies utilized convenience, purposive, or regional samples, which are not nationally representative of the United States population and precludes the generalizability of study findings. Third, our study utilizes a broad diversity of indicators for religious involvement, including organizational, non-organizational, and subjective indicators of religious involvement. Many previous studies exclusively focus on church/religious attendance.

There are also a few limitations worth noting. Given that this study used a cross-sectional design, we are unable to determine how the relationship between religious involvement and sleep outcomes develop over time. There could be substantial differences in religious involvement and sleep outcomes if the individual is a long-time church member with high church attendance and involvement versus an individual who is less consistent over time in both attendance and involvement. Additionally, there could be critical periods (including after a stressful life event and/or the death of a close family member or friend) which further motivates an individual to go to church more often and have greater religious participation while simultaneously influencing their sleep. Furthermore, because of the cross-sectional nature of our study, the potential for reverse causality exists as well. Individuals who have good sleep health could be healthier overall and are more physically able to attend church. Future studies should employ longitudinal data and analytic strategies to disentangle these relationships. This study did not account for the type of church (e.g., mega church, storefront church) that respondents attended. Different types of churches have varying levels of services and programs available to congregants. Utilization of these services could influence sleep outcomes. Future research should control for the type of church that respondents attended or the utilization of services and programs provided at their church. Additionally, this study did not control for nighttime social media use, which is linked to poor sleep quality (Scott & Woods, 2019). However, this is less likely to be a confounding factor in this study, as the NSAL-RIW was collected from 2001–2003. Social media use, especially among older adults, was much less prevalent during that time period than it is now. Nevertheless, future studies should control for the effects of social media use on sleep quality. Lastly, the study measures were self-reported, which are subjected to recall and social desirability biases.

Practice Implications

The current findings have several implications for clinical practice with older African Americans. Given the protective and coping roles of religious involvement in sleep quality, a brief religiosity/spirituality assessment should be part of the clinical assessment. If the client indicates that religion or spirituality is important to them, then a more in-depth assessment is appropriate. For clients who identify their religiosity/spirituality as a strength or resource, clinicians can incorporate aspects of religious practice (e.g., prayer, reading religious texts, service attendance) into the treatment plan. Furthermore, faith-based organizations can play an important role in the sleep health of older African Americans. For example, collaborations between community health centers and churches can increase awareness and access to healthcare that can improve sleep quality and treat sleep disorders and health conditions that affect sleep quality (e.g., hypertension, diabetes). This is particularly important, as many older adults assume that sleep problems are a normative aspect of the aging process rather than treatable medical conditions. In particular, collaborations with clergy are critical. Clergy members often act as gatekeepers to church members and are well-respected and trusted by church members. Thus, collaborative relationships with clergy can help increase older African American’s confidence in and use of health services, especially among people reluctant to seek professional healthcare.

Conclusion

In conclusion, this study identified several religious involvement indicators from multiple dimensions of religious involvement (nonorganizational, organizational, and subjective) that were related to sleep quality among older African Americans. The current analysis demonstrates the importance of examining a diverse range of religious involvement domains, which could point to different explanatory pathways between religious involvement and sleep. The study findings revealed that some indicators of religious involvement (watching religious television programs and subjective religiosity) may function as coping resources for older African Americans who were struggling with restless sleep. Our findings also indicated that religious involvement, particularly service attendance, has a beneficial effect on sleep. As the first study on the connection between religion and sleep specifically among older African Americans, the current findings serve as preliminary evidence for the multiple functions of religious involvement in the sleep quality of this population. Given the dearth of knowledge on sleep and its determinants in African Americans, this study provides critical information that has implications for understanding the racial disparities in sleep between African Americans and non-Hispanic Whites, which has been hypothesized to be a contributing factor to broader racial disparities in health. These findings suggest that clinicians should assess for clients’/patients’ religious orientation and involvement level and consider the role of religious involvement as a strength or coping resource.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The preparation of this article was supported by a grant from the National Heart, Lung, and Blood Institute to Ann W. Nguyen (5R25HL105444-11).

ORCID iDs

Ann W. Nguyen

Karen D. Lincoln

Tyrone Hamler

Uchechi A. Mitchell

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