Religiosity and Physical Health of Middle–Old Aged African Americans: The Linking Role of Self-Control

Abstract

Objective: This study examined a psychological process (i.e., sense of control) that links religiosity to self-reported physical health in older African Americans. Methods: Two waves of data from 231 middle–old aged African Americans (AAs) were used to test two specific hypotheses: (a) religiosity influences changes in sense of control middle–old aged AAs, and (b) sense of control influences changes in global physical health in middle–old aged AAs. The analysis used two modeling approaches: (a) an autoregressive cross-lagged modeland (b) a parallel growth/change model. Results: The results of both types of models showed that religiosity positively influenced changes in sense of control and that sense of control positively influenced changes in physical health in middle–old aged AAs over time. Discussion: These findings provide evidence that sense of control links religiosity to physical health in older African Americans. The theoretical and practical implications of the findings are discussed.

Keywords

Older African Americans religiosity sense of control physical health

Religion is a psychological force that can influence individual outcomes in various life domains including health and well-being (McCullough & Willoughby, 2009; Page et al., 2020). Extant studies conducted in various countries that involved different cultures and religions have consistently documented a positive association between religiosity (i.e., religious involvement as indicated by religious and spiritual beliefs, religious participation, and experiences in relation to the divine) (Page et al., 2020) and general measures of health and well-being in adults, such as self-rated health (Idler and Benyamini, 2009), longevity (McPherson, Smith-Lovin, & Cook, 2001), and decreased mortality rates (Krause et al., 2016). These studies have also shown direct negative associations between various indicators of religiosity and specific physical health problems such as cardiovascular disease, stroke, cancer, hypertension, breast cancer risk, physical functioning, and sleep disturbance (Gillum & Williams, 2009; Hill, Bradshaw, & Burdette, 2016, 2021; Tan et al., 2013; Wolinsky et al., 2009). In addition, religiosity has been shown to have favorable associations with an array of biomarkers across the autonomic nervous system, hypothalamic-pituitary-adrenal axis, and immune systems, such as blood pressure, pulse rate, and C-reactive protein, interleukin-6, and cortisol levels, and with the cumulative index of biomarkers, allostatic load (Das & Nairn, 2014; Hill et al., 2017; Hill, Rote, et al., 2017; Tobin & Slatcher, 2016).

Furthermore, previous studies have provided evidence for the association between various indicators of religiosity and positive health-related attributes, such as lower levels of health-risk behaviors, including substance use (Burdette et al., 2018; Klemmack et al., 2007; D. Hill & McCullough, 2008), and higher levels of health-promoting behaviors, such as eating balanced diets, exercise, attending preventive care, and taking supplementary medicine (Hill & Pargament, 2008; Persynaki et al., 2017, Islam & Johnson, 2003; Shmueli & Tamir, 2007). In addition, religiosity has also been shown to be positively associated with better mental health, including lower levels of depressive symptoms (Acevedo, Ellison, & Xu, 2014) and decreased stress levels (Krause et al., 2016). All these health-related attributes have been shown to contribute to better individual physical health.

In addition, previous research contends that religiosity fosters psychosocial resources that connect various indicators of religiosity to a range of health and well-being outcomes through social-behavioral processes, including social support/control, health behaviors, and coping (Hill & McCullough, 2008; Joiner et al., 2002; King et al., 2020; Strawbridge et al., 2001). As McCullough and Willoughby (2009) pointed out in their seminal article, such social-behavioral processes significantly explain inter-individual inequalities in health and well-being although a large portion of inequalities remains unexplained. An increasing number of related studies suggest that in addition to social-behavioral processes, psychological resources, particularly the control beliefs fostered by religiosity, may play an important role in explaining inter-individual inequalities in health. Psychological resources are expected to connect religiosity to health outcomes through enhanced intraindividual psychological and physiological intraindividual processes (Page et al., 2020).

Previous research has focused on and used different dimensions of control beliefs such as self-control, sense of control, and health locus of control. Self-control, which has been the focus of most psychologically oriented studies, represents one’s self-regulatory strength or the ability to resist basic internal drives (Geyer & Baumeister, 2005; McCullough & Willoughby, 2009). Extant research has documented that religion promotes individual self-control (Friese & Wänke, 2014; Pirutinsky, 2014; Rounding et al., 2012). McCullough and Willoughby (2009) clearly articulated how religion promotes one’s self-control by influencing the selection, pursuance, and organization of individual goals, and by facilitating and fostering self-regulatory strength. Recently, Marcus and McCullough (2021) reviewed a large volume of literature, including longitudinal and experimental studies, and provided supporting evidence for the causal influence of religiosity on control beliefs, specifically self-control.

Sense of control, which has been the focus of social psychologically oriented studies, represents the general beliefs that individuals master and control and that shape various aspects of their lives and reflect the learned generalized expectation that outcomes are contingent on their own choices and actions (Jung, 2019; Ross & Mirowsky, 2013; Schieman et al., 2005). Individuals with a high sense of control report being effective agents in their own lives (Mirowsky & Ross, 2003). That is, sense of control is the cognitive awareness of a connection between actions and their outcomes. Sociologists have extensively investigated and documented how positive life experiences in social domains (e.g., work and economic domains) enhance (or deplete) one’s sense of control or similar constructs such as the loci of control and mastery (e.g., Wickrama et al., 1997, 2008). These researchers posited that in general, life experiences may contribute to changes in one’s values, feelings, attitudes, and behaviors, and these changes may manifest as individual characteristics such as sense of control (Li et al., 2014; Savickas, 2005). Religious studies confirm these findings by showing that religious involvement also fosters one’s sense of control through the development of personal empowerment, enhanced social support, and coloration with God, which will be discussed further in a later section.

The health locus of control is more specific and distinct from the general sense of control because it focuses explicitly on health-related outcomes (Bennett et al., 2017; Hill et al., 2021). Although all these dimensions of perceived control beliefs have been considered distinct constructs influenced by religiosity and contribute to physical health through differing processes, they have been shown to correlate with and overlap each other (James, 1994). In the present study, we specifically investigated the mediating role of a more generalized dimension of perceived control beliefs, which is sense of control, in relation to the association between the religiosity and physical health of older African Americans.

Only a relatively few studies have investigated religiosity and health in older African Americans. Moreover, religiosity is important to older American adults, as aging adults show greater religious participation and importance than their millennial counterparts (King et al., 2020; Pew Research Center, 2016). Older African Americans possess race/culturally specific characteristics related to religion. For example, as previously claimed, compared with the US general public, older African Americans include more protestants who attend black churches (Pew Research Center, February 16, 2021, “Faith Among Black Americans”). In addition, older African Americans show greater congregational cohesiveness and racial homogeneity and a relatively higher level of religious participation than the US general public (Pew Research Center, February 16, 2021, “Faith Among Black Americans”). They also possess more protective religious beliefs (Shorter-Gooden, 2004), higher positive expectations of persons of faith, and more salient religious impacts on health (Levin et al., 2021). Furthermore, African Americans have been shown to have a relative physical health disadvantage, particularly in their older years (Tsao et al., 2022). African American’s health disadvantage may be attributed to adverse physiological processes related to their chronic and cumulative stressful life experiences (e.g., racial/systematic discrimination). These adverse physiological processes unique to African Americans may condition processes involving religiosity, sense of control, and physical health. These unique characteristics of older African Americans warrant an intra-group investigation to reveal culturally specific processes (Goodwin, 2003) that explain intra-group physical health disparities. Such findings may inform health prevention and promotion programs that target older African Americans.

Several methodological issues in previous religiosity–health research must be considered. The findings of most studies have not adequately clarified the potential bi-directional associations among religiosity, control beliefs, and physical health outcomes, although some studies have suggested that mutual influences may exist among these attributes (Krause et al., 2000). Second, previous studies have not explicitly focused on absolute changes in religiosity, sense of control, and health outcomes over time, which would have provided important findings about their associations.

Thus, the specific purpose of the current study is to address two research questions: (a) How are individual religiosity, sense of control and physical health associated with each other? (b) How does the level of one of these attributes influence subsequent changes in another attribute over time? We expect such an analysis to provide important findings regarding the inter-play between religiosity, sense of control and physical health of older African Americans. The present study examines longitudinal data from the study of middle–old aged African Americans, which collected data in four waves (the baseline and three follow-ups). Given the limitation of parallel repeated data on religiosity, the present study uses data from second and third follow-ups only, which were one year apart.

The present study focuses on the religious and spiritual beliefs (hereafter, referred as religio-spiritual beliefs) and religious participation dimensions of religiosity and perceived global physical health as health outcomes. Previous research suggests that perceived global health is an inclusive and accurate measure of health, capturing not only the full array of illnesses but also the symptoms of disease as yet undiagnosed but present in preclinical or prodromal stages. In particular, poor self-rated health has been shown to be associated with inflammation among older adults (Christian et al., 2011). Idler and Benyamini’s (1997) findings from 27 studies in US and international journals show that global self-ratings of health are a valid predictor of mortality.

The present analysis uses two modeling approaches: (a) the autoregressive cross-lagged model (ARCLM) and (b) the parallel growth/change model (PGM), both of which can provide evidence of causal influences among study constructs. First, as depicted in panel A, Figure 1, the present study tests the following specific directional hypotheses using an ARCLM: H1a) Religiosity influences self-control after accounting for the influence of lagged sense of control (rather than the reversed hypothesis H1aR—sense of control influences religiosity after accounting for the influence of lagged religiosity). H1b) sense of control influences physical health after accounting for the influence of lagged physical (rather than the reversed hypothesis H1bR—physical health influences sense of control after accounting for the influence of lagged sense of control) health (see the analysis section for details). Hence, the ARCLM analysis provides evidence for the directional hypotheses by predicting residual changes in the outcome variable. Also, as shown in the figure, this analysis allows to test potential reversed causations and/or bi-directional associations among study attributes.

Figure 1.

Examining associations among religiosity, sense of control, and physical health.

Second, as depicted in panel B, Figure 1, the present study tests the following directional hypotheses using PGM: H2a) The level of religiosity influences subsequent absolute changes in sense of control over time (rather than the revised hypothesis H2aR—the level of sense of control influences subsequent changes in religiosity); H2b). The level of sense of control influences subsequent absolute changes in perceived global physical health (rather than the reversed hypothesis H2bR—the level of physical health influences subsequent absolute changes in sense of control). Therefore, we expect that the PGM analysis will provide evidence for the directional hypotheses by predicting absolute changes in the outcome variable rather than the reversed hypotheses. As depicted in Figure 1, both ARCLM and PGM test the above directional hypotheses after allowing for potential reversed causation or bi-directional associations among the study variables. Each model is tested separately using religio-spiritual beliefs and religious participation as the religiosity measure. These study hypotheses are discussed in the paragraphs that follow.

Religiosity and Sense of Control

Religio-Spiritual Beliefs and Sense of Control

Previous research suggests that religiosity, particularly religio-spiritual beliefs, develops one’s feelings of sense of control. James (1994) elaborated on several mechanisms through which religio-spiritual beliefs may foster one’s sense of control. Religion portrays God as loving, caring, and responsive to the needs of believers (Bradshaw, 2010). Thus, when they believe that God is involved in and represents the cornerstone of their lives for their well-being, they may draw strength from the God connection to resolve problems in their lives (James, 1994; Schieman & Bierman, 2011). Thus, religious individuals may feel that life challenges are easier to overcome, which can bolster their feelings of sense of control. Some studies have even suggested that religious cognition is automatically transmitted as an individual sense of control (Wink et al., 2007), while other studies have explained this association using different perspectives.

Consistent with the sociological notion of reflected appraisal of symbolic interactionism (Rosenberg, 1979), a person’s feelings of self-worth are a product of how that person believes that others see him or her. Religious individuals are taught that they are evaluated by how God sees them to whom they are attached (Kirkpatrick, 2005). Thus, individuals who believe that God has a positive view of them may develop feelings of self-worth, which may, in turn, contribute to a sense of control.

Religious Participation and Sense of Control

Participation in religious affairs and rituals can foster a sense of control through social psychological processes. First, religious institutions provide effective outlets for formation and engagement in groups of similar individuals, in turn creating opportunities for building companionship (Bath & Deeg, 2005). In particular, friendship and engagement with similar persons who share many of the same characteristics, attitudes, behaviors, and beliefs (homogeneous social context) may enhance individual psychological resources. This may be attributed to the fact that similar individuals are more likely to socialize, exchange advice, and respect each other (McPherson, Smith-Lovin, & Cook, 2001). Such encounters tend to give individuals affirmation that they are fulfilling basic role identities and expectations, which would enhance their sense of control (Ellison & George, 1994). Second, religious institutions offer supportive social contexts that provide the exchange of social, financial, and emotional support among individuals/families. Beliefs that they can obtain support in the time of need may develop sense of control (Ellison & Burdette, 2012). Third, religious groups provide opportunities for the development of leadership qualities (Verba et al., 1995), allowing individuals to develop their self-confidence through the planning and implementation of leadership tasks, such as church committees, religious education classes, charitable events, and athletic teams (Ellison & Burdette, 2012). These activities provide individuals with experiences that may help them enhance their skills and capabilities to influence the environment, thereby enhancing their sense of control.

Potential Reversed Causations

Conversely, previous studies have also suggested that reverse causations from individual control beliefs to religiosity or influence each other, forming a reciprocity between them. For example, individuals with a poor sense of control and a positive personality might have difficulty participating in religious activities and committing to religio-spiritual beliefs (Hathaway et al., 2003; McCullough et al., 2003). That is, persons with a low sense of control may be less inclined than their counterparts with a higher sense of control to seek out social participation or collective activities such as attendance in worship services. Instead, they may find clearer, more rigid religious doctrines such as biblical literalism to offer meaning and clarity to an otherwise disordered world (Ellison & Burdette, 2011).

Furthermore, many studies suggest that sense of control consists of two distinct components. One is a trait-like, stable, enduring disposition, and the other is state-like and malleable, which is more likely to vary with individual life experiences (Pressman & Cohen, 2005; Wu, 2016). As the stable attribute is more likely to influence less stable attributes rather than vice versa (Bollen, 1989), it is reasonable to expect that the stable component of sense of control may impact the religious involvements of individuals who have been shown to be less stable over the course of their lives (Ingersoll-Dayton et al., 2002). That is, traits relevant to self-control may influence later levels of religiousness (Wink et al., 2007). Thus, in the present study, we explore the potential bi-directionality between religious involvement and sense of control in older African Americans.

Self-Control and Global Physical Health

Sense of control is a foundational human motivation (Landau et al., 2015). Mainstream psychosocial and health research considers sense of control as a crucial resource that contributes to a range of physical and mental well-being outcomes over the course of one’s life (Lee et al., 2017; Matthews et al., 2010; Page et al., 2020; Ross & Mirowsky, 2013; Wickrama et al., 2012). Sociological research examining differences in community contexts may suggest that perceived control over one’s life and environment is more important than self-control when explaining health differences between different life contexts (Gillbert and De Ridder, 2019). However, the mediating role of control beliefs has not been adequately empirically examined in religiosity–health research (McCullough & Willoughby, 2009). This possible mediating pathway may be particularly likely during the later course of life, given the biological aging processes in later life.

Previous studies have documented that psychological resources, such as positive affect, self-esteem, and sense of control, directly influence individual physical health outcomes by strengthening physiological functions, including hypothalamic-pituitary-adrenal axis (HPA) reactivity to stress and immune and metabolic factors (Matthews et al., 2010; Steptoe et al., 2008). Moreover, research has shown that psychological resources have health-protective biological correlates, such as a lower cortisol level, better ambulatory heart rate, reduced cardiovascular stress reactivity, and a lower rate of disease (Steptoe et al., 2005, 2008). The direct health influence of sense of control suggests neurophysiological mechanisms (Zilioli et al., 2016) in that the association between psychological resources and better physical health may operate through enhanced brain functioning or increased resiliency to stress (e.g., Center on Social Determinants of Health, 2008).

Studies have suggested that greater sense of control is associated with effective coping strategies, which, in turn, are associated with self-reported poor physical health outcomes (Boals et al., 2011). Furthermore, believing that one has control over one’s life can contribute to the initiation and maintenance of positive health behaviors (e.g., eating balanced diets, obtaining preventive care, and physical activity) and to the inhibition of health-damaging behaviors (e.g., substance use) (O’Neal et al., 2014; Wickrama et al., 1997, 2012). Thus, individuals with enhanced psychological resources, such as sense of control, are more likely to engage in an overall positive lifestyle, which has been shown to be linked to better physiological functioning and physical health outcomes (McEwen & Gianaros, 2010). Although we will not test these mediating behavioral mechanisms in the present study, we expect that psychosocial resources such as sense of control will have a positive influence on physical health outcomes in mid-old aged African Americans, partly through behavioral mechanisms.

Conversely, there may also be a possibility that poor physical health may erode one’s positive feelings, including sense of control, because poor health is stressful. However, these potential mutual influences among constructs may exist, although they have not been adequately incorporated in the analyses by previous studies. Thus, in the present study, we explore the potential bi-directional association between sense of control and physical health in middle–old aged African Americans.

Methods

Participants

Data were collected from African American adults who participated in a broader longitudinal study to determine the effectiveness of a church-based intervention to reduce cardiovascular risk. Participants were randomly selected from six churches (three treatment, three comparison) located in a two-county area of North Florida, stratified by age and sex (see Ralston et al., 2014 for a detailed description). Churches represented Missionary Baptist (n = 5) and African Methodist Episcopal (n = 1) denominations which have similar Christian theological beliefs. Participants, who were recruited with assistance from the pastors, included individuals who provided responses to the food and lifestyle questionnaire which was self-administered at data collection sessions at the churches. The sample for this study included participants who completed the questionnaire for at least two of the first three waves (n = 231) Waves of data collection were baseline, six and 18 months, respectively. Overall participant retention rate across the four phases was 92.6% (Ralston et al., 2020). Respondents included men and women (73% female, 27% male). Respondents’ educational attainment ranged from some high school (n = 23; 10.0%) to PhD/M.D./J.D. (n = 5; 2.2%) with a median of some college experience (n = 64; 27.8%). At wave 1, participants reported ages ranging from 43 to 49 (n = 40; 19%) to over 91 (n = 1; .5%) with a median age range of 57–63 years (25.2%). On average, respondents were married (n = 103; 45.0%) with two children (n = 58; 25.4%).

We performed an attrition analysis between the two groups: the participants (stayers) and the attritors (who dropped out after the first wave). The mean differences indicate that stayers possess significantly higher religio-spiritual beliefs. No significant differences were found in the other study variables, which suggests that attrition did not significantly influence the biased study results.

Measures

Religio-Spiritual beliefs

Religio-spiritual beliefs composite measure was created using three items. Item responses range from 0 = Not at all true, 1 = Not very true, 2 = Somewhat true, 3 = Very true and 4 = Completely true/never (0) to very often (4) and higher scores indicate greater positive religio-spiritual beliefs. Questions included “In my life, I experience the presence of the divine,” “My spiritual beliefs lie behind my whole approach to life,” and “I carry my spiritual beliefs into all other dealings in life.” The scale had adequate internal consistencies (α > .80).

Religious Participation

Respondents responded to three items assessing the frequency of attendance at Sunday service, religious enrichment activities, and ministry/auxiliary activities. Response options included ‘ = never, 1 = once a month, 2 = twice a month, 3 = 3 or more times a month, 4 = once a week, 5 = twice a week, 6 = 3 or more times a week. Sum of responses to these three items served as a measure for religious participation. The scale had adequate internal consistencies (α > .80). The means were 9.11 (SD = 4.47) and 9.15 (SD = 4.41), respectively.

Sense of Control

Although the Perceived Stress Scale (PSS; Cohen et al., 1983) is generally used as a single measure of perceptions of stress, (resources and vulnerabilities related stress) confirmatory factor analysis of 12 items from the PSS revealed two distinct factors within this scale (comparative fit index [CFI] > 0.94, root mean square error of approximation [RMSEA] < 0.06, and χ2/df ratio of <2.00) for both waves, and factor loadings ranged from 0.56 to 0.70. Upon reviewing the items comprising these two dimensions, we argue that these dimensions reflect respondents’ psychological confidence or sense of control (5 items), and psychological vulnerability to stress (7 items) (Wallace & Forman, 1998; 2012). The correlation between these two factors was not statistically significant (r < −0.10, p >.20) showing good discriminant validity between the two.

l. Questions for the five-item positive factor included “How often have you felt that you were effectively coping with important changes that were occurring in your life?” “How often have you felt confident about your ability to handle your personal problems?” “How often have you felt things were going your way?” “How often have you been able to control the irritations in your life?” and “How often have you been able to control the way you spend your time?” Responses for the items range from never (0) to very often (4), and higher scores. The factor analysis showed that these five items load into a single factor (the loading were.70, 0.85, 65, 0.56 and 0.57, respectively). Sense of control measure was constructed by summing these five items. Higher scores of this measure indicate greater perceived control. This measure had adequate internal consistency (α > .80). Previous studies have demonstrated that this control measure has good convergent, discriminant and predictive validities and have used as a composite measure of perceived control beliefs (O’Neal et al., 2014; Wickrama, Ralston, O’Neal et al., 2012). Thus, we expect this measure to adequately capture general beliefs about the ability to control one’s own life, that is, sense of control.

Global Physical Health

Self-assessment of global health was obtained in both waves using an item asking participants to rate their overall physical health in general following on a scale from 5 = excellent to 1 = poor: “In general, How would you rate your overall health?” The means for two repeated measures were 3.64 (SD = 0.88) and 3.77 (SD = 077), respectively.

Control Variables

Intervention, age, education, and gender were included as control variables in the current analyses. Approximately half of the sample received an intervention comprised of three conceptual components (health awareness, knowledge/clinical learning, and efficacy development) (Ralston et al., 2017). The length of the intervention was 18 months, with each phase lasted approximately six months. The independent change due to religiosity is the focus of the current paper. Consequently, the intervention was included solely as a control variable. Age was assessed using 12 categories ranging from “18–21” to “over 91.” Gender was coded as “female” (1) and “male” (2). Education level was assessed using eight categories ranging from “some high school” (1) to a “PhD or equivalent degree” (6).

Statistical Analyses

Using two repeated measures, we tested study hypotheses involving individual religiosity, sense of control, and global physical health of middle–old aged African Americans by estimating (a) ARCLM and (b) PGM. As shown in Panel A, Figure 1, the ARCLM in the structural equation modeling (SEM) framework (Mplus, version 8) evaluated the time sequential process involving two time-varying variables over time (e.g., religious belief and sense of control). Typically, ARCLM involves change or stability in rank order between repeated measures of the same variables from one time point to the next (autoregressive [AR] effect between t1 and t2 measures of religio-spiritual beliefs) and rank-order association between different variables (e.g., cross-lagged [CL] effect between religious belief at t1 and sense of control at t2) (Lee et al., 2021). For instance, an individual’s religio-spiritual beliefs in the present moment may likely be related to the previous state of an individual’s religious belief (AR effect), as well as to the previous state of sense of control. Similar relationships exist between sense of control and health outcomes (CL effect). This analysis will answer our research questions, for example, whether (a) religious belief influences sense of control (CL) after accounting for the autoregressive effects (AR), that is, predicting residual change in sense of control, or (b) sense of control influences health (CL), after accounting for the autoregressive effects (AR), that is, predicting residual change in health. Importantly, the ARCLM predicts residual changes in sense of control and health while allowing for potential reversed causations.

As shown in Panel B, Figure 1, PGM, in the SEM framework, evaluates whether one variable at one time point (t1) influences subsequent absolute change in another variable (t1–t2) and vice versa. The levels and change parameters of each variable are defined as latent constructs using two repeated measures (fixing measurement errors to zero). The change parameter is defined as the absolute change of the variable from t1 to t2 by fixing its’ loadings t1 = 0 and t2 = 1 in the latent growth curve SEM model. That is, the estimated change in an attribute is essentially the absolute difference in repeated measures. Although each individual varies in initial level and change, they can be aggregated to create means and variances for the initial level and slope. A significant variance in the initial level implies significant inter-individual differences at t1, and a change parameter implies different amounts of absolute change (t1–t2) among individuals in the sample. In the present study, for instance, a significant variance in the change parameter for sense of control suggests that some African American adults show greater increases or decreases in sense of control from t1 to t2 (a period of one year) than other adults in the sample. Consequently, the variables that explain this variation in absolute change can then be examined. For example, we used the initial level of religio-spiritual beliefs of African American adults to explain the variation in changes in sense of control. Similarly, the initial level of sense of control is expected to explain changes in physical health. We believe that predicting absolute change in the outcome variable provides convincing evidence for the directional influence of the predictor. Full information maximum likelihood (FIML) was used to manage the missing data for all study variables. Goodness-of-fit was assessed using the chi square statistic divided by the degrees of freedom, comparative fit index (CFI), and root mean square error of approximation (RMSEA).

Results

Descriptives and Bi-Variate Correlations

Descriptives and bi-variate correlations are shown in Table 1. Means of religio-spiritual beliefs, religious participation, sense of control, and global physical health showed increases from t1 to t2. Most of study variables were correlated with each other in expected direction, except for correlation between sense of control and physical health at t2. Religio-spiritual beliefs t1 and t2 were significantly correlated with sense of control at t1 and t2 (p <.05), respectively. Sense of control at t1 was correlated with global health at t2 (p <.01) while religious participation at t1and t2 were correlated with global health at t1 and t2 (p <.05), respectively. Reliabilities (Cronbach Alpha) of religio-spiritual beliefs and religious participation measures were greater than 0.80 and those of sense of control measure were 0.77 and 0.80 at t1 and t2, respectively.

Table 1.

Correlation matrix and descriptive statistics for study variables (N = 220–231).

	1	2	3	4	5	6	7	8	9	10	11
1. Beliefs1	–
2. Beliefs2	.380**	–
3. Re. Part1	.223**	.262**	–
4. SELFCT1	.269**	.130	.091	–
5. SELFCT2	.244**	.428**	.177**	.508**	–
6. Health1	.114	.105	.080	−0.023	−0.017	–
7. Health2	.159*	.056	.145*	.213**	.065	.533**	–
8. Re. Part2	.198**	.281**	.741**	.075	.142*	.042	.203**	–
9. Age	−0.042	−0.068	−0.113	−0.009	−0.003	−0.083	−0.080	−0.080	–
10. Gender	−0.118	.010	−0.001	.027	.066	−0.012	−0.007	.071	−0.016	–
11. Intervention	.004	−0.038	−0.078	.035	−0.059	−0.037	.009	−0.081	.167*	.009	–
M (SD)	9.918 (2.390)	10.120 (2.070)	9.113 (4.468)	10.157 (3.232)	10.367 (3.253)	3.639 (0.884)	3.766 (0.768)	9.146 (4.406)	7.076 (1.736)	1.258 (0.450)	.466 (0.499)

Notes. Means (M) and standard deviations (SDs) are presented at the bottom of the table

Beliefs = religio-spiritual beliefs, Selfct = sense of control, Re.part = religious participation, Health = global physical health.

^*p<0.05. ^**p<0.01

Autoregressive Cross-Lagged Model (ARCLM)

Separate ARCLM models were estimated using religio-spiritual beliefs and religious participation. The model with religio-spiritual beliefs (Panel A, Figure 2) provided evidence for the study hypotheses. Religio-spiritual beliefs at t1 was related to subsequent level of sense of control at t2 (CL effect) after controlling for the effect of sense of control at t1 (AR effect) (β = .16, p < .01). That is, religio-spiritual beliefs predicted residual change in sense of control over time. However, sense of control at t1 was not significantly related to religious belief at t2 (β = −0.03, p>0.10), providing evidence for the directional hypothesis involving religio-spiritual beliefs and sense of control, (H1.a); religiosity influences sense of control. In addition, sense of control at t1 was related to subsequent global health at t2 (CL effect) after controlling for the effect of global health at t1 (AR effect) (β = .14, p < .01). That is, sense of control predicted residual change in global health. However, global health at t1 was not significantly related to sense of control or religious belief at t2 (β = .06, p>0.10) providing evidence for the directional hypothesis involving sense of control and religio-spiritual beliefs, (H2.a); sense of control influences global health. Religio-spiritual beliefs, sense of control, and global health had varying rank-order stabilities from t1 to t2 (β = .16, 0.31 and 0.59, respectively, p < .01). Religio-spiritual beliefs showed the lowest stability while physical health showed the highest stability over two time points. Religio-spiritual beliefs were contemporaneously correlated with global health at t2 (r = 0.14, p <.05). Control variables (intervention, gender and age) were not statistically related any of the outcome variable. The model showed a good model-fit with the data (X² (df) = 14.51 (13), RMSEA = 0.04, and CFI = 0.97).

Figure 2.

ARCLMs and PGMs with religiosity, sense of control and physical health. Note. Standardized coefficients. The influence of age, gender, and treatment were not significant, The influences of education level on religious beliefs t1, religious participation t1 and t2, sense of control t1 and t2 were positive and significant in both models, + <0.10, *p <5, **p <.01.

In addition, as shown in panel A, Figure 2 (coefficients are in parentheses), the model with religious participation also provided evidence for the study hypotheses. Religious participation at t1 was related to subsequent sense of control at t2 (CL effect) after controlling for the effect of sense of control at t1 (AR effect) (β = .12, p < .01). That is, religious participation predicted residual change in sense of control. However, sense of control at t1 was not significantly related to religious participation at t2 providing evidence for the directional hypothesis involving religious participation and sense of control (H1.a); religiosity influences sense of control. In addition, sense of control at t1 was related to subsequent global health at t2 after controlling for lagged global health at t1 (β = .14, p < .01). That is, sense of control predicted residual change in global health. However, global health at t1 was not significantly related to sense of control or religious participation at t2 (β = .06, p >.10) providing evidence for the directional hypothesis (H2.a); sense of control influences global health over time. Control variables (intervention, gender, and age) were not statistically related any of the outcome variable. However, the influences of education level on religio-spiritual beliefs t2, religious participation t2, sense of control t1 and t2 were positive and significant in both models. The model showed a good model-fit with the data X² (df) = 11.14 (13), RMSEA = 0.0103; CFII = 0.99. Together, the findings of ACLMs suggest that sense of control longitudinally link religiosity to global physical health in middle–old aged AAs.

Univariate Growth Models

Before testing PGMs, univariate growth models were estimated for religio-spiritual beliefs, religious participation, sense of control, and physical health separately. The level and change parameters of each variable were defined as latent constructs using two repeated measures (fixing measurement errors to be zero). Although each individual varies in initial level and change (Table 2), these were aggregated to create means and variances for the initial level and slope for the sample. A significant variance in a change parameter (Table 2) implied different amounts of change among individuals in the sample. Consequently, variables that explain this variation in absolute change was examined in PGMs. We believe that predicting absolute change in the outcomes variable provides convincing evidence for the directional hypotheses.

Table 2.

Univariate growth models for religious participation, religio-spiritual beliefs, sense of control and global physical health—means and variabilities of the initial level and change (N = 217).

	Mean Initial Level, t1	Variance of Initial Level	Mean Change, t1-t2	Variance of Change	Initial Level-Change Correlation
Religious participation	9.11**	19.90**	1.00**	19.29**	−.80**
Religio-spiritual beliefs	9.91**	5.69**	−.79*	20.71**	−0.32**
Sense of control	10.18**	10.32**	.21(ns)	10.39**	−0.49**
Global physical health	3.65* (.09)	.77* (.72)	.13	.65**-	.59**

Note: All the models showed a perfect model-fit

Parallel Trajectory Model (PGM)

First, PGM model with religio-spiritual beliefs was estimated (panel B, Figure 2). The results provided evidence for the study hypotheses. Religio-spiritual beliefs at t1 was related to subsequent change in sense of control from t1 to t2 (β = .14, p < .01). That is, religio-spiritual beliefs predicted absolute within-individual change in sense of control over time. However, sense of control at t1 was not significantly related to change in religious belief from t1 to t2 (β = −0.02, p >.10) providing evidence for the directional hypothesis (H2.a); the level of religio-spiritual beliefs positively associated with the subsequent change in sense of control. In addition, sense of control at t1 was related to subsequent change in global health from t1 to t2 (β = .14, p < .01). That is, sense of control predicted absolute within-individual change in global health over time. However, global health at t1 was not significantly related to change in sense of control or religio-spiritual beliefs from t1 to t2 (β = .05, p >.10), providing evidence for the directional hypothesis involving religio-spiritual beliefs and sense of control (H2.b); The level of sense of control is positively associated with the subsequent change in global health over time. The levels of religio-spiritual beliefs and global health were negatively related to their own subsequent changes suggesting regression to the means of these attributes over time. The levels of religio-spiritual beliefs were contemporaneously correlated with the levels of sense of control and global health (r = 0.31, 0.11, respectively, p <.05). However, residual change in religiosity and residual change in physical health were negatively associated suggesting differential residual changes in these attributes over the study period. The model showed an acceptable model-fit with the data (X² (df) = 15.42 (10), RMSEA = 0.05, and CFI = 0.96). Control variables (intervention, gender, and age) were not statistically related any of the outcome variable.

Second, PGM with religious participation was estimated (panel B, Figure 2, coefficients are in parentheses). The results provided evidence for the study hypotheses. Religious participation at t1 was related to subsequent change in sense of control from t1 to t2 (β = .10, p < .01). That is, religio-spiritual beliefs predicted within-individual absolute change in sense of control. However, sense of control at t1 was not significantly related to change in religious participation from t1 to t2 (β = .03, p >.10), providing evidence for the directional hypothesis involving sense of control and religious participation (H2.a); the level of religiosity is positively associated with the subsequent change in sense of control over time. In addition, sense of control at t1 was related to subsequent change in global health from t1 to t2 (β = .05, p < .01). That is, sense of control predicted within-individual absolute change in global health. However, global health at t1 was not significantly related to change in sense of control or religio-spiritual beliefs from t1 to t2 (β = .03, p >.10), providing evidence for the directional hypothesis involving sense of control and physical health (H2.b); the level of sense of control is positively associated with the subsequent change in global health over time. The levels of religio-spiritual beliefs were contemporaneously correlated with the level of global health (r = 0.16, respectively, p <.05). However, change in religiosity and change in physical health are negatively correlated showing that these trajectories have changes in different rates over this period. The model showed an acceptable model-fit with the data (X² (df) = 9.36(10), RMSEA = 00, and CFI = 1.0). Control variables (intervention, gender, and age) were not statistically related any of the outcome variable. However, the influences of education level on religio-spiritual beliefs t2, religious participation t1 and t2, sense of control t1 and t2 were positive and significant in both models. Together, the findings of PGMs suggest a sense of control longitudinally link religiosity to global physical health for middle–old aged African Americans.

Discussion

Religion is a psychological force that can influence individual health and well-being (McCullough & Willoughby, 2009). However, previous religiosity–health focused research has not given adequate theoretical and empirical consideration to psychological resources, such as sense of control (McCullough & Willoughby, 2009). Further, only a handful of studies have investigated religiosity and health in middle–old aged African Americans who experience various health disadvantages in later years, although such an intra-group investigation would have revealed culturally specific findings that may have useful practical implications (Goodwin, 2003). The specific purpose of the present study was to investigate the inter-play among religiosity, sense of control, and global physical health in middle–old aged African Americans. This investigation explored several dynamic associations: (a) the association between religiosity and changes in sense of control over time and vice versa, and (b) the association between sense of control and changes in global physical health over time and vice versa. The analysis used two modeling approaches: ARCLM, which focuses on residual changes, and PGM, which focuses on within-individual absolute changes, both of which provided evidence for the causal hypotheses among the study constructs.

ARCLM evaluated the time sequential process involving repeated measures of religiosity, sense of control, and physical health over time. The results showed that religiosity had the lowest rank-order stability over time (a weak AR effect) compared to sense of control and health. That is, African Americans experienced substantive changes in their rank order of religio-spiritual beliefs and religious participation in their later years. Thus, religiosity during these years may be less likely be related to the individual’s own previous state of religiosity. Sense of control and physical health also showed only moderate-level stabilities over time, implying substantial rank-order changes in these attributes. Together, these findings suggest that African Americans are vulnerable to rank-order changes in these attributes during their middle–old years. This suggests possible changes in their socioeconomic and life circumstances in later years. Cross-lagged effects revealed that religiosity during the years studied is related to subsequent residual changes in an individual’s sense of control and that the previous state of sense of control is related to subsequent residual changes in their physical health. These CL influences were estimated after incorporating potential reverse causations into the model. The findings provided evidence for the positive-directional hypotheses that religiosity influences changes (residual changes) in sense of control and that sense of control influences changes (residual changes) in physical health. Together, the findings highlight the fact that religiosity and sense of control are important health resources for African Americans in their middle–old years, and the development of these resources should be targeted by health-promoting interventions for middle–old aged African Americans.

Before testing the PGMs, separate univariate growth models (defined by the initial level and change) were estimated for religio-spiritual beliefs, religious participation, sense of control, and physical health. Unlike residual change, which was the focus of the ARLCM, within-individual absolute change from t1 to t2 was the focus of the PGM models. This absolute change is independent of the influence of the effect of the lagged variable at t1 (AR effect). Importantly, the results revealed significant inter-individual variations in the level and within-individual change in each attribute. Significant variations in change parameters for all attributes suggest that some African American adults show greater absolute increases or decreases in all attributes from t1 to t2 than other adults. PGM explained these variations in changes in sense of control and physical health.

The results of the PGMs showed that religiosity explains the variation in absolute changes in sense of control and that sense of control explains the variation in absolute changes in physical health. Predicting absolute within-individual changes, PGMs provided convincing evidence for the directional hypotheses involving religiosity, sense of control, and health (Wallace & Forman, 1998). These PGM findings are also consistent with those of ARCLMs, which predicted residual changes in sense of control and physical health. Together, these findings highlight the fact that religiosity and sense of control are important health resources for African Americans in their middle–old years. However, due to the data limitation, we estimated the absolute change in each attribute using only two repeated measures in the present study, without accounting for the measurement error. Thus, the estimated change in an attribute is essentially the difference in repeated measures, which has been shown to have low reliability because it reflects the measurement errors of both of their constituent scores (Rogosa & Willett, 1983). Future research should test similar PGMs after accounting for measurement errors (i.e., using at least three repeated measures).

It is important to note that, although religiosity did not show contemporaneous associations with sense of control, the level of religiosity (both beliefs and participation) showed a significant longitudinal association with subsequent sense of control in both ARCLMs and PGMs. Further, contemporaneous associations between the level of sense of control and health were not significant, and the level of sense of control was longitudinally associated with subsequent physical health. Statistically, this longitudinal effect is an interaction of the predictor variable with the time when influencing the subsequent outcome variable. Together, these results suggest that religiosity and sense of control cumulatively contribute to sense of control and health, respectively. This highlights the salience of religiosity and sense of control for older African Americans’ health in their later years.

The study findings are consistent with the general theoretical explanations, often drawn from studies focused on the general population: religion portrays God as responsive to the needs of believers (Bradshaw et al., 2010) to whom they are attached (Kirkpatrick, 2005). When they draw from this God connection to solve their life problems and to enhance their identities (Ellison et al., 2015), they are more likely to feel a high level of sense of control. The study findings are consistent with previous research findings that psychological resources, such as sense of control, contribute to better physical health outcomes through enhanced physiological (e.g., HPA reactivity) and brain functioning (Matthews et al., 2010; Zilioli et al., 2016) as well as through behavioral mechanisms (O’Neal et al., 2014; Wickrama et al., 2012). Although the findings of this African American intra-group investigation are consistent with these general explanations drawn from general populations, future religiosity–health research should further investigate specific mechanisms involving the religiosity–health connection of African Americans in later years.

Although the current study provided evidence for study directional influences of religiosity, there is a possibility that some reverse influences (e.g., physical health to religiosity) may reach statistical significance with a larger sample. This is evident by some of the observed marginally significant regression coefficients; for instance, the paths from physical health to religio-spiritual beliefs, and from physical health to religious participation were marginally significant in the ARCLM analysis. Thus, future research should further investigate the inter-play between these attributes with larger samples of African Americans.

It would be useful if the research questions and models tested here were replicated with other race/ethnic groups, more diverse populations, and other regions of the country. A broader sample representing different regions and populations may show stronger effects in some regions or population groups than others (Chan et al., 2015). For example, Silk and Walsh (2006) suggest that studies focusing on religion are complicated by the large presence of regional differences in religiosity within the United States. Thus, an examination of a broader spectrum of religio-spiritual beliefs may identify limits for the observed associations. Future work focused on younger samples will also be important. Younger adults may have more supportive social networks, which may weaken the presented findings.

An additional limitation of the current research is that the measurement was based entirely on self-reports. Self-report data provide an instantaneous information of an individual’s life and are prone to confounding factors. The present study also assessed religiosity from only two dimensions (participation and beliefs) using five items. Future studies should incorporate a broader measure to capture more facets of religiosity. Future research could also examine whether higher levels of sense of control may amplify the positive influence of religiosity on physical health.

Although social and behavioral mechanisms were not investigated in the present study, these processes may coexist or intervene with the investigated psychological processes. For example, the association between religious participation and sense of control may be mediated by social processes, such as social integration, reduced loneliness, or better marital functioning (King et al., 2022; Olson et al., 2015; Wallace & Forman, 1998). Similarly, sense of control and health associations may be mediated by health-promoting behaviors, such as participation in regular exercises and eating balanced diets (O’Neal et al., 2014; Wickrama et al., 2012). Thus, it is useful to examine whether the observed relationships prevail when these mechanisms are incorporated into the investigation.

The present findings highlight that religiosity enhances sense of control, which in turn contributes to better physical health, mediating the influence of sense of control on the religiosity-physical health association. These findings inform both religious and medical institutions and practitioners involved in physical health promotion and prevention among older African Americans. Given the increasing cost of health care, conducting targeted activities for developing individuals' sense of control would be a cost-effective health preventive effort by religious institutions/congregations. At the same time, existing health services and practitioners should acknowledge and incorporate the effective role of religiosity and sense of control into their treatment programs. Furthermore, in addition to its mediating role, sense of control may operate as a moderator that amplifies the direct beneficial influence of religiosity on physical health. Future studies should investigate this potential dual role (moderated mediation) of sense of control in relation to the religiosity–health link.

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: This research was funded by National Institute on Minority Health and Health Disparities (NIMHD), Award Number R24MD002807 (Principal Investigator, P.A. Ralston). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMHD. Appreciation is expressed to the pastors and health leaders from the participating churches and to staff and students involved in conducting this project. (“Health for Hearts United Longitudinal Trial: Improving …”)

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Florida State University (protocol 2018.25,585; date of approval 30 July 2009).

ORCID iD

Kandauda A. S. Wickrama

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