Matters of the Heart: Childhood Maltreatment,Religious Transitions,and Cardiovascular-Related Problems over the Life Course

Abstract

Objectives:

Childhood maltreatment is associated with a higher risk of cardiovascular-related problems, the leading cause of death in the United States. Drawing from cumulative inequality theory, this study considers whether transitions in religious attendance moderate the deleterious impact of childhood maltreatment on long-term cardiovascular risk.

Methods:

We utilize over 35 years of prospective panel data from the National Longitudinal Study of Youth from the United States (1979–2015).

Results:

Our findings suggest that decreases in religious attendance between adolescence and adulthood (from high to low, and high to moderate attendance) were associated with elevated cardiovascular-related risk for those abused as children. Neither stable high attendance nor increases in attendance buffered against the impact of childhood abuse on cardiovascular-related problems.

Discussion:

We illustrate the importance of incorporating the role of stability and change in religious attendance across the life course and suggest directions for future research.

Keywords

cardiovascular risk childhood abuse religious attendance life course

Introduction

Cardiovascular disease (CVD) is the leading cause of death in the United States, contributing to roughly 1 in 3 deaths (Ahmad & Anderson, 2021; Crimmins & Beltrán-Sánchez, 2011). Cardiovascular problems are also identified as a major reason why the United States life expectancy continues to fall short of other wealthy countries (Ho & Hendi, 2018), and the prevalence of heart problems even for those under 65 years of age remains relatively high in the United States (Vaughan et al., 2020). Moreover, a substantial body of work from life course research has documented that the antecedents of heart-related problems occur much earlier in the life span (Ferraro et al., 2016). Childhood has been recognized as a sensitive period of physiological, social, and psychological development, and events and experiences during this critical time are thought to lay the foundation for later-life health (Ferraro & Shippee, 2009; Miller et al., 2011; Wegman & Stetler, 2009). We focus on the impact of childhood maltreatment (i.e., parental physical abuse), as a particularly noxious form of early life stress (Schafer & Ferraro, 2013; Wheaton, 1994). This form of hardship holds devastating consequences for disease risk; indeed, exposure to parental abuse is associated with a lower probability of remaining “disease free” into later life (Schafer & Ferraro, 2012). Studies have also documented between a 1.5 and 2.0 greater incidence of CVD among those exposed to childhood maltreatment (Anda et al., 2009; Dong et al., 2004; Dube et al., 2009).

Given strong interlinkages between childhood maltreatment and disease risk, a significant body of work has sought to understand factors that may alter these insults to health (Schafer et al., 2011). The present study focuses on attendance at religious services. Though the utility of religious attendance as a stress buffer has been well-documented generally (e.g., Schieman et al., 2013) and in the context of childhood maltreatment (Jung, 2018; Upenieks, 2021), it remains unclear whether stability or increases/decreases in religious attendance over the life course might assist or hinder its capacity to buffer the adverse health effects of parental abuse. To our knowledge, no existing study has considered whether transitions in religious attendance moderates (for better or worse) the deleterious impact of childhood maltreatment on long-term cardiovascular-related risk. We fill this gap, drawing from cumulative inequality (CI) theory and the sociology of religion and utilizing over 35 years of prospective panel data from the National Longitudinal Study of Youth (NLSY79).

Theoretical Background

Cumulative Inequality Theory and Childhood Abuse as an Antecedent for Cardiovascular Problems

This study draws from several components of CI theory, a middle-range theory centered on how stratification processes unfold over the life course. First, CI theory highlights childhood as a critical period for life course development and stratification, emphasizing how childhood experience can influence later-life outcomes (Ferraro & Shippee, 2009). The family plays an essential role in this process, for better or for worse. Experiences such as childhood maltreatment could trigger biological and social processes that raise the risk of later disease (Dong et al., 2004; Felitti et al., 1998; Gilbert et al., 2015).

Second, CI theory devotes significant attention to the timing of life events. Children have very little control over their situations and environments in early life, relying on their parents for resources and support, which can make the experience of parental abuse all the more damaging during this vulnerable time in the life course (Maggi et al., 2010). When children are abused, they may develop an internal working model where they see the world as a dangerous place (Elliot & Briere, 1994), and they may underestimate their own sense of self-efficacy and self-worth in dealing with stressors (Lovallo, 2016). Many physical ailments in midlife and later life bear the imprint of childhood adversities, including cancer (Morton et al., 2012), obesity (Greenfield & Marks, 2009), arthritis (Kemp et al., 2021), and perceptions of health and overall disease burden (Ferraro et al., 2016). Past work has also linked childhood adversities to risk of heart disease and CVD risk factors (Dong et al., 2004; Felitti et al., 1998). This leads to our first hypothesis:

Hypothesis 1

Childhood maltreatment will be associated with higher risk of cardiovascular problems later in the life course.

Transitions in Religious Attendance as a Moderator of the Relationship between Childhood Abuse and Cardiovascular Risk

Axioms 2 and 3 of CI theory emphasize the importance of exposure to risks and resources across the life course. Religious attendance has been associated with numerous biological outcomes, such as lower blood pressure (Buck et al., 2009; Maselko et al., 2007), C-reactive protein (Ferraro & Kim, 2014; Hill et al., 2014), overall allostatic load (Das & Nairn, 2016; Hill et al., 2014; Hill et al., 2017; Maselko et al., 2007), and a lower risk of cardiovascular problems (Hemmati et al., 2019; Masters, 2008). Stability or change in religious attendance in adulthood may be either a risk or resource that could exacerbate or ameliorate the influence of childhood maltreatment on later health. Childhood adversity may set into motion chains of risk, where early disadvantage substantially increases the risk of further negative events occurring. In the domain of heart problems, for instance, experiencing childhood abuse could propel an individual toward risky lifestyle behavior (e.g., smoking, alcohol and drug abuse, obesity) that would heighten cardiovascular risk (Danese & Tan, 2014; Felitti et al., 1998; Greenfield & Marks, 2009). Childhood adversity may also overactivate the hypothalamic-pituitary-adrenal axis, triggering elevated cortisol levels that exact physiological damage over time (Schury & Kolassa, 2012), including to the cardiovascular system. It is possible that changing religious attendance could be another link in the chain of risk or a resource that alters the chain of risk from childhood abuse to cardiovascular-related problems.

Childhood trauma survivors may increase in religiosity, potentially seeking religion and spirituality to make meaning and sense of the trauma experienced (Bryant-Davis, 2005; Walker et al., 2009), or they may decrease in religiosity, as their trauma may make it more difficult to maintain beliefs that God or a divine being is good, just, and close to them, and deities may be blamed for allowing negative experiences to occur (Van Dyke et al., 2009; Walker et al., 2009). Religious attendance, measured in adulthood, has been found to attenuate the negative effects of childhood adversity on positive affect (Jung, 2018) and lower psychological distress (Gall et al., 2007), though some studies have found no buffering effects of religious attendance for victims of childhood abuse (Upenieks, 2021).

It remains an empirical question whether religious attendance must be consistently practiced in order to act as a buffer against early adversity. If declines in religious participation occur, this may limit the effectiveness of religiosity as a buffer. The third axiom of CI theory states that life course trajectories are shaped by the accumulation of risks and resources, and it is possible that resources from religious attendance need to accumulate over time for health benefits. The potential benefits of stable religious attendance for victims of abuse are several-fold. First, supportive resources are often found within religious communities, including emotional support and resourceful networks of information (Jung, 2014; Krause, 2006). Social support can be an impactful source of comfort and hope for victims of childhood abuse (Hill et al., 2010). Second, members of a religious community typically rely on a shared set of discourses and meaning structures, which may help co-religionists confront stressful situations and human suffering. Idler (1995) found that frequent attenders were able to reframe their past (uncontrollable) hardships under the umbrella of a broader divine purpose. Third, religious attendance tends to be associated with higher self-esteem and sense of personal control, which could help individuals actively cope with the effects of negative life events (Ellison & Burdette, 2012; Schieman et al., 2017).

Support provision, as well as the psychosocial resources associated with increased attendance, might take time to build up. A number of studies have found that consistently high attendance from childhood to adulthood was associated with better physical and mental well-being at midlife compared to consistent non-attendance (Chen & VanderWeele, 2018; Upenieks & Schafer, 2020; Upenieks & Thomas, 2021). Consistent religious involvement also tends to favor healthier lifestyles, such as lower levels of smoking and drinking (Upenieks & Schafer, 2020) and abuse of drugs (Jang et al., 2008; Ulmer et al., 2012), better mental health (Upenieks & Thomas, 2021) and better biological functioning, observed through lower allostatic load, and longer telomeres (Hill et al., 2016; Hill et al., 2017; Maselko et al., 2007). Some research in neuropsychology suggests that the emotionally charged dynamics of religious rituals can have positive neuropsychological and immune system effects (Sosis & Alcorta, 2003). This evidence suggests that religious attendance may be protective against the effects of stress in part because it may mitigate harmful pathogenic processes across the life course. This leads to:

Hypothesis 2

Stable religious attendance between adolescence and adulthood will buffer the impact of childhood maltreatment on the risk of cardiovascular problems.

Research suggests that some victims of childhood abuse may go on to increase their religiosity later in the life course. In a sample of people who experienced multiple traumas in childhood, roughly 20% grew more religious after the second trauma (Falsetti et al., 2003). The trauma of childhood abuse, according to theoretical accounts from these studies, could serve as a catalyst for spiritual growth, as individuals seek out religious beliefs or practices to gain a sense of meaning and order in life. If the turn towards a religious community was the impetus to evoke cognitive re-framing processes, then an increase in attendance could be especially important in overcoming the damage caused by childhood maltreatment. Previous research has proposed several potential social (e.g., social integration and support), psychological (e.g., meaning and control beliefs), behavioral (e.g., drinking and smoking), and biological (e.g., stress) mechanisms (George et al., 2002; Hill et al., 2017; Seybold, 2007) of how religion may buffer against the noxious effects of stressful life conditions.

It is also possible that the process of choosing and being welcomed into a religious community might be especially comforting for victims of abuse (Giesbrecht & Sevcik, 2000). Together, this evidence suggests that a religious community might help to assist victims in working through these struggles and seek comfort in their faith communities. A religious transformation of this sort could be accompanied by a greater sense of meaning in life, a stronger sense of self-worth, and greater optimism (Krause, Pargament, & Ironson, 2017). Social support could help adults abused as children to appraise their stress as lower and diminish the chronic activation of the stress response. Religious beliefs or theodicies, reinforced through regular attendance at services, can provide a system of meaning through which individuals can interpret their adverse circumstances, backed by a supportive community of believers (McIntosh et al., 1993). Individuals who report higher levels of religious attendance may also engage in other devotional practices on a regular basis, such as prayer (Schieman & Bierman, 2007). Sharp (2010) argues that prayer is an imaginary social support interaction with a divine being that provides individuals with resources that they may use to manage emotions, for example, an opportunity to express or vent anger or reappraise stressful situations as less threatening. This body of research leads to our third hypothesis:

Hypothesis 3

Increasing religious attendance between adolescence and adulthood will buffer the impact of childhood maltreatment on risk of cardiovascular problems.

Finally, we address the case that declines in religious attendance from childhood to adulthood might set individuals on a different pathway of childhood risk. The occurrence of childhood trauma, especially when people are in an enhanced state of vulnerability, can shatter one’s sense of meaning and fundamental beliefs about the world, including those related to religion. Previous research, while not specific to experiences of childhood maltreatment, has documented some potential adverse health consequences of declines in religious attendance (Fenelon & Danielsen, 2016; Upenieks & Thomas, 2021). Such religious transitions are likely to be experienced as inherently stressful, and disaffiliation could bring about a loss of resources linked to religious participation and collective experiences of religiosity, including social support (Fenelon & Danielsen, 2016; Krause & Pargament, 2017), sense of meaning in life (Upenieks, 2022), and can undermine one’s sense of identity (at least temporarily) as they seek secular alternatives (Ysseldyk et al., 2013).

Removing oneself from a congregation might also be a sign of spiritual struggle, defined as “tension and conflict about sacred matters within oneself, with others, and with the supernatural” (Stauner et al., 2016, p. 1) as some childhood abuse victims question the nature of God and how God could allow such an event to happen to them (Bierman, 2005). The three most commonly studied forms of religious/spiritual struggles are (a) divine relationships, or troubled relationships with God; (b) intrapsychic struggles, or chronic and unresolved religious doubts; and (c) interpersonal struggles, or conflicts with other people about religious matters or in religious settings (see Exline et al., 2014). Spiritual struggles are known correlates of worse mental and physical health (Ellison et al., 2013; Hill et al., 2021) including increased cardiovascular issues (Desai, 2009). Spiritual struggles may also be an antecedent of declines in organizational religious involvement, as people may not want to continue investing in religious worldviews or a personal relationship with God that does not align with their current views of reality (Exline et al., 2020). We therefore hypothesize:

Hypothesis 4

Decreasing religious attendance between adolescence and adulthood will exacerbate the impact of childhood maltreatment on cardiovascular problems.

Data and Methods

We draw on data from the National Longitudinal Survey of Youth (NLSY79), which is a nationally representative panel study, with an oversample of Black and Hispanic respondents living in the United States when the survey began. At the survey’s baseline in 1979, respondents were between 14 and 22 years old. In the present study, we restricted the sample to respondents ages 14–18 in 1979 (N = 3614) to capture adolescents presumably living in the parental home, reflecting religious attendance from the household of origin. NLSY is advantageous for this study because it is one of only a few datasets to include a prospective measure of religious attendance from 1979 to 2000 (adolescence and adulthood, as religious attendance is only available at these two waves). The 2014–2015 wave of the NLSY was the only time in the survey when cardiovascular problems were measured. Respondents were between the ages of 50–54 at the start of this wave.

Dependent Variable: Cardiovascular-Related Problems

As part of a health module in the 2014–2015 wave of the NLSY, participants were asked if they were ever diagnosed with the following cardiovascular and related health problems: (1) stroke, (2) heart problems, (3) high blood pressure, and (4) lung problems. Though lung problems are not technically a CVD, research shows the strong interrelationship between lung impairment and cardiovascular disease (e.g., Lin et al., 2021). Therefore, we also consider lung problems as a related health problem in our analyses.¹ To achieve adequate cell size, we summed the number of cardiovascular-related problems a respondent reported being diagnosed with. Very few respondents (4.48%) had more than 1 cardiovascular-related problem, so we ultimately coded cardiovascular-related problems into a binary (0 = no cardiovascular problems; 1 = 1 or more cardiovascular problems). Nearly one-quarter (24.71%) of the sample reported at least one cardiovascular-related health problem.

Focal Independent Variables

Childhood Abuse

Experiencing parental abuse in childhood was retrospectively measured in the 2014/2015 wave of the NLSY as how often a parent or adult in their home “ever hit, beat, kicked, or physically harmed you in any way.” Given the distribution of this variable, we coded this into a binary where (0) = “no abuse” and (1) = “any abuse.”

Transitions in Religious Attendance

Religious attendance was measured at two time points in the NLSY: in 1979 (baseline), when the study respondents in our sample were 14–18 years old, and then again in 2000, when study respondents were 35–39 years old. Respondents were asked, “In the past year, about how often have you attended religious services?” To ensure reasonably large categories across groups, we modeled religious attendance as a three-category variable: low/no attendance (“not at all” or “several times a year or less”), moderate religious attendance (“once per month” or “two to three times per month”), and high attendance (“once per week” or “more than once per week”).

Starting with these three categories outlined above, we then created a 9-category variable capturing all possible transitions from one attendance category in 1979 to another attendance category in 2000. Those with stably low/no attendance from adolescence to adulthood are treated as our reference group, as we intend to compare those who experience upward or downward shifts in religious participation to this group.

Covariates

We adjust for a number of covariates, including age, gender (1 = female), and race-ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic). In 2014–2015, respondents were asked for a complete marital history up to that point. Taking this information, we created a variable comparing those consistently married throughout their lives (reference group) with those married twice, more than two times, and those who were never married.

Childhood Covariates

Childhood socioeconomic status (SES) was measured in 1979 by the household head’s education level (1 = college degree or higher, 0 = all else) and parental work status (1 = employed, 0 = not employed). We also control for parental family structure by contrasting those in two-parent homes with those who have a stepparent or a single parent. A measure of child residence type was also included, which contrasted those who lived in a town or city to those who lived in the country. We also included a dummy variable of whether the respondent was raised in the South region of the United States (1 = yes, 0 = no).

Finally, we include a measure of respondents’ religious affiliation early in the life course (1979). This is accomplished by creating a categorical variable contrasting those reporting no religious affiliation with Methodist, Presbyterian, Roman Catholic, Jewish, conservative Protestant (e.g., Baptist, Church of Christ), and Other Protestant (e.g., Lutheran, Episcopalian) religious affiliations. While a detailed list of religious traditions was measured in 1979 in the NLSY, only a very condensed list of religious traditions was available at 2000, so we did not have a comparable measure to test transitions in religious affiliation. Table 1 reports descriptive statistics for all study variables. However, in the interest of a parsimonious presentation of results, we do not show control variables in our main statistical tables.

Table 1.

Descriptive Statistics, National Longitudinal Survey of Youth (N = 3614).

	Mean/%	SD	Maximum/Minimum	%Missing Data
Cardiovascular-related problems (2014/2015)	24.71%			<1%
Childhood abuse (0 = No, 1 = Yes)	15.11%			3%
Religious Transitions, 1979–2000
Low/No, Low/No	23%			<1%
Low/No, Moderate	6%
Low/No, High	8%
Moderate, Low/No	10%
Moderate, Moderate	6%
Moderate, High	6%
High, Low/No	15%
High, Moderate	10%
High, High	16%
Race
White	49%			<1%
Black	31%
Hispanic	20%
Gender (Female)	52%			<1%
Religious Affiliation (1979)
None	9%			<1%
Protestant	5%
Methodist	5%
Presbyterian	7%
Roman Catholic	32%
Jewish	1%
Conservative Protestant	40%
Respondent Education
Less than a college degree	76%			4%
College degree or higher	24%			4%
Marital Status (2014)
One marriage	38%			1%
Two marriages	18%
Two or more marriages	27%
Never married	15%
Age (2014)	51.63	1.07	49.53	<1%
Parental Education (head of household)
Less than a college degree	95%			9%
College degree or higher	5%
Higher	5%
Parental work status (household head, when R was 14) (1 = employed)	89%			14%
Family Structure
Two-parent	66%			<1%
Stepparent	9%
Single parent	26%
Childhood Residence
In town or city	80%			<1%
In country, not on farm	15%
On farm or ranch	5%
Raised in the American South	38%			2%
Born in the United States	94%			<1%

Note. Standard deviations are omitted for categorical variables.

Given the potential links between childhood abuse and risky lifestyle behaviors in adulthood, additional analyses also included controls for lifetime smoking, the number of cigarettes smoked per day (measured in 2008, 2010, 2012, and 2014) and drinking (measured in 2006, 2008, 2010, 2012, and 2014), measured by the frequency of having six or more drinks on one occasion. We created average scores across the measured time points. Our results remained unchanged with these measures of smoking and drinking, so we excluded these variables from our final analysis.

Plan of Analysis

We use binary logistic regression with N = 3614 cases, presenting odds ratios and 95% confidence intervals. Though missing data was not extensive on our study variables (see Table 1 for % of cases missing on each variable), we employed multiple imputation with chained equations to handle missing data (m = 20) (Royston, 2005). Notably, our results were also consistent using listwise deletion of cases to handle missingness. Finally, given that our sample spans over 35 years, we also adjust for sample attrition by using inverse-probability-of-attrition weights. All analyses were conducted in Stata version 15.

Results

Table 1 features descriptive statistics for the analysis. We see that 24.71% of the sample reported at least one cardiovascular-related health problem, and just over 15% reported experiencing childhood maltreatment. High blood pressure was the most common cardiovascular problem, reported by 23.57% of our sample, followed by heart problems (6.26%), lung problems (3.51%), and stroke (2.44%). The modal category of religious transitions between adolescence and adulthood was stable low/no (23%), while 16% of the sample reported consistently high attendance. Around 20% reported an increase in attendance between adolescence and adulthood. Just over one third of the sample (35%) reported decreasing religious attendance over time, with the most common pathway of decline being from high to low/no. We note that 40.15% of those declining from high to low/no attendance and 43.19% of respondents decreasing from high to moderate attendance between childhood and adulthood were raised in Conservative Protestant denominations.

Table 2 displays a cross-tabulation of transitions in religious attendance and childhood abuse, with chi-square tests for significant differences between non-abused/abused respondents shown. Percentages of those who did/did not experience childhood abuse were roughly equal across religious transition groups from 1979 to 2000, with a few notable exceptions which did statistically differ between the abused and the non-abused. First, a significantly larger percentage of those who had experienced childhood abuse engaged in stably low/no religious attendance (27.1%) than those who did not experienced childhood abuse (22.6%). Second, a little less than 10% of respondents who experienced childhood abuse engaged in stably high religious attendance compared to 17% of respondents who did not experience childhood abuse. While not focal to our analyses, we also note that childhood religious attendance (1979) was not associated with a significantly higher or lower likelihood of being a victim of childhood abuse.

Table 2.

Cross-Tabulation of Changes in Religious Attendance and Childhood Abuse.

Religious Transitions (1979–2000)	No Childhood Abuse	Childhood Abuse	Chi-Square Test by Abuse Non-Victims/Victims
Low/No, Low/No	22.62%	27.11%	p < .01
Low/No, Moderate	6.68%	8.42%	n.s
Low/No, High	7.63%	7.88%	n.s.
Moderate, Low/No	9.68%	10.26%	n.s.
Moderate, Moderate	5.90%	5.86%	n.s.
Moderate, High	6.39%	6.78%	n.s.
High, Low/No	14.21%	15.93%	n.s.
High, Moderate	9.84%	7.88%	p < .05
High, High	17.05%	9.89%	p < .001

Note. n.s. = not significant.

Multivariable Regression Results Predicting Cardiovascular-Related Problems

Table 3 displays the logistic regression results. In Model 1, we establish the baseline association between childhood abuse and cardiovascular-related problems (controlling for all non-religious study variables). Those who experienced childhood abuse had 37% higher odds of experiencing later cardiovascular-related problems than those who did not experience childhood abuse, consistent with the expectations of Hypothesis 1. In Model 2, we establish the baseline association between transitions in religious attendance and cardiovascular-related problems, adjusting for all study covariates except childhood abuse. Relative to the stable low/no group, only respondents in the stable high religious attendance group were at a lower risk of reporting at least one cardiovascular-related problem (OR = 0.75, p < .05). In Model 2, we also found that relative to those with no religious affiliation, none of the childhood religious affiliations were associated with a higher or lower risk of cardiovascular-related problems (not shown).

Table 3.

Logistic Regression Results Predicting Cardiovascular-Related Problems, National Longitudinal Study of Youth (N = 3,614, ORs and 95% confidence intervals shown).

	Model 1	Model 2	Model 3	Model 4
Childhood abuse	1.37** (1.11–1.69)		1.35** (1.09–1.67)	0.98 (0.64–1.50)
Religious Transitions (1979–2000)^a
Low/No, Moderate		1.01 (0.72–1.43)	1.00 (0.71–1.41)	1.01 (0.70–1.48)
Low/No, High		0.84 (0.60–1.17)	0.84 (0.60–1.17)	0.80 (0.56–1.16)
Moderate, Low/No		1.24 (0.93–1.65)	1.23 (0.92–1.64)	1.15 (0.84–1.58)
Moderate, Moderate		0.74 (0.50–1.09)	0.73 (0.49–1.08)	0.62 (0.40–1.01)
Moderate, High		0.80 (0.56–1.16)	0.80 (0.55–1.15)	0.73 (0.49–1.09)
High, Low/No		0.86 (0.65–1.13)	0.86 (0.65–1.13)	0.81 (0.60–1.09)
High, Moderate		0.78 (0.56–1.08)	0.78 (0.56–1.08)	0.68* (0.47–0.97)
High, High		0.75* (0.56–0.98)	0.76* (0.57–0.98)	0.70* (0.52–0.95)
Religious Transitions (1979–2000) X Childhood Abuse
Low/No, Moderate				0.93 (0.37–2.34)
Low/No, High				1.25 (0.52–3.01)
Moderate, Low/No				1.45 (0.69–3.05)
Moderate, Moderate				1.44 (0.93–6.40)
Moderate, High				1.67 (0.65–4.29)
High, Low/No				2.44* (1.06–4.56)
High, Moderate				2.38* (1.04–5.41)
High, High				1.69 (0.76–3.72)

Notes. ***p < .001, **p < .01, *p < .05.

^aCompared to Low, Low attenders.

Model 1 adjusts for all non-religious study covariates. Models 2–4 adjusts for all study covariates.

Model 3 examines both childhood abuse and religious transitions in the same model. The stable high religious attendance group still reports a lower risk of cardiovascular-related problems (OR = 0.76, p < .05) relative to stable low attenders. Model 3 also shows that respondents who experienced childhood abuse were still at an elevated risk of reporting at least one cardiovascular-related problem (OR = 1.35, p < .01).

Model 4 of Table 3 provides a simultaneous test of Hypotheses 2, 3, and 4 by testing an interaction between transitions in religious attendance and childhood abuse. We see the presence of two significant interaction terms in comparison to the reference group of stably low religious attendance, with the high, low group (OR = 2.44, p < .05) and the high, moderate group (OR = 2.48, p < .05). Because interaction coefficients should not be interpreted directly from non-linear (i.e., binary logistic regression models) (Mize, 2019), we display results in Figure 1, which show the predicted probability of reporting at least one cardiovascular-related problem across religious transition groups for those who did/did not experience childhood abuse.

Figure 1.

Change in Religious Attendance and Cardiovascular-Related Problems by Childhood Abuse.

In Figure 1, we see in the high, low group a 12% gap by childhood abuse experience or not in the risk of cardiovascular-related problems (prob = 0.35 vs. 0.23, respectively). In the second group where a significant interaction term appeared (high, moderate transition group), respondents who had experienced childhood abuse were at a higher risk of cardiovascular problems (0.36) versus their counterparts who were not abused as children (0.20). Taken together, these findings offer support for Hypothesis 4: declines in religious attendance, from high to lesser frequency between adolescence and adulthood, appear to exacerbate the risk of cardiovascular-related problems for victims of childhood abuse.

Discussion

Cardiovascular diseases are the leading causes of morbidity and mortality in the United States (Ahmad & Anderson, 2021; Crimmins & Beltrán-Sánchez, 2011; Ho & Hendi, 2018). Childhood maltreatment has been recognized as a factor that can disrupt normative developmental processes and increase the risk of cardiovascular problems later in the life course (Basu et al., 2017; Morton et al., 2014; O’Rand & Hamil-Luker, 2005). Despite a large body of work on the broader topic of childhood abuse and well-being (Ferraro et al., 2016; Morton et al., 2014; Nurius et al., 2015), greater attention to factors that can alter the impact of childhood abuse on later physical health is needed. Prior evidence suggests that religious attendance in adulthood can attenuate the impact of childhood maltreatment on health (Gall et al., 2007; Jung, 2018); however, we do not yet have a clear understanding of the role of stability or change in religious attendance in exacerbating or ameliorating the negative effects of childhood maltreatment on physical health. Thus, the chief goal of this study was to examine whether stability, increases, or decreases in religious attendance across the early life course moderated the impact of childhood abuse on later cardiovascular-related risk.

This task was accomplished by combining insights from CI theory and the sociology of religion. As suggested by CI theory (Ferraro & Shippee, 2009), childhood is a pivotal stage of the life course that shapes later life inequality. We found that childhood abuse was significantly related to higher odds of cardiovascular-related disease, supporting Hypothesis 1. Adverse experiences such as parental abuse may exert a lasting impact because it can set in motion a lifelong chain of unequal opportunity structures and stress responses, leading to chronic inflammation and higher health risk (Ferraro et al., 2016). We also found that stable high religious attendance between childhood and midlife was associated with a lower risk of cardiovascular-related problems, which is an understudied outcome in religion and health and suggests the salubrious effects of consistent attendance also extend to disease outcomes.

This builds on previous cross-sectional studies which have shown that religious attendance lowers the risk of cardiovascular-related problems (Hemmati et al., 2019; Masters, 2008) and clarifies that what may be driving this association is not merely religious attendance in adulthood but continued and sustained religious practice over time. This speaks directly to the accumulation of resources perspective in CI theory. Indeed, if only adulthood religious attendance mattered for cardiovascular-related risk, then we would expect those who attended religious services at lower rates in childhood but reached “high” attendance by adulthood to also have significantly lower risk. However, this was not observed in the current study.

This finding of reduced cardiovascular-related risk in the stably high attendance group also fits with a host of recent studies which have shown that consistent religiosity over the life course is associated with better cognitive health (Hill et al., 2020), better physical health and lower disease burden (Upenieks & Schafer, 2020), and lower depression (Upenieks & Thomas, 2021). Previous research has drawn from the concept of “spiritual capital” to make sense of these findings of the importance of religious stability (Guest, 2007). According to Guest (2007, p. 16), spiritual capital “facilitates an analysis of religious identity in terms of a spiritual career, which pays greater attention to the flow of influences and resources acquired through the life course.” Enhanced familiarity with church rituals and the tenets of one’s faith could give individuals access to valuable resources and might be efficacious for dealing with stress (Iannaccone, 1990). Thus, to the extent that religiosity is consistently practiced, both the social support benefits and the meaning systems it gives believers access to may provide resources that could accumulate and help individuals handle stress better, ultimately resulting in lower risk of cardiovascular problems.

When it came to the modifying role of transitions in religious attendance for victims/non-victims of childhood maltreatment, it was decreases in religious attendance that mattered. Results from our study suggest that decreases in attendance between adolescence and adulthood (from high to low, and high to moderate) were associated with elevated cardiovascular risk for those abused as children. By contrast, we did not find that stable high attendance, nor increases in attendance, played a buffering role against the impact of childhood abuse on cardiovascular-related problems. We discuss the implications of each of these findings in turn below.

First, we draw from previous research on religious decline to suggest why declines in attendance may be particularly noxious for those with experiences of childhood abuse. Previous research has found links between childhood abuse and lower religious attendance in adulthood (Bierman, 2005). As argued by Bierman (2005), victims of abuse may project a negative characteristic of their abuser onto God or a divine being, leading them to withdraw from the institutional aspects of religion. Prior research has found adverse health consequences from declines in attendance (Fenelon & Danielsen, 2016; Upenieks & Thomas, 2021), so withdrawing from religious communities of childhood, from high participation to only moderate or low participation in adulthood, could be an important loss of social support derived from religious communities (Fenelon & Danielsen, 2016; Krause & Pargament, 2017). Childhood abuse may affect cardiovascular-related risk at a later time point by either limiting or altering one’s access to social support that might be helpful for coping with stress (Umberson et al., 2014). Furthermore, religious decline could also be a form of an unresolved spiritual struggle, of questioning the nature and goodness of God (Exline et al., 2020; Exline, Wilt, Stauner, & Pargament, 2021), which are known to be associated with lower mental and physical well-being (Ellison et al., 2013; Hill et al., 2021; Upenieks, 2021). There is also some evidence that declines in attendance over time are associated with a higher risk of engaging in smoking behavior (Upenieks & Schafer, 2020) and illicit substance use (Guo & Metcalfe, 2019), both of which increase the risk of cardiovascular-related problems. Therefore, to the extent that declines in religious attendance predict lower social support, unresolved spiritual struggles, or a greater propensity to engage in risky health behaviors, it may also exacerbate cardiovascular-related risk among an already vulnerable group of childhood abuse victims.

Second, we found no protective role for increases or stable attendance in mitigating cardiovascular-related risk for victims of abuse. This is consistent with one prior study by Upenieks (2021), who found that changes in religious attendance at different points in adulthood did not buffer the mental health impact of early life emotional or physical abuse. This null moderation pattern is worthy of further reflection. We argue that this pattern of results suggests the importance of looking at religious attendance over the life course. Indeed, if religious resources do take time to accumulate as “spiritual capital” and for individuals to feel fully welcomed and integrated into their religious community (Giesbrecht & Sevcik, 2000), then intermittent participation might obscure the beneficial effects of religious attendance (e.g., social support, higher self-esteem, mastery) found in previous studies (Ellison & Burdette, 2012; Krause, 2006; Schieman et al., 2017).

Limitations and Future Directions

We note several limitations of the current study. First, because of the longitudinal nature of the data, sampling bias may occur due to attrition. However, this would likely mean that the number of respondents reporting at least one cardiovascular-related problem could be underreported, as respondents could have had a cardiovascular problem over the study period and not survive to the 2014–2015 wave, but the fact that childhood maltreatment is still related to risk of cardiovascular-related problems attests to its importance. In addition, though our measures of childhood (1979) and adulthood (2000) religious attendance were measured prior to the measurement of cardiovascular problems, we cannot be certain of the exact time point when declines in religious attendance occurred. Health problems may lead some individuals to disengage from religious involvement (Kelley-Moore & Ferraro, 2001). Thus, prospective longitudinal data with multiple measurements of health problems would be needed to assuage this concern of reverse causality.

Second, several other factors could lead individuals to reduce or discontinue their practice of religious attendance from youth into adulthood and also influence cardiovascular health, which should be explored in future research. For example, marital or relationship strains (Wilmoth et al., 2015) and work or financial stress (Upenieks et al., 2022) could influence religious attendance declines and cardiovascular problems later on in the life course and be more likely among persons who have dealt with childhood maltreatment. In addition, it is also possible that a loss of important resources caused by religious decline may initiate downstream amplification processes related to risky lifestyles that may already disproportionately affect victims of childhood abuse (e.g., self-medication through illicit drugs and alcohol), insecure relationship styles (e.g., severed ties with family and religious communities), poor mental health, and poorer biological functioning. Future research should examine the role of these stressors and lifestyle behaviors in adulthood in potential chains of risk for cardiovascular-related problems.

Third, childhood data are retrospective, and therefore could be subject to recall bias. However, past research on childhood abuse using a similar approach suggests that underestimation is more common than overestimation (i.e., people tend to report fewer adversities than actually occurred) and often lead to conservative results (e.g., Dube, Felitti, Dong, Giles, & Anda, 2003).

Fourth, we only had access to one measure of religiosity in the NLSY, a single-item measure of religious attendance. Some evidence has shown that self-reports of religious attendance tend to be biased upwards in the United States (Brenner, 2011), which has raised the possibility of the role of social desirability bias in responses. However, other work has shown that individuals who overreport their attendance also tend to be those who are most strongly devoted to their religious identities (Brenner, 2017). Based on the latter finding, this could strengthen the case for using religious attendance as a measure of overall religious commitment (see Hout & Greeley, 1998). We also acknowledge that NLSY respondents in our sample were born near the tail end of the Baby Boom era when levels of religious participation were at its peak in the United States (Voas & Chaves, 2016). Since formal religious participation has declined in recent decades, it will be important to examine how other salient factors within the religious/spiritual domain may modify the relationship between religious transitions and cardiovascular risk for victims of abuse. For example, there may be a different impact for people who decline in religious attendance, yet embrace benevolent God images (e.g., as a protector and source of comfort) (Bradshaw et al., 2008). Moreover, respondents’ reasons for increasing, decreasing, or remaining stable in their attendance were not assessed in the current study; coming to a deeper understanding of the motivations underlying such decisions could help to better understand the patterns we observed here. Similarly, a full measure of religious denominations was only available at baseline of the NLSY study, so we could not examine religious transitions between faith traditions. However, our measure of religious transitions is uniquely useful as it is prospective, rather than retrospective, and captures a potentially pivotal time of religious attendance transition from childhood to adulthood. Lastly, the sample came from the United States, so the majority of our respondents were affiliated with a Judeo-Christian faith. This limits the generalizability of our findings beyond this context, and we encourage future research in more religiously diverse samples to test the robustness of our findings.

Conclusion

Despite limitations, this study makes an important contribution to a burgeoning literature on the early life antecedents of health problems by using a nationally representative, prospective sample spanning nearly four decades. Our findings add credence to the growing body of evidence that suggests a link between childhood maltreatment and the risk of cardiovascular-related problems (Hamil-Luker & O’Rand, 2007; Morton et al., 2014) but illustrates the importance of incorporating the role of stability and change in religious attendance across the life course. As we found, declines in attendance from adolescence to adulthood exacerbated cardiovascular risk in midlife for victims of childhood abuse. Therefore, our results highlight that religious participation, measured in a life course fashion, is deserving of further consideration in understanding whether the effects of childhood maltreatment can be modified (for better or worse) by other domains of social life.

Footnotes

Acknowledgments

Support for this research was provided by a grant from the National Institute on Aging (R01 AG043544).

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) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Laura Upenieks

Patricia A. Thomas

Note

References

Ahmad

F. B.

Anderson

R. N.

(2021). The leading causes of death in the US for 2020. JAMA, 325(18), 1829–1830. https://doi.org/10.1001/jama.2021.5469

Anda

R. F.

Dong

Brown

D. W.

Felitti

V. J.

Giles

W. H.

Perry

G. S.

Dube

S. R.

(2009). The relationship of adverse childhood experiences to a history of premature death of family members. BMC Public Health, 9(1), 1–10. https://doi.org/10.1186/1471-2458-9-106

Basu

McLaughlin

K. A.

Misra

Koenen

K. C.

(2017). Childhood maltreatment and health impact: The examples of cardiovascular disease and type 2 diabetes mellitus in adults. Clinical Psychology: Science and Practice, 24(2), 125–139. https://doi.org/10.1111/cpsp.12191

Bierman

(2005). The effects of childhood maltreatment on adult religiosity and spirituality: Rejecting God the Father because of abusive fathers? Journal for the Scientific Study of Religion, 44(3), 349–359. https://doi.org/10.1111/j.1468-5906.2005.00290.x

Bradshaw

Ellison

C. G.

Flannelly

K. J.

(2008). Prayer, God imagery, and symptoms of psychopathology. Journal for the Scientific Study of Religion, 47(4), 644–659. https://doi.org/10.1111/j.1468-5906.2008.00432.x

Brenner

P. S.

(2011). Identity importance and the overreporting of religious service attendance: Multiple imputation of religious attendance using the American Time Use Study and the General Social Survey. Journal for the Scientific Study of Religion, 50(1), 103–115. https://doi.org/10.1111/j.1468-5906.2010.01554.x

Brenner

P. S.

(2017). Narratives of response error from cognitive interviews of survey questions about normative behavior. Sociological Methods & Research, 46(3), 540–564. https://doi.org/10.1177/0049124115605331

Bryant-Davis

(2005). Coping strategies of African American Adult Survivors of Childhood Violence. Professional Psychology: Research and Practice, 36(4), 409–414. https://doi.org/10.1037/0735-7028.36.4.409

Buck

A. C.

Williams

D. R.

Musick

M. A.

Sternthal

M. J.

(2009). An examination of the relationship between multiple dimensions of religiosity, blood pressure, and hypertension. Social Science & Medicine, 68(2), 314–322. https://doi.org/10.1016/j.socscimed.2008.10.010

10.

Chen

VanderWeele

T. J.

(2018). Associations of religious upbringing with subsequent health and well-being from adolescence to young adulthood: An outcome-wide analysis. American Journal of Epidemiology, 187(11), 2355–2364. https://doi.org/10.1093/aje/kwy142

11.

Crimmins

E. M.

Beltrán-Sánchez

(2011). Mortality and morbidity trends: Is there compression of morbidity? The Journals of Gerontology: Series B, 66(1), 75–86. https://doi.org/10.1093/geronb/gbq088

12.

Danese

Tan

(2014). Childhood maltreatment and obesity: Systematic review and meta-analysis. Molecular Psychiatry, 19(5), 544–554. https://doi.org/10.1038/mp.2013.54

13.

Das

Nairn

(2016). Religious attendance and physiological problems in late life. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71(2), 291–308. https://doi.org/10.1093/geronb/gbu089

14.

Desai

K. M.

(2009). Understanding the relationship between spiritual struggles and physical health: A physiological study [Doctoral dissertation, Bowling Green State University].

15.

Dong

Anda

R. F.

Felitti

V. J.

Dube

S. R.

Williamson

D. F.

Thompson

T. J.

Giles

W. H.

(2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 28(7), 771–784. https://doi.org/10.1016/j.chiabu.2004.01.008

16.

Dube

S. R.

Fairweather

Pearson

W. S.

Felitti

V. J.

Anda

R. F.

Croft

J. B.

(2009). Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine, 71(2), 243–250. https://doi.org/10.1097/psy.0b013e3181907888

17.

Dube

S. R.

Felitti

V. J.

Dong

Chapman

D. P.

Giles

W. H.

Anda

R. F.

(2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics, 111(3), 564–572. https://doi.org/10.1542/peds.111.3.564

18.

Elliot

Briere

(1994). Epidemiology of memory and trauma. In International society on traumatic stress studies meeting.

19.

Ellison

C. G.

Burdette

A. M.

(2012). Religion and the sense of control among US adults. Sociology of Religion, 73(1), 1–22. https://doi.org/10.1093/socrel/srr035

20.

Ellison

C. G.

Fang

Flannelly

K. J.

Steckler

R. A.

(2013). Spiritual struggles and mental health: Exploring the moderating effects of religious identity. International Journal for the Psychology of Religion, 23(3), 214–229. https://doi.org/10.1080/10508619.2012.759868

21.

Exline

J. J.

Pargament

K. I.

Grubbs

J. B.

Yali

A. M.

(2014). The Religious and Spiritual Struggles Scale: Development and initial validation. Psychology of Religion and Spirituality, 6(3), 208–222. https://doi.org/10.1037/a0036465

22.

Exline

J. J.

Stauner

Wilt

J. A.

Grubbs

J. B.

(2021). Religious and spiritual struggles around the 2016 and 2020 U.S. presidential elections. Psychology of Religion and Spirituality. Advance online publication. https://doi.org/10.1037/rel0000449

23.

Exline

J. J.

Van Tongeren

D. R.

Bradley

D. F.

Wilt

J. A.

Stauner

Pargament

K. I.

DeWall

C. N.

(2020). Pulling away from religion: Religious/spiritual struggles and religious disengagement among college students. Psychology of Religion and Spirituality. Advance online publication. https://doi.org/10.1037/rel0000375

24.

Falsetti

S. A.

Resick

P. A.

Davis

J. L.

(2003). Changes in religious beliefs following trauma. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 16(4), 391–398. https://doi.org/10.1023/a:1024422220163

25.

Felitti

V. J.

Anda

R. F.

Nordenberg

Williamson

D. F.

Spitz

A. M.

Edwards

Marks

J. S.

(1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8

26.

Fenelon

Danielsen

(2016). Leaving my religion: Understanding the relationship between religious disaffiliation, health, and well-being. Social Science Research, 57, 49–62. https://doi.org/10.1016/j.ssresearch.2016.01.007

27.

Ferraro

K. F.

Kim

(2014). Health benefits of religion among Black and White older adults? Race, religiosity, and C-reactive protein. Social Science & Medicine, 120, 92–99. https://doi.org/10.1016/j.socscimed.2014.08.030

28.

Ferraro

K. F.

Schafer

M. H.

Wilkinson

L. R.

(2016). Childhood disadvantage and health problems in middle and later life: Early imprints on physical health? American Sociological Review, 81(1), 107–133. https://doi.org/10.1177/0003122415619617

29.

Ferraro

K. F.

Shippee

T. P.

(2009). Aging and cumulative inequality: How does inequality get under the skin? The Gerontologist, 49(3), 333–343. https://doi.org/10.1093/geront/gnp034

30.

Gall

T. L.

Basque

Damasceno-Scott

Vardy

(2007). Spirituality and the current adjustment of adult survivors of childhood sexual abuse. Journal for the Scientific Study of Religion, 46(1), 101–117. https://doi.org/10.1111/j.1468-5906.2007.00343.x

31.

George

L. K.

Ellison

C. G.

Larson

D. B.

(2002). Explaining the relationships between religious involvement and health. Psychological Inquiry, 13(3), 190–200. https://doi.org/10.1207/s15327965pli1303_04

32.

Giesbrecht

Sevcik

(2000). The process of recovery and rebuilding among abused women in the conservative evangelical subculture. Journal of Family Violence, 15(3), 229–248. https://doi.org/10.1023/a:1007549401830

33.

Gilbert

L. K.

Breiding

M. J.

Merrick

M. T.

Thompson

W. W.

Ford

D. C.

Dhingra

S. S.

Parks

S. E.

(2015). Childhood adversity and adult chronic disease: An update from ten states and the District of Columbia, 2010. American Journal of Preventive Medicine, 48(3), 345–349. https://doi.org/10.1016/j.amepre.2014.09.006

34.

Greenfield

E. A.

Marks

N. F.

(2009). Violence from parents in childhood and obesity in adulthood: Using food in response to stress as a mediator of risk. Social Science & Medicine, 68(5), 791–798. https://doi.org/10.1016/j.socscimed.2008.12.004

35.

Guest

(2007). In search of spiritual capital. In Flanagan

Jupp

P. C.

(Eds.), A sociology of spirituality (pp. 181–200). Ashgate

36.

Guo

Metcalfe

(2019). Religion as a social control: A longitudinal study of religious involvement and substance use. Crime & Delinquency, 65(8), 1149–1181. https://doi.org/10.1177/0011128718787510

37.

Hamil-Luker

O’Rand

A. M.

(2007). Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood. Demography, 44(1), 137–158. https://doi.org/10.1353/dem.2007.0004

38.

Hemmati

Bidel

Nazarzadeh

Valadi

Berenji

Erami

Al Zaben

Koenig

H. G.

Sanjari Moghaddam

Teymoori

Sabour

Ghanbarizadeh

S. R.

Seghatoleslam

(2019). Religion, spirituality and risk of coronary heart disease: A matched case–control study and meta-analysis. Journal of Religion and Health, 58(4), 1203–1216. https://doi.org/10.1007/s10943-018-0722-z

39.

Hill

T. D.

Rote

S. M.

Ellison

C. G.

Burdette

A. M.

(2014). Religious attendance and biological functioning: A multiple specification approach. Journal of Aging and Health, 26(5), 766–785.

40.

Hill

T. D.

Ellison

C. G.

Burdette

A. M.

Taylor

Friedman

K. L.

(2016). Dimensions of religious involvement and leukocyte telomere length. Social Science and Medicine, 163, 168–175.

41.

Hill

T. D.

Carr

D. C.

Burdette

A. M.

Dowd-Arrow

(2020). Life-course religious attendance and cognitive functioning in later life. Research on Aging, 42(7–8), 217–225. https://doi.org/10.1177/0164027520917059

42.

Hill

T. D.

Kaplan

L. M.

French

M. T.

Johnson

R. J.

(2010). Victimization in early life and mental health in adulthood: An examination of the mediating and moderating influences of psychosocial resources. Journal of Health and Social Behavior, 51(1), 48–63. https://doi.org/10.1177/0022146509361194

43.

Hill

T. D.

Rote

S. M.

Ellison

C. G.

(2017). Religious participation and biological functioning in Mexico. Journal of Aging and Health, 29(6), 951–972. https://doi.org/10.1177/0898264317716244

44.

Hill

T. D.

Zeng

Rambotti

Mossakowski

K. N.

Johnson

R. J.

(2021). Sad eyes, crooked crosses: Religious struggles, psychological distress and the mediating role of psychosocial resources. Journal of Religion and Health, 60(4), 2573–2591. https://doi.org/10.1007/s10943-021-01273-y

45.

J. Y.

Hendi

A. S.

(2018). Recent trends in life expectancy across high income countries: Retrospective observational study. BMJ, 362, k2562. https://doi.org/10.1136/bmj.k2562

46.

Hout

Greeley

(1998). What church officials’ reports don’t show: Another look at church attendance data. American Sociological Review, 63(1), 113–119. https://doi.org/10.2307/2657482

47.

Iannaccone

L. R.

(1990). Religious practice: A human capital approach. Journal for the Scientific Study of Religion, 29(3), 297–314. https://doi.org/10.2307/1386460

48.

Idler

E. L.

(1995). Religion, health, and nonphysical senses of self. Social Forces, 74(2), 683–704. https://doi.org/10.2307/2580497

49.

Jang

S. J.

Bader

C. D.

Johnson

B. R.

(2008). The cumulative advantage of religiosity in preventing drug use. Journal of Drug Issues, 38(3), 771–798. https://doi.org/10.1177/002204260803800306

50.

Jung

J. H.

(2014). Religious attendance, stress, and happiness in South Korea: Do gender and religious affiliation matter? Social Indicators Research, 118(3), 1125–1145. https://doi.org/10.1007/s11205-013-0459-8

51.

Jung

J. H.

(2018). Childhood adversity, religion, and change in adult mental health. Research on Aging, 40(2), 155–179. https://doi.org/10.1177/0164027516686662

52.

Kelley-Moore

J. A.

Ferraro

K. F.

(2001). Functional limitations and religious service attendance in later life: Barrier and/or benefit mechanism? The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56(6), S365–S373. https://doi.org/10.1093/geronb/56.6.s365

53.

Kemp

B. R.

Ferraro

K. F.

Morton

P. M.

Thomas

P. A.

Mustillo

S. A.

Crimmins

E. M.

(2021). Do early-life social, behavioral, and health exposures increase later-life arthritis incidence? Research on Aging, 44(7–8), 479–493. https://doi.org/10.1177/01640275211044979

54.

Krause

(2006). Exploring the stress-buffering effects of church-based and secular social support on self-rated health in late life. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(1), S35–S43. https://doi.org/10.1093/geronb/61.1.s35

55.

Krause

Pargament

K. I.

(2017). Losing my religion: Exploring the relationship between a decline in faith and a positive affect. Applied Research in Quality of Life, 12(4), 885–901.

56.

Krause

Pargament

K. I.

Ironson

(2017). Spiritual struggles and health: Assessing the influence of socioeconomic status. Journal for the Scientific Study of Religion, 56(3), 620–636. https://doi.org/10.1111/jssr.12364

57.

Krause

Pargament

K. I.

Ironson

Hill

(2017). Religious involvement, financial strain, and poly-drug use: Exploring the moderating role of meaning in life. Substance Use & Misuse, 52(3), 286–293. https://doi.org/10.1080/10826084.2016.1225096

58.

Lin

Y. C.

Huang

T. J.

Yeh

M. H.

Lin

M. S.

Chen

M. Y.

(2021). Lung function impairment and cardiovascular risks among rural adults: Implication for an aging society. BMC Public Health, 21(1), 1–9

59.

Lovallo

W.R.

(2016). Stress and health: Biological and psychological interactions (3rd ed.). Sage Publications.

60.

Maggi

Irwin

L. J.

Siddiqi

Hertzman

(2010). The social determinants of early child development: An overview. Journal of Paediatrics and Child Health, 46(11), 627–635. https://doi.org/10.1111/j.1440-1754.2010.01817.x

61.

Maselko

Kubzansky

Kawachi

Seeman

Berkman

(2007). Religious service attendance and allostatic load among high-functioning elderly. Psychosomatic Medicine, 69(5), 464–472. https://doi.org/10.1097/psy.0b013e31806c7c57

62.

Masters

K. S.

(2008). Mechanisms in the relation between religion and health with emphasis on cardiovascular reactivity to stress. Research in the Social Scientific Study of Religion, 19, 91–116

63.

McIntosh

D. N.

Silver

R. C.

Wortman

C. B.

(1993). Religion’s role in adjustment to a negative life event: Coping with the loss of a child. Journal of Personality and Social Psychology, 65(4), 812–821. https://doi.org/10.1037/0022-3514.65.4.812

64.

Miller

G. E.

Chen

Parker

K. J.

(2011). Psychological stress in childhood and susceptibility to the chronic diseases of aging: Moving toward a model of behavioral and biological mechanisms. Psychological Bulletin, 137(6), 959–997. https://doi.org/10.1037/a0024768

65.

Mize

T. D.

(2019). Best practices for estimating, interpreting, and presenting nonlinear interaction effects. Sociological Science, 6, 81–117. https://doi.org/10.15195/v6.a4

66.

Morton

P. M.

Mustillo

S. A.

Ferraro

K. F.

(2014). Does childhood misfortune raise the risk of acute myocardial infarction in adulthood? Social Science & Medicine, 104, 133–141. https://doi.org/10.1016/j.socscimed.2013.11.026

67.

Morton

P. M.

Schafer

M. H.

Ferraro

K. F.

(2012). Does childhood misfortune increase cancer risk in adulthood? Journal of Aging and Health, 24(6), 948–984. https://doi.org/10.1177/0898264312449184

68.

Nurius

P. S.

Green

Logan-Greene

Borja

(2015). Life course pathways of adverse childhood experiences toward adult psychological well-being: A stress process analysis. Child Abuse & Neglect, 45, 143–153. https://doi.org/10.1016/j.chiabu.2015.03.008

69.

O’Rand

A. M.

Hamil-Luker

(2005). Processes of cumulative adversity: Childhood disadvantage and increased risk of heart attack across the life course. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60(Special_Issue_2), S117–S124. https://doi.org/10.1093/geronb/60.special_issue_2.s117

70.

Royston

(2005). Multiple imputation of missing values: Update of ice. The Stata Journal, 5(4), 527–536. https://doi.org/10.1177/1536867x0500500404

71.

Schafer

M. H.

Ferraro

K. F.

(2012). Childhood misfortune as a threat to successful aging: Avoiding disease. The Gerontologist, 52(1), 111–120. https://doi.org/10.1093/geront/gnr071

72.

Schafer

M. H.

Ferraro

K. F.

(2013). Childhood misfortune and adult health: Enduring and cascadic effects on somatic and psychological symptoms? Journal of Aging and Health, 25(1), 3–28. https://doi.org/10.1177/0898264312464884

73.

Schafer

M. H.

Ferraro

K. F.

Mustillo

S. A.

(2011). Children of misfortune: Early adversity and cumulative inequality in perceived life trajectories. American Journal of Sociology, 116(4), 1053–1091. https://doi.org/10.1086/655760

74.

Schieman

Bierman

(2007). Religious activities and changes in the sense of divine control: Dimensions of social stratification as contingencies. Sociology of Religion, 68(4), 361–381. https://doi.org/10.1093/socrel/68.4.361

75.

Schieman

Bierman

Upenieks

Ellison

C. G.

(2017). Love thy self? How belief in a supportive God shapes self-esteem. Review of Religious Research, 59(3), 293–318. https://doi.org/10.1007/s13644-017-0292-7

76.

Schieman

S. H.

Bierman

Ellison

C. G.

(2013). Religion and mental health. In Aneshensel

Phelan

(Eds.), Handbook of the sociology of mental health (pp. 457–478). Springer.

77.

Schury

Kolassa

I.-T.

(2012). Biological memory of childhood maltreatment: Current knowledge and recommendations for future research. Annals of the New York Academy of Sciences, 1262(1), 93–100. https://doi.org/10.1111/j.1749-6632.2012.06617.x

78.

Seybold

K. S.

(2007). Physiological mechanisms involved in religiosity/spirituality and health. Journal of Behavioral Medicine, 30(4), 303–309. https://doi.org/10.1007/s10865-007-9115-6

79.

Sharp

(2010). How does prayer help manage emotions? Social Psychology Quarterly, 73(4), 417–437. https://doi.org/10.1177/0190272510389129

80.

Sosis

Alcorta

(2003). Signaling, solidarity, and the sacred: The evolution of religious behavior. Evolutionary Anthropology: Issues, News, and Reviews: Issues, News, and Reviews, 12(6), 264–274. https://doi.org/10.1002/evan.10120

81.

Stauner

Exline

Grubbs

Pargament

Bradley

Uzdavines

(2016). Bifactor models of religious and spiritual struggles: Distinct from religiousness and distress. Religions, 7(6), 130. https://doi.org/10.3390/rel7060068

82.

Ulmer

J. T.

Desmond

S. A.

Jang

S. J.

Johnson

B. R.

(2012). Religious involvement and dynamics of marijuana use: Initiation, persistence, and desistence. Deviant Behavior, 33(6), 448–468. https://doi.org/10.1080/01639625.2011.636653

83.

Umberson

Williams

Thomas

P. A.

Liu

Thomeer

M. B.

(2014). Race, gender, and chains of disadvantage: Childhood adversity, social relationships, and health. Journal of Health and Social Behavior, 55(1), 20–38. https://doi.org/10.1177/0022146514521426

84.

Upenieks

(2021). Resilience in the aftermath of childhood abuse? Changes in religiosity and adulthood psychological distress. Journal of Religion and Health, 60(4), 2677–2701. https://doi.org/10.1007/s10943-020-01155-9

85.

Upenieks

(2022). Searching for meaning: Religious transitions as correlates of life meaning and purpose in emerging adulthood. Mental Health Religion & Culture, 25, 414–434

86.

Upenieks

Schafer

M. H.

(2020). Religious attendance and physical health in later life: A life course approach. Journal of Health and Social Behavior, 61(4), 486–502. https://doi.org/10.1177/0022146520961363

87.

Upenieks

Schieman

Bierman

(2022). Jitters on the eve of the great recession: Is the belief in divine control a protective resource? Sociology of Religion, 83(2), 194–221. https://doi.org/10.1093/socrel/srab018

88.

Upenieks

Thomas

P. A.

(2021). Gaining faith, losing faith: How education shapes the relationship between religious transitions and later depression. Journal of Health and Social Behavior, 62(4), 582–598. https://doi.org/10.1177/00221465211046356

89.

Van Dyke

C. J.

Glenwick

D. S.

Cecero

J. J.

Kim

S. K.

(2009). The relationship of religious coping and spirituality to adjustment and psychological distress in urban early adolescents. Mental Health, Religion and Culture, 12(4), 369–383.

90.

Vaughan

A. S.

Schieb

Casper

(2020). Historic and recent trends in county-level coronary heart disease death rates by race, gender, and age group, United States, 1979-2017. PLoS One, 15(7), Article e0235839. https://doi.org/10.1371/journal.pone.0235839

91.

Voas

Chaves

(2016). Is the United States a counterexample to the secularization thesis? American Journal of Sociology, 121(5), 1517–1556. https://doi.org/10.1086/684202

92.

Walker

D. F.

Reid

H. W.

O'Neill

Brown

(2009). Changes in personal religion/spirituality during and after childhood abuse: A review and synthesis. Psychological Trauma: Theory, Research, Practice, and Policy, 1(2), 130–145. https://doi.org/10.1037/a0016211

93.

Wegman

H. L.

Stetler

(2009). A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood. Psychosomatic Medicine, 71(8), 805–812. https://doi.org/10.1097/psy.0b013e3181bb2b46

94.

Wheaton

(1994). Sampling the stress universe. In Avison

W. R.

Gotlib

I. H.

(Eds.), Stress and mental health (pp. 77–114). Plenum Press.

95.

Wilmoth

J. D.

Blaney

A. D.

Smith

J. R.

(2015). Marital satisfaction, negative interaction, and religiosity: A comparison of three age groups. Journal of Religion, Spirituality & Aging, 27(2–3), 222–240. https://doi.org/10.1080/15528030.2014.997955

96.

Ysseldyk

Haslam

S. A.

Haslam

(2013). Abide with me: Religious group identification among older adults promotes health and well-being by maintaining multiple group memberships. Aging & Mental Health, 17(7), 869–879. https://doi.org/10.1080/13607863.2013.799120