William J. Strawbridge

Frequent attendance at religious services and mortality over 28 years.

OBJECTIVES This study analyzed the long-term association between religious attendance and mortality to determine whether the association is explained by improvements in health practices and social connections for frequent attenders. METHODS The association between frequent attendance and mortality over 28 years for 5286 Alameda Country Study respondents was examined. Logistic regression models analyzed associations between attendance and subsequent improvements in health practices and social connections. RESULTS Frequent attenders had lower mortality rates than infrequent attenders (relative hazard [RH] = 0.64;95% confidence interval [CI] = 0.53,0.77). Results were stronger for females. Health adjustments had little impact, but adjustments for social connections and health practices reduced the relationship (RH = 0.77; 95% CI = 0.64, 0.93). During follow-up, frequent attenders were more likely to stop smoking, increase exercising, increase social contacts, and stay married. CONCLUSIONS Lower mortality rates for frequent religious attenders are partly explained by improved health practices, increased social contacts, and more stable marriages occurring in conjunction with attendance. The mechanisms by which these changes occur have broad intervention implications.

Prospective association between obesity and depression: evidence from the Alameda County Study

OBJECTIVE: To examine the temporal relation between obesity and depression to determine if each constitutes a risk factor for the other.DESIGN: A two-wave, 5-y-observational study with all measures at both times.SUBJECTS: A total of 2123 subjects, 50 y of age and older, who participated in the 1994 and 1999 waves of the Alameda County Study.MEASUREMENTS: Obesity defined as body mass index (BMI)⩾30. Depression assessed using DSM-IV symptom criteria for major depressive episodes. Covariates include indicators of age, gender, education, marital status, social support, life events, physical health problems, and functional limitations.RESULTS: Obesity at baseline was associated with increased risk of depression 5 y later, even after controlling for depression at baseline and an array of covariates. The reverse was not true; depression did not increase the risk of future obesity.CONCLUSION: These results, the first ever on reciprocal effects between obesity and depression, add to a growing body of evidence concerning the adverse effects of obesity on mental health. More studies are needed on the relation between obesity and mental health and implications for prevention and treatment.

Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships.

Several recent prospective analyses involving community-based populations have demonstrated a protective effect on survival for frequent attendance at religious services. How such involvement increases survival are unclear. To test the hypothesis that religious attendance might serve to improve and maintain good health behaviors, mental health, and social relationships, changes and consistencies in these variables were studied between 1965 and 1994 for 2,676 Alameda County Study participants, from 17 to 65 years of age in 1965, who survived to 1994. Measures included smoking, physical activity, alcohol consumption, medical checkups, depression, social interactions, and marital status. Those reporting weekly religious attendance in 1965 were more likely to both improve poor health behaviors and maintain good ones by 1994 than were those whose attendance was less or none. Weekly attendance was also associated with improving and maintaining good mental health, increased social relationships, and marital stability. Results were stronger for women in improving poor health behaviors and mental health, consistent with known gender differences in associations between religious attendance and survival. Further understanding the mechanisms involved could aid health promotion and intervention efforts.

The Dynamics of Disability and Functional Change in an Elderly Cohort: Results from the Alameda County Study

To examine changes in functional status over time by age, gender, and ethnicity in a representative sample of older persons.

Comparative Impact of Hearing and Vision Impairment On Subsequent Functioning

OBJECTIVES: The purpose of this study was to compare independent impacts of two levels of self‐reported hearing and vision impairment on subsequent disability, physical functioning, mental health, and social functioning.

Are the fat more jolly

Does obesity affect mental health? Two waves of data from a panel study of community residents 50 years and older were used to investigate the association between obesity and eight indicators of mental health: happiness, perceived mental health, life satisfaction, positive affect, negative affect, optimism, feeling loved and cared for, and depression. For none of the eight mental health outcomes examined did we observe a protective effect for obesity. Either no association was observed between obesity and psychological functioning, or the obese were worse off. Using 1994-1999 prospective data, the obese were at increased risk for poorer mental health on five of the outcomes examined using bivariate analyses. However, controlling for mental health problems at baseline and using statistical controls for covariates, the increased relative risk was limited to depression. There has been sufficient disparity of results thus far to justify further research on this question.Does obesity affect mental health? Two waves of data from a panel study of community residents 50 years and older were used to investigate the association between obesity and eight indicators of mental health: happiness, perceived mental health, life satisfaction, positive affect, negative affect, optimism, feeling loved and cared for, and depression. For none of the eight mental health outcomes examined did we observe a protective effect for obesity. Either no association was observed between obesity and psychological functioning, or the obese were worse off. Using 1994-1999 prospective data, the obese were at increased risk for poorer mental health on five of the outcomes examined using bivariate analyses. However, controlling for mental health problems at baseline and using statistical controls for covariates, the increased relative risk was limited to depression. There has been sufficient disparity of results thus far to justify further research on this question.

Religious attendance and cause of death over 31 years

Objective: Frequent attendance at religious services has been reported by several studies to be independently associated with lower all-cause mortality. The present study aimed to clarify relationships between religious attendance and mortality by examining how associations of religious attendance with several specific causes of death may be explained by demographics, socioeconomic status, health status, health behaviors, and social connections. Method: Associations between frequent religious attendance and major types of cause-specific mortality between 1965 and 1996 were examined for 6545 residents of Alameda County, California. Sequential proportional hazards regressions were used to study survival time until mortality from circulatory, cancer, digestive, respiratory, or external causes. Results: After adjusting for age and sex, infrequent (never or less than weekly) attenders had significantly higher rates of circulatory, cancer, digestive, and respiratory mortality (p < 0.05), but not mortality due to external causes. Differences in cancer mortality were explained by prior health status. Associations with other outcomes were weakened but not eliminated by including health behaviors and prior health status. In fully adjusted models, infrequent attenders had significantly or marginally significantly higher rates of death from circulatory (relative hazard [RH] = 1.21, 95 percent confidence interval [CI] = 1.02 to 1.45), digestive (RH = 1.99, p < 0.10, 95 percent CI = 0.98 to 4.03), and respiratory (RH = 1.66, p < 0.10, 95 percent CI = 0.92 to 3.02) mortality. Conclusions: These results are consistent with the view that religious involvement, like high socioeconomic status, is a general protective factor that promotes health through a variety of causal pathways. Further study is needed to determine whether the independent effects of religion are mediated by psychological states or other unknown factors.

Self-Rated Health and Mortality Over Three Decades Results from a Time-Dependent Covariate Analysis

Previous longitudinal studies assessing relative mortality risks associated with fair or poor self-rated health have differed in the extent to which observed relative risks are explained by disease burden and health risk factors. Gender and ethnic differences have rarely been assessed. The authors used proportional hazards models with time-dependent covariates to examine associations between fair or poor self-rated health and mortality over 28 years for 5,976 Alameda County Study respondents age 21 to 94 at baseline. Adjustments for a number of demographic variables, chronic conditions, mobility impairment, and health risk factors accounted for about half of the unadjusted relative risk. No gender or ethnicity differences in relative risk comparisons were found, but consistent with other studies, lower relative risks associated with increasing age were found. The authors conclude that self-rated health is a deceptively simple variable that likely measures a great deal more than disease burden.

An increasing prevalence of hearing impairment and associated risk factors over three decades of the Alameda County Study.

OBJECTIVES This study assessed changes in the prevalence of hearing impairment in persons aged 50 years and older over the past 30 years and identified risk factors. METHODS Age-adjusted hearing impairment prevalence rates at four time intervals were calculated from the Alameda County Study (n = 5108). Logistic regression models analyzed risk factors from 1974 for 1994 incident hearing impairment. RESULTS The prevalence of hearing impairment nearly doubled between 1965 and 1994. The increase was significantly greater for men. The higher incidence was associated with potentially high-noise-exposure occupations for men and with symptoms and conditions associated with ototoxic drug use for both men and women. Exercise was protective. CONCLUSIONS Given the serious health and social consequences of hearing impairment, its increasing prevalence is cause for concern.

Comparative strength of association between religious attendance and survival.

Objective: Analyze effects on long-term survival of frequent religious attendance compared with four widely-accepted beneficial health behaviors. Method: Calculate gender-specific associations with mortality over 29 years for religious attendance, cigarette smoking, physical activity, alcohol consumption, and non-religious social involvement. Subjects were 5,894 participants in the Alameda County Study age 21–75. Analyses use proportional hazards modeling with time-dependent measures to adjust for subsequent changes in attendance and each health behavior over the follow-up period. All statistical models adjust for the same variables. Results: For women, the protective effect of weekly religious attendance was of the same order of magnitude as the four other health behaviors. For men, the protective effect of weekly religious attendance was less than for any of the other health behaviors. Conclusions: The protective effect of religious attendance for women is comparable to those observed for several commonly recommended health behaviors: for men the protective effect of religious attendance is more modest. This strong gender difference may be a key to understanding how religious attendance exerts its effects.