African-American adults who report more frequent participation in religious activities and/or deeper spiritual beliefs may be more likely to meet some of the American Heart Association’s key indicators of cardiovascular health, such as regular exercise , a balanced diet and normal blood pressure, according to new research published today in the Journal of the American Heart Association.
This study is the first to examine among African Americans the relationship between a comprehensive set of cardiovascular health behaviors—the American Heart Association’s Life’s Simple 7 (diet, physical activity, and nicotine exposure) and physiological factors (weight, cholesterol, blood pressure, and blood sugar levels) with religious beliefs and spirituality. Life’s Simple 7 Scores, created in 2010, were expanded and renamed Life’s Essential 8 in June 2022, with sleep added as the eighth component of optimal heart health.
African-Americans have worse overall cardiovascular health than non-Hispanic whites, and cardiovascular disease mortality is higher in African-American adults than in white adults, according to the American Heart Association’s Scientific Statement 2017 Association Cardiovascular Health in African Americans.
“Healthcare professionals and researchers need to recognize the importance of religious and spiritual influences in the lives of African Americans, who tend to be highly religious,” said lead study author LaPrincess C. Brewer, MD, MPH, a preventive cardiologist and assistant professor of medicine. at the Mayo Clinic in Rochester, Minnesota. “With religious and spiritual beliefs incorporated into our approaches, we can make great inroads in fostering the relationship between patients and physicians and between community members and scientists to build trust and sociocultural understanding of this population.”
The researchers analyzed responses measuring religiosity (strong religious feeling or belief in any religion), spirituality, and the Life’s Simple 7 measures of cardiovascular health from surveys and health examinations of 2,967 African-American participants in the Jackson Heart Study. The Jackson Heart Study is the largest single-site, community-based study of cardiovascular disease among African American adults in the United States. On average, participants were 54 years old at study enrollment and 66% were female. The ongoing study, which began in 1998, included more than 5,000 adults ages 21 to 84 who identified as African American and lived in the tri-county area of Jackson, Mississippi.
Researchers grouped participants by religious behavior (according to their self-reported level of church service/Bible study group attendance, private prayer, and use of religious beliefs or practices to adapt to difficult life situations and stressful events—termed religious coping in the study); and spirituality (belief in the existence of a supreme being, deity or God).
Questions about religious behavior were adapted from Fetzer’s Multidimensional Measures of Religiosity/Spirituality (Religious Attendance, Personal Prayer) and Religious Coping Scale (Religious Coping). Measures of spirituality were adapted from the Daily Spiritual Experience Scale, which assesses ordinary daily experiences according to theistic spirituality (belief in the existence of a supreme being, deity, or God and sense of God’s presence, desire for closer union with God, sense of God’s love ) and non-theistic spirituality (feel power in my religion, feel deep inner peace and harmony, or feel spiritually touched by creation).
Participants were then grouped according to religiosity and spirituality scores by health factors: physical activity, diet, smoking, weight, blood pressure, blood sugar, and cholesterol levels, plus the composite score of the seven components of the Life’s Simple 7 cardiovascular assessment health. Researchers estimated the odds of meeting intermediate and ideal levels of heart disease prevention goals based on religiosity/spirituality scores.
Participants who reported more religious activity or had deeper levels of spiritual beliefs were more likely to meet key cardiovascular health measures:
- Greater frequency of attending religious services or activities was associated with a 16% increase in the odds of achieving “intermediate” or “ideal” physical activity scores, 10% for diet, 50% for smoking, 12% for blood pressure, and 15% for cardiovascular health composite score.
- Greater reported frequency of personal prayer was associated with a 12% increased odds of achieving intermediate or ideal dietary benchmarks and a 24% increased odds of achieving the smoking-related benchmark.
- Religious coping was associated with 18% increased odds of achieving intermediate and ideal levels of physical activity, 10% increased odds of a healthy diet, 32% of smoking, and 14% of the composite cardiovascular health outcome.
- Full spirituality was associated with an 11% increase in the odds of achieving intermediate and ideal levels for physical activity and 36% for smoking.
“I was slightly surprised by the findings that multiple dimensions of religiosity and spirituality were associated with improved cardiovascular health across multiple health behaviors that are extremely difficult to change, such as diet, physical activity, and smoking,” Brewer said.
“Our findings highlight the essential role that culturally appropriate health promotion initiatives and lifestyle change recommendations can play in advancing health equity,” she added. “The cultural relevance of interventions may increase the likelihood of impacting cardiovascular health, as well as the sustainability and maintenance of healthy lifestyle changes.”
Brewer added: “This is particularly important for socio-economically disenfranchised communities who face multiple challenges and stressors. Religiosity and spirituality can serve as a stress buffer and have therapeutic purposes or support self-empowerment to practice healthy behaviors and seek preventive health services.”
The religiosity/spirituality survey was conducted at one point during the Jackson Heart Study, so participants’ cardiovascular health was not analyzed over time. In addition, people with known heart disease were not included in this analysis.
Co-authors are Janice Bowie, Ph.D., MPH; Joshua P. Slusser; Christopher G. Scott, MS; Lisa A. Cooper, MD, MPH; Sharonne N. Hayes, MD; Christy A. Patton, PhD; and Mario Sims, Ph.D., MS Author disclosures are listed in the manuscript.
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Journal of the American Heart Association (2022). DOI: 10.1161/JAHA.121.024974
Courtesy of the American Heart Association
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