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Frequency of Attendance at Religious Services and Mortality in a U.S. National Cohort
Open accessAbstract
Objective Few nationally representative cohort studies have appeared on frequency of attendance at religious services and mortality. We test the hypothesis that > weekly attendance compared with nonattendance at religious services is associated with lower probability of future mortality in such a study.Methods Data were analyzed from a longitudinal follow-up study of 8450 American men and women age 40 years and older who were examined from 1988 to 1994 and followed an average of 8.5 years. Measurements at baseline included self-reported frequency of attendance at religious services, sociodemographics, and health, physical and biochemical measurements.Results Death during follow-up occurred in 2058. After adjusting for confounding by baseline sociodemographics and health status, the hazards ratios (95% confidence limits) were never 1.00 (reference); < weekly 0.89 (0.75-1.04), p = 0.15; weekly 0.82 (0.71-0.94) p = 0.005; and > weekly attenders 0.70 (0.59-0.83), p < 0.001. Mediators, including health behaviors and inflammation, explained part of the association.Conclusions In a nationwide cohort of Americans, predominantly Christians, analyses demonstrated a lower risk of death independent of confounders among those reporting religious attendance at least weekly compared to never. The association was substantially mediated by health behaviors and other risk factors.
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“Of the 83 methodologically most rigorous studies, 75 (90%) reported inverse relationships with R/S involvement [213, 285–294].”
From Religion, Spirituality, and Health: The Research and Clinical Implications (2012) · cites this paper as [293]
In the citing paper
“Of the 37 methodologically most rigorous studies, 21 (57%) reported significant positive relationships between R/S and SRH [503, 508–527], whereas three (8%) found the opposite [528–530].”
From Religion, Spirituality, and Health: The Research and Clinical Implications (2012) · cites this paper as [512]
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“ResultsFigure 1 shows details of the flow diagram for this present systematic review. Tables summarizing the 36 articles that were included are available from the first author [”
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“Studies have shown that religiousness and spirituality are related to less depression (H. G. Koenig 2007), better scores on quality-of-life instruments (Tarakeshwar et al. 2006), lower mortality, ( Gillum et al. 2008 ) and greater psychological well-being (Lawler-Row and Elliott 2009).”
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“Higher levels of religiousness ( Gillum et al., 2008; Musick et al., 2004), spirituality (Christensen et al., 1994), personal control (Krause & Shaw, 2000), happiness (Chida & Steptoe, 2008; Koopmans et al., 2010; Martin et al., 2002), selfesteem (Stamatakis et al., 2004), and optimism (Giltay et al., 2004; Rasmussen…”
BackgroundSpirituality and Religiosity and Its Role in Health and Diseases
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Dimensions of religious involvement and leukocyte telomere length
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“…candidates for future mediation analyses include indicators of immune function like c-reactive protein and interleukin 6 (Ferraro and Kim, 2014; Gillum et al., 2008; Lutgendorf et al., 2004) and other measures of mental health like anxiety and chemical dependency (Ellison et al., 2009; Ford…”
BackgroundSpiritual Transformation, Psychological Well-Being, Health, and Survival in People with HIV
Ironson, G., & Kremer, H. (2009) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.39.3.d · Cited by 110
“In the general population, religious service attendance was associated with a lower death risk, even after controlling for health behaviors [57].”
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Mortality Differentials and Religion in the United States: Religious Affiliation and Attendance
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Spiritual Absence and 1-Year Mortality after Hematopoietic Stem Cell Transplant
Pereira, D. B., Christian, L. M., Patidar, S., Bishop, M. M., Dodd, S. M., Athanason, R., Wingard, J. R., & Reddy, V. S. (2010) · Biology of Blood and Marrow Transplantation · doi:10.1016/j.bbmt.2010.03.003 · Cited by 94
“In several largescale studies, less frequent religious attendance [20,21] and participation [22] were associated with greater odds/hazards ratios of mortality, and these relationships were at least partially explained by poorer health status [20], less social integration [20], engagement in unhealthy behaviors [20,21]…”
BackgroundReligious and spiritual beliefs of physicians
Robinson, K. A., Cheng, M.-R., Hansen, P. D., & Gray, R. J. (2017) · Journal of Religion and Health · doi:10.1007/s10943-016-0233-8 · Cited by 91
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“Of the 21 methodologically most rigorous studies, over three-quarters (76% or 16 studies) reported positive relationships [32,33] whereas only two (10%) found negative relationships [34,35].”
Self-citationReligiosity and Health: A Holistic Biopsychosocial Perspective
Page, R. L., Peltzer, J. N., Burdette, A. M., & Hill, T. D. (2020) · Journal of Holistic Nursing · doi:10.1177/0898010118783502 · Cited by 91
Church attendance, allostatic load and mortality in middle aged adults
Bruce, M. A., Martins, D., Duru, K., Beech, B. M., Sims, M., Harawa, N. T., Vargas, R. B., Kermah, D., Nicholas, S. B., Brown, A. F., et al. (2017) · PLoS ONE · doi:10.1371/journal.pone.0177618 · Cited by 95
“who found a lower unadjusted mortality rate among weekly and more-than-weekly church attendees compared with nonattendees using NHANES III participants ages 40 and over; but this association was no longer significant after controlling for common health-related mediating factors [11].”
BackgroundResultMcCullough, M. E., Friedman, H. S., Enders, C. K., & Martin, L. R. (2009) · Journal of Personality and Social Psychology · doi:10.1037/a0016366 · Cited by 85
Religion and healthy lifestyle behaviors among postmenopausal women: the women’s health initiative
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“Discussion As described previously, there is considerable evidence in favor of a positive association of frequent worship attendance and survival (Enstrom & Breslow, 2008; Gillum et al., 2008; House et al., 1982; Hummer et al., 1999; Kark et al., 1996; Koenig et al., 1999; McCullough et al., 2000; Schnall et al., 2008…”
BackgroundReligious Participation and Biological Functioning in Mexico
Hill, T. D., Rote, S. M., & Ellison, C. G. (2017) · Journal of Aging and Health · doi:10.1177/0898264317716244 · Cited by 75
“Hill et al. 965 The patterns for pulse rate, diastolic blood pressure, CRP, and overall allostatic load support previous studies conducted in the United States (Das & Nairn, 2016; Gillum et al., 2008; Hill et al., 2014; King et al., 2002; King et al., 2001; Koenig et al., 1998; Krause et al., 2002; Maselko et al., 200…”
ResultInfluentialHolt‐Lunstad, J., Steffen, P. R., Sandberg, J. G., & Jensen, B. J. (2011) · Journal of Behavioral Medicine · doi:10.1007/s10865-011-9343-7 · Cited by 83
“Lifestyle behaviors, stress, and depression are also predictive of cardiovascular disease and are negatively related to church attendance (Gillum et al., 2008; Hummer et al., 1999; Koenig & Valliant, 2009; Oman et al., 2002; Powell et al., 2003).”
BackgroundInfluentialReligiosity and health: A global comparative study
Zimmer, Z., Rojo, F., Ofstedal, M. B., Chiu, C., Saito, Y., & Jagger, C. (2018) · SSM - Population Health · doi:10.1016/j.ssmph.2018.11.006 · Cited by 80
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“…focused on the association between religious attendance and mortality, and a positive association between religious attendance and longevity is well established (Chida et al. 2009; Gillum et al. 2008; Koenig et al. 2012, p. 478; Moulton and Sherkat 2012; Oman et al. 2002; Strawbridge et al. 1997).”
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“4 Introduction There is increasing interest in the study of the relationship between religiosity/spirituality (R/S) and health, fostered by the finding that individuals who regularly attend religious services [1-9] have a reduction in overall mortality of almost 20%.”
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Paiva, C. E., Paiva, B. S. R., Yennurajalingam, S., & Hui, D. (2013) · Journal of Religion and Health · doi:10.1007/s10943-013-9770-6 · Cited by 64
“In addition, religious involvement was associated with reduced CRP in a large sample from a cohort study (Gillum et al. 2008).”
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KRAUSE, N. M., Ironson, G. H., & Pargäment, K. I. (2016) · Biodemography and Social Biology · doi:10.1080/19485565.2016.1188367 · Cited by 65
“Fourth, our findings involving CRP hold out the promise of providing firmer linkages between religion and more commonly used measures of health, such as chronic illness and mortality (e.g., Gillum et al. 2008).”
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“Numerous studies (e.g., Gillum et al. 2008; Schnall et al. 2010) suggest that religious behavior is linked to improved health.”
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“While many studies of religious participation have sought to statistically control for respondents’ levels of nonreligious participation (e.g., Gillum et al. 2008; Musick, House, and Williams 2004; Strawbridge, Cohen, and Shema 2000; Strawbridge et al. 1997), jointly controlling for both types of…”
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Religious and Spiritual Beliefs in Stroke Rehabilitation
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“[4] Gillum RF, King DE, Obisesan TO, Koenig HG.”
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Self-citationReligious Attendance and Biological Functioning
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“…function, namely, blood pressure (Koenig et al., 1998; Krause et al., 2002; Maselko et al., 2007), and immune function, including CRP (Gillum et al., 2008; King et al., 2001; King et al., 2002), interleukin-6 (Koenig et al., 1997; Lutgendorf et al., 2004), and white blood cells (King…”
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“…Idler et al., 2009); social integration and support (Idler, 2010; Krause, 2006; Oman & Thoresen, 2003); health behaviors (Enstrom & Breslow, 2008; Gillum et al., 2008; Strawbridge, Shema, Cohen, & Kaplan, 2001); a deeper meaning and purpose within illness experiences (Chen & Koening, 2006; Kaye…”
InfluentialReligious Participation and Mortality Risk in Mexico
Hill, T. D., Saenz, J. L., & Rote, S. M. (2018) · The Journals of Gerontology Series B · doi:10.1093/geronb/gby152 · Cited by 53
Religious Involvement, Health Status, and Mortality Risk
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Hybels, C. F., George, L. K., Blazer, D. G., Pieper, C. F., Cohen, H. J., & Koenig, H. G. (2014) · Journal of Aging and Health · doi:10.1177/0898264314527479 · Cited by 50
“Inflammation, for example, has been shown to be a partial mediator in the 682 Journal of Aging and Health 26(4) longitudinal relationship between frequency of attendance at religious services and mortality in a nationally representative cohort of adults aged 40 years and older (Gillum et al., 2008).”
BackgroundSelf-citationThe Impact of Spirituality on Health
Tabei, S. Z., Zarei, N., & Joulaei, H. (2016) · Shiraz E-Medical Journal · doi:10.17795/semj39053 · Cited by 51
Religiosity and telomere length: One step forward, one step back
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Church Attendance and Mobility Limitation Among Black and White Men With Prostate Cancer
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“Participation in organized religious services have been linked to hope, resilience, stress mitigation, and enhanced longevity (Bruce et al., 2017, 2020; Bruce & Thorpe, 2019; Chen et al, 2020; Gillum et al., 2008; Kim & VanderWeele, 2019; Koenig et al., 2012; Krause, 1997; Li et al., 2016).”
BackgroundInfluentialThe Complex Association Between Religious Activities and Functional Limitations in Older Adults
Hybels, C. F., Blazer, D. G., George, L. K., & Koenig, H. G. (2012) · The Gerontologist · doi:10.1093/geront/gnr156 · Cited by 49
Self-citationThe Etiology of Stability and Change in Religious Values and Religious Attendance
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“Furthermore, religiosity or, more specifically, religious attendance, has also been shown to be associated with lower rates of premature mortality (Gillum et al. 2008; McCullough et al. 2000; Musick et al. 2004) and a positive general well-being (Maselko and Kubzansky 2006; Moreira-Almeida et al.”
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United on Sunday: The effects of secular rituals on social bonding and affect
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“We dichotomized religious attendance in this manner because prior research suggests that most Americans in midlife and old age attend a religious service at least weekly (71).”
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“The association did not differ by gender or ethnicity [39].”
BackgroundPerceptions of Longevity and Successful Aging in Very Old Adults
Cherry, K. E., Marks, L. D., Benedetto, T., Sullivan, M. C., & Barker, A. (2013) · Journal of Religion Spirituality & Aging · doi:10.1080/15528030.2013.765368 · Cited by 32
Religion and Adult Mortality: Group- and Individual-Level Perspectives
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“A large body of research has shown that frequent religious-service attendance protects against mortality (Bagiella et al., 2005; Gillum et al., 2008; Musick et al., 2004; Oman and Reed, 1998; Strawbridge et al., 1997), the incidence of chronic physical health conditions, such as hypertension…”
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Spiritual Health and Outcomes in Muslim ICU Patients: A Nationwide Cross-Sectional Study
Bashar, F. R., Vahedian‐Azimi, A., Salesi, M., Hajiesmaeili, M., Shojaei, S., Farzanegan, B., Goharani, R., Madani, S. J., Moghaddam, K. G., Hatamian, S., et al. (2018) · Journal of Religion and Health · doi:10.1007/s10943-017-0543-5 · Cited by 27
“In several large-scale studies, less frequent religious attendance (Hummer et al. 2004; Gillum et al. 2008) and participation (Lutgendorf et al.”
BackgroundHuman Capital and the Supply of Religion
Engelberg, J., Fisman, R. J., Hartzell, J. C., & Parsons, C. A. (2016) · The Review of Economics and Statistics · doi:10.1162/rest_a_00582 · Cited by 23
Religion and the Use of Complementary and Alternative Medicine (CAM) Among Cardiac Patients
Nicdao, E. G., & Ai, A. L. (2013) · Journal of Religion and Health · doi:10.1007/s10943-013-9681-6 · Cited by 23
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“Greater frequency of attendance at religious services has been linked to beneficial health behaviors and a lower risk of mortality (Gillum et al., 2008).”
BackgroundReligiousness, Health, and Depression in Older Adults from a Brazilian Military Setting
Lucchetti, G., Lucchetti, A. L. G., Peres, M. F. P., Moreira‐Almeida, A., & Koenig, H. G. (2012) · ISRN Psychiatry · doi:10.5402/2012/940747 · Cited by 20
“Nevertheless, this profile is different from US studies in which there is a Protestant majority [18].”
BackgroundSelf-citationCausal effects of religious service attendance?
VanderWeele, T. J. (2017) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-017-1434-5 · Cited by 20
Health and Biological Functioning
Hill, T. D., Bradshaw, M., & Burdette, A. M. (2016) · Handbooks of sociology and social research · doi:10.1007/978-3-319-31395-5_2 · Cited by 18
“…Hill et al. 2014 ; Koenig et al. 1998 ; Krause et al. 2002 ; Maselko et al. 2007 ), c-reactive protein (Das and Nairn 2016 ; Ferraro and Kim 2014 ; Gillum et al. 2008 ; Hill et al. 2014 ; King et al. 2001 , 2002 ), interleukin-6 (Koenig et al. 1997 ; Lutgendorf et al. 2004 ), white blood cells…”
BackgroundResultInfluentialAttachment and Spiritual Coping: Theory and Practice With Older Adults
Pickard, J. G., & Nelson-Becker, H. B. (2011) · Journal of Spirituality in Mental Health · doi:10.1080/19349637.2011.565239 · Cited by 17
Religious service attendance and mortality among older Black men
Bruce, M. A., Beech, B. M., Kermah, D., Bailey, S., Phillips, N., Jones, H. P., Bowie, J. V., Heitman, E., Norris, K. C., Whitfield, K. E., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0273806 · Cited by 16
“The responses ranging from 0 to 1095 times a year were divided by 12 and classified into three categories, never attended, attended three or fewer times per month, and attended one or more times per week [27,28].”
BackgroundReligious activity, life expectancy, and disability-free life expectancy in Taiwan
Hidajat, M. M., Zimmer, Z., Saito, Y., & Lin, H.-S. (2013) · European Journal of Ageing · doi:10.1007/s10433-013-0273-9 · Cited by 17
Health Promoting Habits of People Who Pray for Their Health
Harrigan, J. T. (2009) · Journal of Religion and Health · doi:10.1007/s10943-009-9293-3 · Cited by 16
Patient perception of disease control and psychological distress
Mazzotti, E., Sebastiani, C., & Marchetti (2012) · Cancer Management and Research · doi:10.2147/cmar.s35060 · Cited by 17
Jaoude, J. A., Obeïd, S., Malaeb, D. N., Sakr, F., Dabbous, M., Khatib, S. E., Hallit, S. R., Fekih‐Romdhane, F., & Hallit, R. R. (2024) · BMC Psychology · doi:10.1186/s40359-024-01942-z · Cited by 18
“Because religiosity is commonly used as an indicator of population health, involving mental health [17]* has a significant and crucial influence on the way individuals perceive and understand death [11].”
BackgroundCancer family caregiver depression: are religion‐related variables important?
Williams, A.-L., Dixon, J. K., Feinn, R., & McCorkle, R. C. (2014) · Psycho-Oncology · doi:10.1002/pon.3647 · Cited by 17
Importancia de los aspectos espirituales y religiosos en la atención de pacientes quirúrgicos
CANTEROS, M. A. F. (2016) · Revista de Cirugía · doi:10.1016/j.rchic.2016.03.011 · Cited by 15
Makridis, C. A. (2022) · European Economic Review · doi:10.1016/j.euroecorev.2022.104279 · Cited by 14
Religious and Spiritual Issues in DSM-5: Matters of the Mind and Searching of the Soul
Chandler, E. N. (2012) · Issues in Mental Health Nursing · doi:10.3109/01612840.2012.704130 · Cited by 14
Fluidity of Faith: Predictors of Religion in a Longitudinal Sample of Chinese Adults
Francis‐Tan, A., & Tian, F. F. (2021) · Journal for the Scientific Study of Religion · doi:10.1111/jssr.12764 · Cited by 13
Ai, A. L., & Carretta, H. J. (2020) · International Journal of Behavioral Medicine · doi:10.1007/s12529-020-09915-3 · Cited by 13
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Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0001 · Cited by 12
Self-citationKim, Y. J., Crutchfield, J. M., & Kim, Y. K. (2021) · Journal of Religion and Health · doi:10.1007/s10943-021-01224-7 · Cited by 11
Religion Benefiting Brain Tumour Patients: A Qualitative Study
Ravishankar, N., & Bernstein, M. (2014) · Journal of Religion and Health · doi:10.1007/s10943-014-9895-2 · Cited by 10
Weber, J. M., & Doolittle, B. R. (2023) · The International Journal of Psychiatry in Medicine · doi:10.1177/00912174231176171 · Cited by 10
“A study among 85,000 low-income Americans demonstrated an association between weekly religious attendance, an 8% reduction in all-cause mortality, and a 15% reduction in cancer death compared to those who never attended services.(22) Increased spirituality was also associated with improved mortality and decreased hosp…”
BackgroundToward a translational epidemiology of religion: Challenges and applications
Levin, J. (2022) · Annals of Epidemiology · doi:10.1016/j.annepidem.2022.08.053 · Cited by 10
Does religious involvement affect mortality in low-income Americans? A prospective cohort study
Wen, W., Schlundt, D. G., Andersen, S. W., Blot, W. J., & Zheng, W. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028200 · Cited by 9
Cigarette Smoking and Correlates Among Ultra-Orthodox Jewish Males
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Ashe, J. J., Bentley‐Edwards, K. L., Skipper, A. D., Cuevas, A. G., Vieytes, C. A. M., Bah, K., Evans, M. K., Zonderman, A. B., & Waldstein, S. R. (2024) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-024-02113-x · Cited by 7
“…a large body of literature has shown promising associations between frequent religious participation and better cardiovascular health as well as decreased Extended author information available on the last page of the article mortality risk among African American adults [26, 27, 28, 29, 30, 31, 32].”
Ai, A. L., Fincham, F. D., & Carretta, H. J. (2021) · Journal of Religion and Health · doi:10.1007/s10943-020-01146-w · Cited by 7
Physical health in a Canadian Old Order Mennonite community
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Religion and survival among European older adults
Christopoulos, K. (2023) · European Journal of Ageing · doi:10.1007/s10433-023-00789-4 · Cited by 6
“…attendance and mortality in predominately (or exclusively) Christian samples (Ahrenfeldt et al. 2023; Bagiella et al. 2005; Bruce et al. 2022; Gillum et al. 2008; Hill et al. 2005; Hummer et al. 1999; Idler et al. 2017; Kim et al. 2015; La Cour et al. 2006; Li et al. 2016; Musick et al.…”
BackgroundAssociation between Religion and Health in China: Using Propensity Score Matching Method
Zhang, J. H., Zhang, H. S., Liu, C., Jiang, X., Zhang, H., & Iwaloye, O. O. (2020) · Religions · doi:10.3390/rel11010037 · Cited by 6
“In western countries, the religions are congregational and the effects of church attendance on health may be mediated in part by a healthy lifestyle, social cohesion or mitigating stress (Koenig 2012; Bruce et al. 2017; Gillum et al. 2008; Holt et al. 2017).”
BackgroundLindström, M., & Pirouzifard, M. (2023) · SSM - Population Health · doi:10.1016/j.ssmph.2023.101492 · Cited by 5
“Previous international studies have investigated associations between religious service attendance/religious involvement and mortality finding significant associations between religious service attendance and/or religious involvement and lower all-cause mortality (Chida et al., 2009; Gillum et al., 2008; Hummer et al.…”
Background(Un)holy Smokes? Religion and Traditional and E-Cigarette Use in the United States
Hill, T. D., Bostean, G., Upenieks, L., Bartkowski, J. P., Ellison, C. G., & Burdette, A. M. (2022) · Journal of Religion and Health · doi:10.1007/s10943-022-01721-3 · Cited by 6
Driving Status and Religious Service Attendance among Older Americans
McLaughlin, S. J., Brown, K. M., Vivoda, J. M., & Connell, C. M. (2019) · Activities Adaptation & Aging · doi:10.1080/01924788.2019.1618688 · Cited by 5
Beshlideh, K., عالیپور, س., & Yailagh, M. S. (2008) · Cited by 5
Metadata
- Authors
- Gillum, R. F., King, D. E., Obisesan, T. O., & Koenig, H. G.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Medical University of South Carolina (US)
- Howard University (US)
- Duke University (US)
- Corresponding author
- Gillum, R.F.
- Venue
- Annals of Epidemiology
- Publisher
- Elsevier BV
- Published
- 2008-02
- Volume
- 18
- Issue
- 2
- Pages
- 124-129
- ISSN
- 1047-2797 (ISSN-L)
- PMC
- PMC2659561
- OpenAlex
- W2093838162
- Cited by
- 176
- References
- 50
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 7 · 2023: 46 · 2022: 5 · 2021: 10 · 2020: 10 · 2019: 5 · 2018: 7 · 2017: 7 · 2016: 9 · 2015: 4 · 2014: 9 · 2013: 12 · 2012: 9
- FWCI
- 10.20
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (AG00980, K23AG000980)
- Topics
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Social Sciences › Sociology and Political Science › Religion and Society Interactions
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- religious service attendance, mortality, religiosity, health behavior, inflammation, mediation, older adults
- MeSH terms
- Adult, Female, Humans, Longitudinal Studies, Male, Middle Aged, Mortality, Religion, United States, Cohort Studies, Spirituality
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