Cited by 139Religion, Spirituality, and PsychologyCardiac Health and Mental HealthReligion and Society Interactions

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The relationship between religion and cardiovascular outcomes and all-cause mortality in the women's health initiative observational study

Schnall, Eliezer, Wassertheil-Smoller, Sylvia, Swencionis, Charles, Zemon, Vance, Tinker, Lesley, O'Sullivan, Mary Jo, Van Horn, Linda, Goodwin, Mimi·2010·Psychology & Health

DOI 10.1080/08870440802311322

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Abstract

Some studies suggest that religiosity may be related to health outcomes. The current investigation, involving 92,395 Women's Health Initiative Observational Study participants, examined the prospective association of religious affiliation, religious service attendance, and strength and comfort from religion with subsequent cardiovascular outcomes and death. Baseline characteristics and responses to religiosity questions were collected at enrollment. Women were followed for an average of 7.7 years and outcomes were judged by physician adjudicators. Cox proportional regression models were run to obtain hazard ratios (HR) of religiosity variables and coronary heart disease (CHD) and death. After controlling for demographic, socioeconomic, and prior health variables, self-report of religious affiliation, frequent religious service attendance, and religious strength and comfort were associated with reduced risk of all-cause mortality [HR for religious affiliation = 0.84; 95% confidence interval (CI): 0.75-0.93] [HR for service attendance = 0.80; CI: 0.73-0.87] [HR for strength and comfort = 0.89; CI: 0.82-0.98]. However, these religion-related variables were not associated with reduced risk of CHD morbidity and mortality. In fact, self-report of religiosity was associated with increased risk of this outcome in some models. In conclusion, although self-report measures of religiosity were not associated with reduced risk of CHD morbidity and mortality, these measures were associated with reduced risk of all-cause mortality.

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Al‐Yatim, S., & Al‐Yateem, N. (2014) · International Journal of Research in Nursing · doi:10.3844/ijrnsp.2014.17.24 · Cited by 12
Criminal Justice Contact and Health Service Utilization among Women across Health Care Settings: Analyzing the Role of Arrest
Nowotny, K. M., Timmer, A., & Oser, C. B. (2019) · Women s Health Issues · doi:10.1016/j.whi.2018.12.005 · Cited by 12
Definitions
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0001 · Cited by 12
A time-series prediction model of acute myocardial infarction in northern of Iran: the risk of climate change and religious mourning
Nia, H. S., Gorgulu, O., Naghavi, N., Froelicher, E., Fomani, F. K., Goudarzian, A. H., Sharif, S., Pourkia, R., & Haghdoost, A. (2021) · BMC Cardiovascular Disorders · doi:10.1186/s12872-021-02372-0 · Cited by 11
“While some longitudinal studies that have been conducted in a large cohort of healthy people didn’t acknowledged the protective association between religious affiliation and practice [69, 70], the other study findings indicated that restful religiousness was longitudinally associated with higher odds of heart attack […”
Result
Both Intrinsic and Extrinsic Religious Orientation are Positively Associated with Attitudes Toward Cleanliness: Exploring Multiple Routes from Godliness to Cleanliness
Litman, L., Robinson, J., Weinberger-Litman, S. L., & Finkelstein, R. (2017) · Journal of Religion and Health · doi:10.1007/s10943-017-0460-7 · Cited by 10
“At the broadest level of health, numerous studies have shown that religious people live longer (Kark et al. 1996; Hummer et al. 1999; Schnall et al. 2010; Bartkowski et al. 2010; McCullough and Willoughby 2009; McCullough et al. 2005a, b), and that religiosity impacts general health as well as…”
Background
VanderWeele and Chen Respond to “Religion as a Social Determinant of Health”
VanderWeele, T. J., & Chen, Y. (2019) · American Journal of Epidemiology · doi:10.1093/aje/kwz206 · Cited by 10
Validation of the Duke University Religion Index (DUREL) in Portuguese Cancer Patients Undergoing Chemotherapy
Martins, H. T., Caldeira, S., Domingues, T. D., Vieira, M., & Koenig, H. G. (2021) · Journal of Religion and Health · doi:10.1007/s10943-020-01143-z · Cited by 10
Supporting Religion and Spirituality to Enhance Quality of Life of People With Intellectual Disability: A Jewish Perspective
Glicksman, S. (2011) · Intellectual and developmental disabilities · doi:10.1352/1934-9556-49.5.397 · Cited by 9
“Regular involvement in organized religious activities such as prayer has been positively correlated with numerous positive outcomes, including physical health (Idler & Stanislav, 1997; Selway & Ashman, 1998), life expectancy (Schnall, 2010), and happiness (Lewis, 2002; Lewis, Maltby, & Day, 2005; Siegel & Anderman, 20…”
Background
Reliability and Validity of a Bilingual Measure of Religiosity in English and Vietnamese: Preliminary Results from a Pilot Study
Tran, T. V., Chan, K., & Nguyen, T. (2011) · Psychological Reports · doi:10.2466/07.17.pr0.108.3.756-762 · Cited by 9
Divine Placebo: Health and the Evolution of Religion
Lindenfors, P. (2019) · Human Ecology · doi:10.1007/s10745-019-0066-7 · Cited by 8
“ysis controlled for age, ethnicity, income level, and current health (Schnall et al. 2010).”
Background
Association of religiosity and spirituality with survival among older adults: a systematic review
Buja, A., Grotto, G., & Vo, D. (2024) · Journal of Public Health · doi:10.1007/s10389-024-02303-1 · Cited by 8
“(Oman and Reed 1998; Hart 2001; Hill et al. 2005; Bagiella et al. 2005; Teinonen et al. 2005; Dupre et al. 2006; Zhang 2008; Schnall et al. 2010; Zeng et al. 2011; McDougle et al. 2016; Park et al. 2016), one asked whether they were part of a religious community (Fraser et al. 2020), two assessed…”
ADL and IADL Following Open-Heart Surgery: The Role of a Character Strength Factor and Preoperative Medical Comorbidities
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
“Certain character strengths, such as hope and spirituality, have been associated with better health outcomes and survival in older adults and in cardiac patients (Anthony et al. 2016; Bouchard et al. 2018; Chida et al. 2009; Galatzer-Levy and Bonanno 2014; Gillum et al. 2008; Li et al. 2016; Rasmussen et al. 2009; Sch…”
Background
Psychosocial determinants of cardiovascular events among black Americans with chronic kidney disease or associated risk factors in the Jackson heart study
Bhavsar, N. A., Davenport, C. A., Yang, Z., Peskoe, S. B., Scialla, J. J., Hall, R. K., Tyson, C. C., Strigo, T. S., Sims, M., Pendergast, J., et al. (2021) · BMC Nephrology · doi:10.1186/s12882-021-02594-6 · Cited by 6
“A smaller number of studies have reported that religiosity and spirituality are not protective for health outcomes [10, 11] or that there is a salutary association of religiosity and health outcomes [50, 51].”
Background
Religion and survival among European older adults
Christopoulos, K. (2023) · European Journal of Ageing · doi:10.1007/s10433-023-00789-4 · Cited by 6
“…et al. 2000; Hill et al. 2005; Idler et al. 2017; Hummer et al. 1999; Kim et al. 2015; Li et al. 2016; McCullough et al. 2009; Musick et al. 2004; Schnall et al. 2010; Sullivan 2010; VanderWeele et al. 2017), but studies from other countries such as Denmark (Ahrenfeldt et al. 2023; La Cour et…”
Background
Stress and Spirituality in Relation to HPA Axis Gene Methylation Among US Black women: Results from the Black Women’s Health Study and the Study on Stress, Spirituality and Health
Shields, A. E., Zhang, Y., Argentieri, M. A., Warner, E. T., Cozier, Y. C., Liu, C., Dye, C. K., Kent, B. V., Baccarelli, A., & Palmer, J. R. (2021) · Epigenomics · doi:10.2217/epi-2021-0275 · Cited by 9
Religiosity Is Associated with Reduced Risk of All-Cause and Coronary Heart Disease Mortality among Jewish Men
Eilat-Adar, S., Hellerstein, D., & Goldbourt, U. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912607 · Cited by 6
Response to Letter Regarding Article, “Optimism, Cynical Hostility, and Incident Coronary Heart Disease and Mortality in the Women’s Health Initiative”
Tindle, H. A., Chang, Y., Kuller, L. H., Siegle, G. J., Matthews, K. A., Manson, J. E., Robinson, J. G., & Rosal, M. C. (2010) · Circulation · doi:10.1161/circulationaha.109.929166 · Cited by 6
Understanding the Socioeconomic Determinants of Religiosity and Religious Participation in Asia
Zhou, J. (2023) · Journal of Asian and African Studies · doi:10.1177/00219096231200598 · Cited by 5
“Schnall et al. (2010) found that regular religious service attendance was associated with a significantly reduced risk of mortality for women over 50 years.”
Religious Communities, Health, and Well-Being – Address to the US Air Force Chaplain
VanderWeele, T. J. (2018) · Military Medicine · doi:10.1093/milmed/usx206 · Cited by 5
Religious/Spiritual Effects on Physical Morbidity and Mortality
Oman, D. (2018) · Religion, spirituality and health: a social scientific approach · doi:10.1007/978-3-319-73966-3_4 · Cited by 5
Sanctification of Work: A Potential Moderator of the Relationship between Work Stress and Health
Backus, L. N. (2013) · ScholarWorks@BGSU (Bowling Green State University) · Cited by 5
Using Private Prayer for Coping (UPPC): Its Role and Mechanisms in Adversities Facing Diverse Populations
Ai, A. L., Peterson, C., Koenig, H. G., Paloutzian, R. F., & Harris, K. A. (2020) · Springer eBooks · doi:10.1007/978-3-030-52140-0_10 · Cited by 4
Measurement
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0002 · Cited by 5
Understanding the Religion, Mental, and Social Health Relationship
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0016 · Cited by 7
R|S Atlas: Identifying existing cohort study data resources to accelerate epidemiological research on the influence of religion and spirituality on human health
Schachter, A. B., Argentieri, M. A., Seddighzadeh, B., Isehunwa, O. O., Kent, B. V., Trevvett, P., McDuffie, M. T., Mandel, L., Pargäment, K. I., Underwood, L. G., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-043830 · Cited by 3
Positive Psychology and Judaism
SCHIFFMAN, M. H., Cherniak, A. D., Schnall, E., Brooks, S., Pirutinsky, S., & Shabtai, D. (2022) · Springer eBooks · doi:10.1007/978-3-031-10274-5_11 · Cited by 3
Self-citation
Associations between religiosity/spirituality with insulin resistance and metabolic syndrome in the Midlife in the United States (MIDUS) study
Masters, K. S., Wilson, C. L., & Boylan, J. M. (2025) · PLoS ONE · doi:10.1371/journal.pone.0319002 · Cited by 4
Does Religiosity Influence Attitude to Mental Illness? and #8211; A survey of Medical students in a Nigerian University.
Adelufosi, A. O., Abayomi, O., Oyewole, A. O., & Ayankola, A. K. (2013) · Journal of Behavioral Health · doi:10.5455/jbh.20130325033852 · Cited by 3
“Despite a troubled history between psychiatry and religion [9], a growing body of research have reported the positive impact of religiosity on treatment outcomes among those with mental and even physical health problems [10-14].”
Background
My Heart, My Mind, My Life: A Study on the Relation between Spiritual Well-being and Quality of Life in Heart Disease Patients
Kusumawardani, D. N., & Asih, S. R. (2019) · International Conference on Intervention and Applied Psychology (ICIAP) · doi:10.2991/iciap-18.2019.22 · Cited by 2
“In addition, patients’ self-esteem and optimism tend to increase when they have high spiritual well-being (Petrie & Weinman, 2006; Schnall et al., 2010).”
Spiritual Predictors of Improved Resilience in People Recovering from Alcohol Use Disorder: An Exploratory Study
Hiernaux, C., & Varescon, I. (2022) · Alcoholism Treatment Quarterly · doi:10.1080/07347324.2022.2047130 · Cited by 2
“Studies on the relationship between spirituality and health find a significant influence of gender, age (Feinstein, Liu, Ning, Fitchett, & Lloyd-Jones, 2010; Hummer, Rogers, Nam, & Ellison, 1999; Musick, House, & Williams, 2004; Powell, Shahabi, & Thoresen, 2003), marital status (Helm, Hays, Flint, Koenig, & Blazer, 2…”
“Faith Is Not Enough?” Ego-Resiliency and Religiosity as Coping Resources with Pandemic Stress—Mediation Study
Szałachowski, R. R., & Tuszyńska-Bogucka, W. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20031942 · Cited by 2
Psychological Well-Being and Positive Emotions
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Religion, Spirituality, and Cardiovascular Disease
Masters, K. S. (2022) · Springer eBooks · doi:10.1007/978-0-387-85960-6_27 · Cited by 2
Stress Hormones
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0025 · Cited by 1
Substance Use and Substance Use Disorders
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0010 · Cited by 2
Marital and Family Stability
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0014 · Cited by 4
Social Support
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0015 · Cited by 1
Does Religiosity Reduce Mortality Risk Over the Second Half of Life Among Southern Californians? A Multidimensional Model Within a Hazard Modeling Framework
Brown, M. T., Zhang, W., Hwang, W., & Silverstein, M. D. (2025) · Journal of Religion and Health · doi:10.1007/s10943-025-02297-4 · Cited by 1
“…in the U.S. (Dupre et al., 2006; Gillum et al., 2008; Hart, 2001; Hill et al., 2005; Hummer et al., 1999; Li et al., 2016; Oman & Reed, 1998; Schnall et al., 2010; VanderWeele et al., 2017), in Europe (Christopoulos, 2023; Darviri, et al., 2016), and in East Asia (Hidajat et al., 2013; Zeng…”
Mortality
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0027 · Cited by 1
Anxiety
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0008 · Cited by 2
Public Health and Human Flourishing
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0032 · Cited by 1
Understanding the Religion–Physical Health Relationship
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0031 · Cited by 1
Cigarette Smoking
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0017 · Cited by 1
Bipolar Disorder
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0006 · Cited by 1
Mobilizing Meaning
Hochstetler, E., & Hill, K. K. (2024) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2024.03.005 · Cited by 1

Authors: Schnall, E., Wassertheil-Smoller, S., Swencionis, C., Zemon, V., Tinker, L., O'Sullivan, M. J., Van Horn, L., & Goodwin, M.
Affiliations: Yeshiva University (US)
Albert Einstein College of Medicine (US)
Fred Hutch Cancer Center (US)
Corresponding author: Schnall, Eliezer
ORCID: Wassertheil-Smoller, Sylvia
Swencionis, Charles
Zemon, Vance
Tinker, Lesley
Venue: Psychology & Health
Publisher: Informa UK Limited
Published: 2010-02
Volume: 25
Issue: 2
Pages: 249-263
ISSN: 0887-0446 (ISSN-L)
1476-8321
DOI: 10.1080/08870440802311322
OpenAlex: W2162283541
Cited by: 139
References: 23
Citations by year: 2026: 1 · 2025: 2 · 2024: 3 · 2023: 45 · 2022: 4 · 2021: 11 · 2020: 7 · 2019: 8 · 2018: 8 · 2017: 7 · 2016: 8 · 2015: 5 · 2014: 4 · 2013: 10 · 2012: 5
FWCI: 3.90
Type: journal article
Language: en
Open access: closed
Locations: Psychology and Health (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Health › Religion, Spirituality, and Psychology
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Social Sciences › Sociology and Political Science › Religion and Society Interactions
Keywords: religiosity, religious affiliation, religious service attendance, cardiovascular outcomes, coronary artery disease, all-cause mortality, women's health, Women's Health Initiative Observational Study
MeSH terms: Aged, Cardiovascular Diseases, Cause of Death, Female, Humans, Middle Aged, Religion and Medicine, United States, Health Behavior, Proportional Hazards Models, Women's Health, Outcome Assessment, Health Care, Observation

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The relationship between religion and cardiovascular outcomes and all-cause mortality in the women's health initiative observational study

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