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The Journals of Gerontology Series B: Psychological Sciences and Social Sciences logoLink to The Journals of Gerontology Series B: Psychological Sciences and Social Sciences
. 2021 Feb 26;77(1):237–248. doi: 10.1093/geronb/gbab034

Religious Involvement and Cognitive Functioning at the Intersection of Race–Ethnicity and Gender Among Midlife and Older Adults

Andrea K Henderson 1,✉, Katrina M Walsemann 2, Jennifer A Ailshire 3
Editor: Deborah S Carr
PMCID: PMC8923294  PMID: 33640966

Abstract

Objectives

To investigate the association between religious involvement and cognitive functioning at the intersections of race–ethnicity and gender among midlife and older adults, and to determine if psychosocial factors help explain this relationship.

Method

The sample included 14,037 adults aged 50+ from the Health and Retirement Study (HRS). We utilized measures from the HRS 2010 and 2012 Core interviews and Leave-Behind questionnaires and estimated our models using linear regression.

Results

Compared to individuals who frequently attended religious services, infrequent religious service attendance was related to poorer cognitive functioning. Religiosity was inversely associated with cognitive functioning at baseline, but the relationship varied by race/gender subgroup. Greater religiosity was associated with better cognitive functioning among Black women, but lower cognitive functioning among White men and women. Psychosocial factors did little to explain the inverse association between religiosity and cognitive functioning.

Discussion

Results suggest the association between religious involvement and cognitive functioning is varied and complex, and largely dependent on important social identities. The findings have important implications for investigating health-protective factors, like religious involvement, using an intersectional perspective.

Keywords: Gender, Race, Religion and cognitive functioning

Older racial minorities have worse cognitive functioning than non-Hispanic Whites (Castora-Binkley et al., 2015; Weuve et al., 2018). For all adults 65 and older, Black Americans are almost twice as likely to have Alzheimer’s or other dementias compared to older Whites, while Hispanics are about one and one-half times as likely to have Alzheimer’s or other dementias as older Whites (Alzheimer’s Association, 2019). Women are also disproportionately at risk for Alzheimer’s disease (AD) and related dementias (Mazure & Swendsen, 2016; Sinforiani et al., 2010). Yet, few studies have examined the risk for poor cognitive functioning at the intersection of race–ethnicity and gender. Moreover, understanding what social and cultural factors preserve cognitive functioning at multiple axes of social stratification (i.e., race–ethnicity and gender) is essential to understanding and promoting healthy aging.

One important, but underexplored, social factor may be religion. Several decades of work have documented the health-promoting effects of religious involvement (Ellison & Levin, 1998), which is associated with lower mortality and morbidity as well as better psychological well-being (Idler et al., 2017). Scholars have only just begun to explore the relationship between religion and cognition, and current evidence suggests that religion and spirituality may protect cognitive functioning among older adults (Agli et al., 2015; Hosseini et al., 2017). Religion’s promotion of psychosocial resources, like hope, meaning and purpose, and social support has been offered to explain how it may protect the cognitive functioning of older adults (Hill, 2008). However, this work has several notable limitations. First, most studies rely on a single measure of religious involvement, usually religious attendance (Hill et al., 2006; Van Ness & Kasl, 2003), which overlooks the multidimensional nature of religion. Second, they tend to utilize small-scale, regional samples (Hill et al., 2006; Van Ness & Kasl, 2003) that have limited generalizability to the broader U.S. population. Third, they often ignore possible variations in how religious involvement operates to influence cognitive functioning by race–ethnicity, gender, or their intersection. Finally, no studies to date have examined the psychosocial processes that may underlie the relationship between religious involvement and cognitive functioning (George et al., 2002; Morton et al., 2017).

Using a large, nationally representative sample of U.S. adults aged 50 and older, we seek to expand our current knowledge about how religious involvement relates to cognition in two important ways. First, we explore whether the association between various dimensions of religious involvement and cognition varies at the intersection of race–ethnicity and gender. Second, we examine the extent to which several psychosocial factors help explain the association between religious involvement and cognitive functioning among midlife and older adults.

Race, Gender, and Cognitive Functioning

Cognitive functioning refers to the mental capacities involved in thinking, understanding, learning, remembering, problem solving, and decision making. It is a fundamental part of an individual’s ability to engage in activities, accomplish goals, and successfully navigate the world (Blazer &Yaffe, 2015). Large racial and gender disparities exist in healthy cognitive aging: Black and Hispanic older adults are more likely to suffer from cognitive impairment than their White peers (Castora-Binkley et al., 2015; Weuve et al., 2018), and women are more likely to be burdened with diseases associated with cognitive impairment and AD in later life (Sinforiani et al., 2010; Mazure & Swendsen, 2016).

Race–ethnicity and gender shape differential exposure to opportunities and conditions that impact cognitive aging. For example, inequalities in education (i.e., quality and quantity) and race-specific mechanisms (i.e., discrimination and segregation) have been posited to explain the racial gap in cognitive functioning among older Black and Hispanic adults as compared to their White counterparts (Forrester, 2017; Zhang et al., 2016). Biological processes (i.e., hormonal declines) as well as inequalities in structural opportunities (i.e., less education) help explain differences by gender (Wilder, 1996). However, the social inequalities and privileges associated with these identities, which influence cognition across the life course, do not happen in isolation and cannot be understood by examining a single axis.

An intersectional approach, advanced by Black feminist scholarship and more recently health scientists (Bowleg, 2012; Cho et al., 2013; Collins, 2015), maintains that experiences of race–ethnicity and gender are mutually constituted and interconnected, thereby creating unique and complex individual and social contexts that are consequential for social outcomes, including health and aging (Bowleg, 2012). Few studies to date, however, have examined cognitive functioning at the intersection of race–ethnicity and gender. One exception is a study by Díaz-Venegas and colleagues (2016). Using the 2010 Health and Retirement Study (HRS), the authors found older women aged 51 or older had higher average cognitive functioning scores than men, but there were greater gender differences between Whites and Blacks compared with Hispanics. These findings highlight the potential of intersectionality to challenge and extend our understanding of health disparities among older adults and the social factors that influence them.

Religion and Cognitive Functioning

Religion, best considered a multidimensional construct that includes organizational and nonorganizational factors (i.e., private and subjective religious beliefs and practices), is theorized to influence cognition through several mechanisms (Levin et al., 1995). Organized religious participation, generally measured via religious service attendance, is the most widely studied (Agli et al., 2015; Hill, 2008; Hosseini et al., 2017). Individuals who regularly participate in religious services have better cognitive functioning compared to individuals who attend less frequently. For example, using longitudinal data from the New Haven Established Populations for the Epidemiologic Studies of the Elderly, Van Ness and Kasl (2003) found that individuals who attended religious services once a week or more experienced less cognitive decline 3 years later than those who attended less than once a week. This relationship remained significant even after controlling for other forms of social engagement and support.

Religious involvement may impact cognitive functioning in several notable ways. First, it may reduce engagement in risky health behaviors, such as smoking and heavy drinking, that are related to cognitive decline (Hill, 2008). Second, the social elements of religious involvement may promote mental and social stimulation by providing opportunities to cultivate friendships and support (Ellison & George, 1994), including formal (i.e., pastoral counseling or small group meetings) and informal (i.e., socioemotional support) support and services. Social isolation and loneliness are major risk factors for cognitive decline (Cacioppo & Hawkley, 2009) and regular participation in religious communities, via service attendance or small group networks, may offset the risks associated with social isolation. Additionally, regular participation in organized religious services may offer opportunities for increased sensory stimulation and cognitive activity (i.e., activities that encourage thinking, concentration, and memory) by engaging in prayer, scripture reading, singing, sermons, and philosophical discussions. Such activities may help build cognitive reserve capacity that delays the manifestation of cognitive impairment (Hill, 2008).

Secondly, religion may influence cognition via private religious practices. Private dimensions of religious involvement may include private prayer or meditation and various religious coping practices that may assist individuals in stressful situations (Ano & Vasconcelles, 2005). Similar to organizational religious involvement, these private dimensions may directly and indirectly influence older adults’ cognitive functioning in a number of ways. Private religious beliefs and practices may lower anxiety and depression (Ano & Vasconcelles, 2005; Koenig et al., 2004). Poor mental health is thought to negatively impact memory areas of the brain through physiological changes, like elevated blood cortisol, that increase one’s risk for cognitive impairment (Butters et al., 2008). Furthermore, religious coping, that is, ways of understanding and dealing with negative life events in ways related to the sacred, offers opportunities to garner meaning, control, and comfort that may promote healthy cognition and purposeful aging (Pargament et al., 2005). For example, via prayer, individuals may develop a close, personal attachment with God (or a divine other), who offers solace and security, which decreases one’s risk of depression and anxiety, while encouraging feelings of dignity and self-worth (Granqvist & Kirkpatrick, 2013). Lastly, private religious activities offer a general orienting system or framework that helps individuals cultivate existential meaning and purpose, and may alter an individual’s perception, experience, and reaction to stressful events (Pargament et al., 2005). Such coping strategies may guard against cognitive decline because it results in higher cortical functions related to abstract thinking as well as lower rates of psychological dysfunction across the life course (Hill, 2008).

Religion and Health at the Intersection of Race–Ethnicity and Gender

Social location influences the understanding and expression of religion’s cultural toolkit, or the strategies, behaviors, and practices of religion that influence health (Edgell, 2017). Research finds that women and racial/ethnic minorities in the United States are more likely to engage in religious pursuits (Chatters et al., 1999; Sullins, 2006), and at the intersection of race–ethnicity and gender, older Black women are distinctly religious (Banks-Wallace & Parks, 2004; Chatters et al., 1999). Black women exhibit a greater overt focus on religion and spirituality than other groups, including greater engagement in prayer, scripture reading, and a stronger commitment to their wider church community (Chatters et al., 1999). Religion provides Black women with distinct meaning and purpose as well as the necessary social and psychological resources to negotiate a number of adverse circumstances including race and gender oppression, family stress, and daily hassles (Banks-Wallace & Parks, 2004; Musgrave et al., 2002). For example, Mattis (2002) finds Black women use religion and spirituality as analytical devices that help shape rational and critical thought—for example, the ability to reframe and take multiple perspectives—in the face of challenging life events. Other studies find that among older Black women, scripture reading and church-based support are salient resources used to meet daily needs (Musgrave et al., 2002), and religious coping strategies, including collaborative-coping and prayer, are health-protective behaviors in the face of chronic stress (Musgrave et al., 2002). Taken together, these studies indicate that religion occupies a unique role and purpose in the life of Black women. Therefore, paying close attention to if and how the association between religious involvement and cognitive functioning varies at the intersection of race–ethnicity and gender may provide greater insight as to how religious involvement relates to cognition.

Psychosocial Mediators

Efforts to discover how and why religion benefits health have identified several mechanisms that may explain, in part or in sum, the link between religion and cognitive functioning among older adults (George et al., 2002). These mechanisms include psychosocial resources, such as self-esteem and efficacy, meaning and purpose, and optimism (Ellison & Levin, 1998; Oman & Thoresen, 2002). As previously discussed, religious involvement is thought to promote positive self-perception via religious coherence—that is, a sense of meaning and purpose that reduces feelings of hopelessness and helplessness—as well as offer a greater sense of control and positive affect (Pargament et al., 2005). Beliefs about one’s ability or efficacy to manage daily affairs and stressful events influence cognitive processes and motivations and are believed to be an essential factor in promoting long-term cognitive functioning (Seeman et al., 1993). Therefore, to advance the work on religion and cognition among older adults, the present study also includes several psychosocial mechanisms thought to explain the religion–cognition connection, including (a) purpose in life, (b) optimism, (c) hopelessness, (d) mastery, and (e) constraints.

Based on prior empirical evidence and theoretical reasoning, the following patterns are expected for the present study. Religious involvement, both religious attendance and religiosity, will be related to higher cognitive functioning among midlife and older adults. However, the association between these various dimensions of religious involvement will vary at the intersection of race–ethnicity and gender and may be particularly important for Black women. Psychosocial resources will explain—in part or total—the association between religious involvement and cognitive functioning among older adults regardless of race–ethnicity and gender.

Data and Measures

We use the HRS, an ongoing nationally representative study of older Americans, to examine the association between religion and cognition. In 2006, the HRS began collecting data on psychosocial characteristics using the self-administered Leave-Behind questionnaire (LB). The LB obtains information about participants’ evaluations of their life circumstances, subjective well-being, and lifestyle. A random half-sample of households received the LB in 2006 and the second half-sample received it in 2008. Follow-up assessments occurred every 4 years (i.e., 2010 and 2012, respectively) and a new subsample of individuals born between 1954 and 1959 (i.e., Mid Baby Boomer [MBB]) was added in 2010. The MBB also includes a race–ethnic minority oversample in order to boost the size of the minority samples in those cohorts. In order to take advantage of these minority oversamples, we focus our analysis on age-eligible respondents who completed the 2010 or 2012 LB questionnaire, self-identified as White, Black, or Hispanic, and provided data on cognitive functioning (n = 14,037). Missing data on other variables ranged from <1% to 2.3%. To address issues of item nonresponse, we used multiple imputation methods.

Cognitive Functioning

The HRS uses a modified version of the Telephone Instrument for Cognitive Status to assess cognitive function both in face-to-face interviews and by telephone. We constructed a total cognitive function score by summing scores across tests that evaluate memory (10-word immediate and delayed recall), mental status (serial 7-s subtraction test and a backwards counting test), and naming and object identification (name day, date, president, vice-president, and two objects). We assigned full points on the naming and object identification tests for respondents under age 65 who were not asked these questions. These tests do not differentiate impairment in younger populations because adults under age 65 typically provide correct answers to all naming questions. The total cognitive function score was normally distributed, and values ranged from 0 to 35, with higher scores reflecting higher cognitive functioning.

Religion

We assessed two indicators of religious involvement: frequency of religious attendance and religiosity. First, religious attendance was measured by asking the respondent, “How often do you attend religious services?” Original response categories ranged from 1 = “Not at all” to 5 = “More than once a week”; however, responses changed across the 2010–2012 waves, and for consistency, we collapsed responses into three categories: never attend services, infrequently attend services (once a month), and frequently attend services (i.e., daily or weekly attendance), which serves as the reference category. Religiosity, a 4-item scale capturing religious beliefs, values, and coping, includes: (1) “I believe in a God who watches over me”; (2) “Events in my life unfold according to a divine or greater plan”; (3) “I try hard to carry my religious beliefs over into all my other dealings in life”; and (4) “I find strength and comfort in my religion.” Responses ranged from 1 = “strongly disagree” to 6 = “strongly agree.” Items were summed so that higher scores reflect higher levels of religiosity (Cronbach’s alpha = .92).

Moderator

Using self-reported race–ethnicity and gender, we created six mutually exclusive race–ethnic and gender categories: White men, White women, Black men, Black women, Hispanic men, and Hispanic women.

Psychosocial Mechanisms

We include several psychosocial mediators of the religion–cognition relationship (Ellison & Levin, 1998; George et al., 2002), including: (a) purpose in life, a 7-item index, measuring the respondents (dis)agreement with such items as “I have a sense of direction and purpose in my life” and “I enjoy making plans for the future and working to make them a reality” (Keyes et al., 2002; Ryff & Keyes, 1995; Cronbach’s alpha = .77); (b) hopelessness, a 4-item index, assessed via the respondents’ (dis)agreement with questions like “I feel it is impossible for me to reach the goals that I would like to strive for” and “I don’t expect to get what I really want” (Beck et al., 1974; Everson et al., 1997; Cronbach’s alpha = .86); (c) optimism, measured via six questions, including “If something can go wrong for me it will” and “In uncertain times, I usually expect the best” (Scheier et al., 1994; Cronbach’s alpha = .75); (d) mastery, measured via the Pearlin and Schooler’s (1978) perceived mastery index, which includes five items, such as “I can do just about anything I really set my mind to” and “What happens to me in the future mostly depends on me” (Cronbach’s alpha = .90); and (e) constraints, a 5-item scale, including items like “I often feel helpless in dealing with the problems of life” and “I have little control over the things that happen to me” (Lachman & Weaver, 1998; Cronbach’s alpha = .86). Items were reverse coded where necessary so that higher scores on all scales reflect higher psychosocial functioning.

Controls

We include several key background factors that are known or suspected correlates of the dependent and independent variables, and therefore could confound the associations of interest, including age (in years); relationship status (married, divorced/separated, widowed, and unmarried); birth cohort (<1931, 1931–1947, and ≥1948); education (less than high school, high school diploma/General Educational Development, some college, or a college degree or higher); household income (logged dollars), and if the respondent had ever reported having a stroke (1 = history of stroke vs 0 = no stroke history) and ever reported heart problems (1 = heart problem vs 0 = no heart problem).

We also include controls for religious affiliation and two forms of secular social support. First, religious affiliation shapes norms of religious participation and belief, but also intersects with race–ethnicity and gender to help frame those beliefs and behaviors. We categorize respondents on religious affiliation using four mutually exclusive categories: Catholic, other religion, religiously unaffiliated, and Protestant. Second, we assessed social support across four social relationship types—spouses, children, other family, and friends—using three items: (1) how much do [they] really understand the way you feel about things; (2) how much can you rely on [them] if you have a serious problem; and (3) how much can you open up to [them] if you need to talk about your worries? Responses ranged from 1 = “not at all” to 4 = “a lot.” An average score was first created for each relationship mode. Next, an overall social support measure was calculated by averaging the scores across all four relational modes, with higher scores representing higher levels of perceived social support. Lastly, social engagement was assessed using seven items covering a wide range of social activities in nonreligious settings (e.g., educational activities, spending time with children, and volunteering) in which respondents reported frequency of participation. Responses were reverse-coded, such that 0 = “never” to 6 = “daily.” Items were summed, with higher scores reflecting greater social engagement.

Analytical Strategy

The data analysis proceeded in several steps. First, descriptive statistics of the study variables stratified by race–ethnicity/gender subgroups are presented in Table 1. Second, we examined the relationship between religious attendance and religiosity with cognitive functioning using weighted linear least squares regression in Model 1 (Table 2). To examine if race–ethnicity/gender moderated the relationship between religion and cognitive functioning, interaction terms were added (i.e., Attendance × Race/gender) independently (Model 2). To help facilitate interpretation, all continuous variables were mean centered. We used an adjusted Wald test to determine if the set of interactions reached statistical significance at p < .05. If the set of interactions was significant, we proceeded to interpret the individual interactions. If the Wald test was not significant, we did not interpret individual interactions (Aneshensel, 2013). Our final model added the psychosocial mechanisms (Model 3). Importantly, because we were also interested in whether the relationship between religion and cognitive functioning was significantly different from zero within race–ethnicity/gender groups, we also estimated simple slopes (Aiken et al., 1991) and present these estimates from Models 2 and 3 in Table 3. To address issues of item nonresponse, we imputed data using the mi impute command with chained equations specification in Stata v16. Imputation models included all analytic variables as well as variables that were likely to be theoretically related to item nonresponse. This produced 20 data sets. Analyses were replicated across the 20 data sets and combined using mi estimate. This yielded an analytical sample size of n = 14,037.

Table 1.

Characteristics of Leave-Behind 2010–2012 Sample, Weighted Estimates, Health and Retirement Study (n = 14,037)

White men White women Black men Black women Hispanic men Hispanic women
n = 4,388 n = 5,864 n = 793 n = 1,522 n = 605 n = 865
Mean (SE) or % Mean (SE) or % Mean (SE) or % Mean (SE) or % Mean (SE) or % Mean (SE) or %
Cognitive functioning 23.5 (0.08) 24.0 (0.07) 20.0 (0.23) 20.3 (0.18) 20.6 (0.25) 20.3 (0.24)
Religiosity 17.6 (0.12) 19.7 (0.09) 20.3 (0.30) 21.7 (0.15) 19.8 (0.26) 20.6 (0.24)
Church attendance
 Not at all 35.2% 28.0% 19.3% 11.5% 23.3% 17.7%
 Infrequent 35.2% 34.4% 38.3% 32.3% 46.0% 37.0%
 Frequent 29.5% 37.6% 42.4% 56.2% 30.7% 45.3%
Age, years 65.0 (0.16) 66.4 (0.16) 62.8 (0.37) 64.2 (0.34) 62.5 (0.43) 63.7 (0.43)
Marital status, %
 Married 72.7% 57.1% 48.4% 29.1% 68.9% 50.4%
 Unmarried 10.8% 7.6% 23.7% 20.5% 12.7% 10.4%
 Separated/divorced 11.0% 14.2% 20.6% 27.0% 14.8% 20.9%
 Widowed 5.5% 21.0% 7.3% 23.5% 3.6% 18.2%
Cohort, %
 <1931 9.9% 14.2% 4.9% 8.9% 5.2% 7.7%
 1931–1947 39.4% 39.6% 33.8% 35.0% 31.7% 34.7%
 ≥1948 50.6% 46.2% 61.2% 56.1% 63.1% 57.6%
Education, %
 Less than high school 8.2% 9.0% 26.8% 26.2% 42.7% 46.8%
 HS graduation or GED 32.0% 36.6% 33.3% 31.8% 25.2% 26.4%
 Some college 25.4% 27.6% 26.0% 27.6% 19.5% 17.2%
 College degree or higher 34.5% 26.8% 13.9% 14.4% 12.6% 9.6%
HH income (log) 11.0 (0.02) 10.8 (0.02) 10.1 (0.09) 9.8 (0.06) 10.0 (0.10) 9.6 (0.11)
Religious denomination, %
 Protestant 55.2% 62.5% 78.1% 87.1% 16.6% 20.0%
 Catholic 25.8% 25.0% 6.6% 5.5% 72.6% 71.6%
 Other 4.3% 3.6% 4.5% 2.4% 1.7% 2.3%
 None 14.7% 8.9% 10.8% 5.0% 9.2% 6.2%
Social support 3.0 (0.01) 3.2 (0.01) 3.0 (0.03) 3.2 (0.02) 3.0 (0.03) 3.2 (0.03)
Social engagement 6.8 (0.09) 6.9 (0.08) 7.0 (0.29) 6.9 (0.19) 5.5 (0.26) 5.7 (0.23)
Heart problems, % 25.5% 19.4% 18.2% 23.8% 14.6% 13.2%
Stroke, % 6.0% 5.0% 12.6% 8.7% 5.9% 4.2%
Mediators
 Purpose in life 32.1 (0.12) 32.2 (0.10) 32.9 (0.32) 33.0 (0.22) 31.3 (0.35) 30.9 (0.33)
 Hopelessness 9.3 (0.09) 8.9 (0.08) 9.9 (0.26) 9.4 (0.18) 11.1 (0.31) 10.7 (0.26)
 Optimism 26.4 (0.11) 27.2 (0.10) 25.5 (0.26) 26.2 (0.20) 25.2 (0.34) 25.7 (0.27)
 Mastery 23.6 (0.10) 23.5 (0.09) 23.2 (0.29) 23.3 (0.19) 24.3 (0.31) 23.2 (0.31)
 Constraints 10.6 (0.10) 10.7 (0.09) 11.3 (0.28) 11.2 (0.20) 12.0 (0.35) 12.3 (0.31)
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Note: GED = General Educational Development; HH = household; HS = high school.

Table 2.

Weighted Linear Regression Models Predicting Cognitive Functioning in 2010/2012 by Religiosity and Race/Gender

Model 1 Model 2a Model 3a Model 2b Model 3b
b (SE) b (SE) b (SE) b (SE) b (SE)
Church attendance (ref. = frequent)
 Not at all −0.28 (0.11)* 0.07 (0.17) 0.10 (0.17) −0.30 (0.11)* −0.24 (0.11)*
 Infrequent −0.01 (0.09) 0.14 (0.16) 0.15 (0.15) −0.01 (0.09) 0.03 (0.09)
 Religiosity −0.03 (0.01)* −0.03 (0.01)* −0.04 (0.01)* −0.05 (0.01)* −0.06 (0.01)*
Race/ethnicity and gender (ref. = White men)
 White women 0.99 (0.09)* 1.29 (0.14)* 1.27 (0.14)* 1.02 (0.09)* 1.03 (0.09)*
 Black men −2.42 (0.20)* −2.33 (0.30)* −2.43 (0.30)* −2.40 (0.21)* −2.47 (0.21)*
 Black women −1.82 (0.16)* −1.67 (0.21)* −1.79 (0.21)* −2.06 (0.19)* −2.11 (0.18)*
 Hispanic men −1.47 (0.24)* −1.53 (0.44)* −1.52 (0.44)* −1.50 (0.24)* −1.51 (0.23)*
 Hispanic women −1.37 (0.22)* −1.06 (0.28)* −1.05 (0.28)* −1.44 (0.23)* −1.40 (0.23)*
Church attendance × Race/ethnicity and gender
 Not at all × White women −0.56 (0.21)* −0.52 (0.21)*
 Not at all × Black men −0.45 (0.55) −0.26 (0.55)
 Not at all × Black women −0.42 (0.43) −0.28 (0.44)
 Not at all × Hispanic men −0.43 (0.63) −0.40 (0.63)
 Not at all × Hispanic women −1.06 (0.58) −1.10 (0.56)*
 Infrequent × White women −0.33 (0.20) −0.27 (0.20)
 Infrequent × Black men 0.13 (0.44) 0.10 (0.43)
 Infrequent × Black women −0.05 (0.34) −0.00 (0.34)
 Infrequent × Hispanic men 0.40 (0.54) 0.33 (0.53)
 Infrequent × Hispanic women −0.17 (0.43) −0.09 (0.44)
Religiosity × Race/ethnicity and gender
 Religiosity × White women 0.03 (0.01) 0.03 (0.01)*
 Religiosity × Black men 0.03 (0.04) 0.02 (0.04)
 Religiosity × Black women 0.12 (0.03)* 0.11 (0.03)*
 Religiosity × Hispanic men 0.08 (0.04) 0.08 (0.04)
 Religiosity × Hispanic women 0.08 (0.04)* 0.08 (0.04)*
Mediators
 Purpose in life 0.03 (0.01)* 0.03 (0.01)*
 Hopelessness −0.02 (0.01) −0.02 (0.01)
 Optimism 0.04 (0.01)* 0.04 (0.01)*
 Mastery 0.01 (0.01) 0.01 (0.01)
 Constraints −0.04 (0.01)* −0.04 (0.01)*
Religious denomination (Protestant = ref.)
 Catholic 0.25 (0.09)* 0.25 (0.09)* 0.24 (0.09)* 0.25 (0.09)* 0.24 (0.09)*
 Other 0.25 (0.21) 0.26 (0.21) 0.22 (0.20) 0.21 (0.21) 0.18 (0.20)
 None 0.40 (0.14)* 0.38 (0.14)* 0.28 (0.14)* 0.36 (0.14)* 0.26 (0.14)
Social support 0.20 (0.08)* 0.20 (0.08)* −0.18 (0.08)* 0.20 (0.08)* −0.19 (0.08)*
Social engagement 0.06 (0.01)* 0.07 (0.01)* 0.05 (0.01)* 0.07 (0.01)* 0.05 (0.01)*
Ever had heart problems −0.22 (0.10)* −0.21 (0.10)* −0.10 (0.10) −0.22 (0.10)* −0.10 (0.10)
Ever had stroke −1.42 (0.21)* −1.41 (0.20)* −1.28 (0.20)* −1.42 (0.20)* −1.28 (0.20)*
Intercept 22.89 (0.14)* 22.71 (0.16)* 22.81 (0.16)* 22.88 (0.14)* 22.95 (0.14)*
Adjusted Wald test 1.23 1.1 3.61* 3.47*
# of respondents n = 14,037
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Notes: All models control for age, marital status, income, education, and cohort.

*p < .05.

Table 3.

Test of Slopes for Religiosity and Race and Gender Predicting Cognitive Functioning in 2010/2012, Health and Retirement Study (n = 14,037)

Model 2b Model 3b
b (SE) p-value b (SE) p-value
White men −0.05 (0.01) <.001 −0.06 (0.01) <.001
White women −0.03 (0.01) .01 −0.03 (0.01) .002
Black men −0.03 (0.04) .52 −0.04 (0.04) .35
Black women 0.07 (0.03) .04 0.05 (0.03) .14
Hispanic men 0.03 (0.04) .52 0.02 (0.04) .70
Hispanic women 0.03 (0.04) .44 0.02 (0.04) .57
Wald F test for set of interactions 3.61 .003 3.47 .004
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Note: H0: b (Religiosity) + b (Religiosity × Race/gender) ≠ 0.

Results

Table 1 presents weighted descriptive statistics by race–ethnicity and gender. Among women, White women reported the highest levels of cognitive functioning (mean = 24), whereas both Black and Hispanic women reported lower mean cognitive function scores of 20.3. Among men, White men reported an average cognitive function score of 23.5, while Black and Hispanic men reported mean scores of 20.0 and 20.6, respectively. Overall, Black women reported the highest levels of religiosity (mean = 21.7) and religious attendance (56.2% frequently attend), whereas White men reported the lowest levels of religiosity (mean = 17.6) and religious attendance (29.5% frequently attended).

The results presented in Model 1 of Table 2 suggest that compared to those who frequently attend religious services, older adults who never attend religious services reported significantly lower levels of cognitive functioning (b = −0.28, p = .02) net of demographics, socioeconomic status, health status, religious affiliation, social support, and social engagement. Conversely, religiosity was inversely related to cognitive functioning. That is, for every unit increase in religiosity, cognitive functioning declined by 0.03 points (p < .001) among older adults.

Moderation

Models 2a and 2b extend our initial analyses by estimating the moderating effects of race–ethnicity and gender. In Model 2a, we test for interactions between religious attendance and race–ethnicity and gender. The adjusted Wald F test was not significant (F = 1.23, p = .27), which indicates that the set of interaction terms did not improve overall model fit (Aneshensel, 2013). We therefore do not interpret the individual interactions and conclude that attendance is similarly associated with cognitive functioning across race/ethnic and gender groups.

In Model 2b, the introduction of the interactions between religiosity and race/gender groups improved overall model fit (F = 3.61, p = .003). Religiosity was inversely associated with cognitive functioning among White men (b = −0.05, p < .001), but the relationship was significantly different for Black women (b = 0.12, p = .001) and Hispanic women (b = 0.08, p = .032) compared to White men, net of covariates. Next, to examine if the relationship between religiosity and cognitive functioning differed from zero for each of the race–ethnic/gender groups, we computed “simple slopes” (Aiken et al., 1991). These results are presented in Table 3. Similar to White men, religiosity was inversely associated with cognitive functioning among White women (b = −0.03, p = .01), whereas among Black women religiosity was positively associated with cognitive functioning (b = 0.07, p = .04). However, religiosity was not significantly related to cognitive functioning among Black men or Hispanic men and women (i.e., slopes not different from zero). Figure 1 plots predicted cognitive functioning scores from Model 2b for those groups whose slopes were significantly different from zero—Black women, White women, and White men—across levels of religiosity, holding all other variables constant at their mean. The figure reveals a slight downward slope for White men and women as religiosity increased; however, for Black women, as religiosity increased, so too did cognitive functioning.

Figure 1.

Figure 1.

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Predicted cognitive functioning by religiosity, race–ethnicity, and gender; Model 2b.

Psychosocial Mechanisms

Models 3a and 3b present results after the inclusion of the five psychosocial mechanisms. Statistical adjustment for the psychosocial variables did not alter our inferences from Model 2a for religious attendance (Model 3a). Results from Model 3b indicate that about 8% of the difference in the slope between Black women and White men was explained by the psychosocial mediators; however, the relationship remained statistically significant. Conversely, these variables suppressed the religion–cognition relationship among older White men by about 20%. Results from Table 3 on simple slopes, however, suggest the relationship between religiosity and cognitive functioning was no longer significantly different from zero for Black women once the psychosocial mechanisms are introduced (b = 0.05, p = .14). These analyses also suggest that religiosity continues to be inversely related to cognitive functioning for both White men (b = −0.06, p < .001) and women (b = −0.03, p = .002) once the psychosocial mechanisms are included.

Ancillary Analysis

In ancillary analyses (available upon request), we reestimated our models using two subdimensions of the cognitive functioning score: mental status and episodic memory. The patterns we found when using the total cognitive functioning score were also found for mental status and episodic memory. Given that our models included interactions as well as variables that were theoretically correlated, we estimated the variance inflation factor (VIF) to assess multicollinearity. All of the variables had VIF scores below the recommended 10 (Mansfield & Helms, 1982), and most had VIF scores around 1 or 2.

Discussion

In this paper, we examined the association between two dimensions of religious involvement and cognitive functioning at the intersection of race–ethnicity and gender, and considered whether various psychosocial factors help explain the association between religious involvement and cognition among older adults. Based on theory and prior empirical findings, we expected religious involvement to have a positive, protective effect on cognitive functioning among older adults, and that the association would vary by race–ethnicity and gender. Our findings reveal that the nature of the relationship between religious involvement and cognitive functioning is dependent on both race and gender, particularly for older Black women whose cognitive function may be protected by their religious involvement. Such results offer greater understanding of the social relationships that create opportunities and inequalities in health, as well as point to the distinct nature of religion underlying the religion–cognition relationship at these important intersections.

The findings for organized religious participation were consistent with previous research; overall, infrequent religious attendance was associated with lower cognitive functioning compared to those who frequently attended religious services even with adjustments for other forms of social support and engagement. Regular organized religious participation offers unique opportunities to receive social support and services that protect against isolation and loneliness that may lead to cognitive decline (Agli et al., 2015; Hill, 2008; Hosseini et al., 2017). Additionally, regular service attendance may offer opportunities for increased sensory stimulation via prayer, singing, and social engagement that may build cognitive reserve and delay the manifestation of cognitive difficulties (Hill et al., 2006). We found no significant differences between religious attendance and cognitive functioning at the intersection of race–ethnicity and gender.

Contrary to prior work (Koenig et al., 2004) and our expectations, religiosity, a construct capturing private religious beliefs, values, and coping, was associated with lower cognitive functioning scores in the main effects model; however, once we considered the association at the intersection of race–ethnicity and gender, the inverse association was only found among White men and women. Among Black women, the association was positive. Religion and spirituality occupy a unique role in the life of Black women (Banks-Wallace & Parks, 2004; Chatters et al., 1999). Black women grant religion a distinct, overt importance in their daily lives, are more likely to participate in public and private religious activities, and incorporate religion as a salient part of their identity (Banks-Wallace & Parks, 2004; Chatters et al., 1999; Musgrave et al., 2002). The substantive nature of Black women’s religiosity emphasizes its relational nature that manifests as greater purpose and meaning, support and strength, and enhanced positive feelings (i.e., love, happiness, and hope; Mattis, 2002). In ancillary analyses (not shown, but available upon request), we examined whether the five psychosocial mechanisms explained the religiosity–cognitive functioning relationship among race–ethnicity- and gender-stratified models, and the results revealed that among Black women, purpose in life and optimism explain the positive association between religiosity and cognitive function in this population. These results provide additional support for a distinct orientation toward religion among Black women, as well as the salient role it plays in helping them navigate a number of private and public domains (Mattis, 2002; Musgrave et al., 2002).

Conversely, our findings revealed an inverse association between religiosity and cognitive functioning among older White men and women. The exact mechanisms underlying this relationship remain unclear. In supplemental analysis, we also examined whether the religion–cognition relationship among White men and women could be explained by childhood socioeconomic status and adult personality characteristics, including openness, neuroticism, conscientiousness, and agreeableness (analysis available upon request). These additional measures did little to explain the inverse association between religiosity and cognitive functioning among this population. Our findings run counter to previous research and suggests a distinct religious orientation among older White men and women that warrants further investigation. The recent work by Sherkat (2010, 2011) on religion and verbal ability and science literacy may shed light on this issue. His work suggests that religion plays a key role in stratification processes by providing a cultural schema—that is, a specific way of knowing and understanding the world—that impacts learning and development. Specifically, conservative (White) Christian communities may distrust or shirk opportunities to engage with secular knowledge—for example, education, newspapers, media, and other materials—and outside social networks that contradicts religious claims (Rose, 1988; Welch et al., 2007), leading to lower verbal ability and other literacies. Religious communities that promote such hostilities among their adherents to securing and engaging with secular learning and knowledge may influence educational attainment, career trajectories, and perhaps cognitive functioning later in life. Another possible explanation may be that older people, particularly men, report difficulty adjusting to the changes associated with aging, including adjustment to retirement and bereavement (Kim & Moen, 2002), that may result in feelings of discontent, anger, and a loss of control. Perhaps such changes associated with aging become entangled with negative religious meanings and coping strategies that erode physical and mental health. There is a small, but growing, literature that may support such an explanation, which points to distinct differences in God imagery and religious coherence by race–ethnicity and gender and a “dark side of religion” on health (Ellison & Levin, 1998). Future research that investigates the ways White adults approach religious involvement across the life course and how such behaviors and cognitions change as they age may serve to help us better understand this counterintuitive result.

Although our study contributes to a better understanding of the relationship between religion and cognitive functioning in older adults, it also has several limitations. Because the associations examined here are based on cross-sectional data, we cannot establish the causal direction of these associations. These relationships may be bidirectional in that cognitive functioning may influence older adults’ ability to remain involved in both private and public religious pursuits. Although research finds that religious involvement increases with age (Bengtson et al., 2015), cognitively impaired older adults may be unable to continue religious participation. However, this may vary by race–ethnicity and the structure of religious communities. National studies suggest that Black elders report receiving regular informal support from church members and religious communities (i.e., instrumental aid, sick visits) only second to that received by family (Chatters et al., 1986), and elder care is often seen as a form of ministry (Bennett et al., 2014). However, the salience of private, subjective religiosity, a rich source of interpretive schemas that help provide meaning and purpose, may only strengthen with age. While this study examines multiple dimensions of religious involvement—attendance and religiosity—previously unexplored in earlier research on religion and cognition (Agli et al., 2015; Hill, 2008; Hosseini et al., 2017), we were unable to consider other aspects of religious involvement, including religious coping and God imagery, because these constructs were not measured in the HRS. Examining specific dimensions of negative and positive religious coping may help clarify the relationships we found because it may elucidate key differences in the meaning and methods of religion that impact healthy cognitive aging at the intersections of race–ethnicity and gender.

Despite these limitations, our study highlights the distinct and complex nature of religion on cognitive functioning at the intersections of race–ethnicity and gender. Ideally, future research on cognitive functioning should not only consider important cultural resources, like religion, but also how these resources and their underlying processes vary at these important dimensions of identity. Doing so not only promises to offer a better understanding of the factors that influence cognitive aging, but also how we might use these resources to promote healthy aging among individuals across diverse groups.

Funding

This work was supported by Caroline Center on Alzheimer’s Disease and Minority Research, National Institute of Aging (P30AG059294) and Resource Centers for Minority Aging Research, National Institute of Aging (P30AG043073).

Conflict of Interest

None declared.

Author Contributions

A. K. Henderson planned the study and wrote the paper. K. M. Walsemann performed all statistical analyses and contributed to revising the paper. J. A. Ailshire helped with HRS data and revise the manuscript.

References

  1. Agli, O., Bailly, N., & Ferrand, C. (2015). Spirituality and religion in older adults with dementia: A systematic review. International Psychogeriatrics, 27(5), 715–725. doi: 10.1017/S1041610214001665 [DOI] [PubMed] [Google Scholar]
  2. Aiken, L. S., West, S. G., & Reno, R. R. (1991). Multiple regression: Testing and interpreting interactions. Sage. [Google Scholar]
  3. Alzheimer’s Association. (2019). 2019 Alzheimer’s disease facts and figures. Alzheimer’s Dementia, 15(3), 321–387. https://www.alz.org/media/documents/alzheimers-facts-and-figures-2019-r.pdf. [Google Scholar]
  4. Aneshensel, C. (2013). Theory-based data analysis for the social sciences (2nd ed.). Sage Publications. [Google Scholar]
  5. Ano, G. G., & Vasconcelles, E. B. (2005). Religious coping and psychological adjustment to stress: A meta-analysis. Journal of Clinical Psychology, 61(4), 461–480. doi: 10.1002/jclp.20049 [DOI] [PubMed] [Google Scholar]
  6. Banks-Wallace, J., & Parks, L. (2004). It’s all sacred: African American women’s perspectives on spirituality. Issues in Mental Health Nursing, 25(1), 25–45. doi: 10.1080/01612840490249028-22 [DOI] [PubMed] [Google Scholar]
  7. Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology, 42(6), 861–865. doi: 10.1037/h0037562 [DOI] [PubMed] [Google Scholar]
  8. Bengtson, V. L., Silverstein, M., Putney, N. M., & Harris, S. C. (2015). Does religiousness increase with age? Age changes and generational differences over 35 years. Journal for the Scientific Study of Religion, 54(2), 363–379. doi: 10.1111/jssr.12183 [DOI] [Google Scholar]
  9. Bennett, S., Sheridan, M. J., & Richardson, F. (2014). Caregiving as ministry: Perceptions of African Americans providing care for elders. Families in Society, 95(1), 51–58. doi: 10.1606/1044-3894.2014.95.7 [DOI] [Google Scholar]
  10. Blazer, D. G., Yaffe, K., Liverman, C. T., Committee on the Public Health Dimensions of Cognitive Aging, Board on Health Sciences Policy, & Institute of Medicine (Eds.). (2015). Cognitive aging: Progress in understanding and opportunities for action. National Academies Press. doi: 10.17226/21693 [DOI] [PubMed] [Google Scholar]
  11. Bowleg, L. (2012). The problem with the phrase Women and Minorities: Intersectionality—An important theoretical framework for public health. American Journal of Public Health, 102(7), 1267–1273. doi: 10.2105/AJPH.2012.300750 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Butters, M. A., Young, J. B., Lopez, O., Aizenstein, H. J., Mulsant, B. H., Reynolds, C. F.3rd, DeKosky, S. T., & Becker, J. T. (2008). Pathways linking late-life depression to persistent cognitive impairment and dementia. Dialogues in Clinical Neuroscience, 10(3), 345–357. doi: 10.31887/DCNS.2008.10.3/mabutters [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Cacioppo, J. T., & Hawkley, L. C. (2009). Perceived social isolation and cognition. Trends in Cognitive Sciences, 13(10), 447–454. doi: 10.1016/j.tics.2009.06.005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Castora-Binkley, M., Peronto, C. L., Edwards, J. D., & Small, B. J. (2015). A longitudinal analysis of the influence of race on cognitive performance. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 70(4), 512–518. doi: 10.1093/geronb/gbt112 [DOI] [PubMed] [Google Scholar]
  15. Chatters, L. M., Taylor, R. J., & Jackson, J. S. (1986). Aged blacks’ choices for an informal helper network. Journal of Gerontology, 41(1), 94–100. doi: 10.1093/geronj/41.1.94 [DOI] [PubMed] [Google Scholar]
  16. Chatters, L. M., Taylor, R. J., & Lincoln, K. D. (1999). African American religious participation: A multi-sample comparison. Journal for the Scientific Study of Religion, 38(1), 132–145. doi: 10.2307/1387589 [DOI] [Google Scholar]
  17. Cho, S., Crenshaw, K. W., & McCall, L. (2013). Toward a field of intersectionality studies: Theory, applications, and praxis. Signs: Journal of Women in Culture and Society, 38(4), 785–810. doi: 10.1086/669608 [DOI] [Google Scholar]
  18. Collins, P. H. (2015). Intersectionality’s definitional dilemmas. Annual Review of Sociology, 41, 1–20. doi: 10.1146/annurev-soc-073014-112142 [DOI] [Google Scholar]
  19. Díaz-Venegas, C., Downer, B., Langa, K. M., & Wong, R. (2016). Racial and ethnic differences in cognitive function among older adults in the USA. International Journal of Geriatric Psychiatry, 31(9), 1004–1012. doi: 10.1002/gps.4410 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Ebaugh, H. R. (Ed.). (2006). Handbook of religion and social institutions. Springer Science & Business Media. doi: 10.1007/b102451 [DOI] [Google Scholar]
  21. Edgell, P. (2017). An agenda for research on American religion in light of the 2016 election. Sociology of Religion, 78(1), 1–8. doi: 10.1002/gps.4410 [DOI] [Google Scholar]
  22. Ellison, C. G., & George, L. K. (1994). Religious involvement, social ties, and social support in a southeastern community. Journal for the Scientific Study of Religion, 33(1), 46–61. doi: 10.2307/1386636 [DOI] [Google Scholar]
  23. Ellison, C. G., & Levin, J. S. (1998). The religion–health connection: Evidence, theory, and future directions. Health Education & Behavior, 25(6), 700–720. doi: 10.1177/109019819802500603 [DOI] [PubMed] [Google Scholar]
  24. Everson, S. A., Kaplan, G. A., Goldberg, D. E., Salonen, R., & Salonen, J. T. (1997). Hopelessness and 4-year progression of carotid atherosclerosis. The Kuopio Ischemic Heart Disease Risk Factor Study. Arteriosclerosis, Thrombosis, and Vascular Biology, 17(8), 1490–1495. doi: 10.1161/01.atv.17.8.1490 [DOI] [PubMed] [Google Scholar]
  25. Forrester, S. (2017). Perceived stress: A mechanism for cognitive decline among minorities? The American Journal of Geriatric Psychiatry, 25(1), 35–36. doi: 10.1016/j.jagp.2016.11.002 [DOI] [PubMed] [Google Scholar]
  26. George, L. K., Ellison, C. G., & Larson, D. B. (2002). Explaining the relationships between religious involvement and health. Psychological Inquiry, 13(3), 190–200. doi: 10.1207/S15327965PLI1303_04 [DOI] [Google Scholar]
  27. Granqvist, P., & Kirkpatrick, L. A. (2013). Religion, spirituality, and attachment. In Pargament K. I., Exline J. J., & Jones J. W. (Eds.), APA handbooks in psychology®. APA handbook of psychology, religion, and spirituality (vol. 1): Context, theory, and research (pp. 139–155). American Psychological Association. doi: 10.1037/14045-007 [DOI] [Google Scholar]
  28. Hill, T. D. (2008). Religious involvement and healthy cognitive aging: Patterns, explanations, and future directions. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 63(5), 478–479. doi: 10.1093/gerona/63.5.478 [DOI] [PubMed] [Google Scholar]
  29. Hill, T. D., Burdette, A. M., Angel, J. L., & Angel, R. J. (2006). Religious attendance and cognitive functioning among older Mexican Americans. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 61(1), P3–P9. doi: 10.1093/geronb/61.1.p3 [DOI] [PubMed] [Google Scholar]
  30. Hosseini, S., Chaurasia, A., & Oremus, M. (2017). The effect of religion and spirituality on cognitive function: A systematic review. The Gerontologist, 59(2), e76–e85. doi: 10.1093/geront/gnx024 [DOI] [PubMed] [Google Scholar]
  31. Idler, E., Blevins, J., Kiser, M., & Hogue, C. (2017). Religion, a social determinant of mortality? A 10-year follow-up of the Health and Retirement Study. PLoS ONE, 12(12), e0189134. doi: 10.1371/journal.pone.0189134 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Keyes, C. L., Shmotkin, D., & Ryff, C. D. (2002). Optimizing well-being: The empirical encounter of two traditions. Journal of Personality and Social Psychology, 82(6), 1007–1022. doi: 10.1037/0022-3514.82.6.1007 [DOI] [PubMed] [Google Scholar]
  33. Kim, J. E., & Moen, P. (2002). Retirement transitions, gender, and psychological well-being: A life-course, ecological model. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 57(3), P212–P222. doi: 10.1093/geronb/57.3.p212 [DOI] [PubMed] [Google Scholar]
  34. Koenig, H. G., George, L. K., & Titus, P. (2004). Religion, spirituality, and health in medically ill hospitalized older patients. Journal of the American Geriatrics Society, 52(4), 554–562. doi: 10.1111/j.1532-5415.2004.52161.x [DOI] [PubMed] [Google Scholar]
  35. Lachman, M. E., & Weaver, S. L. (1998). The sense of control as a moderator of social class differences in health and well-being. Journal of Personality and Social Psychology, 74(3), 763–773. doi: 10.1037//0022-3514.74.3.763 [DOI] [PubMed] [Google Scholar]
  36. Levin, J. S., Taylor, R. J., & Chatters, L. M. (1995). A multidimensional measure of religious involvement for African Americans. The Sociological Quarterly, 36(1), 157–173. doi: 10.1111/j.1533-8525.1995.tb02325.x [DOI] [Google Scholar]
  37. Mansfield, E. R., & Helms, B. P. (1982). Detecting multicollinearity. The American Statistician, 36(3a), 158–160. doi: 10.1080/00031305.1982.10482818 [DOI] [Google Scholar]
  38. Mattis, J. S. (2002). Religion and spirituality in the meaning-making and coping experiences of African American women: A qualitative analysis. Psychology of Women Quarterly, 26(4), 309–321. doi: 10.1111/1471-6402.t01-2-00070 [DOI] [Google Scholar]
  39. Mazure, C. M., & Swendsen, J. (2016). Sex differences in Alzheimer’s disease and other dementias. The Lancet: Neurology, 15(5), 451–452. doi: 10.1016/S1474-4422(16)00067-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Morton, K. R., Lee, J. W., & Martin, L. R. (2017). Pathways from religion to health: Mediation by psychosocial and lifestyle mechanisms. Psychology of Religion and Spirituality, 9(1), 106–117. doi: 10.1037/rel0000091 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Musgrave, C. F., Allen, C. E., & Allen, G. J. (2002). Spirituality and health for women of color. American Journal of Public Health, 92(4), 557–560. doi: 10.2105/ajph.92.4.557 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Oman, D., & Thoresen, C. E. (2002). ‘Does religion cause health?’: Differing interpretations and diverse meanings. Journal of Health Psychology, 7(4), 365–380. doi: 10.1177/1359105302007004326 [DOI] [PubMed] [Google Scholar]
  43. Pargament, K. I., Magyar-Russell, G. M., & Murray-Swank, N. A. (2005). The sacred and the search for significance: Religion as a unique process. Journal of Social Issues, 61(4), 665–687. doi: 10.1111/j.1540-4560.2005.00426.x [DOI] [Google Scholar]
  44. Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19(1), 2–21. doi: 10.2307/2136319 [DOI] [PubMed] [Google Scholar]
  45. Rose, S. D. (1988). Keeping them out of the hands of Satan: Evangelical schooling in America. Routledge. [Google Scholar]
  46. Ryff, C. D., & Keyes, C. L. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69(4), 719–727. doi: 10.1037//0022-3514.69.4.719 [DOI] [PubMed] [Google Scholar]
  47. Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67(6), 1063–1078. doi: 10.1037//0022-3514.67.6.1063 [DOI] [PubMed] [Google Scholar]
  48. Seeman, T. E., Rodin, J., & Albert, M. (1993). Self-efficacy and cognitive performance in high-functioning older individuals: Macarthur Studies of Successful Aging. Journal of Aging and Health, 5(4), 455–474. doi: 10.1177/089826439300500403 [DOI] [Google Scholar]
  49. Sherkat, D. E. (2010). Religion and verbal ability. Social Science Research, 39, 2–13. doi: 10.1016/j.ssresearch.2009.05.007 [DOI] [Google Scholar]
  50. Sherkat, D. E. (2011). Religion and scientific literacy in the United States. Social Science Quarterly, 92(5), 1134–1150. doi: 10.1111/j.1540-6237.2011.00811.x [DOI] [Google Scholar]
  51. Sinforiani, E., Citterio, A., Zucchella, C., Bono, G., Corbetta, S., Merlo, P., & Mauri, M. (2010). Impact of gender differences on the outcome of Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 30(2), 147–154. doi: 10.1159/000318842 [DOI] [PubMed] [Google Scholar]
  52. Sullins, D. P. (2006). Gender and religion: Deconstructing universality, constructing complexity. American Journal of Sociology, 112(3), 838–880. doi: 10.1086/507852. [DOI] [Google Scholar]
  53. Van Ness, P. H., & Kasl, S. V. (2003). Religion and cognitive dysfunction in an elderly cohort. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 58(1), S21–S29. doi: 10.1093/geronb/58.1.s21 [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Welch, M. R., Sikkink, D., & Loveland, M. T. (2007). The radius of trust: Religion, social embeddedness and trust in strangers. Social Forces, 86(1), 23–46. doi: 10.1353/sof.2007.0116 [DOI] [Google Scholar]
  55. Weuve, J., Barnes, L. L., de Leon Mendes, C. F., Rajan, K. B., Beck, T., Aggarwal, N. T., Hebert, L. E., Bennett, D. A., Wilson, R. S., & Evans, D. A. (2018). Cognitive aging in black and white Americans: Cognition, cognitive decline, and incidence of Alzheimer disease dementia. Epidemiology (Cambridge, Mass.), 29(1), 151–159. doi: 10.1097/EDE.0000000000000747 [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Wilder, G. Z. (1996). Correlates of gender differences in cognitive functioning. Report No. 96 03. College Entrance Examination Board. doi: 10.1097/EDE.0000000000000747 [DOI] [Google Scholar]
  57. Zhang, Z., Hayward, M. D., & Yu, Y. L. (2016). Life course pathways to racial disparities in cognitive impairment among older Americans. Journal of Health and Social Behavior, 57(2), 184–199. doi: 10.1177/0022146516645925 [DOI] [PMC free article] [PubMed] [Google Scholar]

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