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Ann Behav Med. 2018 Nov 12;52(12):989-998. doi: 10.1093/abm/kay001.

Religious and Spiritual Coping and Risk of Incident Hypertension in the Black Women's Health Study.

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Slone Epidemiology Center, Boston University, Boston, MA, USA.
Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
Department of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA.
Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston MA, USA.
Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA.
National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Department of Medicine, Boston, MA, USA.
Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, MA, USA.
Boston University Cancer Center, Boston University, Boston, MA, USA.
Department of Medicine, Harvard Medical School, Boston, MA, USA.



The few studies of the relationship between religion and/or spirituality (R/S) and hypertension are conflicting. We hypothesized that R/S may reduce the risk of hypertension by buffering adverse physiological effects of stress.


We prospectively assessed the association of R/S with hypertension within the Black Women's Health Study (BWHS), a cohort study initiated in 1995 that follows participants through biennial questionnaires. The 2005 questionnaire included four R/S questions: (i) extent to which one's R/S is involved in coping with stressful situations, (ii) self-identification as a religious/spiritual person, (iii) frequency of attending religious services, and (iv) frequency of prayer. Incidence rate ratios (IRRs) and 95% confidence intervals were calculated for each R/S variable in relation to incident hypertension using Cox proportional hazards regression models, controlling for demographics, known hypertension risk factors, psychosocial factors, and other R/S variables.


During 2005-2013, 5,194 incident cases of hypertension were identified. High involvement of R/S in coping with stressful events compared with no involvement was associated with reduced risk of hypertension (IRR: 0.87; 95% CI: 0.75, 1.00). The association was strongest among women reporting greater levels of perceived stress (IRR: 0.77; 95% CI: 0.61, 0.98; p interaction = .01). More frequent prayer was associated with increased risk of hypertension (IRR: 1.12; 95% CI: 0.99, 1.27). No association was observed for the other R/S measures.


R/S coping was associated with decreased risk of hypertension in African American women, especially among those reporting higher levels of stress. Further research is needed to understand the mechanistic pathways through which R/S coping may affect health.

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