Social Support, Religiosity, Other
Psychological Factors, and Health
JERRY LEE, GRAHAM STACEY, AND GARY FRASER
Rather than providing a comprehensive analysis of psychosocial and religious commitment variables and their effects on mortality rates, we will focus here on the roles that some of these factors might play in distorting our dietary analyses. For instance, vegetarian Adventists may have better social support or attend church more regularly. If social support or church attendance are independent predictors of mortality, the apparent influence of vegetarianism would involve a mixture of effects of the related psychosocial variables and of any true effect of vegetarianism. In other words, the dietary and psychosocial variables would then be confounded and both would need to be included in the statistical models if their independent effects were to be estimated. Some possible interrelations between different kinds of variables are shown in Figure 9–1.
A confounding variable needs to be related to both the variable of interest (say, meat consumption) and the endpoint it affects (say, CHD mortality). Hence, in the sections that follow, we provide definitions of some of the psychosocial and religious variables of interest and describe mechanisms by which they may influence mortality. To the extent that the Adventist data allow, associations between psychosocial variables and dietary factors, and between psychosocial factors and mortality, are explored separately to decide if confounding is likely. Finally, analyses that include both dietary variables and the psychosocial variables suspected to be confounders, are used to estimate the independent effects of both kinds of factors.
Social isolation can be considered a chronically stressful condition that may have harmful physiologic and psychologic consequences. Social support