STUDIES OF RELIGIOUS ATTENDANCE AND HEALTH
Idler and Kasl (1997), in a cross-sectional study among disabled and nondisabled persons, found that religious practice, i.e., church attendance, is associated with positive health practices, social ties, and psychosocial benefits. Among the disabled, those that are actively religious, benefits are seen in closer social ties, more optimism, and greater positive affect. These findings demonstrate the importance of religious participation to the health and well being of the elderly and they suggest that there is particular significance in religious participation for disabled elders. Another study by Koenig, Cohen, George, Hays, Larson, & Blazer (1997) found that older adults who frequently attend religious services have healthier immune systems. However, after controlling for covariates, the associations between religious attendance, IL-6 level (an immune system measure), and other variables were relatively weak. In addition, as the authors state, caution should be taken when generalizing this study to other geographic areas. Their rationale is that because subjects were from the "Bible belt", where religious participation is a cultural force in the region and is deeply imbedded into the fabric of their society, these results are not applicable to other geographic areas. A longitudinal study by Strawbridge, Cohen, Shema, and Kaplan (1997) found that there were lower mortality rates for frequent church attendees. Their rationale for this result was that lower mortality rates were an effect of improved health practices, increased social contacts (measured by the Social Network Index, number of social contacts per month, and membership in groups), and more stable marriages occurring in conjunction with attendance. A few studies have looked at the relationships of health and religion in college students. Oleckno and Blacconiere (1991) asked respondents how often they attended church and then they were also asked in a forced choice question how religious they considered themselves to be. These two items were combined to form a religiosity variable. The authors found that religiosity was positively associated with wellness and negatively associated with a number of health-compromising behaviors and illnesses. Frankel and Hewitt (1994) examined religion and well being among university students, specifically looking at on-campus faith groups. Their results showed a positive relationship between faith group involvement and health status. Students who belong to Christian faith groups are healthier, happier, and handle stress better than students with no affiliation.

STUDIES OF RELIGIOSITY AND HEALTH
Idler (1987) has proposed four theoretical mechanisms linking religion and health. First, religious involvement may reduce high-risk behaviors, such as smoking, drinking, and sexual activity. Second, involvement in religious groups may be a source of social support, i.e., in terms of being concerned and offering help. Third, through what Idler calls "coherence", religious involvement provides "access to a unique system of symbols…that allows individuals to make sense and cope with their experiences" (Idler 1987: 229). Last, theodicy, or a person`s interpretation and understanding of religious doctrine, changes perceptions of distress associated with physical suffering. Theodicy allows those that are religiously involved to understand that suffering may exist in the world and in one`s own life and it also allows them to deal more effectively with problems. Most research has focused on the first two of Idler`s theoretical mechanisms. Gardner and Lyon (1982) found that among some religious groups there is a lower rate of cancer. This was attributed to the dietary and hygienic practices of the more religiously involved. In a study of a national sample of noninstitutionalized adults, Ferraro and Albrecht-Jensen (1991) found that those with a more conservative affiliation were poorer in health than those from a more liberal affiliation. Also, people with higher levels of religiosity have lower rates of hypertension and mortality (Jarvis & Northcott, 1987; Levin & Vanderpool, 1987). Park, Cohen, and Herb (1990) examined intrinsic religiousness and religious coping as life stress moderators. The authors found that, for Catholics, religious coping served as a protective function at a high level of controllable negative events. For Protestants, a prospective interaction was also found between uncontrollable life stress and intrinsic religiousness in the prediction of depression. Ellison (1991) confirmed the influence of religious variables on subjective well being. There were four main findings from this study. First, firm religious beliefs enhance cognitive and affective views of life quality. Second, church attendance and private devotion contribute to well-being indirectly by strengthening religious and worldviews. Third, religious faith buffers the negative effects of trauma on well being. Fourth, individuals with liberal, nontraditional, and nondenominational Protestant affiliation have significantly greater life satisfaction than individuals with no religious affiliation. More recently, Koenig, George, & Peterson (1998) found that greater intrinsic religiosity predicted a shorter time to remission of depression.

PROVIDENCE
Providence, or divine intervention, is manifest in Scripture and it is also what people today refer to as little acts of grace, forgiveness, and miracles. The latter example is often referred to as special providence and theologians have hotly debated God`s intervention in the world in this form; even today it is still a controversial issue. Some theologians feel that there are several problems with special providence: 1) sacrificing views of human freedom, 2) the equity of intervention, 3) and the existence of evil (see Tracy, 1994, and Lewis and Berndt, in preparation, for further discussion).Even though theologians disagree on how best to explain or characterize providence, studies have been done that seem to confirm the influence of providence. A recent study by Lewis and Berndt (in preparation) characterizes the acts of providence that people view in their daily lives. The results showed that the majority of believers (in providence) perceived the divinity intervening in special ways, most often in assisting them in decision-making regarding significant opportunities or turning points surrounding school and profession. There was also a major age-related effect, with increasing age there was increased use of general providence and answered prayer and there was a decrease in the use of special providence. A study in a different vein, but still relevant to our study of providence and health, DeVellis, DeVellis, and Spilsbury (1988), examined the role of beliefs in divine influence on parents` responses to simulated episodes of illness in their children. The results suggested that parents`, when faced with a child`s illness, are influenced by beliefs about who or what controls health. Parents` belief in divine influence over their children`s recovery from illness was significantly related to their responses to hypothetical episodes of illness. The results showed that the stronger parents` beliefs in divine influence, the likelier they were to turn to God or a clergyman for aid. In addition, parents with stronger beliefs in divine influence were more likely to seek help from physicians and from friends and relatives. Ellison (1991) points to past research that supports the idea of the positive relationship between providence and health. Capps (1985) suggested that having an awareness of oneself as intimately known and valued by a divine other could result in an increased sense of self-worth and in the "perception of enduring significance beyond one`s physical self and life." Pollner (1989) found that respondents who claim interaction with a `divine being` report increased well being, regardless of stressors. This provides support for Ellison (1991) hypothesis that divine relations could enhance the view that daily situations and crises are manageable through a relationship with a divine being. Pollner (1989) suggests that interaction with a divine other may have a significant effect on well-being as a source of new cognitions in problematic situations, a source of enhancement and empowerment of the self, and as a contributor to a sense of meaningfulness. This fits well with the view that interaction with a divine could bolster individual self-esteem and self-efficacy, which could lead to changes in lifestyle that would affect health (Ellison, 1991). Overall, it seems that Ellison and Pollner are suggesting that a divine being may step into our lives, hence the belief in providence, but in addition this belief has significant cognitive effects that seem to enhance one`s coping or `management` of stressors or problematic situations.

CONCLUSION
The studies discussed above, attendance and health, religiosity and health, and providence, in combination with the resurgence of spirituality in this country, e.g., Promisekeepers and evangelical movements, brings one to the conclusion that providence probably does play a part in individual`s daily lives. It seems plausible that individuals might view an event of special providence as providing a sense of meaning, justification, or guidance. One can assume that providence is an integral part of intrinsic religiosity. If a divine being provides a framework for one`s life then the interplay between a person and divine intervention needs to be understood and/or explained in order to fully comprehend the influence of religious beliefs on an individual. Looking at the Pollner (1989) & Ellison (1991) it seems clear that providence cannot be ignored that it does have considerable influence. These experiences and/or beliefs appear to be a measure of intrinsic religiosity and thus could have an effect upon health, since other religious variables have been shown to influence health. Previous studies on religion and health had several limitations. Oleckno and Blacconiere (1991) used a very narrow measure of religiosity, which mainly focused on religious attendance and a subjective measure of religiosity. Frankel and Hewitt (1994), like so many others, looked only at attendance vs. nonattendance in regards to religion. This current study takes these limitations into consideration and intends to go one step further by showing that a belief in providence, or divine intervention, has a specific impact on health in college students and in older adults. At the core of this present study is the hypothesis that a belief in providence, that God does intervene in daily life, has a positive effect upon health. This paper takes the religion and health research to the next level, trying to discern what parts of religiosity are influencing health, specifically, by examining providence (a measure of intrinsic religiosity) and its effect on several different measures of health.

METHODS

PARTICIPANTS
Participants were students in the Intro to Philosophy and General Psychology classes at Bethel College, a small liberal arts college affiliated with the Mennonite church. There were 63 participants. Age ranged from 17 to 46 with a median of 19 and a mean of about 20 years. There were 44 females and 19 males. Of the 63 participants there were 29 Mennonites, 27 affiliated with another Christian denomination, and 7 not affiliated with any religion.

INSTRUMENTS
There were three data-gathering devices (see Appendix II). The first was an open-ended questionnaire on providence. After reading a definition of providence as "divine guidance or care", the participant went on to answer the following questions: 1) to what extent do you use providence as an explanation for things that happen in your life (then circled one of four choices, none of the time, some of the time, most of the time, all of the time); 2) Please briefly explain your rating above; and 3) What was the most recent occasion in your life that you used providence as an explanation for the things that happened? The next form was the Duke University Religion Index (DUREL) (Koenig, Meador, & Parkerson, 1997). The DUREL is a 5-item scale that measures three major dimensions of religiousness, organizational (OR), non-organizational (NOR), and intrinsic religiosity (IR). 24 students filled out the DUREL. The data gathered from this form were not used in the analysis.The third form concerned sociodemographic information with questions relating to a participant`s religious affiliation and practice, family, health status, general reactions to the study, and possible hypotheses.

PROCEDURE
Participants were solicited in class by the professor. Extra credit was offered for filling out the three forms; responses were kept anonymous. While participants could have as much time as needed to fill out the forms, most all were finished within 10-15 minutes.

CODING SCHEME
A coding scheme was developed for analyzing the open-ended responses to question #3 above. Two major categories included General (e.g., mentioning providence acting in general with no specific examples given) and Special (e.g., mentioning particular occasions with varying degrees of detail). Three other major categories of Prayer, for the self or another, and Qualifications, such as in retrospect or doubts about the applicability of providence, and an Other category finish the coding scheme. (See Appendix I for further information on the coding scheme and some representative examples.) Under the special category fall the following major sub-categories: Helps with Significant Decisions and provides Significant Opportunities (e.g. helping decide where to attend college), Avoids Problems (for example, an illness, loss of control, etc.), Copes with Problems (for example, illness, loss of dreams, etc.), Transforms Negative into Positive (for example, a blessing in disguise), Miracles, Timing (God provides for a good outcome), Serves to Connect (for example, giving advice), and other similar subcategories.

PREPARATION OF DATA FOR ANALYSIS
All responses for question #3 were coded using the coding scheme. When participants identified two or more wholly separate instances of providential action these were coded separately. First, the author independently coded each response, and then codings were compared with a second coder for inter-rater reliability purposes. Proportions were calculated out of 1.00. For example, if there were two different codings for a statement, then 0.5 would be entered under each correct sub-category. These proportions were then entered into SYSTAT for statistical analysis.

METHODS

PARTICIPANTS
The participants for this study were solicited from two facilities, Friendly Acres, a retirement community in Newton, KS, which is affiliated with the United Methodist Church, and Kidron Bethel Village, a retirement community in N. Newton, KS that is affiliated with the Mennonite Church. There were 33 participants; three of the participants had to be excluded from the data sample because they did not fill out the survey properly. Age ranged from 56 to 96, with a median of 86 and a mean of 83 years. There were 7 males and 23 females. Of the 30 participants in the data sample, thirteen were affiliated with the Mennonite Church and seventeen were affiliated with another Christian denomination, primarily Methodist.

INSTRUMENTS
The same data gathering devices, except for the DUREL, were used in this study. There were some slight modifications to the forms. The socio-demographic form is similar to the one used in the first study, but there were some slight differences. The health questions were re-worded slightly to fit a retired population; a question concerning education level was also added.

PROCEDURE
The participants were solicited on three different occasions. Residents in the assisted- living apartments at Friendly Acres were sent the survey with a cover letter, which explained that the survey was for use in a senior thesis paper for a student at Bethel College. Those who chose to fill out the survey returned it in the provided envelope to the social worker in charge. On the second occasion nursing home residents, who were still able to read, comprehend, and write, were gathered together. The experimenter handed out the surveys and told them they could have as much time as needed to fill them out. The experimenter then picked them up. Kidron Bethel Village does not have an assisted living unit; they just have duplexes, apartments, and nursing unit. Participants were solicited from the apartment residents. They were sent the survey with a cover letter, which explained that the survey was for use in a senior thesis paper for a student at Bethel College. The residents could then use the envelope provided to return the survey to the information desk where the experimenter picked them up later in the week.

CODING SCHEME
The same coding scheme, as described in the Methods section in Study One, was used to code the data from both retirement villages.

PREPARATION OF DATA FOR ANALYSIS
The data were prepared as described in Study One`s Methods section. SYSTAT was again used for statistical analysis.

DISCUSSION
Inter-rater reliability was fairly good for the major categories. The major categories were easy to distinguish and most belonged to special providence but the IRR within special providence needs significant improvement. The main results were (1) Mennonites were healthier than non-Mennonites, (2) strong believers in providence were incapacitated more days by an illness than those who were weaker believers in providence, (3) those participants that had a disease used special providence somewhat more than those who did not have a disease, (4) participants who attended college use prayer for self less than those who went to high school or graduate school, (5) and participants who attended graduate school use special providence significantly less than the other participants. The difference in health between the two religious groups could be a result of the methodology. All of the Mennonites in this study were from Kidron Bethel. The main difference between Kidron Bethel and Friendly Acres is that Kidron does not have an assisted living unit. All of the participants from Kidron are capable of living on their own without help whereas the Friendly Acres group was from the assisted living unit and the nursing unit. So, one could assume that there would be differences in health based on the amount of care that the participant needs. Therefore, it is possible that there could be a selection bias in the data. It appears that this difference in health is due to the solicitation procedure and that results could conceivably be different if this bias were eliminated. The next result is difficult to understand. It seems counter-intuitive that those participants who were strong believers were incapacitated more days by an illness and that those that had diseases used special providence more than those whom did not have a disease. One may wonder if there could be an interaction effect between religious affiliation and number of diseases, however, no interaction effects were found, belief was the only factor to have an effect on number of days incapacitated. With this next result, diseases influencing special providence, it appears that our hypothesis has been flipped, health may influence providential belief. This result relates somewhat to the result in the first study of the negative correlation between health and the sub-category of negative to positive. In other words, we have shown that as health decreases negative events come to be viewed more positively. Overall, it could be that those who are sick, in this case measured by the presence of a disease, might become more aware of the divinity acting specially. The divinity might not be intervening any more than before, but the mental mindset of the sick person may be more sharply attuned to these events. Another possibility is that one`s need for assistance drives their perception of life events.In regards to educational level, one could reason that those with less education would see God as stepping in specifically instead of seeing Him as a guiding force throughout life. This is shown in the data, with those who attended graduate school acknowledging special providence less often than those with less education are. It is interesting to note that those who attended graduate school acknowledge general and special providence equally (.22) and acknowledge the presence of God acting through prayer twice as often as the other two categories combined. The significant difference self prayer between those who attended college and the other two education levels is also curious, there does not seem to be a good explanation for this, but the numbers in each sample could be a factor. The college group was twice as large as the other two groups. It is probably safe to say that the results reported in this paper are not definitive.ConclusionThe results from these two studies reveal that there is not much evidence for the hypothesis in its original form. Instead, there does appear to be some correlational support for the claim that health and other social factors affect belief. In the college study, the effects of gender on health, the negative correlation between the numbers of colds/flu and general providence, the negative correlation between health and the sub-category of negative to positive, and the negative correlation between health and the sub-category of self-prayer seem to point to an effect of health and social factors on providential belief. In this study of the elderly, all of the results, except the relation between belief and days incapacitated, seem to support the idea that health and social factors affect belief. In essence, it seems that social factors affect intrinsic and extrinsic religiosity in similar ways; it seems that intrinsic and extrinsic religiosity are not different in kind, but by degree. This sample of late adults is particularly interesting because in some ways their views of providence are quite different from the sample in an earlier study by Lewis & Berndt (in preparation). In the earlier sample the participants accessed each major category, except the Other category. However, in this current sample, there was not a single instance of a qualification of God`s providence, and general providence was used much less than the former sample (.20 compared to .07); this would probably be statistically significant. These differences could be explained by methodological differences. In the previous study, Lewis & Berndt (in preparation) the participants were solicited through campus mail, implying that all the participants still had relatively active lifestyles and were still actively involved in the college community, whereas the participants in this current study were all solicited through a retirement community. This is just one more piece of evidence that environmental and social factors affect providential belief. Even if the there is no clear-cut relation between health and providence shown in this study, it does affirm that there is a developmental change in providential belief that is affected by environmental and social factors, such as educational level. Also, one could argue that there could be a generation effect at work in this study. The samples in this study and the previous study (Lewis & Berndt, in preparation) were solicited eight years apart from each other and there could be some generational beliefs at work in this data. For instance, the college sample in the Lewis & Berndt study did not grow up in this growing wave of spirituality; the students in this current study did spend their formative years (the `80`s) in an age when spirituality was a topic in the news (prayer in school) and in entertainment (Field of Dreams and Touched by an Angel). So, it is possible that this generation difference could account for the differences seen in the providential categories that were accessed.Overall, these two studies do not provide clear-cut evidence that providential belief affects health. One can safely say that providence and health are related in a more subtle way than are religious attendance and health or religiosity and health. Most of the studies mentioned demonstrated that religion and health are related in a social support role. However, it appears that the tie runs much deeper than that; it seems that one`s beliefs, values, and interpretations of religiosity and providence are involved somehow. We had hoped to see a stronger connection between providence and health in the older population when compared to the younger population. A strong connection was not shown but the data did map out a relationship between providence and health, and it does not appear to be inconsequential. After examining the results from both studies, one striking commonality exists: One`s affective state, often related to health, appears to effect providential beliefs. Critiques The results of this study may not be completely trustworthy because of the construction of the questionnaire. While open-ended in terms of its affirming use of general or special providence, or of use or nonuse of providence as an explanatory category at all, it seems to be weighted towards special providence (see Methods-Instrument sub-section). In addition, the samples (especially the older adults) consists of mostly church-going participants who go to a Christian liberal arts college or live in a religiously affiliated retirement community. The results from this study might not be readily generalizable across cultural, racial, and ethnic groups; these results should be applied with caution. Inter-rater reliability is adequate, but it could be much better. Most of the difficulty was seen in distinguishing between codings within the Special category. This is problematic because the Special category was the most used across all age groups. Directions for Further Research More research needs to be done on this topic to replicate the results found in this study, that there does not seem to be a clear causal relation between providence and health, i.e., that a belief in providence increases health. In addition, further research should focus on the nature of the relationship between intrinsic and extrinsic religiosity and health and then to identify if there is a causal relationship. It generally has been accepted that religion and spirituality has a positive influence on a person`s health, as seen through the research of Gardner & Lyon (1982) and Koenig, Cohen, George, Hays, Larson, & Blazer (1997). However, this study seems to demonstrate that health can effect religious beliefs and further study needs to be done to clear up this relation.

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I. GENERAL: Mentions providence acting in general with no specific examples given, e.g. `gives meaning to life in general`; `guides and influences our lives`; `takes care of us`; etc.

II. SPECIFIC: Mentions specific examples with varying amounts of detail.

A. Helps with significant decisions and/or turning points; provides significant opportunities.

1. Spiritual well-being2. Family/relationships3. Occupation/profession/job/school4. Recreation/sports/hobbies5. Property/possessions

B. Avoids problems

1. Mental or Physical Illness/injury/death2. Loss of relationship (through distance, separation, divorce, etc.)3. Loss of dreams/prospects4. Loss of control/autonomy/independence5. Loss of propertya. Natural caused (tornado, flood, storm, forest fire, etc.)b. Human caused (fire, flood, mechanical failure, etc.)6. Other issues or concerns

C. Coping with problems

1. Mental or Physical Illness/injury/death2. Loss of relationship (through distance, separation, divorce, etc.)3. Loss of dreams/prospects4. Loss of control/autonomy/independence5. Loss of propertya. Natural caused (tornado, flood, storm, forest fire, etc.)b. Human caused (fire, flood, mechanical failure, etc.)6. Other issues or concerns

D. Transforms Negative into Positive

1. Bad things happening at good times (i.e., times when they can be more efficiently handled). 2. Blessing in disguise (i.e., things that initially appear bad or very bad turn out to be good in the long-run). 3. Learning from our poor choices and actions (e.g., the holocaust, war, depression, etc.)

E. Miracles or Healing

1. Physical healing 2. Mental/emotional healing3. Relational healing

F. Timing

1. Numerous events had to occur in the right order for a good outcome 2. At the right time and/or place God provided for a good outcome

G. Serves to connect persons with one-another

1. Giving advice 2. Bringing people together.

H. Both timing and connections with others are implicated

I. Divine rewards for earthly sacrifice

J. Little things

K. Other

III. PRAYER

A. Self

1. Physical, mental, and/or emotional health 2. Property 3. Relationships 4. Dreams/prospects B. Other person

1. Physical, mental, and/or emotional health 2. Property 3. Relationships 4. Dreams/prospects

C. Non-human animal

IV. QUALIFICATIONS

A. In retrospect

B. Doubts or ambivalence about applicability of providence

C. May be used in unfortunate circumstances, i.e., to explain the occurrence of bad things.

D. Can be invoked only if you use your head and take care of yourself

E. Limited in use by a concern for preserving the concept of human responsibility.

F. Escape clause: When no other explanation can be found.

G. Other

V. OTHER

Providence ExamplesExample 1: Throughout the first week of football practice God has helped me to stay healthy and strong. He is there for me to keep me from wanting to quit. Coding- IIB1, IIB3

Example 2: The most recent occasion of providence in my life was my decision to continue my schooling. I feel the Lord gave me divine guidance with my decision to pursue towards my bachelor`s degree. Coding- IIA3

Example 3: When I first moved to Bethel a week ago I prayed that I would make it through the first week without any tragic things happening to me. Coding- IIIA

Let us first define "providence", after Webster, as divine guidance or care.

1.) To what extent do you use providence as an explanation for the things that happen in your life?

Not at all some of the time most of the time all of the time

2.) Please briefly explain your rating above:

3.) If you answered "some of the time", or "most of the time", or "all of the time" to question #1 above, then what was the most recent occasion in your life that you used providence as an explanation for the things that happened? Briefly describe the most recent in the space below.

DUREL

(1) How often do you attend church or other religious meetings? (OR)

1. More than once/wk2. Once a week3. A few times a month4. A few time a year5. Once a year or less6. Never

(2) How often do you spend time in private religious activities, such as prayer, meditation or Bible study? (NOR)

1. More than once a day2. Daily3. Two or more times/week4. Once a week5. A few times a month6. Rarely or never

The following section contains 3 statements about religious belief or experience. Please mark the extent to which each statement is true or not true for you.

(3) In my life, I experience the presence of the Divine (i.e., God). (IR)

1. Definitely true of me2. Tends to be true3. Unsure4. Tends not to be true5. Definitely not true

(4) My religious beliefs are what really lie behind my whole approach to life. (IR)

1. Definitely true of me2. Tends to be true3. Unsure4. Tends not to be true5. Definitely not true

(5) 1 try hard to carry my religion over into all other dealings in life. (IR)

1. Definitely true of me2. Tends to be true3. Unsure4. Tends not to be true5. Definitely not true

Socio-demographics

Age: Date of Birth: Sex M F

Religious Affiliation: Y N

If yes, please answer the following:

Denomination:

Are you a member? Y N

Have you been baptized? Y N

Practicing: Y N

If yes, How many times do you attend church-related functions? (Please fill in the appropriate blank):

_______per week _______per month _______ per year

Race: Ethnic Group:

Occupation: Approx. Hrs/ Wk:

Family Size of Origin: (include your parents, yourself, and any siblings)

Birth Order: Oldest Child Middle Child Youngest Child

Health

Unhealthy - - - - - - - Healthy

List any diseases that you have had or currently have:

Please estimate the number of times you experienced colds/flu in the last year.

0 times 1-2 times 3-4 times 5-6 times over 6 times

Please estimate the amount of school and/or work missed last year because of illness:

0-3 days 4-7 days 8-11 days 2-3 wks 4-8 wks over 2mos

Please give some brief general reactions to the study (likes, dislikes, etc.):

Please state briefly what you think we are hoping to show in this study (hypotheses, etc.):