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Relationship between religious involvement and psychological well-being: a social justice perspective.
To address this gap, the purpose of this article is to examine the relationship among religious involvement, private prayer, and depression in a low-income, clinical sample of 230 older U.S.-born and immigrant Latinos residing in a large metropolitan city in the United States. Focusing attention on this group is critical for several reasons. First, the Latino population over the age of 65, which numbered 2 million in 2002, is expected to grow to 13.4 million by 2050 and will comprise the largest racial and ethnic minority population in this age group by 2028 (U.S. Department of Health and Human Services [HHS], 2001b). Second, mental health in the later years is partly influenced by one's ability to balance stressful life events, to be able to count on others for support when needed, and to maintain a positive outlook on life. Personal and social resources such as religion and religious involvement are important to how people live their lives and cope with stress. The association between mental health and religious involvement has been documented with different clinical disorders, genders, ages, denominations, and racial and ethnic groups in the United States. The study presented here furthers the literature in its substantive and methodological approach: Except for a few empirical studies, little is known about how these theoretical relationships apply to older Latin living in the United States (Hill, Angel, Ellison, 8: Angel, 2005; Levin & Markides, 1985; Markides Levin, & Ray, 1987); methodologically, the study examines the effects of religious involvement and depressive illness by using clinically determined criteria for unipolar depression; and using a within-group comparative approach, we examine the experience of U.S.-born and immigrant Latinos.
Immigrants are more likely to participate in religious congregational life than are U.S.-born Latinos (Warner & Wittner, 1998). This can be partially explained by a postimmigration phenomenon explained by Hondagneu-Sotelo, Gaudinez, Lara, and Ortiz (2004) that underscores the nonassimilationist religious practices of Latinos: "Religious identities often intensify after immigration, and distinctive immigrant and ethnic congregations, rather than assimilationist religious forms, now prevail" (p. 135). Moreover, some religious congregations, primarily aligned (although not exclusively) with Roman Catholicism and Protestantism, also promote the principles of liberation theology in support of poor and oppressed people (Hondagneu-Sotelo et al.; Gutierrez, 1988; Levitt, 2001; Matovina & Riebe-Estrella, 2002; Warner &Wittner, 1998). Contemporary congregations can thus enable immigrants to partake in religious activities that reinforce their ethnic identities as well as provide a safe haven for sociopolitical activities that promote empowerment and social justice. Although liberation theology has its roots in Latin America, U.S.-born Latinos have embraced (although not without considerable debate) the theological underpinnings and social movements of liberation theorists with considerable attention to ethnic and racial identity in the United States (mestizaje or mixed European/Indian identities) and the accompanying struggle to balance disparities in power affecting access to religious, social, political, and occupational opportunities (Elizondo, 1983; Matovina & Riebe-Estrella, 2002). This has been well documented in the theological and cultural discourse on the Mexican American experience in the United States, but to a much lesser degree for other Latino subgroups such as Dominicans (Levitt, 2001) and Puerto Ricans (Alvarez, 1998).
Affecting 20 million Americans (HHS, 2001b), or about 15 percent to 20 percent of older people (Koenig & Blazer, 1996; Lebowitz et al., 1997), depression is characterized by a combination of mood, cognitive, and physical symptoms sufficient to interfere with a person's daily functioning (NIH Consensus Development Panel on Depression in Late Life, 1992). Whether depression is the cause or consequence of assaults on well-being is still open to ideological and practical debate and is beyond the scope of this work. Undeniably, symptoms of unipolar depression--sad mood, loss of interest in usual and pleasurable activities, problems with memory and concentration, low energy, feelings of uselessness, problems with sleeping and appetite, thoughts of death, and so forth--interfere with the older person's typical activities and day-to-day functioning. These impairments can lead to persistent problems that are frequently the focus of social work practice, such as actualization of healthy human development, maintenance of social relationships in late-life, and activation of positive mutual exchanges and resources in the service of psychological well-being and quality of life.
Social work practice in health care settings has a long-standing tradition in addressing a client's ability to maximize her or his potential while at the same time addressing disparities in health care equity and access (Galambos, 2005). Drawing on the definition of distributive social justice, "... which emphasizes society's accountability to the individual ... how goods and resources are distributed in a society" (Van Soest & Garcia, 2003, p. 44), we can surmise that depressive symptomatology is a form of psychological "[d]eprivation--[the] lack of essential resources and supports for the achievement of physical, social, and cognitive development [that] impedes the actualization of human potentiality in individuals, families, and communities" (Prigoff, 2003, p. 115). Depression, which is often characterized as a state of hopelessness and powerlessness, can seriously interfere with the older adult's ability to participate actively in social spheres that promote advocacy, empowerment, citizen participation, and so forth (Parsons, Gutierrez, & Cox, 1998).
For Latinos, particular perceptions of the nature of depression and their implications for social justice are worth noting. Empirical and conceptual work exists to highlight the tendency for Latinos to somaticize psychological distress (see HHS, 2001b), which is regarded by some as a reflection of the intersection of mind--body--spirit in mental health, and conversely, of mental illness or depression. In more recent work that was based on a qualitative study of older, medically ill Latinos with a history of depression, the notion that depression was precipitated by persistent stress or "a wear-and-tear"-type lifestyle emerged as an illness attribution (Aranda & Ell, 2004). Also, the Spanish-language term for sad mood--desanimoda(o)--is literally translated as being in a "soulless" state. The study participants were likely to refer to depression as a result of life experiences (for example, life events, poor health, losses, trauma, and persistent strain) that eventually sap the person's vitality. Thus, these persistent experiences of loss and injury may present an assault to the "soul" of the person that transcends physical and psychological consequences and that poses serious challenges to the older person's ability to raise "questions about the relationship between various private problems and related public issues" (Parsons et al., 1998, p. 18). Thus, depression for older Latinos should be viewed as a deeply personal, culturally contextualized, and social justice phenomenon.
Religious involvement is defined here as encompassing formal, public, and collective involvement at worship-related services as well as more informal, private forms of involvement such as private prayer. Although the two forms of religious involvement are complementary and not mutually exclusive (people can engage in private prayer during worship services), examining the separate effects of each dimension on depression extends earlier work on the effects of religious attendance and private prayer on psychological well-being. The rationale for the distinction lies in the notion that each dimension may have differential effects on outcomes. For example, participation in worship services may play a more protective role due to its "public" or communal nature that parallels the sociocentric nature of Latinos and help-seeking or help-giving behavior during times of distress (Aranda & Knight, 1997). For the purpose of the work presented here, religious involvement is operationalized by examining two categories of involvement: participation in worship-related services and private prayer, respectively.
Religious involvement, as variously assessed in the lives of older adults, is an important psychological resource given its role "in establishing continuity across life-course stages, emphasizing the intrinsic and enduring meaning of life, fostering a sense of feeling blessed by God, and providing both personal and community resources that enhance coping with age-associated losses" (Levin, Markides, & Ray, 1996, p. 456). Religious involvement is directly associated with better mental health outcomes (see George, Larson, Koenig, & McCullough, 2000) such as life satisfaction (Anson, Antonovsky, & Sagy, 1990; Levin, Chatters, & Taylor, 1995), lower levels of psychological distress (Ellison, Boardman, Williams, & Jackson, 2001; Levin & Chatters, 1998), fewer depressive symptoms (Ai, Dunkle, Peterson, & Boiling, 1998; Garrison, Marks, Lawrence, & Braun, 2004; Idler, 1994; Koenig, Moberg, & Kvale, 1988; Smith, McCullough, & Poll, 2003; Strawbridge, Shema, Cohen, Roberts, & Kaplan, 1998), and decreased anxiety (Koenig et al., 1988). Religious involvement also decreases the likelihood of anxiety, alcohol and drug abuse and dependence, and clinical depression (see Hill et al., 2005).
The evidence supporting the association between religious involvement and depression has been equivocal (Strawbridge et al., 1998). Some studies support the association between religious involvement and decreased depression for some groups (Ellison, 1995; Nelson, 1990; Pressman, Lyons, Larson, & Strain, 1990), whereas other studies have found no relationship (Idler, 1994; Williams, Larson, Buckler, Heckmann, & Pyle, 1991). Still, in one large cross-sectional study, different forms of religious involvement (organizational, nonorganizational) were associated with exacerbated depression depending on specific types of life stressors, for example, child problems, marital problems, abuse, and caregiving (Strawbridge et al.).
The life stress paradigm is a promising and coherent approach to understanding the positive relationship between religious involvement and mental health outcomes (Ellison et al., 2001). Briefly stated, religious involvement may lead to better mental health by encouraging participants to avoid negative behaviors (for example, high-risk behaviors, risky sexual practices, alcohol and drug use, other addictions), thereby avoiding or delaying stressful life events. Of particular importance is the role that health status plays in the relationship between religious attendance and depression. Hill and his associates (2005) posited that physically and functionally robust older adults are more likely to attend religious activities than are less healthy older adults because of their more favorable health status. Thus, the persistence of a religious effect on psychological well-being should be tested while adjusting for the effects of selective factors such as functional status (Hill et al.). In other words, the salutary effects of religious involvement on well-being can be accounted for not only by lower levels of stress exposure as a result of decreased risk behaviors, but also by better functional health. Moreover, the availability of social resources or support that may arise in religious activities may account for the relationship between religious involvement and psychological well-being (Ellison et al., 2001; George et al., 2000; Hill et al.; Strawbridge et al., 1998). Social resources such as availability of social ties and the perception that others are available during times of need are important links to positive mental health. In summary, the conceptual model (Figure 1) posits that the relationship between religious involvement and psychological well-being should also be tested while controlling for the effects of stressors, functional status, and perceived availability of confidant support.
Earlier epidemiological studies on the health and well-being of older Latinos have focused exclusively on older Mexicans (65 years of age and older) living in the Southwestern United States. (Hill et al., 2005; Levin & Markides, 1985; Levin et al., 1996; Markides et al., 1987). This body of work to date has focused exclusively on religious attendance and not on private prayer. The research suggests that religious attendance is positively related to higher life satisfaction (Levin et al., 1996; Markides et al., 1987), negatively associated with depressive symptoms (Levin & Markides), and negatively associated with mortality (Hill et al.).
Older Latinos, whether born in the United States or abroad, have a very strong connection to their religious affiliation and practices. For example, more than 50 percent of Mexican Americans are 55 years old or older and attend religious services at least one time per week, and almost 70 percent report receiving "a great deal" or "quite a bit" of guidance in their daily lives from religion (Stevens-Arroyo & Diaz-Stevens, 1998). Although Latinos have historically self-identified as Roman Catholic, a significant movement in the last half of the 20th century has shown an increase in Latino Protestantism in the United States (Hunt, 1999). Latinos have demonstrated a rich history of rituals, devotions, and faith expressions that both reinforce tradition and expand on devotional and inspirational practices (Sanchez, 1993) as seen in El Via Crucis (The Way of the Cross, a spiritual meditation done during the season of Lent) (Davalos, 2002), El Dia de los Muertos (The Day of the Dead celebration) (Salvador, 2003), and the evangelical altar call (Avalos, 2001).
The effects of immigration status or nativity (U.S.-born or immigrant) were not explicitly examined in the aforementioned studies on religion and psychological well-being. Examining the relationship of immigrant status with religious involvement and psychological well-being is important given that about 56 percent of older Latinos were born outside of the United States (Villa & Aranda, 2000) and continue to maintain close ties with traditional social values (Espinosa, Elizondo, & Miranda, 2003). Earlier studies on the association between immigrant and foreign-born status and depression among U.S. Latinos have indicated that immigrant Latinos report more favorable mental health outcomes (see HHS, 2001a).The converse appears to be true for older Latinos; older immigrant Latinos (especially women) tend to be at higher risk of depressive symptomatology as shown in several population-based studies (Black, Markides, & Miller, 1998; Gonzalez, Haan, & Hinton, 2001; Kemp, Staples, & Lopez-Aqueres, 1984; Mendes de Leon & Markides, 1988).
The study presented here addresses the gap in the literature on the influence of religious involvement and older Latinos' mental health, specifically in a low-income, clinical population of older Latinos. The work focuses on the association of religious involvement (religious attendance and private prayer) and the outcome measure of depression by using clinical criteria based on the DSM-IV (American Psychiatric Association, 1994). Focus on diagnostic, criteria-based outcomes is important. First, prior work in this area has examined depression exclusively in terms of depressive symptomatology in general. This study is the first to focus on unipolar depression, in particular, through the use of diagnostic criteria for major and minor depression. Second, major and minor depressive disorders are widely distributed in the adult and older adult population and are typically associated with substantial symptom severity and role impairment (Kessler et al., 2003) that may interfere with an individual's normative activities and life span development.
Thus, this study examines the association among religious attendance, religious prayer, and depressive illness while adjusting for the effects of physical functioning, stress exposure, and social support. Specifically, the following three hypotheses are tested:
1. Higher levels of religious attendance will be associated with lower risk of depression after adjusting for physical functioning, stress exposure, and social support.
2. Higher levels of private prayer will be associated with lower risk of depression after adjusting for physical functioning, stress exposure, and social support.
3. Immigrant status (non-U.S.-born nativity) will be associated with higher risk of depression after adjusting for physical functioning, stress exposure, and social support.
Data Sources and Procedures
This is a cross-sectional design that used face-to-face interviews of 230 low-income, English- and Spanish-speaking, male and female Latino consumers (50 years of age and older) of primary medical care services at AltaMed Health Services in the greater Los Angeles area. AltaMed Health Services is a private, nonprofit health and human services organization with a 30-year history of providing medical, preventive, and long-term care to a predominantly Latino community. Potential respondents who met the inclusion criteria (Latino, 50+ years) were identified with the assistance of AltaMed staff. From the list of respondents, the first 230 who were willing to participate were interviewed either at the corresponding clinic sites or in their homes by a trained interviewer. The interviews averaged approximately one to two hours, were conducted by trained interviewers in English or Spanish, and followed a closed-ended, structured survey format.
Depressive Disorder. The dependent variable was depression as measured by the nine-item Depression subscale of the Patient Health Questionnaire (PHQ-9), a standardized diagnostic assessment procedure designed for clinical and research settings (Spitzer, Kroenke, &Williams, 1999). Respondents indicate for each of the nine depressive symptoms (anhedonia, dysphoric mood, sleep and appetite disturbances, decreased energy or fatigue, feelings of worthlessness or guilt, poor concentration psychomotor retardation or agitation, thoughts of death, or suicidal ideation), if during the previous two weeks, the symptom has bothered them "not at all," "several days," "more than half the days," or "nearly every day." Scores on the PHQ-9 are calculated by using a diagnostic algorithm delineated by Spitzer and his associates (1999) and categorized into threshold disorders (corresponding to specific DSM-IV diagnoses, such as major depressive disorder, major depression in partial remission, dysthymia, or other depressive disorder). For the purpose of the work reported here, only the presence of a unipolar depressive disorder ("yes" or "no") was considered.
Religious Involvement. Frequency of attendance at religious services was calculated by asking the respondent, "How often did you attend church, religious or worship services in the last 12 months?" (Hill et al., 2005). Use of private prayer was calculated by asking the respondent, "How much do you pray privately as an individual?" For both items, values were coded as never or almost never = 0, several times a year = 1, once or twice a month = 2, once a week = 3, more than once a week = 4, or daily = 5.
Physical Health. Functional ability was measured by the Physical Role Functioning subscale of the Medical Outcomes Study 36-Item Short-Form Survey (SF-36) (McHorney, Ware, & Raczek, 1993). The four-item (yes or no) subscale assesses the degree to which one's physical health interferes with or limits the person's ability to perform usual activities. The items were summated and a total functional limitation score was calculated. Scores ranged from zero to four, with higher scores indicating higher levels of role or functional limitations. Although the study did not control for specific physical problems, previous work has suggested that functional ability is better suited as a determinant of psychological well-being in older adults than is a list of medical conditions or problems (Berkman & Marimaldi, 2001).
Acute Life Stressors. Respondents were asked to identify (yes or no) all stressors that they had experienced in the previous 12 months from a checklist of 18 acute stress life events. Sample items include illness of spouse, death of family member, increased responsibilities (work, caregiving), relocation from the home, and so forth. These categories of items are frequently used in stress research in older adult populations because of the greater relevance and success in predicting health and mental health outcomes (Aldwin et al., 1996; Glass, Kasl, & Berkman, 1997). Affirmative answers were summated for a total acute life events score.
Social Support. Respondents were queried in the area of confidant support. One item was taken from the Arizona Social Support Interview Schedule (Barrera, 1981) that measures the number of available confidants the person identifies. The number of nonduplicated people was summated for a total confidant support score.
Sociodemographic Measures. Additional items include self-reports of respondent's age, gender, marital status, years of education, annual household income, nativity (U.S.-born or immigrant); and religious preference or identification.
Statistical Analyses. First, descriptive analyses were performed to report depression rates as well as to provide descriptive information of the major variables of interest. Second, the association between the dependent variable (depressive disorder) and the predictor variables was examined with logistic regression modeling (Hosmer & Lemeshow, 2000). The relationship between depressive disorder and predictor variable is represented as an odds ratio indicating the odds of a depressive diagnosis or no diagnosis, given the presence of the specific risk factor delineated in the model.
Sample Description
Overall, the sample of 230 respondents ranged in age from 50 to 94 (M = 69.6, SD = 10.1) (see Table 1). Sixty-seven percent of the sample were women, and two-thirds of the respondents were not married. Slightly more than 60 percent (61.7 percent) of the respondents were born in the United States, and 24.7 percent reported Mexico as their place of birth. Three out of four respondents (77.4 percent) self-identified as Roman Catholic, and 16.9 percent self-identified as Protestant. Only one of three respondents (34.3 percent) reported having at least a high school diploma. About one-half of the sample reported annual household incomes of less than $7,500. Immigrant respondents reported significantly lower household incomes and lower levels of education than did their U.S.-born counterparts (see Table 1).
Major Variables of Interest
Rates of depression indicate that overall almost one out of three (32.2 percent) respondents reported symptoms sufficient to meet the criteria for a PHQ depression diagnosis (see Table 1). The U.S.-born and immigrant groups did not differ significantly in terms of their respective rates of depression. Table 1 also shows the descriptive results for the remaining variables of interest. Overall, respondents were more likely to state that they attended religious services between once a week and once or twice a month (M = 2.29, SD = 1.34). Immigrants were significantly more likely to attend services (M = 2.61, SD = 1.39) than were U.S.-born respondents (M = 2.09, SD = 1.28). For example, immigrants were more than two times more likely to attend services once a week or more than their U.S-born counterparts (10.6 percent compared with 23.9 percent, respectively). No significant differences were found in terms of the frequency of private prayer. Both groups reported high levels of private prayer, with 76.8 percent of U.S-born and 84.1 percent of immigrants reporting they prayed daily or more than once a week.
In terms of physical role functioning, the total sample can be characterized as having a moderate level of functional impairment that interfered with their daily activities: Respondents averaged a physical role functioning score of 1.82 (SD = 1.76) from a possible range of zero to four. There were no significant differences between U.S.-born and immigrant respondents in terms of physical role functioning. It is important to note that both groups reported on average more than three chronic medical conditions (data not shown). Overall, the total sample reported a mean score of 2.25 stress events (SD = 1.63). U.S.-born respondents reported significantly higher levels of stress events (M = 2.51, SD = 1.61) than did the immigrant respondents (M = 1.83, SD = 1.59). Respondents were able to identify an average of three people they could rely on to talk about things that were personal or private (M = 3.27, SD = 3.14). No differences were found in terms of perceived availability of confidant support.
Multivariate Analyses. Three predictor variables were significantly associated with the presence of a depressive disorder: annual household income, religious attendance, and physical role functioning. Religious attendance was negatively associated with depression (odds ratio [OR] = 0.762, 95% confidence interval [CI] 0.594-0.979, p = .034) (Table 2) such that respondents with higher levels of attendance were 24 percent less likely to have a depressive disorder. Second, an increased risk of depression was found among respondents with poor physical role functioning (higher limitations in performing or accomplishing typical physical activities). Respondents with lower levels of functional limitations were 37 percent less likely to have a depressive disorder (OR = 0.762, 95% CI 0.511-0.765, p = .000). A negative association was also found between annual household income and the presence of depression. Respondents with higher levels of income were 15 percent less likely to report depression (OR = 0.854, 95% CI 0.739-0.987, p = .033). After adjusting for potentially confounding variables, no other variables were significantly associated with the risk for depression in the model. In summary, respondents more likely to be at risk of depression were those with low religious attendance, poor physical role functioning, and lower incomes.
The purpose of this article was to examine the relationship among religious involvement, private prayer, and depression in a low-income, clinical sample of older U.S.-born and immigrant Latinos. The cross-sectional data presented here lend support to earlier work that suggests attendance at church-related services or activities is a protective factor against depressive symptoms for older Latinos (Levin & Markides, 1985). Going to church services offers a protection for low-income older Latinos with chronic medical conditions, even when functional limitations, stress exposure, and confidant support could have explained possible health-related engagement in--or disengagement from--activities.
The data point to the positive effects of attendance after controlling for usual confounders of the link between attendance and psychological well-being, namely functional limitations, social support, and stress. Nevertheless, the mechanisms by which these salubrious effects occur cannot be disentangled with the data presented here. Those mechanisms that account for the association between attendance and better psychological well-being cannot be explained given that no information was tapped regarding specific activities related to the religious involvement (nature of the worship services, social contacts involved, perceived benefits of participation, and so forth). Early writers on religion, such as Durkheim (1915/1965), posited that religion is a social phenomenon (not a divinely inspired one) such that religion provides a way to counteract the breakdown of social norms and the increasing impersonality of social life as a result of the ills of modernization. Durkheim regarded anomie as a social and individual state void of order or rules. He also saw that all forms of deviant behavior emanated from the state of anomie, including the act of suicide; so religion offers a vehicle by which people can gather to reaffirm social order, cohesion, and meaning. Thus, as cited by Musick and his associates (2004), "While the ritualistic attachment to the sacred may be celebrated in private, he (Durkheim) argues that these expressions are most powerful when set within a group of like believers" (p. 201).
Overall, the level of religious attendance for the total sample was on average about one to two times per month. Although this may have been the case, almost one out of three respondents (32.2 percent) reported attending services "never or almost never." Thus, caution should be used when ascribing worship behaviors to this group of older Latinos. With that said, the immigrant group engaged in significantly higher levels of worship services (no less than once to twice a month) than their U.S.-born counterparts: 64.8 percent compared with 47.2 percent, respectively. This finding comes as no surprise as U.S. immigrants are more likely to participate in religious worship services than are their U.S.-born counterparts (Warner & Wittner, 1998). Theologians, historians, and social activists have accounted for the increased level of immigrants' participation in religious services as a normal transfer of the sacred from the homeland to the host country, and as important, church is a place that allows celebration of the sacred in one's own language and community (Levitt, 2002; Matovina & Riebe-Estrella, 2002; Warner & Wittner). As stated by Warner and Wittner, "Today, as in the past, people migrating to the United States bring their religions with them, and gathering religiously is one of the ways they make a life here. Their religious identities often (but not always) mean more to them away from home, in their diaspora, than they did before, and those identities undergo more or less modification as the years pass (p. 3)." Religion, therefore, is maintained as a strong indicator of a sociocultural resource in a society that is perniciously oppressive to older Latinos' beliefs, customs, ideologies, and collective realities (Magilvy, Congdon, Martinez, Davis, & Averill, 2000).
The small, yet growing literature on mental health interventions for older racial and ethnic minority groups tends to regard organizational religion not only as an important part of a person's individual and collective identity, but also as a reflection of the person's integration in a web of supportive networks and a potential point of recruitment and psychological intervention efforts. Yet, as older adults become increasingly unable to perform their usual and typical activities, the level of participation in more public forms of worship and interaction with others may be compromised. The data lend support to the negative influence of lower income and lower physical role functioning on psychological well-being. The link between lower socioeconomic status and mental illness (including depression) follows a long empirical tradition (Hudson, 2005). Likewise, the link between poor functional status and depression is well documented and evident in multiple populations (Yang & George, 2005).These circumstances may lead to fewer opportunities for the older adult to engage in such public and mutual exchanges of positive affirmation, tangible or instrumental assistance and guidance, and reinforcement of shared beliefs and meanings in life.
Mutual exchanges can be regarded as a type of social capital in that they are based on access to institutional resources vis-a-vis membership in social networks (Bourdieu, 1985; Ebstyne King & Furrow, 2004), and facilitation of interaction on the basis of norms and meanings, that is, obligations and expectations, informational channels, and social norms (Coleman, 1988). In his study of church-based social support and mortality among 1,500 older adults, Krause (2006) found that providing social support (not receiving support) to fellow church members buffered the effects of financial strain on mortality. Thus, formal church affiliation and church-based support may provide the opportunity for mutual exchanges needed for "the actualization of human potentiality in individuals, families, and communities" (Prigoff, 2003, p. 115) as well as the opportunity for individuals to move from the private spheres of worship to more public spheres of advocacy and empowerment at the small group and institutional levels (Parsons et al., 1998).
With regard to private prayer, overall the data suggest that prayer is a highly practiced activity in this sample. Close to 80 percent of the total sample prayed privately either daily or more than once a week. These results corroborate earlier work by Levin and Taylor (1997) that "prayer is a frequently used form of religious expression among adults in general and older adults in particular" (p. 85). Nevertheless, the second hypothesis that private prayer would be associated with lower risk of depression after adjusting for physical functioning, stress exposure, and social support was not supported by the data. Although regarded as an important indicator of individual coping in the face of medical problems in older adults (Kotarba, 1983; Levin &Taylor, 1997; Pargament & Hahn, 1986), private prayer was not a statistically meaningful correlate of depressive illness in this sample. Unlike attendance at church services, which is an inherently public and social activity, private prayer is just that--private. Perhaps private prayer does not afford this group of respondents the ability to demonstrate publicly their beliefs and commitment to religious doctrine regarding congregational interaction and celebration of important rituals and observances. That notwithstanding, the fact that private prayer was not related to depression could simply be because there was little variance in the responses. Moreover, not all prayer is the same, such that people may pray for many reasons and in many different formats (prayer, meditation, reading sacred literature, and so forth), which was not accounted for in this study. It is important to note that private prayer did not exert the same influence as religious attendance on depression, and there were no significant differences noted between U.S.-born and immigrant study participants. The high levels of private prayer suggest that the variable may not be sensitive enough because of limited variance and thus is of limited value in this analysis. Future work should focus on better ways to operationalize this variable in similar populations.
The third hypothesis that immigrant status (foreign-born Latinos) would be associated with depressive illness was not supported. Although in the bivariate analysis the two groups differed in terms of religious attendance (the immigrant group being more likely to report going to church services), the presence or absence of a depressive illness was not affected by immigration status. A potential explanation for this nonsignificant finding is that the immigrants in this particular sample have been living in the United States for a long time. The longer settlement period coupled with the fact that both groups had comparable rates of health care insurance could have mitigated some of the disparities documented in earlier work indicating higher rates of depression and lower worship service use among older Latino immigrants. There is also a dearth of both clinical and empirical information on the relative experiences of specific subgroups of Latino elders in this area of research as well as in practice. Thus, more comparative information is needed to help disentangle potential similarities and distinctions in this line of inquiry.
Several caveats are worth mentioning. First, the study did not incorporate other measures of religion and religious beliefs that give more information regarding the plethora of church attendance or types of private prayer that may have accounted for some of the relationships (or lack thereof) in the model (Levin et al., 1996). Second, there was very little variance in the responses in terms of religious preference or identification. The respondents were overwhelmingly Roman Catholic (close to 80 percent) followed by Protestant (17 percent). The data cannot answer the question of whether the nature of being Roman Catholic or Protestant makes a difference in terms of church attendance, private prayer, spiritual beliefs, and psychological well-being.
Last, although the theoretical model controlled for social support, the notion that organizational religion is in itself a faith community and thus a form of social capital cannot be ignored. Social support was narrowly defined in the study as the number of available confidants. Religious involvement in faith community-related activities on the other hand provides a critical social group, as posited by Garrison and her associates (2004) in their work with poor, rural mothers of young children. Similarly, although older Latinos may have confidants whom they can turn to during difficult times, being part of a larger web of social contacts connected by purpose and reciprocal exchanges of admiration, respect, and commitment may provide the needed assets and interpersonal resources to buffer the effects of adversity and affronts to empowerment (Hodge, 2001).
Social workers strive to ensure meaningful participation in decision making for all people regardless of age, gender, race or ethnicity, creed, physical ability, and so forth. For many communities and people from socioeconomically disadvantaged backgrounds, participation in a faith community is an empowering source in their lives. It is crucial that social workers approach the biopsychosocial assessment with an examination of the three factors that influenced depression in this study: income, physical ability, and religious involvement. Social workers are advised to assess the individual's spiritual and religious beliefs, activities, and expectations that may influence desired goals of fulfillment and personal realization. Several approaches are now available to serve as guides to social workers in the area of gerontology and social work, including qualitative and narrative queries (see Hodge, 2001, 2005; Ortiz & Langer, 2002). Qualitative assessment methods are well suited for future efforts to contextualize people's experiences by "accounting for the different ways of being religious and practicing religion" (Levin et al., 1996, p. 454). For example, Ortiz and Langer (2002) and Hodge (2001, 2005) provided spiritual assessment protocols that assist social work practitioners in exploring and evaluating their clients' spiritual history, strengths, and current challenges. These tools help practitioners understand client characteristics such as religious affiliation, religious practices, sources of comfort and strength, cross-cultural meanings, influence of immigration, ties with the faith community, and empowerment goals. Last, social workers are well positioned to interact with faith-based groups and institutions to understand those processes that enhance individual and group functioning and integrate these processes into health-promoting interventions.
Original manuscript received January 4, 2006
Final revision received March 22, 2007
Accepted June 19, 2007
Aldwin, C. M., Sutton, K.J., Chiara, G., & Spiro, A., III. (1996). Age differences in stress, coping, and appraisal: Findings from the normative aging study. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 51, P179-188.
Ai, A. L., Dunkle, R. E., Peterson, C., & Bolling, S. F. (1998).The role of private prayer in psychological recovery among midlife and aged patients following cardiac surgery. Gerontologist, 38, 591-601.
Alvarez, C. E. (1998). Is liberation theology finished? Encounter, 59(1/2), 197-208. Retrieved December 21, 2006, from http://www.cts.edu/Forms/ Encounter/59-l_2Alvarez.PDF
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Anson, O., Antonovsky, A., & Sagy, S. (1990). Religiosity and well-being among retirees: A question of causality. Behavior, Health and Aging, 1, 85-97.
Aranda, M. P., & Ell, K. R. (2004, July 15). Using in-depth interviews to understand the nature and course of depression in older adults with chronic illness. Poster session presented at the First Annual Summer Institute, Family Research Consortium, Center on Culture and Health, University of California, Los Angeles, San Juan, Puerto Rico.
Aranda, M. P., & Knight, B. G. (1997). The influence of ethnicity and culture on the caregiver stress and coping process: A sociocultural review and analysis. Gerontologist, 37, 342-354.
Avalos, H. (2001). Maria Atkinson and the rise of Pentecostalism in the U.S.-Mexico borderlands. Journal of Religion and Society, 3, 1-20.
Barrera, M. (1981). Social support in the adjustment of pregnant adolescents: Assessment issues. In B. H. Gottlieb (Ed.), Social networks and social support (pp. 69-96). Beverly Hills, CA: Sage Publications.
Berkman, B., & Maramaldi, P. (200l). Use of standardized measures in agency based research and practice. Social Work in Health Care, 34, 115-129.
Black, S.A., Markides, K. S., & Miller, T. Q. (1998). Correlates of depressive symptomatology among older community-dwelling Mexican Americans: The Hispanic EPESE. Journal of Gerontology: Social Sciences, 53(B), S 198-S208.
Bourdieu, P. (1985). The forms of social capital. In J. G. Richardson (Ed.), Handbook of theory and research for the sociology of education (pp. 241-258). New York: Greenwood.
Coleman, J. S. (1988). Social capital in the creation of human capital. American Journal of Sociology, 94(Suppl.), S95-S120.
Davalos, K. M. (2002). "The real way of praying": The Via Crucis, Mexicano sacred space, and the architecture of domination. In T. Matovina & G. Riebe-Estrella (Eds.), Horizons of the sacred: Mexican traditions in U.S. Catholicism (pp. 41-68). Ithaca, NY: Cornell University Press.
Durkheim, E. (1965). The elementary forms of the religious life. New York: Free Press. (Original work published 1915)
Ebstyne King, P., & Furrow, J. L. (2004). Religion as a resource for positive youth development: Religion, social capital, and moral outcomes. Developmental Psychology, 40, 703-713.
Elizondo, V. (1983). Galilean journey: The Mexican American promise. Maryknoll, NY: Orbis Books.
Ellison, C. G. (1995). Religious involvement and subjective well-being. Journal of Health and Social Behavior, 32, 80-99.
Ellison, C. G., Boardman, J. D., Williams, D. R., & Jackson, J. S. (2001). Religious involvement, stress, and mental health: Findings from the 1995 Detroit Area Study. Social Forces, 80, 215-249.
Ellison, C. G., & Levin, J. S. (1998). The religion-health connection: Evidence, theory, and future directions. Health Education & Behavior, 25, 700-720.
Espinosa, G., Elizondo,V., & Miranda, J. (2003). Hispanic churches in American public life: Summary of findings. Interim Reports Series. Vol. 2 [Electronic version]. Notre Dame, IN: Institute for Latino Studies. Retrieved December 12, 2004, from http://www.nd.edu/~latino/research/pubs/HispChurchesEnglishWEB.pdf
Galambos, C. M. (2005). Celebrating 30 years of scholarship in health and mental health [Editorial]. Health & Social Work, 30, 275-277.
Gardner, J.W., Larson, D. B., & Allen, G. (1991). Religious commitment and mental health: A review of the empirical literature. Journal of Psychology and Theology, 19, 6-25.
Garrison, M.E.B., Marks, L. D., Lawrence, F. C., & Braun, B. (2004). Religious beliefs, faith, community involvement, and depression: A study of rural, low-income mothers. Women & Health, 40, 51-62.
George, L. K., Larson, D. B., Koenig, H. G., & McCullough, M. E. (2000). Spirituality and health: What we know, what we need to know. Journal of Social and Clinical Psychology, 19, 102-116.
Glass, T. A., Kasl, S.V., & Beckman, L. F. (1997). Stressful life events and depressive symptoms among the elderly. Journal of Aging and Health, 9, 70-89.
Gonzalez, H. M., Haan, M. N., & Hinton, L. (2001). Acculturation and the prevalence of depression in older Mexican Americans: Baseline results from the Sacramento Area Latino Study on Aging. Journal of the American Geriatrics Society, 49, 948-953.
Gutierrez, G. (1988). A theology of liberation: History, politics, and salvation. Maryknoll, NY: Orbis Books.
Hill, T. D., Angel, J. L., Ellison, C. G., & Angel R.J. (2005). Religious attendance and mortality: An 8-year follow-up of Mexican Americans. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 60, S102-S109.
Hodge, D. R. (2001). Spiritual assessment: A review of major qualitative methods and a new framework for assessing spirituality. Social Work, 46, 203-214.
Hodge, D. R. (2005). Developing a spiritual assessment toolbox: A discussion of the strengths and limitations of five different assessment methods. Health & Social Work, 30, 314-323.
Hondagneu-Sotelo, P., Gaudinez, G., Lara, H., & Ortiz, B. (2004). "There's a spirit that transcends the border": Faith, ritual, and postnational protest at the U.S.-Mexico border. Sociological Perspectives, 47, 133-159.
Hosmer, D.W., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York: John Wiley & Sons.
Hudson, C. G. (2005). Socioeconomic status and mental illness: Tests of the social causation and selection hypotheses. American Journal of Orthopsychiatry, 75, 3-18.
Hunt, L. L. (1999). Hispanic Protestantism in the United States: Trends by decade and generation. Social Forces, 77, 1601-1623.
Idler, E. (1994). Cohesiveness and coherence: Religion and the health of the elderly. New York: Garland.
James, W (1902). The varieties of religious experience. New York: Longman.
Kemp, B.J., Staples, F., & Lopez-Aqueres, W. (1984). Epidemiology of depression and dysphoria in an elderly Hispanic population. American Geriatrics Society, 35, 920-926.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., Rush, A. J., Walters, E. E., & Wang, P. S. (2003).The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). JAMA, 289, 3095-3105.
Koenig, H. G., & Blazer D. G. (1996). Minor depression in late life. American Journal of Geriatrics Psychiatry, 14, S14-S21.
Koenig, H. G., McCullough, M. E., & Larson, D. B. (Eds.). (2001). Handbook of religion and health. New York: Oxford University Press.
Koenig, H. G., Moberg, D. O., & Kvale, J. N. (1988). Religious activities and attitudes of older adults in a geriatric assessment clinic. Journal of the American Geriatric Society, 36, 362-374.
Kotarba, J. A. (1983). Perceptions of death, belief systems, and the process of coping with chronic pain. Social Science and Medicine, 17, 681-689.
Krause, N. (2006). Church-based social support and mortality. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 61, S140-S146.
Lebowitz, B. D., Pearson, J. L., Schneider, L. S., Reynolds, C. F., Alexopoulos, G., Bruce, M. L., Conwell, Y., Katz, I. R., Meyers, B. S., Morrison, M. E, Mossey, J., Niederehe, G., & Parmelee, P. (1997). Depression and treatment of depression in late life: An overview of the NIH Consensus Statement. JAMA, 278, 1186-1190.
Levin, J. S., & Chatters, L. M. (1998). Religion, health, and psychological well-being in older adults: Findings from three national surveys. Journal of Aging and Health, 10, 504-536.
Levin, J. S., Chatters, L. M., & Taylor, R.J. (1995). Religious effects on health status and life satisfaction among black Americans. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 50, S154-S163.
Levin, J. S., & Markides, K. S. (1985). Religion and health in Mexican Americans. Journal of Religion and Health, 24, 60-69.
Levin, J. S., Markides, K. S., & Ray, L.A. (1996). Religious attendance and psychological well-being in Mexican Americans: A panel analysis of three-generations data. Gerontologist, 36, 454-463.
Levin, J. S., & Taylor, R.J. (1997). Age differences in patterns and correlates of the frequency of prayer. Gerontologist, 37, 75-88.
Levitt, P. (2001). The transnational villagers. Berkeley: University of California Press.
Levitt, P. (2002). Two nations under God? Latino religious life in the United States. In M. M. Suarez-Orozco & M. M. Paez (Eds.), Latinos: Remaking America (pp. 150-164). Berkeley: University of California Press.
Magilvy, J. K., Congdon, J. G., Martinez, R.J., Davis, R., & Averill, J. (2000). Caring for our own: Health care experiences of rural Hispanic elders. Journal of Aging Studies, 14, 171-190.
Markides, K. S., Levin, J. S., & Ray, L.A (1987). Religion, aging, and life satisfaction: An eight-year, three-wave longitudinal study. Gerontologist, 27, 660-678.
Matovina, T., & Riebe-Estrella, G. (2002). Horizons of the sacred: Mexican traditions in U.S. Catholicism. Ithaca, NY: Cornell University Press.
McHorney, C. A., Ware, J. E., & Raczek, A. E. (1993). The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 32, 40-66.
Mendes de Leon, C., & Markides, K. (1988). Depressive symptoms among Mexican Americans: A three-generation study. Journal of Epidemiology, 127, 150-160.
Musick, M. A., House, J. S., & Williams, D. R. (2004). Attendance at religious services and mortality in a national sample. Journal of Health and Social Behavior, 45, 198-213.
Nelson, P. B. (1990). Religious orientation of the elderly. Journal of Gerontological Nursing, 16, 29-35.
NIH Consensus Development Panel on Depression in Late Life. (1992). Diagnosis and treatment of depression in late life. JAMA, 268, 1018-1024.
Ortiz, L. P., & Langer, N. (2002). Assessment of spirituality and religion in later life: Acknowledging clients' needs and personal resources. Journal of Gerontological Social Work, 37, 5-21.
Pargament, K. I., & Hahn, J. (1986). God and the just world: Causal and coping attributions to God in health situations. Journal for the Scientific Study of Religion, 25, 193-207.
Parsons, R. J., Gutierez, L. M., & Cox, E. O. (1998). A model for empowerment practice. In L. M. Gutierrez, R.J. Parsons, & E. O. Cox (Eds.), Empowerment in social work practice (pp. 3-23). Pacific Grove, CA: Brooks/Cole.
Pressman, P., Lyons, J. S., Larson, D. B., & Strain, J. J. (1990). Religious belief, depression, and ambulation status in elderly women with broken hips. American Journal of Psychiatry, 14, 758-760.
Prigoff, A. W. (2003). Social justice framework. In J. Anderson & R. W. Carter (Eds.), Diversity perspectives (pp. 113-129). Boston: Allyn & Bacon.
Salvador, R. J. (2003).What do Mexicans celebrate on the Day of the Dead? In J. D. Morgan & P. Laungani (Eds.), Death and bereavement in the Americas. Death, value and meaning series (Vol. II, pp. 75-76). Amityville, NY: Baywood.
Sanchez, G. J. (1993). Becoming Mexican American: Ethnicity, culture, and identity in Chicano Los Angeles, 1900-1945. New York: Oxford Press.
Smith, T. B., McCullough, M. E., & Poll, J. (2003). Religiousness and depression: Evidence for a main effect and the moderating influence of stressful life events. Psychological Bulletin, 129, 614-636.
Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ Primary Care Study. JAMA, 282, 1737-1744.
Stevens-Arroyo, A., & Diaz-Stevens, A. (1998). The Emmaus paradigm: The Latino religious resurgence. Boulder, CO: Westview Press.
Strawbridge, W. J., Shema, S. J., Cohen, R. D., Roberts, R. E., & Kaplan, G.A. (1998). Religiosity buffers effects of some stressors on depression but exacerbates others. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 53, S118-S126.
U.S. Department of Health and Human Services. (2001a). Mental health care for Hispanic Americans. In Mental health: Culture, race, and ethnicity--A supplement to Mental health: A report of the surgeon general (pp. 127-155). Rockville, MD: Author.
U.S. Department of Health and Human Services. (2001b). A statistical profile of Hispanic older Americans aged 65+. Washington, DC: Author.
Van Soest, D., & Garcia, B. (2003). Diversity education for social justice: Mastering teaching skills. Alexandria, VA: Council on Social Work Education.
Villa, V. M., & Aranda, M. P. (2000). The demographic, economic, and health profile of older Latinos: Implications for health and long-term care policy and the family. Journal of Health and Human Services Administration, 23, 161-180.
Warner, S. R., & Wittner, J. G. (1998). Gatherings in diaspora: Religious communities and the new immigration. Philadelphia: Temple University Press.
Weber, M. (1946). Religious rejections of the world and their directions. In H. H. Gerth & C.W. Mills (Eds.), From Max Weber: Essays in sociology (pp. 323-359). New York: Oxford University Press. (Original work published 1915)
Williams, D. R., Larson, D. B., Buckler, R., Heckmann, R., & Pyle, C. (1991). Religion and psychological distress in a community sample. Social Science and Medicine, 32, 1257-1262.
Yang, Y., & George, L. (2005). Functional disability, disability transitions, and depressive symptoms in late life. Journal of Aging and Health, 17, 263-292.
Maria P. Aranda, PhD, LCSW, is associate professor, School of Social Work, University of Southern California, Montgomery Ross Fisher, #214, Los Angeles, CA, 90089-0411; e-mail: email@example.com. An earlier version of this article was presented at the conference on Religion and Social Justice for Immigrants sponsored by the Center on Religion and Civic Culture, University of Southern California, February 1, 2005, Los Angeles, CA. This study was funded in part by the John A. Hartford Foundation/The Gerontological Society of America and the Center for Religion and Civic Culture/The Pew Charitable Trusts, University of Southern California.
Table 1: Sample Characteristics, by Nativity Status Total Sample (N = 230) Variable M SD n (%) Age (range: 50-94) 69.6 10.1 <60 41 (17.8) 60-69 71 (30.9) 70-79 82 (35.7) 80+ 36 (15.6) Female 154 (67.0) Country of birth United States Mexico Caribbean Central America Other Latin American country Religious preference Catholic 178 (77.4) Protestant 39 (16.9) Other 13 Marital status Married 79 Widowed 73 Separated/divorced 61 Never married 17 Education * No education 10 Elementary 58 Junior high school 32 Some high school 51 High school graduate 23 Some college 56 Annual household income * [less than or equal to] $7,500 107 $10,001-20,000 57 $20,001+ 43 Depression diagnosis (a) 74 Religious attendance (range: 0-5) 2.29 1.34 Daily/more than once a week 9 Once a week 27 Once or twice a month 88 Several times a year 32 Never 74 Private prayer (range: 0-6) 4.53 1.14 Daily/>once a week 183 Once a week 23 Once or twice a month 6 Several times a year 7 Never 10 Functional limitations (range: 0-4) 1.83 1.76 Stress events * (range: 0-7) 2.25 1.63 Confidant support (range: 0-23) 3.27 3.14 U.S.-Born (n = 142) Variable M SD n.(%) Age (range: 50-94) 68.1 9.98 <60 31 (21.8) 60-69 47 (33.1) 70-79 48 (33.8) 80+ 16 (11.2) Female 95 (66.9) Country of birth United States 142 (61.7) Mexico Caribbean Central America Other Latin American country Religious preference Catholic 105 (73.9) Protestant 29 (20.4) Other 8 (5.6) Marital status Married 49 (34.5) Widowed 41 (28.9) Separated/divorced 30 (28.1) Never married 12 (8.5) Education * No education 3 (2.1) Elementary 20 (14.1) Junior high school 23 (16.2) Some high school 42 (29.6) High school graduate 18 (12.7) Some college 36 (25.4) Annual household income * [less than or equal to] $7,500 55 (44.4) $10,001-20,000 38 (30.6) $20,001+ 31 (25.0) Depression diagnosis (a) 45 (31.7) Religious attendance (range: 0-5) 2.09 1.28 Daily/more than once a week 2 (1.4) Once a week 13 (9.2) Once or twice a month 52 (36.6) Several times a year 24 (16.9) Never 51 (35.9) Private prayer (range: 0-6) 4.47 1.90 Daily/>once a week 109 (76.8) Once a week 15 (10.6) Once or twice a month 6 (4.2) Several times a year 4 (2.8) Never 8 (5.6) Functional limitations (range: 0-4) 1.79 1.78 Stress events * (range: 0-7) 2.51 1.61 Confidant support (range: 0-23) 3.44 3.23 Immigrant (n = 88) Variable M SD n (%) Age (range: 50-94) 71.99 9.76 <60 10 (11.4) 60-69 24 (27.3) 70-79 34 (38.6) 80+ 20 (22.8) Female 59 (67.0) Country of birth United States -- Mexico 57 (24.7) Caribbean 14 (6.0) Central America 13 (5.5) Other Latin American country 5 (2.1) Religious preference Catholic 73 (83.0) Protestant 10 (11.3) Other 5 (5.7) Marital status Married 30 (34.1) Widowed 32 (36.4) Separated/divorced 21 (23.8) Never married 5 (5.7) Education * No education 7 (8.0) Elementary 0 (43.2) Junior high school 9 (10.2) Some high school 9 (10.2) High school graduate 5 (5.7) Some college 20 (22.7) Annual household income * [less than or equal to] $7,500 52 (62.7) $10,001-20,000 19 (22.9) $20,001+ 12 (14.4) Depression diagnosis (a) 29 (33.0) Religious attendance (range: 0-5) 2.61 1.39 * Daily/more than once a week 7 (8.0) Once a week 14 (15.9) Once or twice a month 36 (40.9) Several times a year 8 (9.1) Never 23 (26.1) Private prayer (range: 0-6) 4.64 1.06 Daily/>once a week 74 (84.1) Once a week 8 (9.1) Once or twice a month 0 (0) Several times a year 3 (3.4) Never 3 (3.4) Functional limitations (range: 0-4) 1.89 1.73 Stress events * (range: 0-7) 1.83 1.59 Confidant support (range: 0-23) 3.00 3.01 Notes: Some percentages do not add up to 100 because of missing data. Where appropriate, means, standard deviations, and ranges are included for continuous variables. (a) Depression diagnoses were derived from the Depression subscale of the Patient Health Questionnaire with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (American Psychiatric Association, 1994) criteria. These rates include major depression and other unipolar depression diagnoses. * p [less than or equal to] 05. Table 2: Logistic Regression Analysis of the Association between the Presence of Depression and Sociodemographic, Religion-Related, Physical Health, Stress, and Social Support (N = 230) Odds Variable Ratio 95% CI p 0.99 0.952-1.020 .401 Gender 1.77 0.850-3.681 .127 Education 1.00 0.970-1.031 .987 Household income 0.85 0.739-0.987 .033 U.S.-born 1.41 0.702-2.818 .336 Religious attendance 0.76 0.594-0.979 .034 Private prayer 0.94 0.691-1.286 .710 Functional limitations 0.63 0.511-0.765 .000 Acute stress events 0.92 0.732-1.154 .468 Confidant support 1.07 0.964-2.818 .207 Note: CI-confidence interval.
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Kenosha Medical Center Campus
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text:
The alligator pear or avacado.
alligator pear
Origin of alligator pearaltered (? by folk etymology because of the appearance of the skin) ; from avogato: see avocado
alligator pear
See avocado.
Origin of alligator pearBy folk etymology from American Spanish aguacate, avocado (the trees are said to grow in areas infested by alligators); see aguacate.
alligator pear
(plural alligator pears)


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Ben Francisco Needs ABs
Posted by Corey Seidman, Sat, May 29, 2010 03:34 PM | Comments: 4
Analysis, Posts
Had the Phillies traded the package of Lou Marson, Jason Donald, Jason Knapp, and Carlos Carrasco for Cliff Lee alone, the deal would have been lopsided. But the incomprehensible addition of Ben Francisco by Indians GM Mark Shapiro made the trade an absolute fleecing.
Francisco had put together several productive seasons in Cleveland, playing nearly everyday and hitting third. In 2008, Francisco hit 15 homers and 32 doubles in 447 at-bats for the Indians, compiling a league-average .332 on-base percentage in his first full season as a major leaguer.
The next year, a June slump skewed Francisco's numbers – he hit .141/.221/.176 in 95 plate appearances during the month. But once June turned into July, Francisco started hacking. He hit .321 with a 1.043 OPS in July, slugging five homers and nine doubles in 94 plate appearances.
And then Mark Shapiro traded him to the Phillies, a team that killed two birds with one stone by acquiring an ace in Lee and a much-needed righty bench bat in Francisco. It defied logic. Had Francisco's June slump carried over into July, maybe it makes a smidget of sense. But Shapiro essentially gave away a young, productive, cheap outfielder for nothing.
Francisco will make $470,000 this year. He has such little big-league service time that he has not even entered his arbitration years. From 2011-2013, it would be a shock to see Francisco make in excess of $1M. He won't be eligible to test the free agent market until 2014. Francisco is the ideal fourth outfielder; a cheap, high-upside player.
Even if Shapiro believed that Francisco did not fit into the Indians immediate future, there was such a small cost in keeping him that Francisco could have easily stuck around and been a fourth outfielder in Cleveland. It's like if I traded you a roll of paper towels for $20…and then you also threw in a roll of paper towels.
Francisco made his Phillies debut last year in time for a road series in San Francisco. He started three of the four games (two in centerfield) and went 4-for-12 with two doubles. In his second start – which also happened to be Cliff Lee's first – Francisco hit a double that just missed leaving the massive AT&T Park, and twice crushed fly balls that fell just short of the left field wall. It was quite the first impression.
All told, Francisco hit .278/.317/.526 with the Phils in the final months of 2009, with 14 extra-base hits in 97 at-bats. If you were to extrapolate Francisco's numbers with the Phillies to a season of 600 plate appearances, he would have projected to hit 29 homers and 50 doubles. This is not to say that he definitively would have produced those figures, just that he was very productive in limited time.
This year, Francisco has struggled a bit, mostly due to the fact that he has only seen 32 at-bats in 47 games. He has started only five times despite the fact that Raul Ibanez has gotten off to a slow start, especially against same-handed pitching.
In his career, Ibanez has not been one of those lefties that struggles against southpaws, but this year has been a different story. Ibby is hitting a mere .214/.283/.357 against lefties with only three extra base hits. May has been kinder to Ibanez than April was, but it still is not as if he represents a massive upgrade over Francisco, especially against lefthanded pitching.
So, why hasn't Francisco gotten any tick? Well, first off, the Phillies have only faced lefthanded starting pitchers in 13 of 47 games. Of those 13 games, Ibanez has started nine and Francisco has started four. Francisco has not exactly made the most of his limited opportunities, going 3-for-16 in those four starts with two doubles.
But Francisco has an OPS 10% better against lefthanded starters than his career mark, so that 16 at-bat sample size is the definition of useless. The man needs at-bats to be effective as a pinch-hitter and provide value, so giving him more opportunities against lefthanded starters seems to be the best way to accomplish this. A former pinch-hitter himself, Charlie Manuel has stated often that keeping a non-starter fresh and able to produce in such situations requires somewhat frequent at-bats.
It doesn't need to be a strict platoon, but a more favorable ratio must exist for Francisco than one start every three or four times the Phils face a lefty.
Posts: 0 BurrGundy
This article about Francisco is right on point. Cholly needs to use this outfielder more intelligently. He is a proved hitter and he could be the diamond in the rough the Phils need, but we will never know unless he gets to the plate more frequently. PLAY HIM !!!
Posted: 05:57 PM on May 29, 2010
Posts: 0 Jeff of Nova
Well Said!!
Cholly has struggled with utilizing benches to keep them fresh .
Posted: 07:11 PM on May 29, 2010
[...] At Phillies Nation (@philliesnation), Corey Seidman (@coreyseidman) pleads for the Phillies to give Ben Francisco more playing time [...]
Posted: 10:08 AM on May 31, 2010
Posts: 0 joshua sterning
i think we can all agree when i say that joe blanton is the one who needs abs.
Posted: 07:14 PM on June 9, 2010


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Paul Murphy / Eyewitness News
Email: firstname.lastname@example.com | Twitter: @pmurphywwl
NEWORLEANS- Detectives and an ATF agent spent several hours looking for spent gun shells in the 2600 block of Dreux Avenue near Franklin Avenue in the Gentilly neighborhood Thursday.
It is where police say an off-duty Southern University of New Orleans (SUNO) police officer shot and killed an alleged armed robbery suspect around 2 a.m. Thursday. Police say the officer was changing a tire for three women when a car pulled up, a gunman got out and demanded a woman's purse. That's when the officer identified himself as a law enforcement officer, drew his firearm and exchanged gunfire with the suspect.
Neighbors say the women are fortunate the officer was there to interrupt the robbery.
'It was by the grace of God that he was there for her, God bless him,' said Gentilly neighbor Warren Chambers. 'I'm sorry for the young man who lost his life, but if you're not doing wrong, you're all right.'
'Maybe, if the policeman wasn't there, it would have just been a robbery, like most of the time on the street without gunplay,' said Gentilly restaurant owner Stephen Herbert. 'Sounds like the policeman was justified.'
The suspect was taken to the hospital where he later died from several gunshot wounds. No one else was injured in the shooting. The suspect was identified as Jose Valerio, 17, who was out on bond for a pair of prior armed robbery arrests. Court records also indicate Valerio had a prior arrest for simple robbery.
The New Orleans Advocate reported that prosecutors had sought to have a $50,000 bond for two counts of armed robbery revoked after a February arrest on simple robbery. Court documents showed that Judge Laurie White declined to revoke the bond, but instead raised the bond on simple robbery from $15,000 to $40,000.
The Advocate reported that Valerio posted the bond and was released.
'Iset an appropriate bond according to the facts that I was presented, and based on his youth, his non-existent crime history, his high school attendance and regular drug screening and family,' White told the Advocate.
'I just thought it was unnecessary and it's a shame that you can't be safe in your own neighborhood,' said Chambers. 'You shouldn't have to be looking over your shoulder every time you go somewhere.'
'It is targeted violence,' said Herbert. 'This is a real safe neighborhood as long as you're not selling or buying drugs you're in good shape.'
SUNO would not identify the campus officer involved in the shooting, but released this statement. 'As released by the New Orleans Police Department (NOPD), Southern University at New Orleans (SUNO) confirms that the officer involved in the Thursday, May 29 incident on Dreux Street is a campus police officer. SUNO is fully cooperating with NOPD in this matter, which is still under investigation.'
The district attorney's office issued the following statement:
'Any homicide on the streets of New Orleans, whether or not it is justified, is a tragedy. What makes this a horrific tragedy is that it could have easily been prevented but for the systemic failure of one component of our criminal justice system. Jose Valerio was given a woefully inadequate $50,000 bond for two counts of armed robbery. He continually violated the conditions of that bond by testing positive for narcotics for which there was no consequence. Finally, he committed a third robbery, but the court denied the motion by the District Attorney's office to revoke his bond in the armed robbery case.'


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Environment: Content from Across the ABC
26 May 2015 6:56:34am
I am sure the waning impact of Al Gore's AIC film had nothing to do with the litany of falsehoods being pointed out and the associated legal suits. /end sarc
Don't let the facts get in the way of a good emotional wave, eh? There's a reason some people are easily led ... that is because they don't take the time to evaluate the cold, hard, rational facts, but rather go on what "feels right."
Care to write a piece on facts Sara? Not an appeal to some government-run pseudo scientific authority*, but to the facts. The science. The ABC seems to have a real problem on this front.
* Yes, I am referring to the IPCC here. They are a government run body, fronting as a scientific one. Besides which, appeals to authority do not carry any weight in science. Science is not a democracy, but deals with what is factually supported/proven and that which is not. I see none of that in this puff piece. It's a sure sign that you have run out of sound science when you have to resort to psychology to make an impassioned plea for action on climate change (as meaningless as that statement is in any case).


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Hey ladies from Simsbury Connecticut, here goes some sweet looking hounds tooth and paw print lacrosse pinnies. These were sublimated so the ink will last forever. Call us today for your team or school order. All of our items are proudly made to order in Kensington, Maryland USA.
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Monday, June 20, 2005
© Copyright 2015 Clayton News Daily
By Bob firstname.lastname@example.com Thieves have made off with 255 computers from schools in Clayton County in the last three years, and an official said security steps are being stepped up to stem this growing crime. The loss amounted to more than $350,000, according to Steve Holmes, executive director of Information Technology for the 50,000-student school system. "Computer theft is becoming a serious problem. There is a $10 billion lost a year nationally and it is growing at a rate of 25 percent," Holmes said. Holmes said some of the methods the school system is using to slow down the thefts are making it harder to get to the computers and hard to haul them away if they do get to them, but he said one or more things are being done that the district doesn't want to say to tip off the thieves. The computers stolen since 2003 are 182 laptops and 73 desktops. "Easy to carry also means easy to steal," Holmes said in explaining the number of laptops taken. "We are doing everything we can do" to stop this theft, Holmes said. Every laptop now has a "tattoo" that is the seal of the Clayton County School system. Unlike a stick-on identification the tattoo is actually imbedded in the plastic so it can't be removed. This means that even if one of the laptops is snatched it would be harder to fence because it would be clear it was stolen from the school system. Teachers who use their laptops in class are now required to sign a statement that the will take their computer with them when they leave the classroom. This makes it harder to find a computer that is unguarded. For the tabletop computers, they are being bolted to the computer tables with four different kinds of screws which means a thieve would have to have four different tools to unbolt them. The screws themselves are unique enough that the tools are readily available. In addition, all school buildings have security systems designed to stop any break-ins at night. So far, police have only recovered seven stolen laptops. Some are inside jobs and a worker for a contractor doing work for the schools was arrested for stealing some computers, Holmes said. In the past, a cart containing a number of computers was kept at various schools, and in one instance when a thieve broke into one school the theft of one cart resulted in the loss of 15 computers. The system is now storing its computers in a way to cut down on this multiple theft. Clayton County schools were paying $50,000 a year for a security tracking system designed to help at least recover stolen computers, but Holmes said the tracking recovered only one computer and wasn't worth the cost. The following is a breakdown of the losses by schools: Alternative School, 2; Anderson Elementary, 1; Babb Middle, 3; Brown Elementary, 2; Callaway Elementary, 13; Church Street Elementary, 22; East Clayton Elementary, 1; Forest Park High, 1; Fountain Elementary, 1; Harper Elementary 12; Hawthorne, 20; Haynie Elementary, 2; Hendrix Drive Elementary, 1; Jackson Elementary, 1; Jonesboro High 26; Jonesboro Middle, 1; Kemp Elementary, 13. Also, Kendrick Middle, 10; Kilpatrick Elementary, 12; King Elementary, 1; Lake Ridge Elementary, 2; Lee Street Elementary, 1; Lovejoy High, 3; Lovejoy Middle, 5; M.D. Roberts Elementary, 2; McGarrah Elementary, 2; Morrow High, 10; Morrow Middle 1; Mount Zion Elementary, 4; Mount Zion High, 4; Mundy's Mill High, 2; Mundy's Middle, 2; Northcutt Elementary, 6; North Clayton High, 8; North Clayton Middle, 2; Oliver Elementary, 38; Point South Elementary, 1; Point South Middle, 3; Riverdale High, 16; Swint Elementary, 1; Tara Elementary, 1 and West Clayton Elementary, 4. The 14 other schools in the district had no thefts.
More like this story
- School vandalized ( February 8, 2005 )
- North Clayton Middle students go wireless ( October 8, 2009 )
- Pawn shop raided
Business was encouraging theft, buying stolen items ( October 2, 2007 )
- Technology updates education in schools ( June 26, 2004 )
- BOE wants new fraternization policy ( January 30, 2008 )


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Destination: Appalachian Highlands
The Best Places in West Virginia
Years ago, singer John Denver serenaded the state of West Virginia: its misty mountains, green river valleys, and winding country roads. Things haven't changed in the Mountain State. West Virginia is still a heavenly getaway of breathtaking views, outdoor adventure, and down-home comforts. Before long, you'll be humming it, too: "Almost heaven, West Virginia!"If you asked for a hundred people's favorite vacation moment in West Virginia, you would get a hundred different answers. They'll all praise the breathtaking miles of green-carpeted Appalachian highland views. Some will animatedly describe an unforgettable white-water rafting trip. A few will sigh about that peaceful cabin retreat. But no two answers will be the same.
That's because there's something new to explore around every bend—and West Virginia has a lot of bends! Tucked in the folds of rippling mountain ridges and mist-cloaked highways are adventures to suit every taste.
So grab your binoculars and a comfortable pair of shoes and head for the Mountain State. Just inland of Virginia, it's an easy drive for Easterners—and worth the trip for anyone else.


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I am going to be pumping quite a bit with this baby as I work full-time 12 hour shifts. Would it be better to get the Lactina over the Pump In Style? I used the Lactina with my first child and it worked great, I never tried the PIS. I like that the PIS comes in a backpack or a tote bag. It will look a lot nicer carrying it to work. LOL
Sacha, mommy to Satori (1994), Landon (1996), Elizabeth (1999) Dillinger (2001) step-mama to Maleena (2003) and Larissa (2006) and expecting the unexpected February 2013!
I exclusively pump and I've killed one PIS already. The first one had been used some before I started exclusively pumping but 7-10 times/24 hr period for 10 months was just too much for the PIS. If I could go back and do it again, knowing that I would be pumping for the long haul, I'd get a Lactina.
Annie wife v2.0 to DH and joyfully parenting DSS 20 , DSD 17 , DSD 16 , DSS 14, heart hero DD 4 and DS due 6/2015 . 8/2010
Click here to visit Diaper Parties, LLC
I used the PIS for a bit, but the Symphony I rented from the hospital was infinitely better. If you're going to be pumping a lot and for a long time, I'd suggest that. It took me half the time to get the same amount with the Symphony versus PIS. My hospital rented them for $50 a month. Often insurance will cover it, too.
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Triathlon Calculator
10,000 - 50,000 downloadsAdd this app to your listsTweets por @Appszoom
Created by triathletes for triathletes, Triathlon Calculator is an easy to use tool for estimating:
1. Race times for triathlons and duathlons
2. Each race leg times
3. Converting run pace into run times
4. Converting bike speed into bike time
5. Estimating caloric needs
6. Estimating caloric intake start and stop times
7. Emailing estimate reports
8. Standard/Imperial or Metric Support
The following race formats are supported:
1. Full Iron distance (as in Ironman race)
2. Half-iron distance (as in Ironman 70.3 race)
3. Olympic distance (as in Standard course)
4. Sprint distance
5. Duathlons
Keywords: triathlon, duathlon, ironman
Tags: triathlon race calculator.html, triathlon calculator widget, ironman triathlon time calculator, triatlon, triathlon calculator metric, sprint triathlon calculator, triathlon calculator, triathlon, ironman race calculator calories, simpletriathloncalculator.
1. Added Metric support
2. Redesigned navigation between Triathlon and Duathlon modes
3. Added Settings panel for managing standard/imperial or metric systems
(51 stars)
only calculates the sprint distance. shows "tbd" for other distances' calculations. many months later and still no response. are you still there?
(51 stars)
No metric.
(51 stars)
Keep it up
(51 stars)
It's a great app only thing is we should be able to customise our own distances ... Not all sprint tri are the same. Also calories before race should be optional.


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OSRAM SYLVANIA 25w 120v R14 N Intermediate Base incandescent light bulb x 6 pcsItem SKU: 14793*6
Osram Sylvania
$ 7.98
$ 11.18
The OSRAM SYLVANIA is a 25watt, 120volt incandescent light bulb. It has an intermediate Base. The lifespan varies from 1500-1750 hours depending on usage. This lamp is a Buldging Reflector which means its going to be off set with your fixture. It is also lightly frosted from the inside which helps reflect light for a brighter out with its soft 2850k color temperature.


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Nice gun, congrats!
Printable View
Nice gun, congrats!
That's a really nice setup, Ikeepitcold, but I don't know if I'd want to take it into CA, it's got that evil pistol grip and adjustable stock. By the way, I did my undergrad work at UNR.
I haunt the LGS's & Wally-World...no luck yet. That Is a NICE rifle you have there, I have a DPMS LR-308. What brand of scope do you have on the rifle? I can't make it out in the pic.


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Miami University Performing Arts Series: Broadway's Next Hit Musical
Straight from New York City, <i>Broadway's Next Hit Musical</i> abandons the same old song and dance to create a spontaneous evening of music, humor and laughter. The audience votes for their favorite song and watches tat the cast turns it into a full-blown improvised musical. You'll love it! After all, you created it.
Where: Hall Auditorium
Phone: 513-529-3200
Address: 501 E. High St.
Website: http://arts.muohio.edu/performing-arts-series/events/broadways-next-hit-musical-223


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Cheap DEC to Los Angeles flights
Popular Flights from Decatur, Illinois
Top Decatur Flights to US Destinations
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Top Los Angeles Flights to US Destinations
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DEC to LAX Route Map
Decatur to Los Angeles Flights, Stats and Airplanes
Route information for flights from Decatur IL to Los Angeles Intl..
1,674.14 miles
LAX - Los Angeles Intl. Airlines
Browse the most popular airlines servicing the Los Angeles (LAX) airport. Visit their flights pages to learn more about the most popular routes these carriers fly.


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text: I've spent time with a lot of Blu handsets over the past couple of years, and one of the biggest downsides (to me, at least) is always the outdated software. In fact, every Blu phone I've looked at so far this year has been running KitKat. Fortunately, Lollipop is set to hit a few of the company's handsets starting this month, and it also just released the Studio C - its first offering to run Lollipop right out of the box.Read More


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BOSTON -- The stretch of 20 games in 20 days wore on Jarrod Saltalamacchia. After days and weeks of crouching down at the backstop, the Red Sox catcher had grown dehydrated in recent days. With fatigue consuming his body, Saltalamacchia was hooked on IV's in an attempt to regain lost fluid. That's what made Saturday's walk-off, two-run homer in the 3-2 victory more spectacular. Despite the exhaustion, Saltalamacchia -- who entered in the ninth since Kelly Shoppach started -- capitalized on his brief breather. "The IV's helped a little," the catcher said. "Obviously, not starting [on Saturday], I had a...
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Dietary Aide Courses and Classes Overview
Training to become a dietary aide is available through certificate courses as well as associate's and bachelor's degree programs. Continue reading to get some essential information for students seeking dietary aide classes.
Essential Information
Dietary aide classes can culminate in a professional certificate or an associate's or bachelor's degree in nutrition and dietetics. Sometimes, nutrition courses can also be taken individually for personal or professional development. These programs are widely available at 2-year community colleges and 4-year schools.
Students will learn about food preparation, menu planning, nutritional requirements, and dietary management. Coursework combines classroom study as well as practical experience planning nutritional programs and preparing nutritious meals. Special focus may be given to how one's diet can support a healthy immune system, optimal growth and development, and athletic performance.
List of Courses
Keep reading for a list of courses for potential dietary aides.
Nutrition and Food
Students examine the relationship between food and nutrition, for both children and adults, in this beginning dietary aide course. They examine how sound nutrition affects an individual's mental, physical and emotional health. Some lectures focus on the affect nutritional choices have on children's growth and the ability to learn. Recent developments in the field are also discussed; how nutrition research can change our perception of which foods are healthy and which should be avoided is discussed in detail.
Concepts in Nutrition
This research-based intermediate-level course gives students the opportunity to study nutrition concepts in sports nutrition and disease management. They examine the role of good nutrition in managing cardiovascular disease and diabetes. Students learn to modify diets to meet the needs of individuals based on their various health concerns, and, in the case of athletes, their rigorous schedules. This course also examines how vitamins and fast food affect overall nutrition.
Food Service Dietary Aide
In this intermediate dietary aide course, students gain practical experience assisting cooks and chefs. They prepare food for basic meals by washing and chopping vegetables and gathering ingredients. They create simple appetizers, entrees and desserts under supervision. Students are also responsible for making sure meals are nutritionally balanced.
Dietary Management Training
This course provides experience and training to individuals interested in becoming dietary managers. Students work with licensed nutritionists and dieticians to provide nutritional options for individuals with diet concerns. While learning techniques for running a kitchen, they also develop leadership skills used in managing staff, such as cooks, chefs and dietary aides. Usually, this course requires students to gain practical experience working in the field; this experience include creating healthy food options for hospitals, nursing homes and restaurants and supervising other.
Label Reading
This course, is not offered as part of a degree program, but teaches students to understand the importance of labels on food cans and packages. Definitions of ingredients on nutritional labels are discussed, along with how certain ingredients, such as corn syrup, affect a product's overall nutritional value. The class teaches weight and cholesterol control through a discussion of the differences between good fats and bad fats. Teachers also talk about paying attention to portion size, with many packaged and canned foods consisting of two or three portions.
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For The Love of Food ...and it's not good unless it's made with love
A cookbook of family favorites and childhood memories.
by Megan L. Damewood
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