1. Note: Adjusted R square; * = p <.05; ** = p <.01; *** = p <.001 Spiritual Health Locus of Control and Preventive Health Behaviors in a National Sample of African Americans Katrina J. Debnam 1, MPH, Cheryl L. Holt 1, PhD, Eddie M. Clark, PhD 2, David L. Roth 3, Martha Crowther, PhD 4, MPH, Mona N. Fouad, MD MPH 5, H.R. Foushee, PhD 3, and Penny Southward, BS 5 Research has revealed that unique locus of control beliefs may be relevant for diverse populations (Holt et al., 2003). One type in particular is control attributed to a higher power or God, for some populations (Wallston et al., 1999). Spiritual Health Locus of Control and God Locus of Health Control concepts are being used to understand such perceived sources of health control (Holt et al., 2003; Wallston et al., 1999). For the purposes of this study, Spiritual Health Locus of Control is defined as “the belief that a higher power (e.g., God) has control over one’s health” (Holt, Clark, & Klem, 2007, p. 599). These constructs may be relevant for particular populations such as those high in religiosity/spirituality, including African Americans. Empirical studies suggest that there are relationships between Spiritual Health Locus of Control beliefs and health-related behaviors among African American women. However, studies have not yet examined this relationship among African American men. Nor have they included a variety of health behaviors, or had the opportunity to take advantage of a national probability sample. BackgroundResults Department of Public and Community Health Spiritual Health Locus of Control beliefs appear to relate differently to health behaviors among men than for women. Men’s Spiritual Health Locus of Control beliefs are more closely tied to engaging in health risk behaviors than prevention behaviors. Spiritual Health Locus of Control variables were significantly predictive of health risk behaviors (alcoholic drinks and history of cigarette use) for men, while in contrast, female scores on the Spiritual Health Locus of Control variables were predictive of disease prevention behaviors (fruit and vegetable servings per day). Data were collected during telephone interviews with 1,629 African Americans aged 21 and older living in a private residence with a telephone, in any of the 50 states in the US. Measures/Variables Demographics. Participant sex, race, date of birth, marital status, years of education, employment status, and self-rated health status The Spiritual Health Locus of Control Scale is a 13-item instrument that assesses four dimensions of Spiritual Health Locus of Control beliefs (Holt et al., 2007). Active Spiritual (3 items; range 1-15) involves the belief that both a higher power (e.g., God) and the self each contribute to one’s health (  =.66). Passive Spiritual (3 items; range 1-15) assesses the belief that because a higher power has control over one’s health, the individual does not have to engage in healthy behaviors (  =.51). God’s Grace (4 items; range 1-20) involves the belief that a higher power is powerful and good, and has control over one’s health, regardless of one’s behaviors (  =.63). Spiritual Life and Faith (3 items; range 1-15) involves the belief that a higher power would keep one healthy but only if they lead a faithful life (  =.81). Healthy Lifestyle Behaviors Fruit and vegetable consumption. Adaptation of the National Cancer Institute’s Five-A-Day Survey. Participants recall the number of servings of fruit and vegetable consumed in a typical day. Physical Activity. short form of the International Physical Activity Questionnaire (IPAQ; Craig et al., 2003). Number of days in the past week spent engaging in vigorous and moderate physical activity as well as walking. Alcohol and Cigarette Use. Items from the Behavioral Risk Factor Surveillance System (BRFSS). Frequency of alcohol use and binge drinking events in the past 30 days (CDC, 2009). History of cigarette use (e.g. Have you smoked at least 100 cigarettes in your entire life?”). Cancer Screening Behaviors Items from the Behavioral Risk Factor Surveillance System. Whether participants had ever heard of each screening exam, if they ever had each exam, the frequency of their screenings, and if the time frame of their last exam was in compliance with the American Cancer Society screening recommendations. The screening procedures included: mammogram (breast), pap smear (cervical), prostate specific antigen test (PSA; prostate), digital rectal examination (DRE; prostate), fecal occult blood test (FOBT; colorectal), sigmoidoscopy (Sig; colorectal), and colonoscopy (colorectal). Support for this project comes from the National Cancer Institute (# 1 R01 CA105202) and was approved by the University of Alabama at Birmingham (#X051116001) and University of Maryland (#08-0328) Institutional Review Boards. Purpose of the Study The present study seeks to extend research in Spiritual Health Locus of Control by examining the relationship between Spiritual Health Locus of Control beliefs and disease prevention and health risk behaviors in a national sample of African American men and women. This study examines disease prevention (e.g., physical activity, fruit and vegetable consumption, and cancer screening) and health risk (e.g., alcohol use and smoking) behaviors. Methods Results Conclusions and Implications Acknowledgements Note: Pap=pap smear, PSA=prostate specific antigen test, DRE=digital rectal examination, FOBT=fecal occult blood test, Sig=sigmoidoscopy; * = p <.05; ** = p <.01; *** = p <.001 (1)University of Maryland, School of Public Health, Department of Public and Community Health, (2) Saint Louis University, Department of Psychology, (3) University of Alabama at Birmingham, School of Public Health, (4) University of Alabama, Department of Psychology, (5) University of Alabama at Birmingham, School of Medicine, Division of Preventive Medicine Active Spiritual Health Locus of Control beliefs positively associated with physical activity and vegetable consumption among women not predictive of other health behaviors negatively associated with PSA screening for men Passive Spiritual Health Locus of Control beliefs associated with lower vegetable consumption, lower alcohol use, and less likely history of cigarette use associated with physical activity and lower vegetable consumption among women Spiritual Life and Faith beliefs associated with increased fruit consumption negatively associated with awareness of colorectal cancer screening methods such as FOBT and sigmoidoscopy positively associated with fruit consumption among women no pattern was evidenced among men God’s Grace beliefs negatively associated with history of cigarette use and alcohol use, positively associated with awareness of FOBT. associated with PSA utilization among men associated with pap test utilization among women Table 2. Linear and logistic regressions for Spiritual Health Locus of Control subscales and health prevention and risk behaviors Table 1. Participant Demographic Characteristics Table 4. Logistic regressions for Spiritual Health Locus of Control subscales and cancer screening behaviors Days per week vigorous physical activity Days per week moderate physical activity Days per week walked for 10 minutes at a time Fruit servings per day Vegetable servings per day Had a drink in last 30 days (logistic) History of cigarette use (logistic) Var.βββββ OR(95% CI) Step 1 R square.06***.03***.04***.05***.06***-- Age -.14***-.11***-.10***.17***.15***.97(.97-.98)***1.02(1.01-1.02)*** Education.01*.03-.01.08***.15***1.19(1.08-1.32)***.81(.73-.89)*** Health.19***.12***.18***.14***.12***1.10(0.99-1.21).90(.82-1.00)* Step 2 R square.06.03.04.05**.06**-- ACT.06.07.01.02.041.02(.96-1.08)1.04(.98-1.10) PAS.04 -.03-.04-.08**.90(.84-.96)**.92(.86-0.98)** SLF.04-.01.02.11***.01.98(.93-1.04)1.01(.96-1.07) GG -.05-.04.02-.07-.05.95(.90-1.00)*.94(.89-.99)* Days per week vigorous physical activity Days per week moderate physical activity Days per week walked for 10 minutes at a time Fruit servings per day Vegetable servings per day Had a drink in last 30 days (logistic)History of cigarette use (logistic) Var.βββββOR(95% CI) MFMFMFMFMFMFM F Step 1 R square.07***.05***.07***.02***.04***.05***.04***.07***-- Age -.13**-.14***-.21***-.07*-.13*-.09**.14**.18***.11*.17***.99(.97-1.00)*.97(.96-.98)***1.02(1.01-1.03)*** 1.01(1.01-1.02)** Education -.01*.01.03.07.01*.01.12***.07.19***1.13(.95-1.35)1.22(1.07-1.38)**.71(.59-.85)***.84(.75-.95)** Health.23***.17***.14***.11***.17***.18***.20***.11***.17***.11***1.12(.94-1.33)1.08(.96-1.23).80(.67-.95)**.95(.84-1.07) Step 2 R square.07.06**.06.03*.05.04.05.06*.04.08**-- ACT -.02.11**-.03.11**-.00.01-.05.05-.05.08*1.03(.93-1.13)1.01(.94-1.09)1.10(.99-1.22) 1.02(.94-1.10) PAS -.01.07*-.01.06*-.08-.01-.04 -.09-.08**.97(.86-1.08).88(.81-.96)**.88(.78-.99)*.94(.87-1.02) SLF.06.02 -.02.04.01.12.11**.05-.011.05(.96-1.15).95(.88-1.01)1.04(.95-1.15).99(.92-1.06) GG -.05-.02.00-.03.09-.01 -.10*.05-.10*.90(.82-.99)*.98(.92-1.04).87(.79-.95)**.98(.92-1.04) Ever had a mammogram Mammogram adherent Frequency of PapPap adherentEver had a PSAPSA adherentEver had a DREDRE adherent Var. OR(95% CI) Step 1 *** *** Age 1.07(1.04-1.10)***1.02(1.00-1.05)*.96(.95-.97)*** 1.05(1.02-1.08)***1.03(1.00-1.06)1.05(1.02-1.07)***1.03(1.01-1.06)* Education 1.34 (1.04-1.74)*1.12(.89-1.40)1.01(.89-1.14)1.03(.90-1.18)1.50(1.19-1.89)***.98(.76-1.26)1.17(.93-1.48).89(.71-1.11) Health 1.01 (.79-1.30)1.09(.87-1.37)1.12(.98-1.27)1.15(1.00-1.32)*1.11(.88-1.40)1.24(.95-1.61)1.02(.81-1.29)1.15(.91-1.46) Step 2 * ACT 1.10(.93-1.30).87(.75-1.01).96(.89-1.05).95(.87-1.04)1.10(.96-1.26).80(.68-.95)**1.03(.90-1.18).93(.80-1.07) PAS 1.14(.97-1.35).96(.84-1.11)1.01(.93-1.10)1.03(.94-1.13).96(.83-1.11).97(.83-1.14)1.05(.90-1.22)1.08(.93-1.26) SLF.86(.74-1.02).94(.82-1.07)1.00(.93-1.07)1.05(.98-1.13).93(.81-1.07).95(.82-1.10).99(.86-1.13)1.00(.88-1.14) GG.91(.79-1.06)1.09(.97-1.23)1.07(1.00-1.15)*1.05(.98-1.13)1.10(.97-1.24)1.17(1.02-1.35)*1.07(.95-1.21)1.03(.91-1.17) Const..277.197.655.68.0021.76.01.32 Heard of FOBTFOBT adherentHeard of SigSig adherentHeard of colonoscopyColonoscopy adherent Var. OR(95% CI) Step 1 *********** Age 1.03(1.01-1.04)***.98(.96-1.00)*1.00(.99-1.01)1.00(.97-1.03)1.00(.98-1.02)1.03(.97-1.10) Education 1.06(.93-1.21).94(.78-1.12)1.18(1.05-1.33)**.60(.44-.82)***1.49(1.25-1.78)***1.52(.91-2.53) Health 1.02(.89-1.17)1.30(1.07-1.60)**.96(.85-1.08)1.00(.75-1.33).96(.80-1.15)1.15(.69-1.94) Step 2 *** ACT 1.08(.99-1.17).98(.87-1.10)1.02(.94-1.09)1.10(.94-1.30)1.04(.93-1.18)1.04(.75-1.46) PAS.93(.85-1.01).97(.86-1.11).95(.88-1.03)1.11(.89-1.39).93(.83-1.04)1.28(.86-1.91) SLF.88(.81-.95)**1.05(.95-1.16).92(.86-.99)*.93(.79-1.09).92(.82-1.03).76(.53-1.08) GG 1.09(1.02-1.18)**1.03(.93-1.14)1.03(.96-1.10)1.07(.92-1.24)1.02(.91-1.13)1.11(.85-1.46) Const..161.35.802.081.69.25 Table 3. Linear and Logistic regressions for Spiritual Health Locus of Control subscales and health prevention and risk behaviors among men and women Characteristic (N=1,629) Men (N=531) Women (N=1,098) Age mean (sd) 53.63 (14.82)53.06 (14.91)53.96(15.42) Relationship status Single 66.4%59.7%69.6% Married or living w/partner 33.6%40.3%30.4% Education Grade 11 or lower 13.2%10.4%14.6% Grade 12 or higher 86.8%89.6%85.4% Work status Employed 50.0%54.0%48.1% Unemployed 50.0%46.0%51.9% Income < 20k 37.7%27.3%42.9% > 20k 62.3%72.7%57.1% Self-rated health status Poor or Fair 26.0%25.4%26.3% Good, Very Good, or Excellent 74.0%74.6%73.7% Spiritual health locus of control beliefs M(SD) Active 13.13(1.83)13.09(2.01)13.15(1.73) Passive 5.90(1.94)5.81(1.96)5.95(1.93) God’s Grace 16.34(3.08)16.13(3.26)16.44(2.99) Spiritual Life & Faith 11.48(2.64)11.45(2.80)11.49(2.56) Note: Adjusted R square; * = p <.05; ** = p <.01; *** = p <.001 Note: Interaction terms significant only for those significant models shown in bold. * = p <.05; ** = p <.01; *** = p <.001 13.20% References Holt, C. L., Clark, E. M., Kreuter, M. W., & Rubio, D. M. (2003). Spiritual health locus of control and breast cancer beliefs among urban African American women. Health Psychology, 22(3), 294-299. Wallston, K. A., Malcarne, V., Flores, L., Hansdottir, I., Smith, C. A., Stein, M., Weisman, M. H., and Clements, P. J. (1999). Does God determine your health? The God locus of health control scale. Cognitive Therapy and Research, 23(2), 131-142. Holt, C. L., Clark, E. M., & Klem, P. R. (2007). Expansion and validation of the spiritual health locus of control scale: Factorial analysis and predictive validity. Journal of Health Psychology, 12(4), 597-612. Craig, C. L., Marshal, A. L., Sjostrom, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., Pratt, M., … Oja, P. (2003). International Physical Activity Questionnaire: 12-Country Reliability and Validity. Medicine & Science in Sports & Exercise, 35(8), 1381-1395. Centers for Disease Control and Prevention (2009). BRFSS Data Quality, Validity, and Reliability. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA. Retrieved from http://www.cdc.gov/brfss/pubs/quality.htm on December 5, 2009.