01 bo-79X7~XO/OZOl-0059102.00/0

THE PROPHYLACTIC EFFECT OF RELIGION ON BLOOD PRESSURE LEVELS AMONG A

SAMPLE OF IMMIGRANTS

ANTHONY WAUH

Department of Sociology, Bowling Green State University, Bowling Green. Ohio, U.S.A.

Abstract-The twin processes of immigration and assimilation are life changes perhaps more total in scope than any other. Viewing these processes within the general context of stress theory, it is hypothe- sized that those experiencing the most difficulty resolving the anemic experience of assimilation will evidence higher blood pressure levels than those who are able to make a smoother transition. It was also hypothesized that a smoother adjustment is made possible for the immigrant who has a religious outloook on life. Our data do seem to support the contention that such an outlook is an important stress-reducing device.

There have been numerous social epidemiological studies connecting life changes to various cardiovas- cular problems [l-3]. A number of investigators have suggested an increased risk of cardiovascular disease among those entering new social milieux [4-6]. How- ever, a perusal of the sociological, epidemiological, and health-related literature revealed only one study dealing with immigration and coronary heart disease [7]. Cruz-Coke and his colleagues compared a group of Easter Islanders who had immigrated to Chile with a genotypically matched group of Islanders who remained behind. They found that elevated blood pressure was “directly influenced by migration, re- gardless of age”. Given the great interest in the rela- tionship between heart disease and life changes, the paucity of studies concerning immigration is surpris- ing, since immigration is a life change that is perhaps more total in scope than any other.

The twin processes of immigration and assimilation are viewed within the cont.ext of Selye’s [8] theory of environmentally induced stress. Succinctly stated, this theory maintains that exposure to any stressor (such as a life change with emotional content) causes the adrenal cortex to respond with increased secretion of adrenaline and noradrenaline. The increase of lipids in the bloodstream prepares the body for vigorous action (“fight or flight”). Since such active.responses are rarely tenable in modern society-we are more likely to “sit and seethe”-the unconsumed lipids ac- cumulate in the arteries. In time, this accumulation leads to the hardening of the arteries and subsequent cardiovascular problems.

This paper seeks to explore the possible influence of the process of assimilation on blood pressure vari- ation among a non-probability sample of immigrants residing in Toledo, Ohio. Two intervening variables of theoretical importance will be introduced in the elaboration of the basic blood pressure/assimilation relationship. Since moving from one normative con- text to another induces varying degrees of normative conflict and confusion, we shall examine the effect of anomie on the relationship. Additionally, since many authors [9-l l] have stressed the therapeutic value of religion. we will attempt to ascertain the role of re-

Iigion in the success or failure of assimilation through its assumed role as an attenuator of anemic feelings.

ASSIMILATION

Assimilation is a process in the course of which the immigrant comes to think, feel, act, and believe in a way not significantly different than a native member of the host society, feels accepted by host nationals, and considers himself to be a loyal national of that society. This process is not unproblematic. Fairchild [ 121 has stated: “The foreigner has to be ‘denationa- lized’ and ‘renationalized’ at the same time. And let no one imagine for a moment that this is a bland and placid experience! It involves an upheaval of the very depths of emotional personality.”

Health, according to Coddington [S] “depends on the organism’s capacity to maintain some sort of equilibrium between his internal milieu and the exter- nal environment. Resistance to disease depends on the ability to adjust to changes in the external en- vironment.” It is reasonable to assume that the immi- grant will be in a state of disequilibrium on many occasions, for the norms and values he has brought with him will often not mesh well enough for smooth operation in the new milieu. Since we obtain our con- ceptions of who or what we are through social partici- pation, the immigrant must undergo a fundamental reassessment of his very being in terms of a new set of criteria. The morbidity inducing effects of such a men- tal metamorphosis have been enumerated by many students of assimilation [ 13-151. The stress of assimi- lation is, however, differentially experienced. Certain other variables contribute to the attenuation or ex- acerbation of the severity of the process.

ANOMIE

Although anomie has been traditionally conceptua- lized as a property of societies, it has also been use- fully applied as a characteristic of individuals exper- iencing feelings of normative uncertainty and of uprootedness [l&18]. Nisbet [19] saw anomie as “behavior characterized by tensions and distresses

59

60 ANTHONY WALSH

that arise from the efforts of individuals to meet the obligations of two or more irreconcilable norms”. Moss [20] has linked anomie with stress and illness. viewing anomie as the lack of accurate and effective information for normal participation in a given milieu. This cognitive disorientation, feeling of apart- ness, and normative confusion. is inherent in the assi- milation process.

RELIGION

It is our assumption that a religious outlook on life is a valuable resource for the immigrant in his colli- sion with his new world and its alien culture. Jung [I I] has stated that all of his patients over 35 years of age had fallen ill because they did not have a religious outlook on life. Jung’s doubtless exaggeration notwithstanding, it is suggested that religion has a certain prophylactic power, especially for the immi- grant. That it is a vehicle for the inculcation of pre- vailing secular norms is evidenced by Finney’s state- ment : “Immediately upon engaging in religious group ritual, one begins to learn about the organization with which one has become involved-its belief system, other behaviors (public and private) expected of the religious person” [21]. We may view the religious im- migrant, then, as slipping into the traffic patterns that define the quality of American life via the guiding hand of his Church. That the immigrant tends to assi- milate the American secular experience by partici- pation in American ritual is made even more evident in the work of Christenson and Wimberly:

Civil religion draws upon civil events such as the 4th of July, documents such as the U.S. Constitution, personages such as Jefferson and Lincoln, and common religious beliefs such as the belief in God. Some basic tenets of civil religion are the belief that the United States is God’s chosen nation; the perception of Divine sanctions and inherent morality of civil laws; and the ascription of sacred connotations to such secular symbols as flags, presidential inaugurations, and national holidays.. . Civil religious beliefs have been found among most Christian denomina- tions [22].

The religious immigrant evidently receives a large dose of “Americanism” along with what ever other “ism” he is imbibing.

More directly related to blood pressure, Scotch [S] found that church attendance was negatively related to hypertension among a sample of rural-to-urban Zulu migrants: “The more frequent the attendance at church, the greater was the prevalence of normal blood pressure”.

METHODS AND PROCEDURES

The data for this study were collected from a non- probability sample of 75 immigrants representing 19 different countries and now residing in Toledo, Ohio. The sample consisted of 41 males and 34 females. There were 51 Catholics, 14 Protestants, 7 “others”, and three respondents reported no religious affili- ation.

Interviews were conducted in the respondents’ own homes. Blood pressure measurements were taken using a standard mercury sphygmomanometer with the velcro cuff attached to the seated respondent’s left

arm. Sphygmomanometer and researcher perform- ance was checked by a medical professional on several occasions. These quality checks were con- gruent within 4 or 5 millimeters of mercury (mm Hg) either way.

Assimilation scores are based on a composite index consisting of attitudinal and behavioral referent. The 12 item Likert-type index contains such statements as “I often feel conscious of my non-American back- ground”. ” I feel completely at home in America”, and “I prefer the company of native Americans to that of my native countrymen”. The behavioral referents were the acquisition of American citizenship and membership in ethnically-oriented clubs or organiza- tions. Citizenship status contributed strongly to an individual’s score since it is perhaps the most drama- tic step in the assimilation process. Membership in ethnic organizations is not indicative of a desire to cast off the old in favor of the new. In accordance with this view, it was decided to deduct two points from the cumulative assimilation total for each mem- bership held in such organizations.

Anomie was measured by McClosky and Schaar’s Anomy Scale [17].

The religious dimension was measured by church attendance and by how important the respondent considers religion to .be in his or her life. For our purposes, “church attendance” means attendance at religious services of any faith for the purpose of wor- ship or fellowship. The “importance of religion” was introduced to provide a more intrinsic measure of religiosity since a person’s relationship with his God cannot always be ascertained by his attendance at formal services. However, it was found that the two dimensions were highly related (x2 = 20.6; df = I. P < O.OOOl). It was therefore decided to limit the analysis to church attendance alone in the interest of avoiding needless repetition.

An index of cardiovascular health was generated to serve as a control variable. This index consists of various hypertension-related factors enumerated in the medical literature such as Height/weight ratio. family history of cardiovascular problems, kidney trouble. and the respondent’s exercising, drinking. smoking, and dietary habits. Various other back- ground items not included in the analysis were also asked of each respondent.

FINDINGS

Analysis is limited to zero and first-order relation- ships. The small sample size precluded second-order analysis due to inadequate frequencies in most cells. In order to take full advantage of variation within our interval level dependent variable eta (E) is the measure of association used when discussing blood pressure. The F-distribution is used for significance testing of eta correlations. The Chi-square distribution is used in all other cases.

Systolic blood pressure ranged from a low of 106mm Hg to a high nf 191 mm Hg, with a mean of 128.3. Diastolic blood pressure ranged from a low of 60mm Hg to a high of 12Omm Hg, with a mean of 84.2. 24 respondents (32%) were found to be at least borderline hypertensive according to the l40mm Hg systolic or 90 mm Hg diastolic standard suggested by

Prophylactic effect of religion on immigrants 61

Harburg and others [23]. The mean readings of the present sample exceeds the USDHEW [24] national probability sample mean by 2.7 mm Hg systolic, and by 1.9 mm Hg diastolic.

Respondents were coded into low (n = 25), medium (II = 24) and high (II = 26) categories of assimilation. The correlation between systolic BP and assimilation was 0.25: F = 4.8, P c 0.05. Between diastolic BP and assimilation the correlation was 0.36; F = 10.7, P < 0.01. There was a mean difference of 5.5 mm’s Hg on the systolic scale and 5.3 mm’s Hg on the diastolic scale between the low and high catagories of assimila- tion.

Biological cotltrol variables: age and cardiovascular ‘health

No significance tests will be made in this section since we merely wish to ascertain whether or not our relationship holds controlling for these two important biological variables.

Age constitutes an important control variable in the present study since both blood pressure levels and assimilation are affected by the passage of time. Re- spondents were placed into three age categories; 18-34 (n = 20), 35-44 (il = 34), and 45-74 (n = 21). Age was related to systolic and diastolic blood pres- sure at the 0.44 and 0.48 levels respectively, with blood pressure rising with age. The first-order eta’s within the three age categories were 0.1 I, 0.42, and 0.40, re- spectively, on the systolic scale. and 0.24, 0.45, and 0.39, respectively, on the diastolic scale. The basic blood pressure/assimilation -relationship is somewhat diluted in the youngest age category on both BP scales but strengthened within the dther two cate- gories. This is not surprising since the effects of stress require time to manifest themselves in the form of elevated blood pressure.

On the basis of their scores on the index of cardio- vascular health, respondents were placed into good (n = 35), fair (n = 27). and poor (n = 13) categories. The zero-order relationships between the systolic and diastolic scales and cardiovascular health were 0.23 and 0.28. respectively, with the highest mean readings on both scales found in the poor category. The first- order eta’s within’ the three categories were 0.43, 0.23, and 0.38 on the systolic scale, and 0.31, 0.36, and 0.39, on the diastolic scale. Not only did the relationship hold, it was strengthened in most categories of our control variables. In those categories in which the relationship was weakened the diminution was mini- mal. The above tests increase our confidence that stress associated with assimilation has an effect on blood pressure levels independent of known somatic precursors.

The anomie categories were: low (n = 25). medium (II = 28). and high (n = 22). The correlation between systolic blood pressure and anomie was 0.27; F = 5.4, P -c 0.01. On the diastolic scale it was 0.34; F = 9.4, P < 0.01. While Table 1 reveals that the assimilation/ anomie relationship fails to attain statistical signifi- cance (actual x2 value = 0.052). we maintain that it is substantively significant. The gamma coefficient of -0.32 supports the theoretical assertion that the

Table I. Assimilation and anomie

Assimilation

Low

Medium

High

Total N

Low

8.09,, (n = 6) 9.30,;

(n = 7) 16.0%

(n = 12) 25

Anomie Medium

9.32, (n = 7) 17.3::,

(n = 13) 10.7:<,

(II = 8) 28

High

16.09,” (II = 12)

5.39::, (n = 4)

8.01:, (n = 6)

22

z2 = 9.39, df = 4. P = 0.052 NS.

greater the degree of anomie the less is the likelihood of successful assimilation.

Religion

Those who attended church for the purposes of worship or fellowship at least 12 times per year num- bered 39. Non-attenders numbered 36. The relation- ship between systolic and diastolic blood pressure and church attendance were 0.17 and 0.09, respectively: neither relationship being statistically significant. Mean blood pressure readings for church attenders were 5.1 mm’s Hg lower than those of non-attenders on the systolic scale. and 4.9mm’s Hg lower on the diastolic scale.

Table 2 shows that church attenders are more assi- milated into American culture than are non-attenders. Our assumption of temporal sequence is that church attendance leads to assimilation. The possibility exists. however, that religious participation only com- menced after the immigrant felt sufficiently at home in America. Unfortunately, no attempt was made to ascertain when the immigrant started attending re- ligious services, i.e. whether he sought solace in the church as a practice begun in his own country and continued here, or whether religious participation is a form of assimilation and not really a separate vari- able. A definitive answer to this question must await further research.

Table 3 reveals that church attenders experience less anemic feelings than do non-attenders. The argu- ment could be made that low anomie leads to church attendance and that high anomie prevents an immi- grant from participating in community worship. Again no unequivocal statement about temporal ordering can be made. However, in terms of the logic contained in the literature review, we maintain that

Table 2. Assimilation and church attendance

Assimilation Church attendance

Yes No

Low

Medium

High

Total N

10.7% 22.692 (n = 8) (n = 17) 17.7% 14.772

(,I = 13) (n = 11) 24.6x, 10.70/,

(n = 18) (n = 8) 39 36

z’ = 6.68, df = 2. P < 0.05.

62 ANWON\

Table 3. Anomie and church attendance

Anomie Church attendance Low Medium’ High

Yes

NO

Total N

25.30/, 16.00/, 10.7% (n = 19) (n = 12) (/I = 8)

S.OY/, 21.3% 18.79;, (n = 6) (n = 16) (n = 14)

25 28 22

z’ = 8.86. df = 2. P < 0.02.

the sequence is as follows:

Immigration -+ Anemic experiences

Diminution of anomie due to religious participation

To elaborate; it is assumed that all immigrants perience varying degrees of anomie which retards .

ex- the

asslmllatlon process. Some immigrants are left to their own resources to resolve the ambiguities inher- ent in a change of culture. Other immigrants find a smoother cultural transition through the medium of religious participation with its attendant intrinsic and extrinsic satisfactions. As a consequence of a relatively unproblematic cultural adjustment, church attenders should evidence lower blood pressure levels than non- attenders.

When we examine the basic blood pressure/assimi- lation relationship controlling for church attendance we observe that church attendance is a powerful sup- pressor variable in the present sample. On the systolic scale within the church attender category the eta cor- relation was 0.32; F = 3.6, P < 0.05. This finding rep resents a slight increase over the zero-order correla- tion of 0.25. The correspondirig first-order eta within the non-attender category was 0.55; F = 14.2, P < 0.001. On the diastolic scale within the church attender category the eta correlation was 0.29; F = 3.1. NS. This finding represents a slight decrease of the initial zero-order correlation of 0.36. The corre- sponding first-order eta correlation within the non- attender category was a strong 0.61; F = 19.5. P < 0.001.

DISCUSSION

The most obvious limitation of this study is the small sample size which limited a more systematic statistical analysis. Although the correlations obtained were gratifying the size and non-probability nature of the sample does not make them compelling. Consequently, this study should be considered ex- ploratory rather than explanatory in nature.

Our analysis of religion, as operationalized by church attendance, strongly suggests that it has a powerful impact on the blood pressure/assimilation relationship. Various authors [25,26] have found sig- nificant differences between Catholics and Protestants with respect to susceptibility to coronary heart dis-

WALSH

ease. The greater susceptibility of Protestants is in- variably explained by the Protestant’s hard-driving achievement ethic and his sense of personal responsi- bility for his own salvation. Our study is not con- cerned with differences in denominational weltens- chuung, but rather with religious participation as a catalyst in the assimilation process. We believe that religious association functions to diminish the immi- grant’s anemic feelings, provides him with a sense of continuity in his life, a sense of security in situations fraught with uncertainty, and provides him with a

-+ Problematic -+ Elevated blood assimilation pressure (stress)

-+ Relatively -+ Lower blood unproblematic pressure assimilation levels

new sense of belonging. The statistics suggest that while religious association does not completely shield the immigrant from the stress of assimilation. it does provide some answers to the many frustrations inevi- tably experienced, and may well be the Marxian opiate which serves to attenuate the conundrums of the new culture.

Durkheim [27] has stated that religion is a unified system of beliefs and practices which unites adherents into one single moral community. The immigrant may, therefore, not only consider himself to be part of the church which he attends, but also a part of the larger social whole of which the church itself is a part. This contention is supported by the statistically sig- nificant finding (x2 = 3.85; df = 1, P = 0.05) that church attenders are more likely to become U.S. citi- zens than are non-attenders. It goes without saying that church membership provides opportunities for extended interaction with native American members, not only through church services, but also through many of the church’s ancillary functions. Such inter- action not only provides an opportunity to learn the realities of American life, but also serves as a source of positive affect, und a chance to test the clicht “A trouble shared is a trouble halved”.

The non-religious immigrant. on the other hand, is “set free to deal with the world in all its brute objecti- vity” [28]. He is “free” to grapple with his profound life change without the comforting aphorisms of the church and its fellowship. Such reliance on one’s own mental resources may tend to diminish prospects of assimilation, and hence increase the probability of ele- vated blood pressure.

I.

2.

REFERENCES

Lundberg U., Theoral T. and Lind E. Life chances and myocardial infarction: individual differences in life change scaling. J. Psychmom. Rex 19, 27, 1973. Coddington R. The significance of life events as etiolo- gical factors in the diseases of children--II. A study of a normal population. J. Psychosom. Rrs. 16. 205, 1972.

Prophylactic effect of religion on immigrants 63

3. Dohrenwend B. Life events as stressors: a methodo- logical inquiry. J. Hlth Sot. Behao. 14, 167. 1973.

4. Syme L.. Hyman M. and Enterline P.’ So&cultural factors-and coronary heart disease. Sac. Inquiry 34, 81, i 964.

5. Syme L., Borhant N. and Buechley R. Cultural mobi- lity and coronary heart disease in an urban setting. Am. J. Epiderm. 82, 334. 1966.

6. Scotch N. S~i~u~tural factors in the epidemiology of Zulu hy~rtensjon. Am. J. p&l. Hfrh 53, 1205. 1963.

7. Cruz-Coke R.. Etcheverry R. and Nagel R. Influences of migration on blood pressure of Easter Islanders. Lamer March. 697, 1964.

8. Selye H. The Strm of Life. McGraw-Hill, New York; 1956.

9. Sadler W. Modern Psychiatry. Mosby, St. Louis. 1945. JO. Psychology of Personal and Social Adjustment. Ameri-

can. New York. 1953. Il. Jung C. Modern Man in Search oJSou/. Harcourt, New

York. 1933. 12. Fairchild H. Race and Nationaliry. Ronald Press, New

York, 1947. 13. Stonequist E. Marginal Man. Scribner. New York,

1937. l4. Frost I. Homesickness and immigrant psychosis. X

ment. Sci. 84, 801, 1938. 15. Sanua V. Immigration migration and mental illness: a

review of the literature with special emphasis on schizophrenia. In Behavior in New Enuironmenfs (Edited by Brody E.). Sage. Beverly Hills, CA, 1969.

16. Maclver R. The Ramparts We Guard. Macmillan, New York. 1950.

17. McClosky H. and Schaar J. Psychological dimensions of anomy. Am. Sot. Rev. 30. 14. 1965.

18. Durkheim E. Suicide. Free Press. New York, 1966. 19. Nisbet R. The Social Bond. Knopf, New York, 1970. 20. Moss G. Illness. Immunity, and Social Interaction.

Wiley, New York. 1973. 21. Finney J. A theory of religious commitment. Sot. Anal.

39, 19, 1978. 22. Christenson J. and Wimberly R. Who is civil religious?

Sot. Anof. 39. 77. 1978. 23. Harburg E.. Erfort J., Chape C., Hauenstein L., Schull

W. and Schork M. Socioeconomic stressor areas and black-white blood pressure: Detroit. j. chron. Dis. 26, 595. 1973.

24. U.S. Dept. of Hlth, Educ., and Welfare. Advance data: blood pressure of persons 6-74 years of age in the United States. National Center for Health Statistics. Washington. D.C. 1976.

25. Lehr I, Messinger H. and Rosenman R. A sociobiologi- cal approach to the study of coronary heart disease. J. chron. Dis. 26. 13, 1973.

26. Wardwell W.. Hyman M. and Bahnson C. Socio- environme~~l antecedents to coronary heart disease in 87 white males. Sot. Sci. Med. 2, 165, 1968.

27. Durkheim E. The Elementary Forms of R~~jgio~ Life. Free Press, New York, 1947.

28. Barrett W. Irrational Mun. Doubleday, Garden City, NY 1962.