Worship attendance frequency.

To the Editor: Essinger (1) reported that three primary factors influence the attitudes of Tennessee physicians toward euthanasia and assisted death: ethics, religion, and the role of the physician in relieving pain and suffering. Those physicians with strong self-reported theistic religious values were less approving of euthanasia or assisted death than were those without such values. Gartner et al (2) found that "real-life" behavioral variables such as church attendance or financial giving were better indices of religiosity than self-report measures.

A recent study investigated medical decision making as a function of place of worship attendance. Research committees of the James H. Quillen VA Medical Center and the James H. Quillen College of Medicine approved the project. Usable responses were obtained from 160 (54%) of 296 adult outpatients attending the nicotine reduction program at the VA Medical Center. The typical volunteer was male (92%), white (91%), and 54 years old. Responses to the rating item "Estimated place of worship attendance in past 6 months" were used to categorize respondents as either low or high attendees. Low attendees (n = 93) rated themselves as a 1 or 2 (ie, attendance equal to or less than twice monthly), and high attendees checked a 5 or 6 (ie, attendance equal to or more than three times weekly). Groups were not significantly different as a function of race, sex, income, and many health habit variables. However, high attendees were older, drank more alcohol, and smoked fewer cigarettes than did low attendees, and these variables were used as covariates in subsequent analyses of covariance procedures.

Participants responded to three ethically sensitive vignettes used in previous research. (3) Volunteers indicated their extent of approval on a Likert-type scale ranging from 1 (Do not approve) to 7 (Do approve). The birth control vignette described a sexually active single woman asking for birth control medication. The euthanasia vignette described a 70-year-old man in a coma after a myocardial infraction whose family asks the physician to perform euthanasia. The elective abortion vignette described a pregnant woman with a family history of a genetic disease who requests an abortion.

Low attendees were significantly more approving of the euthanasia vignette (F = 7.18, P = 0.009) and the elective abortion vignette (F = 12.79, P < 0.001) than were high attendees. Responses to the birth control vignette followed the same trend, but group differences were not significantly different (F = 2.02, P = 0.158).

Koenig et al (4) summarized many studies and found that people who frequently attend worship services generally have fewer psychological problems, better immune function and physical health, and less juvenile delinquency and marital instability. Research also suggests that worship attendance frequency is not simply another means of measuring physical health. Worship attendance frequency is a behavioral variable that could easily be added to large survey studies such as Essinger's (1) to further make operational the abstraction of "religion."

This project was supported by resources from the James H. Quillen Veterans Affairs Medical Center and College of Medicine, Johnson City, TN.

References

(1.) Essinger D. Attitudes of Tennessee physicians toward euthanasia and assisted death. South Med J 2003;96:427-435.

(2.) Gartner J, Larson DB, Allen GD. Religious commitment and mental health: A review of the empirical literature. J Psychol Theol 1991;19:6-25.

(3.) Neumann JK, Olive KE. Absolute versus relative values: Effects on family practitioners and psychiatrists. South Med J 2003;96:452-457.

(4.) Koenig HG, McCullough ME, Larson DB. Handbook of Religion and Health. New York, Oxford University Press, 2001.

Joseph K. Neumann, PHD

Kenneth E. Olive, MD

Arthur R. Ellis, PHD