Religious service attendance, health behaviors and well-being-an outcome-wide longitudinal analysis

Background: Previous studies of relationship between religiosity, health behaviors and well-being have showed mainly positive relationships, however, are very often limited to results of associative nature and subject to unmeasured confounding. This study focused on evaluating evidence for a positive association between religious service attendance (RSA), health behaviors and well-being in a longitudinal setting and robustness of these associations to unmeasured confounding. Methods: Three waves (2009, 2011 and 2015) of the biennial longitudinal Polish household panel study with response from 6400 respondents were analyzed. Evidence for a positive and robust association between RSA and outcome variables was evaluated using outcome-wide regression analysis with control of all variables temporally prior to the exposure and sensitivity measures (E-values) to give information on the extent to which an unmeasured confounder would need to be associated with both the exposure and the outcomes. Results: RSA is associated with reduced risk of unhealthy behaviors (smoking, alcohol use) and higher emotional well-being. These relationships are robust to substantial unmeasured confounding and difficult to explain by reference to other, unknown, variables. Evidence for a positive relationship between RSA and other well-being variables (social, physical) was less clear. Conclusions: Religiosity may play an important role in public health, particularly in prevention of non-communicable diseases. The strong and robust associations between RSA and some health behaviors (i.e. tobacco use, alcohol abuse) and emotional well-being should arguably be taken into account in health education, health promotion programs, health prevention policy and psychotherapeutic approaches, particularly in more religious populations.