The programme of the John Templeton Foundation (JTF) funded work concerns the investigation of ways in which Religions and/or spiritual beliefs and associated behaviours (RSBB) might be associated with physical or mental health.
Consequently, we initiated the planning of further data collection from both the study parents (G0s) and the study offspring (G1s). The plan was to obtain further longitudinal data so that analyses could be structured from a measure of RSBB through confounders, mediators and moderators to health and developmental outcomes.
Contents
Questionnaires
The most recent RSBB data were collected in Questionnaires administered to both the G0s and G1s in 2019-2020 (BBH2; BBH3). Although we were not aware of it at the time, this collection of data preceded by only a few weeks, the total lock-down of the UK as the result of Covid-19.
The next two questionnaires to G0s and G1s allowed us to determine any changes in religious/spiritual beliefs and behaviours during the pandemic, as well as a variety of environmental and psychosocial factors which could be confounders, mediators or moderators of any association between beliefs or behaviours and health outcomes. These were administered to the G0s starting in Spring 2022. The G1s received the same questions (from the beginning of December 2021), but they were interspersed with other questions on their own children, education and employment, entrepreneurial behaviour, attitudes and risk taking (funded by other research groups). Consequently, to avoid over-burdening the G1s, their questions are spread across four questionnaires, whereas those administered to the G0s were included in three questionnaires.
The Templeton funded data collected from each parent and their offspring include both the psychosocial and the physical environments. These may be treated as mediators, moderators or confounders when considering the relationships between RSBB and health outcomes. They can also be considered as outcomes in their own right.
- Psychosocial Features
Included were measurements of Locus of Control; life events since the start of the Pandemic; measures of personality; quality of partner relationships; beliefs and behaviours concerning climate change; sexual attitudes and experiences; scales measuring optimism/pessimism, altruism, gratitude, meaning/purpose in life, satisfaction with life, forgiveness, self-efficacy and flourishing.
2. Environmental exposures
These include chemicals and fumes in the home/at work/neighbourhood; exposure to noise; physical aspects of the home (heating, ventilation, cooking, decorating, pets and pests); membership of clubs/organisations; smoking; exercise and extensive data on diet; drugs and alcohol.
3. Aspects of Physical and Mental Health.
Much information is already available on the health of the parents and their offspring as collected since the birth of the G1 population in 1991-2. For this programme, we also updated the health data by means of (a) physical examinations, and (b) self-completion questionnaires.
Physical examinations
The study parents (the G0s) examinations began in September 2021, and their offspring (the G1s) in October 2021. Each participant was asked to carry out a variety of tests and examinations described briefly in the Table below. These clinics were completed in Summer 2024. 
G0 measures are all funded by this programme grant plus the G1 DXA scan. The G1 measures are contributed by other funders.
| Topic | Who | Measures |
| Anthropometry | G0, G1 | Height; weight; waist and hip circumferences; leg and trunk lengths; fat, lean and bone mass using DXA machine |
| Physical capability | G0, G1 | Measures of physical ability including grip strength; balance; jumping |
| Cardiovascular system | G0, G1 | Blood pressure measurements |
| Cardiometabolic health | G0, G1 | Glycocalyx scan |
| Mental Health | G0, G1 | CIS-R (online questionnaire) |
| COVID vaccination attitudes | G0, G1 | On-line questionnaire |
| Lung function | G0, G1 | Spirometry |
| Lung function | G1 | Forced oscillometer; FeNo; Cardiopulmonary Exercise Testing |
| Liver health | G1 | Liver scan |
| Vision | G0 | Visual acuity (near and far distance) |
| Hearing | G0 | Speech in noise test and audiometry |
| Biological samples | G1 | Collection of blood (or saliva) and urine |
Questionnaire measures of health
As well as the health and biological measures collected as part of the physical examinations, health outcomes were also collected in questionnaires. These questionnaires were administered to the G0s in Spring 2023 and to the G1s in Autumn 2023. Data collected included many features: medical histories such as diagnoses and surgical procedures, signs and symptoms, vision and hearing, allergies, eating disorders, depression and anxiety, respiratory and gastrointestinal problems, to name but a few.
Interviews concerning methods of coping
Subgroups of the ALSPAC participants from both the parental generation (G0s) and their offspring (G1s) were interviewed to determine how they coped with different types of chronic illness. Three diagnoses were chosen: (i) Long Covid to represent a disorder of sudden onset on which little is known about prognosis (G0 and G1); (ii) diabetes as an example of a chronic disorder for which the prognosis is well-known and appropriate treatment is available (G0); and (iii) asthma as an example of a disease which can wax and wane over time (G1).
120 participants were selected for interview – giving 40 for each disorder. Each diagnostic group comprised half with a faith/belief and half without, matched as near as possible on age, sex and social circumstances. The interviewer was blind initially as to whether the participant had a belief or not. The interviews were partially structured and devised to determine the strategies the participant used to cope with different health situations. Interviews were conducted throughout 2023 and 2024.
Biomarkers of Inflammation
Inflammation is the body’s response to stimuli perceived to be harmful such as pathogens, damaged cells and toxins. Although inflammation is critical for health, chronic inflammation can be damaging and has been linked to the development of non-communicable diseases such as arthritis, diabetes, cancer and heart disease. Inflammation is therefore hypothesized to mediate the negative health effects of a variety of exposures and lifestyle factors also associated with increased inflammation. For example, co-Principal Investigator Abigail Fraser has recently reported increased levels of inflammation in adults who had experienced adverse childhood experiences (ACEs) decades earlier, thus providing a possible explanation for why these individuals also experience increased risk of non-communicable diseases (https://doi.org/10.1016/j.bbi.2021.11.001). We planned to build on this work by investigating how beliefs and associated behaviours might influence inflammation and health. We obtained measurements of the levels of 92 proteins associated with inflammatory diseases and processes in 9000 blood samples collected from ALSPAC participants in childhood, early adulthood and mid-life. Measurements were obtained using the high-performance Olink protein biomarker platform (https://www.olink.com/products-services/target/inflammation/).
Health data available at the start of the grant
Health data on the parents (G0s) and offspring (G1s) available for analysis
Details in the following tables provide information available for time-related analyses using health conditions in relation to measures of religion, spirituality, beliefs and behaviours (RSBB). The frequencies of the RSBB responses are available for the G0s in Appendices 1 and 2 and for the G1s in Appendix 11 of the Project Justification.
Details of physical and mental health concerning the parents (G0)
Table 1 shows the timings of the G0’s measures of RSBB, together with the times at which they can be extrapolated from the previous and subsequent measures as described in the Project Justification document. The timings at which any health measures are collected is shown for comparison. The different health conditions were asked at various time points as shown in Table 2.
Table 1. Depiction of the timing of data collected on RSBB and health at various stages (years from the birth of G1) for the G0 population, where + indicates actual data collection, and E denotes extrapolation backwards (see text in Project Justification).
| Time | PP | P | 0- 1 | 2-3 | 4-5 | 6-7 | 8-9 | 10-11 | 12-13 | 14-15 | 16-17 | 18-19 | 20-21 | 22-23 | 24-26 | 27-28 | 29-32 |
| RSBB | E | + | E | E | + | E | + | E | E | E | E | E | E | E | E | ++ | |
| Health | + | + | + | + | + | + | + | + | + | + | + | + | + | + | + | + | + |
PP = pre-pregnancy; P = during pregnancy; ++ = RSBB data collected as Part I of this project
Table 2. Depiction of data collected on RSBB and a sample of binary measures of specific types of ill-health at various stages (years from the birth of G1) for the G0 population, where + indicates actual data collection, and E denotes extrapolation backwards (see text in Project Justification).
| Time | PP | P | 0- 1 | 2-3 | 4-5 | 6-7 | 8-9 | 10-11 | 12-13 | 14-15 | 18-19 | 20-27 | 27-28 | 29-32 |
| RSBB | E | + | E | E | + | E | + | E | E | E | E | E | ++ | |
| Physical health | ||||||||||||||
| Arthritis | + | + | + | + | + | + | + | + | + | + | +++ | |||
| Asthma | + | + | + | + | +++ | |||||||||
| Wheeze | + | + | + | + | + | + | +++ | |||||||
| Bronchitis | + | + | + | + | + | + | + | +++ | ||||||
| Migraine | + | + | + | + | + | + | + | +++ | ||||||
| Hypertension | + | + | + | + | + | + | + | + | +++ | |||||
| Angina | + | + | + | +++ | ||||||||||
| Diabetes | + | + | + | + | + | + | + | + | +++ | |||||
| Mental health | ||||||||||||||
| Depression | + | + | + | + | + | + | + | + | + | + | ++ | +++ | ||
| Anxiety | + | + | + | + | + | + | + | + | + | + | ++ | +++ | ||
| Anorexia | + | + | + | +++ |
PP = pre-pregnancy; P = during pregnancy; ++ data collected as Part I of this project;
+++ proposed data collection
Table 3. In the table below are shown, for a selection of the health questions with binary outcomes that have been repeated over time: (A) the time at which the question was first enquired, (B) the number of times it was asked, (C) the last time after the birth the condition was enquired, and (D) whether further information is planned within this project. In addition, columns E and F provide the prevalence at the first and last time points for the study mothers.
| Health Condition
of G0s |
A | B | C | D | E
% |
F
% |
| Non-specific | ||||||
| Body mass index (mean) | Pn | 6 | 23 | + | 22.9 | 26.5 |
| Respiratory | ||||||
| Asthma | Pn | 5 | 22 | + | 11.3 | 14.5 |
| Wheezing attacks | Pn | 3 | 11 | + | 16.8 | 15.8 |
| Runny nose | Pn | 3 | 11 | + | 9.6 | 7.3 |
| Bronchitis | 1 | 8 | 18 | + | 1.9 | 3.4 |
| Allergies | Pn | 3 | 11 | + | 42.9 | 40.6 |
| Hay fever | Pn | 3 | 11 | + | 31.5 | 38.5 |
| Watery eyes | Pn | 3 | 11 | + | 5.9 | 6.5 |
| Sneezing | Pn | 3 | 11 | + | 7.8 | 6.9 |
| Skin | ||||||
| Eczema | Pn | 10 | 12 | + | 22.6 | 11.6 |
| Hives | Pn | 3 | 11 | + | 4.6 | 7.3 |
| Pain | ||||||
| Arthritis | Pn | 11 | 18 | + | 3.4 | 21.7 |
| Back pain | Pn | 10 | 12 | + | 46.0 | 39.7 |
| Knee pain | 5 | 2 | 9 | – | 11.1 | 14.0 |
| Neck ache | 1 | 6 | 12 | + | 28.9 | 35.0 |
| Shoulder ache | 1 | 7 | 12 | + | 23.0 | 30.7 |
| Migraine/headaches | 1 | 7 | 12 | + | 43.2 | 76.7 |
| Gastrointestinal | ||||||
| Stomach ulcer | Pn | 10 | 12 | + | 1.2 | 0.8 |
| Haemorrhoids | Pn | 9 | 12 | + | 32.1 | 18.1 |
| Indigestion | 1 | 7 | 12 | + | 68.4 | 26.0 |
| Cardiovascular | ||||||
| Chest pain | 7 | 4 | 22 | + | 17.5 | 12.4 |
| Hypertension | Pn | 8 | 18 | + | 14.7 | 15.7 |
| Varicose veins | Pn | 7 | 12 | + | 11.3 | 9.3 |
| Other specific | ||||||
| Kidney disease | Pn | 3 | 11 | + | 4.5 | 2.8 |
| Epilepsy | Pn | 7 | 12 | + | 1.1 | 0.8 |
| Diabetes | Pn | 9 | 22 | + | 1.0 | 2.6 |
| Urinary infection | Pn | 7 | 12 | + | 54.0 | 10.9 |
Pn = asked prenatally, but often covering pre-pregnancy period; 0 = 1st year after the birth.
Below is a summary of the various physical health outcomes that will be collected for the G0s as part of the current proposal.
- Major outcomes to be obtained by data linkage: Diagnosis of Cancer (with site and grade at diagnosis); Mortality (including causes of death such as suicide, violence, addictions, coronary heart disease).
- Allergic and atopic diseases: asthma, eczema, hay fever, specific allergies.
- Problems with weight: obesity and overweight; low body mass.
- Cardiovascular disorders: hypertension; heart attack; stroke; pulmonary embolism; deep vein thrombosis; angina; varicose veins; haemorrhoids.
- Painful conditions: migraine/headache; arthritis; rheumatism; back pain; osteoporosis; pelvic inflammatory disease; indigestion
- Other conditions: psoriasis; stomach ulcer; urinary infection; incontinence; chronic fatigue syndrome/ME.
There are also a number of health measures which are such that comparison of severity (either in terms of frequency or duration of attacks, perceived severity of symptoms or of actual physical measurements) can be made over time. These include signs and symptoms such as: breathlessness, night cough, cough on waking, sneezing attacks, wheezing attacks, fatigue, rashes such as eczema and hives; measurements including weight, body mass index and blood pressure.
It is important to recall that the prevalence of conditions among the women is often influenced by pregnancies (both during and postnatally, even when the condition is not part of the reproductive system (e.g. urinary infection; haemorrhoids). Consequently, any time-related analyses concerning the mothers’ health conditions will need to take full account of the timing of her pregnancies.
Mental health of the G0s
Although mental health was asked of the G0 mother in regard to whether she suffered from the disorders listed in Table 4, the more accurate method of assessing depression and anxiety concerns the assessments made of each using specific scales repeated from pregnancy onwards, including at 27-28 in Part 1 of this study. For depression this involved the 10-item Edinburgh Postnatal Depression Scale (EPDS), validated for women outside the postnatal phase, as well as for men (Paul et al 2020). Anxiety was measured using the 8-item anxiety subscale of the Crown-Crisp Experiential Index (CCEI; Burgess et al 1987).
Table 4. Details of self-reported mental health concerning the parents (G0) for a selection of questions that have been repeated over time, (A) the time at which it is first enquired, (B) the number of times the question was asked, (C) the last time after the birth the condition was enquired, and (D) whether further information is planned within this project. In addition, columns E and F provide the prevalence at the first and last time points for the study mothers.
| Condition | A | B | C | D | E
% |
F
% |
| Severe depression | Pn | 10 | 11 | + | 9.0 | 10.2 |
| Suicidal thoughts | Pn | 10 | 12 | + | 10.2 | 6.2 |
| Alcoholism | Pn | 7 | 12 | + | 0.9 | 1.1 |
| Anorexia | Pn | 3 | 11 | + | 2.0 | 1.9 |
| Bulimia | Pn | 3 | 11 | + | 2.3 | 3.0 |
| Drug addiction | Pn | 3 | 11 | + | 0.5 | 0.4 |
Health outcomes of the study offspring in relation to the RSBB measures on their parents (G0) and themselves (G1)
Table 5. Depiction of data collected to enable analysis of RSBB of G0s and their offspring in regard to the health at various stages of the G1 population, where + indicates actual data collection, and E denotes extrapolation backwards (see text in Project Justification).
| Time | 0-1 | 2-3 | 4-5 | 6-7 | 8-9 | 10-11 | 12-13 | 14-15 | 16-17 | 18-19 | 20-21 | 22-23 | 24-26 | 27-28 | 28-30- |
| RS-0 | E | E | + | E | + | E | E | E | E | E | E | E | E | ++ | |
| RS-1 | + | + | + | + | + | ++ | |||||||||
| Health | + | + | + | + | + | + | + | + | + | + | + | + | + | + | + |
RS-0 = RSBB questions concerning G0; RS-1 = RSBB questions concerning G1; ++ = RSBB questions used in Part I of this project
Shown in Table 5 are the ages at which Parents’ (G0) RSBB data were collected, and/or extrapolated (E), in regard to the ages at data collection of the children’s health measures. Examples of the types of information collected on measures of physical health reported by the study mothers included:
- Subjective assessments of health
- Allergic and atopic conditions: asthma, eczema, hay fever, specific allergies, IgE
- Anthropometry: stunting, overweight, underweight, obesity.
- Painful conditions: headaches, abdominal pains (including colic in infancy), earache, limb pains (growing pains).
- Infections: helminth infection, acute ear infection, ear discharge (indicating chronic middle ear infection) eye infection, urinary infection, chest infections, bronchitis/ bronchiolitis.
- Repeated gastric symptoms: diarrhoea; vomiting; constipation.
- Other conditions: sleep apnoea; febrile convulsions; incontinence; chronic fatigue syndrome /ME.
Mental health
During the first two years of life, the G1’s temperament was measured using the Carey Infant Temperament scales (Fullard et al 1984); and at 4 and 5 years, the EAS measure (Buss and Plomin, 1986). From age 4 onwards the child’s behaviour was measured using the SDQ, which measures conduct problems, hyperactivity, emotionality, peer problems and prosocial behaviour (Goodman and Scott 1999).
For mental health from about age 10 onwards, measures were collected from the G1s themselves. For example, participants completed the Short Mood and Feelings Questionnaire (SMFQ), to assess clinically meaningful depressive symptoms at ten time points (10.6, 12.8, 13.8, 16.7, 17.8, 18.6, 21.9, 22.9, 23.8 and 25.8 years). SMFQ scores of 11 and above have good specificity for predicting ICD-10 depression. The figure below shows the prevalence of high levels of depressive symptoms (SMFQ score ≥11) at ages 10-26 years. Sample sizes range from 7000 at age 10, to almost 4000 at age 26.
Other measurements of mental health
Prevalence of self-harm in the past year, measured at 16, 18, 21, 24 and 25 years showed prevalences of 17%, 5%, 9%, 9%, 6% and 8% respectively.
Other measures collected longitudinally from the G1s included psychotic-like-symptoms (PLIKS), using information collected from self-completion questionnaires as well as by in-depth interview (Jones et al 2012; Niarchou et al 2015). Details of children diagnosed with autism are available, together with detailed measures of autistic traits (Steer et al 2010). Other specific interviews were undertaken to identify borderline personality disorder (Winsper et al 2017), as well as various types of addiction (e.g. alcohol, cigarettes and gambling).
Two questionnaire methods were used to identify other psychiatric diagnoses: The DAWBA (Goodman et al 2000) and the CIS-R (Brugha et al 1999), from which various disorders were identified including, for example, generalized anxiety, social anxiety and eating disorders.
References
Brugha, T. S., Bebbington, P. E., Jenkins, R., Meltzer, H., Taub, N. A., Janas, M., & Vernon, J. (1999). Cross validation of a general population survey diagnostic interview: a comparison of CIS-R with SCAN ICD-10 diagnostic categories. Psycholl Med 29(5), 1029-1042.
Burgess, P. M., Mazzocco, L., & Campbell, I. M. (1987). Discriminant validity of the Crown-Crisp Experiential Index. Br J Med Psychol 60: 61-69.
Buss, A. H., & Plomin, R. (1986). The EAS approach to temperament. The study of temperament: Changes, continuities and challenges, 67-79.
Fullard, W., McDevitt, S. C., & Carey, W. B. (1984). Assessing temperament in one-to three-year-old children. J Pediatr Psychol 9(2), 205-217.
Goodman, R., Ford, T., Richards, H., Gatward, R., & Meltzer, H. (2000). The development and well‐being assessment: Description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatr 41(5), 645-655.
Goodman, R., & Scott, S. (1999). Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: is small beautiful? J Abnormal Child Psychol 27(1), 17-24.
Jones, R. B., Thapar, A., Lewis, G., & Zammit, S. (2012). The association between early autistic traits and psychotic experiences in adolescence. Schizophrenia Res 135(1-3), 164-169.
Niarchou, M., Zammit, S., & Lewis, G. (2015). The Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort as a resource for studying psychopathology in childhood and adolescence: a summary of findings for depression and psychosis. Soc Psychiatr Psychiatr Epidemiol 50(7), 1017-1027.
Steer, C. D., Golding, J., & Bolton, P. F. (2010). Traits contributing to the autistic spectrum. PloS one, 5(9), e12633.
Winsper, C., Hall, J., Strauss, V. Y., & Wolke, D. (2017). Aetiological pathways to Borderline Personality Disorder symptoms in early adolescence: childhood dysregulated behaviour, maladaptive parenting and bully victimisation. Borderline Pers Disord Emotion Dysreg 4(1), 1-10.
insert app 12
Health data newly available
Clinic photos courtesy of ALSPAC/Sam Frost photos.