Effects of Religious Orientation and Gender On Cardiovascular Reactivity Among Older Adults

Research
on Aging
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Effects of Religious Orientation and Gender on Cardiovascular Reactivity Among Older Adults
Kevin S. Masters, Tera L. Lensegrav-Benson, John C. Kircher and Robert D. Hill
Research on Aging 2005 27: 221
DOI: 10.1177/0164027504270678
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ARTICLE
RESEARCH
Masters
et al. ON
/ RELIGIOUS
AGING
ORIENTATION
10.1177/0164027504270678
Effects of Religious Orientation and

Gender on Cardiovascular Reactivity
Among Older Adults
KEVIN S. MASTERS
Syracuse University
TERA L. LENSEGRAV-BENSON
Utah State University
JOHN C. KIRCHER
ROBERT D. HILL
University of Utah
Recent attention has focused on the relationship between religiosity and health.
Although many pathways have been proposed to account for this relationship, little
empirical research has investigated specific pathways in relation to specific physiological functions. This study assessed the roles that religious orientation and gender
play in moderating psychophysiological reactivity to laboratory stressors among
older adults. Those participants characterized by an intrinsic religious orientation
(IO) demonstrated less reactivity than did those characterized by an extrinsic religious orientation. Gender did not influence reactivity. There was some evidence
that the effect of religious orientation is more pronounced for interpersonal than
cognitive-type stressors, although the strongest findings were evident when stressors
were aggregated. The magnitude of these effects suggests that they are of practical
significance. Given these results and the known relationship between reactivity and
hypertension, it is proposed that IO may result in decreased risk of developing hypertension in older adults.
Keywords: religion; religious orientation; reactivity; aging; intrinsic
The relationship between religiosity and health has been the subject of
increased interest among health researchers in recent years as demonstrated by this special issue and by the number of other respected scientific journals that recently published special issues on this topic or presented a series of articles on it (e.g., American Psychologist, Annals of
Behavioral Medicine, Health Education & Behavior, Journal of Health
RESEARCH ON AGING, Vol. 27 No. 2, March 2005 221-240
DOI: 10.1177/0164027504270678
2005 Sage Publications
221
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RESEARCH ON AGING
Psychology, Psychological Inquiry). (Religiosity will be used interchangeably with spirituality or religiousness. Use of these terms has
been discussed elsewhere [Hill and Pargament 2003; Miller and
Thoresen 2003; Thoresen 1999].) It has been argued on the basis of a
variety of empirical studies that something beneficial related to health
and well-being is associated with religion. What is not understood,
and barely studied, are particular aspects of religiosity that relate to
specific indicators of health or disease. Authors recently suggested
that religiosity and health research move away from general measures
that have dominated the field, such as church attendance or denominational affiliation, and move toward more conceptually grounded
measures (Hill and Pargament 2003; Powell, Shahabi, and Thoresen
2003). Hill and Pargament (2003) noted that the commonly used
indexes underestimate the complexity of religion and overlook the
possibility that something inherent within religious experience influences health.
Although they have not been adequately studied, several pathways
connecting religion and health have been proposed (George, Ellison,
and Larson 2002). Of importance to this article are the effects of belief
systems or forms of religious orientation on psychological and physical functioning (George et al. 2002; Hill and Butler 1995; Levin and
Vanderpool 1991; McIntosh 1995; McIntosh and Spilka 1990).
George and colleagues (2002) suggested that religious orientation has
been understudied with respect to health. Nevertheless, previous studies reviewed by Donahue (1985) and Masters and Bergin (1992) indicate this may be a fertile area of inquiry because the intrinsic religious
orientation (IO) has been found to consistently relate to better mental
health (e.g., lower anxiety, lower depression, greater tolerance and
self-control), whereas extrinsic religious orientation (EO) relates to
poorer psychological functioning.
AUTHORS NOTE: This research was supported in part by grant 1 R03 AG 18554-01
awarded by the National Institute on Aging. We thank Timothy W. Smith, James A. Blumenthal,
Carl E. Thoresen, Edward M. Heath, and Jennifer A. Fallon for their assistance. Correspondence
concerning this article should be directed to Kevin S. Masters, Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244; phone: (315) 443-3666; fax: (315)
443-4085; e-mail: kemaster@syr.edu.
Masters et al. / RELIGIOUS ORIENTATION
223
RELIGIOUS ORIENTATION
IO and EO were conceptualized by Allport and Ross (1967) based

on the assumption that church attenders are not a homogeneous group.
They defined IO as characteristic of individuals who view religion
itself as an end or master motive. These individuals embrace a religious creed, internalize it, and attempt to follow it. Other needs are
less important and are, therefore, met only to the degree that they correspond with the central religious beliefs. Attendance at church for
those characterized by IO may be thought of as motivated by desire for
spiritual growth. EO, on the other hand, is characterized by individuals who use their religion to serve utilitarian purposes such as enhancing their security or status, providing self-justification for actions, or
promoting social or political aims. Their church attendance is less
motivated by a desire for spiritual growth and more influenced by
other factors.
Although Allport and Rosss formulation is less than 40 years old,
the basic concept that religious involvement may be fueled by intrinsic or extrinsic motives is prominent throughout history. For example,
the Book of Job tells that Job is accused by his adversary as being a
believer who will lose faith if he does not maintain the rewards to
which he is accustomed. Job is accused of possessing EO. William
James (1902) similarly discussed the concepts of firsthand direct religion versus secondhand institutional religion.
A major aspect of religiosity for those who are characterized by IO
is that religions provide a coherent and comprehensive worldview that
provides meaning in life (Ellison 1991; Hill and Pargament 2003) and
a way to understand, or even construct beneficial explanations for,
lifes potentially stressful circumstances. For example, religions teach
that despite whatever challenges may be presently faced, God is
benevolent and will provide peace or a way of coping in this life and
reward in the next. Someone abiding by these principles, aspects of
IO, would seemingly be less likely to respond to a variety of stressors
with arousal or anger. This is not assumed for EO, however, which is a
less principled approach to religiosity and lacks guidance for coping
stressful encounters.
Prominent within religions are teachings specifically regarding
proper attitudes and conduct in interpersonal situations. Williams
(1989) noted that the worlds prominent religions instruct regarding
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RESEARCH ON AGING
the value of service, hope, trust, and kindness toward others. Incorporation of these characteristics into ones cognitive schema and behavioral response style is likely to result in less stress and arousal in a
number of situations, most prominently those that are interpersonal in
nature, as compared to adoption of characteristics that religions typically denounce or try to limit such as cynicism, self-absorption, and
basic mistrust of others. Similarly, Hill and Pargament (2003) noted
that the worlds great religions emphasize both the Golden Rule and
the value of human relationships. In fact, these relationships may be
seen as a metaphor for ones relationship with God (Buber 1970).
Those intrinsically devoted to their religious creed should, therefore,
be more committed to their relationship with God and to behaving in
accord with Gods instruction regarding the values associated with
interacting with other humans than would those characterized by EO.
In fact, EO-type individuals may view relations with others through a
utilitarian prism that may increase the stressful properties of such relationships. The Christian principle of love thy neighbor is relevant.
Consequently, given the religious emphasis placed on achieving and
maintaining loving and kind relationships, it follows that those who
incorporate these edicts into their lives will experience less interpersonal stress, and this reduced stress will be manifest in many ways,
including decreased psychophysiological indicators of stress
response.
RELIGION, HYPERTENSION, AND REACTIVITY
A particular area of interest for religion and health research generally, and for studies of psychophysiological reactivity in particular,
pertains to how religion may influence the development and course of
hypertension; a significant health concern in the United States. Recent
figures suggest that hypertension afflicts 50 million Americans (Izzo,
Levy, and Black 2000). Because blood pressure (BP) steadily
increases with age, the risk of developing clinically significant hypertension is more pronounced among older adults. Interestingly, several
investigators (Hixson, Gruchow, and Morgan 1998; Koenig et al.
1998; Levin and Vanderpool 1989; Seeman, Dubin, and Seeman
2003) report the intriguing possibility of a protective effect of religion
such that individuals demonstrating higher levels of religiosity are apt
to have lower measures of BP. Of particular interest, Hixson and col-
225
leagues (1998) and Nelson (1989) suggested that IO may be a significant factor accounting for the beneficial influence of religion on BP.
Presently, between 80% and 90% of cases of hypertension have no
known cause, although many theories are being advanced (Gibbons
1998). Psychological factors and the sympathetic nervous system
have long been suspected as playing key roles in at least some of these
cases. For many years, investigators hypothesized that chronic, exaggerated psychophysiological reactivity to stress has a connection with
hypertension. Psychophysiological reactivity is typically defined as
the change from baseline on a physiological measure that occurs in
response to the presentation of a stressor stimulus. The most commonly investigated physiological variables in reactivity studies related
to hypertension are BP and heart rate (HR), although a number of
other relevant variables have been examined (e.g., sodium and potassium excretion; aspects of renal hemodynamics; renin, catecholamine, and cortisol levels), and studies using impedance cardiography
have supplied evidence for the presence of different hemodynamic
(e.g., increased peripheral resistance versus increased HR) response
patterns to reactive stimuli based on ethnicity, type of stimulus, coping activities, and other variables. Various stimuli have also been used
to induce reactivity in laboratory studies. Recent writers have focused
on the particular importance of interpersonal stressors (Linden, Gerin,
and Davidson 2003; Waldstein et al. 1998) as well as the need for multiple stressors within studies (Kamarck and Lovallo 2003; Kamarck
et al. 1992; Schwartz et al. 2003). In the strong form, heightened reactivity is hypothesized to be causally linked with hypertension, whereas in the milder form, exaggerated reactivity is limited to the role of
marker for hypertension risk (Gerin et al. 2000). Debate regarding the
adequacy of the evidence for a causal link between reactivity and
hypertension continues (Gerin et al. 2000; Linden et al. 2003; Lovallo
and Gerin 2003; Schwartz et al. 2003); however, support for the predictor model has solidified (Treiber et al. 2003). Even if it is eventually demonstrated that reactivity is not causally related to hypertension, its status as a marker of future risk has importance and clinical
usefulness in studying disease processes.
Older adults are not only more likely to develop hypertension but
are also characterized as generally more religious than their younger
counterparts (Koenig 1997). Consequently, investigation of the specific nature of the relationship between religion and hypertension
226
RESEARCH ON AGING
among older adults is particularly important. Furthermore, older

adults are underrepresented in reactivity studies (Uchino et al. 1999;
Vitaliano et al. 1993) in general, and there are no studies of the effects
of religiosity on reactivity in this population. Adding to the importance of studying reactivity in older adults are findings indicating possible age-related differences in reactivity profiles. For example, it has
been documented that older individuals tend to demonstrate smaller
HR increases in response to psychological stress but show greater BP,
particularly systolic BP (SBP), reactivity (Folkow and Svanborg 1993;
McNeilly and Anderson 1996; Uchino et al. 1999; Uchino, KiecoltGlaser, and Cacioppo 1992). Perhaps of even more importance is the
observation of variability within the older population (Folkow and
Svanborg 1993; Uchino et al 1999). Jennings and colleagues (1997),
for example, in a study of reactivity among middle-aged men concluded that individual differences (e.g., personality traits, social factors) were likely to play a major role in determining reactivity. Over
the course of many years, the effects of variables that influence cardiovascular response to stress are likely enhanced, producing either more
or less favorable reactivity profiles among aging individuals. Consequently, religious orientation constitutes a promising construct for
evaluating religiosity and reactivity in this population.
Finally, the influence of gender on reactivity as it reacts with religious orientation is of interest. Women are recognized as generally
being more religious than men, and there have been suggestions of
gender differences in reactivity among older people. For example,
Seeman and colleagues (2001) found that older women demonstrated
greater hypothalamic-pituitary-adrenal (HPA) response to challenge,
as measured by salivary cortisol, when compared with older men.
Vitaliano et al. (1993) found increased BP reactivity for older women
compared with older men but only in response to an emotional task (5
minutes speaking about current relationship with spouse) and not to a
cognitive stressor. Uchino and colleagues (1999) found no differences
on measures of reactivity to a speech and math stressor between men
and women who ranged in age from 30 to 70 years. They noted that
few studies have compared older adult men and women within the
same sample. Given the greater religiosity among women and unclear
patterns of reactivity noted in previous studies, it is not known if and
how gender will influence reactivity when considered along with
religious orientation.
227
STUDY PURPOSE
This study was designed to determine the influence of religious orientation, separately and crossed with gender, on cardiovascular reactivity to laboratory stressors in a sample of older adults. It was hypothesized that individuals characterized by IO would demonstrate less
aggregated reactivity than EO participants. No specific hypotheses
were developed regarding the interaction of gender and religious orientation because this has not been previously tested, and theoretical
arguments could be advanced for either more or less reactivity.
Because type of stressor has proven to be an important variable in past
reactivity research (Kamarck and Lovallo 2003; Waldstein et al. 1998)
and because religious teachings and values may have more salience
for interpersonal or confrontational interactions than for less personal
stressors, exploratory analyses investigating the influence of religious
orientation on different types of stressors were conducted. It was
hypothesized that IO participants would demonstrate less reactivity to
the interpersonal situation than EO participants and that there would
be no differences on the cognitive task.
Method
RECRUITMENT
Participants were self-selected in response to advertisements in

local newspapers and on television programs that announced a study
of religion and stress. Targeted recruitment was also conducted via
announcements to seniors groups. For inclusion, individuals were
required to be between the ages of 60 and 80 years. Individuals were
further screened for depression (Geriatric Depression ScaleShort
Form [Yesavage et al. 1983] inclusion cutoff score > 5), dementia
(Mini-Mental State Examination [Folstein, Folstein, and McHugh
1975] inclusion cutoff score < 24), and recent history (past 5 years) of
myocardial infarction or cerebrovascular accident. Those exhibiting
any of these conditions were excluded from the study. Individuals still
qualified underwent a final screening wherein they completed the
Religious Orientation Scale (ROS) to determine if they met classification criteria for either IO or EO.
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RESEARCH ON AGING
The ROS measures religious orientation using 20 items divided

between two scales (i.e., intrinsic and extrinsic). A prototypic intrinsic
item is My religious beliefs are what really lie behind my whole
approach to life, whereas a representative extrinsic item is The
church is most important as a place to formulate good social relationships. The ROS is the most widely used measure in the empirical
study of religion and has been the subject of much discussion (Kirkpatrick and Hood 1990, 1991; Masters 1991). Donahue (1985) conducted a comprehensive review and meta-analysis and concluded that
the ROS provides a powerful instrument to resolve controversies surrounding religion and mental health. Burris (1999) ended his review
of the ROS by concluding that the research on its theoretical basis and
psychometric properties was generally supportive (p. 150). Internal
consistency estimates for the intrinsic scale are typically in the mid
.80s and for the extrinsic scale are in the .70s. Two-week test-retest
reliabilities of .84 and .78 for intrinsic and extrinsic have been
reported (Burris 1999). Consistent with Donahues (1985) recommendation for use of the scale to obtain distinct types and maintain
consistency across samples, participants had to score either above 27
on the intrinsic scale and below 33 on the extrinsic scale (the respective theoretical midpoints) to qualify as demonstrating IO, or they had
to score below 27 on the intrinsic scale and above 33 on the extrinsic
scale to qualify as exhibiting EO.
PROCEDURES
Baseline. Qualified individuals were scheduled for an appointment

at the psychophysiology laboratory at one of two western U.S. universities where they individually participated in the experiment. They
were instructed to abstain from caffeine (coffee, tea, and colas) for 12
hours and refrain from cigarette smoking for 1 hour prior to their
appointment. Upon arrival, all participants were greeted by a research
assistant, completed institutional review board approved written
informed consent statements, and identified the most important person in their lives (e.g., grandchild, boy/girl friend, etc.). A finger cuff
for recording continuous BP was then attached to the middle phalanx
of the middle finger of their nondominant hand. The nondominant
lower arm was positioned at heart level and held stationary on a supportive table throughout the experiment. Subsequently, participants
229
entered a 10-minute baseline period in which they completed a minimally involving activity (i.e., reviewing National Geographic magazines and choosing their favorite story).
Reactivity manipulations. The first of two reactivity tasks was then
introduced. Order of presentation of the two tasks was counterbalanced, and all participants completed both tasks, that is, a cognitive
stressor task (mental arithmetic) and interpersonal challenge (role
play). The effect of verbal behavior was controlled by having participants speak continuously for equal time intervals on both tasks.
The mental arithmetic challenge required participants to perform
serial subtractions of 13 and additions of 7 (starting at 600) aloud for
180 seconds. Participants were instructed to work as quickly as they
could without making mistakes. During the trial, participants were left
alone in the lab (reducing the immediate interpersonal element in the
stressor) but informed that their performance was being recorded on a
cassette tape sitting visibly nearby.
The interpersonal challenge required participants to role-play confrontation with an insurance adjuster who had just denied payment for
a medically necessary intervention (bone marrow transplantation) for
the person they had earlier identified as most important to them. They
were told that the insurance coverage was denied because of the
expense and scarcity of local providers who were authorized by the
insurance company to perform the procedure even though competent
and experienced physicians capable of performing it practiced nearby.
Participants were instructed to take 5 minutes to prepare their
response (180 seconds) to be given in front of the research assistant
and a small audience consisting of three experimental assistants
(increasing the salience of the interpersonal nature of the task). After
the first task, participants entered a second 10-minute baseline period
identical to the first before being introduced to the second reactivity
task. At the conclusion of the second reactivity task, the participants
were paid $30 and thanked for their cooperation.
MEASURES
Physiological. Recordings of BP and HR were monitored during

baseline and experimental periods using a procedure adapted from
Smith and colleagues (1997). A 2300 Finapres portable Blood Pres-
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RESEARCH ON AGING
sure Monitor (Ohmeda, Englewood, CA) provided the measures. Previous studies have documented the reliability and validity of HR as
well as SBP and diastolic BP (DBP) reactivity assessments using the
Finapres (Parati et al. 1989; Podlesny and Kircher 1999), and it has
been used in a number of previous reactivity studies.
Baseline physiological functioning was determined by averaging
readings of BP and HR collected at 15-second intervals throughout
the last three minutes of the baseline period prior to presentation of
each stressor. Thus, a single mean baseline measure was recorded for
each participant prior to exposure to each stressor condition. Measures of BP and HR were collected at 15-second intervals during the
three minutes of exposure to the stressor situations as well. These
observations were then averaged to produce mean SBP, DBP, and HR
for each stressor.
Covariates. Previous research suggests a number of variables that
may influence reactivity. Although it is not possible to control all of
them in any one study, we collected measures of education level, adequacy of social contacts (rated from inadequate to adequate), trait
anger (State-Trait Anger Expression Inventory2 [STAXI-2]; Spielberger 1999), and physical activity (CAPS Typical Week Physical
Activity Survey [CAPS]; Ainsworth et al. 2000) to use as covariates.
There is evidence that each of these variables may influence reactivity.
For complete psychometric information on the STAXI-2 and CAPS,
readers are referred to the original references.
DATA ANALYSIS
Consistent with recommendations about the choice of reactivity

indexes (Llabre et al. 1991) and publications in this field (Smith et al.
1997), mental arithmetic minus baseline and role play minus baseline
change scores were calculated for each dependent measure. These
scores were then aggregated in accord with the literature for improving the reliability of laboratory reactivity measures (Gerin et al. 2000;
Kamarck et al. 1992; Schwartz et al. 2003). Aggregated physiological
change scores were analyzed in a 2 (religious orientation) 2 (gender)
analysis of covariance (ANCOVA), where measures of education
level, adequacy of social contacts, trait anger, and total met minutes of
weekly physical activity served as covariates. Subsequent exploratory
231
TABLE 1
Mean and Standard Deviation Blood Pressure and Heart Rate Reactivity
Change Scores Aggregated Across Stressors
SBP
All IO (n = 37)
All EO (n = 38)
All female (n = 36)
All male (n = 39)
DBP
HR
SD
SD
SD
18.914
32.174
26.729
24.421
20.343
18.584
16.996
23.466
11.341
17.176
15.310
13.262
8.857
10.464
8.851
11.121
7.671
5.540
6.521
6.686
9.451
5.827
7.690
8.140
NOTE: SBP = systolic blood pressure; DBP = diastolic blood pressure; HR = heart rate; IO = intrinsic religious orientation; EO = extrinsic religious orientation.
calculations used the same analytic strategy with stressor type added
as a within-subjects independent variable. Standardized effect sizes
were also estimated to assess the magnitude of significant effects.
Results
PARTICIPANTS
The final sample consisted of 75 older adults (48% female, 95%

European American) divided equally between IO (n = 37 ) and EO
(n = 38) groups. Men and women distributed evenly among religious
orientation groups. The sample averaged 71.65 years of age, had a
mean income of $44,148 per year (median = $40,000), and approximately half possessed a four-year college degree. Half of the women
were taking some form of hormone replacement medication, and they
were distributed equally among religious orientation groups.
REACTIVITY OUTCOMES
Mean aggregate change scores for SBP, DBP, and HR are displayed
in Table 1.
SBP. The 2 2 ANCOVA calculated on SBP revealed a significant
main effect for religious orientation, F(1, 66) = 7.57, p < .01. The IO
group demonstrated less SBP reactivity than the EO group. The interaction was not significant and neither was the main effect of gender.
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RESEARCH ON AGING
DBP. For DBP, the 2 2 ANCOVA again revealed a significant

main effect for religious orientation, F(1, 66) = 5.44, p < .05. As with
SBP, the IO group demonstrated dampened reactivity relative to the
EO group. The interaction and main effect of gender were not
significant.
HR. The data for HR do not follow the trend for BP. The 2 2
ANCOVA was not significant, although the main effect of religious
orientation approached the traditional cutoff (p = .10). In this case,
however, it is the EO group that demonstrated marginally lower
reactivity.
Clinical significance. The following analyses shed light on the
extent that the statistically significant findings described above are of
sufficient magnitude to be practically meaningful. One method used
to make such estimates is to calculate an effect size statistic using the
standardized mean difference; d = (M1 M2) /SD pooled. This provides an
estimate of the magnitude of the effect independent of sample size.
Cohen (1992) developed guidelines for interpreting these effects in
behavioral research. The effect sizes for the comparisons between IO
and EO for SBP and DBP are .68 and .61, respectively. According to
Cohens (1992) system, these are in the medium size range.
EXPLORATORY ANALYSES
Because it was tentatively hypothesized that the salient aspects of

IO would be more influential in interpersonally stressful situations
and because previous research has documented the importance of type
of stressor, particularly social stressors (Kamarck and Lovallo 2003;
Larkin et al. 1998; Linden, Rutledge, and Con 1998; Waldstein et al.
1998), in reactivity research, exploratory analyses (ANCOVA) identical to those above, except for the inclusion of stressor type as a withinsubjects variable, were conducted. None of the interaction terms that
included stressor type were significant, although the Stressor Type
Religious Orientation interaction approached significance (p = .07)
for SBP. Subsequent exploratory analyses showed that IO and EO differed significantly during the role play (p < .01), with IO demonstrating reduced reactivity, but not during the mental arithmetic. The effect
size of this significant difference was d = .66, a medium effect.
233
Discussion
This study showed that older adults who vary in their religious orientation demonstrate significantly different BP reactivity to aggregated laboratory stressors. The differences remained when the effects
of education level, perceived adequacy of social contacts, trait anger,
and weekly physical activity were statistically controlled. Specifically, older participants characterized by IO displayed reduced BP
reactivity, both SBP and DBP, when compared with EO individuals.
Furthermore, the magnitude of these differences suggests they are
clinically meaningful, particularly if they are generally characteristic
of the individuals typical functioning. The effect sizes found here are
larger than those for many established cardiovascular disease risk factors, including lack of exercise, Body Mass Index, and waist:hip ratio
(Rutledge and Loh 2004).
The BP reactivity differences underscore the importance of studying individual-difference variables within the older population.
Although aging results in predictable patterns of change in cardiovascular and other body systems, these changes are not invariant in terms
of rate or type. Identification of factors that influence the process of
physical change experienced by individuals as they age is important.
This study suggests that religious orientation is one such variable, and
it should be added to a small but growing database of research on psychologically relevant individual-difference variables that influence
cardiovascular reactivity among older persons (Uchino et al. 1999). It
was also noted in the exploratory analyses that although there was
some support for the specificity of IO with regard to type of stressor,
the bulk of the evidence herein suggests that religious orientation is
influential across stressors.
Although it is true that religious creeds specifically teach the
importance of relationships with others based on kindness and love,
they also offer general suggestions of comfort in all of lifes circumstances based on the premise that a God sympathetic to the challenges
encountered by believers will ease their pain and angst. Ultimately for
the religious mind, transcendence of the material world will bring
about lasting peace. Those who internalize these tenets of faith (IO)
may be predisposed to generally see the world as less threatening and
more psychologically safe. This may be exhibited in an overall
dampening of stress reactivity.
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RESEARCH ON AGING
Another possible, perhaps complementary, explanation for the

reduced reactivity of IO individuals could lie in the strength that
comes from adopting a coherent and comprehensive worldview that
has explanatory power and provides meaning to life (Ellison 1991;
Hill and Pargament 2003). Antonovsky (1979) referred to this as a
sense of coherence, and Ryan, Rigby, and King (1993) termed it identification; a form of religious internalization. Ellison (1991), investigating the related concept of existential certainty, found that this construct mediated the relationship between church attendance and
psychological well-being. Intrinsic religiosity may offer one pathway
to a meaningful worldview and/or existential certainty. This is not
meant to imply that IO, or any religious construct for that matter, provides the only path to meaning in life (cf. Masters, Ives, and Shearer
1997; Ross 1990). Yet, particularly toward the end of life, having a
sense of a firmly held religious worldview may prove comforting in
the face of daily hassles or larger life stresses.
Findings regarding HR did not conform to the patterns found for
BP. Religious orientation did not have a significant effect, but the
trend in the data was in the opposite direction, that is, lower HR reactivity for the EO group. Considering the hemodynamic pattern of all
three cardiovascular measures, it is clear that the differentially
increased BP reactivity experienced by those in the EO condition was
not due to differentially increased HR and is therefore due to either
increased stroke volume, greater vascular peripheral resistance, or
both. Given what is known about functioning of the autonomic nervous system during stressful encounters and the effects of aging on the
vasculature (Folkow and Svanborg 1993; McNeilly and Anderson
1996), it seems likely that peripheral resistance was at least a contributor to the greater BP reactivity for the EO participants. More important, it is believed that the general age-related increase in BP found in
Western societies is largely the result of stiffening arterioles and other
factors that result in increased peripheral resistance (Gibbons 1998;
Lakatta 1990) rather then being due to increased cardiac output. The
pattern of reactivity demonstrated by the EO participants is consistent
with what has been termed a vascular response, that is, a response
mediated by alpha-adrenergic activity that is characterized by restriction in the periphery (Kline et al. 2002; Saab and Schneiderman
1995). This pattern, in turn, has been implicated as more likely to predict increased BP and a variety of other negative outcomes (e.g., vas-
235
cular endothelial dysfunction, left-ventricular hypertrophy) than has

the beta-adrenergic response that seems more characteristic of the
IO participants. The beta-adrenergic response is associated with
increases in myocardial activity but not by increased circulatory resistance. If true, this indicates that older adults who demonstrate EO also
demonstrate a pattern of reactivity that is generally considered to
more strongly predict subsequent pathologic end points. Speculation
regarding the patterns of reactivity as they relate to religious orientation needs investigation through direct examination via impedance
cardiography techniques. Simple BP and HR data cannot confirm
these hunches, although they provide an intriguing beginning.
Similar to what has been found in at least some of the limited
research with older adults, there were no findings of differences in
reactivity based on gender. Because a variety of factors, including
small sample size, can produce null findings, effect sizes were calculated for comparisons that included gender. None of these reached the
level of a small effect, that is, d = .20. Thus, among older adults, it
appears that neither gender alone nor gender in combination with religious orientation influences reactivity to stress. Nevertheless, given
previous findings on the effects of menopause on reactivity (Farag
et al. 2003) and the fact that few studies have considered gender
among older adults in a reactivity paradigm, it is too soon to rule out
gender as a variable. Furthermore, pertaining to reactivity and religiosity, the present investigation is the only study yet conducted on an
older sample, and it is known that male-female differences exist in
religious commitment and experience. Thus, until a substantial database has developed that includes studies incorporating a variety of
types of psychological stressors (cf. Vitaliano et al. 1993), researchers
are encouraged to continue investigating effects of gender in reactivity studies with older adults.
There are several limitations of this study. A significant one that
directly suggests possibilities for future research is the lack of measurement of variables that, as indicated in the discussion, may mediate
the religious orientation-reactivity relationship. For instance, there
were no measures of sense of coherence or purpose in life. Follow-up
studies of these and other possible mediators is indicated. Similarly,
only some of the many potentially important confounding variables
were assessed and statistically controlled. Reactivity research has
grown in many directions, and it is not possible to control all potential
236
RESEARCH ON AGING
confounds in one study. The effects seen in this study could potentially vanish if controls for other variables were implemented. It
should be noted, however, that the interpretive significance of covariate effects depends on the theoretical and practical issues involved
with the particular variables in the context of the particular study.
Another limitation of the present study is that the stability and ecological validity of the findings remain unknown. This study establishes
religious orientation as a variable to be considered in reactivity assessments, but the extent to which these laboratory-based results concur
with those obtained by ambulatory measures in the field awaits further
investigation. The relation between these findings and actual health
outcomes is also not known.
This study included only two of the four possible religious orientation types that may be obtained with the ROS (IO; EO; nonreligious
low scores on both scales; indiscriminately pro-religioushigh scores
on both scales), and religious orientation is only one of the many ways
of conceptualizing and specifying the broad phenomenon of religiosity. Studies using all four types and studies incorporating other religious constructs into reactivity investigations are indicated. Finally,
there has been debate about the precise nature of the IO and EO constructs. In keeping with the previous recommendation, some investigators may want to measure finer aspects of these orientations to see if
IO and EO may be further divided in ways that are useful in terms of
how they relate with psychophysiological reactivity to varying stressful stimuli. For example, some may want to study the personal (Ep)
and social (Es) dimensions of extrinsic religiosity proposed by Kirkpatrick (1989) and determine if these predict reactivity differently
depending on the stressor involved. Nevertheless, given these results
and those of previous studies, it seems that the molar concept of religious orientation remains worthy of further investigation in its own
right.
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Tera L. Lensegrav-Benson received her M.S. from Utah State University where she is
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John C. Kircher received his Ph.D in experimental psychology from the University of
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Robert D. Hill is a professor and chair of the Department of Educational Psychology
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areas of interest include health psychology, life span development, and aging.

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