Scientists and theologians agree that faith organizations can have a considerable impact on society and its members. Churches, mosques, temples, and other places of worship are among the oldest organizations in communities and are often recognized for their traditions of hope and healing.1,2 These organizations have represented viable settings of services to underserved and hard-to-reach populations because of their well-earned community trust as well as their dense and extensive social networks. Since the turn of the 21st century, faith organizations have been identified as those that can provide services to an increasing number of individuals struggling to care for themselves and their loved ones during an era of financial crises and small government. It was also during this time that a growing number of health scientists and public health care practitioners have begun to work with faith institutions in health promotion and disease prevention efforts designed to improve the health of "vulnerable" populations and reduce disparities in health between those of means and those who lie beyond the margins of societal care and concern. The emergence of these efforts has sparked interests in examining the relationship between faith and health. "Faith" like "health" is a concept with multiple descriptions and applications, making it difficult to specify elements of successful collaboration between scientific and spiritual institutions.
The scientific literature has grown in recent years to include articles that highlight the diversity of faith-influenced programs and their potential impact for individuals and their communities. Given the maturity of this line of research, we drafted a call for papers to provide scholars with an opportunity to build upon the existing foundation and expand the discourse associated with exploring the relationship between faith and health. The response to our call was significant as we gained an appreciation of the degree to which faith-influenced health programs have expanded to faiths outside of the mainstream and into different regions around the world. We received many noteworthy submissions; because of space limitations, we were forced to make difficult decisions about which papers to include in this special issue of Family & Community Health. We thank all authors for submitting their work for consideration.
The articles included in this issue represent state of the science in familiar and new areas of inquiry. Faith leaders are the focus of the first 3 articles in this issue. Bopp and colleagues provide an overview of studies examining health, behaviors, and the well-being of clergy and underscore the role of clergy in the delivery of health promotion interventions. The authors conclude their article by providing recommendations for improving clergy health and involving clergy in health promotion activities. The article by Gwin and colleagues reports results from a study designed to specify predictors of physical activity among clergy in Oklahoma. The sample population is of note because the clergy in the study were almost exclusively white, college-educated, and obese. The results indicate that clergy in this study were much like the general population, and behavioral intention, behavioral attitudes, subjective norms, and perceived behavioral control were found to be major predictors of participation in physical activity. An article by Baruth and coauthors is the third article under the "faith leaders" theme. In their article, the authors report findings from an analysis examining links between pastor support and program-related variables in churches that were part of a larger intervention study. Pastor support was found to have a positive relationship with meeting recruitment goals and meeting study requirements. The authors also note that the departure of a pastor can adversely affect health promotion efforts, as pastor turnover was found to have a negative correlation with the likelihood of church members completing posttest assessments. Clergy are often approached for access to individuals under their leadership; however, these 3 articles demonstrate that the health status and the support level of faith leaders can have considerable implications for the success of health promotion efforts within faith organizations.
The remaining articles in this issue are categorized by health outcomes. Cancer prevention is the focus of articles written by Lumpkins and colleagues and Saunders and colleagues. Both sets of authors emphasize cancer risk prevention and use a community-based participatory research strategy for intervention development. Lumpkins and colleagues present results from a study examining the church's role as a social marketer and health promoter of colorectal cancer risk and prevention messages. The authors show that pastors of churches in the study acknowledged the importance of cancer as a health issue, without specific knowledge of colorectal cancer. These pastors also felt that congregants had limited knowledge about colorectal cancer risk and prevention and that the church could improve efforts to communicate about these issues. The article by Saunders and colleagues describes the development of a spiritually based intervention to increase informed decision making for prostate cancer screening through African American churches. The authors' discussion of formative research associated with their project underscores the commitment needed to adopt and follow community-based participatory research principles during intervention development. According to the authors, time was critical for allowing the investigator-community partnership to grow and mature. The churches evolved from participants to co-owners of the study, and this evolution has resulted in a culturally competent and theory-informed intervention ready to be assessed in an activated population. Both of these studies highlight the need for community-oriented health scientists and practitioners to meet partners where they are and demystify diseases such as cancer before launching intervention studies.
The articles led by Condrasky and colleagues and Boutain and colleagues have obesity-related themes. Condrasky and colleagues report results from a church-based intervention study designed to increase fruit and vegetable consumption. The authors present an analysis of data from baseline to 15 months and show that participants with greater waist circumference, greater baseline consumption, greater leisure time physical activity, more social support, more church attendance, obesity, and no baseline diabetes had higher postintervention changes in fruit and vegetable intake. The article by Boutain and colleagues documented changes implemented by 6 faith-based organizations attempting to prevent childhood obesity and showed the easiest/earliest changes to make were environmental changes, followed by policy and systems changes. These articles underscore the potential for church-based intervention studies to have a positive impact on weight-related behaviors, as well as church policies that can serve as facilitators or barriers to weight-related behaviors, and to play an important role in impacting the obesity epidemic.
The final 2 articles in this issue have controversial themes in some faith-based organizations: HIV/AIDS prevention and sexual health promotion. Pichon and colleagues present an analysis of survey and interview data from 29 African American faith leaders who participated in a 2-day workshop focusing on HIV/AIDS outreach, prevention, and education. The authors argue that the beliefs of African American faith leaders have evolved over the past 3 decades and demonstrate how education about HIV/AIDS can change beliefs about sexual health and the role of the church in HIV/AIDS prevention effort. Sexual health promotion is the primary focus of the article by Stewart and colleagues as they provide a theoretical exploration of social and church organizational factors associated with the relative silence within African American faith communities regarding sexual health issues. According to the authors, an understanding of how social factors such as racism or homophobia and organizational factors such as local autonomy can help scientists and practitioners design sexual health interventions that frames churches as places of hope and healing rather than judgment.
It is important to note our deliberate use of the term faith-influenced, as opposed to faith-based, in this Foreword. An important part of how the role of churches influences health is related to the faith tenets and biblical principles that are taught in churches. There is a distinction between faith-based and faith-placed research. Faith-based research incorporates tenets of the faith organization (eg, religious beliefs, scriptural references) and involves the faith organization in the planning of the research from beginning to end.3 Faith-placed research is developed outside the faith organization and simply carried out within the church but does not attempt to incorporate elements of the faith organization.3 Collaborative programs implemented in churches have the most potential for success, and programs that are not collaborative may limit program acceptability, sustainability, fidelity and, ultimately, program success. Lasater and colleagues4 identified 4 levels by which health-related programs are carried out in churches. Level I research uses the church only as a venue for participant recruitment. Level II research is delivered on-site at the church but generally does not include partnerships with churches. Level III research includes congregation members in research-related activities, and level IV research integrates spiritual elements, scriptures, and messages within research content. Lasater and colleagues argue that more research is needed on level III and IV programs to better maximize the strengths of both faith organizations and academic partners.
When we wrote the call for papers for this issue, it was our intent to identify papers that could help further broaden the understanding of the relationship between faith and health. We believe that the compilation of articles incorporates levels I to III as described by Lasater and colleagues and show that the future is bright for research examining the relationship between faith and health. Each article provides sound ideas and evidence for readers to consider. There remains considerable room for growth in this area of research and practice, particularly as it relates to incorporating faith tenets into research content and fully engaging the faith community as research partners rather than merely research participants so that research truly becomes faith-based rather than faith-placed or faith-influenced (Lasater's level IV). It is our hope that articles featured in this issue will stimulate thinking and motivate health scholars and advocates to consider health promotion projects in, and most importantly, with faith organizations.
-Marino A. Bruce, PhD, MSRC, MDiv, CRC
Jackson State University, Jackson, Mississippi
University of Mississippi Medical Center, Jackson, Mississippi
-Melicia C. Whitt-Glover, PhD, FACSM
Gramercy Research Group, Winston-Salem, North Carolina
Issue Editors
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