Organizational Religious Activity, Hypertension, and Sexual Orientation: Results From a Nationally Representative Sample

Organizational Religious Activity, Hypertension, and Sexual Orientation: Results From a... Abstract Background Hypertension is a major public health concern, given prevalence and morbidity. Among the general population, greater religious attendance is associated with lower blood pressure (BP). However, no known studies have examined the association between religious attendance and BP among sexual minorities. Purpose To examine the association between BP/hypertension and organizational religious activity as a function of sexual orientation. Methods Data were utilized from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a publicly available, U.S. nationally representative data set. Of the 4,874 individuals included in analyses, 366 participants were identified as a sexual minority. An organizational religious activity variable was created by summing responses of two separate items. BP was measured as systolic blood pressure (SBP) and diastolic blood pressure (DBP). Increasing levels of clinical severity of hypertension were also examined. Relevant covariates were controlled for in two separate models. Significant interactions between religious attendance and sexual orientation were explored in simple slope analyses. Results Overall, results indicated that sexual orientation moderated the association between organizational religious activity, and BP/hypertension. Crossover interactions were present for the dependent variables SBP, DBP, and prehypertension and higher (prehypertension, and hypertension 1 and 2). Generally, a negative association between organizational religious activity and hypertension was revealed among the heterosexual group, whereas a positive association was found among the sexual minority group. Conclusions Organizational religious activity is differentially associated with BP/hypertension among sexual minority versus heterosexual individuals. Organizational religious activity may represent a risk factor for hypertension among sexual minority individuals. Hypertension, Organizational religious attendance, Blood pressure, Sexual minority, Cardiovascular disease Introduction Hypertension (i.e., elevated blood pressure [BP]) is one of the most common preventable risk factors of morbidity and premature mortality globally [1]. For example, hypertension is strongly associated with cardiovascular disease (CVD), a condition responsible for nearly one third of all deaths per year [1]. Approximately 45% of deaths from CVD are due to elevated BP [1]; similarly, hypertension is responsible for 51% of deaths due to stroke [1]. As of 2017, the number of Americans with hypertension was approximately 85.7 million [2]. There are many hypothesized factors associated with hypertension, which include chronic stress as a risk factor and social support as a protective factor [3, 4]. These variables may play an important role in the context of religion and health. Religiosity, the degree to which individuals adhere to and value their religious beliefs, rituals, and traditions has generally been found to be positively associated with improved physical and mental health outcomes [5, 6]. Organizational religious activity, a subconstruct of religiosity, is often measured by participation in religious activities and events and has been shown to have some of the strongest associations with health outcomes [7]. Indeed, many studies have concluded that religious attendance is a protective factor from CVD and hypertension [6, 8, 9]; however, some findings may be moderated by demographic factors, particularly ethnicity [6, 10]. Theoretically, participation in religious activities may buffer individuals from CVD and hypertension by encouraging health behaviors (e.g., decreased substance use) [11] and providing social support [10] both of which subsequently reduce stress [6]. However, this noted health benefit of organizational religious activity may not be present among all individuals. One group that has been overlooked in the study of religiosity and health is sexual minorities (i.e., gay, lesbian, bisexual, or other nonheterosexually defined individuals). Sexual minorities disproportionally experience negative mental and physical health outcomes [12]. When examining hypertension, several studies have reported higher prevalence rates of CVD and hypertension among sexual minorities compared to heterosexual groups [13, 14]. Sexual minority health disparities are frequently explained by minority stress theory, which posits sexual minorities experience additional stress due to their stigmatized sexual orientation as compared to their heterosexual counterparts [15]. The sexual minority stress model further states that identity can play an important role, such that it can buffer the effects of stress through successful integration of many complex identities, or it can exacerbate the effects of stress through the inability to converge two or more perceived conflicting identities [15]. Minority stress often presents as discrimination, internalized stigma, sexual minority identity concealment, prejudice, and fear of rejection [15], which exacerbate general stress, resulting in poor health outcomes [16]. A paucity of research has been conducted examining differences between religious and nonreligious sexual minority individuals. One study found that when comparing religious, spiritual, and atheist sexual minority individuals, few to no differences were found in gender, age, race/ethnicity, or geographical location [17]. However, significant differences were found in levels of “outness” and internalized heterosexism, such that more religious individuals were less “out” and had greater levels of internalized heterosexism [17]. However, researchers have also discovered significant differences in health behaviors between religious and nonreligious sexual minorities. In a study examining the effect of religious climate on risk behaviors, sexual minority youth in religious climates that were more supportive of sexual minorities were less likely to abuse alcohol and have fewer sexual partners compared to sexual minority youth in religious climates that were less supportive [18]. Although research has begun to explore salient differences between religious and nonreligious sexual minority individuals, additional exploration is needed, particularly utilizing samples that are representative of all U.S. adults. Although previous research has examined the association between sexual orientation and hypertension, no known studies to date have assessed the association of organizational religious activity and hypertension among a sample of sexual minority individuals. Theoretically, it is plausible that organizational religious activity among sexual minorities displays an inverse association with hypertension. That is, in lieu of serving as a buffer for hypertension, organizational religious activity may be a risk factor among sexual minorities given most major world religions condemn same-sex relationships [19]. These embedded principles often lead to anti-gay attitudes in religious communities [20]. Thus, identifying as religious and a sexual minority may confer stress due to the perceived dissonance between these two identities [21]. The current study seeks to build upon previous studies by assessing the association between organizational religious activity, sexual orientation, and hypertension in a nationally representative sample. In addition, this study aims to examine potential demographic group differences between religious and nonreligious sexual minorities. It is hypothesized that sexual orientation will moderate the associations between organizational religious activity and BP/hypertension. Based on findings in prior literature, it is hypothesized that greater organizational religious activity will be associated with lower BP and decreased odds of hypertension among heterosexual individuals. Consistent with sexual minority stress theory, it is hypothesized that greater organizational religious activity will be associated with elevated BP and greater odds of hypertension among sexual minority individuals. Methods Participants and Procedures The current study utilized the publicly available version of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of U.S. adolescents followed into adulthood. Currently, there are four waves of data in Add Health. Wave I was conducted from 1994 to 1995 in 80 high schools and 52 middle schools in the USA. Schools were selected with an unequal probability of selection as a function of sampling stratification regarding school size, school type, region, urbanicity, and ethnicity [22]. Wave IV was conducted in 2008 and consisted of in-home interviews that included self-report survey data and biological data recorded by trained in-person interviewers [22]. Of the respondents from Wave I of the study, 92.5% were located for Wave IV, with an 80.3% response rate of the 92.5% located. Only Wave IV data were employed in the current study (N = 5,115). Total number of participants included in the current analytic sample is 4,874 (mean age = 29; standard deviation [SD] = 1.78 years). In total, 241 participants (4.7%) were excluded from analyses due to missing data. Measures Sexual orientation Sexual orientation was defined via responses to two items: sexual identity and sexual attraction. Sexual identity: “Please choose the description that best fits how you think about yourself.” Same sex attraction: “Have you ever had a romantic attraction to a male?” or “Have you ever had a romantic attraction to a female?” Participants were included in the sexual minority group for analyses if they either indicated a nonheterosexual identity through responses of “bisexual,” “mostly homosexual,” or “100% homosexual” to the sexual identity item, or same-sex attraction, a common approach in the sexual orientation health literature [23]. All other individuals were assigned to the heterosexual group. A binary variable was created to represent sexual orientation such that “heterosexual = 0” and “sexual minority = 1.” Hypertension Hypertension was assessed using BP measurements and hypertension clinical cutoff scores. BP was measured as systolic blood pressure (SBP) and diastolic blood pressure (DBP). Each was measured during in-home interviews by a trained interviewer via three 30-s interval readings, with scores equaling the average of the second and third reading. Additionally, several binary variables of hypertension were created, based on consensus criteria in the field [24]: normal (SBP < 120 and DBP < 80), prehypertension (SBP 120–139 or DBP 80–89), hypertension 1 (SBP 140–159 or DBP 90–99), and hypertension 2 (SBP ≥ 160 or DBP ≥ 100). Organizational religious activity An organizational religious activity scale was created using two items assessing religious behaviors. The first item measured religious attendance: “In the past 12 months, how often did you attend religious services?” The second item measured participation in religious activities: “Many churches, synagogues, and other places of worship have special activities outside of regular worship services-such as classes, retreats, small groups, or choir. In the past 12 months, how often have you taken part in such activities?” Responses ranged from “never = 0” to “more than once a week = 5” for both items. Scores on these two items were summed to create an organizational religious activity scale, with internal consistency of α = 0.70. An item similar to these has been included in the psychometrically validated scale the Duke University Religion Index under the organizational religious activity subscale [25] and items measuring religious attendance have a long history of use to measure organizational religious activity in the literature [7, 26, 27]. Relevant covariates Previous research has found significant associations between age, sex, race, socioeconomic status, health behaviors (e.g., smoking, alcohol use, physical activity), body mass index (BMI), and hypertension [13]. Thus, these variables were considered as possible covariates in our analytic models. Smoking and alcohol use were assessed with the following items: “During the past 30 days, on how many days did you smoke cigarettes?” and “During the past 30 days, on how many days did you drink?” Physical activity was derived from seven items assessing frequency of various activities over a 7-day period that increase heart rate, such as: “In the past seven days, how many times did you participate in individual sports such as running, wrestling, swimming, cross-country skiing, cycle racing, or martial arts?” These seven items were summed to create an overall physical activity frequency variable. BMI was calculated by the standard formula using height and weight measurements. Planned analyses Complex Samples within SPSS (v23) was employed to account for the weighting, clustering, and stratification inherent to Add Health. Outliers in the continuous outcome variables (SBP and DBP) were corrected for by transforming BP values greater than 3.3 SDs to the next highest value that was not an outlier [28]. Overall, 0.08% of the data were identified as outliers. Due to missing data, 241 participants were excluded from analyses. Associations between organizational religious activity, sexual orientation, and BP were examined in a series of progressive general linear and logistic regression models. Model 1 controlled for covariates (age, sex, and BMI) that proved significant in bivariate correlations with all possible covariates and SBP and DBP (p < .05). Model 2 controlled for all potential covariates (age, sex, race, BMI, smoking and alcohol use, socioeconomic status, physical activity). Two general linear regression models were conducted with SBP and DBP as the dependent variables. Three subsequent logistic regression models were conducted examining increasing levels of clinical severity in hypertension (prehypertension and higher, hypertension 1 and 2, and hypertension 2). In all five models, organizational religious activity and sexual orientation were entered as the independent variables, along with the organizational religious activity by sexual orientation interaction term. If significant interaction terms emerged, subsequent simple slope analyses were conducted, examining the association between organizational religious activity and the outcome within each level of sexual orientation. Unstandardized regression coefficients, standard errors (SEs), and 95% confidence intervals (CIs) are reported for the general linear regression models and odds ratios (ORs), SEs, and 95% CIs are reported for the logistic regression models. R2 and Nagelkerke pseudo R2 are reported for linear and logistic regression models, respectively. Additionally, to test within sexual minority group differences between religious and nonreligious participants on sociodemographic variables (level of education, neighborhood type, income, household type, and age), a binary variable was created to represent religious attendance; “0 = no religious attendance in the past 12 months” and “1 = attended religious services a few times or more in the past 12 months.” Results The overall sample was roughly evenly distributed by sex (female: 50.5%) and was predominately White (80.2%). The breakdown of hypertension levels is as follows: 1719 (32.7%) normal, 2340 (47.7%) prehypertension, 729 (15.8%) hypertension 1, and 195 (3.8%) hypertension 2. See Table 1 for additional demographics for the total sample and within sexual orientation subgroups. There were no significant demographic differences between nonreligious and religious sexual minority individuals. See Table 2 for statistical analyses of demographic differences between religious and nonreligious sexual minority individuals. Table 1 Sample Characteristics Variable Sexual minority N (% weighted) Heterosexual N (% weighted) Total N (% weighted) Sex  Female 263 (70.8%) 2,499 (47.9%) 2,762 (49.5%)  Male 103 (29.2%) 2,249 (52.1%) 2,352 (50.5%) Race  White 258 (81.1%) 3,413 (80.2%) 3,671 (80.2%)  Non-White 107 (18.9%) 1,331 (19.8%) 1,438 (19.8%) Hypertension levels  Normal 145 (40.4%) 1,574 (32.2%) 1,719 (32.7%)  Prehypertension 149 (42.4%) 2,191 (48.1%) 2,340 (47.7%)  Hypertension 1 47 (13.4%) 682 (16%) 729 (15.8%)  Hypertension 2 17 (3.8%) 178 (3.8%) 195 (3.8%) M (SD) Organizational Religious Activity Scale 1.43 (2.05) 2.38 (2.58) 2.26 (2.55) Religious attendance 1.06 (1.34) 1.69 (1.61) 1.65 (1.6) Religious activities 0.37 (0.962) 0.63 (1.23) 0.61 (1.21) Age (years) 28.68 (2.78) 29.03 (1.78) 29 (1.78) BMI 29.22 (11.75) 29.11 (7.44) 29.14 (7.49) Education 5.52 (2.46) 5.85 (2.42) 5.83 (2.42) Income 7.35 (2.84) 8.05 (2.55) 8 (2.58) Smoking 11.61 (13.79) 8.01 (12.61) 8.27 (12.73) Alcohol 2.35 (1.49) 2.3 (1.44) 2.3 (1.45) Physical Activity 6.75 (5.79) 6.35 (5.98) 6.38 (5.97) SBP 123.15 (15.05) 124.55 (13.51) 124.45 (13.56) DBP 78.28 (13.18) 79.09 (10.15) 79.05 (10.2) Variable Sexual minority N (% weighted) Heterosexual N (% weighted) Total N (% weighted) Sex  Female 263 (70.8%) 2,499 (47.9%) 2,762 (49.5%)  Male 103 (29.2%) 2,249 (52.1%) 2,352 (50.5%) Race  White 258 (81.1%) 3,413 (80.2%) 3,671 (80.2%)  Non-White 107 (18.9%) 1,331 (19.8%) 1,438 (19.8%) Hypertension levels  Normal 145 (40.4%) 1,574 (32.2%) 1,719 (32.7%)  Prehypertension 149 (42.4%) 2,191 (48.1%) 2,340 (47.7%)  Hypertension 1 47 (13.4%) 682 (16%) 729 (15.8%)  Hypertension 2 17 (3.8%) 178 (3.8%) 195 (3.8%) M (SD) Organizational Religious Activity Scale 1.43 (2.05) 2.38 (2.58) 2.26 (2.55) Religious attendance 1.06 (1.34) 1.69 (1.61) 1.65 (1.6) Religious activities 0.37 (0.962) 0.63 (1.23) 0.61 (1.21) Age (years) 28.68 (2.78) 29.03 (1.78) 29 (1.78) BMI 29.22 (11.75) 29.11 (7.44) 29.14 (7.49) Education 5.52 (2.46) 5.85 (2.42) 5.83 (2.42) Income 7.35 (2.84) 8.05 (2.55) 8 (2.58) Smoking 11.61 (13.79) 8.01 (12.61) 8.27 (12.73) Alcohol 2.35 (1.49) 2.3 (1.44) 2.3 (1.45) Physical Activity 6.75 (5.79) 6.35 (5.98) 6.38 (5.97) SBP 123.15 (15.05) 124.55 (13.51) 124.45 (13.56) DBP 78.28 (13.18) 79.09 (10.15) 79.05 (10.2) M mean; SD standard deviation; N number of participants; BMI body mass index; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10, Education scaled “1 = 8th grade or less” to “13 = Completed a doctoral degree,” Income scaled “1 = Less than $5,000” to “12 = $150,000 or more,” Smoking scaled 1 to 30, Alcohol scaled “0 = None” to “6 = Every day or almost every day,” Physical Activity scaled 0 to 35. View Large Table 1 Sample Characteristics Variable Sexual minority N (% weighted) Heterosexual N (% weighted) Total N (% weighted) Sex  Female 263 (70.8%) 2,499 (47.9%) 2,762 (49.5%)  Male 103 (29.2%) 2,249 (52.1%) 2,352 (50.5%) Race  White 258 (81.1%) 3,413 (80.2%) 3,671 (80.2%)  Non-White 107 (18.9%) 1,331 (19.8%) 1,438 (19.8%) Hypertension levels  Normal 145 (40.4%) 1,574 (32.2%) 1,719 (32.7%)  Prehypertension 149 (42.4%) 2,191 (48.1%) 2,340 (47.7%)  Hypertension 1 47 (13.4%) 682 (16%) 729 (15.8%)  Hypertension 2 17 (3.8%) 178 (3.8%) 195 (3.8%) M (SD) Organizational Religious Activity Scale 1.43 (2.05) 2.38 (2.58) 2.26 (2.55) Religious attendance 1.06 (1.34) 1.69 (1.61) 1.65 (1.6) Religious activities 0.37 (0.962) 0.63 (1.23) 0.61 (1.21) Age (years) 28.68 (2.78) 29.03 (1.78) 29 (1.78) BMI 29.22 (11.75) 29.11 (7.44) 29.14 (7.49) Education 5.52 (2.46) 5.85 (2.42) 5.83 (2.42) Income 7.35 (2.84) 8.05 (2.55) 8 (2.58) Smoking 11.61 (13.79) 8.01 (12.61) 8.27 (12.73) Alcohol 2.35 (1.49) 2.3 (1.44) 2.3 (1.45) Physical Activity 6.75 (5.79) 6.35 (5.98) 6.38 (5.97) SBP 123.15 (15.05) 124.55 (13.51) 124.45 (13.56) DBP 78.28 (13.18) 79.09 (10.15) 79.05 (10.2) Variable Sexual minority N (% weighted) Heterosexual N (% weighted) Total N (% weighted) Sex  Female 263 (70.8%) 2,499 (47.9%) 2,762 (49.5%)  Male 103 (29.2%) 2,249 (52.1%) 2,352 (50.5%) Race  White 258 (81.1%) 3,413 (80.2%) 3,671 (80.2%)  Non-White 107 (18.9%) 1,331 (19.8%) 1,438 (19.8%) Hypertension levels  Normal 145 (40.4%) 1,574 (32.2%) 1,719 (32.7%)  Prehypertension 149 (42.4%) 2,191 (48.1%) 2,340 (47.7%)  Hypertension 1 47 (13.4%) 682 (16%) 729 (15.8%)  Hypertension 2 17 (3.8%) 178 (3.8%) 195 (3.8%) M (SD) Organizational Religious Activity Scale 1.43 (2.05) 2.38 (2.58) 2.26 (2.55) Religious attendance 1.06 (1.34) 1.69 (1.61) 1.65 (1.6) Religious activities 0.37 (0.962) 0.63 (1.23) 0.61 (1.21) Age (years) 28.68 (2.78) 29.03 (1.78) 29 (1.78) BMI 29.22 (11.75) 29.11 (7.44) 29.14 (7.49) Education 5.52 (2.46) 5.85 (2.42) 5.83 (2.42) Income 7.35 (2.84) 8.05 (2.55) 8 (2.58) Smoking 11.61 (13.79) 8.01 (12.61) 8.27 (12.73) Alcohol 2.35 (1.49) 2.3 (1.44) 2.3 (1.45) Physical Activity 6.75 (5.79) 6.35 (5.98) 6.38 (5.97) SBP 123.15 (15.05) 124.55 (13.51) 124.45 (13.56) DBP 78.28 (13.18) 79.09 (10.15) 79.05 (10.2) M mean; SD standard deviation; N number of participants; BMI body mass index; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10, Education scaled “1 = 8th grade or less” to “13 = Completed a doctoral degree,” Income scaled “1 = Less than $5,000” to “12 = $150,000 or more,” Smoking scaled 1 to 30, Alcohol scaled “0 = None” to “6 = Every day or almost every day,” Physical Activity scaled 0 to 35. View Large Table 2 Demographic Comparisons of Religious Versus Nonreligious Sexual Minority Individuals Variable Nonreligious N (% within row variable) Religious N (% within row variable) Total (percent of total) Chi-square Total 167 (45.6%) 199 (54.4%) 366 (100%) Education 4.35  High school and below 54 (53.5%) 47 (46.5%) 101 (27.6%)  Some college 72 (45%) 88 (55%) 160 (43.7%)  College and above 41 (39%) 64 (61%) 105 (28.7%) Neighborhood 1.80  Rural 29 (51.8%) 27 (48.2%) 56 (18.1%)  Suburban 59 (49.2%) 61 (50.8%) 120 (38.7%)  Urban 57 (42.5%) 77 (57.5%) 134 (43.2%) Income 1.76  ≤$39,999 77 (49.4%) 79 (50.6%) 156 (45.7%)  ≥$40,000 78 (42.2%) 107 (57.8%) 185 (54.3%) Household type 5.06~  Parents’ home 19 (33.3%) 38 (66.7%) 57 (15.7%)  Another home 13 (41.9%) 18 (58.1%) 31 (8.6%)  Own home 135 (49.3%) 139 (50.7%) 274 (75.7%) M (SD) M (SD) t-value Age 28.57 (1.68) 28.70 (1.72) −0.72 Variable Nonreligious N (% within row variable) Religious N (% within row variable) Total (percent of total) Chi-square Total 167 (45.6%) 199 (54.4%) 366 (100%) Education 4.35  High school and below 54 (53.5%) 47 (46.5%) 101 (27.6%)  Some college 72 (45%) 88 (55%) 160 (43.7%)  College and above 41 (39%) 64 (61%) 105 (28.7%) Neighborhood 1.80  Rural 29 (51.8%) 27 (48.2%) 56 (18.1%)  Suburban 59 (49.2%) 61 (50.8%) 120 (38.7%)  Urban 57 (42.5%) 77 (57.5%) 134 (43.2%) Income 1.76  ≤$39,999 77 (49.4%) 79 (50.6%) 156 (45.7%)  ≥$40,000 78 (42.2%) 107 (57.8%) 185 (54.3%) Household type 5.06~  Parents’ home 19 (33.3%) 38 (66.7%) 57 (15.7%)  Another home 13 (41.9%) 18 (58.1%) 31 (8.6%)  Own home 135 (49.3%) 139 (50.7%) 274 (75.7%) M (SD) M (SD) t-value Age 28.57 (1.68) 28.70 (1.72) −0.72 M mean; SD standard deviation; N number of participants. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 2 Demographic Comparisons of Religious Versus Nonreligious Sexual Minority Individuals Variable Nonreligious N (% within row variable) Religious N (% within row variable) Total (percent of total) Chi-square Total 167 (45.6%) 199 (54.4%) 366 (100%) Education 4.35  High school and below 54 (53.5%) 47 (46.5%) 101 (27.6%)  Some college 72 (45%) 88 (55%) 160 (43.7%)  College and above 41 (39%) 64 (61%) 105 (28.7%) Neighborhood 1.80  Rural 29 (51.8%) 27 (48.2%) 56 (18.1%)  Suburban 59 (49.2%) 61 (50.8%) 120 (38.7%)  Urban 57 (42.5%) 77 (57.5%) 134 (43.2%) Income 1.76  ≤$39,999 77 (49.4%) 79 (50.6%) 156 (45.7%)  ≥$40,000 78 (42.2%) 107 (57.8%) 185 (54.3%) Household type 5.06~  Parents’ home 19 (33.3%) 38 (66.7%) 57 (15.7%)  Another home 13 (41.9%) 18 (58.1%) 31 (8.6%)  Own home 135 (49.3%) 139 (50.7%) 274 (75.7%) M (SD) M (SD) t-value Age 28.57 (1.68) 28.70 (1.72) −0.72 Variable Nonreligious N (% within row variable) Religious N (% within row variable) Total (percent of total) Chi-square Total 167 (45.6%) 199 (54.4%) 366 (100%) Education 4.35  High school and below 54 (53.5%) 47 (46.5%) 101 (27.6%)  Some college 72 (45%) 88 (55%) 160 (43.7%)  College and above 41 (39%) 64 (61%) 105 (28.7%) Neighborhood 1.80  Rural 29 (51.8%) 27 (48.2%) 56 (18.1%)  Suburban 59 (49.2%) 61 (50.8%) 120 (38.7%)  Urban 57 (42.5%) 77 (57.5%) 134 (43.2%) Income 1.76  ≤$39,999 77 (49.4%) 79 (50.6%) 156 (45.7%)  ≥$40,000 78 (42.2%) 107 (57.8%) 185 (54.3%) Household type 5.06~  Parents’ home 19 (33.3%) 38 (66.7%) 57 (15.7%)  Another home 13 (41.9%) 18 (58.1%) 31 (8.6%)  Own home 135 (49.3%) 139 (50.7%) 274 (75.7%) M (SD) M (SD) t-value Age 28.57 (1.68) 28.70 (1.72) −0.72 M mean; SD standard deviation; N number of participants. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Model 1 was significant for SBP (F(6,126) = 183.94, p < .001, R2 = .25), DBP (F(6,126) = 83.89, p < .001, R2 = .14), prehypertension and higher (F(6,126) = 109.50, p < .001, R2 = .26), hypertension 1 and 2 (F(6,126) = 35.74, p < .001, R2 = .13), and hypertension 2 (F(6,126) = 15.18, p < .001, R2 = .10). In Model 1, the organizational religious activity by sexual orientation interaction proved significant for all possible BP and hypertension outcomes (Table 3). Simple slope analyses revealed a crossover interaction for SBP, DBP, and prehypertension or higher. Organizational religious activity displayed a negative association with SBP and DBP in the heterosexual group and a positive association in the sexual minority group. In the heterosexual group, greater organizational religious activity was significantly associated with decreased odds of being diagnosed with prehypertension or higher (OR = 0.95, SE = 0.01, p < .001), whereas in the sexual minority group organizational religious activity was significantly associated with increased odds of being diagnosed with prehypertension or higher (OR = 1.18, SE = 0.07, p = .02). Simple slope analyses revealed that organizational religious activity was not significantly associated with hypertension 2 in the heterosexual group, but was significantly associated with increased odds of being diagnosed with hypertension 2 in the sexual minority group (OR = 1.38, SE = 0.02, p < .001). Simple slope analyses did not reveal significant associations for organizational religious activity and hypertension 1 and 2 in either the heterosexual or sexual minority groups; however, organizational religious activity did approach significance in the sexual minority group, such that greater organizational religious activity was associated with increased odds of being diagnosed with hypertension 1 and 2 (OR = 1.13, SE = 0.07, p = .06). See Table 6 for full statistics reported for simple slope analyses. Table 3 BP and Hypertension Associations With Organizational Religious Activity and Sexual Orientation Interaction Effects b (SE) t-value 95% CI SBP  Model 1a −1.57 (0.39)*** −3.97 [−2.36, −0.08]  Model 2b −1.57 (0.39)*** −3.98 [−2.36, −0.08] DBP  Model 1a −0.997 (0.35)** −2.87 [−1.68, −0.31]  Model 2b −0.993 (0.34)** −2.91 [−1.67, −0.32] b (SE) t-value 95% CI Prehypertension and higher  Model 1a −0.21 (0.08)** −2.63 [−0.38, −0.05]  Model 2b −0.23 (0.09)** −2.65 [−0.39, −0.06] Hypertension 1 and 2  Model 1a −0.15 (0.07)* −2.08 [−0.30, −0.01]  Model 2b −0.15 (0.07)~ −1.97 [−0.29, 0.00] Hypertension 2  Model 1a −0.39 (0.11)*** −3.51 [−0.62, −0.17]  Model 2b −0.37 (0.12)** −3.24 [−0.60, −0.15] b (SE) t-value 95% CI SBP  Model 1a −1.57 (0.39)*** −3.97 [−2.36, −0.08]  Model 2b −1.57 (0.39)*** −3.98 [−2.36, −0.08] DBP  Model 1a −0.997 (0.35)** −2.87 [−1.68, −0.31]  Model 2b −0.993 (0.34)** −2.91 [−1.67, −0.32] b (SE) t-value 95% CI Prehypertension and higher  Model 1a −0.21 (0.08)** −2.63 [−0.38, −0.05]  Model 2b −0.23 (0.09)** −2.65 [−0.39, −0.06] Hypertension 1 and 2  Model 1a −0.15 (0.07)* −2.08 [−0.30, −0.01]  Model 2b −0.15 (0.07)~ −1.97 [−0.29, 0.00] Hypertension 2  Model 1a −0.39 (0.11)*** −3.51 [−0.62, −0.17]  Model 2b −0.37 (0.12)** −3.24 [−0.60, −0.15] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aModels controlling for age, sex, and BMI. bModels controlling for all covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 3 BP and Hypertension Associations With Organizational Religious Activity and Sexual Orientation Interaction Effects b (SE) t-value 95% CI SBP  Model 1a −1.57 (0.39)*** −3.97 [−2.36, −0.08]  Model 2b −1.57 (0.39)*** −3.98 [−2.36, −0.08] DBP  Model 1a −0.997 (0.35)** −2.87 [−1.68, −0.31]  Model 2b −0.993 (0.34)** −2.91 [−1.67, −0.32] b (SE) t-value 95% CI Prehypertension and higher  Model 1a −0.21 (0.08)** −2.63 [−0.38, −0.05]  Model 2b −0.23 (0.09)** −2.65 [−0.39, −0.06] Hypertension 1 and 2  Model 1a −0.15 (0.07)* −2.08 [−0.30, −0.01]  Model 2b −0.15 (0.07)~ −1.97 [−0.29, 0.00] Hypertension 2  Model 1a −0.39 (0.11)*** −3.51 [−0.62, −0.17]  Model 2b −0.37 (0.12)** −3.24 [−0.60, −0.15] b (SE) t-value 95% CI SBP  Model 1a −1.57 (0.39)*** −3.97 [−2.36, −0.08]  Model 2b −1.57 (0.39)*** −3.98 [−2.36, −0.08] DBP  Model 1a −0.997 (0.35)** −2.87 [−1.68, −0.31]  Model 2b −0.993 (0.34)** −2.91 [−1.67, −0.32] b (SE) t-value 95% CI Prehypertension and higher  Model 1a −0.21 (0.08)** −2.63 [−0.38, −0.05]  Model 2b −0.23 (0.09)** −2.65 [−0.39, −0.06] Hypertension 1 and 2  Model 1a −0.15 (0.07)* −2.08 [−0.30, −0.01]  Model 2b −0.15 (0.07)~ −1.97 [−0.29, 0.00] Hypertension 2  Model 1a −0.39 (0.11)*** −3.51 [−0.62, −0.17]  Model 2b −0.37 (0.12)** −3.24 [−0.60, −0.15] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aModels controlling for age, sex, and BMI. bModels controlling for all covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Model 2 was significant for SBP (F(12,120) = 103.46, p < .001, R2 = .25), DBP (F(12,120) = 44.93, p < .001, R2 = .15), prehypertension and higher (F(12,120) = 62.98, p < .001, R2 = .27), hypertension 1 and 2 (F(12,120) = 18.15, p < .001, R2 = .13), and hypertension 2 (F(12,120) = 7.79, p < .001, R2 = .11). In Model 2, the organizational religious activity by sexual orientation interaction proved significant for SBP, DBP, prehypertension and higher, and hypertension 2 (Table 3). Simple slope analyses displayed a crossover interaction for SBP, DBP, and prehypertension or higher. Organizational religious activity displayed a negative association with SBP and DBP in the heterosexual group and a positive association with SBP and DBP in the sexual minority group. For a visual representation of this crossover interaction effect for SBP and DBP, see Fig. 1. In the heterosexual group, greater organizational religious activity was significantly associated with decreased odds of being diagnosed with prehypertension or higher (OR = 0.96, SE = 0.01, p = .01), whereas in the sexual minority group organizational religious activity was significantly associated with increased odds of being diagnosed with prehypertension or higher (OR = 1.20, SE = 0.08, p = .02). Simple slope analyses revealed that organizational religious activity was not significantly associated with hypertension 2 in the heterosexual group, but was significantly associated with increased odds of being diagnosed with hypertension 2 in the sexual minority group (OR = 1.33, SE = 0.10, p = .01). See Tables 4 and 5 for associations of all covariates in the linear and logistic regression models. Table 4 Results of Linear Regression Analyses for BP Associations With All Covariatesa b (SE) t-value 95% CI SBP  Organizational Religious Activity 1.36 (0.40)*** 3.40 [0.57, 2.15]  Sexual Minority 1.79 (0.90)* 2.00 [0.02, 3.57]  Organizational Religious Activity × Sexual Orientation −1.57 (0.40)*** −3.98 [−2.36, −0.79]  Female 9.86 (0.40)*** 24.85 [9.07, 10.64]  Non-White −0.68 (0.56) −1.21 [−1.79, 0.43]  BMI 0.59 (0.04)*** 15.95 [0.52, 0.66]  Smoking 0.01 (0.02) 0.26 [−0.03, 0.04]  Alcohol 0.63 (0.14)*** 4.35 [0.34, 0.91]  Income −0.10 (0.10) −0.96 [−0.29, 0.10]  Education −0.12 (0.09) −1.28 [−0.30, 0.06]  Physical Activity −0.01 (0.03) −0.23 [−0.07, 0.05]  Age 0.27 (0.12)* 2.23 [0.03, 0.50] DBP  Organizational Religious Activity 0.87 (0.34)* 2.55 [0.20, 1.54]  Sexual Orientation 1.32 (0.87) 1.53 [−0.38, 3.04]  Organizational Religious Activity × Sexual Orientation −0.99 (0.34)** −2.91 [−1.67, −0.32]  Female 4.59 (0.32)*** 14.36 [3.95, 5.22]  Non-White −0.34 (0.48) −0.70 [−1.29, 0.62]  BMI 0.37 (0.03)*** 14.55 [0.32, 0.42]  Smoking 0.01 (0.01) 0.19 [−0.02, 0.03]  Alcohol 0.56 (0.11)*** 4.96 [0.11, 0.34]  Income −0.09 (0.07) −1.41 [−0.22, 0.04]  Education −0.06 (0.09) −0.67 [−0.23, 0.11]  Physical Activity −0.07 (0.03)** −2.85 [−0.12, 1.02]  Age 0.54 (0.09)*** 5.91 [0.36, 0.73] b (SE) t-value 95% CI SBP  Organizational Religious Activity 1.36 (0.40)*** 3.40 [0.57, 2.15]  Sexual Minority 1.79 (0.90)* 2.00 [0.02, 3.57]  Organizational Religious Activity × Sexual Orientation −1.57 (0.40)*** −3.98 [−2.36, −0.79]  Female 9.86 (0.40)*** 24.85 [9.07, 10.64]  Non-White −0.68 (0.56) −1.21 [−1.79, 0.43]  BMI 0.59 (0.04)*** 15.95 [0.52, 0.66]  Smoking 0.01 (0.02) 0.26 [−0.03, 0.04]  Alcohol 0.63 (0.14)*** 4.35 [0.34, 0.91]  Income −0.10 (0.10) −0.96 [−0.29, 0.10]  Education −0.12 (0.09) −1.28 [−0.30, 0.06]  Physical Activity −0.01 (0.03) −0.23 [−0.07, 0.05]  Age 0.27 (0.12)* 2.23 [0.03, 0.50] DBP  Organizational Religious Activity 0.87 (0.34)* 2.55 [0.20, 1.54]  Sexual Orientation 1.32 (0.87) 1.53 [−0.38, 3.04]  Organizational Religious Activity × Sexual Orientation −0.99 (0.34)** −2.91 [−1.67, −0.32]  Female 4.59 (0.32)*** 14.36 [3.95, 5.22]  Non-White −0.34 (0.48) −0.70 [−1.29, 0.62]  BMI 0.37 (0.03)*** 14.55 [0.32, 0.42]  Smoking 0.01 (0.01) 0.19 [−0.02, 0.03]  Alcohol 0.56 (0.11)*** 4.96 [0.11, 0.34]  Income −0.09 (0.07) −1.41 [−0.22, 0.04]  Education −0.06 (0.09) −0.67 [−0.23, 0.11]  Physical Activity −0.07 (0.03)** −2.85 [−0.12, 1.02]  Age 0.54 (0.09)*** 5.91 [0.36, 0.73] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aResults are from Model 2, controlling for all possible covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 4 Results of Linear Regression Analyses for BP Associations With All Covariatesa b (SE) t-value 95% CI SBP  Organizational Religious Activity 1.36 (0.40)*** 3.40 [0.57, 2.15]  Sexual Minority 1.79 (0.90)* 2.00 [0.02, 3.57]  Organizational Religious Activity × Sexual Orientation −1.57 (0.40)*** −3.98 [−2.36, −0.79]  Female 9.86 (0.40)*** 24.85 [9.07, 10.64]  Non-White −0.68 (0.56) −1.21 [−1.79, 0.43]  BMI 0.59 (0.04)*** 15.95 [0.52, 0.66]  Smoking 0.01 (0.02) 0.26 [−0.03, 0.04]  Alcohol 0.63 (0.14)*** 4.35 [0.34, 0.91]  Income −0.10 (0.10) −0.96 [−0.29, 0.10]  Education −0.12 (0.09) −1.28 [−0.30, 0.06]  Physical Activity −0.01 (0.03) −0.23 [−0.07, 0.05]  Age 0.27 (0.12)* 2.23 [0.03, 0.50] DBP  Organizational Religious Activity 0.87 (0.34)* 2.55 [0.20, 1.54]  Sexual Orientation 1.32 (0.87) 1.53 [−0.38, 3.04]  Organizational Religious Activity × Sexual Orientation −0.99 (0.34)** −2.91 [−1.67, −0.32]  Female 4.59 (0.32)*** 14.36 [3.95, 5.22]  Non-White −0.34 (0.48) −0.70 [−1.29, 0.62]  BMI 0.37 (0.03)*** 14.55 [0.32, 0.42]  Smoking 0.01 (0.01) 0.19 [−0.02, 0.03]  Alcohol 0.56 (0.11)*** 4.96 [0.11, 0.34]  Income −0.09 (0.07) −1.41 [−0.22, 0.04]  Education −0.06 (0.09) −0.67 [−0.23, 0.11]  Physical Activity −0.07 (0.03)** −2.85 [−0.12, 1.02]  Age 0.54 (0.09)*** 5.91 [0.36, 0.73] b (SE) t-value 95% CI SBP  Organizational Religious Activity 1.36 (0.40)*** 3.40 [0.57, 2.15]  Sexual Minority 1.79 (0.90)* 2.00 [0.02, 3.57]  Organizational Religious Activity × Sexual Orientation −1.57 (0.40)*** −3.98 [−2.36, −0.79]  Female 9.86 (0.40)*** 24.85 [9.07, 10.64]  Non-White −0.68 (0.56) −1.21 [−1.79, 0.43]  BMI 0.59 (0.04)*** 15.95 [0.52, 0.66]  Smoking 0.01 (0.02) 0.26 [−0.03, 0.04]  Alcohol 0.63 (0.14)*** 4.35 [0.34, 0.91]  Income −0.10 (0.10) −0.96 [−0.29, 0.10]  Education −0.12 (0.09) −1.28 [−0.30, 0.06]  Physical Activity −0.01 (0.03) −0.23 [−0.07, 0.05]  Age 0.27 (0.12)* 2.23 [0.03, 0.50] DBP  Organizational Religious Activity 0.87 (0.34)* 2.55 [0.20, 1.54]  Sexual Orientation 1.32 (0.87) 1.53 [−0.38, 3.04]  Organizational Religious Activity × Sexual Orientation −0.99 (0.34)** −2.91 [−1.67, −0.32]  Female 4.59 (0.32)*** 14.36 [3.95, 5.22]  Non-White −0.34 (0.48) −0.70 [−1.29, 0.62]  BMI 0.37 (0.03)*** 14.55 [0.32, 0.42]  Smoking 0.01 (0.01) 0.19 [−0.02, 0.03]  Alcohol 0.56 (0.11)*** 4.96 [0.11, 0.34]  Income −0.09 (0.07) −1.41 [−0.22, 0.04]  Education −0.06 (0.09) −0.67 [−0.23, 0.11]  Physical Activity −0.07 (0.03)** −2.85 [−0.12, 1.02]  Age 0.54 (0.09)*** 5.91 [0.36, 0.73] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aResults are from Model 2, controlling for all possible covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 5 Results of Logistic Regression Analyses for Hypertension Associations With All Covariatesa OR (SE) t-value 95% CI Prehypertension and higher  Organizational Religious Activity 1.21 (0.09)* 2.21 [1.02, 1.43]  Sexual Orientation 0.92 (0.17)* 2.29 [0.58, 1.44]  Organizational Religious Activity × Sexual Orientation 0.80 (0.09)** −2.65 [0.68, 0.94]  Female 5.05 (0.08)*** 19.85 [4.30, 5.93]  Non-White 0.98 (0.10) −0.24 [0.81, 1.19]  BMI 1.10 (0.01)*** 13.28 [1.09, 1.12]  Smoking 0.99 (0.01) −0.34 [0.99, 1.01]  Alcohol 1.14 (0.03)*** 4.62 [1.08, 1.20]  Income 0.98 (0.02) −0.98 [0.95, 1.02]  Education 0.97 (0.02) −1.54 [0.93, 1.01]  Physical Activity 0.99 (0.01) −2.65 [0.98, 1.01]  Age 1.05 (0.02)* 2.13 [1.00, 1.10] Hypertension 1 and 2  Organizational Religious Activity 1.14 (0.07)~ 1.10 [0.99, 1.32]  Sexual Orientation 0.81 (0.27) 0.36 [0.55, 1.19]  Organizational Religious Activity × Sexual Orientation 0.87 (0.07)~ −1.97 [0.76, 1.00]  Female 2.97 (0.11)*** 9.87 [2.39, 3.69]  Non-White 0.82 (0.11)~ −1.74 [0.66, 1.03]  BMI 1.08 (0.01)*** 11.71 [1.06, 1.09]  Smoking 1.01 (0.01)~ 1.70 [0.99, 1.01]  Alcohol 1.08 (0.03)** 2.33 [1.01, 1.15]  Income 0.99 (0.02) −0.64 [0.95, 1.03]  Education 0.99 (0.02) −0.51 [0.94, 1.04]  Physical Activity 0.99 (0.01) −0.07 [0.98, 1.02]  Age 1.09 (0.03)** 3.13 [1.03, 1.15] Hypertension 2  Organizational Religious Activity 1.36 (0.11)** 2.85 [1.10, 1.68]  Sexual Orientation 0.93 (0.43) 1.62 [0.49, 1.76]  Organizational Religious Activity × Sexual Orientation 0.71 (0.12)** −3.24 [0.57, 0.89]  Female 1.97 (0.19)*** 3.65 [1.36, 2.84]  Non-White 0.53 (0.23)** −2.79 [0.34, 0.83]  BMI 1.09 (0.01)*** 8.27 [1.07, 1.11]  Smoking 1.01 (0.01) 0.85 [0.99, 1.02]  Alcohol 1.00 (0.07) 0.01 [0.88, 1.14]  Income 1.01 (0.04) 0.25 [0.94, 1.09]  Education 0.97 (0.03) −0.63 [0.89, 1.07]  Physical Activity 0.98 (0.02) −1.28 [0.95, 1.01]  Age 1.10 (0.05)~ 1.73 [0.99, 1.22] OR (SE) t-value 95% CI Prehypertension and higher  Organizational Religious Activity 1.21 (0.09)* 2.21 [1.02, 1.43]  Sexual Orientation 0.92 (0.17)* 2.29 [0.58, 1.44]  Organizational Religious Activity × Sexual Orientation 0.80 (0.09)** −2.65 [0.68, 0.94]  Female 5.05 (0.08)*** 19.85 [4.30, 5.93]  Non-White 0.98 (0.10) −0.24 [0.81, 1.19]  BMI 1.10 (0.01)*** 13.28 [1.09, 1.12]  Smoking 0.99 (0.01) −0.34 [0.99, 1.01]  Alcohol 1.14 (0.03)*** 4.62 [1.08, 1.20]  Income 0.98 (0.02) −0.98 [0.95, 1.02]  Education 0.97 (0.02) −1.54 [0.93, 1.01]  Physical Activity 0.99 (0.01) −2.65 [0.98, 1.01]  Age 1.05 (0.02)* 2.13 [1.00, 1.10] Hypertension 1 and 2  Organizational Religious Activity 1.14 (0.07)~ 1.10 [0.99, 1.32]  Sexual Orientation 0.81 (0.27) 0.36 [0.55, 1.19]  Organizational Religious Activity × Sexual Orientation 0.87 (0.07)~ −1.97 [0.76, 1.00]  Female 2.97 (0.11)*** 9.87 [2.39, 3.69]  Non-White 0.82 (0.11)~ −1.74 [0.66, 1.03]  BMI 1.08 (0.01)*** 11.71 [1.06, 1.09]  Smoking 1.01 (0.01)~ 1.70 [0.99, 1.01]  Alcohol 1.08 (0.03)** 2.33 [1.01, 1.15]  Income 0.99 (0.02) −0.64 [0.95, 1.03]  Education 0.99 (0.02) −0.51 [0.94, 1.04]  Physical Activity 0.99 (0.01) −0.07 [0.98, 1.02]  Age 1.09 (0.03)** 3.13 [1.03, 1.15] Hypertension 2  Organizational Religious Activity 1.36 (0.11)** 2.85 [1.10, 1.68]  Sexual Orientation 0.93 (0.43) 1.62 [0.49, 1.76]  Organizational Religious Activity × Sexual Orientation 0.71 (0.12)** −3.24 [0.57, 0.89]  Female 1.97 (0.19)*** 3.65 [1.36, 2.84]  Non-White 0.53 (0.23)** −2.79 [0.34, 0.83]  BMI 1.09 (0.01)*** 8.27 [1.07, 1.11]  Smoking 1.01 (0.01) 0.85 [0.99, 1.02]  Alcohol 1.00 (0.07) 0.01 [0.88, 1.14]  Income 1.01 (0.04) 0.25 [0.94, 1.09]  Education 0.97 (0.03) −0.63 [0.89, 1.07]  Physical Activity 0.98 (0.02) −1.28 [0.95, 1.01]  Age 1.10 (0.05)~ 1.73 [0.99, 1.22] OR odds ratio; SE standard error; CI confidence interval; BMI body mass index. Organizational Religious Activity Scale scaled 0 to 10. aResults are from Model 2, controlling for all possible covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 5 Results of Logistic Regression Analyses for Hypertension Associations With All Covariatesa OR (SE) t-value 95% CI Prehypertension and higher  Organizational Religious Activity 1.21 (0.09)* 2.21 [1.02, 1.43]  Sexual Orientation 0.92 (0.17)* 2.29 [0.58, 1.44]  Organizational Religious Activity × Sexual Orientation 0.80 (0.09)** −2.65 [0.68, 0.94]  Female 5.05 (0.08)*** 19.85 [4.30, 5.93]  Non-White 0.98 (0.10) −0.24 [0.81, 1.19]  BMI 1.10 (0.01)*** 13.28 [1.09, 1.12]  Smoking 0.99 (0.01) −0.34 [0.99, 1.01]  Alcohol 1.14 (0.03)*** 4.62 [1.08, 1.20]  Income 0.98 (0.02) −0.98 [0.95, 1.02]  Education 0.97 (0.02) −1.54 [0.93, 1.01]  Physical Activity 0.99 (0.01) −2.65 [0.98, 1.01]  Age 1.05 (0.02)* 2.13 [1.00, 1.10] Hypertension 1 and 2  Organizational Religious Activity 1.14 (0.07)~ 1.10 [0.99, 1.32]  Sexual Orientation 0.81 (0.27) 0.36 [0.55, 1.19]  Organizational Religious Activity × Sexual Orientation 0.87 (0.07)~ −1.97 [0.76, 1.00]  Female 2.97 (0.11)*** 9.87 [2.39, 3.69]  Non-White 0.82 (0.11)~ −1.74 [0.66, 1.03]  BMI 1.08 (0.01)*** 11.71 [1.06, 1.09]  Smoking 1.01 (0.01)~ 1.70 [0.99, 1.01]  Alcohol 1.08 (0.03)** 2.33 [1.01, 1.15]  Income 0.99 (0.02) −0.64 [0.95, 1.03]  Education 0.99 (0.02) −0.51 [0.94, 1.04]  Physical Activity 0.99 (0.01) −0.07 [0.98, 1.02]  Age 1.09 (0.03)** 3.13 [1.03, 1.15] Hypertension 2  Organizational Religious Activity 1.36 (0.11)** 2.85 [1.10, 1.68]  Sexual Orientation 0.93 (0.43) 1.62 [0.49, 1.76]  Organizational Religious Activity × Sexual Orientation 0.71 (0.12)** −3.24 [0.57, 0.89]  Female 1.97 (0.19)*** 3.65 [1.36, 2.84]  Non-White 0.53 (0.23)** −2.79 [0.34, 0.83]  BMI 1.09 (0.01)*** 8.27 [1.07, 1.11]  Smoking 1.01 (0.01) 0.85 [0.99, 1.02]  Alcohol 1.00 (0.07) 0.01 [0.88, 1.14]  Income 1.01 (0.04) 0.25 [0.94, 1.09]  Education 0.97 (0.03) −0.63 [0.89, 1.07]  Physical Activity 0.98 (0.02) −1.28 [0.95, 1.01]  Age 1.10 (0.05)~ 1.73 [0.99, 1.22] OR (SE) t-value 95% CI Prehypertension and higher  Organizational Religious Activity 1.21 (0.09)* 2.21 [1.02, 1.43]  Sexual Orientation 0.92 (0.17)* 2.29 [0.58, 1.44]  Organizational Religious Activity × Sexual Orientation 0.80 (0.09)** −2.65 [0.68, 0.94]  Female 5.05 (0.08)*** 19.85 [4.30, 5.93]  Non-White 0.98 (0.10) −0.24 [0.81, 1.19]  BMI 1.10 (0.01)*** 13.28 [1.09, 1.12]  Smoking 0.99 (0.01) −0.34 [0.99, 1.01]  Alcohol 1.14 (0.03)*** 4.62 [1.08, 1.20]  Income 0.98 (0.02) −0.98 [0.95, 1.02]  Education 0.97 (0.02) −1.54 [0.93, 1.01]  Physical Activity 0.99 (0.01) −2.65 [0.98, 1.01]  Age 1.05 (0.02)* 2.13 [1.00, 1.10] Hypertension 1 and 2  Organizational Religious Activity 1.14 (0.07)~ 1.10 [0.99, 1.32]  Sexual Orientation 0.81 (0.27) 0.36 [0.55, 1.19]  Organizational Religious Activity × Sexual Orientation 0.87 (0.07)~ −1.97 [0.76, 1.00]  Female 2.97 (0.11)*** 9.87 [2.39, 3.69]  Non-White 0.82 (0.11)~ −1.74 [0.66, 1.03]  BMI 1.08 (0.01)*** 11.71 [1.06, 1.09]  Smoking 1.01 (0.01)~ 1.70 [0.99, 1.01]  Alcohol 1.08 (0.03)** 2.33 [1.01, 1.15]  Income 0.99 (0.02) −0.64 [0.95, 1.03]  Education 0.99 (0.02) −0.51 [0.94, 1.04]  Physical Activity 0.99 (0.01) −0.07 [0.98, 1.02]  Age 1.09 (0.03)** 3.13 [1.03, 1.15] Hypertension 2  Organizational Religious Activity 1.36 (0.11)** 2.85 [1.10, 1.68]  Sexual Orientation 0.93 (0.43) 1.62 [0.49, 1.76]  Organizational Religious Activity × Sexual Orientation 0.71 (0.12)** −3.24 [0.57, 0.89]  Female 1.97 (0.19)*** 3.65 [1.36, 2.84]  Non-White 0.53 (0.23)** −2.79 [0.34, 0.83]  BMI 1.09 (0.01)*** 8.27 [1.07, 1.11]  Smoking 1.01 (0.01) 0.85 [0.99, 1.02]  Alcohol 1.00 (0.07) 0.01 [0.88, 1.14]  Income 1.01 (0.04) 0.25 [0.94, 1.09]  Education 0.97 (0.03) −0.63 [0.89, 1.07]  Physical Activity 0.98 (0.02) −1.28 [0.95, 1.01]  Age 1.10 (0.05)~ 1.73 [0.99, 1.22] OR odds ratio; SE standard error; CI confidence interval; BMI body mass index. Organizational Religious Activity Scale scaled 0 to 10. aResults are from Model 2, controlling for all possible covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 6 Simple Slope Analyses of Organizational Religious Activity With BP and Hypertension Within Heterosexual and Sexual Minority Groupsa Heterosexual Group (N = 4,748) Sexual Minority Group (N = 366) b (SE) t-value 95% CI b (SE) t-value 95% CI SBP  Model 1b −0.26 (0.07)*** −3.65 [−0.40, −0.12] 1.32 (0.40)*** 3.27 [0.52, 2.12]  Model 2c −0.21 (0.08)** −2.85 [−0.36, −0.07] 1.41 (0.43)*** 3.25 [0.55, 2.26] DBP  Model 1b −0.17 (0.06)** −3.12 [−0.28, −0.06] 0.86 (0.34)* 2.53 [0.19, 1.54]  Model 2c −0.13 (0.06)* −2.09 [−0.25, −0.01] 0.95 (0.37)* 2.59 [0.22, 1.68] OR (SE) t-value 95% CI OR (SE) t-value 95% CI Prehypertension and higher  Model 1b 0.95 (0.01)*** −3.57 [0.93, 0.98] 1.18 (0.07)* 2.31 [1.02, 1.36]  Model 2c 0.96 (0.01)** −2.62 [0.94, 0.99] 1.20 (0.08)* 2.22 [1.02, 1.41] Hypertension 1 and 2  Model 1b 0.98 (0.02) −1.03 [0.95, 1.02] 1.13 (0.07)~ 1.90 [0.99, 1.29] Hypertension 2  Model 1b 0.94 (0.04) −1.41 [0.87, 1.03] 1.38 (0.02)*** 3.42 [1.15, 1.66]  Model 2c 0.94 (0.05) −1.49 [0.85, 1.02] 1.33 (0.11)** 2.65 [1.08, 1.65] Heterosexual Group (N = 4,748) Sexual Minority Group (N = 366) b (SE) t-value 95% CI b (SE) t-value 95% CI SBP  Model 1b −0.26 (0.07)*** −3.65 [−0.40, −0.12] 1.32 (0.40)*** 3.27 [0.52, 2.12]  Model 2c −0.21 (0.08)** −2.85 [−0.36, −0.07] 1.41 (0.43)*** 3.25 [0.55, 2.26] DBP  Model 1b −0.17 (0.06)** −3.12 [−0.28, −0.06] 0.86 (0.34)* 2.53 [0.19, 1.54]  Model 2c −0.13 (0.06)* −2.09 [−0.25, −0.01] 0.95 (0.37)* 2.59 [0.22, 1.68] OR (SE) t-value 95% CI OR (SE) t-value 95% CI Prehypertension and higher  Model 1b 0.95 (0.01)*** −3.57 [0.93, 0.98] 1.18 (0.07)* 2.31 [1.02, 1.36]  Model 2c 0.96 (0.01)** −2.62 [0.94, 0.99] 1.20 (0.08)* 2.22 [1.02, 1.41] Hypertension 1 and 2  Model 1b 0.98 (0.02) −1.03 [0.95, 1.02] 1.13 (0.07)~ 1.90 [0.99, 1.29] Hypertension 2  Model 1b 0.94 (0.04) −1.41 [0.87, 1.03] 1.38 (0.02)*** 3.42 [1.15, 1.66]  Model 2c 0.94 (0.05) −1.49 [0.85, 1.02] 1.33 (0.11)** 2.65 [1.08, 1.65] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; OR odds ratio; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aSimple slope analyses conducted only for significant interaction effects at p < .05. bModels controlling for age, sex, and BMI. cModels controlling for all covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 6 Simple Slope Analyses of Organizational Religious Activity With BP and Hypertension Within Heterosexual and Sexual Minority Groupsa Heterosexual Group (N = 4,748) Sexual Minority Group (N = 366) b (SE) t-value 95% CI b (SE) t-value 95% CI SBP  Model 1b −0.26 (0.07)*** −3.65 [−0.40, −0.12] 1.32 (0.40)*** 3.27 [0.52, 2.12]  Model 2c −0.21 (0.08)** −2.85 [−0.36, −0.07] 1.41 (0.43)*** 3.25 [0.55, 2.26] DBP  Model 1b −0.17 (0.06)** −3.12 [−0.28, −0.06] 0.86 (0.34)* 2.53 [0.19, 1.54]  Model 2c −0.13 (0.06)* −2.09 [−0.25, −0.01] 0.95 (0.37)* 2.59 [0.22, 1.68] OR (SE) t-value 95% CI OR (SE) t-value 95% CI Prehypertension and higher  Model 1b 0.95 (0.01)*** −3.57 [0.93, 0.98] 1.18 (0.07)* 2.31 [1.02, 1.36]  Model 2c 0.96 (0.01)** −2.62 [0.94, 0.99] 1.20 (0.08)* 2.22 [1.02, 1.41] Hypertension 1 and 2  Model 1b 0.98 (0.02) −1.03 [0.95, 1.02] 1.13 (0.07)~ 1.90 [0.99, 1.29] Hypertension 2  Model 1b 0.94 (0.04) −1.41 [0.87, 1.03] 1.38 (0.02)*** 3.42 [1.15, 1.66]  Model 2c 0.94 (0.05) −1.49 [0.85, 1.02] 1.33 (0.11)** 2.65 [1.08, 1.65] Heterosexual Group (N = 4,748) Sexual Minority Group (N = 366) b (SE) t-value 95% CI b (SE) t-value 95% CI SBP  Model 1b −0.26 (0.07)*** −3.65 [−0.40, −0.12] 1.32 (0.40)*** 3.27 [0.52, 2.12]  Model 2c −0.21 (0.08)** −2.85 [−0.36, −0.07] 1.41 (0.43)*** 3.25 [0.55, 2.26] DBP  Model 1b −0.17 (0.06)** −3.12 [−0.28, −0.06] 0.86 (0.34)* 2.53 [0.19, 1.54]  Model 2c −0.13 (0.06)* −2.09 [−0.25, −0.01] 0.95 (0.37)* 2.59 [0.22, 1.68] OR (SE) t-value 95% CI OR (SE) t-value 95% CI Prehypertension and higher  Model 1b 0.95 (0.01)*** −3.57 [0.93, 0.98] 1.18 (0.07)* 2.31 [1.02, 1.36]  Model 2c 0.96 (0.01)** −2.62 [0.94, 0.99] 1.20 (0.08)* 2.22 [1.02, 1.41] Hypertension 1 and 2  Model 1b 0.98 (0.02) −1.03 [0.95, 1.02] 1.13 (0.07)~ 1.90 [0.99, 1.29] Hypertension 2  Model 1b 0.94 (0.04) −1.41 [0.87, 1.03] 1.38 (0.02)*** 3.42 [1.15, 1.66]  Model 2c 0.94 (0.05) −1.49 [0.85, 1.02] 1.33 (0.11)** 2.65 [1.08, 1.65] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; OR odds ratio; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aSimple slope analyses conducted only for significant interaction effects at p < .05. bModels controlling for age, sex, and BMI. cModels controlling for all covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Fig. 1. View largeDownload slide Sexual orientation moderates the association between organizational religious activity and BP. BP blood pressure; SBP systolic blood pressure; DBP diastolic blood pressure; SD standard deviation; M mean (2.26 is reflective of the total sample mean on the Organizational Religious Activity Scale). Fig. 1. View largeDownload slide Sexual orientation moderates the association between organizational religious activity and BP. BP blood pressure; SBP systolic blood pressure; DBP diastolic blood pressure; SD standard deviation; M mean (2.26 is reflective of the total sample mean on the Organizational Religious Activity Scale). Discussion This was the first known study to examine the association between organizational religious activity and hypertension among sexual minorities—an at risk group for CVD. Results indicated that sexual orientation moderates the associations between organizational religious activity and BP/hypertension. For the dependent variables SBP, DBP, and prehypertension or higher, crossover interaction effects were present, such that organizational religious activity was a protective factor for the heterosexual group and organizational religious activity was a risk factor for the sexual minority group. Results generally supported the hypotheses that organizational religious activity would be a protective factor among heterosexual individuals. Additionally, results supported the hypotheses that greater organizational religious activity was associated with elevated BP and greater odds of meeting clinical levels of hypertension among the sexual minority group. These findings are inconsistent with the majority of studies examining the association between organizational religious activity and BP, which have found significantly lower BP among those who are more religious [6]. One reason for this may be that sexual minorities do not experience organizational religious activity as a protective factor, given that most major world religions do not support sexual minority behavior and promote heterosexism [29]. Additionally, religious communities may not provide the same social support to sexual minority individuals as heterosexual individuals [30]. As such, these findings are consistent with minority stress theory, in which organizational religious activity may represent an additional stressor for this population [16]. The data also revealed that there were no significant demographic differences between nonreligious and religious sexual minority individuals. Limitations and future directions Findings from the current study should be interpreted considering some limitations and future directions. This study utilized a cross-sectional design, thus findings are unable to address temporality. Although this study’s method of collecting BP measurements is valid and commonly employed, the gold standard for measuring BP and diagnosing hypertension is 24-hr ambulatory monitoring and should be considered in future studies [31]. The current study was also unable to explore specific religious affiliations and denominations. It is possible that the association between organizational religious activity and hypertension varies as a function of religious group. It is also possible that attitudes toward sexual minority status have changed since the data were collected in 2008, as support for same-sex marriage has reached majority level in Protestant and Catholic groups as of this writing [32]. However, as of 2014, same-sex marriage continues to be least supported by those attending religious services most regularly [20]. Additionally, the current study also examined only crude associations between organizational religious activity and hypertension. Future research utilizing multidimensional measures of religiosity beyond organizational religious activity, inclusive of spirituality and other subconstructs of religiosity, is encouraged. Spirituality represents one’s individual relationship with a higher power and it may not confer the same social and cultural implications as organizational religious activity or other subconstructs of religiosity. Organizational religious activity may influence health through a number of different mechanisms [6]. For example, it may provide a way of coping with stress through the sense of control, religious doctrines, or prosocial behaviors promoted by all religions. From a meaning systems perspective, organizational religious activity may also be a core component of religious individual’s global beliefs, goals, and sense of meaning in life [33]; however, sexual minority identity may conflict with this sense of meaning. While researchers have proposed potential models hypothesizing ways religion can influence physical health outcomes [6, 33, 34], it would be important to examine these models specifically within the context of hypertension while incorporating sexual orientation and minority stressors. See Fig. 2 for a proposed theoretical model of study. Future study of these associations is necessary in order to better understand how organizational religious activity impacts sexual minority health, as these mechanisms may not influence sexual minorities in the same way as heterosexual groups. Fig. 2. View largeDownload slide Proposed theoretical model predicting hypothesized associations from organizational religious activity to hypertension. “+” on a pathway denotes a positive association; “−” on a pathway denotes a negative association. Fig. 2. View largeDownload slide Proposed theoretical model predicting hypothesized associations from organizational religious activity to hypertension. “+” on a pathway denotes a positive association; “−” on a pathway denotes a negative association. Implications These findings highlight the importance of considering sexual orientation when examining the health benefits of organizational religious activity. They add to the growing body of literature suggesting that organizational religious activity does not confer the same benefits for sexual minority individuals as heterosexual individuals [29]. This is an important implication for practitioners to consider, as an intersectional approach to therapy that addresses both a sexual minority and religious identity may be beneficial. Because many individuals believe they must choose between religious and sexual identities [35], one possible approach may aim to help individuals accept the aspects of religion that may cause stress, while emphasizing a personal relationship with a higher power [36]. Perhaps reconciling these two identities would mitigate the positive association between minority stressors and poor health outcomes. More broadly, findings on organizational religious activity in sexual minority individuals could be used to inform leaders of religious institutions, potentially allowing churches and congregations to be better equipped to create a more accepting, less heterosexist, environment. A public education campaign on the association between organizational religious activity and health outcomes may also provide sexual minority religious groups with important resources. Compliance with Ethical Standards Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards Authors Kalina M. Lamb, Kelsey A. Nogg, Benjamin M. Rooney, and Aaron J. Blashill declare that they have no conflict of interests. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Conflict of Interest: The authors declare that they have no conflict of interest. Informed Consent: For this type of study formal consent is not required. Ethical Standards: The authors have adhered to all ethical standards required by the field. 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Organizational Religious Activity, Hypertension, and Sexual Orientation: Results From a Nationally Representative Sample

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10.1093/abm/kax066
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Abstract

Abstract Background Hypertension is a major public health concern, given prevalence and morbidity. Among the general population, greater religious attendance is associated with lower blood pressure (BP). However, no known studies have examined the association between religious attendance and BP among sexual minorities. Purpose To examine the association between BP/hypertension and organizational religious activity as a function of sexual orientation. Methods Data were utilized from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a publicly available, U.S. nationally representative data set. Of the 4,874 individuals included in analyses, 366 participants were identified as a sexual minority. An organizational religious activity variable was created by summing responses of two separate items. BP was measured as systolic blood pressure (SBP) and diastolic blood pressure (DBP). Increasing levels of clinical severity of hypertension were also examined. Relevant covariates were controlled for in two separate models. Significant interactions between religious attendance and sexual orientation were explored in simple slope analyses. Results Overall, results indicated that sexual orientation moderated the association between organizational religious activity, and BP/hypertension. Crossover interactions were present for the dependent variables SBP, DBP, and prehypertension and higher (prehypertension, and hypertension 1 and 2). Generally, a negative association between organizational religious activity and hypertension was revealed among the heterosexual group, whereas a positive association was found among the sexual minority group. Conclusions Organizational religious activity is differentially associated with BP/hypertension among sexual minority versus heterosexual individuals. Organizational religious activity may represent a risk factor for hypertension among sexual minority individuals. Hypertension, Organizational religious attendance, Blood pressure, Sexual minority, Cardiovascular disease Introduction Hypertension (i.e., elevated blood pressure [BP]) is one of the most common preventable risk factors of morbidity and premature mortality globally [1]. For example, hypertension is strongly associated with cardiovascular disease (CVD), a condition responsible for nearly one third of all deaths per year [1]. Approximately 45% of deaths from CVD are due to elevated BP [1]; similarly, hypertension is responsible for 51% of deaths due to stroke [1]. As of 2017, the number of Americans with hypertension was approximately 85.7 million [2]. There are many hypothesized factors associated with hypertension, which include chronic stress as a risk factor and social support as a protective factor [3, 4]. These variables may play an important role in the context of religion and health. Religiosity, the degree to which individuals adhere to and value their religious beliefs, rituals, and traditions has generally been found to be positively associated with improved physical and mental health outcomes [5, 6]. Organizational religious activity, a subconstruct of religiosity, is often measured by participation in religious activities and events and has been shown to have some of the strongest associations with health outcomes [7]. Indeed, many studies have concluded that religious attendance is a protective factor from CVD and hypertension [6, 8, 9]; however, some findings may be moderated by demographic factors, particularly ethnicity [6, 10]. Theoretically, participation in religious activities may buffer individuals from CVD and hypertension by encouraging health behaviors (e.g., decreased substance use) [11] and providing social support [10] both of which subsequently reduce stress [6]. However, this noted health benefit of organizational religious activity may not be present among all individuals. One group that has been overlooked in the study of religiosity and health is sexual minorities (i.e., gay, lesbian, bisexual, or other nonheterosexually defined individuals). Sexual minorities disproportionally experience negative mental and physical health outcomes [12]. When examining hypertension, several studies have reported higher prevalence rates of CVD and hypertension among sexual minorities compared to heterosexual groups [13, 14]. Sexual minority health disparities are frequently explained by minority stress theory, which posits sexual minorities experience additional stress due to their stigmatized sexual orientation as compared to their heterosexual counterparts [15]. The sexual minority stress model further states that identity can play an important role, such that it can buffer the effects of stress through successful integration of many complex identities, or it can exacerbate the effects of stress through the inability to converge two or more perceived conflicting identities [15]. Minority stress often presents as discrimination, internalized stigma, sexual minority identity concealment, prejudice, and fear of rejection [15], which exacerbate general stress, resulting in poor health outcomes [16]. A paucity of research has been conducted examining differences between religious and nonreligious sexual minority individuals. One study found that when comparing religious, spiritual, and atheist sexual minority individuals, few to no differences were found in gender, age, race/ethnicity, or geographical location [17]. However, significant differences were found in levels of “outness” and internalized heterosexism, such that more religious individuals were less “out” and had greater levels of internalized heterosexism [17]. However, researchers have also discovered significant differences in health behaviors between religious and nonreligious sexual minorities. In a study examining the effect of religious climate on risk behaviors, sexual minority youth in religious climates that were more supportive of sexual minorities were less likely to abuse alcohol and have fewer sexual partners compared to sexual minority youth in religious climates that were less supportive [18]. Although research has begun to explore salient differences between religious and nonreligious sexual minority individuals, additional exploration is needed, particularly utilizing samples that are representative of all U.S. adults. Although previous research has examined the association between sexual orientation and hypertension, no known studies to date have assessed the association of organizational religious activity and hypertension among a sample of sexual minority individuals. Theoretically, it is plausible that organizational religious activity among sexual minorities displays an inverse association with hypertension. That is, in lieu of serving as a buffer for hypertension, organizational religious activity may be a risk factor among sexual minorities given most major world religions condemn same-sex relationships [19]. These embedded principles often lead to anti-gay attitudes in religious communities [20]. Thus, identifying as religious and a sexual minority may confer stress due to the perceived dissonance between these two identities [21]. The current study seeks to build upon previous studies by assessing the association between organizational religious activity, sexual orientation, and hypertension in a nationally representative sample. In addition, this study aims to examine potential demographic group differences between religious and nonreligious sexual minorities. It is hypothesized that sexual orientation will moderate the associations between organizational religious activity and BP/hypertension. Based on findings in prior literature, it is hypothesized that greater organizational religious activity will be associated with lower BP and decreased odds of hypertension among heterosexual individuals. Consistent with sexual minority stress theory, it is hypothesized that greater organizational religious activity will be associated with elevated BP and greater odds of hypertension among sexual minority individuals. Methods Participants and Procedures The current study utilized the publicly available version of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of U.S. adolescents followed into adulthood. Currently, there are four waves of data in Add Health. Wave I was conducted from 1994 to 1995 in 80 high schools and 52 middle schools in the USA. Schools were selected with an unequal probability of selection as a function of sampling stratification regarding school size, school type, region, urbanicity, and ethnicity [22]. Wave IV was conducted in 2008 and consisted of in-home interviews that included self-report survey data and biological data recorded by trained in-person interviewers [22]. Of the respondents from Wave I of the study, 92.5% were located for Wave IV, with an 80.3% response rate of the 92.5% located. Only Wave IV data were employed in the current study (N = 5,115). Total number of participants included in the current analytic sample is 4,874 (mean age = 29; standard deviation [SD] = 1.78 years). In total, 241 participants (4.7%) were excluded from analyses due to missing data. Measures Sexual orientation Sexual orientation was defined via responses to two items: sexual identity and sexual attraction. Sexual identity: “Please choose the description that best fits how you think about yourself.” Same sex attraction: “Have you ever had a romantic attraction to a male?” or “Have you ever had a romantic attraction to a female?” Participants were included in the sexual minority group for analyses if they either indicated a nonheterosexual identity through responses of “bisexual,” “mostly homosexual,” or “100% homosexual” to the sexual identity item, or same-sex attraction, a common approach in the sexual orientation health literature [23]. All other individuals were assigned to the heterosexual group. A binary variable was created to represent sexual orientation such that “heterosexual = 0” and “sexual minority = 1.” Hypertension Hypertension was assessed using BP measurements and hypertension clinical cutoff scores. BP was measured as systolic blood pressure (SBP) and diastolic blood pressure (DBP). Each was measured during in-home interviews by a trained interviewer via three 30-s interval readings, with scores equaling the average of the second and third reading. Additionally, several binary variables of hypertension were created, based on consensus criteria in the field [24]: normal (SBP < 120 and DBP < 80), prehypertension (SBP 120–139 or DBP 80–89), hypertension 1 (SBP 140–159 or DBP 90–99), and hypertension 2 (SBP ≥ 160 or DBP ≥ 100). Organizational religious activity An organizational religious activity scale was created using two items assessing religious behaviors. The first item measured religious attendance: “In the past 12 months, how often did you attend religious services?” The second item measured participation in religious activities: “Many churches, synagogues, and other places of worship have special activities outside of regular worship services-such as classes, retreats, small groups, or choir. In the past 12 months, how often have you taken part in such activities?” Responses ranged from “never = 0” to “more than once a week = 5” for both items. Scores on these two items were summed to create an organizational religious activity scale, with internal consistency of α = 0.70. An item similar to these has been included in the psychometrically validated scale the Duke University Religion Index under the organizational religious activity subscale [25] and items measuring religious attendance have a long history of use to measure organizational religious activity in the literature [7, 26, 27]. Relevant covariates Previous research has found significant associations between age, sex, race, socioeconomic status, health behaviors (e.g., smoking, alcohol use, physical activity), body mass index (BMI), and hypertension [13]. Thus, these variables were considered as possible covariates in our analytic models. Smoking and alcohol use were assessed with the following items: “During the past 30 days, on how many days did you smoke cigarettes?” and “During the past 30 days, on how many days did you drink?” Physical activity was derived from seven items assessing frequency of various activities over a 7-day period that increase heart rate, such as: “In the past seven days, how many times did you participate in individual sports such as running, wrestling, swimming, cross-country skiing, cycle racing, or martial arts?” These seven items were summed to create an overall physical activity frequency variable. BMI was calculated by the standard formula using height and weight measurements. Planned analyses Complex Samples within SPSS (v23) was employed to account for the weighting, clustering, and stratification inherent to Add Health. Outliers in the continuous outcome variables (SBP and DBP) were corrected for by transforming BP values greater than 3.3 SDs to the next highest value that was not an outlier [28]. Overall, 0.08% of the data were identified as outliers. Due to missing data, 241 participants were excluded from analyses. Associations between organizational religious activity, sexual orientation, and BP were examined in a series of progressive general linear and logistic regression models. Model 1 controlled for covariates (age, sex, and BMI) that proved significant in bivariate correlations with all possible covariates and SBP and DBP (p < .05). Model 2 controlled for all potential covariates (age, sex, race, BMI, smoking and alcohol use, socioeconomic status, physical activity). Two general linear regression models were conducted with SBP and DBP as the dependent variables. Three subsequent logistic regression models were conducted examining increasing levels of clinical severity in hypertension (prehypertension and higher, hypertension 1 and 2, and hypertension 2). In all five models, organizational religious activity and sexual orientation were entered as the independent variables, along with the organizational religious activity by sexual orientation interaction term. If significant interaction terms emerged, subsequent simple slope analyses were conducted, examining the association between organizational religious activity and the outcome within each level of sexual orientation. Unstandardized regression coefficients, standard errors (SEs), and 95% confidence intervals (CIs) are reported for the general linear regression models and odds ratios (ORs), SEs, and 95% CIs are reported for the logistic regression models. R2 and Nagelkerke pseudo R2 are reported for linear and logistic regression models, respectively. Additionally, to test within sexual minority group differences between religious and nonreligious participants on sociodemographic variables (level of education, neighborhood type, income, household type, and age), a binary variable was created to represent religious attendance; “0 = no religious attendance in the past 12 months” and “1 = attended religious services a few times or more in the past 12 months.” Results The overall sample was roughly evenly distributed by sex (female: 50.5%) and was predominately White (80.2%). The breakdown of hypertension levels is as follows: 1719 (32.7%) normal, 2340 (47.7%) prehypertension, 729 (15.8%) hypertension 1, and 195 (3.8%) hypertension 2. See Table 1 for additional demographics for the total sample and within sexual orientation subgroups. There were no significant demographic differences between nonreligious and religious sexual minority individuals. See Table 2 for statistical analyses of demographic differences between religious and nonreligious sexual minority individuals. Table 1 Sample Characteristics Variable Sexual minority N (% weighted) Heterosexual N (% weighted) Total N (% weighted) Sex  Female 263 (70.8%) 2,499 (47.9%) 2,762 (49.5%)  Male 103 (29.2%) 2,249 (52.1%) 2,352 (50.5%) Race  White 258 (81.1%) 3,413 (80.2%) 3,671 (80.2%)  Non-White 107 (18.9%) 1,331 (19.8%) 1,438 (19.8%) Hypertension levels  Normal 145 (40.4%) 1,574 (32.2%) 1,719 (32.7%)  Prehypertension 149 (42.4%) 2,191 (48.1%) 2,340 (47.7%)  Hypertension 1 47 (13.4%) 682 (16%) 729 (15.8%)  Hypertension 2 17 (3.8%) 178 (3.8%) 195 (3.8%) M (SD) Organizational Religious Activity Scale 1.43 (2.05) 2.38 (2.58) 2.26 (2.55) Religious attendance 1.06 (1.34) 1.69 (1.61) 1.65 (1.6) Religious activities 0.37 (0.962) 0.63 (1.23) 0.61 (1.21) Age (years) 28.68 (2.78) 29.03 (1.78) 29 (1.78) BMI 29.22 (11.75) 29.11 (7.44) 29.14 (7.49) Education 5.52 (2.46) 5.85 (2.42) 5.83 (2.42) Income 7.35 (2.84) 8.05 (2.55) 8 (2.58) Smoking 11.61 (13.79) 8.01 (12.61) 8.27 (12.73) Alcohol 2.35 (1.49) 2.3 (1.44) 2.3 (1.45) Physical Activity 6.75 (5.79) 6.35 (5.98) 6.38 (5.97) SBP 123.15 (15.05) 124.55 (13.51) 124.45 (13.56) DBP 78.28 (13.18) 79.09 (10.15) 79.05 (10.2) Variable Sexual minority N (% weighted) Heterosexual N (% weighted) Total N (% weighted) Sex  Female 263 (70.8%) 2,499 (47.9%) 2,762 (49.5%)  Male 103 (29.2%) 2,249 (52.1%) 2,352 (50.5%) Race  White 258 (81.1%) 3,413 (80.2%) 3,671 (80.2%)  Non-White 107 (18.9%) 1,331 (19.8%) 1,438 (19.8%) Hypertension levels  Normal 145 (40.4%) 1,574 (32.2%) 1,719 (32.7%)  Prehypertension 149 (42.4%) 2,191 (48.1%) 2,340 (47.7%)  Hypertension 1 47 (13.4%) 682 (16%) 729 (15.8%)  Hypertension 2 17 (3.8%) 178 (3.8%) 195 (3.8%) M (SD) Organizational Religious Activity Scale 1.43 (2.05) 2.38 (2.58) 2.26 (2.55) Religious attendance 1.06 (1.34) 1.69 (1.61) 1.65 (1.6) Religious activities 0.37 (0.962) 0.63 (1.23) 0.61 (1.21) Age (years) 28.68 (2.78) 29.03 (1.78) 29 (1.78) BMI 29.22 (11.75) 29.11 (7.44) 29.14 (7.49) Education 5.52 (2.46) 5.85 (2.42) 5.83 (2.42) Income 7.35 (2.84) 8.05 (2.55) 8 (2.58) Smoking 11.61 (13.79) 8.01 (12.61) 8.27 (12.73) Alcohol 2.35 (1.49) 2.3 (1.44) 2.3 (1.45) Physical Activity 6.75 (5.79) 6.35 (5.98) 6.38 (5.97) SBP 123.15 (15.05) 124.55 (13.51) 124.45 (13.56) DBP 78.28 (13.18) 79.09 (10.15) 79.05 (10.2) M mean; SD standard deviation; N number of participants; BMI body mass index; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10, Education scaled “1 = 8th grade or less” to “13 = Completed a doctoral degree,” Income scaled “1 = Less than $5,000” to “12 = $150,000 or more,” Smoking scaled 1 to 30, Alcohol scaled “0 = None” to “6 = Every day or almost every day,” Physical Activity scaled 0 to 35. View Large Table 1 Sample Characteristics Variable Sexual minority N (% weighted) Heterosexual N (% weighted) Total N (% weighted) Sex  Female 263 (70.8%) 2,499 (47.9%) 2,762 (49.5%)  Male 103 (29.2%) 2,249 (52.1%) 2,352 (50.5%) Race  White 258 (81.1%) 3,413 (80.2%) 3,671 (80.2%)  Non-White 107 (18.9%) 1,331 (19.8%) 1,438 (19.8%) Hypertension levels  Normal 145 (40.4%) 1,574 (32.2%) 1,719 (32.7%)  Prehypertension 149 (42.4%) 2,191 (48.1%) 2,340 (47.7%)  Hypertension 1 47 (13.4%) 682 (16%) 729 (15.8%)  Hypertension 2 17 (3.8%) 178 (3.8%) 195 (3.8%) M (SD) Organizational Religious Activity Scale 1.43 (2.05) 2.38 (2.58) 2.26 (2.55) Religious attendance 1.06 (1.34) 1.69 (1.61) 1.65 (1.6) Religious activities 0.37 (0.962) 0.63 (1.23) 0.61 (1.21) Age (years) 28.68 (2.78) 29.03 (1.78) 29 (1.78) BMI 29.22 (11.75) 29.11 (7.44) 29.14 (7.49) Education 5.52 (2.46) 5.85 (2.42) 5.83 (2.42) Income 7.35 (2.84) 8.05 (2.55) 8 (2.58) Smoking 11.61 (13.79) 8.01 (12.61) 8.27 (12.73) Alcohol 2.35 (1.49) 2.3 (1.44) 2.3 (1.45) Physical Activity 6.75 (5.79) 6.35 (5.98) 6.38 (5.97) SBP 123.15 (15.05) 124.55 (13.51) 124.45 (13.56) DBP 78.28 (13.18) 79.09 (10.15) 79.05 (10.2) Variable Sexual minority N (% weighted) Heterosexual N (% weighted) Total N (% weighted) Sex  Female 263 (70.8%) 2,499 (47.9%) 2,762 (49.5%)  Male 103 (29.2%) 2,249 (52.1%) 2,352 (50.5%) Race  White 258 (81.1%) 3,413 (80.2%) 3,671 (80.2%)  Non-White 107 (18.9%) 1,331 (19.8%) 1,438 (19.8%) Hypertension levels  Normal 145 (40.4%) 1,574 (32.2%) 1,719 (32.7%)  Prehypertension 149 (42.4%) 2,191 (48.1%) 2,340 (47.7%)  Hypertension 1 47 (13.4%) 682 (16%) 729 (15.8%)  Hypertension 2 17 (3.8%) 178 (3.8%) 195 (3.8%) M (SD) Organizational Religious Activity Scale 1.43 (2.05) 2.38 (2.58) 2.26 (2.55) Religious attendance 1.06 (1.34) 1.69 (1.61) 1.65 (1.6) Religious activities 0.37 (0.962) 0.63 (1.23) 0.61 (1.21) Age (years) 28.68 (2.78) 29.03 (1.78) 29 (1.78) BMI 29.22 (11.75) 29.11 (7.44) 29.14 (7.49) Education 5.52 (2.46) 5.85 (2.42) 5.83 (2.42) Income 7.35 (2.84) 8.05 (2.55) 8 (2.58) Smoking 11.61 (13.79) 8.01 (12.61) 8.27 (12.73) Alcohol 2.35 (1.49) 2.3 (1.44) 2.3 (1.45) Physical Activity 6.75 (5.79) 6.35 (5.98) 6.38 (5.97) SBP 123.15 (15.05) 124.55 (13.51) 124.45 (13.56) DBP 78.28 (13.18) 79.09 (10.15) 79.05 (10.2) M mean; SD standard deviation; N number of participants; BMI body mass index; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10, Education scaled “1 = 8th grade or less” to “13 = Completed a doctoral degree,” Income scaled “1 = Less than $5,000” to “12 = $150,000 or more,” Smoking scaled 1 to 30, Alcohol scaled “0 = None” to “6 = Every day or almost every day,” Physical Activity scaled 0 to 35. View Large Table 2 Demographic Comparisons of Religious Versus Nonreligious Sexual Minority Individuals Variable Nonreligious N (% within row variable) Religious N (% within row variable) Total (percent of total) Chi-square Total 167 (45.6%) 199 (54.4%) 366 (100%) Education 4.35  High school and below 54 (53.5%) 47 (46.5%) 101 (27.6%)  Some college 72 (45%) 88 (55%) 160 (43.7%)  College and above 41 (39%) 64 (61%) 105 (28.7%) Neighborhood 1.80  Rural 29 (51.8%) 27 (48.2%) 56 (18.1%)  Suburban 59 (49.2%) 61 (50.8%) 120 (38.7%)  Urban 57 (42.5%) 77 (57.5%) 134 (43.2%) Income 1.76  ≤$39,999 77 (49.4%) 79 (50.6%) 156 (45.7%)  ≥$40,000 78 (42.2%) 107 (57.8%) 185 (54.3%) Household type 5.06~  Parents’ home 19 (33.3%) 38 (66.7%) 57 (15.7%)  Another home 13 (41.9%) 18 (58.1%) 31 (8.6%)  Own home 135 (49.3%) 139 (50.7%) 274 (75.7%) M (SD) M (SD) t-value Age 28.57 (1.68) 28.70 (1.72) −0.72 Variable Nonreligious N (% within row variable) Religious N (% within row variable) Total (percent of total) Chi-square Total 167 (45.6%) 199 (54.4%) 366 (100%) Education 4.35  High school and below 54 (53.5%) 47 (46.5%) 101 (27.6%)  Some college 72 (45%) 88 (55%) 160 (43.7%)  College and above 41 (39%) 64 (61%) 105 (28.7%) Neighborhood 1.80  Rural 29 (51.8%) 27 (48.2%) 56 (18.1%)  Suburban 59 (49.2%) 61 (50.8%) 120 (38.7%)  Urban 57 (42.5%) 77 (57.5%) 134 (43.2%) Income 1.76  ≤$39,999 77 (49.4%) 79 (50.6%) 156 (45.7%)  ≥$40,000 78 (42.2%) 107 (57.8%) 185 (54.3%) Household type 5.06~  Parents’ home 19 (33.3%) 38 (66.7%) 57 (15.7%)  Another home 13 (41.9%) 18 (58.1%) 31 (8.6%)  Own home 135 (49.3%) 139 (50.7%) 274 (75.7%) M (SD) M (SD) t-value Age 28.57 (1.68) 28.70 (1.72) −0.72 M mean; SD standard deviation; N number of participants. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 2 Demographic Comparisons of Religious Versus Nonreligious Sexual Minority Individuals Variable Nonreligious N (% within row variable) Religious N (% within row variable) Total (percent of total) Chi-square Total 167 (45.6%) 199 (54.4%) 366 (100%) Education 4.35  High school and below 54 (53.5%) 47 (46.5%) 101 (27.6%)  Some college 72 (45%) 88 (55%) 160 (43.7%)  College and above 41 (39%) 64 (61%) 105 (28.7%) Neighborhood 1.80  Rural 29 (51.8%) 27 (48.2%) 56 (18.1%)  Suburban 59 (49.2%) 61 (50.8%) 120 (38.7%)  Urban 57 (42.5%) 77 (57.5%) 134 (43.2%) Income 1.76  ≤$39,999 77 (49.4%) 79 (50.6%) 156 (45.7%)  ≥$40,000 78 (42.2%) 107 (57.8%) 185 (54.3%) Household type 5.06~  Parents’ home 19 (33.3%) 38 (66.7%) 57 (15.7%)  Another home 13 (41.9%) 18 (58.1%) 31 (8.6%)  Own home 135 (49.3%) 139 (50.7%) 274 (75.7%) M (SD) M (SD) t-value Age 28.57 (1.68) 28.70 (1.72) −0.72 Variable Nonreligious N (% within row variable) Religious N (% within row variable) Total (percent of total) Chi-square Total 167 (45.6%) 199 (54.4%) 366 (100%) Education 4.35  High school and below 54 (53.5%) 47 (46.5%) 101 (27.6%)  Some college 72 (45%) 88 (55%) 160 (43.7%)  College and above 41 (39%) 64 (61%) 105 (28.7%) Neighborhood 1.80  Rural 29 (51.8%) 27 (48.2%) 56 (18.1%)  Suburban 59 (49.2%) 61 (50.8%) 120 (38.7%)  Urban 57 (42.5%) 77 (57.5%) 134 (43.2%) Income 1.76  ≤$39,999 77 (49.4%) 79 (50.6%) 156 (45.7%)  ≥$40,000 78 (42.2%) 107 (57.8%) 185 (54.3%) Household type 5.06~  Parents’ home 19 (33.3%) 38 (66.7%) 57 (15.7%)  Another home 13 (41.9%) 18 (58.1%) 31 (8.6%)  Own home 135 (49.3%) 139 (50.7%) 274 (75.7%) M (SD) M (SD) t-value Age 28.57 (1.68) 28.70 (1.72) −0.72 M mean; SD standard deviation; N number of participants. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Model 1 was significant for SBP (F(6,126) = 183.94, p < .001, R2 = .25), DBP (F(6,126) = 83.89, p < .001, R2 = .14), prehypertension and higher (F(6,126) = 109.50, p < .001, R2 = .26), hypertension 1 and 2 (F(6,126) = 35.74, p < .001, R2 = .13), and hypertension 2 (F(6,126) = 15.18, p < .001, R2 = .10). In Model 1, the organizational religious activity by sexual orientation interaction proved significant for all possible BP and hypertension outcomes (Table 3). Simple slope analyses revealed a crossover interaction for SBP, DBP, and prehypertension or higher. Organizational religious activity displayed a negative association with SBP and DBP in the heterosexual group and a positive association in the sexual minority group. In the heterosexual group, greater organizational religious activity was significantly associated with decreased odds of being diagnosed with prehypertension or higher (OR = 0.95, SE = 0.01, p < .001), whereas in the sexual minority group organizational religious activity was significantly associated with increased odds of being diagnosed with prehypertension or higher (OR = 1.18, SE = 0.07, p = .02). Simple slope analyses revealed that organizational religious activity was not significantly associated with hypertension 2 in the heterosexual group, but was significantly associated with increased odds of being diagnosed with hypertension 2 in the sexual minority group (OR = 1.38, SE = 0.02, p < .001). Simple slope analyses did not reveal significant associations for organizational religious activity and hypertension 1 and 2 in either the heterosexual or sexual minority groups; however, organizational religious activity did approach significance in the sexual minority group, such that greater organizational religious activity was associated with increased odds of being diagnosed with hypertension 1 and 2 (OR = 1.13, SE = 0.07, p = .06). See Table 6 for full statistics reported for simple slope analyses. Table 3 BP and Hypertension Associations With Organizational Religious Activity and Sexual Orientation Interaction Effects b (SE) t-value 95% CI SBP  Model 1a −1.57 (0.39)*** −3.97 [−2.36, −0.08]  Model 2b −1.57 (0.39)*** −3.98 [−2.36, −0.08] DBP  Model 1a −0.997 (0.35)** −2.87 [−1.68, −0.31]  Model 2b −0.993 (0.34)** −2.91 [−1.67, −0.32] b (SE) t-value 95% CI Prehypertension and higher  Model 1a −0.21 (0.08)** −2.63 [−0.38, −0.05]  Model 2b −0.23 (0.09)** −2.65 [−0.39, −0.06] Hypertension 1 and 2  Model 1a −0.15 (0.07)* −2.08 [−0.30, −0.01]  Model 2b −0.15 (0.07)~ −1.97 [−0.29, 0.00] Hypertension 2  Model 1a −0.39 (0.11)*** −3.51 [−0.62, −0.17]  Model 2b −0.37 (0.12)** −3.24 [−0.60, −0.15] b (SE) t-value 95% CI SBP  Model 1a −1.57 (0.39)*** −3.97 [−2.36, −0.08]  Model 2b −1.57 (0.39)*** −3.98 [−2.36, −0.08] DBP  Model 1a −0.997 (0.35)** −2.87 [−1.68, −0.31]  Model 2b −0.993 (0.34)** −2.91 [−1.67, −0.32] b (SE) t-value 95% CI Prehypertension and higher  Model 1a −0.21 (0.08)** −2.63 [−0.38, −0.05]  Model 2b −0.23 (0.09)** −2.65 [−0.39, −0.06] Hypertension 1 and 2  Model 1a −0.15 (0.07)* −2.08 [−0.30, −0.01]  Model 2b −0.15 (0.07)~ −1.97 [−0.29, 0.00] Hypertension 2  Model 1a −0.39 (0.11)*** −3.51 [−0.62, −0.17]  Model 2b −0.37 (0.12)** −3.24 [−0.60, −0.15] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aModels controlling for age, sex, and BMI. bModels controlling for all covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 3 BP and Hypertension Associations With Organizational Religious Activity and Sexual Orientation Interaction Effects b (SE) t-value 95% CI SBP  Model 1a −1.57 (0.39)*** −3.97 [−2.36, −0.08]  Model 2b −1.57 (0.39)*** −3.98 [−2.36, −0.08] DBP  Model 1a −0.997 (0.35)** −2.87 [−1.68, −0.31]  Model 2b −0.993 (0.34)** −2.91 [−1.67, −0.32] b (SE) t-value 95% CI Prehypertension and higher  Model 1a −0.21 (0.08)** −2.63 [−0.38, −0.05]  Model 2b −0.23 (0.09)** −2.65 [−0.39, −0.06] Hypertension 1 and 2  Model 1a −0.15 (0.07)* −2.08 [−0.30, −0.01]  Model 2b −0.15 (0.07)~ −1.97 [−0.29, 0.00] Hypertension 2  Model 1a −0.39 (0.11)*** −3.51 [−0.62, −0.17]  Model 2b −0.37 (0.12)** −3.24 [−0.60, −0.15] b (SE) t-value 95% CI SBP  Model 1a −1.57 (0.39)*** −3.97 [−2.36, −0.08]  Model 2b −1.57 (0.39)*** −3.98 [−2.36, −0.08] DBP  Model 1a −0.997 (0.35)** −2.87 [−1.68, −0.31]  Model 2b −0.993 (0.34)** −2.91 [−1.67, −0.32] b (SE) t-value 95% CI Prehypertension and higher  Model 1a −0.21 (0.08)** −2.63 [−0.38, −0.05]  Model 2b −0.23 (0.09)** −2.65 [−0.39, −0.06] Hypertension 1 and 2  Model 1a −0.15 (0.07)* −2.08 [−0.30, −0.01]  Model 2b −0.15 (0.07)~ −1.97 [−0.29, 0.00] Hypertension 2  Model 1a −0.39 (0.11)*** −3.51 [−0.62, −0.17]  Model 2b −0.37 (0.12)** −3.24 [−0.60, −0.15] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aModels controlling for age, sex, and BMI. bModels controlling for all covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Model 2 was significant for SBP (F(12,120) = 103.46, p < .001, R2 = .25), DBP (F(12,120) = 44.93, p < .001, R2 = .15), prehypertension and higher (F(12,120) = 62.98, p < .001, R2 = .27), hypertension 1 and 2 (F(12,120) = 18.15, p < .001, R2 = .13), and hypertension 2 (F(12,120) = 7.79, p < .001, R2 = .11). In Model 2, the organizational religious activity by sexual orientation interaction proved significant for SBP, DBP, prehypertension and higher, and hypertension 2 (Table 3). Simple slope analyses displayed a crossover interaction for SBP, DBP, and prehypertension or higher. Organizational religious activity displayed a negative association with SBP and DBP in the heterosexual group and a positive association with SBP and DBP in the sexual minority group. For a visual representation of this crossover interaction effect for SBP and DBP, see Fig. 1. In the heterosexual group, greater organizational religious activity was significantly associated with decreased odds of being diagnosed with prehypertension or higher (OR = 0.96, SE = 0.01, p = .01), whereas in the sexual minority group organizational religious activity was significantly associated with increased odds of being diagnosed with prehypertension or higher (OR = 1.20, SE = 0.08, p = .02). Simple slope analyses revealed that organizational religious activity was not significantly associated with hypertension 2 in the heterosexual group, but was significantly associated with increased odds of being diagnosed with hypertension 2 in the sexual minority group (OR = 1.33, SE = 0.10, p = .01). See Tables 4 and 5 for associations of all covariates in the linear and logistic regression models. Table 4 Results of Linear Regression Analyses for BP Associations With All Covariatesa b (SE) t-value 95% CI SBP  Organizational Religious Activity 1.36 (0.40)*** 3.40 [0.57, 2.15]  Sexual Minority 1.79 (0.90)* 2.00 [0.02, 3.57]  Organizational Religious Activity × Sexual Orientation −1.57 (0.40)*** −3.98 [−2.36, −0.79]  Female 9.86 (0.40)*** 24.85 [9.07, 10.64]  Non-White −0.68 (0.56) −1.21 [−1.79, 0.43]  BMI 0.59 (0.04)*** 15.95 [0.52, 0.66]  Smoking 0.01 (0.02) 0.26 [−0.03, 0.04]  Alcohol 0.63 (0.14)*** 4.35 [0.34, 0.91]  Income −0.10 (0.10) −0.96 [−0.29, 0.10]  Education −0.12 (0.09) −1.28 [−0.30, 0.06]  Physical Activity −0.01 (0.03) −0.23 [−0.07, 0.05]  Age 0.27 (0.12)* 2.23 [0.03, 0.50] DBP  Organizational Religious Activity 0.87 (0.34)* 2.55 [0.20, 1.54]  Sexual Orientation 1.32 (0.87) 1.53 [−0.38, 3.04]  Organizational Religious Activity × Sexual Orientation −0.99 (0.34)** −2.91 [−1.67, −0.32]  Female 4.59 (0.32)*** 14.36 [3.95, 5.22]  Non-White −0.34 (0.48) −0.70 [−1.29, 0.62]  BMI 0.37 (0.03)*** 14.55 [0.32, 0.42]  Smoking 0.01 (0.01) 0.19 [−0.02, 0.03]  Alcohol 0.56 (0.11)*** 4.96 [0.11, 0.34]  Income −0.09 (0.07) −1.41 [−0.22, 0.04]  Education −0.06 (0.09) −0.67 [−0.23, 0.11]  Physical Activity −0.07 (0.03)** −2.85 [−0.12, 1.02]  Age 0.54 (0.09)*** 5.91 [0.36, 0.73] b (SE) t-value 95% CI SBP  Organizational Religious Activity 1.36 (0.40)*** 3.40 [0.57, 2.15]  Sexual Minority 1.79 (0.90)* 2.00 [0.02, 3.57]  Organizational Religious Activity × Sexual Orientation −1.57 (0.40)*** −3.98 [−2.36, −0.79]  Female 9.86 (0.40)*** 24.85 [9.07, 10.64]  Non-White −0.68 (0.56) −1.21 [−1.79, 0.43]  BMI 0.59 (0.04)*** 15.95 [0.52, 0.66]  Smoking 0.01 (0.02) 0.26 [−0.03, 0.04]  Alcohol 0.63 (0.14)*** 4.35 [0.34, 0.91]  Income −0.10 (0.10) −0.96 [−0.29, 0.10]  Education −0.12 (0.09) −1.28 [−0.30, 0.06]  Physical Activity −0.01 (0.03) −0.23 [−0.07, 0.05]  Age 0.27 (0.12)* 2.23 [0.03, 0.50] DBP  Organizational Religious Activity 0.87 (0.34)* 2.55 [0.20, 1.54]  Sexual Orientation 1.32 (0.87) 1.53 [−0.38, 3.04]  Organizational Religious Activity × Sexual Orientation −0.99 (0.34)** −2.91 [−1.67, −0.32]  Female 4.59 (0.32)*** 14.36 [3.95, 5.22]  Non-White −0.34 (0.48) −0.70 [−1.29, 0.62]  BMI 0.37 (0.03)*** 14.55 [0.32, 0.42]  Smoking 0.01 (0.01) 0.19 [−0.02, 0.03]  Alcohol 0.56 (0.11)*** 4.96 [0.11, 0.34]  Income −0.09 (0.07) −1.41 [−0.22, 0.04]  Education −0.06 (0.09) −0.67 [−0.23, 0.11]  Physical Activity −0.07 (0.03)** −2.85 [−0.12, 1.02]  Age 0.54 (0.09)*** 5.91 [0.36, 0.73] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aResults are from Model 2, controlling for all possible covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 4 Results of Linear Regression Analyses for BP Associations With All Covariatesa b (SE) t-value 95% CI SBP  Organizational Religious Activity 1.36 (0.40)*** 3.40 [0.57, 2.15]  Sexual Minority 1.79 (0.90)* 2.00 [0.02, 3.57]  Organizational Religious Activity × Sexual Orientation −1.57 (0.40)*** −3.98 [−2.36, −0.79]  Female 9.86 (0.40)*** 24.85 [9.07, 10.64]  Non-White −0.68 (0.56) −1.21 [−1.79, 0.43]  BMI 0.59 (0.04)*** 15.95 [0.52, 0.66]  Smoking 0.01 (0.02) 0.26 [−0.03, 0.04]  Alcohol 0.63 (0.14)*** 4.35 [0.34, 0.91]  Income −0.10 (0.10) −0.96 [−0.29, 0.10]  Education −0.12 (0.09) −1.28 [−0.30, 0.06]  Physical Activity −0.01 (0.03) −0.23 [−0.07, 0.05]  Age 0.27 (0.12)* 2.23 [0.03, 0.50] DBP  Organizational Religious Activity 0.87 (0.34)* 2.55 [0.20, 1.54]  Sexual Orientation 1.32 (0.87) 1.53 [−0.38, 3.04]  Organizational Religious Activity × Sexual Orientation −0.99 (0.34)** −2.91 [−1.67, −0.32]  Female 4.59 (0.32)*** 14.36 [3.95, 5.22]  Non-White −0.34 (0.48) −0.70 [−1.29, 0.62]  BMI 0.37 (0.03)*** 14.55 [0.32, 0.42]  Smoking 0.01 (0.01) 0.19 [−0.02, 0.03]  Alcohol 0.56 (0.11)*** 4.96 [0.11, 0.34]  Income −0.09 (0.07) −1.41 [−0.22, 0.04]  Education −0.06 (0.09) −0.67 [−0.23, 0.11]  Physical Activity −0.07 (0.03)** −2.85 [−0.12, 1.02]  Age 0.54 (0.09)*** 5.91 [0.36, 0.73] b (SE) t-value 95% CI SBP  Organizational Religious Activity 1.36 (0.40)*** 3.40 [0.57, 2.15]  Sexual Minority 1.79 (0.90)* 2.00 [0.02, 3.57]  Organizational Religious Activity × Sexual Orientation −1.57 (0.40)*** −3.98 [−2.36, −0.79]  Female 9.86 (0.40)*** 24.85 [9.07, 10.64]  Non-White −0.68 (0.56) −1.21 [−1.79, 0.43]  BMI 0.59 (0.04)*** 15.95 [0.52, 0.66]  Smoking 0.01 (0.02) 0.26 [−0.03, 0.04]  Alcohol 0.63 (0.14)*** 4.35 [0.34, 0.91]  Income −0.10 (0.10) −0.96 [−0.29, 0.10]  Education −0.12 (0.09) −1.28 [−0.30, 0.06]  Physical Activity −0.01 (0.03) −0.23 [−0.07, 0.05]  Age 0.27 (0.12)* 2.23 [0.03, 0.50] DBP  Organizational Religious Activity 0.87 (0.34)* 2.55 [0.20, 1.54]  Sexual Orientation 1.32 (0.87) 1.53 [−0.38, 3.04]  Organizational Religious Activity × Sexual Orientation −0.99 (0.34)** −2.91 [−1.67, −0.32]  Female 4.59 (0.32)*** 14.36 [3.95, 5.22]  Non-White −0.34 (0.48) −0.70 [−1.29, 0.62]  BMI 0.37 (0.03)*** 14.55 [0.32, 0.42]  Smoking 0.01 (0.01) 0.19 [−0.02, 0.03]  Alcohol 0.56 (0.11)*** 4.96 [0.11, 0.34]  Income −0.09 (0.07) −1.41 [−0.22, 0.04]  Education −0.06 (0.09) −0.67 [−0.23, 0.11]  Physical Activity −0.07 (0.03)** −2.85 [−0.12, 1.02]  Age 0.54 (0.09)*** 5.91 [0.36, 0.73] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aResults are from Model 2, controlling for all possible covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 5 Results of Logistic Regression Analyses for Hypertension Associations With All Covariatesa OR (SE) t-value 95% CI Prehypertension and higher  Organizational Religious Activity 1.21 (0.09)* 2.21 [1.02, 1.43]  Sexual Orientation 0.92 (0.17)* 2.29 [0.58, 1.44]  Organizational Religious Activity × Sexual Orientation 0.80 (0.09)** −2.65 [0.68, 0.94]  Female 5.05 (0.08)*** 19.85 [4.30, 5.93]  Non-White 0.98 (0.10) −0.24 [0.81, 1.19]  BMI 1.10 (0.01)*** 13.28 [1.09, 1.12]  Smoking 0.99 (0.01) −0.34 [0.99, 1.01]  Alcohol 1.14 (0.03)*** 4.62 [1.08, 1.20]  Income 0.98 (0.02) −0.98 [0.95, 1.02]  Education 0.97 (0.02) −1.54 [0.93, 1.01]  Physical Activity 0.99 (0.01) −2.65 [0.98, 1.01]  Age 1.05 (0.02)* 2.13 [1.00, 1.10] Hypertension 1 and 2  Organizational Religious Activity 1.14 (0.07)~ 1.10 [0.99, 1.32]  Sexual Orientation 0.81 (0.27) 0.36 [0.55, 1.19]  Organizational Religious Activity × Sexual Orientation 0.87 (0.07)~ −1.97 [0.76, 1.00]  Female 2.97 (0.11)*** 9.87 [2.39, 3.69]  Non-White 0.82 (0.11)~ −1.74 [0.66, 1.03]  BMI 1.08 (0.01)*** 11.71 [1.06, 1.09]  Smoking 1.01 (0.01)~ 1.70 [0.99, 1.01]  Alcohol 1.08 (0.03)** 2.33 [1.01, 1.15]  Income 0.99 (0.02) −0.64 [0.95, 1.03]  Education 0.99 (0.02) −0.51 [0.94, 1.04]  Physical Activity 0.99 (0.01) −0.07 [0.98, 1.02]  Age 1.09 (0.03)** 3.13 [1.03, 1.15] Hypertension 2  Organizational Religious Activity 1.36 (0.11)** 2.85 [1.10, 1.68]  Sexual Orientation 0.93 (0.43) 1.62 [0.49, 1.76]  Organizational Religious Activity × Sexual Orientation 0.71 (0.12)** −3.24 [0.57, 0.89]  Female 1.97 (0.19)*** 3.65 [1.36, 2.84]  Non-White 0.53 (0.23)** −2.79 [0.34, 0.83]  BMI 1.09 (0.01)*** 8.27 [1.07, 1.11]  Smoking 1.01 (0.01) 0.85 [0.99, 1.02]  Alcohol 1.00 (0.07) 0.01 [0.88, 1.14]  Income 1.01 (0.04) 0.25 [0.94, 1.09]  Education 0.97 (0.03) −0.63 [0.89, 1.07]  Physical Activity 0.98 (0.02) −1.28 [0.95, 1.01]  Age 1.10 (0.05)~ 1.73 [0.99, 1.22] OR (SE) t-value 95% CI Prehypertension and higher  Organizational Religious Activity 1.21 (0.09)* 2.21 [1.02, 1.43]  Sexual Orientation 0.92 (0.17)* 2.29 [0.58, 1.44]  Organizational Religious Activity × Sexual Orientation 0.80 (0.09)** −2.65 [0.68, 0.94]  Female 5.05 (0.08)*** 19.85 [4.30, 5.93]  Non-White 0.98 (0.10) −0.24 [0.81, 1.19]  BMI 1.10 (0.01)*** 13.28 [1.09, 1.12]  Smoking 0.99 (0.01) −0.34 [0.99, 1.01]  Alcohol 1.14 (0.03)*** 4.62 [1.08, 1.20]  Income 0.98 (0.02) −0.98 [0.95, 1.02]  Education 0.97 (0.02) −1.54 [0.93, 1.01]  Physical Activity 0.99 (0.01) −2.65 [0.98, 1.01]  Age 1.05 (0.02)* 2.13 [1.00, 1.10] Hypertension 1 and 2  Organizational Religious Activity 1.14 (0.07)~ 1.10 [0.99, 1.32]  Sexual Orientation 0.81 (0.27) 0.36 [0.55, 1.19]  Organizational Religious Activity × Sexual Orientation 0.87 (0.07)~ −1.97 [0.76, 1.00]  Female 2.97 (0.11)*** 9.87 [2.39, 3.69]  Non-White 0.82 (0.11)~ −1.74 [0.66, 1.03]  BMI 1.08 (0.01)*** 11.71 [1.06, 1.09]  Smoking 1.01 (0.01)~ 1.70 [0.99, 1.01]  Alcohol 1.08 (0.03)** 2.33 [1.01, 1.15]  Income 0.99 (0.02) −0.64 [0.95, 1.03]  Education 0.99 (0.02) −0.51 [0.94, 1.04]  Physical Activity 0.99 (0.01) −0.07 [0.98, 1.02]  Age 1.09 (0.03)** 3.13 [1.03, 1.15] Hypertension 2  Organizational Religious Activity 1.36 (0.11)** 2.85 [1.10, 1.68]  Sexual Orientation 0.93 (0.43) 1.62 [0.49, 1.76]  Organizational Religious Activity × Sexual Orientation 0.71 (0.12)** −3.24 [0.57, 0.89]  Female 1.97 (0.19)*** 3.65 [1.36, 2.84]  Non-White 0.53 (0.23)** −2.79 [0.34, 0.83]  BMI 1.09 (0.01)*** 8.27 [1.07, 1.11]  Smoking 1.01 (0.01) 0.85 [0.99, 1.02]  Alcohol 1.00 (0.07) 0.01 [0.88, 1.14]  Income 1.01 (0.04) 0.25 [0.94, 1.09]  Education 0.97 (0.03) −0.63 [0.89, 1.07]  Physical Activity 0.98 (0.02) −1.28 [0.95, 1.01]  Age 1.10 (0.05)~ 1.73 [0.99, 1.22] OR odds ratio; SE standard error; CI confidence interval; BMI body mass index. Organizational Religious Activity Scale scaled 0 to 10. aResults are from Model 2, controlling for all possible covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 5 Results of Logistic Regression Analyses for Hypertension Associations With All Covariatesa OR (SE) t-value 95% CI Prehypertension and higher  Organizational Religious Activity 1.21 (0.09)* 2.21 [1.02, 1.43]  Sexual Orientation 0.92 (0.17)* 2.29 [0.58, 1.44]  Organizational Religious Activity × Sexual Orientation 0.80 (0.09)** −2.65 [0.68, 0.94]  Female 5.05 (0.08)*** 19.85 [4.30, 5.93]  Non-White 0.98 (0.10) −0.24 [0.81, 1.19]  BMI 1.10 (0.01)*** 13.28 [1.09, 1.12]  Smoking 0.99 (0.01) −0.34 [0.99, 1.01]  Alcohol 1.14 (0.03)*** 4.62 [1.08, 1.20]  Income 0.98 (0.02) −0.98 [0.95, 1.02]  Education 0.97 (0.02) −1.54 [0.93, 1.01]  Physical Activity 0.99 (0.01) −2.65 [0.98, 1.01]  Age 1.05 (0.02)* 2.13 [1.00, 1.10] Hypertension 1 and 2  Organizational Religious Activity 1.14 (0.07)~ 1.10 [0.99, 1.32]  Sexual Orientation 0.81 (0.27) 0.36 [0.55, 1.19]  Organizational Religious Activity × Sexual Orientation 0.87 (0.07)~ −1.97 [0.76, 1.00]  Female 2.97 (0.11)*** 9.87 [2.39, 3.69]  Non-White 0.82 (0.11)~ −1.74 [0.66, 1.03]  BMI 1.08 (0.01)*** 11.71 [1.06, 1.09]  Smoking 1.01 (0.01)~ 1.70 [0.99, 1.01]  Alcohol 1.08 (0.03)** 2.33 [1.01, 1.15]  Income 0.99 (0.02) −0.64 [0.95, 1.03]  Education 0.99 (0.02) −0.51 [0.94, 1.04]  Physical Activity 0.99 (0.01) −0.07 [0.98, 1.02]  Age 1.09 (0.03)** 3.13 [1.03, 1.15] Hypertension 2  Organizational Religious Activity 1.36 (0.11)** 2.85 [1.10, 1.68]  Sexual Orientation 0.93 (0.43) 1.62 [0.49, 1.76]  Organizational Religious Activity × Sexual Orientation 0.71 (0.12)** −3.24 [0.57, 0.89]  Female 1.97 (0.19)*** 3.65 [1.36, 2.84]  Non-White 0.53 (0.23)** −2.79 [0.34, 0.83]  BMI 1.09 (0.01)*** 8.27 [1.07, 1.11]  Smoking 1.01 (0.01) 0.85 [0.99, 1.02]  Alcohol 1.00 (0.07) 0.01 [0.88, 1.14]  Income 1.01 (0.04) 0.25 [0.94, 1.09]  Education 0.97 (0.03) −0.63 [0.89, 1.07]  Physical Activity 0.98 (0.02) −1.28 [0.95, 1.01]  Age 1.10 (0.05)~ 1.73 [0.99, 1.22] OR (SE) t-value 95% CI Prehypertension and higher  Organizational Religious Activity 1.21 (0.09)* 2.21 [1.02, 1.43]  Sexual Orientation 0.92 (0.17)* 2.29 [0.58, 1.44]  Organizational Religious Activity × Sexual Orientation 0.80 (0.09)** −2.65 [0.68, 0.94]  Female 5.05 (0.08)*** 19.85 [4.30, 5.93]  Non-White 0.98 (0.10) −0.24 [0.81, 1.19]  BMI 1.10 (0.01)*** 13.28 [1.09, 1.12]  Smoking 0.99 (0.01) −0.34 [0.99, 1.01]  Alcohol 1.14 (0.03)*** 4.62 [1.08, 1.20]  Income 0.98 (0.02) −0.98 [0.95, 1.02]  Education 0.97 (0.02) −1.54 [0.93, 1.01]  Physical Activity 0.99 (0.01) −2.65 [0.98, 1.01]  Age 1.05 (0.02)* 2.13 [1.00, 1.10] Hypertension 1 and 2  Organizational Religious Activity 1.14 (0.07)~ 1.10 [0.99, 1.32]  Sexual Orientation 0.81 (0.27) 0.36 [0.55, 1.19]  Organizational Religious Activity × Sexual Orientation 0.87 (0.07)~ −1.97 [0.76, 1.00]  Female 2.97 (0.11)*** 9.87 [2.39, 3.69]  Non-White 0.82 (0.11)~ −1.74 [0.66, 1.03]  BMI 1.08 (0.01)*** 11.71 [1.06, 1.09]  Smoking 1.01 (0.01)~ 1.70 [0.99, 1.01]  Alcohol 1.08 (0.03)** 2.33 [1.01, 1.15]  Income 0.99 (0.02) −0.64 [0.95, 1.03]  Education 0.99 (0.02) −0.51 [0.94, 1.04]  Physical Activity 0.99 (0.01) −0.07 [0.98, 1.02]  Age 1.09 (0.03)** 3.13 [1.03, 1.15] Hypertension 2  Organizational Religious Activity 1.36 (0.11)** 2.85 [1.10, 1.68]  Sexual Orientation 0.93 (0.43) 1.62 [0.49, 1.76]  Organizational Religious Activity × Sexual Orientation 0.71 (0.12)** −3.24 [0.57, 0.89]  Female 1.97 (0.19)*** 3.65 [1.36, 2.84]  Non-White 0.53 (0.23)** −2.79 [0.34, 0.83]  BMI 1.09 (0.01)*** 8.27 [1.07, 1.11]  Smoking 1.01 (0.01) 0.85 [0.99, 1.02]  Alcohol 1.00 (0.07) 0.01 [0.88, 1.14]  Income 1.01 (0.04) 0.25 [0.94, 1.09]  Education 0.97 (0.03) −0.63 [0.89, 1.07]  Physical Activity 0.98 (0.02) −1.28 [0.95, 1.01]  Age 1.10 (0.05)~ 1.73 [0.99, 1.22] OR odds ratio; SE standard error; CI confidence interval; BMI body mass index. Organizational Religious Activity Scale scaled 0 to 10. aResults are from Model 2, controlling for all possible covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 6 Simple Slope Analyses of Organizational Religious Activity With BP and Hypertension Within Heterosexual and Sexual Minority Groupsa Heterosexual Group (N = 4,748) Sexual Minority Group (N = 366) b (SE) t-value 95% CI b (SE) t-value 95% CI SBP  Model 1b −0.26 (0.07)*** −3.65 [−0.40, −0.12] 1.32 (0.40)*** 3.27 [0.52, 2.12]  Model 2c −0.21 (0.08)** −2.85 [−0.36, −0.07] 1.41 (0.43)*** 3.25 [0.55, 2.26] DBP  Model 1b −0.17 (0.06)** −3.12 [−0.28, −0.06] 0.86 (0.34)* 2.53 [0.19, 1.54]  Model 2c −0.13 (0.06)* −2.09 [−0.25, −0.01] 0.95 (0.37)* 2.59 [0.22, 1.68] OR (SE) t-value 95% CI OR (SE) t-value 95% CI Prehypertension and higher  Model 1b 0.95 (0.01)*** −3.57 [0.93, 0.98] 1.18 (0.07)* 2.31 [1.02, 1.36]  Model 2c 0.96 (0.01)** −2.62 [0.94, 0.99] 1.20 (0.08)* 2.22 [1.02, 1.41] Hypertension 1 and 2  Model 1b 0.98 (0.02) −1.03 [0.95, 1.02] 1.13 (0.07)~ 1.90 [0.99, 1.29] Hypertension 2  Model 1b 0.94 (0.04) −1.41 [0.87, 1.03] 1.38 (0.02)*** 3.42 [1.15, 1.66]  Model 2c 0.94 (0.05) −1.49 [0.85, 1.02] 1.33 (0.11)** 2.65 [1.08, 1.65] Heterosexual Group (N = 4,748) Sexual Minority Group (N = 366) b (SE) t-value 95% CI b (SE) t-value 95% CI SBP  Model 1b −0.26 (0.07)*** −3.65 [−0.40, −0.12] 1.32 (0.40)*** 3.27 [0.52, 2.12]  Model 2c −0.21 (0.08)** −2.85 [−0.36, −0.07] 1.41 (0.43)*** 3.25 [0.55, 2.26] DBP  Model 1b −0.17 (0.06)** −3.12 [−0.28, −0.06] 0.86 (0.34)* 2.53 [0.19, 1.54]  Model 2c −0.13 (0.06)* −2.09 [−0.25, −0.01] 0.95 (0.37)* 2.59 [0.22, 1.68] OR (SE) t-value 95% CI OR (SE) t-value 95% CI Prehypertension and higher  Model 1b 0.95 (0.01)*** −3.57 [0.93, 0.98] 1.18 (0.07)* 2.31 [1.02, 1.36]  Model 2c 0.96 (0.01)** −2.62 [0.94, 0.99] 1.20 (0.08)* 2.22 [1.02, 1.41] Hypertension 1 and 2  Model 1b 0.98 (0.02) −1.03 [0.95, 1.02] 1.13 (0.07)~ 1.90 [0.99, 1.29] Hypertension 2  Model 1b 0.94 (0.04) −1.41 [0.87, 1.03] 1.38 (0.02)*** 3.42 [1.15, 1.66]  Model 2c 0.94 (0.05) −1.49 [0.85, 1.02] 1.33 (0.11)** 2.65 [1.08, 1.65] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; OR odds ratio; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aSimple slope analyses conducted only for significant interaction effects at p < .05. bModels controlling for age, sex, and BMI. cModels controlling for all covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Table 6 Simple Slope Analyses of Organizational Religious Activity With BP and Hypertension Within Heterosexual and Sexual Minority Groupsa Heterosexual Group (N = 4,748) Sexual Minority Group (N = 366) b (SE) t-value 95% CI b (SE) t-value 95% CI SBP  Model 1b −0.26 (0.07)*** −3.65 [−0.40, −0.12] 1.32 (0.40)*** 3.27 [0.52, 2.12]  Model 2c −0.21 (0.08)** −2.85 [−0.36, −0.07] 1.41 (0.43)*** 3.25 [0.55, 2.26] DBP  Model 1b −0.17 (0.06)** −3.12 [−0.28, −0.06] 0.86 (0.34)* 2.53 [0.19, 1.54]  Model 2c −0.13 (0.06)* −2.09 [−0.25, −0.01] 0.95 (0.37)* 2.59 [0.22, 1.68] OR (SE) t-value 95% CI OR (SE) t-value 95% CI Prehypertension and higher  Model 1b 0.95 (0.01)*** −3.57 [0.93, 0.98] 1.18 (0.07)* 2.31 [1.02, 1.36]  Model 2c 0.96 (0.01)** −2.62 [0.94, 0.99] 1.20 (0.08)* 2.22 [1.02, 1.41] Hypertension 1 and 2  Model 1b 0.98 (0.02) −1.03 [0.95, 1.02] 1.13 (0.07)~ 1.90 [0.99, 1.29] Hypertension 2  Model 1b 0.94 (0.04) −1.41 [0.87, 1.03] 1.38 (0.02)*** 3.42 [1.15, 1.66]  Model 2c 0.94 (0.05) −1.49 [0.85, 1.02] 1.33 (0.11)** 2.65 [1.08, 1.65] Heterosexual Group (N = 4,748) Sexual Minority Group (N = 366) b (SE) t-value 95% CI b (SE) t-value 95% CI SBP  Model 1b −0.26 (0.07)*** −3.65 [−0.40, −0.12] 1.32 (0.40)*** 3.27 [0.52, 2.12]  Model 2c −0.21 (0.08)** −2.85 [−0.36, −0.07] 1.41 (0.43)*** 3.25 [0.55, 2.26] DBP  Model 1b −0.17 (0.06)** −3.12 [−0.28, −0.06] 0.86 (0.34)* 2.53 [0.19, 1.54]  Model 2c −0.13 (0.06)* −2.09 [−0.25, −0.01] 0.95 (0.37)* 2.59 [0.22, 1.68] OR (SE) t-value 95% CI OR (SE) t-value 95% CI Prehypertension and higher  Model 1b 0.95 (0.01)*** −3.57 [0.93, 0.98] 1.18 (0.07)* 2.31 [1.02, 1.36]  Model 2c 0.96 (0.01)** −2.62 [0.94, 0.99] 1.20 (0.08)* 2.22 [1.02, 1.41] Hypertension 1 and 2  Model 1b 0.98 (0.02) −1.03 [0.95, 1.02] 1.13 (0.07)~ 1.90 [0.99, 1.29] Hypertension 2  Model 1b 0.94 (0.04) −1.41 [0.87, 1.03] 1.38 (0.02)*** 3.42 [1.15, 1.66]  Model 2c 0.94 (0.05) −1.49 [0.85, 1.02] 1.33 (0.11)** 2.65 [1.08, 1.65] b unstandardized coefficient; BP blood pressure; BMI body mass index; SE standard error; CI confidence interval; OR odds ratio; SBP systolic blood pressure; DBP diastolic blood pressure. Organizational Religious Activity Scale scaled 0 to 10. aSimple slope analyses conducted only for significant interaction effects at p < .05. bModels controlling for age, sex, and BMI. cModels controlling for all covariates. ~p < .10, *p < .05, **p < .01, ***p < .001. View Large Fig. 1. View largeDownload slide Sexual orientation moderates the association between organizational religious activity and BP. BP blood pressure; SBP systolic blood pressure; DBP diastolic blood pressure; SD standard deviation; M mean (2.26 is reflective of the total sample mean on the Organizational Religious Activity Scale). Fig. 1. View largeDownload slide Sexual orientation moderates the association between organizational religious activity and BP. BP blood pressure; SBP systolic blood pressure; DBP diastolic blood pressure; SD standard deviation; M mean (2.26 is reflective of the total sample mean on the Organizational Religious Activity Scale). Discussion This was the first known study to examine the association between organizational religious activity and hypertension among sexual minorities—an at risk group for CVD. Results indicated that sexual orientation moderates the associations between organizational religious activity and BP/hypertension. For the dependent variables SBP, DBP, and prehypertension or higher, crossover interaction effects were present, such that organizational religious activity was a protective factor for the heterosexual group and organizational religious activity was a risk factor for the sexual minority group. Results generally supported the hypotheses that organizational religious activity would be a protective factor among heterosexual individuals. Additionally, results supported the hypotheses that greater organizational religious activity was associated with elevated BP and greater odds of meeting clinical levels of hypertension among the sexual minority group. These findings are inconsistent with the majority of studies examining the association between organizational religious activity and BP, which have found significantly lower BP among those who are more religious [6]. One reason for this may be that sexual minorities do not experience organizational religious activity as a protective factor, given that most major world religions do not support sexual minority behavior and promote heterosexism [29]. Additionally, religious communities may not provide the same social support to sexual minority individuals as heterosexual individuals [30]. As such, these findings are consistent with minority stress theory, in which organizational religious activity may represent an additional stressor for this population [16]. The data also revealed that there were no significant demographic differences between nonreligious and religious sexual minority individuals. Limitations and future directions Findings from the current study should be interpreted considering some limitations and future directions. This study utilized a cross-sectional design, thus findings are unable to address temporality. Although this study’s method of collecting BP measurements is valid and commonly employed, the gold standard for measuring BP and diagnosing hypertension is 24-hr ambulatory monitoring and should be considered in future studies [31]. The current study was also unable to explore specific religious affiliations and denominations. It is possible that the association between organizational religious activity and hypertension varies as a function of religious group. It is also possible that attitudes toward sexual minority status have changed since the data were collected in 2008, as support for same-sex marriage has reached majority level in Protestant and Catholic groups as of this writing [32]. However, as of 2014, same-sex marriage continues to be least supported by those attending religious services most regularly [20]. Additionally, the current study also examined only crude associations between organizational religious activity and hypertension. Future research utilizing multidimensional measures of religiosity beyond organizational religious activity, inclusive of spirituality and other subconstructs of religiosity, is encouraged. Spirituality represents one’s individual relationship with a higher power and it may not confer the same social and cultural implications as organizational religious activity or other subconstructs of religiosity. Organizational religious activity may influence health through a number of different mechanisms [6]. For example, it may provide a way of coping with stress through the sense of control, religious doctrines, or prosocial behaviors promoted by all religions. From a meaning systems perspective, organizational religious activity may also be a core component of religious individual’s global beliefs, goals, and sense of meaning in life [33]; however, sexual minority identity may conflict with this sense of meaning. While researchers have proposed potential models hypothesizing ways religion can influence physical health outcomes [6, 33, 34], it would be important to examine these models specifically within the context of hypertension while incorporating sexual orientation and minority stressors. See Fig. 2 for a proposed theoretical model of study. Future study of these associations is necessary in order to better understand how organizational religious activity impacts sexual minority health, as these mechanisms may not influence sexual minorities in the same way as heterosexual groups. Fig. 2. View largeDownload slide Proposed theoretical model predicting hypothesized associations from organizational religious activity to hypertension. “+” on a pathway denotes a positive association; “−” on a pathway denotes a negative association. Fig. 2. View largeDownload slide Proposed theoretical model predicting hypothesized associations from organizational religious activity to hypertension. “+” on a pathway denotes a positive association; “−” on a pathway denotes a negative association. Implications These findings highlight the importance of considering sexual orientation when examining the health benefits of organizational religious activity. They add to the growing body of literature suggesting that organizational religious activity does not confer the same benefits for sexual minority individuals as heterosexual individuals [29]. This is an important implication for practitioners to consider, as an intersectional approach to therapy that addresses both a sexual minority and religious identity may be beneficial. Because many individuals believe they must choose between religious and sexual identities [35], one possible approach may aim to help individuals accept the aspects of religion that may cause stress, while emphasizing a personal relationship with a higher power [36]. Perhaps reconciling these two identities would mitigate the positive association between minority stressors and poor health outcomes. More broadly, findings on organizational religious activity in sexual minority individuals could be used to inform leaders of religious institutions, potentially allowing churches and congregations to be better equipped to create a more accepting, less heterosexist, environment. A public education campaign on the association between organizational religious activity and health outcomes may also provide sexual minority religious groups with important resources. Compliance with Ethical Standards Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards Authors Kalina M. Lamb, Kelsey A. Nogg, Benjamin M. Rooney, and Aaron J. Blashill declare that they have no conflict of interests. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Conflict of Interest: The authors declare that they have no conflict of interest. Informed Consent: For this type of study formal consent is not required. Ethical Standards: The authors have adhered to all ethical standards required by the field. 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Annals of Behavioral MedicineOxford University Press

Published: Feb 14, 2018

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