Religion and Health in African Americans (RHIAA) Study erronerously assumes Black monolith, Makes poor practices

Dr. Williams wrote to the authors of a manuscript for the Religion and Health in African American (RHIAA) study, raising major ethical and methodological concerns.

May 7, 2025

I recently read your January 2025 study, "Indices of neighborhood disadvantage and individual cancer control behaviors among African American adults." I am deeply concerned that your research perpetuates a false notion of an African American monolith. Besides salient issues of scientific ethics, I am struggling with the practical significance of this study - not clear where policymakers should intervene for whom to what extent - manageably and judiciously.

The study included the US South, Midwest, and Mid-Atlantic - highly variable regions. There is no common conceptual framework or attribute that is intended to methodologically unify study participants other than the authors' reliance on readers to assume meaning where there is not. I cannot locate the survey to determine the options for race (e.g., did it allow multiple options?; Enable African American vs Jamaican, Nigerian, US-born?), but I suspect a forced single option.

I also have concerns about an assumption of conditional independence. There is likely considerable confounding. The manuscript mentions this only in passing. The adjustment for covariates was likely not sufficient given the effects of similar forms of structural racism (e.g., neglected and segregated neighborhoods like Wards 7 and 8 in Washington, DC) across cities. In other words, African Americans are not the same. They do not have a uniform shared experience. Many persist under deep neighborhood depravity (apartheid adjacency), so the mean odds ratios are attenuated due to the lack of independence. In my mind, it would have been more defensible to include a hierarchical model.

I think a counterfactual would be helpful. I have revised your abstract to illustrate my concerns and the overgeneralized claims in the study.

Longitudinal effects of religious involvement on religious coping and health behaviors in a national sample of White Americans in the US South, Midwest, and Mid-Atlantic

by Knott and colleagues

Given the relatively high levels of religious involvement among White Americans and the important role that religious coping styles may play in health, the present study tested a longitudinal model of religious coping as a potential mediator of a multidimensional religious involvement construct (beliefs; behaviors) on multiple health behaviors (e.g., diet, physical activity, alcohol use, cancer screening). 

A national probability sample of White Americans was enrolled in the RHIAA (Religion and Health In White Americans) study and three waves of telephone interviews were conducted over a 5-year period (N = 565). Measurement models were fit followed by longitudinal structural models. Positive religious coping decreased modestly over time in the sample, but these reductions were attenuated for participants with stronger religious beliefs and behaviors. Decreases in negative religious coping were negligible and were not associated with either religious beliefs or religious behaviors. Religious coping was not associated with change in any of the health behaviors over time, precluding the possibility of a longitudinal mediational effect. Thus, mediation observed in previous cross-sectional analyses was not confirmed in this more rigorous longitudinal model over a 5-year period. However, findings do point to the role that religious beliefs have in protecting against declines in positive religious coping over time, which may have implications for pastoral counseling and other faith-based interventions.

October 1, 2024

I am writing with great concern about the Religion and Health in African Americans (RHIAA) Study. I recently stumbled upon an article from this study and began exploring RHIAA. What strikes me most is the assumption of Black homogeneity and race inherency - the study premise being that answering "yes" to a national survey question on being "Black" is meaningful, accurate, and ethical. The study uses an "African American" label ("Religion and Health in African Americans: The Role of Religious Coping"), but this term is historically tied to ADOS. It is personally offensive because a "Black" catch-all is erasure of my US ethnicity and ancestry - descendants of US enslaved and Jim Crow families. Non-ADOS are estimated to comprise at least 20% of this population. I believe that race science and the diminution of ADOS represent abuse of science. I also had a similar ethical and scientific set of concerns about the Woodlawn Study. My worry is that future public health leaders will not be taught appropriate framing and methodologies to avoid race essentialism, racism in science, and scientific error. There are considerable threats to research quality from race essentialism (Critical Race Framework Study). Reliably interpreting data estimates is challenging considering major threats, although it is commonly assumed that current practices constitute sound science. I also posit in my dissertation that this race science retards scientific progress.

"Race is a social construct rooted in justifications for slavery and white supremacy ideology (Eigen & Larrimore, 2012). Race is highly attenuated, lacking clarity for public health practice. By extension, it suggests that public health practice perpetuates an inappropriate and potentially offensive framing, absent a clear and meaningful construction of race." (Critical Race Framework Study)

Sincerely, 

Christopher Williams, PhD