Spirituality and
adolescent health

Background: Physical activity (PA) has been recognized to have tangible health benefits for children, but there is a need to comprehensively understand its effects on children's mental well-being beyond traditional indicators of health status.

Objective: This study investigated the strength and consistency of associations between moderate-to-vigorous PA and various indicators of spiritual health.

Methods: This 2018 study involved 45,460 participants aged 11-15 years from eight countries. As informed by theory, pathways evaluating the correlation between PA and spirituality were investigated using structural equation modelling (SEM). 

Results: SEM findings demonstrated clear and positive connections between moderate-to-vigorous PA and elevated spirituality scores with the exception of spirituality (overall, or by domain) in girls from Poland. In all other countries, these were consistent across genders, spirituality domains, and within all eight countries involved in the study. Additionally, direct associations were found between family support and spirituality, as well as between older age and spirituality. Notable relationships included a strong and direct correlation between high levels of family support and reported increases in PA, and a negative direct association between older age and decreased family support, followed by reduced engagement in PA. Family affluence was strongly linked to increased PA, but only moderately associated with spirituality.

Conclusions: Engaging in moderate-to-vigorous PA is directly associated with higher levels of spirituality. The consistency of this association was notable. Public health policies that promote PA among adolescents should recognize the additional benefit of enhanced spiritual well-being. The roles of families in fostering spiritual well-being should also be acknowledged.

Background. The health of adolescents is determined by structural and intermediary factors. Such factors operate through pathways that foster different opportunities to achieve health and wellbeing, contributing to inequities. We explored such pathways in order to confirm the existence of relationships between economic position and seven indicators of adolescent health status, and whether any observed inequities could be explained by the strength of connections afforded by a healthy spirituality.

Methods. Eligible participants (n=18,962) completed the 2018 Canadian HBSC survey. Survey data were used to model the potential effect of perceived levels of relative affluence on each of seven health indicators. Comparison of crude and adjusted relative risks estimates from binomial regression models provided evidence of indirect mediating effects attributable to each of four domains of spirituality.

Results. As perceived levels of family affluence increased, the percentages of young people who reported each (7/7) of the negative health outcomes decreased. The spiritual health domains “connections to self” mediated the strength of relationships between relative affluence and each (7/7) of the seven outcomes in boys and girls. “Connections to others” mediated the strength of relationships between relative affluence and each (7/7) of the seven outcomes among girls. Inconsistent evidence of possible mediation was identified for connections to others in boys, as well as the other two domains of spirituality (connections to nature, then connections to the transcendent) in boys and girls.

Conclusion. Specific aspects of a healthy spirituality that foster connections to self and others could be intermediary determinants of health in Canadian adolescent populations.

Background. The “Commission on the Social Determinants of Health” (CDHS) conceptual framework identifies socio-economic position as a structural determinant of health. Recognized intermediary determinants include biological, behavioural, and psychosocial factors. We examined whether connections afforded by a healthy spirituality act as unrecognized intermediary determinants in adolescent populations, contributing to inequities in mental health.

Methods. Reports from 42,843 children (21,007 boys, 21,836 girls) from eight countries who participated in the 2017- 2018 Health Behavior in School-aged Children (HBSC) Study were used to describe relationships between family affluence and positive levels of subjective health symptoms – a valid indicator of mental health status. Based on the CSDH conceptual framework and multivariable regression analyses, we then examined whether these relationships were mediated by spiritual health and its four domains.

Results. Connections afforded by a high level of spiritual health were universally associated with positive mental health status. There was evidence that in three Western nations, affluence was associated with better mental health, and that this was partly mediated by spiritual health. Among the four Eastern European countries, there was no evidence that affluence was associated with mental health, and our findings did not support aspects of the CSDH framework that focus on affluence as a direct determinant of health.

Interpretation. Spiritual health appears to act as an intermediary determinant of children’s health in some Western countries. There is less evidence of such effects in Eastern countries. The universality of social determinants of health models and the measures used in their evaluation require careful assessment across cultures, political contexts, and health outcomes.