Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Edward Alan Miller

Second Advisor

Kyungmin Kim

Third Advisor

Susan McFadden


On any given day, 3.9% to 4.2% of the US population can be found residing in nursing homes, and as such, research has focused on identifying underlying factors associated with nursing home utilization. However, one important factor is missing from the extant literature, religiosity, defined as one’s religious beliefs and behaviors. Religiosity is important to consider due to its salience in the lives of most Americans, with 81% reporting a belief in God (Gallup, 2022), 76% engaging in prayer, and with older adults exhibiting the highest levels of involvement in religious activities (Pew Research Center, 2014a, 2014b, 2015).

This study examined the relationship between three dimensions of religiosity (organizational, non-organizational, and intrinsic) and nursing home utilization. It also assessed the relationship between religiosity and number of nights spent in a nursing home. Furthermore, potential mediating (health behaviors) and moderating (sex, race/ethnicity) factors were examined. A total of 7,564 respondents (> 51 years) from the 2006 wave of the Health and Retirement Study, with no prior nursing home use, were assessed every two years, until 2014.

Generalized Estimating Equations Multinomial Logistic Regressions were used to model the relationship between religiosity and subsequent NH use, and Binomial Poisson Regressions were employed to examine the relationship between religiosity and number of nights spent in a nursing home, while controlling for other factors. Results indicate that high levels of organizational religiosity (e.g., service attendance), compared to moderate and low levels, are associated with higher rates of nursing home utilization (B = 0.13, p < .001), while higher levels of non-organizational religiosity (e.g., private prayer) are associated with a lower likelihood of nursing home use (B = -0.03, p < .05). No relationship was found between intrinsic religiosity and nursing home use and any dimension of religiosity and number of nights spent in a nursing home. Furthermore, while health behaviors were not found to have a mediating effect, sex and race did serve as moderators in these relationships. The positive association between service attendance and nursing home utilization may reflect the sharing of information about available resources through one’s social support networks, including congregations. In contrast, individuals who were more likely to pray independently, may lack the social support provided by congregations, and as a result, experience more limited knowledge transfers about available resources.


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