The associations between religious/spiritual beliefs and behaviours and study participation in a prospective cohort study (ALSPAC) in Southwest England

Longitudinal studies are key to understanding risk factors for health, well-being, and disease, yet associations may be biased if study invitation and participation are non-random. Religious/spiritual beliefs and behaviours (RSBB) are increasingly recognised as having potentially important relationships with health. However, it is unclear whether RSBB is associated with study participation. We examine whether RSBB is associated with participation in the longitudinal birth cohort ALSPAC (Avon Longitudinal Study of Parents and Children). Three RSBB factors were used: religious belief (belief in God/a divine power; yes/not sure/no), religious affiliation (Christian/none/other), and religious attendance (frequency of attendance at a place of worship). Participation was measured in three ways: i) total number of questionnaires/clinics completed (linear and ordinal models); ii) completion of the most recent questionnaire (logistic model); and iii) length of participation (survival model). Analyses were repeated for the ALSPAC mothers, their partners, and the study children, and were adjusted for relevant socio-demographic confounders. Religious attendance was positively associated with participation in all adjusted models in all three cohorts. For example, study mothers who attended a place of worship at least once a month on average completed two more questionnaires (out of a possible 50), had 50% greater odds of having completed the most recent questionnaire, and had 25% reduced risk of drop-out, relative to those who did not attend. In the adjusted analyses, religious belief and attendance were not associated with participation. However, the majority of unadjusted models showed associations between RSBB and participation. After adjusting for confounders, religious attendance - not religious belief or affiliation - was associated with participation in ALSPAC. These results indicate that use of RSBB variables (and religious attendance in particular) may result in selection bias and spurious associations; these potential biases should be explored and discussed in future studies using these data.