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Summary: Objective: This systematic review aims to summarize the current body of evidence concerning the prevalence of obesity among clergy (i.e., the officially designated leaders of a religious group) in the United States. Method: From November 2022 to February 2023, five databases, one data repository, and gray matter were searched for articles and data sources. The search was restricted to articles published or raw data collected from 2001 to 2021. Study quality was assessed with a template, and heterogeneity was assessed using the I2 statistic. The protocol for this review was registered with PROSPERO (CRD42022376592). Results: Forty‐seven studies of clergy obesity involving 35,064 individuals were eligible. The pooled prevalence estimate of obesity across studies was 34.8% (95% confidence interval [CI]: 32.5–37.2). Obesity prevalence was found to be increasing over time and to vary considerably between clergy from different religious traditions. Compared to national estimates, from 2005 onwards, obesity prevalence was higher than in the US adult population. [ABSTRACT FROM AUTHOR]

In this study, we examine the role of spiritual struggles among clergy, in the form of "divine struggle" or feelings of alienation from God and their associations with well-being (depressive symptoms and burnout) among clergy. Drawing from a life-stress perspective, we also test whether received and anticipated congregational support moderates these associations. Using two waves of data (2016–2019) of the Clergy Panel Health Survey of United Methodist clergy in North Carolina (n = 1,261), results suggest that it was clergy who increased in divine struggles over time who had the highest depressive symptom and burnout scores. However, clergy who received significant emotional support from members of their congregation were protected from elevated depressive symptoms and greater burnout. Anticipated congregational support only buffered the relationship between increasing divine struggles and one component of burnout (positive achievement). We offer some broader implications for supporting clergy well-being in the face of divine struggles. [ABSTRACT FROM AUTHOR]

Are religious leaders unusually unhealthy? This question has long occupied scholars interested in the study of religious institutions, and a significant body of research has examined the causes, correlates, and effects of poor health among clergy. In this study, we aimed to: (1) outline the development of, and bias inherent to, the scholarly understanding of clergy health over the past 50 years; (2) test, using a recently collected nationally representative sample of clergy, the standing assumption that clergy are an especially unhealthy vocational group, specifically in terms of depression, obesity, and self‐rated health; and (3) identify the major correlates of health among clergy using these data. Contrary to the recent tenor of scholarly research on this subject, our research revealed that clergy are not a particularly unhealthy group. We suggest potential pathways forward to ameliorate the bias inherent in the research into clergy well‐being. [ABSTRACT FROM AUTHOR]

The job–demand–control–support model indicates that clergy are at high risk for chronic stress and adverse health outcomes. A multi-group pre-test–post-test design was used to evaluate the feasibility, acceptability, and range of outcome effect sizes for four potentially stress-reducing interventions: stress inoculation training, mindfulness-based stress reduction (MBSR), the Daily Examen, and Centering Prayer. All United Methodist clergy in North Carolina were eligible and recruited via email to attend their preferred intervention. Surveys at 0, 3, and 12 weeks assessed symptoms of stress, anxiety, and perceived stress reactivity. Heart rate variability (HRV) was assessed at baseline and 12 weeks using 24 h ambulatory heart rate monitoring data. A subset of participants completed in-depth interviews and reported skill practice using daily text messages. Standardized mean differences with 95% and 75% confidence intervals were calculated for the change observed in each intervention from baseline to 3 and 12 weeks post-baseline to determine the range of effect sizes likely to be observed in a definitive trial. 71 clergy participated in an intervention. The daily percentage of participants engaging in stress management practices ranged from 47% (MBSR) to 69% (Examen). Results suggest that participation in Daily Examen, stress inoculation, or MBSR interventions could plausibly result in improvement in stress and anxiety at 12 weeks with small-to-large effect sizes. Small effect sizes on change in HRV were plausible for MBSR and Centering Prayer from baseline to 12 weeks. All four interventions were feasible and acceptable, although Centering Prayer had lower enrollment and mixed results. [ABSTRACT FROM AUTHOR]

This research examines the social actors and interactions that facilitate seminary students' sense of calling. Drawing from 36 in‐depth interviews with first year Masters of Divinity students, we introduce six ideal typical social others who play a formative role in the early stages of a call to ministry: instigators, exemplars, interpreters, affirmers, challengers, and codiscerners. Together, these findings demonstrate that the call to ministry, while deeply personal, emerges through social interactions that facilitate and make plausible a person's sense of calling and that sustain it over time. Extending Richard Pitt's conceptualization of the "horizontal call," this paper argues that social others help evoke and solidify—not merely legitimate—a personal sense of call. This research also highlights differences in the social structuring of call by gender. Despite considerable gains in the ordination of women, we find that many still face obstacles to experiencing and embracing a call to ministry. [ABSTRACT FROM AUTHOR]

The Seminary to Early Ministry (SEM) Study is a mixed-method, prospective study designed to provide high-quality empirical data on student formation in theological education. The study will use a series of surveys and in-depth interviews to track three cohorts of divinity school students from matriculation into the early years of their careers. As a result, the study hopes to compile the most comprehensive longitudinal dataset on theological education to date, enabling researchers to better understand who attends seminaries, how seminaries form students, and how the training of future religious leaders can be improved. [ABSTRACT FROM AUTHOR]

As an occupational group, clergy exhibit numerous physical health problems. Given the physical health problems faced by clergy, understanding where physical health falls within the priorities of seminary students, the ways students conceptualize physical health, and how seminary students do or do not attend to their physical health in the years immediately prior to becoming clergy, can inform intervention development for both seminary students and clergy. Moreover, understanding and shaping the health practices of aspiring clergy may be particularly impactful, with cascading effects, as clergy serve as important role models for their congregants. Drawing on 36 in-depth, qualitative interviews with first-year seminary students, this study examines the complex dynamics between religious frameworks related to physical health, explicit intentions to maintain healthy practices, and reported physical health behaviors. Our findings suggest that even students who deploy religious frameworks in relation to their physical health—and who, as a result, possess positive intentions to implement and maintain healthy behaviors—often report being unable to live up to their aspirations, especially in the face of barriers to health practices posed by the seminary program itself. After reviewing these findings, we offer suggestions for physical health focused interventions, including action and coping planning, which could be implemented at seminaries to reduce the intention–behavior gap and improve clergy health. [ABSTRACT FROM AUTHOR]

Introduction: Like many helping professionals in emotional labor occupations, clergy experience high rates of mental and physical comorbidities. Regular stress management practices may reduce stress-related symptoms and morbidity, but more research is needed into what practices can be reliably included in busy lifestyles and practiced at a high enough level to meaningfully reduce stress symptoms.Methods and Analysis: The overall design is a preference-based randomized waitlist control trial. United Methodist clergy in North Carolina will be eligible to participate. The intervention and waitlist control groups will be recruited by email. The interventions offered are specifically targeted to clergy preference and include mindfulness-based stress reduction, Daily Examen, and stress inoculation training. Surveys will be conducted at 0, 12, and 24 weeks with heart rate data collected at 0 and 12 weeks. The primary outcomes for this study are self-reported symptoms of stress and heart rate at week 12 for each intervention compared to waitlist control; the secondary outcome is symptoms of anxiety comparing each intervention vs waitlist control.Ethics and Dissemination: Ethical approval was obtained from the Duke University Campus IRB (2019-0238). The results will be made available to researchers, funders, and members of the clergy community.Strengths and Limitations Of This Study: While evidence-based stress reduction practices such as mindfulness-based stress reduction (MBSR) exist, a wider variety of practices should be tested to appeal to different individuals. Clergy in particular may prefer, and consequently enact, spiritual practices like the Daily Examen, and individuals such as clergy who spend most of their time thinking and feeling may prefer experiential-based practices like stress inoculation training. If efficacious, the Daily Examen and stress inoculation training practices have high feasibility in that they require few minutes per day. This study is limited by the inclusion of Christian clergy of only one denomination.Trial Registration: ClinicalTrials.gov NCT04625777 . November 12, 2020. [ABSTRACT FROM AUTHOR]

The Trier Social Stress Test (TSST) is a widely used, reliable, and ecologically valid method for inducing acute stress under controlled conditions. Traditionally, the TSST is administered with staff physically present with participants, which limits the participant populations that can be exposed to the TSST. We describe an adaptation of the TSST to remote, online delivery over video-conferencing, which we call the internet-delivered Trier Social Stress Test (iTSST). This adaption has participants use wearable, self-administered ECG monitors received and returned via mail. Fifty participants were recruited to take part in a pilot study evaluating stress-reduction interventions and completed the iTSST at two occasions separated by approximately 12 weeks. Perceived stress and heart rate variability (HRV) were measured during both administrations of the iTSST. Forty-one participants completed both assessments and were included in the set of analyses. Both administrations were characterized by an increase in self-reported stress and reduction in self-reported relaxation from the resting phase to the speech task, which returned to baseline during recovery. In terms of HRV, we observed a significant parasympathetic response to the iTSST in 90% of participants, evidenced by a decrease in RMSSD and increase in heart rate from resting to the speech task, which recovered during the recovery phase. In terms of repeatability, there was little evidence of habituation and the iTSST elicited a stress response during both the initial administration and the 12-week follow-up. While the utility is limited by the lack of a measure of sympathetic and HPA-axis activity, the iTSST represents a promising research tool when physically interacting with participants is not feasible. • The Trier Social Stress Test was adapted to an online environment (iTSST). • Parasympathetic withdrawal in response to the iTSST occurred among 90% of participants. • iTSST reliably increased self-reported stress and reduced relaxation. • Little evidence of habituation to the iTSST was observed over 12-weeks time. • iTSST may be a cost effective and ecologically valid ambulatory stress test. [ABSTRACT FROM AUTHOR]

Studies of caregivers of orphans and vulnerable children (OVC) rarely examine the role religion plays in their lives. We conducted qualitative interviews of 69 caregivers in four countries: Ethiopia, Kenya, Cambodia, and India (Hyderabad and Nagaland), and across four religious traditions: Christian (Orthodox, Roman Catholic, and Protestant), Muslim, Buddhist, and Hindu. We asked respondents to describe the importance of religion for their becoming a caregiver, the way in which religion has helped them make sense of why children are orphans, and how religion helps them face the challenges of their occupation. Using qualitative descriptive analysis, three major themes emerged. Respondents discussed how religion provided a strong motivation for their work, reported that religious institutions were often the way in which they were introduced to caregiving as an occupation, and spoke of the ways religious practices sustain them in their work. They rarely advanced religion as an explanation for why OVC exist—only when pressed did they offer explicitly religious accounts. This study has implications for OVC care, including the importance of engaging religious institutions to support caregivers, the significance of attending to local religious context, and the vital need for research outside of Christian contexts. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (Met-S) has a robust concurrent association with depression. A small, methodologically limited literature suggests that Met-S and depression are reciprocally related over time, an association that could contribute to their overlapping influences on morbidity and mortality in cardiovascular disease, diabetes, and cancer.Purpose: Using a refined approach to the measurement of Met-S as a continuous latent variable comprising continuous components, this study tested the prospective associations between Met-S and depression.Methods: This study of 1114 clergy included four annual assessments of depressive symptoms and Met-S components. Standard methods were used to measure Met-S risk factors, and the Patient Health Questionnaire-8 was used to assess depressive symptoms. We used confirmatory factor analysis to verify the structure of Met-S and depression and structural equation modeling to quantify the prospective relationships.Results: The statistical models confirmed the validity of quantifying Met-S as a continuous latent variable, replicated previous evidence of a concurrent association, and indicated a significant prospective association of initial depressive symptoms with subsequent Met-S. Initial Met-S was at most only weakly associated with subsequent depressive symptoms, and the former prospective effect was significantly larger. Associations of depressive symptoms and Met-S were significant for both men and women, but somewhat stronger among men.Conclusions: Results support representation of Met-S as a continuous latent variable. The association of initial depressive symptoms with later Met-S suggests that interventions addressing these correlated risk factors may prove useful in preventive efforts. [ABSTRACT FROM AUTHOR]

We argue that perceived support is best conceptualized more as a measure of how an individual appraises his/her situation rather than a true reflection of how much support he/she receives. To test this theory, we used survey data from the Clergy Health Initiative Panel Survey to examine the relationship between perceived and received social support and their association with depressive symptoms in clergy (N = 1,288). Overall, analyses revealed perceived support had a weak association with received support. Greater perceived support had a significant relationship with lower depressive symptoms. In contrast, greater received support had only a small relationship with lower depressive symptoms, which was fully mediated by perceived support. Our results raise questions about the effectiveness of many clergy social support interventions, which often aim to boost the quality and/or quantity of received social support. We suggest it may be more advantageous to boost perceptions of social support, possibly through cognitive reframing or positive mental health interventions. [ABSTRACT FROM AUTHOR]

Past research reveals mixed results regarding the relationship between gender and charitable giving. We show gender plays a significant role in giving but only when considered alongside marital status and religion. Using the 2006 Portraits of American Life Study, we model a household’s propensity to give and the amount given. We extend past research by disaggregating unmarried households to look at divorced, widowed, and never-married households, and by including multiple religion measures. Results indicate households headed by never-married females have lower giving levels compared with those headed by divorced and widowed women. In households headed by single males, these differences are largely absent. Religious attendance has a stronger association with giving in male-headed households. The respondent’s gender is also related to the amount married households report giving to charity. Future research on giving should consider both gender and marital status to more fully capture increasing diversity in American families. [ABSTRACT FROM AUTHOR]

The dominant view of megachurches claims they represent a new religious form, born in the United States in the 1970s and 80s. Contrary to this position, this research demonstrates that megachurches enjoy a long history in Protestantism. An important example from the 16th Century Huguenot architect Jacques Perret reveals an early Protestant vision for a large, multi-functional worship space. Soon after, this vision became realized in bricks and mortar. Revivalism and the Institutional Church Movement of the 19th and early 20th Centuries provide further connections between megachurches and the past. Revivalism provided the motivation for Protestants to go out and reach the masses, and the Institutional Church Movement provided the infrastructure to attract, convert, and nurture them. The demographic shifts that occurred following WWII led to the proliferation of churches in post-war America. This meant that large churches became increasingly visible, but journalists and social commentators mistook their increase in prevalence for lack of historical precedent. Pastors and other leaders, capitalizing on the appeal of innovation, reinforced this view. This research offers an important corrective that helps situate megachurches in the United States in their proper context. [ABSTRACT FROM AUTHOR]

According to the General Social Survey, the combined rate of weekly and monthly attendance at religious services in Canada has declined by about 20 points from 1986 to 2008. Approximately half of this decline stems from the increase in the proportion of people reporting no religion, who, for the most part, do not attend religious services. The other portion of this decline is attributable to eroding attendance rates among Catholics, particularly older Catholics, and Protestants in Québec. Attendance rates for Protestants outside of Québec show signs of increase. The reported increase in weekly attendance in Canada by the Project Canada surveys and cited by Bibby as a possible indicator of a religious renaissance is revealed as an artifact in the data due to an oversample of Protestants. I find another weighting problem in the Canadian Survey of Giving, Volunteering and Participating that leads to underestimates of aggregate religious attendance rates. [ABSTRACT FROM AUTHOR]

Chaves (2010) argues that much of the work in the sociology of religion is susceptible to the religious congruence fallacy-the tendency to assume consistency between religious beliefs and one's attitudes and behaviors across situations when they are in fact highly variable. We build on and extend this argument by focusing on intersecting group identities as a mechanism for identifying such incongruence, not only within religious contexts, but also at the intersection of categories such as gender and race. To illustrate this argument, the analysis draws on data from the 2006 Panel Study of American Religion and Ethnicity (PS-ARE) to assess how race, gender, and religion interact to produce different levels of attitude and behavior incongruencies on key issues of the day, specifically conservative social values and voting behaviors. The results find marked differences and inconsistent relationships between attitudes and behaviors across racial-gender groups. We use the analysis to highlight the conditions that result in incongruence at the intersections of identity categories and pinpoint where social scientists are most vulnerable to committing the congruence fallacy. [ABSTRACT FROM AUTHOR]

Maintaining healthy behaviors is challenging. Based upon previous reports that in North Carolina (NC), USA, overweight/obese clergy lost weight during a two-year religiously tailored health intervention, we described trajectories of diet, physical activity, and sleep. We investigated whether behavior changes were associated with weight and use of health-promoting theological messages. Improvements were observed in sleep, calorie-dense food intake, and physical activity, with the latter two associated with weight loss. While theological messages were well-retained, their relationship with behaviors depended on the specific message, behavior, and timing. Findings offer insights into weight loss mechanisms, including the role of theological messages in religiously tailored health interventions. [ABSTRACT FROM AUTHOR]

The author comment on the article "National oncology practice benchmark: 2011 report on 2010 data," by TR Barr. He suggests that the article discusses high quality oncology care which involves many indispensable elements, including, care coordination, treatment planning and supportive care and delivery of these services require appropriate amount of staff, space and resources. The National Oncology Practice Benchmark study provides invaluable data to illustrate the financial impact of these changes on practices. He opines that the experiment of replacing something with nothing has been proven to be unsustainable for private oncology practice.

David Eagle’s article on changing patterns of religious service attendance appeared in the March 2011 issue of Journal for the Scientific Study of Religion. He presented a comprehensive analysis of three data sets that allow social scientists to estimate the rate of religious service attendance in Canada: Project Canada Survey (PCS), the General Social Survey (GSS), and the Canadian Survey of Giving, Volunteering, and Participating (GSGVP). Reginald Bibby initiated the PCS in 1975, 10 years before Statistics Canada began conducting the GSS in 1985, and 22 years before the GSGVP began in 1997. He comments on the Eagle article, cautions scholars to be mindful of important methodological differences across samples, and offers his own analysis of trends in religious service attendance. [ABSTRACT FROM AUTHOR]

Clergy are tasked with multiple interpersonal administrative, organizational, and religious responsibilities, such as preaching, teaching, counseling, administering sacraments, developing lay leader skills, and providing leadership and vision for the congregation and community. The high expectations and demands placed on them put them at an increased risk for mental distress such as depression and anxiety. Little is known about whether and how clergy, helpers themselves, receive care when they experience mental distress. All active United Methodist Church (UMC) clergy in North Carolina were recruited to take a survey in 2019 comprising validated depression and anxiety screeners and questions about mental health service utilization. Bivariate and Poisson regression analyses were conducted on the subset of participants with elevated depressive and anxiety symptoms to determine the extent of mental health service use during four different timeframes and the relationship between service use and sociodemographic variables. A total of 1,489 clergy participated. Of the 222 (15%) who had elevated anxiety or depressive symptoms or both, 49.1% had not ever or recently (in the past two years) seen a mental health professional. Participants were more likely to report using services currently or recently (in the past two years) if they were younger, had depression before age 21, or "very often" felt loved and cared for by their congregation. The rate of mental health service use among UMC clergy is comparable to the national average of service use by US adults with mental distress. However, it is concerning that 49% of clergy with elevated symptoms were not engaged in care. This study points to clergy subgroups to target for an increase in mental health service use. Strategies to support clergy and minimize mental health stigma are needed. [ABSTRACT FROM AUTHOR]

Background: Community Health Workers (CHWs) provide vital services during disease outbreaks. Appropriate burials of those who died from an infectious disease outbreak is a critical CHW function to prevent infection and disease spread. During the 2018 Ebola Virus Disease (EVD) outbreak in Beni Town, North Kivu, Democratic Republic of the Congo, we sought to understand the levels of understanding, trust, and cooperation of the community in response to the outbreak, the barriers burial workers faced in their health work and its impact on local burial workers and other CHWs. Methods: 12 EVD burial CHWs in Beni Town completed an hour-long qualitative in-depth interview on their experiences. They were recruited from a local counseling center. Interviews were recorded, transcribed and translated into English. A team of 3 researchers identified structural and emergent themes using applied thematic analysis. Results: Workers reported major misconceptions in the community surrounding the initiation of the outbreak. Community misconceptions were based on widespread governmental mistrust as well as a belief system that intertwines traditional and scientific understandings of the world. EVD burial workers identified violence directed at them and community misinformation as the two largest barriers to effectively carrying out their work. They named several important support systems including family and friends, personal relaxation techniques, and a local counseling center. Conclusions: As with other disease outbreaks globally, we found that government mistrust and religious beliefs strongly impacted community perceptions of the EVD outbreak. Previous studies have demonstrated clinic-based medical personnel are often the targets of violence. Our research shows that burial workers were also targeted and exposed to extreme levels of violence in their work. Along with their ability to effectively respond to the outbreak, violence has a negative impact on their own mental wellbeing. Burial workers found group counseling sessions to be an effective tool for managing the stress associated with their work. Further developing and testing of group-based interventions for this group is a priority for future research. [ABSTRACT FROM AUTHOR]

The VIA Classification of Character Strengths has broken important ground for measuring character strengths across cultures. Because the VIA Classification is a closed system of abstract strengths, however, it is unknown how end-users engage strengths in particular cultural and practical contexts, define strengths for themselves, or identify additional strengths. In this study, residential care directors (n = 18) and other caregivers (n = 64) for orphans and vulnerable children (OVCs) in five distinct global locations prioritized with a card-sort the VIA Character Strengths most important for the work of caregiving, defined these strengths, and proposed additional strengths. Supervisors were then asked how caregivers embodied their prioritized strengths. Participants most frequently prioritized Love, Honesty, Forgiveness, and Kindness as important for caregiving; demonstrated high concordance but also some deviation from the definitions of the VIA Classification; and proposed additional strengths (e.g. Caring, Self-drive, and Initiative) that were perceived not to overlap with existing VIA Character Strengths. [ABSTRACT FROM AUTHOR]

Abstract Background Child well-being is associated with caregiver mental health. Research has focused on the absence or presence of mental health problems, such as depression, in caregivers. However, positive mental health – defined as the presence of positive emotions, psychological functioning, and social functioning – likely prevents depression and in caregivers may benefit children more than the mere absence of mental health problems. Little attention has been given to how caregivers sustain positive mental health, particularly when doing challenging work in impoverished settings. Objective The study's objective was to determine what successful caregivers of orphaned and vulnerable children (OVC) in diverse countries do to sustain their positive mental health. Methods Using a mixed-methods, cross-sectional study design, trained local interviewers recruited a convenience sample of OVC caregivers through residential care institutions from five geographic regions (Kenya; Ethiopia; Cambodia; Hyderabad, India; and Nagaland, India). Participants completed surveys and in-depth interviews about strategies used to sustain their mental health over time or improve it during challenging times. Results Sixty-nine OVC caregivers from 28 residential care institutions participated. Positive mental health survey scores were high. We organized the strategies named into six categories ordered from most to least frequently named: Religious Practices; Engaging in Caregiving; Social Support; Pleasurable Activities; Emotion Regulation; and Removing Oneself from Work. Prayer and reading religious texts arose as common strategies. Participants reported promoting positive emotions by focusing on their work's meaning and playing with children. The similar findings across diverse regions were striking. Some differences included more emphasis on emotion control in Ethiopia; listening to music/singing in Kenya and Hyderabad; and involving children in the tasks the participants enjoyed less (e.g., cleaning) in Cambodia. Conclusions Under real-world conditions, small daily activities appeared to help sustain positive mental health. In addition, fostering structures that allow caregivers to engage regularly in rewarding caregiving tasks may be an affordable and scalable idea which could potentially benefit caregivers, children, and employers. Highlights • Similar positive mental health strategies were named by caregivers in four countries. • Engaging in enjoyable/meaningful time with children may improve caregivers' emotions. • Caregiver strategies to sustain positive mental health included religious practices. • Caregiver strategies to sustain positive mental health included emotion regulation. • Taking breaks from caregiving was named less often than other strategies. [ABSTRACT FROM AUTHOR]

Introduction: This study sought to determine the effect of a 2-year, multicomponent health intervention (Spirited Life) targeting metabolic syndrome and stress simultaneously.Design: An RCT using a three-cohort multiple baseline design was conducted in 2010-2014.Setting/participants: Participants were United Methodist clergy in North Carolina, U.S., in 2010, invited based on occupational status. Of invited 1,745 clergy, 1,114 consented, provided baseline data, and were randomly assigned to immediate intervention (n=395), 1-year waitlist (n=283), or 2-year waitlist (n=436) cohorts for a 48-month trial duration.Intervention: The 2-year intervention consisted of personal goal setting and encouragement to engage in monthly health coaching, an online weight loss intervention, a small grant, and three workshops delivering stress management and theological content supporting healthy behaviors. Participants were not blinded to intervention.Main Outcome Measures: Trial outcomes were metabolic syndrome (primary) and self-reported stress and depressive symptoms (secondary). Intervention effects were estimated in 2016 in an intention-to-treat framework using generalized estimating equations with adjustment for baseline level of the outcome and follow-up time points. Log-link Poisson generalized estimating equations with robust SEs was used to estimate prevalence ratios (PRs) for binary outcomes; mean differences were used for continuous/score outcomes.Results: Baseline prevalence of metabolic syndrome was 50.9% and depression was 11.4%. The 12-month intervention effect showed a benefit for metabolic syndrome (PR=0.86, 95% CI=0.79, 0.94, p<0.001). This benefit was sustained at 24 months of intervention (PR=0.88; 95% CI=0.78, 1.00, p=0.04). There was no significant effect on depression or stress scores.Conclusions: The Spirited Life intervention improved metabolic syndrome prevalence in a population of U.S. Christian clergy and sustained improvements during 24 months of intervention. These findings offer support for long-duration behavior change interventions and population-level interventions that allow participants to set their own health goals.Trial Registration: This study is registered at www.clinicaltrials.gov NCT01564719. [ABSTRACT FROM AUTHOR]

• Caregivers find meaning in educational activities, supervising, and caregiving. • Caregivers most enjoy informal educational activities and supervising children. • Caregivers find cleaning unpleasant and yet spend substantial time on it. • Enjoyment of caring for children may be undermined by behavior problems. There are many orphaned and separated children (OSC) in the world and caregivers play a crucial role in raising them. Frameworks on employee mental health incorporate elements of both enjoyment/difficulties and values (i.e., hedonic and eudaimonic elements), yet existing studies focus on caregivers' mental illness and overlook their specific work activities. We collected diary activity log, survey, and interview data from caregivers from five geographic locations: Hyderabad, India; Nagaland, India; Ethiopia; Kenya; and Cambodia. We coded and calculated the amount of time spent on five frequent activities: cleaning, cooking, caring for children, supervising children, and informal educational activities. We calculated the mean scores of perceived importance, meaningfulness, enjoyment, and unpleasantness for each of the five activities by geographic location. A total of 82 participants completed surveys and activity logs, and 69 of them participated in interviews. Mean time spent per day for the five activities combined ranged from 4.4 h (Nagaland) to 9.0 h (Ethiopia). Cooking and cleaning constituted a large portion of caregivers' days, ranging from 0.8 h per caregiver per day in Nagaland to 4.7 h in Cambodia, and informal educational activities (such as advising, teaching children their letters, and teaching from religious texts) constituted the least time, ranging from 0.1 h per caregiver per day in Hyderabad to 1.1 h in Nagaland. Participants rated all activities high in importance, with cleaning being relatively lower. Overall, enjoyment scores were lower than importance and meaningfulness scores. Informal educational activities had the highest enjoyment scores in three locations, whereas supervising children did in two locations. Participants rated cleaning as the most unpleasant activity in each geographic region except Cambodia, where it was rated on par with educational activities. OSC caregivers consider several regular activities to be very important and meaningful. Enjoyment may be improved through additional support in child behavior management or spending more time providing informal educational activities; at minimum, caregiver mental health should be considered before turning informal educational activities over to volunteers. [ABSTRACT FROM AUTHOR]