title: Inequalities in the spiritual health of young Canadians: a national, cross-sectional study.
abstract: Spiritual health, along with physical, emotional, and social aspects, is one of four domains of health. Assessment in this field of research is challenging methodologically. No contemporary population-based studies have profiled the spiritual health of adolescent Canadians with a focus on health inequalities. In a 2014 nationally representative sample of Canadians aged 11-15 years we therefore: (1) psychometrically evaluated a series of items used to assess the perceived importance of spiritual health and its four potential sub-domains (connections with: self, others, nature and the natural environment, and the transcendent) to adolescents; (2) described potential inequalities in spiritual health within adolescent populations, overall and by spiritual health sub-domain, by key socio-demographic factors.
  
  
  
  Cross-sectional analysis of survey reports from the 2014 (Cycle 7) of the Canadian Health Behaviour in School-aged Children study (weighted n = 25,036). Principal components analysis followed by confirmatory factor analysis were used to explore the psychometric properties of the spiritual health items and the associated composite scale describing perceived importance of spiritual health. Associations among this composite scale, its individual sub-domains, and key socio-demographic factors were then explored.
  
  
  
  The principal components analysis best supported a four-factor structure where the eight scale items loaded highly according to the original four domains. This was also supported in confirmatory factor analyses. We then combined the eight items into composite spiritual health score as supported by theory, principal components analysis findings, and acceptable tests of reliability. Further confirmatory factor analysis suggested the need for additional refinements to this scale. Based upon exploratory cross-sectional analyses, strong socio-demographic inequalities were observed in the spiritual health measures by age, gender, relative material wealth, immigration status, and province/territory.
  
  
  
  Study findings highlight potential inequalities in the spiritual health of young Canadians, as well as opportunities for methodological advances in the assessment of adolescent spiritual health in our population.
authors.affiliation: Department of Public Health Sciences, Carruthers Hall, Queen's University, Kingston, ON, K7L 3 N6, Canada.|School of Religion, Queen's University, Kingston, Canada.
authors.forename: Valerie
authors.initials: V
authors.lastname: Michaelson
authors.affiliation: Social Program Evaluation Group, Faculty of Education, Queen's University, Kingston, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Freeman
authors.affiliation: Department of Public Health Sciences, Carruthers Hall, Queen's University, Kingston, ON, K7L 3 N6, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: King
authors.affiliation: Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Hannah
authors.initials: H
authors.lastname: Ascough
authors.affiliation: Department of Public Health Sciences, Carruthers Hall, Queen's University, Kingston, ON, K7L 3 N6, Canada.|Department of Emergency Medicine, Queen's University, Kingston, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: Davison
authors.affiliation: School of Religion, Queen's University, Kingston, Canada.
authors.forename: Tracy
authors.initials: T
authors.lastname: Trothen
authors.affiliation: Department of Psychology, Queen's University, Kingston, Canada.
authors.forename: Sian
authors.initials: S
authors.lastname: Phillips
authors.affiliation: Department of Public Health Sciences, Carruthers Hall, Queen's University, Kingston, ON, K7L 3 N6, Canada. will.pickett@queensu.ca.|Social Program Evaluation Group, Faculty of Education, Queen's University, Kingston, Canada. will.pickett@queensu.ca.|Department of Emergency Medicine, Queen's University, Kingston, Canada. will.pickett@queensu.ca.
authors.forename: William
authors.initials: W
authors.lastname: Pickett
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D003430:Cross-Sectional Studies; D003710:Demography; D005163:Factor Analysis, Statistical; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D010465:Perception; D025341:Principal Component Analysis; D011594:Psychometrics; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D029181:Spirituality; D011795:Surveys and Questionnaires
keywords: Adolescent; Child; Determinants of health; Epidemiology; Health inequalities; Spiritual health