Does Activism Mean Being Active? Considering the Health Correlates of Activist Purpose

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Introduction
The research on sense of purpose has been rapidly increasing in recent years, due to substantial representation within the health psychology literature. A sense of purpose is defined as the perception one has of a direction in life that guides future activity engagement (Ryff 1989;Scheier et al. 2006); as such, this construct is measured at the individual, rather than collective, level, focusing on how purposeful people feel in their lives. This construct has been distinguished from related ones, such as meaning and coherence, insofar that purpose tends to focus more on goal-directed engagement (see e.g., Costin and Vignoles 2020). A sense of purpose has been linked prospectively to a wide variety of wellbeing and developmental benefits (Pfund and Lewis 2020), as well as to a number of important physical health outcomes (see Kim et al. 2019;Ryff and Kim 2020 for reviews). A number of mechanistic accounts are potentially responsible for these health benefits, including how purposeful individuals-those with a stronger sense of purpose-may be more inclined to engage in healthier lifestyle behaviors (Hill et al. 2019;Hooker and Masters 2016;Kim et al. 2020). However, the research to date has focused on the associations between a sense of purpose and health variables, and most work has largely failed to consider specific forms of purpose. This issue is not specific to health constructs, as researchers have called for greater attention to be given to the ways in which a sense of purpose and the content of one's purpose may uniquely or interactively predict life outcomes (Burrow et al. 2021).
The current study addressed these calls, by focusing its attention on a nascent construct in the purpose literature, namely activist purpose (Wilson and Hill 2023a), which has been defined as commitment to a purpose in life that focuses on engaging in activist aims, toward social change. The current study sought to replicate the established associations between a sense of purpose and healthy lifestyle behaviors, and then extend this literature to test whether higher levels of activist purpose also positively predicted health behavior engagement. We also explored the associations between health behaviors and other existing purpose orientations (Hill et al. 2010), again advancing our insights into whether purpose content is linked to health indicators. Finally, we examined whether a sense of purpose interacted with activist purpose in the prediction of health behaviors, allowing insights into whether activist purpose levels are more associated with health behaviors for those with a stronger sense of purpose.

Sense of Purpose and Healthy Lifestyle Behaviors
Although there is no singular definition for, or conception of, sense of purpose, three primary components are commonly noted in the existing literature (McKnight and Kashdan 2009;Ryff 1989;Scheier et al. 2006). Firstly, individuals with a clearer sense of purpose view their lives as being directed toward a broader aim. In this vein, researchers have described purpose as being similar to a compass or lighthouse (McKnight and Kashdan 2009), insofar that it guides individuals, and provides a path for the future. Secondly, having a sense of purpose commonly involves future-orientated thinking, as purposeful individuals engage with activities that make progress toward their aim. Research demonstrates that individuals who report a higher sense of purpose also tend to view their future as more open-ended in nature, and believe that their future is full of opportunities (Pfund et al. 2022); in other words, purposeful individuals may be more likely to envision a future wherein they have more chances to continue progressing toward their life aim. Thirdly, purposeful individuals are generally more active, and exhibit higher levels of engagement. Indeed, life engagement has been viewed as a critical element of sense of purpose within the health psychology literature (Scheier et al. 2006).
In summary, the field consistently recognizes that purposeful individuals are directed, perceive more positive futures, and engage more in their daily lives. As such, it is perhaps unsurprising that a sense of purpose is correlated with healthier lifestyle behaviors, given that purposeful individuals are more active and motivated to ensure their future success. A sense of purpose has been associated with engagement with a variety of health behaviors, including better diet, more physical activity, better oral health, appropriate healthcare utilization, and higher-quality sleep (Hill et al. 2019;Kim et al. 2014Kim et al. , 2015Yemiscigil and Vlaev 2021). In addition, longitudinal studies link a sense of purpose to a reduced likelihood of becoming sedentary, or developing a worse body mass index ). Moreover, a sense of purpose predicts a reduced future risk of sleep disturbances (Kim et al. 2015). These findings help to explain the robust evidence that a sense of purpose prospectively predicts the risk for cardiovascular health events, and even early mortality for a metaanalytic review, see (Cohen et al. 2016).
A common refrain in this literature is the notion that purposeful individuals should be motivated toward promoting and maintaining their personal health, regardless of their specific purpose. Presumably, for progress toward any purpose in life, it is valuable to stay in better health, to maximize one's potential to continue pursuing that purpose. Similarly, researchers have suggested that having a purpose in life promotes optimal resource allocation (McKnight and Kashdan 2009), and personal health is presumably among the most important resources for future purpose pursuit. However, studies have largely failed to formally test this claim, which necessitates the consideration of specific types of purpose, not simply the level of sense of purpose.

Activist Purpose as a Nascent Construct
Past studies have considered the form of purpose that one orients toward, captured by participants' levels of commitment to different potential life goals (Hill et al. 2010(Hill et al. , 2011Sumner 2017). For instance, this work considered how individuals may report an orientation toward a more prosocial (e.g., helping others), financial/occupational (promotion at work), personal recognition (acknowledgment for success), or creative (artistic pursuits) purpose. Of note, these categories are not mutually exclusive, insofar that people commonly do report goal engagements related to more than one orientation. Past work suggests that all of these orientations appear personally adaptive in some manner, as higher levels of each are associated with some aspect of personal wellbeing (Hill et al. 2010(Hill et al. , 2011. Again, in line with recent theoretical work (Burrow et al. 2021), that research also shows that different purpose contents may yield differential outcomes, insofar that the specific benefits accrued may depend on what purpose is pursued. However, the studies to date have failed to consider the associations between these orientations and healthy lifestyle behaviors.
Recent research has described activist purpose as another type of purpose content, which is conceptually distinct from the aforementioned four orientations (Wilson and Hill 2023a). Individuals espousing activist purpose find their direction in life through engagement with movements to promote social change. Qualitative work suggests that individuals who espouse activist purpose may deal with greater stressors and obstacles as a result of active engagement with movements to change societal norms (Wilson and Hill 2023b). In addition, activist purpose engagement may be the result of personal experiences of discrimination and inequity in the system (Wilson and Hill 2023a). Activist purpose thus provides an interesting test case for whether all purposes lead to healthy lifestyle behaviors. Although this purpose retains the active engagement component of other purposes, both perceived discrimination (Pascoe and Richman 2009) and stress (O'Connor et al. 2021) have been consistently associated with less healthy behaviors. It remains an open question, then, whether espousing activist purpose yields the same health benefits seen for other, potentially less stress-inducing forms of purpose.

Current Study
The current study, thus, sought to examine the health correlates of activist purpose, along with the four previously identified purpose orientations. Firstly, we expected that a sense of purpose would be positively associated with self-rated health, as well as all forms of protective health behavior. Secondly, we predicted that the scores for the four previously identified purpose orientations (prosocial, occupational, personal recognition, and creative) would be associated with better health, and greater engagement with healthy lifestyle behaviors. Thirdly, we predicted that the activist purpose scores would also be positively linked to health and healthier behaviors. However, these associations may be weaker than for other forms of purpose, given that activist purpose may hold greater consequences for mental health. Fourthly, we explored whether this association was moderated by the sense of purpose, heeding calls to examine whether the benefits of a sense of purpose depend on its content (Burrow et al. 2021).

Participants
The participants included 307 US adults, recruited via Prolific (M Age = 38.10, 48.03% female, 73% white), who took part in an approximately 10-20-min online survey. To confirm their eligibility, once they had consented to participate, participants were asked to selfreport whether they were at least 18 years of age, and resided in the US. Anyone meeting these criteria on Prolific was shown the advertisement for the study, until the spots were filled for the survey; as such, the response rates cannot be calculated with regard to a total potential sample. The sample displayed no evidence of straight-line responding (i.e., providing the same response for each item), or of completing the survey in under a minute, solely to receive credit. Participants were paid according to Prolific's "good" rate ($10.50 per hour/$3.50 for 20 min). With regard to education, 39.8% of the sample reported having a bachelor's degree, 33.6% reported some post-high school training, 13.5% reported high school or GED only, and 11.2% reported having an advanced professional degree.

Materials/Measures
Sense of Purpose. The sense of purpose was assessed using the 9-item Sense of Purpose Subscale (Scheier et al. 2006). The participants were asked to respond with their agreement with each statement on a scale from 1 (Strongly disagree) to 5 (Strongly agree). The responses were averaged to create a sense-of-purpose score, wherein higher scores indicate a greater sense of purpose (e.g., "Some people wander aimlessly through life, but I am not one of them"; reliability in the current sample: α = 0.82).
Activist Purpose. The level of activist purpose was assessed using the 4-item Activist Purpose Orientation Scale (Wilson et al. 2023). The participants were asked to respond with their agreement with each statement on a scale from 1 (Not at all) to 5 (Very much). These four items were averaged to create an activist purpose score, with higher scores indicating a higher level of activist purpose (e.g., "Activism provides a direction in my life"; α = 0.94). These items were developed by adapting past sense-of-purpose measures (Hill et al. 2016;Ryff 1989) to reflect an activist focus. The measure intentionally avoids any suggestion of which causes or programs "count" as activism, allowing individuals to report higher levels of activist purpose across different ideologies. Past work has demonstrated the reliability and concurrent validity of this measure, with regard to sense of purpose and other wellbeing outcomes (Wilson et al. 2023).
Self-rated Health. The self-rated health was assessed using the Official Short Form-36 (SF-36) measure (Ware and Sherbourne 1992); developed at RAND as part of the Medical Outcomes Study. While the specific response options varied depending on the question, all items were coded according to a scale of 1-100, such that higher scores indicate better health. The composite scores were calculated for each of the eight health concepts captured in this measure: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional wellbeing, social functioning, energy/fatigue, and general health perceptions. As shown in Table 1, all the subscales were correlated similarly to sense of purpose. Therefore, for all subsequent analyses, an overall health score was calculated, by averaging the scores from the eight subscales (α = 0.84). Note. M and SD are used to represent the mean and standard deviation, respectively. * indicates p < 0.05. ** indicates p < 0.01. Due to space limitations, the correlations between the various health indicators were not included, but all were positively correlated with one another (p < 0.001).
Purpose Orientations. Four purpose orientations (creative, prosocial, financial, and personal recognition) were assessed using the 17-item Purpose Orientation Scale (Hill et al. 2010). The participants were asked to rate how important they perceived each goal as being, on a scale from 1 (Not important) to 4 (Essential). Creative purpose can be broadly defined as one's purpose in life relating to the creation of art or succeeding in the arts (e.g., "Creating artistic work (painting, sculpture, decorating, etc.)"; α = 0.74). Prosocial purpose can be thought of as having a life direction focused on helping others (e.g., "Helping others who are in difficulty"; α = 0.82). In contrast, a financial purpose orientation is associated with goals related to financial success or wellbeing (e.g., "Being successful in a business of my own"; α = 0.52). Finally, a personal recognition purpose is defined as a purpose in life related to gaining authority or recognition from others (e.g., "Becoming an authority in my field."; α = 0.76).
Health Behaviors. Health behaviors were assessed using the 16-item Health Behavior Checklist . The participants were asked to respond with how typical engagement with each health behavior was for them on a scale from 1 (Not at all like me) to 5 (Very much like me). The responses from the 16 items were averaged to create a single health behavior score, with a higher score indicating a greater engagement with health behaviors (e.g., "I get enough sleep."; α = 0.89).

Transparency and Openness
All analyses were conducted in R, utilizing the psych, multicon, Hmisc, and ppcor packages. This research was considered exempt by the IRB of Washington University in St. Louis, due to the anonymity of the participants and the lack of experimental manipulation. The materials and analysis code for this study are available to access upon emailing the corresponding author. For the analyses below, we included participants in all analyses for which they met the threshold for completing an individual scale (at least 75% of the items). However, the missingness was very limited, with at least 302 participants included (98.3% of the sample) in all of the correlational analyses below.

Descriptive Statistics and Correlations between Purpose Constructs
In order to understand how each type of purpose (i.e., all the purpose orientations and a sense of purpose) related to health, the correlations between all the relevant variables were conducted 1 . A full correlation table between all the relevant variables, including the means and standard deviations, can be found in Table 1. The participants reported high levels of sense of purpose (M = 4.01, SD = 0.95). However, they reported relatively low levels of the specific purpose orientations. For instance, on average, participants scored lowest on the personal recognition purpose orientation (M = 1.72, SD = 0.71). In addition, the sense of purpose was only weakly to moderately correlated with the four Hill et al. (2010) purpose orientations (see Table 1), suggesting that these constructs tap into unique aspects of purpose. Similarly, the sense of purpose was unassociated with the levels of activist purpose (r(302) = 0.03, p = 0.604, 95% CI [−0.08, 0.14]), again pointing to the distinction between the purpose content and sense of purpose.

Purpose and Self-Rated Health
Replicating past research, a higher sense of purpose was also related to better selfrated health across all indicators, separately (see Table 1), and when examining the selfrated health composite. In contrast to the positive associations found with the sense of purpose, the activist purpose showed a negative association with the self-rated health overall (r(304) = −0.16, p = 0.005, 95% CI [−0.27, −0.05]), though this association was not significant for all the indicators separately (see Table 1 for all the significant and nonsignificant effects). Contrary to the hypotheses, the other existing purpose orientations (i.e., prosocial, creative, financial, and personal recognition) were not significantly associated with self-rated health (see Table 1).

Exploratory Analyses
In order to test whether the above associations would hold when controlling for demographic variables, firstly, partial correlations for all the variables were calculated. In addition, in order to assess whether the activist purpose and sense of purpose uniquely predict health behaviors, a multiple regression was conducted, with the sense of purpose and activist purpose predicting health behaviors. Finally, in order to examine whether the sense of purpose would lead to differences in the relationship between the activist purpose and health and health behaviors, two multiple regression analyses were conducted, including the sense of purpose and activist purpose, and their interaction, predicting overall self-rated health and health behaviors.

Partial Correlations
Partial correlations were conducted to control for the effects of age, gender, race, and education on the relationships between the activist purpose and self-rated health, and the activist purpose and health behaviors. The results showed that the associations with the activist purpose held, with regard to the self-rated health (r(307) = −0.17, 95% CI [0.08, 0.30]) and health behaviors (r(307) = 0.19, 95% CI [−0.28, −0.06]).

Sense of Purpose and Activist Purpose Predicting Health
The multiple regression model including the sense of purpose and activist purpose predicting the self-rated health showed that both the sense of purpose and activist purpose uniquely predicted the self-rated health, such that the sense of purpose predicted better selfrated health (b = 10.28, p < 0.001, 95% CI [8.30,12.26]), and the activist purpose predicted worse self-rated health (b = −3.04, p < 0.001, 95% CI [−4.68, −1.41]). Similarly, the multiple regression model including the sense of purpose and activist purpose predicting health behaviors also showed the unique effects of the sense of purpose and activist purpose, wherein both the sense of purpose (b = 0.33, p < 0.001, 95% CI [0.24, 0.42]) and activist purpose (b = 0.15, p < 0.001, 95% CI [0.07, 0.22]) predicted greater engagement with health behaviors.
Moving on to the moderation analyses, the multiple regression model including the sense of purpose, activist purpose, and their interaction predicting the self-rated health showed that the sense of purpose did not significantly moderate the relationship between the activist purpose and the self-rated health (b = 0.84, p = 0.332, 95% CI [−0.86, 2.54]). Similarly, the model including the sense of purpose, activist purpose, and their interaction predicting health behaviors also showed that the sense of purpose did not significantly moderate the relationship between the activist purpose and health behaviors (b = −0.07, p = 0.081, 95% CI [−0.15, 0.01]).

Discussion
Among the strongest evidence for the value of a sense of purpose has been the work highlighting its linkages to health and health behaviors (Kim et al. 2019;Ryff and Kim 2020). However, limited discussion has considered whether a commitment to specific forms of purpose yields similar health benefits. The current study addressed this need, considering activist purpose, a new form of purpose, focused on whether individuals reported a life direction focused on social change through activism (Wilson and Hill 2023a;Wilson et al. 2023). Our findings paint an intriguing picture regarding the role of purpose in promoting a healthy life. Replicating past research (Kim et al. 2019;Ryff and Kim 2020), consistent evidence was again found for a sense of purpose being a positive correlate of health and health behaviors. However, the content of purpose (i.e., purpose orientation) was more positively associated with behaviors than with health itself. Finally, no significant moderation effects were evidenced with regard to whether the sense of purpose influenced the associations between the activist purpose and health indicators. We discuss below the implications for the study of the activist purpose, and for our understanding of how purpose is associated with health in general.

Activist Purpose and Health
Activist engagement can be an arduous activity that can take a physical and psychological toll on individuals. In support of this, the current study found that individuals who reported a higher activist purpose scores tended to report lower levels of self-rated health, greater role limitations, more pain, and worse social functioning. All of these associations ran counter to the directions found for a sense of purpose in general, and the findings speak to how health researchers cannot assume that all forms of purpose will be uniformly "healthy" in nature. That said, the activist purpose scores were positively associated with health behaviors. A possible explanation for this seemingly counterintuitive finding is that, like with most forms of purpose, individuals see the value of healthy lifestyle behaviors in order to continue the pursuit of their life direction. Activism can increase exposure to health risks, such as greater identity-relevant stressors, the disruption of social ties, and even altercations with authorities, which may lead individuals with activist purpose to attribute an even greater importance to health behaviors. Future research should consider the associations between purpose and the perceived value of a healthy lifestyle, and whether the importance of staying healthy is consistent across individuals with different life purposes. An intriguing side note of the current work is that the other content domains (prosocial, financial, creative, and personal recognition) were all more associated with the activist purpose than the sense of purpose. These associations support not only the claims that activist purpose engagement can take multiple forms (Wilson and Hill 2023a), but also the potential for certain values (such as health promotion) to be common across different purposes.
In fact, given the toll of activism, perhaps one should be surprised that the associations between the activist purpose and health indicators were not more strongly negative. Across all the self-reported health variables, the associations with the activist purpose were modest in magnitude, and several failed to reach significance. Although not positive in direction as predicted, these findings may still point to the potential health resilience imbued by having a purpose in life focused on activism. In a similar vein, research has suggested that having a sense of belonging within activist groups can serve to protect youth against the potential health risks associated with activist engagement (Conner et al. 2023). Deriving purpose from activism may similarly help to protect individuals from experiencing even more negative associations between activist engagement and health. Activist purpose may serve to counter the ill-effects of more frequent exposure to societal injustice, as shown in past qualitative work (Wilson and Hill 2023b). Given that activist purpose is a nascent construct, several directions are presented for future research on this front. Firstly, researchers should compare the health indicators between activists with and without commitment to a purpose in life, as well as between those who do and do not see activism as their purpose. Secondly, work is also needed to identify the health promotion factors (i.e., increased health behaviors, self-definition, etc.) and health risks (stressful experiences, social functioning issues) linked to having an activist-orientated purpose. Following these points, researchers then can prepare better programs to facilitate the development of an activist purpose, including tailored health support along the way.

Purpose Content and Health
More broadly, it is also noteworthy that none of the purpose orientations showed consistent positive associations with the health indicators. Past theoretical work has pointed to the need for additional inquiries that compare the purpose content with the sense of purpose (Burrow et al. 2021), and the current work suggests that the sense of purpose, not what the purpose is, may be the critical factor for predicting health outcomes. These findings should not be taken as support for the development of any purpose, such as societally destructive ones. All five of the purpose content domains examined here are generally positive to pursue, insofar that they all likely yield personal benefits, such as wellbeing, success, and/or identity development. However, before making broader claims, research should consider alternative purposes, beyond the current subset. Instead, we would suggest that the current findings provide evidence against the claims that certain purposes are "better" than others, at least with regard to health. These findings assist with the interpretation of past work linking a sense of purpose to health. Sense-of-purpose measures are generally agnostic to the form of purpose (Hill et al. 2016;Ryff 1989;Scheier et al. 2006), and the current findings demonstrate that no one purpose orientation may be more or less promotive of a sense of purpose. Indeed, the purpose orientations were only weakly associated with the sense of purpose. Past studies focusing on sense of purpose have been left calling for additional work on whether the content matters for these associations. Heeding these calls, the current work further paints the picture that the sense of purpose, not the type of purpose, may be the critical factor when predicting health outcomes.
If true, these results provide valuable insights for community health interventions and programs. Theoretical work has provided a roadmap for helping to cultivate and support purpose development among individuals (Burrow 2023;Hill et al. 2023;Moran 2020), pointing to the importance of identifying personally important activities in everyday life. Similar to the recommendations made by several therapy programs, this model suggests that individuals can benefit from reflecting upon what has given them a sense of purpose and direction today or this week. After identifying these purposeful states and experiences, the model points to how people should develop habits to enact these purposeful activities more frequently. For some individuals, this may be engagement with activism, but others will find it in the arts or in succeeding at work. Critically, no one activity will serve as "the" element that promotes purpose for everyone , and the current findings point to how the connections with health and health behaviors are relatively similar across the different forms of purpose that people may espouse. As such, intervention programs would seemingly benefit from focusing on the sense of purpose, rather than a specific form of purpose, as the critical target.

Limitations and Conclusions
These recommendations, however, come with the acknowledgment that the current work is limited in important ways. First and foremost, the current data are cross-sectional in nature, and warrant further attention in longitudinal studies. That said, the notion of purpose yielding health behaviors aligns with past longitudinal research , as well as with theoretical expectations (Kim et al. 2019), and the evidence is equivocal regarding whether health behaviors may predict a future sense of purpose (Yemiscigil and Vlaev 2021;Zhang and Chen 2021). Therefore, it appears that the assessed purpose variables are more likely to precede health behaviors than vice versa, but additional research is needed to examine bidirectionality. Secondly, the current study did not assess actual purpose-relevant behaviors and, thus, participants' self-reported purpose orientations may reflect self-report biases. Past measurement recommendations (Burrow 2023) have noted that researchers should avoid problematic declarations regarding whether people only "have" purpose when they can show progress toward it; therefore, self-reports of purpose content are integral to identifying one's purpose orientation. However, future research may wish to integrate self-reports with observer reports or behavioral-based measures, in order to reduce potential biases. Finally, it would be valuable to include longer, more comprehensive health behavior composites in future research, as we are currently unable to fully break down which forms of health behavior are more associated with the sense of purpose or purpose content.
These caveats aside, the current study provides valuable insights into the nature of activist purpose, and what it means for health outcomes. Namely, participants with an activist purpose may be at a slightly greater risk for health concerns, which runs counter to the findings on a sense of purpose in general. However, given that these associations were modest in magnitude, paired with the positive association between the activist purpose and health behaviors, the current study also points to how having a purpose centered on activism may yield some health protection. It may be that having an activist purpose promotes health for those who attempt to follow it, compared to individuals with a less clear purpose in life. Future research, however, needs to follow up on these findings, to more specifically consider when, why, and for whom commitment to an activist purpose can hinder or promote physical wellbeing and health behaviors. Such research is critical to advancing our knowledge of the pathways linking activist engagement to health, heeding calls for additional work understanding the health benefits and costs associated with activism and related activities (Ballard and Ozer 2016;Ballard et al. 2019Ballard et al. , 2021Gidengil and Wass 2023). Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Data Availability Statement: Data for the current paper can be made available to interested readers through contacting the first author.

Conflicts of Interest:
The authors declare no conflict of interest.

1
In order to receive a composite score for a particular measure, participants must have responded to at least 75% of items in that measure. An alpha of 0.05 was used throughout the analyses.