Religion and drug use by adolescents

Abstracts

INTRODUÇÃO: Estudos internacionais e nacionais mostram que a religiosidade é um modulador importante no consumo de álcool e drogas entre estudantes adolescentes. OBJETIVOS: verificar se diferentes variáveis da religiosidade influenciam o uso freqüente e/ou pesado de álcool e drogas entre estudantes de 1º e 2º graus. MÉTODOS: Estudo transversal com uma técnica de amostragem do tipo intencional. Foi utilizado um questionário anônimo de autopreenchimento. A amostra foi constituída por 2.287 estudantes de escolas públicas periféricas e centrais e escolas particulares da cidade de Campinas, SP, entrevistados no ano de 1998. As drogas estudadas foram: álcool, tabaco, solventes, medicamentos, maconha, cocaína e ecstasy. As variáveis independentes incluídas na análise de regressão logística foram: filiação religiosa, freqüência de ida ao culto/missa por mês, considerar-se pessoa religiosa e educação religiosa na infância. Para identificar como as variáveis de religiosidade influenciam o uso de álcool e drogas utilizaram-se análises bivariadas e a análise de regressão logística para resposta dicotômica. RESULTADOS: O uso pesado de pelo menos uma droga foi maior entre os estudantes que tiveram educação na infância sem religião. O uso no mês de cocaína e de "medicamentos para dar barato" foi maior nos estudantes que não tinham religião. O uso no mês de ecstasy e de "medicamentos para dar barato" foi maior nos estudantes que não tiveram educação religiosa na infância. CONCLUSÕES: Várias dimensões da religiosidade relacionam-se com o uso de drogas por adolescentes, com possível efeito inibidor. Particularmente interessante foi que uma maior educação religiosa na infância mostrou-se marcadamente importante em tal possível inibição.

Religião; Abuso de drogas; Bebidas alcoólicas; Saúde dos adolescentes

ORIGINAL ARTICLE

Religion and drug use by adolescents

Paulo Dalgalarrondo^I; Meire Aparecida Soldera^I; Heleno Rodrigues Corrêa Filho^II; Cleide Aparecida M Silva^III

^IDepartamento de Psicologia Médica e Psiquiatria - FCM-UNICAMP

^IIDepartamento de Medicina Preventiva e Social - FCM-UNICAMP

^IIIComissão de Pesquisa-FCM-UNICAMP

^{Correspondence}

ABSTRACT

INTRODUCTION: Many international studies show that religion is an important dimension modulating the use of alcohol and drugs by adolescents.

OBJECTIVES: to determine which religious variables are associated to frequent or heavy use of alcohol, tobacco and drugs among adolescents in intermediate and high schools in Campinas, Brazil.

METHODS: A cross-sectional study using a self-report anonymous questionnaire was administered to 2.287 students from a convenience sample of seven schools: five from central areas (two public and three private schools) and two public schools from the outskirts of the city, in 1998. The study analyzes data regarding the use of alcohol, tobacco, medicines, solvents, marijuana, cocaine and ecstasy. The religious variables included in the regression analysis were: religious affiliation, church attendance, self-assessed religiousness, and religious education in childhood. For the substances, nicotine, alcohol, marijuana, cocaine, ecstasy and "abuse of medicines" a logistic regression analysis for dicotomic answer was applied.

RESULTS: The heavy use of at least one drug during the last month was more frequent among students that did not have a religious education during childhood. The use in the last month of cocaine, ecstasy and (abuse of) medicines was more frequent among those students that had no religion (cocaine and medicines) and that did not have a religious education during childhood (ecstasy and medicines).

CONCLUSIONS: this study is consistent with previous investigations demonstrating a strong influence of religious variables over the use of drugs among adolescents. Interesting, it was found that no or weaker religious education during childhood was markedly associated with significant more use of drugs during adolescence.

Keywords: Religion. Drug abuse. Teen Health. Alcoholic beverages.

Introduction

The relationship between religiousness and alcohol and drug use by adolescents has been subject of investigation by many researchers, as for adolescents both the religious involvement and practice as well as alcohol and drug use are very significant dimensions of their personal and social experience.¹ These dimensions have significant impact on the physical and mental health, on the risk behaviors and on the psychosocial development of adolescents.² Understanding the relationships between these two dimensions is a task of utmost importance.

Alcohol and drug use and dependence are a complex phenomenon determined by genetic, psychological and social factors.³ Many studies performed in different sociocultural contexts show that in adolescent and young populations there is an association between not having a religion affiliation (or pertaining to more liberal persuasions), having scarce religiousness, not attending to church or cults and higher alcohol and drug use (Tables 1 and 2).

Therefore, international studies indicate an important effect of religious affiliation and different dimensions of religiousness associated with the modulation of alcohol and drug use in adolescents.

Religion and alcohol and drug use among adolescents in Brazil

In our country, the most comprehensive study including the subject religion and drug use among adolescents was performed in 1992.²⁴ This study included 16,117 elementary and high-school students from fifteen Brazilian cities and showed a weak but constant negative correlation between alcohol and drugs and attendance to religious activities. Youngsters who perform religious activities tended, therefore to a lower use of alcohol and drugs.

Borini et al.²⁵ (1994) studying 322 medical students in Marília, São Paulo, verified that the prevalence of alcohol use (including mild, moderate and excessive drinkers) was significantly lower among Protestants (50%) compared to Catholics (75.2%), Spiritualists (75.0%) and Atheists (94.5%). They had also not detected in that sample excessive drinkers among Protestants and Spiritualists. With a substantially larger sample, the study by Queiroz²⁶ included 2,564 college students from 21 courses of the University of São Paulo – USP-, and used a logistic regression analysis. This study revealed a higher association of drug use with not having a religion.

More recently, Kerr-Corrêa et al.²⁷ (2002) accomplished a survey with 11,876 students (11,382 from college and 624 from high school) of the state of São Paulo. Using a logistic regression analysis, the authors identified that the excessive use of alcohol among high-school students was related to not having a religious practice. Among college students the use of cannabis was associated with not having any religion and the use of solvents was related to not having a religious practice. Analyzing the results as a whole, the authors concluded that alcohol and drug use is modulated by group rules, values and practices, both in family and in extra-family groups (friends, religious groups, etc).

The goal of this study was to verify how the variables related to religiousness, such as having or not a religion, religious affiliation, attendance to cults, high or low self-reported religiousness, and religious upbringing in childhood can influence the frequent and/or heavy alcohol and drug use among adolescents.

Method

This is a cross-sectional study with an intentional, convenient sampling technique. In the year 1998, 2,287 elementary and high-school students of schools from different socioeconomic and cultural contexts were assessed: two peripheral public schools, two central public schools and three central private schools from Campinas-SP.

A self-reported anonymous questionnaire of CEBRID (Brazilian Information Center on Alcohol and Drugs) was used.²⁸ In this study we analyzed and commented the variables linked to religiousness. Other significant dimensions and variables found are discussed in other study.²⁹

Studied variables

The questionnaire employed collected data on the following variables: gender; age; socioeconomic level, school type; grade and period of the day in which the student studied, work; type of leisure; friends’ and/or boy/girlfriends’ understanding and support; person responsible for the rearing in the last two years; parental situation; with whom lives; family support and understanding; school delay; GHQ-12³⁰ and use of licit and illicit drugs. The GHQ-12 (General Health Questionnaire) is a screening instrument for mental disorders, which contains 12 questions with the most common psychiatric symptoms in the community. Mari and Williams validated it for the Brazilian population in 1985.³⁰ Regarding religiousness, the following data were collected in this study: having or not a religion (being an adept of any religion or religious persuasion); religious affiliation; monthly attendance to church; self-reported religiousness (very much, moderately, hardly or not religious) and religious upbringing in childhood (very religious, moderately religious, hardly or not religious).

Studied drugs

The studied drugs were: alcohol, tobacco, medications, cannabis, solvents, cocaine and ecstasy. According to WHO,³¹ it was considered use in the month, the use of drugs in the 30 days prior to the study; frequent use, the use 6 to 19 times in the 30 days prior to the study and heavy use, the use in 20 days or more in the 30 days prior to the study.

For widely-used substances such as tobacco, alcohol, cannabis and solvents, individual multivariate analyses were performed for each of them, considering heavy use. For cocaine, 'medications to get high' and ecstasy, as the frequency of use was quite lower in our sample, we chose to work with 'use in the month'.

As the concomitant use of several drugs was very common (polyuse) and aiming to compare students who had not used any drug in the month and students who used heavily at least one drug, it was created a variable called DRUG. This variable assumes the value 0, if students had not used in the month any of the mentioned drugs; and 1, if they used at least one of the studied drugs in 20 days or more in the previous month.

Statistical analysis

The variables related to religiousness were: having or not any religion, religious affiliation, time in which subjects pertain to the religious persuasion, monthly attendance to church, self-reported religiousness; and religious upbringing in childhood. In order to identify how the variables of religiousness influence the heavy use of any drug (alcohol, tobacco, cannabis, solvents, cocaine, ecstasy and 'medications to get high' it was used a multivariate analysis procedure (which considers variables as a whole); the Logistic Regression Analysis for Dicotomic Answer. The selection method of explicative variables used in the logistic regression was stepwise.

Statistical tests used were: chi-square, for differences in frequency, ANOVA for the comparison of two or more means and Student t test for two means.

Ethical aspects

The Ethical Committee of the School of Medical Sciences of the State University of Campinas – UNICAMP – approved this study and the informed consent was obtained from the Official Education Agencies, from the Principals and the Parents' Associations of the involved schools.

Before the application of the questionnaire, students were explicitly told that they had the full right of not participating in the study and that this refusal would not imply any form of disapproval or reprehension. The application was collective, at schoolroom, without the presence of the teacher. Assurance and certainty of anonymity was emphasized at the beginning of the interviews.

Results

1. General aspects of the sample

The initial sample had 2,375 students. Of these, 86 students aged above 26 years were excluded (despite studying in elementary or high schools). Two questionnaires were discarded for their incomplete filling or lack of understanding. There were no refusals to answer. It was not possible to quantify the exact number of absent students, but according to the application reports it is estimated that they were not numerous as the great majority of schoolrooms were full at the moment of the interview. Therefore, 2,287 students were included for the study’s analysis. Of these, 1,188 (52.0%) were males and 1,096 (48.0%) were females. Mean age was 15.8 (Standard Deviation 2.7; variation 11-26); 781 (34.1%) studied in central public schools, 763 (33.6%), in peripheral public schools and 738 (32.3%) studied in central private schools; 1,159 (50.8%) coursed elementary school and 1,122 (49.2%) coursed high school.

The results of the bivariate analysis (which crosses two variables) are shown in Tables 3 and 4. In Table 5 the results of the multivariate analysis are shown.

Multivariate analysis (Table 5)

In the multivariate analysis model employed, we could not identify a statistically significant relation between specific heavy use of tobacco, alcohol, solvents and cannabis and variables of religiousness. For cocaine, 'medications' and ecstasy (with which we have only worked with use in the month) the significant values found are shown in table 3. In the same table the significant results for the variable created a posteriori called 'DRUG' are also displayed.

Discussion

The data from the current study reinforce clearly the evidence demonstrated by the international and national literature, namely: several dimensions of religiousness are possibly relevant in the modulation of use and abuse of alcohol and drugs by several population groups, particularly adolescents and youngsters.

Limitations of the study

Some methodological limitations of this study are worth to be mentioned. As this is a convenient sample, we intentionally chose public and private schools from central and peripheral neighborhoods, in order to contrast the socioeconomic and cultural reality of the students. Therefore, this was not a representative sample from all students of Campinas. Thus, possible generalizations from the data could only be performed very cautiously.

In a relatively surprising way, we had no refusals from students to answer the questionnaires at schoolrooms, what can be possibly due to the extremely skilful explanation of this study’s objectives to the students and to the emphatic assurance of anonymity. On the other hand, it was not possible to control the bias produced by absent students, in the day of the interview. Actually, these students are possibly the most severely involved in the use of alcohol and drugs. However, this is a limitation of any study performed at schools. Anyway, interviewers observed that in the days of application the classes were, as a rule, full, indicating that the number of absent students was possibly small.

Finally a criticism can be made as we have included tobacco with alcohol and other drugs in the construct 'DRUG' (heavy use of any drug in the last month). In general, tobacco use tends to be daily, configuring almost always a 'heavy use'. This use surely does not necessarily imply severe behavioral and psychosocial alterations (as is the case of heavy use of alcohol, cannabis or cocaine). However, we have chosen to keep tobacco in the set of heavily used drugs, as this use implies severe risks to the adolescent's physical health.

It is not superfluous to remind here that as this is an observational and cross-sectional study, we have not identified causal relationships (such as higher religiousness producing lower drug use), but only descriptive associations, whose causal factors may reside in points not identified by researchers.

Religiousness in the studied sample

In our sample, the analysis of the relationship of religiousness with the socio-demographic profile of students and type of school found that girls claimed more having a religion and having had a religious upbringing as well as a higher self-reported religiousness than boys. A higher religiousness among females is a very recurrent finding in several cultures (including Western ones), which has been relatively well documented in the sociological literature.³² There were no differences regarding the variables of religiousness and age. Students of peripheral public schools tend to be more affiliate to historical Protestantism or Pentecostalism and less frequently to Spiritualism, as well as having a higher self-reported religiousness, having a higher attendance to religious cults, and having had more frequently a very religious upbringing in childhood. Summing up, girls and boys from peripheral public schools are most intensely religious.

Variables of religiousness

As a rule, many are the variables related to religion assessed in studies about alcohol and drug use among adolescents. Most part of the studies has predominantly investigated the religious affiliation and the attendance to cults. However, several researchers^9,17,22,33 have also included variables such as: importance given to religiousness in life, religious commitment, measures of religiousness (belief in God, intensity of the faith, etc.), personal religious practices (solitary prays, religious readings, etc.), participation in activities in church, besides cults, time spent with religious activities and orthodox or fundamentalist beliefs and values. Therefore, it is difficult to compare the studies and even to identify which dimension of religious experience is the most significant for the modulation of alcohol and drug use. In this study, we dealt with only four dimensions: religious affiliation, attendance to cults and a general self-reported measure regarding religiousness, implied in considering oneself (in several degrees) a religious person. Besides, we have included the religious upbringing in childhood, as this would indicate the influence of the family religiousness over the adolescent.

Among the religious persuasions in our society, historical Protestants and Pentecostalists showed, relatively, a higher frequency of non-users and Catholics and Spiritualists, a higher frequency (also relative) of heavy users. This is in accordance with the literature,^3,4,16,25 in which it is verified that the most conservative religious persuasions tend to present less alcohol and drug users among their members.

Generally, in the bivariate analysis it was verified that all religious variables, except for 'attendance to cults', were significantly associated with heavy drug use. Such an association occurred always in the sense of - the more religious is the student subgroup the lower the frequency of heavy drug use.

The absence of relationship between attendance to cults and drug use in our sample is noteworthy, as most studies have identified that the more adolescents attend to cults or Masses, the less they use alcohol or drugs (review by Francis³³). However, some studies^33,34 could not, like us, find this relationship.

Of the four studied variables, the most recurrent one in the multivariate analysis, associated with a possible inhibitory effect on alcohol and drug use, was 'having had a religious or very religious upbringing in childhood'.

It must be also highlighted that both 'not having a religious upbringing in childhood', and self-reported religiousness, were the characteristics which were related to a higher punctuation in the GHQ-12, which indicates the presence of psychopathological symptoms. Although the absolute difference in the punctuation is small, it may be speculated that adolescents with less religious upbringing and less current personal religiousness tend to be also those who feel psychologically worse.

In this study, in the multivariate analysis, it was noteworthy that the variable 'having had a religious upbringing in childhood' was the one that more recurrently was related to lower use in the month as well as to lower heavy use of the different drugs. Such finding is intriguing, as between these two phenomena (drug use in adolescence and religious upbringing in childhood) there is a considerable temporal distance.

Actually, there are many possible implications of claiming 'having had a religious upbringing in childhood'. Initially, it was found that the definition of what is exactly a 'religious upbringing' is complex and relatively vague. Boys³⁵, reviewing the subject 'religious education', states that the several concepts and notions implied denote a considerable conceptual and empirical confusion.

In our study, having had a religious upbringing in childhood may imply having had an education with more clear moral and behavioral rules and norms, having had a more structured socio-familial environment, as well as having internalized values which give significance to life. Available data, however, do not allow such details, obliging us to have a position of interpretative caution. Jessor and Jessor³⁶ have not found a relationship between the degree of parental religious fundamentalism and the use of alcohol by children. On the other hand, an important recently published study,³⁷ had investigated data related to education, religiousness and moral attitudes among 16,604 subjects in 15 countries. The authors could identify that the moral attitudes of an individual reared by religious parents is clearly more 'conservative' than that of those reared by non-religious parents. They also verified that the effects of socialization in childhood with religious parents are kept during adulthood. Finally, they verified that the influence of religiousness on moral attitudes is more intense in less secular countries. According to the authors, in countries in which religiousness was, as a rule, more important in social life, the individual and parental religiousness tended to more remarkably guide the moral attitudes and behavioral patterns of subjects.

In general, data from the current study (higher influence of 'religious upbringing', 'self-reported religiousness' and less influence of 'attendance to cults') indicate that dimensions of religiousness related to the internalization of moral and religious rules, values and attitudes were more important than a possible religious social practice, such as the attendance to cults and Masses.

This finding is corroborated by two studies^9,38 which point to the same direction. Patocvk-Peckham et al.,⁹ verified that, among 263 college students, intrinsic religiousness (religious values and rules, as well as introjected personal ethical rules, utilized in daily life) was associated to lower alcohol use and less alcohol-related problems, whereas the so-called extrinsic religiousness (related to the utilitarian seek of safety, sociability, status and self-justification in church) was not related to alcohol use.

In the same sense, Laflin et al.,³⁸ while studying variables such as drug use, attitudes regarding drugs, subjective rules and selfesteem among 2,074 high-school and college students in the US, have identified that subjective rules and attitudes regarding the use of drugs were more important than the current selfesteem of the student to determine alcohol and drug use. These authors, based on the theories of 'planned action' and 'rationalized action', sustain that subjective rules and internalized attitudes regarding drug use are the factors most strongly associated with the use or not of drugs among adolescents. Subjective rules which orient attitudes are much more 'introjected dimensions' of religiousness than the external social practices of attendance to cults.

Also supporting this interpretation, data from this study, as well as from other studies^16,39 reveal that groups of Protestant students pertaining to the more conservative persuasions use significantly less alcohol and drugs than the others. These groups (in the US, conservative Protestants and in Brazil, historical Protestants and Pentecostals) condemn the use of alcohol and drugs more clearly and explicitly than more liberal groups ( in the US, liberal protestants and Catholics, and in Brazil, Catholics and Spiritualists), among which the condemnation is not so emphasized. Bock et al.,⁴⁰ when analyzing data from the US census from 1972 to 1980 for non-institutionalized people aged above 18 years, verified that the inhibitory impact of religion on alcohol use and abuse is progressively higher in those religious groups which explicitly condemn this use. In this line, two recent studies^41,42 identified, in extensive samples and with strict epidemiological methods, the association of pertaining to conservative religious groups, as well as having a higher personal religious devotion and less frequent use and less dependence on alcohol and other drugs.

Therefore, our results, as well as the mentioned studies, point to a possible higher influence of internalized religiousness, with rules, values and prohibitions inserted in the adolescent's subjectivity, a dimension which is possibly more important than simply attending to a determined religious persuasion. Further studies should investigate more deeply this possibility.

As a conclusion, we would like to remind that the adhesion to a religious persuasion and being involved with patterns of religiousness, signify the adhesion to a set of social values, symbols, behaviors and practices, i.e., the adhesion to a comprehensive and complex religious ethos, which includes, among other things, the acceptance or refusal of alcohol and drugs.

References

Sponsor: Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP.

Received 04.06.2003

Accepted 17.11.2003

Reviewed version 08.10.2003

Departamento de Psicologia Médica e Psiquiatria - FCM-UNICAMP

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Publication Dates

• Publication in this collection
  27 Oct 2004
• Date of issue
  June 2004

History

• Accepted
  17 Nov 2003
• Received
  04 June 2003