Religiosity and patterns of alcohol consumption among users of primary healthcare facilities in Brazil

Martinez, Edson Zangiacomi; Silva, Anderson Soares da; Giglio, Flávia Masili; Terada, Natalia Akemi Yamada; Zucoloto, Miriane Lucindo

doi:10.1590/1414-462X201900020234

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Sumário

Original Article • Cad. saúde colet. 27 (02) • Apr-Jun 2019 • https://doi.org/10.1590/1414-462X201900020234 copy

Religiosity and patterns of alcohol consumption among users of primary healthcare facilities in Brazil

Religiosidade e padrões de consumo de álcool entre usuários de unidades de atenção primária à saúde no Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

A number of studies have been reported on the role of religiosity in health beliefs and behaviors.

Objective

The objective of this cross-sectional study is to examine the association between religious involvement and patterns of alcohol consumption in a large representative sample of users of primary healthcare facilities in Ribeirão Preto, Southeast Brazil.

Method

Data were collected through personal interviews. Religiosity was measured using the Duke University Religion Index (DUREL) and the alcohol consumption was measured using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire. Multinomial logistic regression models were used to evaluate the associations between the participant characteristics, the AUDIT risk levels, and the drinking groups.

Results

The sample was composed of 841 women with a mean age of 39.5 years old and 214 men with a mean age of 45.1 years old. A significant relationship between patterns of alcohol consumption and the multiple dimensions of religiosity was detected, such as religious affiliation, religious practices, self-perception of the level of religiosity and the ORA, NORA and IR components of DUREL. Lower levels of drinking risk were detected among religious individuals and among those who practice their religions compared to individuals who have no religion and/or non-practicing individuals, respectively.

Conclusion

A lifestyle motivated by religious concerns is associated with alcohol use habits among the Brazilian users of the public healthcare facilities.

Keywords:
alcohol abuse; religion; epidemiology; primary health care

Item	Women		Men
Item	n	%	n	%
1. Drinks containing alcohol
Never	522	62.1	84	39.2
Monthly or less	119	14.1	24	11.2
2 to 4 times a month	136	16.2	49	22.9
2 to 3 times a week	50	5.9	35	16.4
4 or more times a week	14	1.7	22	10.3

2. Number of drinks on a typical day ^a a n = 449 respondents
1 or 2	120	37.6	37	28.5
3 or 4	92	28.8	35	26.9
5 or 6	60	18.8	26	20.0
7 to 9	19	6.0	10	7.7
10 or more	28	8.8	22	16.9

3. Frequency of six or more drinks^a
Never	156	48.9	39	30.0
Less than monthly	58	18.2	16	12.3
Monthly	41	12.9	31	23.9
Weekly	61	19.1	36	27.7
Daily or almost daily	3	0.9	8	6.1

4. Frequency of impaired control over drinking^a
Never	282	88.4	104	80.0
Less than monthly	22	6.9	16	12.3
Monthly	10	3.1	5	3.9
Weekly	5	1.6	3	2.3
Daily or almost daily	0	0	2	1.5

5. Failure to do what expected because of drinking^a
Never	307	96.2	122	93.8
Less than monthly	7	2.2	5	3.8
Monthly	3	0.9	1	0.8
Weekly	2	0.6	1	0.8
Daily or almost daily	0	0	1	0.8

6. Need of a first drink in the morning^a
Never	315	98.8	124	95.4
Less than monthly	2	0.6	2	1.5
Monthly	1	0.3	1	0.8
Daily or almost daily	1	0.3	3	2.3

7. Feeling guilty after drinking^a
Never	268	84.0	109	83.9
Less than monthly	29	9.1	11	8.5
Monthly	16	5.0	6	4.6
Weekly	6	1.9	1	0.7
Daily or almost daily	0	0	3	2.3

8. Unable to remember what happened night before^a
Never	290	90.9	107	82.3
Less than monthly	16	5.0	17	13.0
Monthly	11	3.5	4	3.1
Weekly	2	0.6	1	0.8
Daily or almost daily	0	0	1	0.8

9. Injured because of drinking
No	788	93.8	189	88.3
Yes, but not in the last year	36	4.3	21	9.8
Yes, during the last year	16	1.9	4	1.9

10. Others’ concern about drinking
No	733	87.1	131	61.2
Yes, but not in the last year	40	4.8	37	17.3
Yes, during the last year	68	8.1	46	21.5

	n	AUDIT risk level			*III or IV versus* I OR1 (95% CI)** ^a a Odds ratios adjusted by sex, age and socioeconomic status	*II versus* I OR2 (95% CI)^a**
	n	I	II	III or IV		*II versus* I OR2 (95% CI)^a**
Sex
Women	841	88.8	9.3	1.9	Reference	Reference
Men	214	66.4	27.1	6.5	5.2 (2.4-11.2)^* * Confidence intervals that do not include 1 are marked with an asterisk (similar to p<0.05)	4.3 (2.9-6.5)*

Age group (years)
Until 25	188	86.7	11.2	2.1	Reference	Reference
26-30	132	79.6	16.7	3.8	1.6 (0.4-6.3)	1.5 (0.8-2.7)
31-40	250	80.4	16.0	3.6	3.2 (0.9-11.8)	2.3 (1.3-4.3)*
41-50	173	83.2	12.7	4.1	2.8 (0.9-8.8)	2.1 (1.2-3.6)*
51-60	164	83.5	13.4	3.5	2.9 (0.9-9.5)	1.5 (0.8-2.7)
> 60	148	93.9	6.1	0	-	-

Educational level
Higher education	126	86.5	12.7	0.8	Reference	Reference
Medium school	517	86.1	11.6	2.3	2.8 (0.3-22)	0.9 (0.5-1.7)
Fundamental II	221	79.2	18.5	2.3	2.8 (0.3-26)	1.4 (0.7-2.8)
Fundamental I	61	85.2	11.5	3.3	4.3 (0.3-58)	0.8 (0.2-2.3)
Insufficient	130	83.1	9.2	7.7	11.7 (1.2-109)*	0.8 (0.3-1.9)

Marital status
Single	247	84.6	13.4	2.0	Reference	Reference
Married	648	84.4	12.8	2.8	1.2 (0.3-3.4)	0.8 (0.4-1.3)
Widowed	53	90.5	5.7	3.8	4.5 (0.7-30.2)	0.6 (0.1-2.4)
Divorced	107	79.4	15.9	4.7	3.0 (0.7-12.3)	1.5 (0.7-3.1)

Socioeconomic status
A or B	355	85.9	12.1	1.2	Reference	Reference
C1	368	86.1	11.7	2.2	1.1 (0.3-3.0)	0.9 (0.5-1.5)
C2	235	82.6	14.0	3.4	1.9 (0.6-5.4)	1.3 (0.7-2.1)
D or E	97	75.3	17.5	7.2	3.9 (1.3-11.9)*	1.5 (0.8-2.9)

Self-perception of health
Good	735	84.4	13.2	2.4	Reference	Reference
Regular	280	85.0	11.8	3.2	1.4 (0.6-3.5)	1.0 (0.6-1.6)
Poor	40	77.5	15.0	7.5	3.2 (0.8-12.3)	1.3 (0.4-3.3)

Have health insurance
Yes	154	79.9	18.8	1.3	Reference	Reference
No	901	85.0	11.9	3.1	1.9 (0.4-8.6)	0.6 (0.3-0.9)*

Self-reported hypertension
No	823	84.1	12.9	3.0	Reference	Reference
Yes	232	84.9	12.9	2.2	0.7 (0.2-2.2)	1.1 (0.6-1.8)

Self-reported diabetes
No	971	83.9	13.3	2.8	Reference	Reference
Yes	84	88.1	8.3	3.6	1.3 (0.3-5.0)	0.6 (0.2-1.4)

Smoking status
Never smoked	697	89.1	9.3	1.6	Reference	Reference
Ex-smokers	216	83.8	13.9	2.3	1.6 (0.5-4.8)	1.7 (1.0-2.8)
Current smokers	142	61.3	28.8	9.9	10.2 (4.3-24)*	5.1 (3.1-8.3)*

Have a religion
Yes	916	85.8	11.7	2.5	Reference	Reference
No	139	74.1	20.9	5.0	2.3 (0.9-5.9)	2.2 (1.3-3.5)*

Religious affiliation (b)
Evangelic	332	91.9	6.6	1.5	Reference	Reference
Catholic	495	81.6	15.2	3.2	2.3 (0.8-6.8)	2.5 (1.5-4.3)*
Spiritist	62	87.1	12.9	0	-	-
Others	27	85.2	7.4	7.4	9.0 (1.4-57)*	1.6 (0.3-7.5)

Practice their religion (b)
Yes	665	88.9	9.3	1.8	Reference	Reference
No	251	77.7	17.9	4.3	2.4 (1.1-5.9)*	2.0 (1.3-3.3)^* * Confidence intervals that do not include 1 are marked with an asterisk (similar to p<0.05)

Are you a religious person? (b)
Very religious	215	91.6	7.4	0.9	Reference	Reference
Moderately religious	559	84.4	12.5	3.0	3.8 (0.8-17)	1.9 (1.1-3.5)*
A little or nothing	142	82.4	14.8	2.8	3.3 (0.5-19)	2.2 (1.1-4.7)*

Growing up in a religious home
No	280	83.9	13.6	2.5	Reference	Reference
Yes	775	84.4	12.6	3.0	1.8 (0.5-5.5)	1.0 (0.6-1.7)

	n	Drinking group			No binge versus abstemious OR1 (95% CI) ^a a Odds ratios adjusted by sex, age and socioeconomic status	Binge versus abstemious OR2 (95% CI)^a
	n	Abstemious	No-binge	Binge		Binge versus abstemious OR2 (95% CI)^a
Sex
Women	841	62.1	18.6	19.4	Reference	Reference
Men	214	39.2	18.2	42.5	1.5 (0.9-2.3)	4.0 (2.7-5.7)^* * Confidence intervals that do not include 1 are marked with an asterisk (similar to p<0.05)

Age group (years)
Until 25	188	58.0	16.0	26.1	Reference	Reference
26-30	132	55.3	13.6	31.1	0.8 (0.4-1.7)	1.2 (0.7-2.0)
31-40	250	54.4	17.6	28.0	1.2 (0.6-2.0)	1.0 (0.6-1.6)
41-50	173	58.4	17.3	24.3	1.0 (0.5-1.9)	0.7 (0.4-1.3)
51-60	164	61.6	14.6	23.8	0.8 (0.4-1.5)	0.7 (0.4-1.5)
> 60	148	58.1	33.1	8.8	1.9 (1.1-3.3)*	0.2 (0.1-0.4)*

Educational level
Higher education	126	48.4	23.8	27.8	Reference	Reference
Medium school	517	59.8	17.4	22.8	0.7 (0.3-1.4)	0.8 (0.4-1.7)
Fundamental II	221	52.9	19.0	28.1	0.5 (0.1-1.1)	0.6 (0.2-1.5)
Fundamental I	61	65.6	14.8	19.7	0.8 (0.4-1.4)	1.0 (0.5-1.8)
Insufficient	130	60.8	18.4	20.8	0.7 (0.4-1.2)	0.7 (0.4-1.2)

Marital status
Single	247	51.8	18.6	29.6	Reference	Reference
Married	648	59.7	17.6	22.7	0.7 (0.4-1.1)	0.5 (0.3-0.8)*
Widowed	53	62.3	20.7	17.0	0.8 (0.3-1.8)	0.8 (0.3-2.1)
Divorced	107	54.2	22.4	23.4	0.9 (0.5-1.8)	0.9 (0.5-1.8)

Socioeconomic status
A or B	355	52.1	22.5	25.4	Reference	Reference
C1	368	59.5	16.6	23.9	0.6 (0.4-0.9)*	0.8 (0.5-1.2)
C2	235	61.3	17.9	20.8	0.7 (0.4-1.1)	0.6 (0.4-1.1)
D or E	97	59.8	12.4	27.8	0.4 (0.2-0.9)*	0.8 (0.4-1.4)

Self-perception of health
Good	735	57.6	17.4	25.0	Reference	Reference
Regular	280	56.8	20.7	22.5	1.2 (0.8-1.8)	1.2 (0.8-1.7)
Poor	40	60.0	22.5	17.5	1.2 (0.5-2.8)	0.7 (0.3-1.9)

Have health insurance
Yes	154	52.6	21.4	26.0	Reference	Reference
No	901	58.3	18.0	23.8	0.8 (0.5-1.3)	0.9 (0.6-1.4)

Self-reported hypertension
No	823	57.0	17.7	25.3	Reference	Reference
Yes	232	59.1	21.1	19.8	1.0 (0.6-1.5)	0.8 (0.5-1.3)

Self-reported diabetes
No	971	57.1	18.1	24.8	Reference	Reference
Yes	84	61.9	22.6	15.5	0.9 (0.5-1.7)	0.6 (0.3-1.2)

Smoking status
Never smoked	697	63.0	18.1	18.9	Reference	Reference
Ex-smokers	216	55.5	20.4	24.1	1.2 (0.8-1.9)	1.7 (1.1-2.5)*
Current smokers	142	33.1	17.6	49.3	1.9 (1.1-3.2)*	5.9 (3.7-9.3)*

Have a religion
Yes	916	59.8	17.7	22.5	Reference	Reference
No	139	41.7	23.8	34.5	2.3 (1.4-3.7)*	2.2 (1.3-3.4)*

Religious affiliation (b)
Evangelic	332	78.9	30.7	11.1	Reference	Reference
Catholic	495	48.9	21.8	29.3	3.3 (2.1-5.2)*	4.2 (2.7-6.5)*
Spiritist	62	37.1	30.6	32.3	6.4 (3.1-13.3)*	7.7 (3.7-15.9)*
Others	27	77.8	7.4	14.8	0.8 (0.1-3.9)	1.6 (0.4-5.0)

Practice their religion (b)
Yes	665	66.0	15.5	18.5	Reference	Reference
No	251	43.4	23.5	33.1	2.5 (1.6-3.7)*	2.7 (1.8-3.9)*

Are you a religious person? (b)
Very religious	215	76.3	12.6	11.1	Reference	Reference
Moderately religious	559	57.9	18.1	24.0	1.9 (1.2-3.2)*	2.8 (1.6-4.7)*
A little or nothing	142	42.3	23.9	33.8	4.3 (2.3-8.2)*	5.3 (2.8-10.0)*

Growing up in a religious home
No	280	62.2	13.2	24.6	Reference	Reference
Yes	775	55.7	20.4	23.9	2.0 (1.2-3.3)*	1.4 (0.9-2.1)

AUDIT risk level	Women		Men
AUDIT risk level	n	Mean (SD)	n	Mean (SD)
ORA
I	747	4.39 (1.53)	142	4.13 (1.67)
II	78	3.90 (1.62)	58	3.10 (1.57)^* * Statistically significant differences from the reference group (AUDIT level I) are marked with an asterisk
III	12	3.42 (1.44)*	8	3.63 (0.74)
IV	4	3.75 (1.26)	6	2.67 (1.86)*

NORA
I	747	4.75 (1.18)	142	4.54 (1.41)
II	78	4.38 (1.36)*	58	4.07 (1.52)*
III	12	3.75 (1.60)*	8	4.88 (0.35)
IV	4	5.00 (0.82)	6	4.33 (1.21)

IR
I	747	13.88 (1.82)	142	13.89 (1.83)
II	78	13.23 (2.26)	58	12.62 (2.99)*
III	12	12.08 (2.15)	8	13.75 (1.58)
IV	4	14.00 (0.82)	6	13.67 (1.51)

Drinking group	Women		Men
Drinking group	n	Mean (SD)	n	Mean (SD)
ORA
Abstemious	522	4.59 (1.54)	84	4.33 (1.78)
No-binge drinking	156	3.87 (1.49)*	39	3.90 (1.52)
Binge drinking	163	3.79 (1.52)*	91	3.25 (1.52)^* * Statistically significant differences from the reference group (abstemious respondents) are marked with an asterisk

NORA
Abstemious	522	4.81 (1.15)	84	4.60 (1.43)
No-binge drinking	156	4.63 (1.28)*	39	4.67 (1.15)
Binge drinking	163	4.43 (1.31)*	91	4.15 (1.49)*

IR
Abstemious	522	14.05 (1.64)	84	13.87 (1.83)
No-binge drinking	156	13.46 (2.12)*	39	13.77 (1.87)
Binge drinking	163	13.31 (2.23)*	91	13.12 (2.67)

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[1] Correspondence: Edson Zangiacomi Martinez – Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Av. Bandeirantes 3900 – Monte Alegre – CEP: 14049-900 – Ribeirão Preto (SP), Brasil – Email: edson@fmrp.usp.br