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Religious beliefs and alcohol control policies: a Brazilian nationwide study

Abstract

Objective:

The connection between lower alcohol use and religiousness has been extensively examined. Nevertheless, few studies have assessed how religion and religiousness influence public policies. The present study seeks to understand the influence of religious beliefs on attitudes toward alcohol use.

Methods:

A door-to-door, nationwide, multistage population-based survey was carried out. Self-reported religiousness, religious attendance, and attitudes toward use of alcohol policies (such as approval of public health interventions, attitudes about drinking and driving, and attitudes toward other alcohol problems and their harmful effects) were examined. Multiple logistic regression was used to control for confounders and to assess explanatory variables.

Results:

The sample was composed of 3,007 participants; 57.3% were female and mean age was 35.7 years. Religiousness was generally associated with more negative attitudes toward alcohol, such as limiting hours of sale (p < 0.01), not having alcohol available in corner shops (p < 0.01), prohibiting alcohol advertisements on TV (p < 0.01), raising the legal drinking age (p < 0.01), and raising taxes on alcohol (p < 0.05). Higher religious attendance was associated with less alcohol problems (OR: 0.61, 95%CI 0.40-0.91, p = 0.017), and self-reported religiousness was associated with less harmful effects of drinking (OR: 0.61, 95%CI 0.43-0.88, p = 0.009).

Conclusions:

Those with high levels of religiousness support more restrictive alcohol policies. These findings corroborate previous studies showing that religious people consume less alcohol and have fewer alcohol-related problems.

Religion and medicine; spirituality; substance-related disorders; alcoholism


Introduction

The connection between alcohol use and religiousness has been extensively studied during the past three decades.11. Michalak L, Trocki K, Bond J. Religion and alcohol in the US National Alcohol Survey: how important is religion for abstention and drinking? Drug Alcohol Depend. 2007;87:268-80.

2. Patock-Peckham JA, Hutchinson GT, Cheong J, Nagoshi CT. Effect of religion and religiosity on alcohol use in a college student sample. Drug Alcohol Depend. 1998;49:81-8.

3. Edlund MJ, Harris KM, Koenig HG, Han X, Sullivan G, Mattox R, et al. Religiosity and decreased risk of substance use disorders: is the effect mediated by social support or mental health status? Soc Psychiatry Psychiatr Epidemiol. 2010;45:827-36.
-44. Brown TL, Parks GS, Zimmerman RS, Phillips CM. The role of religion in predicting adolescent alcohol use and problem drinking. J Stud Alcohol. 2001;62:696-705. Religious attendance, religious affiliation, and intrinsic religiousness have been associated with lower rates of alcohol use/abuse, binge drinking, and lifetime use of alcohol.11. Michalak L, Trocki K, Bond J. Religion and alcohol in the US National Alcohol Survey: how important is religion for abstention and drinking? Drug Alcohol Depend. 2007;87:268-80.,55. Menagi FS, Harrell ZA, June LN. Religiousness and college student alcohol use: examining the role of social support. J Relig Health. 2008;47:217-26.

6. Nonnemaker JM, McNeely CA, Blum RW, National Longitudinal Study of Adolescent Health. Public and private domains of religiosity and adolescent health risk behaviors: evidence from the National Longitudinal Study of Adolescent Health. Soc Sci Med. 2003;57:2049-54.

7. Lucchetti G, Lucchetti AL, Puchalski CM. Spirituality in medical education: global reality? J Relig Health. 2012;51:3-19.
-88. Lucchetti G, Peres MF, Lucchetti AL, Koenig HG. Religiosity and tobacco and alcohol use in a Brazilian shantytown. Subst Use Misuse. 2012;47:837-46.

Mullen et al.99. Mullen K, Blaxter M, Dyer S. Religion and attitudes towards alcohol use in the Western Isles. Drug Alcohol Depend. 1986;18:51-72. found that Catholics are more permissive in their attitudes, while Protestants are more likely to endorse abstinence from alcohol. Religious affiliation could also serve as a reference group that influences behavior,1010. Cochran JK, Beeghley L, Bock EW. Religiosity and alcohol behavior: an exploration of reference group theory. Sociol Forum. 1988;3:256-76. and conservative religious groups have higher negative expectations (expected negative consequences of alcohol consumption) and lower drinking motives.1111. Galen LW, Rogers WM. Religiosity, alcohol expectancies, drinking motives and their interaction in the prediction of drinking among college students. J Stud Alcohol. 2004;65:469-76.

Social modeling,1212. Drerup ML, Johnson TJ, Bindl S. Mediators of the relationship between religiousness/spirituality and alcohol problems in an adult community sample. Addict Behav. 2011;36:1317-20. negative beliefs about alcohol,1212. Drerup ML, Johnson TJ, Bindl S. Mediators of the relationship between religiousness/spirituality and alcohol problems in an adult community sample. Addict Behav. 2011;36:1317-20. personal attitudes,1313. Chawla N, Neighbors C, Lewis MA, Lee CM, Larimer ME. Attitudes and perceived approval of drinking as mediators of the relationship between the importance of religion and alcohol use. J Stud Alcohol Drugs. 2007;68:410-8. approval/disapproval of significant others/relatives/friends,1313. Chawla N, Neighbors C, Lewis MA, Lee CM, Larimer ME. Attitudes and perceived approval of drinking as mediators of the relationship between the importance of religion and alcohol use. J Stud Alcohol Drugs. 2007;68:410-8.,1414. Gryczynski J, Ward BW. Religiosity, Heavy Alcohol Use, and Vicarious Learning Networks Among Adolescents in the United States. Health Educ Behav. 2012;39:341-51. and alcohol use attitudes1515. Vaughan EL, de Dios MA, Steinfeldt JA, Kratz LM. Religiosity, alcohol use attitudes, and alcohol use in a national sample of adolescents. Psychol Addict Behav. 2011;25:547-53. are some proposed pathways for these associations.

Despite investigating the individual-level mechanisms between alcohol use and religiousness, the goal of the present study is to investigate macro implications with respect to the way that religiousness shapes public support for government alcohol policies.

Indeed, religion and religiousness appear to influence attitudes toward many aspects of life, such as politics,1616. Baumgartner JC, Francia PL, Morris JS. A clash of civilizations? The influence of religion on public opinion of US foreign policy in the Middle East. Political Res Quart. 2008;61:171-9. ethical/cultural issues,1717. Parboteeah KP, Hoegl M, Cullen JB. Ethics and religion: an empirical test of a multidimensional model. J Bus Ethics. 2008;80:387-98. and even attitudes toward health in general.1818. Zou J, Yamanaka Y, John M, Watt M, Ostermann J, Thielman N. Religion and HIV in Tanzania: influence of religious beliefs on HIV stigma, disclosure, and treatment attitudes. BMC public health. 2009;9:75.,1919. Curlin FA, Lawrence RE, Chin MH, Lantos JD. Religion, conscience, and controversial clinical practices. N Engl J Med. 2007;356:593-600. Nevertheless, few studies have assessed these attitudes as they pertain to alcohol policies.

If a religious person has a more supportive opinion toward alcohol policies, such as not drinking and driving, not only will he/she support such policies, but this may also impact other people's attitudes toward these issues. A better understanding of this relationship may assist in the development of strategies for preventing alcohol use and abuse. Likewise, such studies are relevant because public opinion has demonstrated the capacity to facilitate legislative change on alcohol policy issues2020. Latimer WW, Harwood EM, Newcomb MD, Wagenaar AC. Measuring public opinion on alcohol policy: a factor analytic study of a US probability sample. Addict Behav. 2003;28:301-13. and to indicate areas in need of potential education efforts.2121. Room R. Recent research on the effects of alcohol policy changes. J Primary Prevent. 1990;11:83-94.

Therefore, the present study aims to examine the influence of religiousness on attitudes toward alcohol policies (such as approval of public health interventions, drinking and driving) and concerns about the problems associated with and harmful effects of alcohol.

Methods

Sample selection

The sample studied was the 1st Brazilian Nationwide Survey (BNAS) on alcohol consumption patterns, which was conducted from November 2005 to April 2006. This door-to-door, multistage, population-based survey included 143 Brazilian cities. The design, selection, and study population has been previously described elsewhere.2222. Laranjeira R, Pinsky I, Sanches M, Zaleski M, Caetano R. Alcohol use patterns among Brazilian adults. Rev Bras Psiquiatr. 2010;32:231-41.

23. Castro-Costa E, Ferri CP, Lima-Costa MF, Zaleski M, Pinsky I, Caetano R, et al. Alcohol consumption in late-life--The first Brazilian National Alcohol Survey (BNAS). Addict Behav. 2008;33:1598-601.
-2424. Pinsky I, Sanches M, Zaleski M, Laranjeira R, Caetano R. Opinion about alcohol control policies among Brazilians: the first national alcohol survey. Contemp Drug Prob. 2007;34:635-48. The study was approved by the Ethics Committee (institutional review board-equivalent) of Universidade Federal de São Paulo (code: CEP 1672/04). All respondents signed an informed consent form and were assured of the confidential nature of the study before the interview.

Brazilian municipalities were divided into 25 strata according to their size and region. Within each stratum, a systematic selection was carried out whereby municipalities were initially sorted on the basis of income and selected with probability proportional to their size (PPS). Within each stratum, the municipalities were arranged by the average income and selected in probability proportional to their estimated population (both average income and population were based on the last national sociodemographic census conducted by the Brazilian Institute of Geography and Statistics, IBGE).

In the second stage of sampling, census sectors were chosen within the cities selected in the first stage. All sectors were included, even rural ones. The sectors were also chosen proportionally to their size, after having been arranged by average income. Each allotted sector had its households counted and listed, and households were then selected according to a table of random numbers. The objective was to obtain eight interviews per census sector. Therefore, a greater number of households were chosen to adjust for nonresponse. This rate was calculated according to the Brazilian Social Survey (PESB), per region (http://www.uff.br/datauff/PESB.htm).

After selecting the household, the interviewer listed all its residents and the person whose birthday was nearest to the date of sampling (either the last birthday or the next) was chosen for the interview. To ensure a high response rate, rules were put in place for those cases where the interviewer was not able to find the selected person. The interviewer was required to revisit the household at least three times at three different times of day and on three different days of the week, including one day during the weekend.

The final sample was composed of 3,007 participants (2,346 adults aged 18 years or older and 661 adolescents aged between 14 and 17 years) and was representative of the Brazilian population, excluding native Brazilians who live in Indian reservations and the institutionalized population.

Procedures

Trained interviewers carried out face-to-face interviews with a mean duration of 53 minutes. The response rate was 66.4%. The survey instrument was an adapted version of the questionnaire used in the Hispanic Americans Baseline Alcohol Survey (HABLAS).2525. Caetano R, Ramisetty-Mikler S, Rodriguez LA. The Hispanic Americans Baseline Alcohol Survey (HABLAS): rates and predictors of DUI across Hispanic national groups. Accid Anal Prev. 2008;40:733-41. The questionnaire was translated by the survey's coordinators and adapted to the socio-cultural aspects of the Brazilian population.

Variables

For the present study, the following variables were used: 1) sociodemographic variables: gender, age, family income, years of education, and marital status; 2) alcohol use: use of alcoholic beverages (“how often do you generally drink any alcoholic beverage [including beer, wine, distilled beverages, ice drinks, or any other drink]?”); alcohol dependence: a positive answer to three or more of seven questions on alcohol dependence from the Composite International Diagnostic Interview (CIDI)2626. Pull CB, Saunders JB, Mavreas V, Cottler LB, Grant BF, Hasin DS, et al. Concordance between ICD-10 alcohol and drug use disorder criteria and diagnoses as measured by the AUDADIS-ADR, CIDI and SCAN: results of a cross-national study. Drug Alcohol Depend. 1997;47:207-16.; alcohol abuse: a positive answer to one or more of six questions on alcohol abuse from the CIDI2626. Pull CB, Saunders JB, Mavreas V, Cottler LB, Grant BF, Hasin DS, et al. Concordance between ICD-10 alcohol and drug use disorder criteria and diagnoses as measured by the AUDADIS-ADR, CIDI and SCAN: results of a cross-national study. Drug Alcohol Depend. 1997;47:207-16.; problems related to alcohol consumption: a 28-item questionnaire about possible lifetime problems including social, working, familial, legal, physical, and those related to violence. Questions included: “drinking may have affected my chances of being promoted, being given a salary raise or work improvement,” “I had a violent argument while drinking,” and “a doctor suggested I should drink less”, with two possible answers, yes or no; harmful effects of alcohol: a 6-item questionnaire assessing effects on friendship/social life, family/marriage, future perspectives, finance, health, and employment; 3) alcohol attitudes: approval of public health policies regarding alcohol tax, legal drinking age, prevention programs, alcohol treatment, alcohol prohibition, alcohol promotion/advertising, alcohol policy, supervision of alcohol sales, and others; drinking and driving: assessed using statements such as: “when others drink and drive it is a threat to my personal safety and the security of my family” and “most people who drive after drinking too much alcohol are alcoholics or problem drinkers”; 4) religiousness: religiousness was understood as the “extent to which an individual believes, follows, and practices a religion, organizational (church or temple attendance) or non-organizational (praying, reading books, or watching religious programs on television).” The following measures were used: religious attendance: “how often do you attend religious services?” was used to address organizational religiousness (once a week or more, once or twice a month, sometimes during a month, sometimes during a year, rarely, or never); importance of religion: “how important is religion in your life?” was used to address self-reported religiousness (very important, somewhat important, indifferent, not really important, or not a bit important); religious affiliation: “I will now read a list of several religions and would like you to tell me when I say the name of your religion.” (Umbanda, Candomblé, Kardecist Spiritism, Pentecostal Evangelical, other Evangelical, Protestant, Charismatic Catholic, Base Ecclesial Communities Catholic, Traditional Catholic, other, or no religion).

Statistical analysis

The data were weighted to take into account the method of sample selection and nonresponse rate. Post-stratification weights were calculated to adjust the sample to the known distributions of the population regarding gender, age, and region of the country.2222. Laranjeira R, Pinsky I, Sanches M, Zaleski M, Caetano R. Alcohol use patterns among Brazilian adults. Rev Bras Psiquiatr. 2010;32:231-41. All analyses were performed with the complex samples module of SPSS version 17.0.

First, we conducted a bivariate analysis (chi-square test) associating religious attendance and self-reported religiousness with alcohol opinions (drinking and driving and approval of public health interventions). Then, for those statistically significant results, we conducted a multiple logistic regression (enter method) using: a) dependent variables: alcohol attitudes (binary). Since each specific policy represents a different concept, and these concepts do not fully overlap, we decided to include each separately in the analysis. For instance, respondents with strict opinions regarding alcohol advertising could have softer opinions regarding compulsory health clinics or warning messages. Therefore, we decided to separate all policies and describe them separately; b) independent variables: religious attendance (once a week or more vs. less than once a week) and self-reported religiousness (very important vs. somewhat important/not a bit important); and c) confounding variables: sex (male/female), age (years), educational attainment (years), marital status (married/not married), family income (continuous), alcohol use (yes/no), alcohol dependency (yes/no), and alcohol abuse (yes/no).

P-values < 0.05 were considered statistically significant and confidence intervals of 95% were used throughout.

We then conducted another logistic regression with alcohol problems (at least one/none) and harmful effects of drinking (at least one/none) as dependent binary variables. The independent variables were: religious attendance (once a week or more vs. less than once a week), self-reported religiousness (very important vs. somewhat important/not a bit important), religious affiliation (yes vs. no), and religious denomination (Protestant vs. others). All independent variables were included together in the multiple logistic regression (enter method). P-values < 0.05 were considered statistically significant and confidence intervals of 95% were used throughout. Goodness of fit was evaluated by the Hosmer-Lemeshow test.

Results

The final sample comprised 3,007 participants, 1,285 (42.7%) male and 1,722 (57.3%) female, with a mean age of 35.7 years (SD 17.9; range, 14-91 years). Overall, 48.1% of the participants were married and 78.2% had a mean monthly family income of less than R$ 900.00 (approximately US$400.00). Sociodemographic characteristics are presented in Table 1.

Table 1
Sociodemographic characteristics and alcohol patterns of the study population

Concerning alcohol use, 47.1% of the participants reported they never drank alcoholic beverages, 208 (6.9%) were dependent on alcohol, and 217 (7.2%) met criteria for alcohol abuse (Table 1).

With regards to religious characteristics, 67.3% were Catholic, 23.3% Evangelical Protestant, 3.6% from other religions, and 5.8% had no religious affiliation. More than half of participants (50.3%) attended religious services to some degree but less than once a week, followed by those who attended once a week or more (36.7%) and those who had never attended (12.9%). Most participants believed their religion was very important in their lives (82.9%), followed by those who thought it somewhat important (29.0%) and those who indicated it was not important (2.6%).

Religiousness and attitudes toward alcohol

Approval of public health interventions

Higher religious attendance (once a week or more) was associated with more supportive attitudes toward higher taxes on alcoholic beverages (p < 0.05), restrictions on hours for the sale of alcoholic beverages (p < 0.01), avoidance of serving alcohol to customers who are already drunk (p < 0.01), prohibition on selling alcoholic beverages at bakeries, pastry shops, and grocery stores (p < 0.01), a ban on advertising alcoholic beverages on television, including wine, liquor, beer, whiskey, rum, vodka, and other fermented and distilled beverages (p < 0.05), a ban on sponsorship of sporting and cultural events by alcoholic beverage manufacturers (p < 0.001), and setting aside a space on the labels of bottles or cans of alcoholic beverages for messages warning about the hazards and problems caused by alcohol (p < 0.05). In addition, these respondents believed that it is very easy for a person under the age of 18 to purchase alcohol in Brazil, even though this is prohibited by law (p < 0.05).

Higher self-reported religiousness (very important vs. somewhat important/not a bit important) was associated with attitudes toward increasing the legal age for purchasing of alcoholic beverages (p < 0.01), restrictions on hours for the sale of alcoholic beverages (p < 0.01), prohibition on selling alcoholic beverages at bakeries, pastry shops, and grocery stores (p < 0.01), and a ban of advertising alcoholic beverages on television, including wine, liquor, beer, whiskey, rum, vodka, and other fermented and distilled beverages (p < 0.05).

Religious affiliation (yes vs. no) was associated with support for restrictions on hours for the sale of alcoholic beverages (p < 0.05), and religious denomination (Protestant vs. others) was associated with more supportive attitudes toward higher taxes on alcoholic beverages (p < 0.05) (Tables 2 and 3).

Table 2
Association between religiousness and alcohol control policies (public health interventions), n (%)
Table 3
Association between religiousness and alcohol control policies, n (%)

Drinking and driving

Higher self-reported religiousness (very important) and higher religious attendance (once a week or more) were associated with the attitude that “most people who drive after drinking too much alcohol are alcoholics or problem drinkers” (p < 0.05). Religious affiliation and denomination were not associated with these opinions (Table 4).

Table 4
Association between religiousness and drinking and drive, n (%)

Attitudes toward alcohol problems

Higher religious attendance was associated with fewer self-reported alcohol problems (OR: 0.62, 95%CI 0.41-0.93, p = 0.023). Self-reported religiousness (OR: 0.68, 95%CI 0.49-0.94, p = 0.021) and religious denomination (Protestant) (OR: 0.60, 95%CI 0.40-0.91, p = 0.017) were associated with fewer harmful effects of drinking (Table 5).

Table 5
Association between religiousness, alcohol problems, and harmful effects of drinking

Discussion

This report investigates the relationship between religiousness and attitudes toward alcohol policies. Participants with higher religious attendance or higher self-reported religiousness were found to be more supportive of policies regarding public health interventions against the use of alcohol, including drunk-driving prevention policies. Additionally, since these participants consumed less alcohol, they had fewer alcohol-related problems.

In the last decades, research interest in public opinion relating to alcohol policies has grown.2727. Giesbrecht N, Greenfield TK. Public opinions on alcohol policy issues: a comparison of American and Canadian surveys. Addiction. 1999;94:521-31.

28. Giesbrecht N, Ialomiteanu A, Anglin L. Drinking patterns and perspectives on alcohol policy: results from two Ontario surveys. Alcohol Alcohol. 2005;40:132-9.
-2929. Richter L, Vaughan RD, Foster SE. Public attitudes about underage drinking policies: results from a national survey. J Public Health Policy. 2004;25:58-77. The objectives of such studies are diverse, and have included rank ordering of support across alcohol policy topics, plotting changes in public opinions, exploring the association between public opinion and actual policy, and identifying demographic groups that tend to support or oppose certain policies.2828. Giesbrecht N, Ialomiteanu A, Anglin L. Drinking patterns and perspectives on alcohol policy: results from two Ontario surveys. Alcohol Alcohol. 2005;40:132-9.

Some studies have found that the level of alcohol consumption influences individuals' support for alcohol control policies.2424. Pinsky I, Sanches M, Zaleski M, Laranjeira R, Caetano R. Opinion about alcohol control policies among Brazilians: the first national alcohol survey. Contemp Drug Prob. 2007;34:635-48. Others3030. Giesbrecht N, Greenfield TK. Public opinions on alcohol policy issues: a comparison of American and Canadian surveys. Addiction. 1999;94:521-31.,3131. Latimer WW, Harwood EM, Newcomb MD, Wagenaar AC. Measuring public opinion on alcohol policy: a factor analytic study of a US probability sample. Addict Behav. 2003;28:301-13. have found that lighter drinkers and older persons were more likely to support restrictive policies and to support policies that restricted alcohol use in public places.

Within this context, opinions regarding alcohol policies are a driving force in policy planning and implementation2424. Pinsky I, Sanches M, Zaleski M, Laranjeira R, Caetano R. Opinion about alcohol control policies among Brazilians: the first national alcohol survey. Contemp Drug Prob. 2007;34:635-48. and warrant further attention.

Several studies have investigated the impact of religion and religiousness, on public policies. Baumgartner et al.1616. Baumgartner JC, Francia PL, Morris JS. A clash of civilizations? The influence of religion on public opinion of US foreign policy in the Middle East. Political Res Quart. 2008;61:171-9. evaluated the role of religious beliefs in predicting U.S. public opinion on foreign policy issues in the Middle East. They found that Evangelicals were more supportive of U.S. foreign policy than other religious groups.

Another study3232. Minkenberg M. Religion and public policy institutional, cultural, and political impact on the shaping of abortion policies in western democracies. Comp Pol Stud. 2002;35:221-47. found that the most restrictive abortion policies are found in Catholic countries with high levels of religiosity, pointing to the impact of religiousness on government policy. In addition, Zou et al.1818. Zou J, Yamanaka Y, John M, Watt M, Ostermann J, Thielman N. Religion and HIV in Tanzania: influence of religious beliefs on HIV stigma, disclosure, and treatment attitudes. BMC public health. 2009;9:75. found that religious beliefs strongly influence the way Tanzanians think about HIV/AIDS and government policies.

However, few studies have assessed the influence of religiousness on support for alcohol control policies. Since there is already strong evidence of the association between higher religiousness and lower alcohol use and abuse in different countries, groups, and settings,11. Michalak L, Trocki K, Bond J. Religion and alcohol in the US National Alcohol Survey: how important is religion for abstention and drinking? Drug Alcohol Depend. 2007;87:268-80.,55. Menagi FS, Harrell ZA, June LN. Religiousness and college student alcohol use: examining the role of social support. J Relig Health. 2008;47:217-26.,77. Lucchetti G, Lucchetti AL, Puchalski CM. Spirituality in medical education: global reality? J Relig Health. 2012;51:3-19.-88. Lucchetti G, Peres MF, Lucchetti AL, Koenig HG. Religiosity and tobacco and alcohol use in a Brazilian shantytown. Subst Use Misuse. 2012;47:837-46. the influence of religious beliefs on these alcohol policies warrants investigation.

In a previous BNAS analysis, Pinski et al.2424. Pinsky I, Sanches M, Zaleski M, Laranjeira R, Caetano R. Opinion about alcohol control policies among Brazilians: the first national alcohol survey. Contemp Drug Prob. 2007;34:635-48. evaluated 2,346 adults and found that sex, intensity of alcohol consumption, age, marital status, educational attainment, and religious affiliation were associated with approval for alcohol policies. In that analysis, Evangelical Protestants were more supportive of limiting alcohol availability in corner stores and raising taxes on alcohol, whereas Catholics were more supportive of limiting hours of sale than were those with no religious affiliation. These results are in line with the present analysis, which found that religiousness (not only religious affiliation) was associated with a greater likelihood of approving restrictive alcohol policies.

In another study, Frendeis et al.3333. Frendreis J, Tatalovich R. “A Hundred Miles of Dry”: religion and the persistence of prohibition in the US States. State Pol Policy Quart. 2010;10:302-19. evaluated why certain counties within the U.S restrict the sale of alcohol and others do not. The authors analyzed data from over 3,000 U.S. counties and found that the strongest factor associated with the restriction status of a county was religious composition, specifically the presence of Evangelical Protestants.

Finally, Herd3434. Herd D. Community mobilization and the framing of alcohol-related problems. Int J Environ Res Public Health. 2010;7:1226-47. explored how different types of activists (politicians, professionals, or clergy) defined alcohol problems. She found that religious leaders were significantly more likely to define alcohol problems in terms of alcohol sales and marketing - alcohol policies in general (p = 0.021) than were other informants, supporting the role of religiousness on opinions toward alcohol policies.

Within this context, the present study raises some questions for future research: Can acceptance of more restrictive alcohol policies be predicted on the basis of religious beliefs? Can alcohol consumption patterns be predicted on the basis of attitudes toward alcohol? Can we use this kind of information for the development of alcohol policies, alcohol restrictions, and health promotion? Could these attitudes be mediators of this relationship or are they merely consequences?

The present study has both strengths and limitations. Particular strengths include the novelty of investigating the association between religiousness and attitudes toward the support of alcohol policies, the nature of the sample (nationwide), and the method of sample selection (population-based).

Limitations include the cross-sectional nature of the study, which precludes inferences on causal association, and measurement of religiousness. Since religiousness is a very complex and multifaceted dimension, self-reported religiousness and religious attendance may not explore all aspects needed.

In summary, we found that individuals with high levels of religiousness are more supportive of restrictive alcohol policies, such as approval of public health interventions and not drinking and driving. Our results also support the finding from previous studies that religious people consume less alcohol, and, therefore, have fewer alcohol-related problems.

The BNAS was supported by the Brazilian National Secretariat on Drugs Policies (SENAD - process no. 017/2003).

References

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    Michalak L, Trocki K, Bond J. Religion and alcohol in the US National Alcohol Survey: how important is religion for abstention and drinking? Drug Alcohol Depend. 2007;87:268-80.
  • 2
    Patock-Peckham JA, Hutchinson GT, Cheong J, Nagoshi CT. Effect of religion and religiosity on alcohol use in a college student sample. Drug Alcohol Depend. 1998;49:81-8.
  • 3
    Edlund MJ, Harris KM, Koenig HG, Han X, Sullivan G, Mattox R, et al. Religiosity and decreased risk of substance use disorders: is the effect mediated by social support or mental health status? Soc Psychiatry Psychiatr Epidemiol. 2010;45:827-36.
  • 4
    Brown TL, Parks GS, Zimmerman RS, Phillips CM. The role of religion in predicting adolescent alcohol use and problem drinking. J Stud Alcohol. 2001;62:696-705.
  • 5
    Menagi FS, Harrell ZA, June LN. Religiousness and college student alcohol use: examining the role of social support. J Relig Health. 2008;47:217-26.
  • 6
    Nonnemaker JM, McNeely CA, Blum RW, National Longitudinal Study of Adolescent Health. Public and private domains of religiosity and adolescent health risk behaviors: evidence from the National Longitudinal Study of Adolescent Health. Soc Sci Med. 2003;57:2049-54.
  • 7
    Lucchetti G, Lucchetti AL, Puchalski CM. Spirituality in medical education: global reality? J Relig Health. 2012;51:3-19.
  • 8
    Lucchetti G, Peres MF, Lucchetti AL, Koenig HG. Religiosity and tobacco and alcohol use in a Brazilian shantytown. Subst Use Misuse. 2012;47:837-46.
  • 9
    Mullen K, Blaxter M, Dyer S. Religion and attitudes towards alcohol use in the Western Isles. Drug Alcohol Depend. 1986;18:51-72.
  • 10
    Cochran JK, Beeghley L, Bock EW. Religiosity and alcohol behavior: an exploration of reference group theory. Sociol Forum. 1988;3:256-76.
  • 11
    Galen LW, Rogers WM. Religiosity, alcohol expectancies, drinking motives and their interaction in the prediction of drinking among college students. J Stud Alcohol. 2004;65:469-76.
  • 12
    Drerup ML, Johnson TJ, Bindl S. Mediators of the relationship between religiousness/spirituality and alcohol problems in an adult community sample. Addict Behav. 2011;36:1317-20.
  • 13
    Chawla N, Neighbors C, Lewis MA, Lee CM, Larimer ME. Attitudes and perceived approval of drinking as mediators of the relationship between the importance of religion and alcohol use. J Stud Alcohol Drugs. 2007;68:410-8.
  • 14
    Gryczynski J, Ward BW. Religiosity, Heavy Alcohol Use, and Vicarious Learning Networks Among Adolescents in the United States. Health Educ Behav. 2012;39:341-51.
  • 15
    Vaughan EL, de Dios MA, Steinfeldt JA, Kratz LM. Religiosity, alcohol use attitudes, and alcohol use in a national sample of adolescents. Psychol Addict Behav. 2011;25:547-53.
  • 16
    Baumgartner JC, Francia PL, Morris JS. A clash of civilizations? The influence of religion on public opinion of US foreign policy in the Middle East. Political Res Quart. 2008;61:171-9.
  • 17
    Parboteeah KP, Hoegl M, Cullen JB. Ethics and religion: an empirical test of a multidimensional model. J Bus Ethics. 2008;80:387-98.
  • 18
    Zou J, Yamanaka Y, John M, Watt M, Ostermann J, Thielman N. Religion and HIV in Tanzania: influence of religious beliefs on HIV stigma, disclosure, and treatment attitudes. BMC public health. 2009;9:75.
  • 19
    Curlin FA, Lawrence RE, Chin MH, Lantos JD. Religion, conscience, and controversial clinical practices. N Engl J Med. 2007;356:593-600.
  • 20
    Latimer WW, Harwood EM, Newcomb MD, Wagenaar AC. Measuring public opinion on alcohol policy: a factor analytic study of a US probability sample. Addict Behav. 2003;28:301-13.
  • 21
    Room R. Recent research on the effects of alcohol policy changes. J Primary Prevent. 1990;11:83-94.
  • 22
    Laranjeira R, Pinsky I, Sanches M, Zaleski M, Caetano R. Alcohol use patterns among Brazilian adults. Rev Bras Psiquiatr. 2010;32:231-41.
  • 23
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Publication Dates

  • Publication in this collection
    10 Dec 2013
  • Date of issue
    Jan-Mar 2014

History

  • Received
    13 Nov 2012
  • Accepted
    21 June 2013
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