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Substance use, religiosity, and other protective factors among Hungarian adolescents
Addictive Behaviors 29 (2004) 1095 – 1107
Substance use, religiosity, and other protective factors among Hungarian adolescents Bettina F. Pikoa,*, Kevin M. Fitzpatrickb a
Department of Psychiatry, Division of Behavioral Sciences, University of Szeged, 6721 Szeged, Szentharomsag u.5. Hungary b Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
Abstract A number of risk factors have emerged as important correlates of adolescent substance use. In addition, research continues to focus on which factors act as mediators protecting adolescents from negative outcomes. One of these protective factors is religiosity, and the focus of this paper is to examine its role in the life of adolescents in postsocialist Hungary, where active religious participation was highly discouraged until a decade ago. The sample of adolescents (N = 1240) consists of middle and high school students living in Szeged, Hungary. The calculated odds ratios for the relationship between religiosity, and other protective factors, and substance use revealed that smoking, drinking, and marijuana use among boys and marijuana use only among girls were related to religiosity. Group membership, for example, participation in school clubs, sports clubs, or religious groups, seems to be more important for boys compared with girls. A more careful examination of the protective role of religion in postsocialist Hungary could be extremely important in a country where both adult and adolescent smoking and alcohol use is among the highest in Europe. D 2004 Elsevier Ltd. All rights reserved. Keywords: Substance use; Adolescence; Religiosity; Protection
1. Introduction Religion has always been considered a major factor affecting morbidity and mortality (Jarvis & Northcott, 1987; Sloan, Bagiella, & Powell, 1999; Strawbridge, Cohen, Shema, & Kaplan, 1997). Religious participation has become an epidemiologically justified protective * Corresponding author. Tel./fax: +36-62-420-530. E-mail address: [email protected] (B.F. Piko). 0306-4603/$ – see front matter D 2004. Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2004.03.022
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factor, whose effect is seen in both prevention and primary health care (Astrow, Puchalsky, & Sulmasy, 2001; Levin, Larson, & Puchalski, 1997). Religious beliefs and practices have a positive effect on life satisfaction, mental well-being, and lifestyle. As a result, all these beneficial health effects have been noted as influencing the general maintenance of one’s health and recovery from illness (Dossey, 2000; Ellison, 1991). As Wallace and Williams (1997) have pointed out, there are several factors mediating religion and better health relationship, including health-related behaviors and practices, social support, group identity, coping, and guideline provisions for a coherent value system. Their model also suggests that children internalize religious beliefs and attitudes as a part of their ongoing socialization, and the family plays a crucial role in this process. Specifically, the development of religiosity often starts with joint family attendance at religious services (Turner, 1994). The role of religion in supporting a healthy lifestyle and reducing substance use has important potential for preventing disease. A sound health preventive strategy would make good use of the protective effects of religion at an early age. Therefore, research investigating the protective factors of adolescent substance use should receive high priority. Numerous correlates of adolescent substance use have already been identified. Studies have revealed a protective effect of religiosity against substance use and abuse in adolescence (Brown, Parks, Zimmerman, & Phillips, 2001; Miller, Davies, & Greenwald, 2000; Wallace & Forman, 1998). It was found that indicators of religiosity (e.g., religious denomination, attendance of religious services, or personal devotion) were inversely related to alcohol consumption and/or illicit drug use (Miller et al., 2000). Among the different motives for not drinking, religious constraints are found to be a key factor for adolescents (Stritzke & Butt, 2001). Moreover, while adolescents sometimes turn to substance use in stressful situations, praying, as a way of coping, may be related to lower levels of substance use (Piko, 2001a). This protective effect has been identified at both the individual and group levels (Bachman, Johnston, O’Malley, & Humphrey, 1988). In many places, the church, as a social institution, is also an important vehicle for general risk education (drug and alcohol, sex, AIDS prevention, etc.) for adolescents (Kutter & McDermott, 1997). Based on previous findings, researchers conclude that low levels of religiosity were associated with the onset of substance use (Chatters, 2000). Active membership in other social groups, such as school or sports clubs, as well as other school-related factors, for example, having high academic achievement or being happy with school, also have proved to be important protective factors against adolescents’ substance use (Hawkins, Catalano, & Miller, 1992; Jessor, 1993). According to data from a nationally representative U.S. study between 1976 and 1997, a high degree of consistency exists across time in the role that religiosity plays in predicting substance use (Brown, Schulenberg, Bachman, O’Malley, & Johnston, 2001). The role of religion in the adolescents’ identity development and community-oriented attitudes also has been found to be significant (Youniss, McLellan, & Yates, 1999). Moreover, female adolescents are usually more religious than males are, as measured by attendance and affiliation variables (Wallace & Forman, 1998). While religious beliefs and attitudes are widespread among American youth—in fact, 93% of them report being affiliated with a religious group or denomination (Gallup & Bezilla, 1992)—persons living in Hungary, a postsocialist country, report much lower levels of
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religious affiliation. Although religious practices were not inhibited, religious affiliation was discouraged, and people who took charge of their religious beliefs had to face social disadvantages during the early years of socialism. Therefore, the relationship between religion and health-related variables has not been examined thus far. On the other hand, in Hungary, as well as much of Eastern Europe, the frequency of smoking and alcohol consumption is significantly higher compared with the rates in Western Europe and the United States (Cockerham, 1999). In addition, after the opening of the Eastern European borders, drug use and trafficking have also started to increase, particularly among youth. Substance use, as a part of the general health-related lifestyle, has been argued to have the most serious effect on the low life expectancy and the high mortality rates due to heart diseases, neoplasms, and gastrointestinal diseases in Eastern Europe (Foster & Jo´zan, 1990; Kopp, Skrabski, & Szedma´k, 2000). Not only for adults but adolescents as well, smoking and alcohol use has a higher occurrence compared with rates in Western Europe and the United States (Piko, 2000, 2001b). Therefore, the concept of protective factors such as religiosity should be applied in our development of frameworks designed to improve not only our understanding of the mechanisms that put adolescents at risk, but also what factors protect them from engaging in substance use behaviors. This concept might even be of special significance in a postsocialist country, where religious life is undergoing a dramatic reconceptualization after the fall of socialism. The primary focus of the present paper is to examine the relationship between three types of substance use (cigarette smoking, binge drinking, and marijuana use) and protective factors such as adolescents’ religiosity, school and sports club membership, and two school-related factors. As a first step in mapping the intricate weave between adolescents’ religiosity and their health, the first question to ask is whether it is possible to detect differences between substance users and nonusers with regard to elements of their religiosity.
2. Methods 2.1. Participants and procedure Data were collected from middle and high school students, using randomly selected classes from six school districts in Szeged, Hungary. The total number of students sampled was 1500 (approximately 13% of the whole student population). Of the questionnaires, 1240 were returned and analyzed, yielding a response rate of over 80%. The age range of the respondents was 11–20 years of age; 53% (n = 658) of the sample was male and 47% (n = 582) was female. The data were collected during the spring of 2000, using a self-administered questionnaire. The parents were informed of the study, with their consent obtained prior to data collection. A standardized procedure of administration followed. Trained high school teachers (acting as health promoter) distributed the questionnaires to the students in each class after briefly explaining the study objectives and instructions on how to fill out the questionnaire. Similar information was attached on the cover page of each questionnaire. The completed ques-
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tionnaires were returned in sealed envelopes, assuring that the respondents would remain anonymous and their answers kept confidential. Students filled out the questionnaires during a single class period, which took approximately 30–40 min. 2.2. Measures The data obtained from the adolescent survey included three types of substance use: cigarette smoking, binge drinking (e.g., more than five drinks in a prescribed period of time), and marijuana use (as a most common type of illicit drug use). The main goal of these questionnaire items was to obtain information about the present status of the students’ substance use (whether they were users or nonusers), the frequency of their use in the past 30 days (Piko, 2000; Piko & Fitzpatrick, 2002), and the students’ age of first use. Responses on their user status, regardless of the frequency, were dichotomized and coded as 1 = yes, they had used the substance, or 0 = no, they had not used the substance. Religiosity was assessed using three independent variables. In addition to religious denomination, praying was an indicator of personal devotion, and attendance at religious services assessed commitment to the religious community (Miller et al., 2000; Wallace & Forman, 1998). As to religious denominations, 67.8% of the respondents reported having a religious denomination, the clear majority were Catholic (71.5%), 6.8% were being Protestant, 19.8% were simply being Christian, and 1.9% responded by saying they were some other denomination such as Greek Orthodox. In Hungary, unfortunately, religious denomination seldom fits together with active religious participation; therefore, praying and attendance of religious services seem to be more valid indicators of religiosity. In response to the question ‘‘Do you pray?,’’ 33.8% of the youth said yes and 66.2% said no. Three levels of religious attendance were identified: Most of the respondents reported that they ‘‘never attend religious services’’ (43.3%), 40.6% said they ‘‘go to church only on the occasion of the great religious feasts,’’ and 16.1% said that they attend religious services on a regular basis. Besides the religiosity variables, there were several other protective factors that we examined. School and sports club memberships were both coded as 0 = no, they did not belong to any clubs or teams, and 1 = yes, they had been a member of any school club or sports team. In addition, we included two school domain questions: being happy with school was coded as 0 = very/rather unhappy and 1 = very/rather happy, and self-reported grades was coded as 0 = students reported getting mostly Cs, Ds, and Fs, 1 = students reported getting mostly Bs and Cs, and 2 = students reported getting mostly As and Bs. 2.3. Analysis SPSS for MS Windows 9.0 program was used in the calculations, and the minimum significance level set to 5%. Beyond the descriptive statistics, we calculated the odds ratios, which helped detect the bivariate relationships between each type of substance use, religiosity, and other protective variables. The frequency of substance use was dichotomized and expressed the presence or absence of the substance use in question (Piko, 2000). The main goal of the analysis was to detect the differences between substance users and nonusers with
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Table 1 Descriptive statistics of substance use among youth Variables (%) Smoking Yes No Frequency of smoking among smokers in the last None Sometimes 1 – 2 1 – 5/day 6 – 10/day 11 – 20/day More than 20/day Age of first use of smoking among smokers** Less than 9 9 – 10 11 – 12 13 – 14 15 – 16 17 or more
Boys (n = 658)
Girls (n = 582)
41.8 58.2 30 days** 0.4 15.3 23.6 34.2 21.8 4.7
38.8 61.2 1.3 22.6 33.2 26.1 15.0 1.8
9.9 10.2 17.4 35.6 21.1 5.8
2.2 5.3 20.8 41.2 26.5 4.0
Binge drinking** Yes 40.6 No 59.4 Frequency of binge drinking among alcohol drinkers in the last 30 days** One time 32.2 2 times 27.0 3 – 5 times 26.6 6 – 9 times 9.0 10 or more 5.2 Age of first alcohol use among binge drinkers* Less than 9 4.1 9 – 10 10.1 11 – 12 13.5 13 – 14 41.2 15 – 16 30.7 17 or more 0.4 Marijuana** Yes 12.8 No 87.2 Frequency of marijuana use among drug users in the last 30 days* None 25.0 1–2 35.7 3–9 21.4 10 – 19 6.0 20 – 39 7.1 More than 40 4.8
27.5 72.5 50.6 29.4 16.9 1.9 1.2 1.9 4.4 13.1 43.1 35.0 2.5
6.5 93.5 52.6 31.6 7.9 5.3 0 2.6 (continued on next page)
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Table 1 (continued ) Variables (%)
Boys (n = 658)
Girls (n = 582)
Marijuana** Age of first marijuana use among users Less than 9 9 – 10 11 – 12 13 – 14 15 – 16 17 or more * P < .05, chi-square test. ** P < .01, chi-square test.
2.4 0 4.8 20.2 52.4 20.2
0 0 2.9 14.3 51.4 31.4
regard to varying levels of protection. The results of the binary logistic regression analyses are presented as a series of odds. The baseline odds are set to 1.0. An odds ratio > 1.0 indicates that there is a positive association between the factors of interest to the baseline odds, while a value < 1.0 indicates the inverse. Confidence intervals (95%) were also calculated for statistically significant relationships based on the criterion that the CIs did not include 1.0. Table 2 Descriptive statistics of religiosity and other possible protective variables among youth Variables (%) Religious denomination* No Yes Praying** No Yes Religious attendance** Never Occasionally Regularly School club membership No Yes Sports club membership** No Yes How happy with school** Very/rather unhappy Very/rather happy Grades at school** Mostly Cs, Ds, and Fs (%) Mostly Bs and Cs (%) Mostly As and Bs (%) * P < .05, chi-square test. ** P < .01, chi-square test.
Boys (n = 658)
Girls (n = 582)
34.8 65.2
29.2 70.8
75.1 24.9
56.0 44.0
48.9 36.9 14.1
36.8 44.8 18.4
58.1 41.9
53.6 46.4
58.8 41.2
79.7 20.3
23.1 76.9
16.9 83.1
33.3 54.9 11.8
20.0 56.6 23.4
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3. Results Table 1 shows the descriptive statistics of the variables measuring substance use in this sample of Hungarian youth. Among the boys, 41.8% reported smoking, 40.6% binge drinking, and 12.8% marijuana use. Among the girls, 38.8% reported smoking, 27.5% binge drinking, and 6.5% marijuana use. While there were no statistically significant gender differences in smoking, binge drinking and marijuana use were more common among boys than among girls. There were, however, significant gender differences in the amount of all types of substance use; that is, boys smoked more cigarettes, drank more alcohol, and used more marijuana than girls did. Likewise, the boys started using these substances at an earlier age, except for marijuana. Table 2 shows the descriptive statistics of religiosity and other protective variables. All the religiosity variables were reported more frequently by the girls. While there were no gender differences in the frequency of school club membership, the boys were more likely to Table 3 Calculated odds ratios for the relationship between substance use, religiosity, and other protective variables for the whole sample Total Sample (N = 1240)
Smoking
Religious denomination Noc Yes Praying Noc Yes Religious attendance Neverc Occasionally Regularly School club membership Noc Yes Sports club membership Noc Yes How happy with school Very/rather unhappyc Very/rather happy Grades at school Mostly Cs, Ds, and Fsc Mostly Bs and Cs Mostly As and Bs a
Binge drinking b
95% CIb
0.72 – 1.19
1.0 0.49
0.33 – 0.71*
1.0 0.67
0.52 – 0.86*
1.0 0.50
0.32 – 0.78*
0.73 – 1.19 0.41 – 0.82*
1.0 0.73 0.49
0.56 – 0.94* 0.34 – 0.71*
1.0 0.56 0.26
0.38 – 0.84* 0.12 – 0.56*
1.0 0.64
0.50 – 0.81*
1.0 0.53
0.42 – 0.67*
1.0 0.67
0.45 – 0.98*
1.0 1.07
0.84 – 1.36
1.0 0.87
0.67 – 1.12
1.0 0.56
0.36 – 0.88*
1.0 0.56
0.42 – 0.74*
1.0 0.52
0.39 – 0.69*
1.0 0.52
0.34 – 0.78*
1.0 0.15 0.48
0.10 – 0.23* 0.37 – 0.62*
1.0 0.18 0.65
0.11 – 0.28* 0.50 – 0.85*
1.0 0.22 0.71
0.10 – 0.50* 0.48 – 1.07
95% CI
OR
1.0 0.99
0.78 – 1.26
1.0 0.93
1.0 0.74
0.58 – 0.95*
1.0 0.93 0.58
OR, odds ratios. 95% CI, 95% confidence intervals. c Reference category. * Statistically significant odds ratio values ( P < .05). b
a
Marijuana ORa
OR
a
95% CI
b
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participate in a sports club, and girls were more likely to report being happy with school and having better grades. The results of the calculated odds ratios for the relationship between religiosity and substance use are shown in Table 3 (the whole sample). Religious denomination was not a significant predictor of either smoking or drinking. However, it was associated with a decreased likelihood of reported marijuana use (OR = 0.49, CI: 0.33–0.71). Praying was a stronger predictor than religious denomination was, as it significantly decreased the odds of reporting each type of substance use. Regular religious attendance was a significant predictor in each case; students who regularly attend church had a significantly lower likelihood of smoking, binge alcohol drinking, and marijuana use. Youth reporting regularly going to religious services had a lower chance of smoking, binge drinking, and drug use; even those reporting going to church only occasionally had lower odds of binge drinking and marijuana use. Being a member of a school club, being happy with school, and reporting earning higher Table 4 Calculated odds ratios for the relationship between substance use, religiosity, and other protective variables for the boys’ sample Boys (n = 658)
Smoking OR
Religious denomination Noc Yes Praying Noc Yes Religious attendance Neverc Occasionally Regularly School club membership Noc Yes Sports club membership Noc Yes How happy with school Very/rather unhappyc Very/rather happy Grades at school Mostly Cs, Ds, and Fsc Mostly Bs and Cs Mostly As and Bs a
a
Binge drinking 95% CI
OR
a
Marijuana b
95% CI
ORa
95% CIb
1.0 1.1
0.82 – 1.58
1.0 1.08
0.78 – 1.50
1.0 0.57
0.36 – 0.90*
1.0 0.67
0.47 – 0.97*
1.0 0.50
0.34 – 0.73*
1.0 0.62
0.34 – 1.11
1.0 0.89 0.56
0.64 – 1.25 0.34 – 0.92*
1.0 0.73 0.46
0.52 – 1.02 0.27 – 0.76*
1.0 0.65 0.30
0.40 – 1.07 0.11 – 0.76*
1.0 0.75
0.54 – 1.02
1.0 0.58
0.42 – 0.79*
1.0 0.69
0.45 – 0.98*
1.0 0.92
0.67 – 1.26
1.0 0.88
0.64 – 1.21
1.0 0.46
0.28 – 0.77*
1.0 0.65
0.45 – 0.94*
1.0 0.59
0.41 – 0.85*
1.0 0.82
0.49 – 1.39
1.0 0.23 0.48
0.13 – 0.41* 0.34 – 0.68*
1.0 0.21 0.70
0.11 – 0.40* 0.50 – 0.99*
1.0 0.35 0.67
0.13 – 0.93* 0.41 – 1.08
OR, odds ratios. 95% CI, 95% confidence intervals. c Reference category. * Statistically significant values ( P < .05). b
b
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grades were all significant protective factors, although sports club membership was significant only for marijuana use. Clearly, gender matters. There were significant differences between girls and boys in terms of both types of substance use, religious involvement, and other protective factors. In addition, as an extension of the analysis for the general sample, the odds ratios were calculated for male and female students separately (Tables 4 and 5, respectively). Among the boys (Table 4), those reporting going to church on a regular basis had lower odds of engaging in all types of substance use. Praying was also associated with a decreased likelihood of smoking and binge drinking, but not marijuana use. Religious denomination was related to a lower chance of boys’ marijuana use. School-related protective factors (being happy with school and self-reported grades) were significant factors in lowering the odds of smoking and binge drinking, while group memberships, that is, participation in a school or sports club, seemed to be more important factors protecting youth against marijuana use. Table 5 Calculated odds ratios for the relationship between substance use, religiosity, and other protective variables for the girls’ sample Girls (n = 582)
Smoking
Religious affiliation Noc Yes Praying Noc Yes Religious attendance Neverc Occasionally Regularly School club membership Noc Yes Sports club membership Noc Yes How happy with school Very/rather unhappyc Very/rather happy Grades at school Mostly Cs, Ds, and Fsc Mostly Bs and Cs Mostly As and Bs a
Binge drinking b
95% CIb
0.54 – 1.19
1.0 0.38
0.19 – 0.75*
1.0 1.1
0.76 – 1.58
1.0 0.50
0.24 – 1.02
0.70 – 1.45 0.38 – 1.02
1.0 0.86 0.62
0.58 – 1.23 0.36 – 1.08
1.0 0.52 0.27
0.26 – 1.05 0.07 – 0.91*
1.0 0.54
0.38 – 0.76*
1.0 0.49
0.33 – 0.71*
1.0 0.51
0.25 – 1.03
1.0 1.31
0.87 – 1.98
1.0 0.51
0.30 – 0.85*
1.0 0.44
0.15 – 1.28
1.0 0.47
0.31 – 0.73*
1.0 0.48
0.30 – 0.74*
1.0 0.25
0.12 – 0.49*
1.0 0.10 0.44
0.06 – 0.20* 0.22 – 0.68*
1.0 0.19 0.66
0.10 – 0.36* 0.42 – 1.02
1.0 0.18 1.07
0.04 – 0.85* 0.49 – 2.34
95% CI
OR
1.0 0.84
0.58 – 1.21
1.0 0.81
1.0 0.83
0.59 – 1.16
1.0 1.0 0.62
OR, odds ratios. 95% CI, 95% confidence intervals. c Reference category. * Statistically significant odds ratio values ( P < .05). b
a
Marijuana ORa
OR
a
95% CI
b
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For the girls (Table 5), besides religious denomination, regular attendance at religious services was associated with a lower likelihood of marijuana use. None of the religiosity variables were found to be related to smoking or binge drinking among the girls. However, religious denomination was related to a lower chance of marijuana use among both sexes. Over all, the relationships between religiosity and substance use are more convincing for the boys than for the girls. Similar with the boys, school-related factors were important forms of protection for girls. Group memberships, however, were not significant protective factors against marijuana use, only when girls felt happy with school did ‘‘school’’ make a difference. It should also be noted here that the self-reported grades variable did not provide significant protection against marijuana use for the highest achieving boys and girls.
4. Discussion Studies suggest that the relationship between religion and better health is partly due to health-related behavior and lifestyle practices (Jarvis & Northcott, 1987; Wallace & Williams, 1997). This same lower frequency of substance use and abuse can also be detected among adolescents (Brown, Parks et al., 2001; Miller et al., 2000; Stritzke & Butt, 2001). This relationship, however, has never been investigated in a postsocialist country, where religious affiliation was highly discouraged during the years of socialism. As a consequence, religiosity might play less of a role in organizing people’s lives as compared with its role in the United States (see, e.g., Gallup & Bezilla, 1992; Wallace & Forman, 1998). Therefore, the primary focus of the present paper has been to explore the relationship between smoking, binge drinking, and marijuana use and adolescents’ religiosity, along with other protective factors such as school/sports club membership and other school-domain variables. We focused on the specific research question that asked: Is it possible to differentiate between substance users and nonusers when focusing exclusively on adolescents’ religiosity and other forms of protection? Results suggest that religious denomination alone may not play a very important role in determining adolescent smoking and binge drinking. Marijuana use, on the other hand, was related to religious denomination for both sexes. This finding suggests support for the hypothesis that Christians, even if they do not outwardly practice their religion, possess a certain moral or value system that prevents them from engaging in certain negative behaviors. Values have been noted elsewhere as playing an important role in adolescents’ substance use behaviors (Reifman, Barnes, Dintcheff, Uhteg, & Farrell, 2001), and religion has always encouraged health-promoting practices. Marijuana use was less frequent than smoking and drinking. Marijuana is an illicit drug in Hungary, whose consumption is legally inhibited and socially less accepted by the population compared with cigarettes and alcohol. It may be possible that adolescents identifying with Christian values and beliefs tend to avoid breaking the official laws. Moreover, marijuana use was the only substance that was related to the religiosity variables in both sexes. Regular attendance at religious services was also related to a lower likelihood of marijuana use, both among boys and girls.
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While religiosity was more common among girls, based on the descriptive statistics, similar with previous findings (e.g., Wallace & Forman, 1998), the relationship between substance use and religiosity was stronger for boys. Among the girls, none of the religiosity variables were important factors affecting smoking and binge drinking, while among the boys, both praying and regular attendance at church were associated with these types of substance use. Further research is needed to explore how boys benefit more from the favorable effect of religiosity and, on the contrary, why girls do not receive a similar benefit from this relationship. Related phenomenon could be found in the relationship between social coping and adolescents’ psychosocial health; girls receive more social support, but boys may benefit more from this strategy of coping (Piko, 2001a). Attendance at religious services may have a different meaning for adolescents. Besides satisfying their spiritual and community/social needs (Youniss et al., 1999), it also may serve as a tool of family cohesion (Turner, 1994). In religious families, parents may use higher levels of monitoring, which, in turn, are often found to be related to lower levels of substance use (Li, Stanton, & Feigelman, 2000). But regular attendees may also benefit from the frequent social contacts and a consequently higher level of social support (Strawbridge et al., 1997). As both praying and religious attendance are important negative correlates of male adolescents’ substance use, it underscores the importance of religion not only as an individual-level factor, but as a group-level protective factor as well (Bachman et al., 1988). We conclude that there is a relationship between adolescents’ substance use and their religiosity among this sample of Hungarian adolescents. Some important gender differences are detected, in need of further clarification. Among the boys, not only was decreased marijuana use associated with their attendance at religious services, but also smoking and binge drinking. Moreover, praying was also related to a lower likelihood of cigarette and alcohol use. Among the girls, only marijuana use was associated with the religiosity variables. Finally, even religious denomination was related to a lower likelihood of marijuana use for both sexes. Among the other variables of protection, some gender differences can be highlighted. For example, among the girls, school/sports club memberships were not a significant form of protection against marijuana use. Besides, the likelihood of all types of substance use was lower when girls felt happy with school. For the boys, not only their attendance at religious services but also other group membership, that is, participation in a school or sports club, was associated with a lower level of marijuana use. It should also be noted here that self-reported grades, while an important protection against smoking and binge drinking for both sexes, did not provide significant protection against marijuana use for the highest achieving boys and girls. This finding suggests that despite conceptual similarities, there are also differences in the background variables for different types of substance use (Gilvarry, 2000). Although our research has limitations (e.g., the cross-sectional study design and the low measurement level of variables used), our initial findings are encouraging. More sophisticated study designs and more complex models should be used to verify the multiple variations of the relationship between adolescent substance use and religiosity. Further data on this issue would be extraordinarily important in a country where both adult and adolescent substance abuse rates continue to increase and create multidimensional social and health problems.
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Acknowledgements This study was supported by the ETT T9 003/2000 grant of the Ministry of Health Care (Hungary), a Bolyai Research Fellowship provided to Bettina F. Piko by the Hungarian Academy of Sciences (Hungary), and a Fulbright Research Fellowship to Kevin M. Fitzpatrick. The authors wish to thank Darlene Wright for her helpful comments on an earlier version of this manuscript.
References Astrow, A. B., Puchalski, C. M., & Sulmasy, D. P. (2001). Religion, spirituality, and health care: Social, ethical, and practical consideration. American Journal of Medicine, 110, 283 – 287. Bachman, J. G., Johnston, L. D., O’Malley, P. M., & Humphrey, R. H. (1988). Explaining the recent decline in marijuana use: Differentiating the effects of perceived risks, disapproval, and general lifestyle factors. Journal of Health and Social Behavior, 29, 92 – 112. Brown, T. L., Parks, G. S., Zimmerman, R. S., & Phillips, C. M. (2001). The role of religion in predicting adolescent alcohol use and problem drinking. Journal of Studies on Alcohol, 62, 696 – 705. Brown, T. N., Schulenberg, J., Bachman, J. G., O’Malley, P. M., & Johnston, L. D. (2001). Are risk and protective factors for substance use consistent across historical time?: National data from the high school classes of 1976 through 1997. Preventive Science, 2, 29 – 43. Chatters, L. M. (2000). Religion and health. Public health research and practice. Annual Review of Public Health, 21, 335 – 367. Cockerham, W. C. (1999). Health and social change in Russia and Eastern Europe. New York: Routledge. Dossey, L. (2000). Prayer and medical science. Archives of Internal Medicine, 160, 1135 – 1338. Ellison, C. G. (1991). Religious involvement and subjective well-being. Journal of Health and Social Behavior, 32, 80 – 99. Foster, D. P., & Jo´zan, P. (1990). Health in Eastern Europe. Lancet, 335, 458 – 460. Gallup, G. H. Jr., & Bezilla, R. (1992). The religious life of young Americans. Princeton, NJ: George H. Gallup International Institute. Gilvarry, E. (2000). Substance abuse in young people. Journal of Child Psychology and Psychiatry, 41, 55 – 80. Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112, 64 – 105. Jarvis, G. K., & Northcott, H. C. (1987). Religion and differences in morbidity and mortality. Social Science and Medicine, 25, 813 – 824. Jessor, R. (1993). Successful adolescent development among youth in high-risk settings. American Psychologist, 48, 117 – 126. ´ ., & Szedma´k, S. (2000). Psychosocial risk factors, inequality and self-rated morbidity in Kopp, M. S., Skrabski, A a changing society. Social Science and Medicine, 51, 1350 – 1361. Kutter, C. J., & McDermott, D. S. (1997). The role of the church in adolescent drug education. Journal of Drug Education, 27, 293 – 305. Levin, J. S., Larson, D. B., & Puchalski, C. M. (1997). Religion and spirituality in medicine: Research and education. Journal of the American Medical Association, 278, 792 – 793. Li, X., Stanton, B., & Feigelman, S. (2000). Impact of perceived parental monitoring on adolescent risk behavior over 4 years. Journal of Adolescent Health, 27, 49 – 56. Miller, L., Davies, M., & Greenwald, S. (2000). Religiosity and substance use and abuse among adolescents in the National Comorbidity Survey. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1190 – 1197.
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Piko, B. (2000). Perceived social support from parents and peers: Which is the stronger predictor of adolescent substance use? Substance Use and Misuse, 35, 617 – 630. Piko, B. (2001a). Gender differences and similarities in adolescents’ ways of coping. Psychological Record, 51, 223 – 235. Piko, B. (2001b). Smoking in adolescence: Do attitudes matter? Addictive Behaviors, 26, 201 – 217. Piko, B. F., & Fitzpatrick, K. M. (2002). Without protection: Substance use among Hungarian adolescents in highrisk settings. Journal of Adolescent Health, 30, 463 – 466. Reifman, A., Barnes, G. M., Dintcheff, B. A., Uhteg, L., & Farrell, M. P. (2001). Health values buffer socialenvironmental risks for adolescent alcohol misuse. Psychology of Addictive Behaviors, 15, 149 – 250. Sloan, R. P., Bagiella, E., & Powell, T. (1999). Religion, spirituality, and medicine. Lancet, 353, 664 – 667. Strawbridge, W. J., Cohen, R. D., Shema, S. J., & Kaplan, G. A. (1997). Frequent attendance at religious services and mortality over 28 years. American Journal of Public Health, 87, 957 – 961. Stritzke, W. G. K., & Butt, J. C. M. (2001). Motives for not drinking alcohol among Australian adolescents: Development and initial validation of a five-factor scale. Addictive Behaviors, 26, 633 – 649. Turner, S. (1994). Family variables related to adolescent substance misuse: Risk and resiliency factors. In T. P. Gullotta, G. R. Adams, & R. Montemayor (Eds.), Substance misuse in adolescence ( pp. 36 – 55). Thousand Oaks: Sage Publications. Wallace Jr., J. M., & Forman, T. A. (1998). Religion’s role in promoting health and reducing risk among American youth. Health Education and Behavior, 25, 721 – 741. Wallace Jr., J. M., & Williams, D. R. (1997). Religion and adolescent health-compromising behavior. In J. Schulenberg, J. L. Maggs, & K. Hurrelmann (Eds.), Health risks and developmental transitions during adolescence ( pp. 444 – 469). Cambridge: Cambridge Univ. Press. Youniss, J., McCellan, J. A., & Yates, M. (1999). Religion, community service, and identity in American youth. Journal of Adolescence, 22, 243 – 253.
Substance use, religiosity, and other protective factors among Hungarian adolescents Bettina F. Pikoa,*, Kevin M. Fitzpatrickb a
Department of Psychiatry, Division of Behavioral Sciences, University of Szeged, 6721 Szeged, Szentharomsag u.5. Hungary b Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
Abstract A number of risk factors have emerged as important correlates of adolescent substance use. In addition, research continues to focus on which factors act as mediators protecting adolescents from negative outcomes. One of these protective factors is religiosity, and the focus of this paper is to examine its role in the life of adolescents in postsocialist Hungary, where active religious participation was highly discouraged until a decade ago. The sample of adolescents (N = 1240) consists of middle and high school students living in Szeged, Hungary. The calculated odds ratios for the relationship between religiosity, and other protective factors, and substance use revealed that smoking, drinking, and marijuana use among boys and marijuana use only among girls were related to religiosity. Group membership, for example, participation in school clubs, sports clubs, or religious groups, seems to be more important for boys compared with girls. A more careful examination of the protective role of religion in postsocialist Hungary could be extremely important in a country where both adult and adolescent smoking and alcohol use is among the highest in Europe. D 2004 Elsevier Ltd. All rights reserved. Keywords: Substance use; Adolescence; Religiosity; Protection
1. Introduction Religion has always been considered a major factor affecting morbidity and mortality (Jarvis & Northcott, 1987; Sloan, Bagiella, & Powell, 1999; Strawbridge, Cohen, Shema, & Kaplan, 1997). Religious participation has become an epidemiologically justified protective * Corresponding author. Tel./fax: +36-62-420-530. E-mail address: [email protected] (B.F. Piko). 0306-4603/$ – see front matter D 2004. Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2004.03.022
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factor, whose effect is seen in both prevention and primary health care (Astrow, Puchalsky, & Sulmasy, 2001; Levin, Larson, & Puchalski, 1997). Religious beliefs and practices have a positive effect on life satisfaction, mental well-being, and lifestyle. As a result, all these beneficial health effects have been noted as influencing the general maintenance of one’s health and recovery from illness (Dossey, 2000; Ellison, 1991). As Wallace and Williams (1997) have pointed out, there are several factors mediating religion and better health relationship, including health-related behaviors and practices, social support, group identity, coping, and guideline provisions for a coherent value system. Their model also suggests that children internalize religious beliefs and attitudes as a part of their ongoing socialization, and the family plays a crucial role in this process. Specifically, the development of religiosity often starts with joint family attendance at religious services (Turner, 1994). The role of religion in supporting a healthy lifestyle and reducing substance use has important potential for preventing disease. A sound health preventive strategy would make good use of the protective effects of religion at an early age. Therefore, research investigating the protective factors of adolescent substance use should receive high priority. Numerous correlates of adolescent substance use have already been identified. Studies have revealed a protective effect of religiosity against substance use and abuse in adolescence (Brown, Parks, Zimmerman, & Phillips, 2001; Miller, Davies, & Greenwald, 2000; Wallace & Forman, 1998). It was found that indicators of religiosity (e.g., religious denomination, attendance of religious services, or personal devotion) were inversely related to alcohol consumption and/or illicit drug use (Miller et al., 2000). Among the different motives for not drinking, religious constraints are found to be a key factor for adolescents (Stritzke & Butt, 2001). Moreover, while adolescents sometimes turn to substance use in stressful situations, praying, as a way of coping, may be related to lower levels of substance use (Piko, 2001a). This protective effect has been identified at both the individual and group levels (Bachman, Johnston, O’Malley, & Humphrey, 1988). In many places, the church, as a social institution, is also an important vehicle for general risk education (drug and alcohol, sex, AIDS prevention, etc.) for adolescents (Kutter & McDermott, 1997). Based on previous findings, researchers conclude that low levels of religiosity were associated with the onset of substance use (Chatters, 2000). Active membership in other social groups, such as school or sports clubs, as well as other school-related factors, for example, having high academic achievement or being happy with school, also have proved to be important protective factors against adolescents’ substance use (Hawkins, Catalano, & Miller, 1992; Jessor, 1993). According to data from a nationally representative U.S. study between 1976 and 1997, a high degree of consistency exists across time in the role that religiosity plays in predicting substance use (Brown, Schulenberg, Bachman, O’Malley, & Johnston, 2001). The role of religion in the adolescents’ identity development and community-oriented attitudes also has been found to be significant (Youniss, McLellan, & Yates, 1999). Moreover, female adolescents are usually more religious than males are, as measured by attendance and affiliation variables (Wallace & Forman, 1998). While religious beliefs and attitudes are widespread among American youth—in fact, 93% of them report being affiliated with a religious group or denomination (Gallup & Bezilla, 1992)—persons living in Hungary, a postsocialist country, report much lower levels of
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religious affiliation. Although religious practices were not inhibited, religious affiliation was discouraged, and people who took charge of their religious beliefs had to face social disadvantages during the early years of socialism. Therefore, the relationship between religion and health-related variables has not been examined thus far. On the other hand, in Hungary, as well as much of Eastern Europe, the frequency of smoking and alcohol consumption is significantly higher compared with the rates in Western Europe and the United States (Cockerham, 1999). In addition, after the opening of the Eastern European borders, drug use and trafficking have also started to increase, particularly among youth. Substance use, as a part of the general health-related lifestyle, has been argued to have the most serious effect on the low life expectancy and the high mortality rates due to heart diseases, neoplasms, and gastrointestinal diseases in Eastern Europe (Foster & Jo´zan, 1990; Kopp, Skrabski, & Szedma´k, 2000). Not only for adults but adolescents as well, smoking and alcohol use has a higher occurrence compared with rates in Western Europe and the United States (Piko, 2000, 2001b). Therefore, the concept of protective factors such as religiosity should be applied in our development of frameworks designed to improve not only our understanding of the mechanisms that put adolescents at risk, but also what factors protect them from engaging in substance use behaviors. This concept might even be of special significance in a postsocialist country, where religious life is undergoing a dramatic reconceptualization after the fall of socialism. The primary focus of the present paper is to examine the relationship between three types of substance use (cigarette smoking, binge drinking, and marijuana use) and protective factors such as adolescents’ religiosity, school and sports club membership, and two school-related factors. As a first step in mapping the intricate weave between adolescents’ religiosity and their health, the first question to ask is whether it is possible to detect differences between substance users and nonusers with regard to elements of their religiosity.
2. Methods 2.1. Participants and procedure Data were collected from middle and high school students, using randomly selected classes from six school districts in Szeged, Hungary. The total number of students sampled was 1500 (approximately 13% of the whole student population). Of the questionnaires, 1240 were returned and analyzed, yielding a response rate of over 80%. The age range of the respondents was 11–20 years of age; 53% (n = 658) of the sample was male and 47% (n = 582) was female. The data were collected during the spring of 2000, using a self-administered questionnaire. The parents were informed of the study, with their consent obtained prior to data collection. A standardized procedure of administration followed. Trained high school teachers (acting as health promoter) distributed the questionnaires to the students in each class after briefly explaining the study objectives and instructions on how to fill out the questionnaire. Similar information was attached on the cover page of each questionnaire. The completed ques-
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tionnaires were returned in sealed envelopes, assuring that the respondents would remain anonymous and their answers kept confidential. Students filled out the questionnaires during a single class period, which took approximately 30–40 min. 2.2. Measures The data obtained from the adolescent survey included three types of substance use: cigarette smoking, binge drinking (e.g., more than five drinks in a prescribed period of time), and marijuana use (as a most common type of illicit drug use). The main goal of these questionnaire items was to obtain information about the present status of the students’ substance use (whether they were users or nonusers), the frequency of their use in the past 30 days (Piko, 2000; Piko & Fitzpatrick, 2002), and the students’ age of first use. Responses on their user status, regardless of the frequency, were dichotomized and coded as 1 = yes, they had used the substance, or 0 = no, they had not used the substance. Religiosity was assessed using three independent variables. In addition to religious denomination, praying was an indicator of personal devotion, and attendance at religious services assessed commitment to the religious community (Miller et al., 2000; Wallace & Forman, 1998). As to religious denominations, 67.8% of the respondents reported having a religious denomination, the clear majority were Catholic (71.5%), 6.8% were being Protestant, 19.8% were simply being Christian, and 1.9% responded by saying they were some other denomination such as Greek Orthodox. In Hungary, unfortunately, religious denomination seldom fits together with active religious participation; therefore, praying and attendance of religious services seem to be more valid indicators of religiosity. In response to the question ‘‘Do you pray?,’’ 33.8% of the youth said yes and 66.2% said no. Three levels of religious attendance were identified: Most of the respondents reported that they ‘‘never attend religious services’’ (43.3%), 40.6% said they ‘‘go to church only on the occasion of the great religious feasts,’’ and 16.1% said that they attend religious services on a regular basis. Besides the religiosity variables, there were several other protective factors that we examined. School and sports club memberships were both coded as 0 = no, they did not belong to any clubs or teams, and 1 = yes, they had been a member of any school club or sports team. In addition, we included two school domain questions: being happy with school was coded as 0 = very/rather unhappy and 1 = very/rather happy, and self-reported grades was coded as 0 = students reported getting mostly Cs, Ds, and Fs, 1 = students reported getting mostly Bs and Cs, and 2 = students reported getting mostly As and Bs. 2.3. Analysis SPSS for MS Windows 9.0 program was used in the calculations, and the minimum significance level set to 5%. Beyond the descriptive statistics, we calculated the odds ratios, which helped detect the bivariate relationships between each type of substance use, religiosity, and other protective variables. The frequency of substance use was dichotomized and expressed the presence or absence of the substance use in question (Piko, 2000). The main goal of the analysis was to detect the differences between substance users and nonusers with
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Table 1 Descriptive statistics of substance use among youth Variables (%) Smoking Yes No Frequency of smoking among smokers in the last None Sometimes 1 – 2 1 – 5/day 6 – 10/day 11 – 20/day More than 20/day Age of first use of smoking among smokers** Less than 9 9 – 10 11 – 12 13 – 14 15 – 16 17 or more
Boys (n = 658)
Girls (n = 582)
41.8 58.2 30 days** 0.4 15.3 23.6 34.2 21.8 4.7
38.8 61.2 1.3 22.6 33.2 26.1 15.0 1.8
9.9 10.2 17.4 35.6 21.1 5.8
2.2 5.3 20.8 41.2 26.5 4.0
Binge drinking** Yes 40.6 No 59.4 Frequency of binge drinking among alcohol drinkers in the last 30 days** One time 32.2 2 times 27.0 3 – 5 times 26.6 6 – 9 times 9.0 10 or more 5.2 Age of first alcohol use among binge drinkers* Less than 9 4.1 9 – 10 10.1 11 – 12 13.5 13 – 14 41.2 15 – 16 30.7 17 or more 0.4 Marijuana** Yes 12.8 No 87.2 Frequency of marijuana use among drug users in the last 30 days* None 25.0 1–2 35.7 3–9 21.4 10 – 19 6.0 20 – 39 7.1 More than 40 4.8
27.5 72.5 50.6 29.4 16.9 1.9 1.2 1.9 4.4 13.1 43.1 35.0 2.5
6.5 93.5 52.6 31.6 7.9 5.3 0 2.6 (continued on next page)
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Table 1 (continued ) Variables (%)
Boys (n = 658)
Girls (n = 582)
Marijuana** Age of first marijuana use among users Less than 9 9 – 10 11 – 12 13 – 14 15 – 16 17 or more * P < .05, chi-square test. ** P < .01, chi-square test.
2.4 0 4.8 20.2 52.4 20.2
0 0 2.9 14.3 51.4 31.4
regard to varying levels of protection. The results of the binary logistic regression analyses are presented as a series of odds. The baseline odds are set to 1.0. An odds ratio > 1.0 indicates that there is a positive association between the factors of interest to the baseline odds, while a value < 1.0 indicates the inverse. Confidence intervals (95%) were also calculated for statistically significant relationships based on the criterion that the CIs did not include 1.0. Table 2 Descriptive statistics of religiosity and other possible protective variables among youth Variables (%) Religious denomination* No Yes Praying** No Yes Religious attendance** Never Occasionally Regularly School club membership No Yes Sports club membership** No Yes How happy with school** Very/rather unhappy Very/rather happy Grades at school** Mostly Cs, Ds, and Fs (%) Mostly Bs and Cs (%) Mostly As and Bs (%) * P < .05, chi-square test. ** P < .01, chi-square test.
Boys (n = 658)
Girls (n = 582)
34.8 65.2
29.2 70.8
75.1 24.9
56.0 44.0
48.9 36.9 14.1
36.8 44.8 18.4
58.1 41.9
53.6 46.4
58.8 41.2
79.7 20.3
23.1 76.9
16.9 83.1
33.3 54.9 11.8
20.0 56.6 23.4
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3. Results Table 1 shows the descriptive statistics of the variables measuring substance use in this sample of Hungarian youth. Among the boys, 41.8% reported smoking, 40.6% binge drinking, and 12.8% marijuana use. Among the girls, 38.8% reported smoking, 27.5% binge drinking, and 6.5% marijuana use. While there were no statistically significant gender differences in smoking, binge drinking and marijuana use were more common among boys than among girls. There were, however, significant gender differences in the amount of all types of substance use; that is, boys smoked more cigarettes, drank more alcohol, and used more marijuana than girls did. Likewise, the boys started using these substances at an earlier age, except for marijuana. Table 2 shows the descriptive statistics of religiosity and other protective variables. All the religiosity variables were reported more frequently by the girls. While there were no gender differences in the frequency of school club membership, the boys were more likely to Table 3 Calculated odds ratios for the relationship between substance use, religiosity, and other protective variables for the whole sample Total Sample (N = 1240)
Smoking
Religious denomination Noc Yes Praying Noc Yes Religious attendance Neverc Occasionally Regularly School club membership Noc Yes Sports club membership Noc Yes How happy with school Very/rather unhappyc Very/rather happy Grades at school Mostly Cs, Ds, and Fsc Mostly Bs and Cs Mostly As and Bs a
Binge drinking b
95% CIb
0.72 – 1.19
1.0 0.49
0.33 – 0.71*
1.0 0.67
0.52 – 0.86*
1.0 0.50
0.32 – 0.78*
0.73 – 1.19 0.41 – 0.82*
1.0 0.73 0.49
0.56 – 0.94* 0.34 – 0.71*
1.0 0.56 0.26
0.38 – 0.84* 0.12 – 0.56*
1.0 0.64
0.50 – 0.81*
1.0 0.53
0.42 – 0.67*
1.0 0.67
0.45 – 0.98*
1.0 1.07
0.84 – 1.36
1.0 0.87
0.67 – 1.12
1.0 0.56
0.36 – 0.88*
1.0 0.56
0.42 – 0.74*
1.0 0.52
0.39 – 0.69*
1.0 0.52
0.34 – 0.78*
1.0 0.15 0.48
0.10 – 0.23* 0.37 – 0.62*
1.0 0.18 0.65
0.11 – 0.28* 0.50 – 0.85*
1.0 0.22 0.71
0.10 – 0.50* 0.48 – 1.07
95% CI
OR
1.0 0.99
0.78 – 1.26
1.0 0.93
1.0 0.74
0.58 – 0.95*
1.0 0.93 0.58
OR, odds ratios. 95% CI, 95% confidence intervals. c Reference category. * Statistically significant odds ratio values ( P < .05). b
a
Marijuana ORa
OR
a
95% CI
b
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participate in a sports club, and girls were more likely to report being happy with school and having better grades. The results of the calculated odds ratios for the relationship between religiosity and substance use are shown in Table 3 (the whole sample). Religious denomination was not a significant predictor of either smoking or drinking. However, it was associated with a decreased likelihood of reported marijuana use (OR = 0.49, CI: 0.33–0.71). Praying was a stronger predictor than religious denomination was, as it significantly decreased the odds of reporting each type of substance use. Regular religious attendance was a significant predictor in each case; students who regularly attend church had a significantly lower likelihood of smoking, binge alcohol drinking, and marijuana use. Youth reporting regularly going to religious services had a lower chance of smoking, binge drinking, and drug use; even those reporting going to church only occasionally had lower odds of binge drinking and marijuana use. Being a member of a school club, being happy with school, and reporting earning higher Table 4 Calculated odds ratios for the relationship between substance use, religiosity, and other protective variables for the boys’ sample Boys (n = 658)
Smoking OR
Religious denomination Noc Yes Praying Noc Yes Religious attendance Neverc Occasionally Regularly School club membership Noc Yes Sports club membership Noc Yes How happy with school Very/rather unhappyc Very/rather happy Grades at school Mostly Cs, Ds, and Fsc Mostly Bs and Cs Mostly As and Bs a
a
Binge drinking 95% CI
OR
a
Marijuana b
95% CI
ORa
95% CIb
1.0 1.1
0.82 – 1.58
1.0 1.08
0.78 – 1.50
1.0 0.57
0.36 – 0.90*
1.0 0.67
0.47 – 0.97*
1.0 0.50
0.34 – 0.73*
1.0 0.62
0.34 – 1.11
1.0 0.89 0.56
0.64 – 1.25 0.34 – 0.92*
1.0 0.73 0.46
0.52 – 1.02 0.27 – 0.76*
1.0 0.65 0.30
0.40 – 1.07 0.11 – 0.76*
1.0 0.75
0.54 – 1.02
1.0 0.58
0.42 – 0.79*
1.0 0.69
0.45 – 0.98*
1.0 0.92
0.67 – 1.26
1.0 0.88
0.64 – 1.21
1.0 0.46
0.28 – 0.77*
1.0 0.65
0.45 – 0.94*
1.0 0.59
0.41 – 0.85*
1.0 0.82
0.49 – 1.39
1.0 0.23 0.48
0.13 – 0.41* 0.34 – 0.68*
1.0 0.21 0.70
0.11 – 0.40* 0.50 – 0.99*
1.0 0.35 0.67
0.13 – 0.93* 0.41 – 1.08
OR, odds ratios. 95% CI, 95% confidence intervals. c Reference category. * Statistically significant values ( P < .05). b
b
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grades were all significant protective factors, although sports club membership was significant only for marijuana use. Clearly, gender matters. There were significant differences between girls and boys in terms of both types of substance use, religious involvement, and other protective factors. In addition, as an extension of the analysis for the general sample, the odds ratios were calculated for male and female students separately (Tables 4 and 5, respectively). Among the boys (Table 4), those reporting going to church on a regular basis had lower odds of engaging in all types of substance use. Praying was also associated with a decreased likelihood of smoking and binge drinking, but not marijuana use. Religious denomination was related to a lower chance of boys’ marijuana use. School-related protective factors (being happy with school and self-reported grades) were significant factors in lowering the odds of smoking and binge drinking, while group memberships, that is, participation in a school or sports club, seemed to be more important factors protecting youth against marijuana use. Table 5 Calculated odds ratios for the relationship between substance use, religiosity, and other protective variables for the girls’ sample Girls (n = 582)
Smoking
Religious affiliation Noc Yes Praying Noc Yes Religious attendance Neverc Occasionally Regularly School club membership Noc Yes Sports club membership Noc Yes How happy with school Very/rather unhappyc Very/rather happy Grades at school Mostly Cs, Ds, and Fsc Mostly Bs and Cs Mostly As and Bs a
Binge drinking b
95% CIb
0.54 – 1.19
1.0 0.38
0.19 – 0.75*
1.0 1.1
0.76 – 1.58
1.0 0.50
0.24 – 1.02
0.70 – 1.45 0.38 – 1.02
1.0 0.86 0.62
0.58 – 1.23 0.36 – 1.08
1.0 0.52 0.27
0.26 – 1.05 0.07 – 0.91*
1.0 0.54
0.38 – 0.76*
1.0 0.49
0.33 – 0.71*
1.0 0.51
0.25 – 1.03
1.0 1.31
0.87 – 1.98
1.0 0.51
0.30 – 0.85*
1.0 0.44
0.15 – 1.28
1.0 0.47
0.31 – 0.73*
1.0 0.48
0.30 – 0.74*
1.0 0.25
0.12 – 0.49*
1.0 0.10 0.44
0.06 – 0.20* 0.22 – 0.68*
1.0 0.19 0.66
0.10 – 0.36* 0.42 – 1.02
1.0 0.18 1.07
0.04 – 0.85* 0.49 – 2.34
95% CI
OR
1.0 0.84
0.58 – 1.21
1.0 0.81
1.0 0.83
0.59 – 1.16
1.0 1.0 0.62
OR, odds ratios. 95% CI, 95% confidence intervals. c Reference category. * Statistically significant odds ratio values ( P < .05). b
a
Marijuana ORa
OR
a
95% CI
b
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For the girls (Table 5), besides religious denomination, regular attendance at religious services was associated with a lower likelihood of marijuana use. None of the religiosity variables were found to be related to smoking or binge drinking among the girls. However, religious denomination was related to a lower chance of marijuana use among both sexes. Over all, the relationships between religiosity and substance use are more convincing for the boys than for the girls. Similar with the boys, school-related factors were important forms of protection for girls. Group memberships, however, were not significant protective factors against marijuana use, only when girls felt happy with school did ‘‘school’’ make a difference. It should also be noted here that the self-reported grades variable did not provide significant protection against marijuana use for the highest achieving boys and girls.
4. Discussion Studies suggest that the relationship between religion and better health is partly due to health-related behavior and lifestyle practices (Jarvis & Northcott, 1987; Wallace & Williams, 1997). This same lower frequency of substance use and abuse can also be detected among adolescents (Brown, Parks et al., 2001; Miller et al., 2000; Stritzke & Butt, 2001). This relationship, however, has never been investigated in a postsocialist country, where religious affiliation was highly discouraged during the years of socialism. As a consequence, religiosity might play less of a role in organizing people’s lives as compared with its role in the United States (see, e.g., Gallup & Bezilla, 1992; Wallace & Forman, 1998). Therefore, the primary focus of the present paper has been to explore the relationship between smoking, binge drinking, and marijuana use and adolescents’ religiosity, along with other protective factors such as school/sports club membership and other school-domain variables. We focused on the specific research question that asked: Is it possible to differentiate between substance users and nonusers when focusing exclusively on adolescents’ religiosity and other forms of protection? Results suggest that religious denomination alone may not play a very important role in determining adolescent smoking and binge drinking. Marijuana use, on the other hand, was related to religious denomination for both sexes. This finding suggests support for the hypothesis that Christians, even if they do not outwardly practice their religion, possess a certain moral or value system that prevents them from engaging in certain negative behaviors. Values have been noted elsewhere as playing an important role in adolescents’ substance use behaviors (Reifman, Barnes, Dintcheff, Uhteg, & Farrell, 2001), and religion has always encouraged health-promoting practices. Marijuana use was less frequent than smoking and drinking. Marijuana is an illicit drug in Hungary, whose consumption is legally inhibited and socially less accepted by the population compared with cigarettes and alcohol. It may be possible that adolescents identifying with Christian values and beliefs tend to avoid breaking the official laws. Moreover, marijuana use was the only substance that was related to the religiosity variables in both sexes. Regular attendance at religious services was also related to a lower likelihood of marijuana use, both among boys and girls.
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While religiosity was more common among girls, based on the descriptive statistics, similar with previous findings (e.g., Wallace & Forman, 1998), the relationship between substance use and religiosity was stronger for boys. Among the girls, none of the religiosity variables were important factors affecting smoking and binge drinking, while among the boys, both praying and regular attendance at church were associated with these types of substance use. Further research is needed to explore how boys benefit more from the favorable effect of religiosity and, on the contrary, why girls do not receive a similar benefit from this relationship. Related phenomenon could be found in the relationship between social coping and adolescents’ psychosocial health; girls receive more social support, but boys may benefit more from this strategy of coping (Piko, 2001a). Attendance at religious services may have a different meaning for adolescents. Besides satisfying their spiritual and community/social needs (Youniss et al., 1999), it also may serve as a tool of family cohesion (Turner, 1994). In religious families, parents may use higher levels of monitoring, which, in turn, are often found to be related to lower levels of substance use (Li, Stanton, & Feigelman, 2000). But regular attendees may also benefit from the frequent social contacts and a consequently higher level of social support (Strawbridge et al., 1997). As both praying and religious attendance are important negative correlates of male adolescents’ substance use, it underscores the importance of religion not only as an individual-level factor, but as a group-level protective factor as well (Bachman et al., 1988). We conclude that there is a relationship between adolescents’ substance use and their religiosity among this sample of Hungarian adolescents. Some important gender differences are detected, in need of further clarification. Among the boys, not only was decreased marijuana use associated with their attendance at religious services, but also smoking and binge drinking. Moreover, praying was also related to a lower likelihood of cigarette and alcohol use. Among the girls, only marijuana use was associated with the religiosity variables. Finally, even religious denomination was related to a lower likelihood of marijuana use for both sexes. Among the other variables of protection, some gender differences can be highlighted. For example, among the girls, school/sports club memberships were not a significant form of protection against marijuana use. Besides, the likelihood of all types of substance use was lower when girls felt happy with school. For the boys, not only their attendance at religious services but also other group membership, that is, participation in a school or sports club, was associated with a lower level of marijuana use. It should also be noted here that self-reported grades, while an important protection against smoking and binge drinking for both sexes, did not provide significant protection against marijuana use for the highest achieving boys and girls. This finding suggests that despite conceptual similarities, there are also differences in the background variables for different types of substance use (Gilvarry, 2000). Although our research has limitations (e.g., the cross-sectional study design and the low measurement level of variables used), our initial findings are encouraging. More sophisticated study designs and more complex models should be used to verify the multiple variations of the relationship between adolescent substance use and religiosity. Further data on this issue would be extraordinarily important in a country where both adult and adolescent substance abuse rates continue to increase and create multidimensional social and health problems.
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Acknowledgements This study was supported by the ETT T9 003/2000 grant of the Ministry of Health Care (Hungary), a Bolyai Research Fellowship provided to Bettina F. Piko by the Hungarian Academy of Sciences (Hungary), and a Fulbright Research Fellowship to Kevin M. Fitzpatrick. The authors wish to thank Darlene Wright for her helpful comments on an earlier version of this manuscript.
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