Alcohol use and religiousness/spirituality among adolescents.Background: Previous studies indicate that religiousness is associated with lower levels of substance use among adolescents, but less is known about the relationship between spirituality and substance use. The objective of this study was to determine the association between adolescents' use of alcohol and specific aspects of religiousness and spirituality. Methods: Twelve- to 18-year-old patients coming for routine medical care at three primary care sites completed a modified Brief Multidimensional mul·ti·di·men·sion·al adj. Of, relating to, or having several dimensions. mul  ti·di·men Measure of Religiousness/Spirituality; the Spiritual
Connectedness Scale; and a past-90-days alcohol use Timeline Followback
calendar. We used multiple logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. analysis to assess the
association between each religiousness/spirituality measure and odds of
any past-90-days alcohol use, controlling for age, gender,
race/ethnicity, and clinic site. Timeline Followback data were
dichotomized to indicate any past-90-days alcohol use and
religiousness/spirituality scale scores were z-transformed for analysis.
Results: Participants (n = 305) were 67% female, 74% Hispanic or black, and 45% from two-parent families. Mean [+ or -] SD age was 16.0 [+ or -] 1.8 years. Approximately 1/3 (34%) reported past-90-day alcohol use. After controlling for demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. and clinic site, Religiousness/Spirituality scales that were not significantly associated with alcohol use included: Commitment (OR = 0.81, 95% CI 0.36, 1.79), Organizational Religiousness (OR = 0.83, 95% CI 0.64, 1.07), Private Religious Practices (OR = 0.94, 95% CI 0.80, 1.10), and Religious and Spiritual Coping -- Negative (OR = 1.07, 95% CI 0.91, 1.23). All of these are measures of religiousness, except for Religious and Spiritual Coping -- Negative. Scales that were significantly and negatively associated with alcohol use included: Forgiveness (OR = 0.55, 95% CI 0.42-0.73), Religious and Spiritual Coping -- Positive (OR = 0.67, 95% CI 0.51-0.84), Daily Spiritual Experiences (OR = 0.67, 95% CI 0.54-0.84), and Belief (OR = 0.76, 95% CI 0.68-0.83), which are all measures of spirituality. In a multivariable model that included all significant measures, however, only Forgiveness remained as a significant negative correlate of alcohol use (OR = 0.56, 95% CI 0.41, 0.74). Conclusions: Forgiveness is associated with a lowered risk of drinking during adolescence. Key Words: spirituality, religion, substance-related disorders, alcoholism alcoholism, disease characterized by impaired control over the consumption of alcoholic beverages. Alcoholism is a serious problem worldwide; in the United States the wide availability of alcoholic beverages makes alcohol the most accessible drug, and alcoholism is , adolescence ********** Adolescence is an important time of life when young people begin to assert their independence and make personal decisions that will form the basis of adult behavior. Research has shown that people who begin drinking during adolescence are more likely to have alcohol dependence as adults, compared with those who wait until their adult years. (1-3) It is therefore important to identify modifiable factors that influence adolescents' decision to use alcohol. Religiousness has been consistently identified as a protective influence on adolescent substance abuse. (4-7) A national survey by the Gallup Poll Gallup Poll Noun a sampling of the views of a representative cross section of the population, usually used to forecast voting [after G H Gallup, statistician] Gallup poll n → found that 95% of teenagers believe in God, 93% believe that God loves them, 80% say that their religious beliefs are very or fairly important to them, and 52% have attended a religious service in the past month. (8) Miller et al (9) found that religiousness had twice the negative strength of association with substance dependence among adolescents compared with adults. However, not enough research has focused on the protective association of religiousness and its potential for positive health outcomes. (7) This may be related in part to the perceived difficulty in measuring the different aspects of religiousness/spirituality and differentiating them from other aspects of identity such as culture, ethnicity and personality traits. (10) As knowledge in the field continues to expand, researchers have acknowledged a multidimensional understanding of religiousness. (11-14) This has enabled studies to better define the constructs that they seek to measure. Francis (15) demonstrated that belief in God was one of the strongest aspects of religiousness associated with adolescents' attitudes toward substance use. Several other studies have demonstrated that participation (eg, attendance at religious services) and salience sa·li·ence also sa·li·en·cy n. pl. sa·li·en·ces also sa·li·en·cies 1. The quality or condition of being salient. 2. A pronounced feature or part; a highlight. Noun 1. (eg, importance of religious beliefs, commitment to religious beliefs) are stronger predictors than simple affirmation (eg, church membership, denominational de·nom·i·na·tion n. 1. A large group of religious congregations united under a common faith and name and organized under a single administrative and legal hierarchy. 2. affiliation). (16,17) Nonnemaker et al (18) examined the relationship between public religiousness (attendance at religious services and participation in youth group activities) and private religiousness (prayer and importance of religion) and adolescent substance use. Both were found to be protective factors, but public religiousness was found to have greater impact on regular use of substances while private religiousness was found to have greater impact on experimental use of substances. Research has moved even further to distinguish a difference between "Religiousness" and "Spirituality," related terms that are sometimes used interchangeably INTERCHANGEABLY. Formerly when deeds of land were made, where there Were covenants to be performed on both sides, it was usual to make two deeds exactly similar to each other, and to exchange them; in the attesting clause, the words, In witness whereof the parties have hereunto . "Religiousness" generally refers to beliefs, practices and behaviors associated with organized religious groups, such as church affiliation and attendance at religious services. (19) "Spirituality" generally refers to the more personal and abstract beliefs and practices, such as a sense of the divine in daily life or communication with a transcendent power, which may or may not be associated with organized religious practices. (19) These two concepts are not mutually exclusive Adj. 1. mutually exclusive - unable to be both true at the same time contradictory incompatible - not compatible; "incompatible personalities"; "incompatible colors" . Little is known about the spiritual experiences, beliefs and practices of adolescents, how these factors are protective against the use of alcohol and drugs, and whether these spiritual factors are distinct from religious factors. A better understanding of these associations will lead to more effective substance use prevention and intervention approaches for adolescents. For example, specific spiritual constructs may be shown to produce a protective effect against early initiation to alcohol use and, if so, clinicians should inquire in·quire also en·quire v. in·quired, in·quir·ing, in·quires v.intr. 1. To seek information by asking a question: inquired about prices. 2. about them and offer positive reinforcement positive reinforcement, n a technique used to encourage a desirable behavior. Also called positive feedback, in which the patient or subject receives encouraging and favorable communication from another person. when adolescent patients mention them. Alternatively, a greater understanding of the effects of spiritual connectedness may indicate that assessment of both religious affiliation and religious peer group influences should be included as part of counseling for alcohol- and drug-involved youth. The objective of this study was to identify specific aspects of religiousness and spirituality that are associated with alcohol use among adolescents. We hypothesized that higher spirituality scale scores will be associated with lower rates of alcohol use, but that the effect size will vary among scales and be independent of religiousness. Method This prospective, observational study In statistics, the goal of an observational study is to draw inferences about the possible effect of a treatment on subjects, where the assignment of subjects into a treated group versus a control group is outside the control of the investigator. was conducted in a convenience sample (n = 305) of 12- to 18-year-old patients arriving for routine care between May 2001 and April 2002 at one of three adolescent primary care medical clinics in Boston, Massachusetts “Boston” redirects here. For other uses, see Boston (disambiguation). Boston is the capital and most populous city of Massachusetts.[3] The largest city in New England, Boston is considered the unofficial economic and cultural center of the entire New . They were the Adolescent/Young Adult Medical Practice at Children's Hospital Boston Children's Hospital Boston is a children's hospital located in the Longwood Medical and Academic Area of Boston, Massachusetts. Located at 300 Longwood Avenue, Children's is adjacent both to its teaching affiliate, Harvard Medical School, and to Dana-Farber Cancer Institute. (CHB), the Adolescent Clinic at the Floating Hospital for Children (FHC FHC Fernando Henrique Cardoso (President of Brazil, 1994-2002) FHC Family History Center FHC Financial Holding Company FHC Feline Health Center (Cornell University) FHC Fixed Head Coupe ), and the Adolescent Clinic at the Martha Eliot Health Center (MEHC). These clinics serve both inner city and suburban youth from a wide range of social strata, racial groups, and ethnic backgrounds. A research assistant who was not involved inpatient care inpatient care Managed care Services delivered to a Pt who needs physician care for > 24 hrs in a hospital invited patients to participate while in the waiting room (FHC, MEHC), or flagged the clinic records of age-eligible patients so that the medical care provider could invite them to participate at the conclusion of the medical visit (CHB). Patients who were unable to read and understand English were excluded (n = 14), as were those with acute medical or psychiatric psy·chi·at·ric adj. Of or relating to psychiatry. psychiatric adjective Pertaining to psychiatry, mental disorders problems that precluded participation in research on the day of the clinic visit (n = 18). Interested patients met with the research assistant, who explained the study procedures and obtained parental consent Parental consent laws (also known as parental involvement or parental notification laws) in some countries require that one or more parents consent to or be notified before their minor child can legally engage in certain activities. , either in person or by telephone, as well as signed adolescent assent An intentional approval of known facts that are offered by another for acceptance; agreement; consent. Express assent is manifest confirmation of a position for approval. . Patients whose parents could not be reached to provide consent were excluded (n = 16). Participants were told that the purpose of the study was to assess the relationship between spirituality and alcohol/drug use and that their answers would be kept confidential. They were informed that the research team would notify their provider if a serious problem (eg, current suicidality) were identified so that appropriate care could be arranged. The Children's Hospital Boston Committee on Clinical Investigations and the Tufts New England New England, name applied to the region comprising six states of the NE United States—Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut. The region is thought to have been so named by Capt. Medical Center Human Investigations Review Committee approved the study protocol. The assessment battery included eight items recording demographic information; a 90-day Timeline Followback Calendar (TLFB TLFB Timeline Followback Method (alcoholism) ) (20) that separately recorded use of alcohol, cannabis cannabis: see hemp; marijuana. cannabis Any plant of the genus Cannabis, which contains a single species, C. sativa. It is widely cultivated throughout the northern temperate zone. and other drugs; a 66-item modified Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS), (19) and the 15-item Spiritual Connectedness Scale (eg, "I feel very close to some of my friends at church"). (21) The BMMRS was developed by a national work group supported by the National Institutes of Health and the Fetzer Institute, whose charge was to identify "key dimensions of religiousness/spirituality as they relate to physical and mental health." (19) The BMMRS includes scales measuring religiousness: Private Religious Practices (5 items, alpha = 0.76) (eg, "How often do you read the Bible or other religious literature?), Religious Support (12 items; 3 each for anticipated support (alpha = 0.95) (eg, "If you had a problem or were faced with a difficult situation, how much comfort would the people in your congregation be willing to give you?"), emotional support received (alpha = 0.94) (eg, "How often do people in your congregation make you feel loved and cared for?"), emotional support given (alpha = 0.93) (eg, "How often do you make the people in your congregation feel loved and cared for?"), and negative interaction support experiences (alpha = 0.73) (eg, "How often do the people in your congregation make too many demands on you?"), Religious Commitment (2 items assessing monthly financial contribution and hours per week devoted to religious/spiritual activities), Organizational Religiousness (2 items) (eg, "How often do you attend religious services?"), and Religious Preference (1 item) ("At the present time, what is your religious preference?"). The BMMRS also includes scales measuring spirituality: Daily Spiritual Experiences (15 items, alpha = 0.94) (eg, "I am spiritually touched by the beauty of creation"), Belief (1 item) ("I believe in a God who watches over me"), Forgiveness (3 items, alpha = 0.68) (eg, "I have forgiven myself for things that I have done wrong"), Religious and Spiritual Coping -- Positive (5 items, alpha = 0.88) (eg, "I look to God for strength, support and guidance"), and Religious and Spiritual coping -- Negative (5 items, alpha = 0.54) (eg, "I wonder whether God has abandoned me"). A research assistant administered the TLFB and recorded participants' responses, and then monitored completion of the questionnaire. Each participant received a $25 merchandise certificate as compensation for his/her time. All data were independently entered twice into a data management program. The dual entry files were then compared and discrepancies reconciled by checking the original data source. Text variables (eg, Religious Preference) were independently coded by at least two investigators and disagreements resolved by the lead investigator. Frequencies and descriptive statistics descriptive statistics see statistics. were computed for all demographic items and spirituality scale scores. We separately computed frequencies of demographic items, self-reported attendance at a religious congregation, religious preference, and clinic site for the subgroup sub·group n. 1. A distinct group within a group; a subdivision of a group. 2. A subordinate group. 3. Mathematics A group that is a subset of a group. tr.v. of drinkers (n = 103) and used the [chi square chi square (kī), n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies. ] test adjusted for cluster effects The cluster effect is the effect of buyers and sellers of a particular good or service congregating in a certain place and hence inducing other buyers and sellers to relocate there as well. of the 3-site sample design to compare proportions. The religiousness/spirituality response scales varied in length from 1 to 16 items, and in response categories from 4 to 8 forced choices, making unadjusted comparisons very difficult to interpret. Therefore, we performed z transformation of these scores to facilitate comparisons of effect measures across individual scales. Because substance use frequency and quantity data were highly skewed skewed curve of a usually unimodal distribution with one tail drawn out more than the other and the median will lie above or below the mean. skewed Epidemiology adjective Referring to an asymmetrical distribution of a population or of data , TLFB data were dichotomized to indicate presence or absence of past-90-day use of alcohol, cannabis, other drugs, and any substance. Few differences were found in analyses across substance use categories (alcohol versus cannabis versus other drugs versus any substance), so we are reporting alcohol use data only. We used logistic regression analysis to examine the relationship between alcohol use and spirituality, with dichotomized past-90-day alcohol use as the dependent variable and the z-transformed total scale score as the independent variable, while controlling for age, race/ethnicity, and clinic site where recruitment occurred. We adjusted the precision estimates for the effect on the sample of clinic site clustering with SUDAAN statistical software, using site as the nest variable. The odds ratio, 95% confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. , and significance level were computed. We then performed backward selection multivariable logistic regression analysis, using variable entry and exit criteria of P > 0.20 for the change in maximum likelihood criteria. (22) Results The study sample (n = 305) was 66.6% female and included a majority of nonwhite non·white n. A person who is not white. non  white adj. participants. (Table 1) The mean age was 16.0 [+ or -] 1.8
years. Slightly less than half of the participants (45.2%) came from
households with two parents and most (85.5%) had at least one parent
with a high school education. About three-fourths of participants
(79.7%) reported attending a religious congregation during the past
year. Of 264 participants who reported a religious preference, 67.0%
were "Christian," 12.9% were "Other" (eg, Jewish,
Buddhist), 11.4% were "Atheist/None," and 8.7% were
"Don't know/Confused." Slightly less than two-thirds of
participants (63.3%) were recruited from one clinic site (CHB).
Slightly more than one-third of participants (33.7%) reported alcohol use within the past 90 days, and drinking data were highly right-skewed. Among those who reported past-90-days drinking (n = 103), the median number of drinking days was 2 (range 1-43), median drinks per drinking day was 2 (range 0.3-14) and median total drinks during the past 90-days was 5 (range 1-276). Alcohol use was not associated with gender, socioeconomic so·ci·o·ec·o·nom·ic adj. Of or involving both social and economic factors. socioeconomic Adjective of or involving economic and social factors Adj. 1. indicators (two-parent family, parent educational level), past-year attendance at a religious congregation, or clinic site. Alcohol use was significantly associated with older age and "white" race/ethnicity. The "None/Atheist" group had the highest apparent rate of alcohol use (53.3%), followed by "Other" (47.1%), "Christian" (31.1%), and "Don't know/Confused" (21.7%). After adjusting for sample cluster effect of clinic site, however, these differences did not rise to the level of statistical significance. The odds ratios for past-90-day alcohol use for religiousness/spirituality scales are presented in Table 2. The odds were computed based on an increase of one standard deviation In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. in the scale score while controlling for age, race/ethnicity, and clinic site. Forgiveness, Religious and Spiritual Coping -- Positive, Daily Spiritual Experiences, and Belief, all measures of spirituality, were associated with significantly lower odds of alcohol use for the entire sample. Commitment, Organizational Religiousness, Private Religious Practices, and Religious and Spiritual Coping -- Negative were not significantly associated with alcohol use. All of these are measures of religiousness, except for Religious and Spiritual Coping -- Negative. We separately analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. data on the subgroup of participants who reported past-year attendance at a religious congregation (n = 239), for whom certain scales would be most relevant (ie, scales that assumed affiliation with a religious congregation). The only measure associated with significantly lower odds of alcohol use among past-year congregants was Spiritual Connectedness. Scales not associated with alcohol use among congregants were Religious Support -- Anticipated, Religious Support -- Negative Interaction, Religious Support -- Emotional Given and Religious Support -- Emotional Received, as well as Religious Commitment. Multivariable analysis of past-90-days alcohol use and religiousness/spirituality scales is presented in Table 3. We ran separate models for all participants and for past-year congregants. Forgiveness was the only statistically significant spirituality/religiousness variable that remained in the model for all participants (n = 295), as well as for the model for those attending a religious congregation (n = 234). To assess the association between Forgiveness and alcohol use in more detail, we entered each of the three Forgiveness items: ("I have forgiven myself for things that I have done wrong," "I have forgiven those who hurt me," "I know that God forgives me") individually into three separate final models to examine the effect of each specific type of forgiveness. For the entire sample, each of the three forgiveness items was significantly and negatively associated with alcohol use (p-value range 0.02-0.04). However, the "I have forgiven those who hurt me" item had a relatively weaker effect (OR = 0.67) compared with the other two items (OR = 0.59 for "I know that God forgives me" and OR = 0.57 for "I have forgiven myself"). The item on forgiving others had an even weaker effect, failing to meet statistical significance, in analysis of the subgroup of youth who participated in a congregation. For the subgroup of past-year congregants, the "I know that God forgives me" item had the strongest protective effect on alcohol use (OR = 0.44). Discussion This study suggests that forgiveness is an important spiritual construct for adolescents and that it is associated with lower risk of alcohol use during this vulnerable developmental period. Unforgiving thoughts have been shown to have a negative effect on skin conductance, heart rate, and blood pressure. (23) It is therefore not surprising that previous studies have also found forgiveness to be associated with improved outcomes in rehabilitation rehabilitation: see physical therapy. from traumatic brain injury Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. TBI can result from a closed head injury or a penetrating head injury and is one of two subsets of acquired brain , (24) patients with cancer, (25,26) management of low back pain, (27) and alleviating Post Traumatic Stress Disorder Post traumatic stress disorder (PTSD) A disorder that occurs among survivors of severe environmental stress such as a tornado, an airplane crash, or military combat. Symptoms include anxiety, insomnia, flashbacks, and nightmares. symptom severity, (28) among other health problems. One study has shown forgiveness therapy to be important in recovery for adult substance abuse treatment clients. (29) However, we could find no previous studies on the relationship between forgiveness and substance use during adolescence. Some have suggested that forgiveness can be characterized as either a state or a trait trait (trat) 1. any genetically determined characteristic; also, the condition prevailing in the heterozygous state of a recessive disorder, as the sickle cell trait. 2. a distinctive behavior pattern. . (30,31) State forgiveness is associated with a specific other person or act, while trait forgiveness is an individual temperamental tem·per·a·men·tal adj. 1. Relating to or caused by temperament: our temperamental differences. 2. Excessively sensitive or irritable; moody. 3. characteristic. The items in our study primarily measured "trait forgiveness" and it remains unknown whether state forgiveness is similarly protective of alcohol use during adolescence. Future studies should examine this question and further explore the relationship between various aspects of forgiveness and substance use during adolescence, as well as the relationship between forgiveness and other high risk behaviors and mood states. Our study did not find that alcohol use during adolescence was significantly associated with religious preference, although our sample was not adequately powered to fully examine this question. Other studies have shown a strong association between religious preference and substance use. In one study of more than 2000 Canadian adolescents, Adlaf and Smart (32) found Catholic youth less likely than Protestant or nonaffiliated youth to have used cannabis or other illicit drugs illicit drug Street drug, see there during the past year. Other, even larger studies, have shown that youth from denominations with clear prohibitions on use of alcohol or drugs (eg, evangelical Christians This is a list of people who are notable due to their influence on the popularity or development of evangelical Christianity or for their professed Evangelicalism. Historical
While we found that other spirituality measures (Religious Coping religious coping, n means of dealing with stress (which may be a consequence of illness) that are religious. These include prayer, congregational support, pastoral care, and religious faith. , Daily Spiritual Experiences, Belief) had a significant, negative association with alcohol use when analyzed individually, the effect was not seen in our multivariable model. This finding may be due to colinearity, or it may be that all of these scales are in fact measuring different facets of the same higher-order construct of intrinsic religiousness/spirituality. Our study also found no association between alcohol use and Religious Coping -- Negative, which has been found to be a significant correlate of poorer health outcomes in adult studies. (34,35) It may be that adolescents are less likely than adults to feel that God is punishing them or has abandoned them, or it may be that our measure was not sufficiently sensitive for use in an adolescent sample. This association should be further studied in a larger sample of adolescents, with a measurement tool that has been specifically validated among adolescents. This study has some potential limitations. First the sample size was relatively small, yielding low power for subgroup analyses. Second, participants were a convenience sample, which may not be representative of all adolescent clinic patients or the larger adolescent population. The sample had a high proportion of racial/ethnic minorities (Hispanics and African Americans African American Multiculture A person having origins in any of the black racial groups of Africa. See Race. ), which included large numbers of evangelical Christians and Roman Catholics. The study required parental consent, which raises the possibility of self-selection bias in the direction of a lower risk sample (ie, one with less substance use). This was a cross sectional sec·tion·al adj. 1. Of, relating to, or characteristic of a particular district. 2. Composed of or divided into component sections. n. study that cannot determine causal relationships. In addition, because of the rapid development of cognitive, psychological, social, and emotional processes during adolescence, the relationship between alcohol use and religiousness/spirituality may be fragile. Future studies should be longitudinal in design to overcome this limitation. The measurement battery also presents potential limitations. The TLFB relies on self-report to measure substance use and there were no collateral reports or objective measures. Nonetheless, previous studies have shown self-report to be a reliable means of measuring substance use and it compares favorably fa·vor·a·ble adj. 1. Advantageous; helpful: favorable winds. 2. Encouraging; propitious: a favorable diagnosis. 3. with other methods of substance use detection (eg, laboratory testing). (36,37) Lastly, not all of the religiousness/spirituality scales used in this study, notably those from the BMMRS, have been previously validated in adolescents. However, we have demonstrated in a separate report from this dataset that these measures generally have adequate internal consistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. , test-retest reliability test-retest reliability Psychology A measure of the ability of a psychologic testing instrument to yield the same result for a single Pt at 2 different test periods, which are closely spaced so that any variation detected reflects reliability of the instrument , and good discriminant validity Discriminant validity describes the degree to which the operationalization is not similar to (diverges from) other operationalizations that it theoretically should not be similar to. . (Harris SK, personal communication). In summary, this study suggests that forgiveness is an important correlate of adolescent substance use, and this may have implications for both prevention and treatment programs targeting youth. 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The impact of personality and religion on attitude towards substance use among 13-15 year olds. Drug Alcohol Depend 1997;44:95-103. 16. Bahr SJ, Hawks RD, Wang G. Family and religious influences on adolescent substance abuse. Youth and Society 1993;24:443-465. 17. Potvin RH, Lee CF. Multistage mul·ti·stage adj. 1. Functioning in more than one stage: a multistage design project. 2. Relating to or composed of two or more propulsion units. path models of adolescent alcohol and drug use: age variations J Stud Alcohol 1980;41:531-542. 18. Nonnemaker JM, McNeely CA, Blum RW. Public and private domains of religiosity and adolescent health risk behaviors: evidence from the National Longitudinal Study of Adolescent Health The National Longitudinal Study of Adolescent Health (also called Add Health) is the first and only nationally-representative study of adolescent sexuality, which has spawned over one thousand peer-reviewed publications on many issues related to adolescent health and . Soc Sci Med 2003;57:2049-2054. 19. Fetzer Institute. Multidimensional Meaurement of Religiousness, Spirituality for Use in Health Research. A Report of a National Working. Kalamazoo, MI: Fetzer Institute, 1999. 20. Sobell L, Sobell M. Alcohol Timeline Followback User's Manual. Toronto: Addiction Research Foundation; 1995. 21. Holder DW, DuRant RH, Harris TL, et al. The association between adolescent spirituality and voluntary sexual activity. J Adolesc Health 2000;26:295-302. 22. Mickey RM, Greeland S. The impact of confounder con·found tr.v. con·found·ed, con·found·ing, con·founds 1. To cause to become confused or perplexed. See Synonyms at puzzle. 2. selection criteria on effect estimation. Am J Epidemiol 1989;129:125-137. 23. van Oyen Witvliet C, Ludwig TE, Vander Laan KL. Granting forgiveness or harboring grudges: implications for emotion, physiology, and health. Psychol Sci 2001;12:117-123. 24. Gisi TM, D'Amato RC. What factors should be considered in rehabilitation: are anger, social desirability, and forgiveness related in adults with traumatic brain injuries? Int J Neurosci 2000;105:121-133. 25. Mickley JR, Cowles K. Ameliorating a·mel·io·rate tr. & intr.v. a·me·lio·rat·ed, a·me·lio·rat·ing, a·me·lio·rates To make or become better; improve. See Synonyms at improve. [Alteration of meliorate. the tension: use of forgiveness for healing. Oncol Nurs Forum 2001;28:31-37. 26. Romero C, Friedman LC, Kalidas M, et al. Self-forgiveness, spirituality, and psychological adjustment in women with breast cancer. J Behav Med 2006;29:29-36. 27. Carson JW, Keefe FJ, Goli V, et al. Forgiveness and chronic low back pain: a preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress psychological distress The end result of factors–eg, psychogenic pain, internal conflicts, and external stress that prevent a person from self-actualization and connecting with 'significant others'. See Humanistic psychology. . J Pain 2005;6:84-91. 28. Witvliet CV, Phipps KA, Feldman ME, et al. Posttraumatic posttraumatic /posttrau·mat·ic/ (post?traw-mat´ik) occurring as a result of or after injury. post·trau·mat·ic adj. Following or resulting from injury or trauma. mental and physical health correlates of forgiveness and religious coping in military veterans. J Trauma Stress 2004;17:269-273. 29. Lin WF, Mack D, Enright RD, et al. Effects of forgiveness therapy on anger, mood, and vulnerability to substance use among inpatient inpatient /in·pa·tient/ (in´pa-shent) a patient who comes to a hospital or other health care facility for diagnosis or treatment that requires an overnight stay. in·pa·tient n. substance-dependent clients. J Consult Clin Psychol 2004;72:1114-1121. 30. Lawler KA, Younger JW, Piferi RL, et al. A change of heart: cardiovascular correlates of forgiveness in response to interpersonal conflict. J Behav Med 2003;26:373-393. 31. Lawler KA, Younger JW, Piferi RL, et al. The unique effects of forgiveness on health: an exploration of pathways. J Behav Med 2005;28:157-167. 32. Adlaf EM, Smart RG. Drug use and religious affiliation, feelings, and behavior. Br J Addict Any individual who habitually uses any narcotic drug so as to endanger the public morals, health, safety, or welfare, or who is so drawn to the use of such narcotic drugs as to have lost the power of self-control with reference to his or her drug use. 1985;80:163-171. 33. Hadaway CK, Elifson KW, Peterson DM. Religious involvement and drug use among urban adolescents. J Scientific Study of Religion 1984;23:109-128. 34. Pargament KI, Koenig HG, Tarakeshwar N, et al. Religious coping methods as predictors of psychological, physical and spiritual outcomes among medically ill elderly patients: a two-year longitudinal study longitudinal study a chronological study in epidemiology which attempts to establish a relationship between an antecedent cause and a subsequent effect. See also cohort study. . J Health Psychol 2004;9:713-730. 35. Pargament KI, Koenig HG, Perez LM. The many methods of religious coping: development and initial validation of the RCOPE. J Clin Psychol 2000;56:519-543. 36. Babor TF, Kranzler HR, Lauerman RJ. Early detection of harmful alcohol consumption: comparison of clinical, laboratory, and self-report screening procedures. Addict Behav 1989;14:139-157. 37. Winters KC, Stinchfield RD, Henly GA, et al. Validity of adolescent self-report of alcohol and other drug involvement. Int J Addict 1990;25:1379-1395. John R. Knight, MD, Lon Sherritt, MPH, Sion Kim Harris, PhD, David W. Holder, MD, MPH, John Kulig, MD, MPH, Lydia A. Shrier, MD, MPH, Joy Gabrielli, BA, and Grace Chang, MD, MPH From the Department of Pediatrics and the Division on Addictions at Cambridge Health Alliance Cambridge Health Alliance (CHA) is a health system in Cambridge, Somerville, and Boston, Massachusetts's metro-north communities. It includes three hospital campuses, more than 20 primary care and specialty practices, the Cambridge Public Health Department, and the Network Health , Harvard Medical School Harvard Medical School (HMS) is one of the graduate schools of Harvard University. It is a prestigious American medical school located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts. , Boston, MA; the Center for Adolescent Substance Abuse Research, Children's Hospital A children's hospital is a hospital which offers its services exclusively to children. The number of children's hospitals proliferated in the 20th century, as pediatric medical and surgical specialties separated from internal medicine and adult surgical specialties. , Boston, MA; the Division of General Pediatrics and the Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, MA; the Department of Pediatrics, Tufts University School of Medicine The Tufts University School of Medicine is one of the eight schools that comprise Tufts University. Located on the university's health sciences campus in the Chinatown district of Boston, Massachusetts, the medical school has clinical affiliations with thousands of doctors and , Boston, MA; the Division of General Pediatrics and Adolescent Medicine adolescent medicine n. The branch of medicine concerned with the treatment of youth between 13 and 21 years of age. Also called ephebiatrics, hebiatrics. , Floating Hospital for Children at Tufts-New England Medical Center Tufts-New England Medical Center (Tufts-NEMC) is a medical institution in Boston, Massachusetts. It is a center for research and is the principal teaching hospital for Tufts University School of Medicine where all full-time Tufts-NEMC physicians hold faculty appointments. , Boston, MA; the Department of Psychiatry, Brigham and Women's Hospital Brigham and Women's Hospital (BWH) is a hospital in the Longwood Area of the Boston, Massachusetts neighborhood of Mission Hill. With Massachusetts General Hospital, it is one of the two founding members of Partners HealthCare. , Boston, MA; and the Department of Psychiatry, Harvard Medical School, Boston, MA. Reprint reprint An individually bound copy of an article in a journal or science communication requests to Dr. John R. Knight, Center for Adolescent Substance Abuse Research, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115. Email: john.knight@childrens.harvard.edu This study was supported by grant R21 AA13029 from the National Institute on Alcohol Abuse and Alcoholism The National Institute on Alcohol Abuse and Alcoholism (NIAAA), as part of the U.S. National Institutes of Health, supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. and The Fetzer Institute. Other support provided by grant K07 AA013280 (JRK JRK Jugendrotkreuz (German: Youth Red Cross) JRK Jerky, Mouse ) and grant K24 AA00289 (GC) from the National Institute on Alcohol Abuse and Alcoholism, grants 5T20MC000-11-06 (JRK) and 5T71MC 00009-10 (SKH SKH Stichting Keuringsbureau Hout (Dutch) SKH Session Key Header ) from the Maternal and Child Health Bureau, and by an unrestricted gift from the Novotny/Swahnberg Fund at the Boston Foundation. The study protocol was approved by the Committee on Clinical Investigations at Children's Hospital Boston, and the Human Investigations Review Committee of Tufts, New England Medical Center. Accepted December 1, 2006. RELATED ARTICLE: Key Points * Multivariable analysis found that forgiveness was the only significant correlate of alcohol use. * The association was in the negative direction (high forgiveness: lower risk of alcohol use).
Table 1. Demographic characteristics of total sample and participants
reporting past-90-day alcohol use (n = 103/305)
Past-90-day
Total sample alcohol use
(n = 305) (n = 103)
n % n % P
Gender
Female 203 66.6 67 33.0 0.81
Male 102 33.4 36 35.0
Median age (16.0 years)
Older 153 50.2 77 50.7 0.05
Younger 152 49.8 26 17.0
Race/ethnicity
Asian non-Hispanic 45 7.2 5 22.7 0.02
Black non-Hispanic 103 33.8 31 30.1
Hispanic 123 40.3 38 30.9
White non-Hispanic 22 14.8 26 57.8
Other non-Hispanic 3 3.9 3 25.0
Parents in household
Two parent household 138 45.2 47 33.5
<Two parent household 167 54.8 56 34.1 0.93
Highest parent education level
(3 cats.)
<High school grad 41 14.4 15 36.6 0.19
High school grad 125 44.0 36 28.8
College grad 118 41.5 47 39.8
Congregation attendance (past year)
Yes 239 79.7 80 34 0.58
No 61 20.3 22 36
Religious preference
None/atheist 30 11.4 16 53.3 0.09
Don't know/confused 23 8.7 5 21.7
Christian 177 67.0 55 31.1
Other 34 12.9 16 47.1
Site
CHB adolescent clinic (a) 193 63.3 70 36.3 0.08
MEHC adolescent clinic (b) 50 16.4 13 26.0
Tufts-NEMC adolescent clinic (c) 62 20.3 20 32.3
(a) Children's Hospital Boston, Boston, MA; (b) Martha Eliot Health
Center, Boston, MA; (c) Tufts-New England Medical Center, Boston, MA.
Table 2. Association of religious/spirituality scales and past-90-day
alcohol use controlling for age, race/ethnicity, and clinic site
Odds ratio
Measure Items n (95% CI) P
All responders
Forgiveness 3 295 0.55 (0.42, 0.73) 0.01
Religious/spiritual 5 296 0.67 (0.51, 0.84) 0.02
coping -- positive
Daily spiritual 15 293 0.67 (0.54, 0.84) 0.02
experiences
Belief 1 302 0.76 (0.68, 0.83) 0.01
Commitment 1 299 0.81 (0.36, 1.79) 0.36
Organizational 2 296 0.83 (0.64, 1.07) 0.08
religiousness
Private religious 5 295 0.94 (0.80, 1.10) 0.22
practices
Religious/spiritual 5 295 1.07 (0.91, 1.23) 0.18
coping -- negative
Past-year congregants (a)
Spiritual connectedness 15 212 0.60 (0.41, 0.88) 0.03
Religious support -- 3 231 0.68 (0.39, 1.18) 0.10
anticipated
Religious support -- 3 229 0.70 (0.39, 1.29) 0.13
negative interaction
Religious support -- 3 228 0.77 (0.55, 1.10) 0.09
emotional given
Religious support -- 3 233 0.78 (0.56, 1.07) 0.07
emotional received
Religious commitment 2 194 0.76 (0.44, 1.30) 0.16
(a) N = 239 who reported attending a religious congregation at least
once during the past year.
Table 3. Religious/spirituality variables remaining in multivariable
logistic regression model, (a) and individual items in each scale
separately
Model (all) Odds ratio
n = 295 (95% CI) P
Forgiveness 0.55 (0.41, 0.76) 0.01
I have forgiven myself 0.57 (0.40, 0.82) 0.02
I have forgiven others 0.67 (0.67, 0.98) 0.04
God forgives me 0.59 (0.40, 0.91) 0.03
Model (past-year congregants)
n = 234 Odds ratio (95% CI) P
Forgiveness 0.51 (0.30, 0.87) 0.03
I have forgiven myself 0.60 (0.30, 1.20) 0.09
I have forgiven others 0.77 (0.45, 1.33) 0.18
God forgives me 0.44 (0.23, 0.85) 0.03
(a) Using backwards selection, with change in maximum likelihood
criteria (P > 0.20 enter/exit).
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