The protective influence of spiritual--religious lifestyle profiles on tobacco use, alcohol use, and gambling.

Author:Hodge, David R.
Position:Report
 
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The costs associated with the use of addictive substances and practices underscore the need for research on protective factors that inhibit use. In this study, the protective influences of various spiritual-religious lifestyle profiles on tobacco smoking, alcohol use, and gambling frequency and expenditures are examined. Among the predominantly Hispanic sample used in the study (N = 249), cluster analysis produced three lifestyle profiles: neither spiritual nor religious, spiritual and religious, and spiritual but not religious. Of these three, the spiritual and religious lifestyle profile exhibited the strongest protective influence across all four dependent measures. Although the exploratory nature of the study precludes definitive recommendations, a number of tentative implications from the findings are drawn.

KEY WORDS: addiction; protective factors; religion; spirituality; substance use

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Addictive substances and practices are a major social problem (Frances, Miller, & Mack, 2005).The costs of tobacco (Single, 2003; Sloan, Ostermann, Conover, Taylor, & Picone, 2004) and alcohol use (Kinney, 2006; Simon, Patel, & Sleed, 2005) alone exceed $100 billion annually in health care outlays, law enforcement expenditures, and lost productivity. Although the costs of gambling are appreciably less, they still amount to $5 billion annually (Cunningham, 2005).

In addition to the economic costs, the intangible personal costs are also substantial. Although quantifying quality-of-life costs is difficult, they are just as real as monetary losses to those who experience them. The early onset of cancer, alcohol-related driving injuries, and excessive gambling losses--to cite some examples--typically cause substantial pain and suffering. Also, more subtle quality-of-fife losses exist. For instance, among a representative sample of noninstitutionalized adults, current smokers were more likely to report poor mental health and activity limitations than were nonsmokers (Mody & Smith, 2006).

To help alleviate this problem, attempts have been made to identify protective factors (Haight, 1998; Smith, 2006). Protective factors facilitate positive outcomes by buffering individuals from constructs that place them at risk to engage in addictive substances and practices (Fraser, Richman, & Galinsky, 1999; Little, Axford, & Morpeth, 2004; Ruffolo, Sarri, & Goodkind, 2004; Waller, Okamoto, Miles, & Hurdle, 2003). Hence, they decrease the likelihood that individuals will participate in harmful activities.

Religion is one of the protective factors identified as facilitating positive outcomes (Corcoran & Nichols-Casebot, 2004). At the turn of the century, nearly 100 studies indicated that religion inhibits substance use (Koenig, McCullough, & Larson, 2001). More recent work continues to confirm this relationship (Jessor, Costa, Krueger, & Turbin, 2006; Kogan, Luo, Murry, & Brody, 2005; Piko & Fitzpatrick, 2004; Wallace, Brown, Bachman, & Laveist, 2003). In other words, various measures of religion, such as attendance at religious services, are generally inversely related to the use of tobacco, alcohol, and other addictive substances.

SPIRITUAL--RELIGIOUS LIFESTYLE PROFILES

Traditionally, the terms spirituality and religion have been used interchangeably (Hill & Pargament, 2003). Recently, however, scholars have tended to differentiate them (Sahlein, 2002; Sheridan, 2004). More specifically, spirituality and religion are increasingly defined as distinct but overlapping constructs (Derezotes, 2006; Miller & Thoresen, 2003). Spirituality is commonly defined in individual, existential, or relational terms, typically incorporating some reference to the sacred or the transcendent (Hodge, 2005). Conversely, religion tends to be conceptualized in communal, organizational, or structural terms (Canda & Furman, 1999).

The distinct but overlapping conceptualization of religion and spirituality implicitly suggests the existence of a number of lifestyle profiles (Mallett, Rosenthal, Myers, Milburn, & Rotheram--Borus, 2004; Rice, 2002). Lifestyle profiles can be understood as shorthand for the way in which individuals order or structure their lives around a given set of variables (Zimmerman & Maton, 1992). Rather than living their lives in a completely random manner, people typically develop patterns of interactions that reflect personal preferences.

In the case of spirituality and religion, theory suggests that individuals tend to incorporate these variables into their lives in a manner that reflects relatively distinct profiles (Scott, 2001). Perhaps most obviously, those who are uninterested in spirituality and religion would have a lifestyle profile that might be called neither spiritual nor religious. Those individuals who express their spirituality in religious settings might be considered to have a spiritual and religious lifestyle profile. Some people, however, may be spiritual but eschew religion. Because spirituality represents an interior, subjective experience, it can be expressed within or outside religious settings. Those who tend to express their spirituality outside of religious settings would have a lifestyle profile that could be called spiritual but not religious.

Research on spirituality and religion as distinct but overlapping constructs is still in its infancy. As the National Institutes of Health Working Group on Spirituality, Religion and Health observed, almost all the empirical studies on health outcomes have used various measures of religion (Miller & Thoresen, 2003). Consequently, the working group has called for research that reflects this new theoretical perspective (Miller & Thoresen).

In response to this call, our study examines the protective influence of various data-driven spiritual--religious lifestyle profiles on tobacco smoking, alcohol use, and gambling frequency and expenditures. In recognition of the evolving understanding of spirituality and religion, some researchers have operationalized spirituality and religion as distinct constructs and explored their protective influence with various substances (Hodge, Cardenas, & Montoya, 2001; Ritt-Olson et al., 2004). Although these studies represent an important contribution to the academic knowledge base, exploring the protective influence of spiritual--religious lifestyle profiles may better approximate people's lived experience. Put simply, this approach may be more ecologically valid than more traditional approaches (for example, regression) because it more accurately captures the way people tend to live (Mallett et al., 2004; Zimmerman & Maton, 1992). In studies seeking to identify protective factors that inhibit the "real-life" use of addictive substances and practices, this seems like a particularly important consideration.

Although the development of explicit hypotheses is premature given the exploratory nature of the research, we did have three tentative expectations. First, in keeping with the theory discussed earlier, we expected spirituality and religion to emerge as distinct constructs with analysis yielding a number of data-driven spiritual--religious lifestyle profiles. Second, consistent with the extant research indicating that spirituality and religion inhibit substance use (Hodge et al., 2001; Koenig et al., 2001; RAtt-Olson et al., 2004), it seemed plausible that profiles featuring spirituality and religion in some combination (for example, spiritual and religious or spiritual but not religious) might exhibit a greater degree of protective influence relative to the neither spiritual nor religious profile. Third, among those profiles featuring spirituality and religion in some combination, we had no expectations regarding which profile, if any, might exhibit greater protective influence. Finally, we used a Hispanic-majority study sample in light of the fact that this population is both understudied (Hodge et al.; Hunt, 2001) and growing at a rapid pace (U.S. Census Bureau, 2000, 2004a).

METHOD

Participants

The sample consisted of 249 adults living in the Espanola, New Mexico, catchment area. Consistent with the underlying demographics of the Espanola area (U.S. Census Bureau, 2004b), the majority of the sample was Hispanic and Catholic (see Table 1). Most respondents had completed a high school education. Household income was relatively low, with close to 75% of the sample reporting income levels below $40,000.

Instruments

In addition to demographic variables, the survey instrument included two independent measures and four dependent measures. The two independent variables consisted of a measure of spirituality and a measure of religion. Spirituality was measured using the Index of Core Spiritual Experiences (INSPIRIT) scale developed by Kass, Friedman, Leserman, Zuttermeister, and Benson (1991). Consistent with the theoretical understanding of spirituality delineated earlier, this seven-item scale is designed to measure respondents' internal...

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