ARTICLE IN PRESS

Social Science & Medicine 57 (2003) 2049–2054

Public and private domains of religiosity and adolescent health risk behaviors: evidence from the National Longitudinal Study of Adolescent Health
James M. Nonnemakera,*, Clea A. McNeelyb, Robert Wm. Blumb
a

Research Triangle Institute International, Health, Social, and Economic Research, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 22709-2194, USA b Division of General Pediatrics and Adolescent Health, University of Minnesota, USA

Abstract The purpose of this study was to examine the association of public and private domains of religiosity and adolescent health-related outcomes using data from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of American adolescents in grades 7–12. The public religiosity variable combines two items measuring frequency of attendance at religious services and frequency of participation in religious youth group activities. The private religiosity variable combines two items measuring frequency of prayer and importance of religion. Our results support previous evidence that religiosity is protective for a number of adolescent health-related outcomes. In general, both public and private religiosity was protective against cigarettes, alcohol, and marijuana use. On closer examination it appeared that private religiosity was more protective against experimental substance use, while public religiosity had a larger association with regular use, and in particular with regular cigarette use. Both public and private religiosity was associated with a lower probability of having ever had sexual intercourse. Only public religiosity had a significant effect on effective birth control at first sexual intercourse and, for females, for having ever been pregnant. However, neither dimension of religiosity was associated with birth control use at first or most recent sex. Public religiosity was associated with lower emotional distress while private religiosity was not. Only private religiosity was significantly associated with a lower probability of having had suicidal thoughts or having attempted suicide. Both public and private religiosity was associated with a lower probability of having engaged in violence in the last year. Our results suggest that further work is warranted to explore the causal mechanisms by which religiosity is protective for adolescents. Needed is both theoretical work that identifies mechanisms that could explain the different patterns of empirical results and surveys that collect data specific to the hypothesized mechanisms. r 2003 Elsevier Science Ltd. All rights reserved.
Keywords: USA; Religiosity; Adolescents; Risk behaviors; Substance use; Sexual behavior

Introduction In recent years there has been growing interest in the role religion may play in reducing harm (e.g., Resnick et al., 1997) and contributing to the resilience of young people (e.g., Werner & Smith, 1992). Evidence from
*Corresponding author. Tel.: +1-919-541-7064; fax. +1919-541-6683. E-mail address: jnonnemaker@rti.org (J.M. Nonnemaker).

national survey data for the United States also has consistently indicated that religion is important to American adolescents (Bridges & Moore, 2002; Donahue & Benson, 1995; Johnston, Bachman, & O’Malley, 1999; Regnerus, 2003). Recently, faith-based initiatives for addressing adolescent issues have received greater attention because of the Bush administration’s policy to fund interventions for adolescents through faith-based communities (Bridges & Moore, 2002; Glazer, 2001; Miller & Gur, 2002).

0277-9536/03/$ - see front matter r 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0277-9536(03)00096-0

including responsible and planned birth control use. 1997. 2000). Davies. To the extent that public and private religiosity varies for adolescents by religious affiliation. see Wilcox. Albrecht. For the present analysis we used data from the Wave 1 in-home sample with sampling weights (n ¼ 18. public and private religiosity. Brick. Miller et al. though available evidence would suggest that religiosity is protective (Wallace & Forman. That is. 1993. & Berry. Then. Note that we do control for different levels of the outcomes by affiliation. (1999) discuss this issue in more detail. omitting an interaction between religious affiliation and our religiosity variables or not stratifying by religious affiliation is a limitation of this study. Given the categorization of affiliations in our data it is likely that there is significant heterogeneity within religious affiliations that would complicate any interpretation of results by affiliation. 924). 2000. whether respondent is 2 years younger than the average age in their grade. & Guilkey. and various measures of adolescent health and health risk behaviors. A few studies have found that religiosity is related to lower levels of suicidal thoughts or attempts (Donahue & Benson. & Greenwald. ethnicity (black. whether respondent appears older or younger than his or her peers.. 2000). Nonnemaker et al. Wallace & Forman. & Miller. and other race/ ethnicity). & Wright.. we used OLS and logistic regression. Methods Data and measures Data for this study were drawn from the National Longitudinal Study of Adolescent Health (Add Health). 1996). & Udry. 1 We do not consider differences in the effects of our public and private religiosity variables on outcomes by religious affiliation mostly because of concerns over the poor measurement of religious affiliation in our data. 1998). & Farrelly. Pierce. McCullough. controlling for age. Gilpin. The substance use categorizations and modeling strategies are motivated by models of the smoking uptake process (Choi. it might also be associated with less contraceptive use (Cooksey. 1989. 1996. We also statistically tested for the difference between the public and private religiosity coefficients within each model using a Wald test adjusted for sample design. 1996. Analytic strategy To examine the relationship between public and private religiosity and the health-related outcomes. Miller et al. Farkas. marijuana use (Amey et al. Leventhal & Cleary. Wallace Jr. Higher levels of religiosity have been associated with lower levels of cigarette use (Amey. Cochran & Akers. a nationally representative sample of American adolescents in grades 7–12 (Bearman. gender. there is some evidence that while religiosity may delay the initiation of sexual intercourse (for a review. 1998). step family. / Social Science & Medicine 57 (2003) 2049–2054 Relationship of religiosity to adolescent health-related outcomes Religiosity has been found to be protective against participation in adolescent health risk behaviors. 1980. For marijuana use. The purpose of this paper is to explore the relationship between two dimensions of religiosity.g. Cochran & Akers. an indicator of personal conservatism was associated with unprotected sex. Table 1 presents descriptions of the religiosity variables and the health-related outcomes as well as the descriptive statistics for these variables. 1996. 2001. Randall.ARTICLE IN PRESS 2050 J. we estimated the effect of religiosity on the probability of any use and then the effect on problem use conditional on any use. 1989. Regarding sexual behavior. and other family structure). 2000). the variation within religious denomination could be greater than the variation between religious denominations on characteristics of the denomination that are related to outcomes (e. 1996. Latino.. for a summary). The sample size is therefore 16. 1998). race. Conversely. Zhang & Jin. 1997).0 using weights and adjusting for the complex sample design. An additional 358 respondents who did not answer the religiosity questions were excluded. Evidence of the relationship between religiosity and violence is sparse. family structure (single-parent biological family. 1995. 1998). 1996).M.306. alcohol use (Amey et al. whether respondent is 2 years older than the average age in their grade. we examined the effect of religiosity on the probability of regular or problem use compared to experimental or occasional use. Wallace & Forman. household size. and illicit drug use (Amey et al. were associated with greater sexual responsibility. A number of studies have also documented an association between greater religious involvement and lower levels of depression (see Koenig. personal devotion and frequent religious service attendance. the proscriptiveness of denomination regarding specific behaviors). and religious denomination. modified PPVT score. & Forman. . Flay. 2000. Matthews et al.. Mowery. we modeled the effect of religiosity on the probability that an adolescent is an experimental or occasional substance user compared to being a non-user. Rindfuss. Rostosky.. household income. Miller and Gur (2002) found that two indicators of religiosity. For cigarette and alcohol use. Miller. & Larson.1 Analyses were done in Stata 6. Jones. Those adolescents who reported no religious affiliation (n ¼ 2260) were excluded from the analysis because they were not asked to answer the religiosity questions.

197 16.614 0.146 0.M. lonely.26 0.13 0.28 0. moody. very high on alcohol’’ 2–3 days a month or more Marijuana use in past 30 days Any Regular (used more than 3 times) Sexual behaviors Ever had sex Birth control at 1st intercourse viz condom.242 Our measurement strategy was based on the available items for measuring religiosity in Add Health.306 15. and other places of worship have special activities for teens—such as youth groups.174 6275 0.14 0. / Social Science & Medicine 57 (2003) 2049–2054 Table 1 Weighted descriptive statistics for health-related outcomes. sad.301 0. ‘‘Many churches.19 0 0 1 1 6275 3080 8.10 0 1 16.298 16. very high on alcohol’’ 1–2 days in past 12 months up to once a month or less (regular users excluded) Regular Got ‘‘drunk or very.59 3.06 0 0 1 1 16.061 0.36 0. Depo Provera.ARTICLE IN PRESS J. shot or stabbed someone.22 0 1 16.65 0. Private religiosity was the mean response to two questions: ‘‘How important is religion to you?’’ (responses range from very important (4) to not important at all (1)) and ‘‘How often do you pray?’’ (responses range from at least once a day (5) to never (1)). birth control pills. or choir.300 16. synagogues. fearful. b Mean of responses to 17 questions asking how often in the past week or year the adolescent felt depressed. Nonnemaker et al.09 6.01 0. How often did you attend such religious activities?’’ Responses range from once a week or more (4) to never (1). or diaphragm Birth control at most recent intercourse Ever pregnant (females only) Mental health Emotional distressb Suicide attempt Ever attempted suicide in the past 12 months Suicidal ideation Ever seriously thought about committing suicide in the past 12 months (among those who have not attempted suicide) Weapon-related violence in last 12 monthsc a 2051 Mean/ proportion 2.197 16. used a weapon in a fight.92 1 0 4 4 16.13 0 0 0 1 1 1 16.83 0 0 0 51 1 1 16.63 0 0 1 1 16. pulled a knife or gun on someone. National Longitudinal Study of Adolescent Health Measures Religiositya Public religiosity Private religiosity Health-related outcomes Cigarette use in last 30 days Any Experimental (smoked 1–19 days) Regular (smoked 20–30 days) Alcohol use in past 12 months Any Ever got ‘‘drunk or very. Bible classes. very high on alcohol’’ Occasional Got ‘‘drunk or very. had cried or had a poor appetite.65 0.146 14.04 0.16 SD Minimum Maximum Unweighted N 1. Public religiosity was the mean response to 2 questions about the past 12 months: ‘‘How often did you attend religious services?’’ and. Responses range from never or rarely (1) to most or all of the time (4) (a ¼ 0:87).576 0.20 0 0 1 1 16. . c In last year committed at least one of the following acts: threatened to use a weapon to get something from someone.197 0.061 16. or hurt someone badly enough to need bandages or medical care.

both public and private religiosity was equally protective. any alcohol use. Private but not public religiosity was associated with involvement in weapon-related violence in the last year. National Longitudinal Study of Adolescent Health (A) Cigarette use Public religiosity Private religiosity N (B) Alcohol use Public religiosity Private religiosity N Any use À0.e. Ã Ã Ãpo0:001: a Difference of religiosity coefficients. any cigarette use.23*** (0.11*a (0. whereas private religiosity had no significant effect.ARTICLE IN PRESS 2052 J.07) 0. po0:05: . or any marijuana use.08* (0. but private religiosity had no significant effect. public religiosity was associated with less use.05 (0.04) 8320 Experimental use Regular use À0. (C) Marijuana use Any use Public religiosity Private religiosity N À0. public religiosity having a significantly stronger relation.28***a (0.00 (0.27***a (0. Mental health and violence Table 4 presents the results for the association between public and private religiosity and the three mental health outcomes. Higher levels of public and private religiosity were associated with lower levels of any use and the coefficients for public and private religiosity were not statistically different. i.03) À0. but the difference was not significant. / Social Science & Medicine 57 (2003) 2049–2054 Results Substance use The results from the models examining the relationship between public and private religiosity and substance use outcomes are summarized in Table 2.06) 3681 Problem use À0.17 (0. conditional on being a user. However but the difference between coefficients was not significant. National Longitudinal Study of Adolescent Health Ever had sex Public religiosity Private religiosity N À0.04) 13022 Occasional use À0.04) 16.04) À0.14 (0. Neither public nor private religiosity was associated with birth control use at most recent intercourse. Higher values of public religiosity are associated with lower levels of emotional distress. public religiosity was protective for having ever been pregnant. Among females.03 (0. Ã Ã po0:01.19*** (0.03 (0.15*** (0.04) 14. Private religiosity. both public and private religiosity Ãpo0:05. private religiosity was protective but public religiosity was not.03) À0.05) 5753 Effective birth control at last sex À0.06) 4105 Problem use À0.06 (0. When we examined regular substance use.06) À0.04) 14. Sexual behaviors Table 3 shows that both public and private religiosity were significantly associated with lower levels of ever having had sex.24*** (0. though the coefficients were not statistically significant.05) 5753 Ever pregnant (females only) À0.07 (0.643 Discussion The purpose of this study was to examine the association of religiosity and adolescent health-related outcomes. Only public religiosity had a significant effect on effective birth control use at first sexual intercourse.07) À0.15** (0.07 (0.07) 1970 alcohol.08) 2860 Ãpo0:05. In general.04) 6868 À0.163 Effective birth control at first sex À0.719 Any use À0. was significantly associated with the suicidal ideation and suicide attempt variables.19*** (0.06) À0..M.01 (0. Ã Ã Ãpo0:001: a Difference of religiosity coefficients po0:05: Table 3 Weighted logit coefficients (SE) for the effect of public and private religiosity on sexual behaviors.11* (0. For experimental use (compared to no use) of cigarettes and Table 2 Weighted logit coefficients (SE) for the effect of public and private religiosity on substance use.04) À0.21*** (0.06 (0.04) À0. the difference was significant for regular cigarette use.04) À0. but not public religiosity. whereas private religiosity is not. Ã Ã po0:01.04) 0. When the outcome was defined as any use. Nonnemaker et al.04) À0.22**a (0.

07 (0. alcohol. perhaps because they do not want to disclose abortions. Ã Ã Ãpo0:001: a Difference of religiosity coefficients. Given this result. there are not consistent norms for contraception across religions. adolescents who frequently attend religious services or youth group activities could have sex less frequently.03) 14.08 14. 1983). This may be due to less than truthful responses from those who are highly religious. Wallace & Forman. But for other outcomes only one of the two dimensions of religiosity had a significant protective effect. Chapters 8 and 15. & Rushing. and current theories of social control and social learning.26**a (0. specifically.. but not private. in contrast. private religiosity was not. (1996) found that birth control use varies by denomination. / Social Science & Medicine 57 (2003) 2049–2054 Table 4 Weighted coefficients (SE) for the effect of public and private religiosity on mental health and weapon-related violence Mental Health Emotional distress (OLS coefficients) Public religiosity Private religiosity R2 N À0. This is consistent with prior research (Wilcox et al. While public religiosity increases opportunities for social support. . On closer examination it appears that private religiosity is more protective against initiating substance use (assuming that the probability of being in the experimental category is related to initiation).08) 14. Alternatively. Ã Ã po0:01.08) À0.06 (0.08) À0. Public religiosity and to a lesser extent private religiosity were associated with a lower probability of having ever had sex. it is somewhat surprising that public religiosity appears to be protective against pregnancy.809 Weapon-related violence Weapon-related violence in last year (logit coefficients) À0. religiosity is also associated with a lower probability of ever having been pregnant. somewhat surprisingly. A third explanation that cannot be ruled out by the cross-sectional analysis presented here is that adolescents attend religious services or youth groups more frequently after becoming pregnant.262 Suicide attempt (logit coefficients) À0. 1989. whereas public religiosity has a larger association with regular use. that it is better to delay first sexual intercourse. public religiosity was not protective but private religiosity was (see Koenig et al. Whereas most religious denominations have consistent values about sex. our results support previous evidence that religiosity is protective for a number of adolescent health risk behaviors and outcomes.04) 14. and marijuana. po0:05: is protective against any use of cigarettes. perhaps reflecting the lack of a consistent norm. Private religiosity was modestly associated with use of an effective birth control method at first sexual intercourse.26** (0.12) 0.ARTICLE IN PRESS J. 1998. Cochran & Akers..12** (0.03) À0. We found evidence for independent effects for both public and private religiosity for some health-related outcomes. Similarly. The different pattern of results for public and private religiosity on experimental and regular smoking outcomes suggests the need for more work. We found that public religiosity was associated with lower emotional distress but. but once the decision is made to have sex there is little association with birth control use. Nonnemaker et al. we found that both public and private religiosity were protective for violence.801 2053 *po0:05. but neither religiosity variable was associated with effective birth control at most recent sex. These results are consistent with the general consensus in the literature that higher levels of religiosity are associated with lower levels of substance use (Amey et al. 2000).M. Stark.14** (0.12 (0.08 (0. For suicidal ideation and suicide attempts. conditional on having had sex. to understand this process. private religiosity may increase selfesteem or a sense of self-efficacy. the cross-sectional design limits our ability to make any causal conclusions. Without a clear theoretical model that makes testable empirical predictions it is impossible to suggest specific causal mechanisms. Acknowledgements This study was supported by a grant (No. Public. Frequency of sexual intercourse was not measured in Add Health. Thus. Cooksey et al. it would appear that religiosity has a protective effect on the probability an adolescent has had sex. Consistent with previous research (Wallace & Forman. 1996. 1998).805 Suicidal ideation (logit coefficients) À0. Miller et al. It is not surprising to find little relation between religiosity and birth control use.. as well as openness to social support. 2001.. 1999-00218) of the Charles Stuart Mott foundation. and in particular with regular cigarette use. In general. 2000). Doyle. both theoretical and empirical.04) À0.

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