Journal of Youth and Adolescence

, Volume 47, Issue 4, pp 818–828 | Cite as

The Moderating Role of Spirituality in the Association between Stress and Substance Use among Adolescents: Differences by Gender

  • Katrina J. Debnam
  • Adam J. Milam
  • Morgan M. Mullen
  • Krim Lacey
  • Catherine P. Bradshaw
Empirical Research


Adolescents are exposed to various stressors that may increase the risk for substance use. Due to the detrimental, and potentially long-lasting, effects related to substance use, it is necessary to explore more optimal coping strategies. This study explored the association between substance use and stress among male and female high school students in relation to spirituality as a moderator. To examine these relationships, the study used cross-sectional data collected from 27,874 high school students (Male = 50.7%, Female = 49.3%) across 58 high schools in Maryland that included an ethnically diverse sample (49% Caucasian, 30% African American) with an average age of 16 years old. Bivariate results showed differences in substance use, stress, and spirituality between male and female students. Higher rates of substance use were generally found among male students compared to female students; rates tended to be higher among female students for stress and spirituality compared to their male counterparts. Multilevel analyses indicated a positive association between stress and substance use among male and female students after adjusting for demographic and school-level factors. Both male and female students who reported turning to spiritual beliefs when experiencing problems were less likely to use substances. However, the interaction between stress and spirituality was significant for males only. These findings suggest that stress may increase the propensity for substance use and that spirituality might be a viable coping mechanism useful for helping high school students adapt to stressful circumstances and situations.


Adolescents Substance use Stress Spirituality Gender 



Support for this study came from the Centers for Disease Control and Prevention (1U49CE000728 & 5U01CE001954-05), the U.S. Department of Education’s Safe and Supportive Schools Initiative, the William T. Grant Foundation, and the National Institute of Justice. We thank the Maryland State Department of Education and Sheppard Pratt Health System for their continued support of this research through the Maryland Safe and Supportive Schools Project.

Author Contributions

K.D. developed the study, contributed to the study design and analysis, and assisted in drafting the manuscript; A.M. assisted in the study design and analyses, and helped draft the manuscript; M.M. performed literature reviews and helped draft the manuscript; K.L. helped with the study analyses and assisted in drafting the manuscript; C.B. is the principal investigator on the larger study and reviewed drafts of the manuscript and analyses. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Ethical Approval

All procedures performed in the current study were in accordance with the ethical standards of the Institutional Review Boards at the Johns Hopkins Bloomberg School of Public Health and University of Virginia, and are consistent with the 1964 Helsinki declaration in order to ensure proper treatment, safety, and confidentiality of all participants.

Informed Consent

Passive consent was obtained from parents of students who participated in the study.


  1. Anderson, K. G., Ramo, D. E., & Brown, S. A. (2006). Life stress, coping, and comorbid youth: An examination of the stress-vulnerability model for substance relapse. Journal of Psychoactive Drugs, 38(3), 255–262.CrossRefPubMedGoogle Scholar
  2. Bradshaw, C. P., Waasdorp, T. E., Debnam, K. J., & Lindstrom Johnson, S. (2014). Measuring school climate in high schools: A focus on safety, engagement, and the environment. Journal of School Health, 84(9), 593–604.CrossRefPubMedGoogle Scholar
  3. Brook, J. S., Lee, J. Y., Finch, S. J., Seltzer, N., & Brook, D. W. (2013). Adult work commitment, financial stability, and social environment as related to trajectories of marijuana use beginning in adolescence. Substance Abuse, 34(3), 298–305.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Brown, S. A., Vik, P. W., Patterson, T. L., Grant, I., & Schuckit, M. A. (1995). Stress, vulnerability and adult alcohol relapse. Journal of Studies on Alcohol and Drugs, 56(5), 538.CrossRefGoogle Scholar
  5. Carmody, J., Reed, G., Kristeller, J., & Merriam, P. (2008). Mindfulness, spirituality, and health-related symptoms. Journal of Psyhosomatic Research, 64, 393–403.CrossRefGoogle Scholar
  6. Centers for Disease Control and Prevention. (2014). Youth risk behavior surveillance – United States 2013. Morbidity and Mortality Weekly Report, 63(4), 1–168.Google Scholar
  7. Charles, N. E., Mathias, C. W., Acheson, A., Bray, B. C., Ryan, S. R., Lake, S. L., & Dougherty, D. M. (2015). Increased pre-and early-adolescent stress in youth with a family history of substance use disorder and early substance use initiation. Journal of Youth and Adolescence, 44, 1–14.CrossRefGoogle Scholar
  8. Charles, N. E., Mathias, C. W., Acheson, A., & Dougherty, D. M. (2017). Preadolescent sensation seekin gand early adolescent stress relate to at-risk adolescents’ substance use by age 15. Addictive Behaviors, 69, 1–7.CrossRefPubMedGoogle Scholar
  9. Cohen, S., Kessler, R. C., & Gordon, L. U. (1995). Strategies for measuring stress in studies of psychiatric and physical disorders. Measuring Stress: A Guide for Health and Social Scientists, 1995, 3–26.Google Scholar
  10. Coley, R. L., Sims, J., & Carrano, J. (2017). Environmental risks outweigh dopaminergic genetic risks for alcohol use and abuse from adolescnes through early adulthood. Durg and Alcohol Dependence, 175, 106–118.CrossRefGoogle Scholar
  11. Cotton, S., Larkin, E., Hoopes, A., Cromer, B. A., & Rosenthal, S. L. (2005). The impact of adolescent spirituality on depressive symptoms and health risk behaviors. Journal of Adolescent Health, 36, 529.e7–529.e14.Google Scholar
  12. Cotton, S., McGrady, M. E., & Rosenthal, S. L. (2010). Measurement of religiosity/spirituality in adolescent health outcomes research: Trends in recommendations. Journal of Religion and Health, 49(4), 414–444.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Debnam, K., Holt, Cheryl, L., Clark, E. M., Roth, D., Foushee, H. R., Crowther, M., Fouad, M., & Southward, P. L. (2012a). Spiritual health locus of control and health behaviors in a national sample of African Americans. American Journal of Health Behavior, 36, 360–372.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Debnam, K., Holt, Cheryl, L., Clark, E. M., Roth, D., & Southward, P. L. (2012b). Religious and general social support and health lifestyle behaviors in a national sample of African Americans. Journal of Behavioral Medicine, 35, 179–189.CrossRefPubMedGoogle Scholar
  15. Debnam, K. J., Milam, A., & Bradshaw, C. P. (2016). The role of stress and spirituality in adolescent substance use. Substance Use and Misuse, 51(6), 733–741. doi: 10.3109/10826084.2016.1155224.CrossRefPubMedGoogle Scholar
  16. Ellison, C. G., & Henderson, A. K. (2011). Religion and mental health: Through the lens of the stress process. In A. J. Blasi (Ed.), Toward a sociological theory of religion and health (pp. 11–44). Leiden, The Netherlands: Koninklijke Brill NV.Google Scholar
  17. Ellison, C. G., & McFarland, M. J. (2013). The social context of religion and spirituality in the United States. APA handbook of psychology, religion, and spirituality, 1, 21–50.Google Scholar
  18. Greeson, J. M., Smoski, M. J., Suarez, E. C., Brantley, J. G., Ekblad, A. G., Lynch, T. R., & Wolever, R. Q. (2015). Decreases symptoms of depression after mindfulness-based stress reduction: Potential moderating effects of religiosity, spirituality, trait mindfulness, sex, and age. The Journal of Alternative and Complementary Medicine, 21(3), 166–174.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Harris, K. M., Halpern, C. T., Whitsel, E., Hussey, J., Tabor, J., Entzel, P., & Udry, J. R. (2009). The national longitudinal study of adolescent to adult health: Study design. Eunice Kennedy Shriver National Institute of Child Health and Human Development & UNC Carolina Population Center.
  20. Hill, D., & Mrug, S. (2015). School-level correlates of adolescent tobacco, alcohol, and marijuana use. Substance Use & Misuse, 50(12), 1518–1528.CrossRefGoogle Scholar
  21. Holt, C. L., Roth, D. L., Huang, J., & Clark, E. M. (2015). Gender differences in the roles of religion and locus of control on alcohol use and smoking among African Americans. Journal of Studies on Alcohol and Drugs, 76, 482–492.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Horton, G. E., Luna, N. (2016). Spirituality in the treatment of substance use disorders: Proposing the three-legged stool as a model for intervention. Journal of Religion & Spirituality in Social Work: Social Thought, 35(3), 179–199.CrossRefGoogle Scholar
  23. Horton, G. E., Luna, N., & Malloy, T. (2016). Associations between spirituality, meaning in life, and depressive disorders among a sample of individuals in treatment for substance-use disorders. Journal of Spirituality in Mental Health, 18(4), 283–299.CrossRefGoogle Scholar
  24. Kann, L., McManus, T., Harris, W. A., et al. (2015). Youth risk behavior surveillance United States, 2015. MMWR Surveill Summ 2016, 65(No. SS-6), 1–174. doi: Scholar
  25. Kitsantas, A., Ware, H. W., & Martinez-Arias, R. (2004). Students’ perceptions of school safety: Effects by community, school environment, and substance use variables. Journal of Early Adolescence, 24(4), 412–430.CrossRefGoogle Scholar
  26. Kovacs, E., Piko, B. F., & Fitzpatrick, K. M. (2011). Religiosity as a protective factor against substance use among hungarian high school students. Substance Use & Misuse, 46(10), 1346–1357.CrossRefGoogle Scholar
  27. Krok, D. (2015). Religiousness, spirituality, and coping with stress among late adolescents: A meaning-making perspective. Journal of Adolescence, 45, 196–203.CrossRefPubMedGoogle Scholar
  28. Lee, J. Y., Brook, J. S., Finch, S. J., & Brook, D. W. (2015). Trajectories of marijuana use from adolescence to adulthood predicting unemployment in the mid-thirties. American Journal on Addictions, 24(5), 452–459.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Marlatt, G. A., & Gordon, J. R. (1985). Relapse prevention: Maintenance strategies in addictive behavior change. New York: Guilford.Google Scholar
  30. McMahon, B. T., & Biggs, H. C. (2012). Examining spirituality and intrinsic religious orientations as a means of coping with exam anxiety. Vulnerable Groups & Inclusion, 3, 173–212.CrossRefGoogle Scholar
  31. McNeely, C. A., & Falci, C. (2004). School connectedness and the transition into and out of health risk behaviors among adolescents: A comparison of social belonging and teacher support. Journal of School Health, 74, 284–292.CrossRefPubMedGoogle Scholar
  32. Miller, W. R., & Thoresen, C. E. (2003). Spritiuality, religion, and health: An emerging research field. American Psychology, 58, 24.CrossRefGoogle Scholar
  33. Muthén, L. K. & Muthén, B. O. (2012). Mplus. The comprehensive modelling program for applied researchers: User’s guide, 5.Google Scholar
  34. Pargament, K., Koenig, H. G., Tarakeshwar, N., & Hahn, J. (2004). Religious coping methods as predictors of psychological, physical and spiritual outcomes among medically ill elderly patients: a two-year longitudinal study. Journal of Health Psychology, 9, 713–730.CrossRefPubMedGoogle Scholar
  35. Porche, M. V., Fortuna, L. R., Wachholtz, A., & Stone, R. T. (2015). Distal and proximal religiosity as protective factors for adolescent and emerging adult alcohol use. Religions, 6(2), 365–384.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Rhode, P., Lewinsohn, P. M., Seeley, J. R., Klein, D. N., Andrew, J. A., & Small, J. W. (2007). Psychological functioning of adults who experienced substance use disorders as adolescents. Psychology of Addictive Behaviors, 21(2), 155.CrossRefGoogle Scholar
  37. Ritt-Olson, A., Milam, J., Unger, J. B., Trinidad, D., Teran, L., Dent, C. W., & Sussman, S. (2004). The protectice influence of spirituality and “Health-as-a-Value” against monthly substance use among adolescents varying in risk. Journal of Adolescent Health, 34, 192–199.CrossRefPubMedGoogle Scholar
  38. Rostosky, S. S., Wilcox, B. L., Wright, M. L. C., & Randall, B. A. (2004). The impact of religiosity on adolescent sexual behavior: A review of the evidence. Journal of Adolescent Research, 19(6), 677–697.CrossRefGoogle Scholar
  39. Scheer, S. D., Borden, L. M., & Donnermeyer, J. F. (2000). The relationship between family factors and adolescent substance use in rural, suburban, and urban settings. Journal of Child and Family Studies, 9(1), 105–115.CrossRefGoogle Scholar
  40. Sebena, R., Ansari, W. E., Stock, C., Orosova, O., & Mikolajczyk, R. T. (2012). Are perceived stress, depressive symptoms, and religiosity associated with alcohol consumption? A survey of freshmen university students across five European countries. Substance Abuse Treatment, Prevention, and Policy, 7(21), 1–10.Google Scholar
  41. Sibinga, E. M. S., Perry-Parish, C., Thorpe, K., Mika, M., & Ellen, J. M. (2014). A small mixed-method RCT of mindfulness instruction for urban youth. Explore: The Journal of Science and Healing, 10, 180–186.CrossRefGoogle Scholar
  42. Sinha, J. W., Cnaan, R. A., & Gelles, R. W. (2007). Adolescent risk behaviors and religion: Findings from a national study. Journal of Adolescence, 30(2), 231–249.CrossRefPubMedGoogle Scholar
  43. Stata Corp, LP (2013). Stata Statistical Software: Release 13 (Software).Google Scholar
  44. Substance Abuse and Mental Health Services Administration (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. US Department of Health and Human Services Publication, 414–483.Google Scholar
  45. Thoresen, C. E. (1998). Spirituality, health and science. In S. Roth-Roemer, S. R. Kurpius, C. Carmin (Eds.), The emerging role of counseling psychology in health care (pp. 490–531). New York, NY: Norton.Google Scholar
  46. Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370(23), 2219–2227.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Williams, K., & McGillicuddy-De Lisi, A. (1999). Coping strategies in adolescents. Journal of Applied Developmental Psychology, 10(4), 537–549.CrossRefGoogle Scholar
  48. Yadav, R., Khanna, A., & Singh, D. (2017). Exploration of relationship between stress and spirituality characteristics of male and female engineering students: A comprehensive study. Journal of Religion and Health, 56, 388–399.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Katrina J. Debnam
    • 1
  • Adam J. Milam
    • 2
    • 3
  • Morgan M. Mullen
    • 4
  • Krim Lacey
    • 2
  • Catherine P. Bradshaw
    • 1
    • 4
  1. 1.University of VirginiaCharlottesvilleUSA
  2. 2.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of Anesthesiology, Cedars-Sinai Medical CenterLos AngelesUSA
  4. 4.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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