The Role of Religious Involvement in Black-White Differences in Alcohol Use Disorders

Objective: To date, a paradox in the social epidemiology of alcohol use disorders (AUDs) remains unresolved: non-Hispanic Blacks experience higher socioeconomic disadvantage, stressor exposures, and individual stress-prominent AUD risk factors, yet have lower than expected AUD risk compared with non-Hispanic Whites. Religious involvement is associated with lower AUD risk. Non-Hispanic Blacks are highly religiously involved. Together, those facts may account for Black-White differences in AUD risk.

Method: We used Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (N = 26,784) to examine whether (a) religious involvement accounts for Black-White differences in AUD risk, and (b) race moderates the association between religious involvement and AUD. Religious involvement indicators were service attendance, social interaction, and subjective religiosity and spirituality. Twelve-month AUD prevalence as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, was the outcome. Covariates were age, education, income, marital status, and U.S.-born versus foreign-born nativity.

Results: Blacks were significantly less likely than Whites to have an AUD (adjusted odds ratio [aOR] for men = 0.70, 95% CI [0.59, 0.83]; aOR for women = 0.71, 95% CI [0.57, 0.89]). An adjusted model with all three religious involvement indicators explained 17% of race differences among men (OR = 0.82) and 45% among women (OR = 1.03). There was no evidence that the association between religious involvement and AUD differed between Blacks and Whites.

Conclusions: Religious service attendance, subjective religiosity, and spirituality account for a meaningful share of the Black-White differences in AUD. Future research is needed to conduct more fine-grained analyses of the aspects of religious involvement that are potentially protective against AUD, ideally differentiating between social norms associated with religious involvement, social support offered by religious participation, and deeply personal aspects of spirituality.