Date of Award

6-26-2026

Date Published

August 2026

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Sociology

Advisor(s)

Shannon Monnat

Keywords

Adverse Childhood Experiences;Health Disparities;Life Course;Religion;Sexual Minority;Substance Use

Subject Categories

Social and Behavioral Sciences | Sociology

Abstract

Substance use is a leading cause of premature mortality in the United States, with overdose and alcohol-related deaths rising sharply in adulthood and midlife. Religiosity is among the most well-documented social factors associated with lower substance use, operating through community ties, behavioral norms, and meaning-making. Yet despite the life course nature of substance use, research has centered primarily on adolescence, relied on cross-sectional data, and typically employed single measures of religiosity. Consequently, it remains unclear whether religiosity functions similarly across its multiple dimensions or among populations exposed to heightened social disadvantage, including individuals with adverse childhood experiences (ACEs) and sexual minority adults. Using five waves of the National Longitudinal Study of Adolescent to Adult Health (1994–2025), I examine associations between substance use and religiosity from adolescence through midlife. I fit mixed-effects logistic and ordered logistic regression models with a Mundlak decomposition to estimate between- and within-person associations across five dimensions of religiosity: service attendance, organized religious activities, prayer frequency, religious importance, and religious affiliation. Outcomes include past-30-day illicit drug use, past-30-day marijuana use, and past-year alcohol use. Three patterns emerge. First, more religious individuals reported lower substance use across the life course and across all five dimensions of religiosity. Public dimensions (service attendance, organized religious activities) showed stronger associations than private dimensions (prayer, religious importance). Second, more ACE exposure predicted higher substance use, but religiosity did not dependably reduce this risk. For illicit drugs, religiosity was associated with lower use but did not alter the ACE–use association. For marijuana, public religiosity weakened the association between ACEs and use at the highest levels of involvement, while private religiosity reversed it: among the most adversity-exposed, frequent prayer and high religious importance were associated with greater marijuana use. For alcohol, more religious individuals with greater ACE exposure were less likely to abstain and more likely to drink heavily. Third, individuals who identified as sexual minorities reported substantially higher illicit drug, marijuana, and heavy alcohol use than their heterosexual peers. Religiosity conditioned these disparities in a dimension- and substance-specific way rather than identically. For marijuana, the disparity was significantly smaller at higher levels of public religiosity (service attendance, organized activities) and religious importance; for illicit drugs, it was smaller at higher service attendance. For alcohol, no dimension reliably narrowed the disparity. The clearest exception ran in the opposite direction: Protestant affiliation was associated with a wider illicit drug disparity, more than twice as large among Protestants as among the unaffiliated. Overall, religiosity was broadly associated with lower substance use from adolescence through midlife, but the strength and direction of those associations varied across dimensions of religiosity, substances, and populations, narrowing disparities in some cases, leaving them unchanged in others, and widening them in one.

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