Testing the Mediation Effect of Spirituality on Drug Use Among High-Risk and Gang-Involved Men in San Salvador

BACKGROUND & PURPOSE: The protective effect of spirituality on substance use has been repeatedly documented in US and global north studies. Still, limited evidence is available for this effect on populations in Latin America, and few studies have analyzed associations between drug use and prominent cultural characteristics of marginalized and high-crime communities, such as machismo, code of the street, and recurrent experiences of trauma. The present study aims to test direct and indirect associations between multiple cultural and contextual factors, and drug use. In testing this, we particularly examine moderating or mediating roles of spirituality on the associations between negative cultural and contextual factors and drug use.        

METHODS:  This study was conducted as part of a large study, High Risk and Gang-Involved Youth in El Salvador, A sample of 403 males ages 13 to 30 were analyzed for this study. This sample was collected using a chain referral sampling from 15 marginalized communities in the San Salvador Metropolitan Area. For analysis purposes, the sample was categorized as adolescents aged 13 to 17 (n=111, M=15.95, SD=1.18) and young adults (n=292, M=22.10, SD=3.28). Three outcome variables were used in this study: dichotomous measures of four different types of substance (i.e., alcohol, cigarette, marijuana, and other drugs), number of drugs, and alcohol use problem symptoms. Multiple regression analyses were conducted to test direct associations between demographic characteristics, cultural and contextual factors (machismo, code of the street, and experiences of trauma), spirituality, and the outcome variables. Conditional process models (Hayes, 2013) were employed to test mediating and moderating roles of spirituality on the associations between the cultural and contextual factors, and the number of substances and alcohol use problem symptoms.

RESULTS: Findings for all males revealed that: a) spirituality is a protective factor for each type of substance; b) trauma experience is associated with substance use, except cigarettes; c) code of the street is also associated with marijuana and alcohol use; d) machismo is associated only with marijuana use. For adolescents, a) intrinsic spirituality is a protective factor for all types of drugs except cigarettes; b) trauma experience is associated only with alcohol consumption; c) machismo is associated with all types of substance. High levels of code of the street and trauma experience, and low level of spirituality are associated with greater number of substance use and alcohol use problem symptoms; higher levels of machismo are associated only with greater number of substance use. Importantly, spirituality mediates the relationships between the negative cultural and contextual factors, and number of substance use. No significant mediating, moderating and conditional process models were found for alcohol use problem symptoms.          

CONCLUSIONS & IMPLICATIONS: The buffering effect of spirituality on the number of substance use is confirmed in this sample. Additionally, cultural characteristics of these poor communities (machismo and code of the street) are associated with greater number of substance use and alcohol use problem symptoms.  Interventions aiming to ameliorate these negative cultural components and promote spirituality at community level are recommended. Further implications will be discussed.