the effects of spirituality and religiosity on child neglect in substance use disorder families

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The Effects of Spirituality and Religiosity on ChildNeglect in Substance Use Disorder FamiliesChris Stewart PhD a & Ada C. Mezzich PhD b ca University of South Florida, School of Social work , Tampa, FLb University of Pittsburgh, School of Pharmacy, Department of Pharmaceutical Sciencesc Center for Education and Drug Abuse Research (CEDAR)Published online: 23 Sep 2008.

To cite this article: Chris Stewart PhD & Ada C. Mezzich PhD (2007) The Effects of Spirituality and Religiosity on Child Neglectin Substance Use Disorder Families, Journal of Family Social Work, 10:2, 35-57, DOI: 10.1300/J039v10n02_03

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The Effects of Spiritualityand Religiosity on Child Neglect

in Substance Use Disorder Families

Chris Stewart, PhDAda C. Mezzich, PhD

ABSTRACT. The role of spirituality and religiosity in neglect etiology isunknown. Further, the effects of these factors may be influenced by exist-ing familial substance use disorder (SUD). This study examined the roleof spirituality as conceptualized multidimensionally, in parental childneglect. A sample of 100 (40 SUD; 60 Control) intact families were givenmeasures of spirituality, religiosity, and multiperspective measures ofchild neglect. Results demonstrated significant direct protective effectsfor both paternal and maternal neglect of several religious and spiritual di-mensions. Interestingly, several other spirituality dimensions were signif-icant risk factors for child neglect. Discussion of implications is included.doi:10.1300/J039v10n02_03 [Article copies available for a fee from TheHaworth Document Delivery Service: 1-800-HAWORTH. E-mail address:<[email protected]> Website: <http://www.HaworthPress.com>© 2006 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Child neglect, spirituality, religiosity, substance abuse,families

Chris Stewart is Associate Professor, University of South Florida, School of SocialWork, Tampa, FL.

Ada C. Mezzich is Associate Professor, University of Pittsburgh, School ofPharmacy, Department of Pharmaceutical Sciences, and also Associate Professor ofPsychiatry, Center for Education and Drug Abuse Research (CEDAR).

Address correspondence to: Chris Stewart, University of South Florida, Schoolof Social Work, 4202 East Fowler Avenue, MGY 132, Tampa, FL 33620 (E-mail:[email protected]).

Journal of Family Social Work, Vol. 10(2) 2006Available online at http://jfsw.haworthpress.com

© 2006 by The Haworth Press, Inc. All rights reserved.doi:10.1300/J039v10n02_03 35

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INTRODUCTION

Neglect poses a significant risk for children throughout their develop-ment and is often linked with serious consequences that reach into adult-hood and evidence demonstrates that the rate of neglect is increasing(Dubowitz, 1999; Schumacher, Slep, & Heyman, 2001; Youngblade &Belsky, 1990). Despite the high prevalence of child neglect, research spe-cifically addressing neglect is significantly lagging behind research ex-amining other types of maltreatment (Schumacher, Slep, & Heyman,2001; Zuravin, 1999). Existing results are often affected by several im-portant limitations. Because the majority of neglect research involvesinfants, little information is available concerning neglect across the de-velopmental life span. It is likely that neglect occurring in infancy wouldrequire a different conceptualization and measure than adolescent ne-glect. Further, existing conceptualizations of neglect often utilize defini-tions from many different state agencies and may include only a singlereporting source. Lastly, much neglect research is conducted with thechild’s mother so there remains a dearth of information concerning pater-nal influence on neglectful outcomes (Dunn, Tarter, Mezzich, Vanyukov,Kirisci, & Kirillova, 2002; Zuravin, 1999). Significant efforts should bemade to address these factors in continuing neglect research.

Parental spirituality is another factor that may have some impact uponneglectful outcomes but also has received little empirical attention. Gener-ally, there is an increased interest in spirituality in other areas of human be-havioral research and numerous articles investigate the possible benefits ofspiritual domains for physical and mental health (Cooper-Patrick, Powe,Jenckes, Gonzales, Levine, & Ford, 1997; Ming, Wesley, Simpson, &Lyons, 2002; Russinova, Wewiorski, & Cash, 2002; Thoreson & Harris,2002). Similarly, spirituality has been the focus of work in the addictiontreatment arena (Connors, Tonigan, & Miller, 1996; Cancellaro, Larson, &Wilson, 1982; Koenig, George, Meador, Blazer, & Ford, 1994; Miller,1998). While outcome results are not conclusive, there appears to be suffi-cient evidence to suggest that spirituality constructs contribute to positiveoutcomes in many other facets of life and, therefore may have some impactupon child neglect (Hackney & Sanders, 2003).

While there is a dearth of available information on the role of parentalspirituality in child neglect, related evidence has explored the effectsof parental religiosity on parenting practices. However, this researchis inconclusive as results demonstrate that parental religiosity may con-tribute to poor parenting practices or, conversely, can provide a founda-tion for effective and warm parent-child relationships (Dollahite, 1998;

36 JOURNAL OF FAMILY SOCIAL WORK

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Mahoney, Pargamnet, Tarakeshwar, & Swank, 2001; Snider, Clements, &Vazsony, 2004; Strayhorn, Weidman, & Larson, 1990). Negative out-comes generally involve conservative religious beliefs with authoritar-ian parenting philosophies and techniques such as corporal punishment(Danso, Hunsberger, & Pratt, 1997; Mahoney, Pargamnet, Tarakeshwar, &Swank, 2001; Snider, Clements, & Vazsony, 2004). Extant evidence,however, also suggests that religiosity may provide assumptions criticalto forming warm parent-child relationships (Gunnoe, Hetherington, &Reiss, 1999; Mahoney, Pargamnet, Tarakeshwar, & Swank, 2001). Re-sults demonstrate that parental religiosity is associated with greater moni-toring among fathers, social support and closeness which have all beenidentified as important factors in productive parenting (Bartkowski &Xu, 2000; Snider, Clements, & Vazsony, 2004; Strayhorn, Weidman, &Larson, 1990; Gunnoe, Hetherington, & Reiss, 1999).

While this evidence exploring parental religiosity supports an inves-tigation of parental spirituality, there are methodological issues in re-searching spirituality that must be addressed (Hill & Pargament, 2003;Idler et al., 2003; McCullough, Hoyt, Larson, Koenig, & Thoresen,2000; Powell, Shahabi, & Thoresen, 2003; Miller, 2003).

Spirituality is a complex construct that is most accurately defined asmultidimensional, encompassing every individual’s beliefs concerning re-ality beyond the sensory, material world (Miller, 2003; Larson, Swyers, &McCullough, 1997). Spirituality might even be seen as a latent variablesuch as happiness or personality traits (Miller, 2003; Miller & Thoresen,1999). The exact number and nature of spirituality dimensions has beenthe subject of some debate in the literature but most conceptualizationsinclude religiosity as one dimension of a more global spirituality (Miller,2003; Miller & Thoreson, 1999).

Although spirituality and religiosity are closely related and some be-lieve that many elements are shared, it is important to differentiate thetwo concepts (Miller, 2003; Thoreson, 1998). Spirituality–and its corre-sponding dimensions–is generally defined as an individual set of be-liefs and practices that may include religiosity, whereas religiosity andreligious practices, generally considered as a part of spirituality, tend torefer exclusively to a social phenomenon (Miller, 1998, 2003). For thepurposes of this research, there will be differentiations between theconcepts for clarity, measurement, and discussion of the relevant litera-ture. Religious factors will focus more on beliefs, rituals, and prac-tices or more social institutional elements while spiritual factors willencompass individual subjective experiences that are, at times, sharedwith others (Miller, 2003; Miller & Thoreson, 1999).

Chris Stewart and Ada C. Mezzich 37

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While knowledge of parental spirituality is important for an overall un-derstanding of child neglect, it is crucial to simultaneously consider otherfactors that have also demonstrated significance and may indicate differ-ent pathways to neglect. Substance use disorder (SUD) is one such factoras parental SUD has demonstrated strong significance as a risk factor forchild neglect (Dunn, Tarter, Mezzich, Vanyukov, Kirisci, & Kirillova,2002; Kelleher, Chaffin, Hollenberg, & Fisher, 1994; Kirisci, Dunn,Mezzich, & Tarter, 2001). The rate of SUD is significantly higher amongneglecting parents than the general population and parents with SUD areat greater risk for neglecting their children (Chaffin, Kelleher, &Hollenberg, 1996). Parents may also be negatively impacted through en-vironmental stressors–such as poverty, which often coexists in SUD fam-ilies–and are themselves a significant risk factor for child neglect (Belsky,1993; Dubowitz, 1999; Dunn, Tarter, Mezzich, Vanyukov, Kirisci, &Kirillova, 2002). Controlling for important factors such as these will fur-ther identify the accurate contribution of parental spirituality to neglectfuloutcomes.

The role of parental spirituality and religiosity in neglect etiology isunknown. This study was conducted to determine the role of spiritualityand religiosity as conceptualized multidimensionally, in parental childneglect. The identified considerations for both neglect and spiritualitywere addressed, including multidimensional, multiperspective assess-ment and utilization of complete families. Because the effects of paren-tal spirituality and religiosity may be influenced by existing familialSUD or poverty, these factors are controlled. The main study hypothe-ses are as follows.

H1. To determine any differences in spirituality, religiosity, andchild neglect between SUD families and non-SUD families.

H2. To determine the effects of spirituality and religiosity on childneglect outcomes from multiple sources controlling for parentalSUD and SES.

METHODS

Recruitment Procedure

Families were recruited from multiple sources including newspaperand radio advertisements, research projects, treatment facilities, and asampling frame purchased from a marketing firm. Families were recruited


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and assigned to groups on the basis of father’s SUD status and having atleast one biological child of either gender between the ages of 10 and 12years that was then identified as the primary subject of the study. Somefamilies had siblings of other ages, if so all siblings were also includedin family-testing procedure. Fathers and offspring were excluded if theyhad chronic physical, neurological diseases or psychotic disorders thatwould impede their participation in the research protocol. Written in-formed consent was obtained after a full description of the study wasprovided. The study was approved by the Institutional Review Boardfrom the participating University and was provided with a Certificate ofConfidentiality by NIDA.

Diagnostic Procedure

Upon recruitment, the fathers were administered an expanded ver-sion of the Structured Clinical Interview for DSM-IV (SCID; Spitzer,Williams, & Gibbon, 1996) to determine their eligibility for participa-tion in the study. The fathers were divided into two diagnostic groups.The first group, or high-risk SUD group, was composed of fathers who metcriteria for a lifetime diagnosis of SUD according to the Diagnostic andStatistical Manual of Mental Disorders (DSM-IV; American PsychiatricAssociation, 1994), excluding nicotine dependence, with or without otherAxis I psychiatric disorders. The second group, or control group, in-cluded fathers who did not meet DSM-IV criteria for SUD or any otherAxis I diagnosis.

The following procedure, described by Clark, Pollock, Mezzich,Cornelius, and Martin (2001), was used to obtain SUD diagnosis. TheDrug and Alcohol Checklist (Mezzich, 1989) was first administered toassess lifetime consumption of 42 psychoactive substances and fourpsychoactive substances most frequently used. Next, an expanded ver-sion of the Structured Clinical Interview for DSM-IV (SCID) (Spitzer,Williams, & Gibbon, 1996) was administered to each subject by trainedclinical research associates to determine if the subject met diagnosticcriteria for SUD for each of the four psychoactive substances most fre-quently used. The SUD diagnostic formulation was conducted in a con-sensus conference by a diagnostic team comprising two psychiatrists,the clinical research associate who conducted the diagnostic interviewof the father, and other clinical research associates who participated inthe family assessment. The diagnosis was obtained using the best esti-mate method (Leckman, Scholomkas, Tompson, Belanger, & Weissman,1982) whereby information from the clinical interview, in conjunction


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with diagnostic information gathered from other sources, is used to for-mulate the diagnosis.

Sample

Table 1 provides descriptive information on demographic variables.The entire sample comprised 100 families, 40 with a father diagnosedwith substance use disorder (SUD) and 60 with non-SUD controlfathers. All 100 families had a child aged 10 to 12. The ethnicity of thesample was primarily Caucasian with 12% of fathers reporting as AfricanAmerican, while mothers reported 11% African American. The father’sage ranged from 31 to 60 with an average age of 44 and the mother’sreported ages from 27 to 53 years old with a mean age of 43. For the chil-dren, 42% of the children in this sample are females. The average age ofthe offspring was 11.4 years with a range of 10 to 12 years old.

Dependent Variables

Child Neglect

The Child Neglect Questionnaire (CNQ) consists of 46 questionswhich measure the following four dimensions of neglect. (1) PhysicalNeglect (16 items), (2) Emotional Neglect (15 items), (3) EducationalNeglect (8 items), and (4) Monitoring/Supervision (7 items). There is


TABLE 1. Demographic Characteristics of Sample

M SD Range

Fathers (N = 100)

Age 44.2 6.14 31-60

Education 14.2 1.74 10-17

SES 47.4 12.7 14-66

Mothers (N = 100)

Age 42.6 7.91 27-53

Education 14.3 1.74 8-17

SES 47.8 12.8 8-66

Children (N = 100)

Age 11.4 0.79 10-12

Education 5.1 0.88 3-7

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also a Total Score, which is a summation of all 46 items. Examples ofthe CNQ are–“given me enough food to eat,” “paid attention to me ifI was upset crying,” “been concerned about my feelings,” “known whatI did with my friends,” “made sure I did my homework.” The responsescale ranges from 1 to 4 with the higher scores indicating more severeneglect. Data are collected from the child reporting on the mother andfather, and from each parent reporting on him/herself. For this analysis,all three sources were used as dependent variables of parental neglect.Psychometric analyses revealed that father, mother, and child versionshad Cronbach’s Alpha values of .96, .89, and .95, respectively, demon-strating excellent internal consistency.

Predictor Variables

Religiosity

The Religious Orientation Scale-Revised, (ROS) was utilized to con-ceptualize dimensions of religiosity (Gorsuch & McPherson, 1989).This scale is a revision of the popular Religious Orientation Scale devel-oped by Allport and Ross (1967). It is designed to measure religiosityon three dimensions, Intrinsic, Extrinsic-Personally Oriented (EX-P),and Extrinsic-Socially Oriented (EX-S). Intrinsic religiosity is concep-tualized as derived directly from an individual’s religious beliefs. Thus,religious beliefs become a central framework for many of life’s deci-sions. Conversely, extrinsic orientation refers to religious beliefs thatare utilitarian and are often utilized for specific goals, such as receivingpersonal comfort (Extrinsic-Personal) or acquiring social approval(Extrinsic-Social) (Hill & Hood, 1999). The reliability, Cronbach’s al-pha scores are .83, .78, and .75, respectively. There has been some inde-pendent validation of these factors (Kirkpatrick, 1989).

Spirituality

The Spiritual Assessment Inventory (SAI) was used to conceptualizespirituality through six factors: Awareness, Disappointment, RealisticAcceptance, Grandiosity, and Instability (Hall & Edwards, 2002). Aware-ness and Realistic Acceptance seek to measure the awareness of God inan individual’s life, while Disappointment, Grandiosity, and Instabilityseek to conceptualize the quality of that relationship. The latest versionalso includes a scale, Impression Management, intended as a measure-ment of reliability of an individual’s responses. This instrument draws


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on object relations theory to measure spiritual development from a soundtheoretical perspective. Spirituality, then, is conceptualized as distinctfrom religiosity by tapping different dimensions of relationship with theperceived Divine. Extensive research has been conducted with thismeasure through factor analysis and concurrent validity with Cronbach’salpha reliability scores reported as: Awareness .95, Disappointment .90,Realistic acceptance .83, Grandiosity .73, and Instability .84 (Hall &Edwards, 2002).

Control Variables

Socio-Economic Status

Because SES has been identified as a significant correlate of neglect,it was controlled for in all statistical analyses. SES in this study was as-sessed using Hollingshead’s criteria (1975) based on education and oc-cupation of the head of household.

Parental Severity of Substance Use Disorders

The severity of parental lifetime SUD (e.g., alcohol, amphetamine,cannabis, cocaine, pcp, opioids, hallucinogens, inhalants, sedatives)was indexed by the number of SUDs. An expanded version of the Struc-tured Clinical Interview for DSM-IV (SCID) (Spitzer, Williams, &Gibbon, 1996) was administered to both parents separately to determinediagnosis of SUD. The SUD scales utilized in the analysis demonstratedacceptable Cronbach’s alpha scores, .81 for the father and .83 for themother.

Statistical Analysis

The first study hypothesis was addressed through t-tests to identifyany difference in parental spirituality, religiosity, and child neglect be-tween the SUD and control groups. The second hypothesis utilized atwo-step procedure to determine the impact of spirituality and religios-ity on neglect outcomes. Bivariate correlations were used to establishrelationships between dependent variables and predictor variables priorto further multiple regression analysis. Each parent was analyzed sepa-rately as was each reporting source, parent on self, parent on spouse,and child on parent. Hierarchical linear regression equations were usedto test the role of parental religiosity and spirituality on parental child


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neglect scales as reported by each parent and the child (summed, physi-cal, emotional, supervision, and educational scales). The control vari-ables, SES and parental SUD, were entered first as a block before thereligiosity and spirituality variables were entered into the equations.

RESULTS

The first hypothesis, determining SUD and control group differencesin spirituality, religiosity, and neglect was addressed utilizing t-test meanscomparisons. Table 2 summarizes the spirituality and religiosity meanscomparisons for fathers and mothers from the families. There was a sig-nificant difference in the ROS Intrinsic subscale and SAI Awarenessmeasures for both parents with the control group scoring higher on bothmeasures.

In terms of child neglect, there were no significant group differencesfor paternal neglect from any reporting source. Table 3 summarizes theresults for maternal neglect. For mothers’ self-report, there was a signif-icant difference between the groups with the SUD group higher in Su-pervisory Neglect. Similarly, for fathers reporting on mothers, the SUDgroup was higher than the control group for both Supervision Neglectand Educational Neglect. Children reporting on mothers neglect re-ported significant differences for the Summed Neglect scale, Supervi-sion Neglect, and Educational Neglect with the SUD group higher in allinstances.

The second hypothesis, determining any influence of spirituality andreligiosity on neglect outcomes, was addressed in a two-part analysis.Correlational analyses between the study variables were conducted first.The bivariate correlation results demonstrated similar trends for eachreporting source. For example, for fathers reporting their own neglect,the ROS EX-P correlated with Total Score (r = �.273, p < .01), Emo-tional (r = �.331, p < .01), and Educational (r = �.216, p < .05), neglectscales. The SAI: Instability subscale was significantly correlated withthe Total Score (r = .250, p < .05), Supervision (r = .363, p < .01), andEducational (r = .225, p < .05), subscales. The ROS Intrinsic (r = �.266,p < .01), and SAI: Disappointment (r = .287, p < .01), subscales weresignificantly correlated with the Supervision subscale.

The Mother reporting on the Father demonstrated similar trends withthe ROS EX-P significantly correlating with the Total Score (r = �.245,p < .05), Emotional (r = �.245, p < .05), and Supervision (r = �.209,p < .05), neglect subscales. The ROS Intrinsic scale was significantly


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correlated with the Total Score (r = �.213, p < .05), Emotional (r =�.247, p < .05), and Educational (r = �.231, p < .05), subscales. TheSAI: Instability was significantly correlated with Total Score (r = .285,p < .05), Physical (r = .257, p < .05), Supervision (r = .285, p < .01), andEducational (r = .309, p < .01) neglect scales as dependent variables. TheSAI: Disappointment scale was important in correlating with the TotalScore (r = .263, p < .05), Physical (r = .249, p < .05), Supervision (r =.261, p < .05), and Educational (r = .285, p < .01) Neglect subscales.


TABLE 2. Spirituality and Religiosity Means Comparisons for SUD and ControlGroups

Fathers Mothers

M SD t M SD t

Spirituality (SAI)

Awareness

SUD 52.95 22.23 �2.930* 59.67 21.77 �2.060*

Control 65.87 20.07 68.02 16.08

Realistic acceptance

SUD 12.07 10.62 �0.478 15.23 11.01 �0.929

Control 13.12 10.49 17.33 10.98

Instability

SUD 15.41 5.37 0.968 16.33 4.81 0.962

Control 14.33 5.46 15.32 5.61

Disappointment

SUD 12.62 4.95 �0.001 14.03 5.81 0.103

Control 12.62 5.44 13.90 6.15

Religiosity (ROS)

Intrinsic

SUD 24.69 6.69 �3.100* 26.36 5.92 �3.570***

Control 28.87 6.32 30.63 5.67

Extrinsic-Personal

SUD 8.41 3.02 �0.310 10.05 2.34 1.660

Control 8.60 2.90 9.20 2.64

Extrinsic-Social

SUD 5.07 2.48 0.022 5.36 2.27 0.055

Control 5.06 1.90 5.33 2.32

*p � .05; **p � .01; ***p � .001.

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For children reporting on paternal neglect, the trend was a bit differentwith the ROS EX-P subscale correlating only with the Emotional (r =�.246, p < .05) Neglect subscale. Further the SAI: Instability subscalewas correlated with the Physical (r = .256, p < .05) and Supervision (r =.261, p < .05) dependent scales. Lastly, the SAI: Disappointment scalewas significantly correlated with the Total Score (r = .247, p < .05), Phys-ical (r = .286, p < .01), and Supervision (r = .317, p < .01) Neglect scales.

The correlation analysis results for maternal neglect and the predictorvariables were not as strong as for fathers. For mothers reporting on theirown neglect only the SAI: Realistic Acceptance correlated with the TotalScore (r = �.230, p < .05), and Educational (r = �.245, p < .05) subscales.For fathers reporting on mothers, the ROS EX-P was correlated withthe Summed (r = �.239, p < .05) and Emotional (r = �.274, p < .01)Neglect scales. Children reporting on mothers had the ROS Intrinsic(r = �.248, p < .05), SAI: Realistic Acceptance (r = �.203, p < .05), and


TABLE 3. Maternal Child Neglect Means Comparisons for SUD and Con-trol Groups

Mothers Self-Report Fathers on Mothers Child on Mothers

M SD t M SD t M SD t

Total neglect

SUD 61.13 8.44 1.870 59.83 9.38 1.780 58.16 8.51 2.60**

Control 58.08 6.78 56.52 7.77 53.55 8.15

Physical neglect

SUD 19.55 2.20 0.970 19.39 2.27 1.490 19.33 2.38 1.94

Control 19.10 2.30 18.63 2.58 18.32 2.60

Emotional neglect

SUD 21.79 4.22 0.839 21.08 4.70 0.728 20.14 4.80 1.76

Control 21.07 4.00 20.38 4.31 18.52 3.50

Supervision neglect

SUD 7.18 1.21 0.964 7.47 1.65 2.290* 7.26 1.64 2.14*

Control 6.95 1.21 6.77 1.04 6.60 1.18

Educational neglect

SUD 12.61 2.79 3.240*** 11.89 2.82 2.000* 11.32 2.48 2.47*

Control 10.97 1.76 10.75 2.41 10.07 2.31

*p � .05; **p � .01; ***p � .001.

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the SAI: Awareness (r = �.222, p < .05) predictor scales correlating withthe Educational Neglect subscale.

For the second step, only the significantly correlated predictors wereutilized to analyze each dependent neglect scale using hierarchical mul-tiple regression. For fathers self-reporting (Table 4) the primary signifi-cant predictors included the ROS Extrinsic Personal subscale and theSAI Instability subscale for all significant models. The Supervisionsubscale was significantly predicted by the ROS Intrinsic subscale. ThePhysical Neglect scale was not influenced by any paternal spirituality orreligiosity variables. The ROS scales were significant in a negativedirection indicating that religiosity and religious practices were protec-tive factors against the significant neglect scales. The significant SAIscales proved to be positively predictive of neglect. Predictor variableswith no results and blank spaces did not correlate significantly and werenot utilized in the model.

Mothers reporting on fathers (Table 5) revealed a similar trendwith the SAI Instability subscale being quite influential on all testedneglect subscales except Emotional neglect. The ROS Extrinsic Personalsubscale was also predictive for all models except Educational and theIntrinsic subscale significant for the Total Score, Emotional and Educa-tional scales. The direction of the results was identical to the father’sself-report results with the ROS scales significant in a negative direc-tion and the SAI scales indicating a positive trend. Mother’s reportingalso mirrored the Fathers self-reporting as the Physical Neglect was notinfluenced by any of the predictor variables.

The children reporting on fathers (Table 6) demonstrated a differenttrend with the SAI: Disappointment subscale finding significance in thePhysical and Supervision scales. The direction was positive again indi-cating increased risk for these types of neglect. The Total Score, Emo-tional and Educational neglect scales were not predicted by any of thereligiosity, spirituality, or control variables.

As with the bivariate correlation results, the religiosity and spiritual-ity predictors were not as significant for mothers as for fathers in pre-dicting neglect (Table 7). Mothers’ self-reporting had only the SAI:Realistic Acceptance subscale predicting the Educational neglect scale.This SAI scale was significant in the positive direction indicating that arealistic attitude with God served as a protective factor for neglect. As inprevious results, the ROS Extrinsic Personal subscale was significant inthe negative direction for fathers reporting on mother’s Emotional Ne-glect subscale. Finally, for children reporting on mothers only the Edu-cational Neglect variable was predicted by the ROS Intrinsic subscale in


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TABLE 6. Hierarchical Regression Model of Child-Reported Paternal Neglect

Overall Model Physical Neglect(R2 = .12, F = 3.740, p = .14)

Supervision Neglect(R2 = .13, F = 4.567, p = .005)

Beta t Beta t

SES .167 1.600 .143 1.400

Paternal SUD .031 .302 .070 0.701

Spirituality (SAI)

Awareness

Realistic acceptance

Instability .177 1.580 .153 1.380

Disappointment .274 2.673** .303 3.040**

Religiosity (ROS)

Intrinsic

Extrinsic-Personal

Extrinsic-Social

*p � .05; **p � .01.

TABLE 7. Hierarchical Regression Model of Maternal Neglect

Overall Model Mother Reporting on SelfEducational Neglect(R2 = .08, F = 2.704,

p = .05)

Father Reportingon Mother

Emotional Neglect(R2 = .10, F = 3.348,

p = .023)

Child Reportingon Mother

Educational Neglect(R2 = .18, F = 4.890,

p = .003)

Beta t Beta t Beta t

SES .007 0.067 .110 1.200 .040 0.376

Maternal SUD .069 0.635 .156 1.450 .064 0.590

Paternal SUD .179 1.670 .019 0.178 .118 1.100

Spirituality (SAI)

Awareness �.092�0.636

Realistic acceptance �.206 �2.041* �.187 �1.890

Instability

Disappointment

Religiosity (ROS)

Intrinsic �.200 �2.510*

Extrinsic-Personal �.306 �2.880*

Extrinsic-Social

*p � .05; **p � .01.

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a negative direction. Non-significant models were not included in thetables. None of the control variables, SES or parental SUD, reached sig-nificance in any of the tested models for either parent indicating thateffect of the spirituality and religiosity variables was quite strong. It wasalso hypothesized that one parent’s religiosity or spirituality may have areciprocal effect on neglectful behavior of each parent but bivariatecorrelation results failed to support the hypothesis.

DISCUSSION

The first study hypothesis was to determine differences in parentalspirituality, religiosity, and child neglect between the SUD and controlgroups. First, the control group scored significantly higher in intrinsicreligiosity than the SUD group for both parents. The mothers, in partic-ular demonstrated quite strong results. Strong religiosity has been re-ported as a protective factor for substance use, so it is not surprising todiscover that parents with higher religiosity have lower incidencesof substance use disorder (Connors, Tonigan, & Miller, 1996; Cancellaro,Larson, & Wilson, 1982; Koenig, George, Meador, Blazer, & Ford,1994; Miller, 1998).

The control group also scored significantly higher on the Awarenesssubscale of the SAI for both parents. This subscale measures an aware-ness of divine presence in everyday life and, as with the previous religi-osity result; it is likely that a strong spiritual foundation or focus wouldconflict with the substance-use lifestyle of SUD. Although there wasnot a dramatic difference in the spirituality or religiosity of the parentsfrom different groups, it does suggest a trend that internally focused spiri-tuality tends to be incompatible with problematic substance use and,therefore, could be an important protective factor for neglect.

While there was no difference between the groups for measured childneglect for fathers, mothers did demonstrate differences in two mea-sured areas. Supervision Neglect, which measures how well parentsmonitor their child, was significantly higher for the SUD group formother self-reporting, the father reporting on the mother, and the childreporting on the mother. In addition, Education Neglect, which mea-sures how parents provide for their child’s education, was also signifi-cantly higher for the SUD group for father reporting on the mother andchild reporting on the mother. Increased risk for neglect is strongly cor-related with parental SUD, so it is surprising that this trend was not rep-licated with fathers (Dunn, Tarter, Mezzich, Vanyukov, Kirisci, &


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Kirillova, 2002; Kelleher, Chaffin, Hollenberg, & Fisher, 1994; Kirisci,Dunn, Mezzich, & Tarter, 2001). There is evidence, however, to suggestthat maternal influence within SUD families may be more proximallyresponsible for paternal neglectful outcomes than paternal SUD (Stewart,Mezzich, & Day, 2006). It may be that the mother’s influence on neglect-ful outcomes may be more important in this study as well. Further, it ispossible that a combined or interactive effect may be important andshould be tested in subsequent research.

The second purpose of this study was to determine the overall impactof parental spirituality and religiosity on child neglect. These results gen-erally supported reported literature trends with spirituality and religiositydemonstrating both protective and risk factor effects (Dollahite, 1998;Mahoney, Pargamnet, Tarakeshwar, & Swank, 2001; Snider, Clements, &Vazsony, 2004; Strayhorn, Weidman, & Larson, 1990). The regressionresults generally support a direct effect of spiritual and religiosity fac-tors on child neglect, although it appears that different dimensions oper-ate for each parent.

For fathers, a protective effect against neglect is provided by an inte-grated, internally focused religiosity as well as the utilization of reli-gious practices for specific purposes as indicated by the significanceof the ROS Intrinsic and Extrinsic Personal subscales. One use of reli-gion is comfort in difficult times, which is similar to religious coping(Pargament, 1997). Although the ROS scales are not an exact measureof religious coping, it is likely that these fathers utilized religious partic-ipation as a coping mechanism in some situations and if fathers did em-ploy religious coping, perhaps finding comfort in difficult times mayhave helped protect against neglect regardless of whether or not SUDwas present. This result further demonstrates that internalized motiva-tion for religious participation and having religious beliefs as an orga-nizing life tenet can offer a strong buffering effect against child neglecteven in the presence of a strong risk factor such as SUD.

Maternal results demonstrated similar trends. In fact, positive spiritu-ality and religiosity played a larger role for mothers than fathers. Boththe ROS Extrinsic Personal and Intrinsic subscales demonstrated mod-erate significance along with the SAI: Realistic Acceptance scale. Thesignificance of these dimensions verifies the protective effects of a posi-tive relationship with God, or more accurately, an ability to put effortinto maintaining a positive relationship with the divine, despite ever-present difficulties.

Religious practices may help parents cope with difficult parentingsituations and most religions promote universal values that may protect


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parents against neglecting their children. Similarly, some spirituality di-mensions also promote universal principles of well-being and harmonythat are incompatible with neglectful behavior. It is important to recog-nize, however, that these benefits apply primarily to internal spiritualityand religiosity dimensions as evidenced by the results of externally focusedspirituality.

If some aspects of paternal religiosity demonstrated strong protectivetraits, results also indicate that certain spiritual characteristics may in-crease the risk of neglectful outcomes. The SAI Instability and Disap-pointment subscales demonstrated significance in many of the paternalneglect dimensions from multiple reporting perspectives. The signifi-cance of these dimensions indicates that a fearful, unstable, or disap-pointing relationship with God, or perhaps fear of God, appear to be riskfactors for paternal child neglect. Importantly, as with the protective ef-fects of religiosity, the impact exists while controlling for the influenceof SUD.

The failure of the external or socially motivated religiosity to achievesignificance is also supported in the extant literature (Danso, Hunsberger, &Pratt, 1997; Mahoney, Pargamnet, Tarakeshwar, & Swank, 2001; Snider,Clements, & Vazsony, 2004). These negative spiritual dimensions or anoverall negative spiritual orientation may not necessarily directly influ-ence the neglect. Available evidence demonstrates that SUD severelydisrupts emotional development with many serious consequences forparenting, including child neglect (Dunn, Tarter, Mezzich, Vanyukov,Kirisci, & Kirillova, 2002; Kelleher, Chaffin, Hollenberg, & Fisher,1994). The risk effects from the spirituality and religious dimensionsmay also be indicative of an interaction related directly to SUD or maybe related to problematic personality traits often comorbid with SUD.From this perspective, it is not the spirituality or religiosity but negativepersonality traits that are more proximal to a neglectful outcome. Theinfluence of such traits operating in this manner has been reported inprevious research (Stewart, Mezzich, & Day, 2006). Testing these hy-potheses is beyond the scope of this project but may explain the risk fac-tor effects.

While antisocial characteristics may be part of the neglect phenome-non, these results do indicate that spirituality and religiosity are importantas separate, direct factors. Internal religiosity significantly differentiatedthe mothers in SUD families from the control group. Further, this factcombined with the significance of spirituality and religiosity dimen-sions as both risk and protective factors, while controlling for parental


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SUD, emphasizes the importance of parental spirituality for neglectfuloutcomes.

IMPLICATIONS FOR PRACTICE

There is little general knowledge concerning persistent neglectful par-enting (Dubowitz, 1999). One finding, however, is that family stress hasbeen found to be associated with recurring neglect (DePanfilis & Zuravin,2002; Jonson-Reid, Drake, Chung, & Way, 2003; Ethier, Couture, &Lacharite, 2004). Results from this sample demonstrate that some spiri-tuality and religiosity dimensions offer protective effects against childneglect, even in the presence of powerful risk factors such as SUD.Though the exact mechanisms are unknown, it may be that positivespirituality may help ameliorate family stress, such as that often seen inSUD families, and should be considered as resources in assessing familyfunctioning.

It becomes important, then, to include those aspects of spirituality thatare most likely to improve the situation within interventions. Spirituality,and religious beliefs, that are internalized and generally considered posi-tive seem to be the most helpful in reducing the chance for neglect fromall perspectives. These beliefs are most commonly defined as being con-centrated on love of both self and others and achieving a peaceful har-mony with both transcendental reality and the material world.

Conversely, those beliefs that tend to focus on practices for the sake ofpractice or external motivation are not as helpful in reducing the chanceof neglect and may actually contribute to incidents of neglect, althoughmore research is required to identify the exact role and mechanism.These dimensions often involve issues of dogma or a focus on sin andwrongdoing.

The issue of spirituality in social work practice, however, is oftencontroversial. Inclusion of spiritually related aspects into interventionsis not appropriate for all clients and should not be universally applied.There is currently little outcome evidence to support inclusion of spiri-tual aspects in practice but a growing body of evidence does demon-strate the importance of these factors to many clients.

It is likely that many families in treatment for neglectful parentingmight be able to use their spirituality as one facet of a treatment plan. Aschild neglect is a multifaceted problem with a complex etiology it is,therefore, important to address the issue on many levels and considering


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parental spirituality can only help increase treatment effectiveness of agrowing chronic problem.

LIMITATIONS

A significant limitation of this study is that it involves a cross-sectionalanalysis and, as such the results need to be verified with further proscrip-tive, longitudinal designs. A lifetime prevalence rate for substance usedisorder was utilized and it is possible that the failure of SUD to achievesignificance, for either parent, may be due to this approach and may need,in future research to be measured more proximally to occurring neglect.There also needs to be replication with an increased sample of familiesto further verify these results and increase generalizability. Also, morework is needed to determine the overall contribution of both parents si-multaneously. Despite these limitations, the results here provide a be-ginning for understanding the powerful influence of both religiosity andspirituality on parental child neglect.

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Received: 07/18/06Revised: 08/16/06

Accepted: 09/11/06

doi:10.1300/J039v10n02_03


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the effects of spirituality and religiosity on child neglect in substance use disorder families

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