The Power of Faith: A Systematic Review and Meta-Analysis on Religiosity’s Influence on Smoking, Alcohol, Drug Use, and Internet/Gaming Addiction

The Power of Faith: A Systematic Review and Meta-Analysis on Religiosity’s Influence on Smoking, Alcohol, Drug Use, and Internet/Gaming Addiction | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review The Power of Faith: A Systematic Review and Meta-Analysis on Religiosity’s Influence on Smoking, Alcohol, Drug Use, and Internet/Gaming Addiction Ali Nasith, Muhammad Farhan Hibatulloh, Candra Agung Wibisana, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6538335/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Addiction to substances and gadgets is still a global problem. Not only among teenagers, even adults are also vulnerable to getting trapped in it. When addiction occurs, more problems can occur such as impulsive behaviour and loss of self-control. This is why preventive steps should be the first choice over rehabilitative ones. One of the preventive measures that can be taken from an early age is to instil religious behaviour in oneself. The purpose of this study is to determine the effectiveness of religiosity on reducing the incidence of substance use and games/internet that potentially cause addiction. This review was conducted based on PRISMA 2020 checklist. Forest plot was made using Review manager v5.4 with Odds ratio as measure effect. The inclusion study characteristics and findings from each study were summarised in an extraction table and then synthesised qualitatively. Overall, both qualitative and quantitative synthesis showed a significant reduction in substance use in the religious group (Pooled OR= 2.29, 95% CI [1.61, 3.27], p<0.00001, I²=94%). Likewise, with the use of games/internet, there was a decrease in the tendency of addiction in the religious group. Higher levels of religiosity were shown to be associated with a decrease in the incidence of substance use and may prevent future addictions that have the potential to cause harm. However, further studies with consistent methods of presenting results are needed so that meta-regression and subgroup analyses can be conducted to obtain more specific result based on sample characteristics. Psychology Sociology Religiosity Smoking Alcohol Drug Use and Internet/Gaming Addiction Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The global challenge of addiction to substances such as drugs, alcohol, and cigarettes, as well as behavioral addictions like internet use and gaming, is escalating in urgency. In 2022, the prevalence of substance use disorder (SUD) was 2.2% of the global population [1]. In 2021, the global population of drug users reached 296 million, accounting for 5.8% of the total population, reflecting a 23% increase over the previous decade [2,3]. In 2020, hazardous alcohol consumption impacted 1.3 million individuals, of which 77.6% were male and 38% engaged in regular alcohol consumption [4,5]. The prevalence of active cigarette smokers results in substantial health losses. Daily smoking prevalence among adults was 15.2%, with Europe exhibiting the highest rates [6]. Moreover, internet and gaming addiction is often neglected. The global prevalence of internet addiction is estimated to be between 6–15%, with the Middle East exhibiting the highest rates. Internet Gaming Disorder (IGD) is under consideration for inclusion in the DSM-5, while only Gaming Disorder (GD) has received official recognition as a mental health issue by the WHO in ICD-11. This highlights the severity of internet and gaming addiction, which warrants serious consideration [7,8]. The use of addictive substances and digital activities may lead to significant adverse effects. The impacts may be immediate or enduring [9]. Immediate effects may encompass impulsive behaviors, cognitive deficits, and increased risk of injury. Conversely, long-term effects may include chronic illnesses, mental health disorders, and social issues, such as diminished productivity and possible social isolation [10]. Addictive behaviors are associated with disturbances in the dopamine system and changes in the prefrontal cortex. This results in individuals needing greater quantities to achieve equivalent satisfaction, thereby complicating efforts to regulate their impulses towards substance use or specific behaviors [11,12]. Upon successfully discontinuing such behaviors, individuals frequently face challenges including withdrawal symptoms, the potential for relapse, and the need to cultivate healthy social relationships. Rehabilitation strategies are regarded as a more feasible and effective approach to support individuals ensnared in cycles of addiction. This approach necessitates a comprehensive method for interventions to enhance thoroughness and sustainability [13,14]. Preventive strategies should be prioritized over rehabilitation methods for addiction prevention. These measures are generally more effective and efficient in reducing the likelihood of developing dependencies. Research demonstrates that preventive strategies such as health promotion, life skills training, and character education within families can enhance resilience to social pressures and various risk factors [15]. Character education plays a crucial role in addiction prevention by promoting robust moral, religious, and ethical values, as well as social skills, from an early age [16]. An essential component of character education to impart early is the notion of religiosity [17]. Establishing a spiritual mindset and behavior early in life provides individuals with meaning and purpose, which enhances their ability to resist impulsive behaviors that may result in addiction. Engaging in religious practices, such as worship, can foster inner peace and strengthen spiritual identity, assisting individuals in navigating life's challenges [18–20]. Preventative efforts to enhance religiosity are considered effective in addressing addiction, as they create environments that promote positive behavior [21,22]. This review aims to assess the correlation between an individual's level of religiosity and the reduction of substance use and the potential for addiction to gaming and internet activities. Material and Methods This systematic review and meta-analysis adhered to the PRISMA 2020 guidelines and statements. The review protocol is registered in PROSPERO under ID number CRD42025636170. Eligibility Criteria Inclusion and exclusion criteria were defined to assess data relevance prior to the literature search. The inclusion criteria included: (1) Population: Individuals of any age, gender, or cultural background; (2) Exposure: Religiosity as the primary exposure, measurable through religious practices (e.g., praying, attending worship services), applied religious values, or any instrument assessing religiosity; (3) Comparison: Groups with lower levels of religiosity, atheists, or secular individuals; (4) Outcome: Behaviors such as not smoking, abstaining from alcohol, avoiding drug use, and reduced internet or gaming addiction; (5) Research design: Quantitative studies, including cross-sectional, cohort, and case-control studies. Exclusion criteria consisted of: (1) Text articles that could not be accessed in full; (2) Inappropriate language; (3) Protocols. Sources and Data Search A literature search was performed utilizing seven databases: PubMed, Cochrane CENTRAL, Taylor and Francis, Scopus, EBSCO, ScienceDirect, and Google Scholar. The search was conducted until December 15, 2024. All terms adhered to MeSH (Medical Subject Headings) standards and were combined using Boolean operators, yielding the following keywords: (religiosity OR spirituality) AND (smoking OR tobacco OR alcohol OR addiction OR drugs) AND (randomised OR randomised OR quasi OR observational OR cohort OR case control OR cross-sectional OR prospective OR retrospective). Advanced method searches were conducted on databases that provided these features. Study Selection All studies from the database were compiled using Rayyan.ai. The PRISMA flow chart illustrates the search and study selection process. Following the removal of duplicates, three independent reviewers (MFH, EI, CAW) and two collaborators (JRA, MIS) conducted a screening of all collected articles based on year, title, and abstract. Subsequently, full-text articles were evaluated for eligibility. In instances of conflict, AN served as a mediator. Data Extraction and Analysis All authors extracted key information from each study and presented it in an extraction table. The data obtained from the chosen studies included study identity, country of origin, sample size, distribution of religiosity levels, measuring instruments, study design, and the results or findings of the study. All inclusion studies were synthesized for inference. Risk of Bias Assessment The selection of instruments for measuring research quality was determined by the study design of the included studies. All authors conducted the risk of bias assessment independently, with the majority judgment applied in the event of any conflict. The New Castle Ottawa Scale (NOS) was chosen for cohort studies. This instrument evaluates three primary domains: selection bias, comparability, and outcome. The highest possible score for this instrument is 9. Studies are classified as high quality with a final score of ≥ 7, moderate quality with a score of 5–6, and low quality with a score of < 5. The Critical Appraisal Skills Programme (CASP) was selected for the evaluation of cross-sectional studies. The instrument comprises 11 questions designed to evaluate the study's purpose and relevance, the appropriateness of the study design, the description of the target population and the representativeness and absence of bias in the sample, the validity and reliability of data collection methods, the suitability of data analysis and consideration of causal factors or biases, the clarity of result reporting, the support of conclusions by valid data, and the applicability of study results to a broader context. A score of 1 indicates 'Yes', 0.5 indicates 'Unclear', and 0 indicates 'No'. Quantitative Data Synthesis (Meta-Analysis) Review Manager 5.4.1. (The Nordic Cochrane Center, The Cochrane Collaboration, Copenhagen) was used to quantitatively analyse the data. The probabilities of samples not utilizing the substance were obtained alongside the total sample size for each group (religious and non-religious). Pooled effects were analysed with a random effects model (REM) given the diversity of the characteristics of each inclusion study. The analysis employed the Mantel-Haenszel method, utilizing the odds ratio (OR) and a 95% confidence interval as the effect size measures. Sensitivity analysis was performed to identify outlier studies that may influence the degree of heterogeneity. Result Study Selection Results and Risk of Bias Assessment After the search process in seven databases, 5,157 articles were collected. A total of 2,119 duplicate articles were removed and 1704 articles were detected as not meeting the criteria by the automated tool, leaving 1,334 articles for manual selection based on title and abstract. A total of 1,277 articles were excluded, because they met the exclusion criteria or did not meet the inclusion criteria by reading the title and abstract. This left 57 articles to be accessed and read in full. A total of 10 articles could not be accessed in full, so they were excluded. A comprehensive article assessment was conducted on 47 articles. A total of 6 articles had outcomes that were not in line with the objectives of this review, 4 studies had study designs that were also inappropriate. The final result of the selection process was 37 inclusion articles. Details of the selection process can be seen in Fig. 1 . A total of 4 inclusion studies whose study design was a cohort were assessed for risk of bias using the New Castle Ottawa Scale. Only one study showed a moderate risk of bias, namely the study by Carra et al. (2023). The other three studies showed a low risk of bias. The risk of bias assessment heatmap can be seen in Fig. 2 . There were 33 studies that had a cross-sectional study design that were analysed using CASP. All studies analysed using this instrument showed a low risk of bias, although there were some aspects of the questions that showed doubt or vagueness, especially in question 6 relating to the control of confounding variables. The results of the CASP analysis can be seen in Fig. 3 . Qualitative Synthesis There were 37 studies conducted across five continents, South America (Brazil), North America (United States), Europe (Norway, Finland, Hungary, France, Spain, Germany, Italy and Czech Republic), Asia (Israel, Iran, Saudi Arabia, Jordan, Hong Kong, Pakistan and South Korea) and Africa (South Africa). The study collectively involved a total of 302,948 participants, covering a wide range of age groups (10 years to over 80 years). The participants came from various backgrounds, such as students, college students, military veterans, patients with specific health conditions (e.g. HIV/AIDS, cleft lip and palate, asthma), and the general population. The religions studied were categorized into broad groups, including Christianity (e.g., Catholic, Protestant, and Orthodox), Islam (both religious and non-religious Muslims), Judaism, and secular or non-religious affiliations. Measures of religiosity are largely divided based on organizational religiosity (e.g., attendance at religious services), non-organizational religiosity (e.g., personal religious practices such as prayer), and intrinsic religiosity (e.g., application of faith in life). Of the studies that examined alcohol use, 19 studies reported a significant negative association between religiosity and alcohol use, with higher religiosity associated with reduced alcohol consumption or abuse. Higher intrinsic religiosity scores significantly reduced alcohol use (p = 0.002 [23]; p < 0.01 [24]; p = 0.005 [25]; p < 0.001 [26]). Organizational religiosity also showed a significant effect on water pipe smoking (p = 0.005 [23]; p = 0.009 [24]; p < 0.001 [26]). Non-organizational religiosity had mixed findings, significant in Celestino (2024) (p < 0.001) but not in Queiroz (2015) (p = 0.504) [23][26]. Extrinsic religiosity also showed a significant negative association with alcohol use (p < 0.001) [27]. Correlations between religiosity and drug use show mixed results. A significant negative correlation, higher levels of religious involvement often serve as a protective factor against drug abuse. For example, intrinsic religiosity significantly impacts cannabis use (p = 0.001) [28], while extrinsic religiosity shows varying effects. Similarly, a significant negative association between subjective religiosity and cannabis use (b = -0.29, OR = -0.75, p < 0.001) [27]. Everhart (2023) revealed an inverse relationship between strong religious beliefs and cannabis use (β = -0.051, p = 0.001) [29]. Rezende-Pinton (2018) noted that organizational religiosity delays the onset of drug use [30]. The relationship between religiosity and tobacco/cigarette use shows mixed results. Overall, out of 19 stmudies, 12 reported significant findings. Intrinsic religiosity was significantly associated in studies such as Morawa (2018) (p = 0.009) and Queiroz (2015) (p = 0.004) [25][26]. Non-organizational religiosity was also related to smoking reduction in Nabipour (2017) (p = 0.027) but showed weaker significance in Queiroz (2015) (p < 0.05) [26][31]. Organizational religiosity had mixed results; although it significantly reduced smoking with cigarette and water pipe in (p = 0.014) [31], organizational religiosity was positively associated with smoking in (p < 0.001) [26]. Of the 5 studies, all reported a significant negative relationship between religiosity and gaming or internet use, indicating that higher religiosity is associated with reduced problem behaviors. For example, Pong (2022) found that spiritual well-being was inversely correlated with dimensions of gaming addiction (p < 0.001) [32], and Nadeem (2019) showed intrinsic religiosity reduced internet use among Muslim students (β=-0.121, p < 0.05) [33]. Arani (2019) reported a significant negative correlation between spiritual attitudes and addiction potential (r=-0.25, p < 0.001) [34]. However, studies such as Kadar (2023) did not find a significant relationship with video games, suggesting possible cultural or methodological differences [35]. Forest plot As a result of the meta-analysis, religious individuals had an odds ratio (OR) of 2.34 (95% CI: 1.32–4.15) for avoiding alcohol consumption compared to non-religious individuals. The analysis of drug use found an odds ratio of 3.56 (95% CI: 1.39–9.08), which was also statistically significant (p = 0.008). These results also showed significant variation between studies (I 2 = 97%). Compared to the alcohol category, heterogeneity between studies was lower (I 2 = 74%), and the meta-analysis showed that religiosity had a significant association with nicotine use avoidance, with an OR of 1.93 (95% CI: 1.36–2.73). This category also showed significant results (p = 0.0002) and high heterogeneity (I 2 = 65%). Overall, religious individuals were 2.29 times more likely to avoid unhealthy behaviours (95% CI: 1.61–3.27) than non-religious individuals. This analysis was significant (p < 0.00001), but the level of pooled heterogeneity was high (I² = 94%), indicating variation in methodology, population, or other factors among the studies analysed. Forest plot of impact religiosity towards substance use can be seen in Fig. 4 . As part of the sensitivity analysis, this meta-analysis was re-run with certain data adjusted or removed to assess the stability and consistency of previous results. The sensitivity analysis regarding the presence or absence of alcohol consumption resulted in an odds ratio (OR) of 2.95 (95% CI: 2.18 to 3.98), which remained statistically significant (p < 0.00001). The degree of heterogeneity was significantly reduced to I² = 62% compared to the main analysis (I² = 97%). This decrease in heterogeneity is most likely due to the removal of data from Francis (2019) who previously reported different results from other studies. Removing this data will improve consistency across studies. Similarly, in the sensitivity analysis for the no nicotine category, the OR was 1.71 (95% CI: 1.39–2.10), and the result remained significant (p < 0.00001). Heterogeneity in this category decreased significantly to I² = 0%, indicating that the results were highly consistent across studies after adjustment. This reduction in heterogeneity may be due to the removal of data from Martinez (2021), which previously showed non-significant results (CIs included a value of 1) and contributed to heterogeneity. In the substance use category, there were only two studies, so sensitivity analyses were not conducted. Overall, the odds ratio after sensitivity analysis was 2.51 (95% CI: 1.86–3.37) and remained significant (p < 0.00001). The degree of pooled heterogeneity was slightly reduced compared to the main analysis (I² = 94%), I² = 79%. This reduction reflects the positive effect of excluding studies that found different results or outliers. Forest plot of impact religiosity towards substance use after sensitivity analysis can be seen in Fig. 5 . Discussion This study's results demonstrate that the majority of research indicates a significant negative correlation between religiosity and the use of alcohol, drugs, and tobacco. The influence of religiosity on the reduction of unhealthy behaviors is significant, as evidenced by a meta-analysis indicating that religious individuals are more likely to avoid such behaviors overall (OR 2.29), including alcohol consumption (OR 2.34), drug use (OR 3.56), and nicotine use (OR 1.93). Religiosity manifests through participation in religious activities, encompassing both individual and organized beliefs. Religiosity serves as a framework for human existence, impacting socio-cultural interactions and influencing behavior [36]. Religiosity contributes to stress reduction, fosters a sense of calm, enhances resilience, and offers problem-solving strategies, enabling individuals to confront challenging circumstances [37]. Individuals exhibiting strong religiosity often demonstrate the capacity for delayed gratification and possess effective self-control skills, which contribute to a reduction in reliance on addictive behaviors [37]. In addition, religiosity can prevent risky behaviors such as drug use and others by influencing moral acceptance, reducing attraction to addictive behaviors, limiting opportunities, and increasing self-control [38]. Numerous studies indicate a negligible relationship between religiosity and addictive behaviors, including alcohol, drug, and tobacco use. Potential explanations for this insignificance include sample heterogeneity and the intricate interactions between religiosity and other variables. Variability in sample characteristics, such as age, gender, and education level, may influence outcomes, resulting in non-significant findings or elevated I² values. Additionally, factors such as environmental context, genetics, and socioeconomic status may obscure the relationship between religiosity and addictive behavior. Addictive behaviors are influenced by the surrounding environment, including familial and social relationships, which can convey beliefs and moral values that deter such behaviors [39]. A person who develops with a poor environment and religiosity can increase the risk of misbehavior [40]. The five inclusion studies indicated a significant negative correlation between religiosity and internet game addiction; specifically, individuals with lower levels of religiosity are more likely to engage in excessive gaming and internet use. Religiosity may mitigate game and internet addiction by alleviating stress, enhancing self-control, offering a sense of purpose, fostering community support through religious engagement, and promoting the pursuit of more constructive leisure activities [37]. The inclusion studies investigating the relationship between religiosity and gaming/internet could not be subjected to meta-analysis due to a limited number of studies, heterogeneous measurement instruments, and the absence of data such as odds ratios or mean differences. Nine inclusion studies in this research utilized the Duke University Religion Index (DUREL) instrument to measure religiosity. The DUREL measures religiosity through three dimensions: organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiosity (IR). Among the nine inclusion studies, six demonstrate a negative relationship between ORA and addictive behavior, two indicate a negative relationship between NORA and addictive behavior, and eight reveal a relationship between IR and addictive behavior. The data indicates that the dimension of religiosity exhibiting the strongest negative correlation with addictive behavior is IR. IR is assessed through three inquiries: the degree to which an individual perceives God's presence in their life, the correlation between religious beliefs and life experiences, and the endeavors to implement religious teachings across all facets of daily existence [41]. Individuals with elevated intrinsic religiosity who align their lives with religious values, perceive a divine presence, and endeavor to adhere to religious teachings have been identified as a protective factor against addictive behaviors [42]. Various inclusion studies assess religiosity through diverse instruments and question formats. Examples of instruments utilized include the Religious Commitment Index, which assesses religiosity through ten questions, the Spiritual Well-Being Questionnaire (SWBQ) that evaluates four dimensions of spiritual well-being, Kendler's General Religiosity Scale measuring the intensity of religious beliefs, as well as the assessments of Subjective Religiosity (SR) and Organizational Religiosity (OR), among other tools and inquiries. Many of these instruments classify the research sample into religious and non-religious categories, indicating that a higher score corresponds to a greater level of religiosity. Several inclusion studies examine the correlation between religiosity and addictive behavior through the use of adjusted and unadjusted models. The adjusted model indicates that variables potentially influencing the results, including the sociodemographic characteristics of the sample, will be controlled during data analysis. The unadjusted model indicates that variables potentially influencing the results are not controlled in the data analysis. This review represents the inaugural systematic meta-analysis evaluating the role of religiosity in mitigating addictive behaviors, encompassing alcohol, drug, tobacco, and gaming/internet usage. The inclusion studies encompassed research from multiple continents, featuring samples that represented all age groups and diverse backgrounds. The risk of bias assessment for these inclusion studies indicated a low risk of bias, suggesting that the research is both reliable and valid. One study employing a cohort design exhibits a risk of bias score of 6, as it inadequately details the initial conditions of the sample and the follow-up process. Additionally, eight studies employing a cross-sectional design received a score of 0.5 in the confounders controlled domain due to unclear identification of confounding variables. Two studies scored 0.5 in the representative sample domain, as the explanation regarding sample representation and selection is insufficient. Furthermore, two studies attained a score of 0.5 in the reliable outcome measurement domain, as there is a lack of clarity regarding the validity of the instruments used. The meta-analysis exhibits significant heterogeneity attributable to the varied sample characteristics in this study. Subgroup analysis and meta-regression are not feasible because of the insufficient number of studies available for quantitative analysis. This study employs sensitivity analysis to address high sample heterogeneity by excluding data from outlier studies. Specifically, it omits Francis (2019), which reported divergent results compared to other studies, and Martinez (2021), which yielded insignificant results (CI includes a value of 1) and contributed to the observed heterogeneity. This review highlights the beneficial role of religiosity in reducing the risk of addiction related to substance use and internet/gaming. These findings suggest that instilling religious values in children from an early age can be advantageous. Additionally, increasing the construction of places of worship may serve to enhance religious engagement within the community. Conclusion This review presents evidence highlighting the beneficial impact of religiosity on the prevention of detrimental lifestyle habits, specifically regarding substance use, including drugs, alcohol, and nicotine, as well as addictions to the internet and gaming. Increased religiosity is correlated with a reduction in substance use incidence and may mitigate the risk of future addictions that could lead to harm. Further studies employing uniform methods for presenting results are necessary to facilitate meta-regression and subgroup analyses, thereby yielding more specific outcomes based on sample characteristics. 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Shepperd JA, Forsyth RB. How Does Religion Deter Adolescent Risk Behavior? Current Directions in Psychological Science. 2023;32(4):337–342. Guimarães MO, de Lima Guimarães G, da Silva JWR, et al. Does Religiosity Impact Binge Drinking Among Early Adolescents? A Cross-Sectional Study in A City in Southeastern Brazil. Ciencia e Saude Coletiva. 2022;27(9):3669–3678. Rajab TM, Saquib J, Rajab AM, et al. The Associations of Religiosity and Family Atmosphere with Lifestyle among Saudi Adolescents. SSM - Population Health. 2021;14:100766. Martinez EZ, Bueno-silva CC, Bartolomeu IM, et al. Undergraduate Health Sciences Students. Trends Psychiatry Psychother. 2021;43(1):17–22. Queiroz NDR, Portella LF, Abreu AMM. Association between Alcohol and Tobacco Consumption and Religiosity. ACTA Paulista de Enfermagem. 2015;28(6):546–552. Celestino LC, Fukushiro AP, Cintra FMRN, et al. Religiosity and Alcohol Use in Adolescents with Orofacial Cleft: Correlational Study. Rev Paul Pediatr. 2024;43:e2023265. Celik I. Does Religiosity Matter? The Role of Subjective and Organizational Religiosity on Substance Use Among Adolescents. Child Youth Care Forum. Springer; 2024. p. 909–930. Everhart RS, Lohr KD, Ramos MS, et al. Perceived Stress, Religiosity, and Substance Use Among African American and Latinx College Students with Asthma in the USA. J Relig Health. 2023;62(2):1050–1069. Jokela M, Laakasuo M. Health Trajectories of Individuals Who Quit Active Religious Attendance: Analysis of Four Prospective Cohort Studies in the United States. Soc Psychiatry Psychiatr Epidemiol. 2024;59(5):871–878. Kádár BK, Péter L, Paksi B, et al. Religious Status and Addictive Behaviors: Exploring Patterns of Use and Psychological Proneness. Compr Psychiatry. 2023;127. Kaur A, Lal R, Sen MS, et al. Psychosocial Correlates of Recovery Capital in Alcohol and Opioid-Dependent Patients: A Cross-Sectional Comparative Study. Indian J Soc Psychiatry. 2023;39(1):36–41. Guimarães MO, de Lima Guimarães G, da Silva JWR, et al. Does Religiosity Impact Binge Drinking Among Early Adolescents? A Cross-Sectional Study in A City in Southeastern Brazil. Ciencia e Saude Coletiva. 2022;27(9):3669–3678. Ishaq B, Østby L, Johannessen A. Muslim Religiosity and Health Outcomes: A Cross-Sectional Study Among Muslims in Norway. SSM Popul Health. 2021;15. Brito MA, Amad A, Rolland B, et al. Religiosity and Prevalence of Suicide, Psychiatric Disorders and Psychotic Symptoms in the French General Population. Eur Arch Psychiatry Clin Neurosci. 2021;271(8):1547–1557. Livne O, Wengrower T, Feingold D, et al. Religiosity and Substance Use in U.S. Adults: Findings from A Large-Scale National Survey. Drug Alcohol Depend. 2021;225. Doolittle BR, McGinnis K, Ransome Y, et al. Mortality, Health, and Substance Abuse by Religious Attendance Among HIV Infected Patients from the Veterans Aging Cohort Study. AIDS Behav. 2021;25(3):653–660. Buchtova M, Malinakova K, Kosarkova A, et al. Religious Attendance in A Secular Country Protects Adolescents from Health-Risk Behavior Only in Combination with Participation in Church Activities. Int J Environ Res Public Health. 2020;17(24):1–13. Francis JM, Myers B, Nkosi S, et al. The Prevalence of Religiosity and Association Between Religiosity and Alcohol Use, Other Drug Use, and Risky Sexual Behaviours Among Grade 8-10 Learners in Western Cape, South Africa. PLoS One. 2019;14(2). Charro Baena B, Meneses C, Caperos JM, et al. The Role of Religion and Religiosity in Alcohol Consumption in Adolescents in Spain. J Relig Health. 2019;58(5):1477–1487. Nordfjærn T. Religiosity and Alcohol Use: Is Religiosity Important for Abstention and Consumption Levels in the Second Half of Life? Subst Use Misuse. 2018;53(14):2271–2280. Isralowitz R, Reznik A, Sarid O, et al. Religiosity as a Substance Use Protective Factor Among Female College Students. J Relig Health. 2018;57(4):1451–1457. Mohammadpoorasl A, Ghahramanloo AA, Allahverdipour H, et al. Substance Abuse in Relation to Religiosity and Familial Support in Iranian College Students. Asian J Psychiatr. 2014;9:41–44. Jokela M, Laakasuo M. Health Trajectories of Individuals Who Quit Active Religious Attendance: Analysis of Four Prospective Cohort Studies in the United States. Soc Psychiatry Psychiatr Epidemiol. 2024;59(5):871–878. Reza Karimirad M, Khodadoust B, Gholami A, et al. Substance Use and its Related Factors Among Iranian University Students [Internet]. Article in Pakistan Journal of Medical & Health Sciences. 2021. Available from: https://www.researchgate.net/publication/350823036. Burdette AM, Hill TD, Webb NS, et al. Religious Involvement and Substance Use Among Urban Mothers. Debnam KJ, Milam AJ, Mullen MM, et al. The Moderating Role of Spirituality in the Association between Stress and Substance Use among Adolescents: Differences by Gender. J Youth Adolesc. 2018;47(4):818–828. Bahr SJ, Hoffmann JP. Parenting Style, Religiosity, Peers, and Adolescent Heavy Drinking*. Stud. Alcohol Drugs. 2010. Hill TD, Bostean G, Upenieks L, et al. (Un)holy Smokes? Religion and Traditional and E-Cigarette Use in the United States. J Relig Health. 2024;63(2):1334–1359. Rajab TM, Saquib J, Rajab AM, et al. The Associations of Religiosity and Family Atmosphere with Lifestyle among Saudi Adolescents. SSM Popul Health. 2021;14. Martinez EZ, Bueno-Silva CC, Bartolomeu IM, et al. Relationship between Religiosity and Smoking among Undergraduate Health Sciences Students. Trends Psychiatry Psychother. 2021;43(1):17–22. Al-Shatnawi SF, Alzoubi KH, Khabour OF. Withdrawal Symptoms among Cigarette and Waterpipe Smokers: A Study in Natural Setting. Clinical Practice & Epidemiology in Mental Health. 2021;17(1):114–120. Martinez EZ, Giglio FM, Terada NAY, et al. Smoking Prevalence Among Users of Primary Healthcare Units in Brazil: The Role of Religiosity. J Relig Health. 2017;56(6):2180–2193. Allahverdipour H, Abbasi-Ghahramanloo A, Mohammadpoorasl A, et al. Cigarette Smoking and its Relationship with Perceived Familial Support and Religiosity of University Students in Tabriz. Shim JY. Christian Spirituality and Smartphone Addiction in Adolescents: A Comparison of High-Risk, Potential-Risk, and Normal Control Groups. J Relig Health. 2019;58(4):1272–1285. Additional Declarations The authors declare no competing interests. Supplementary Files Supplementaryfiles.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6538335","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":448533540,"identity":"af8af1be-f05e-415b-9d5f-f8dcddd4a0c7","order_by":0,"name":"Ali 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analysis\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6538335/v1/8d7cfd69c236fc3df867f529.png"},{"id":81613105,"identity":"6db611bb-b8fa-4e14-a23f-9c83dfc50e07","added_by":"auto","created_at":"2025-04-29 07:44:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1135099,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6538335/v1/d524029b-224c-4eaf-ab54-f21ad9368778.pdf"},{"id":81612254,"identity":"726df907-6c1b-4c00-bf6a-cb50d3a9403a","added_by":"auto","created_at":"2025-04-29 07:36:12","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":143094,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Supplementaryfiles.docx","url":"https://assets-eu.researchsquare.com/files/rs-6538335/v1/f2b4b3adf1107ac5df578be1.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eThe Power of Faith: A Systematic Review and Meta-Analysis on Religiosity’s Influence on Smoking, Alcohol, Drug Use, and Internet/Gaming Addiction\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe global challenge of addiction to substances such as drugs, alcohol, and cigarettes, as well as behavioral addictions like internet use and gaming, is escalating in urgency. In 2022, the prevalence of substance use disorder (SUD) was 2.2% of the global population [1]. In 2021, the global population of drug users reached 296\u0026nbsp;million, accounting for 5.8% of the total population, reflecting a 23% increase over the previous decade [2,3]. In 2020, hazardous alcohol consumption impacted 1.3\u0026nbsp;million individuals, of which 77.6% were male and 38% engaged in regular alcohol consumption [4,5]. The prevalence of active cigarette smokers results in substantial health losses. Daily smoking prevalence among adults was 15.2%, with Europe exhibiting the highest rates [6]. Moreover, internet and gaming addiction is often neglected. The global prevalence of internet addiction is estimated to be between 6\u0026ndash;15%, with the Middle East exhibiting the highest rates. Internet Gaming Disorder (IGD) is under consideration for inclusion in the DSM-5, while only Gaming Disorder (GD) has received official recognition as a mental health issue by the WHO in ICD-11. This highlights the severity of internet and gaming addiction, which warrants serious consideration [7,8].\u003c/p\u003e \u003cp\u003eThe use of addictive substances and digital activities may lead to significant adverse effects. The impacts may be immediate or enduring [9]. Immediate effects may encompass impulsive behaviors, cognitive deficits, and increased risk of injury. Conversely, long-term effects may include chronic illnesses, mental health disorders, and social issues, such as diminished productivity and possible social isolation [10]. Addictive behaviors are associated with disturbances in the dopamine system and changes in the prefrontal cortex. This results in individuals needing greater quantities to achieve equivalent satisfaction, thereby complicating efforts to regulate their impulses towards substance use or specific behaviors [11,12]. Upon successfully discontinuing such behaviors, individuals frequently face challenges including withdrawal symptoms, the potential for relapse, and the need to cultivate healthy social relationships. Rehabilitation strategies are regarded as a more feasible and effective approach to support individuals ensnared in cycles of addiction. This approach necessitates a comprehensive method for interventions to enhance thoroughness and sustainability [13,14].\u003c/p\u003e \u003cp\u003ePreventive strategies should be prioritized over rehabilitation methods for addiction prevention. These measures are generally more effective and efficient in reducing the likelihood of developing dependencies. Research demonstrates that preventive strategies such as health promotion, life skills training, and character education within families can enhance resilience to social pressures and various risk factors [15]. Character education plays a crucial role in addiction prevention by promoting robust moral, religious, and ethical values, as well as social skills, from an early age [16]. An essential component of character education to impart early is the notion of religiosity [17]. Establishing a spiritual mindset and behavior early in life provides individuals with meaning and purpose, which enhances their ability to resist impulsive behaviors that may result in addiction. Engaging in religious practices, such as worship, can foster inner peace and strengthen spiritual identity, assisting individuals in navigating life's challenges [18\u0026ndash;20]. Preventative efforts to enhance religiosity are considered effective in addressing addiction, as they create environments that promote positive behavior [21,22]. This review aims to assess the correlation between an individual's level of religiosity and the reduction of substance use and the potential for addiction to gaming and internet activities.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eThis systematic review and meta-analysis adhered to the PRISMA 2020 guidelines and statements. The review protocol is registered in PROSPERO under ID number CRD42025636170.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEligibility Criteria\u003c/h2\u003e \u003cp\u003eInclusion and exclusion criteria were defined to assess data relevance prior to the literature search. The inclusion criteria included: (1) Population: Individuals of any age, gender, or cultural background; (2) Exposure: Religiosity as the primary exposure, measurable through religious practices (e.g., praying, attending worship services), applied religious values, or any instrument assessing religiosity; (3) Comparison: Groups with lower levels of religiosity, atheists, or secular individuals; (4) Outcome: Behaviors such as not smoking, abstaining from alcohol, avoiding drug use, and reduced internet or gaming addiction; (5) Research design: Quantitative studies, including cross-sectional, cohort, and case-control studies. Exclusion criteria consisted of: (1) Text articles that could not be accessed in full; (2) Inappropriate language; (3) Protocols.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSources and Data Search\u003c/h3\u003e\n\u003cp\u003eA literature search was performed utilizing seven databases: PubMed, Cochrane CENTRAL, Taylor and Francis, Scopus, EBSCO, ScienceDirect, and Google Scholar. The search was conducted until December 15, 2024. All terms adhered to MeSH (Medical Subject Headings) standards and were combined using Boolean operators, yielding the following keywords: (religiosity OR spirituality) AND (smoking OR tobacco OR alcohol OR addiction OR drugs) AND (randomised OR randomised OR quasi OR observational OR cohort OR case control OR cross-sectional OR prospective OR retrospective). Advanced method searches were conducted on databases that provided these features.\u003c/p\u003e\n\u003ch3\u003eStudy Selection\u003c/h3\u003e\n\u003cp\u003eAll studies from the database were compiled using Rayyan.ai. The PRISMA flow chart illustrates the search and study selection process. Following the removal of duplicates, three independent reviewers (MFH, EI, CAW) and two collaborators (JRA, MIS) conducted a screening of all collected articles based on year, title, and abstract. Subsequently, full-text articles were evaluated for eligibility. In instances of conflict, AN served as a mediator.\u003c/p\u003e\n\u003ch3\u003eData Extraction and Analysis\u003c/h3\u003e\n\u003cp\u003eAll authors extracted key information from each study and presented it in an extraction table. The data obtained from the chosen studies included study identity, country of origin, sample size, distribution of religiosity levels, measuring instruments, study design, and the results or findings of the study. All inclusion studies were synthesized for inference.\u003c/p\u003e\n\u003ch3\u003eRisk of Bias Assessment\u003c/h3\u003e\n\u003cp\u003eThe selection of instruments for measuring research quality was determined by the study design of the included studies. All authors conducted the risk of bias assessment independently, with the majority judgment applied in the event of any conflict. The New Castle Ottawa Scale (NOS) was chosen for cohort studies. This instrument evaluates three primary domains: selection bias, comparability, and outcome. The highest possible score for this instrument is 9. Studies are classified as high quality with a final score of \u0026ge;\u0026thinsp;7, moderate quality with a score of 5\u0026ndash;6, and low quality with a score of \u0026lt;\u0026thinsp;5. The Critical Appraisal Skills Programme (CASP) was selected for the evaluation of cross-sectional studies. The instrument comprises 11 questions designed to evaluate the study's purpose and relevance, the appropriateness of the study design, the description of the target population and the representativeness and absence of bias in the sample, the validity and reliability of data collection methods, the suitability of data analysis and consideration of causal factors or biases, the clarity of result reporting, the support of conclusions by valid data, and the applicability of study results to a broader context. A score of 1 indicates 'Yes', 0.5 indicates 'Unclear', and 0 indicates 'No'.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative Data Synthesis (Meta-Analysis)\u003c/h2\u003e \u003cp\u003eReview Manager 5.4.1. (The Nordic Cochrane Center, The Cochrane Collaboration, Copenhagen) was used to quantitatively analyse the data. The probabilities of samples not utilizing the substance were obtained alongside the total sample size for each group (religious and non-religious). Pooled effects were analysed with a random effects model (REM) given the diversity of the characteristics of each inclusion study. The analysis employed the Mantel-Haenszel method, utilizing the odds ratio (OR) and a 95% confidence interval as the effect size measures. Sensitivity analysis was performed to identify outlier studies that may influence the degree of heterogeneity.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStudy Selection Results and Risk of Bias Assessment\u003c/h2\u003e \u003cp\u003eAfter the search process in seven databases, 5,157 articles were collected. A total of 2,119 duplicate articles were removed and 1704 articles were detected as not meeting the criteria by the automated tool, leaving 1,334 articles for manual selection based on title and abstract. A total of 1,277 articles were excluded, because they met the exclusion criteria or did not meet the inclusion criteria by reading the title and abstract. This left 57 articles to be accessed and read in full. A total of 10 articles could not be accessed in full, so they were excluded. A comprehensive article assessment was conducted on 47 articles. A total of 6 articles had outcomes that were not in line with the objectives of this review, 4 studies had study designs that were also inappropriate. The final result of the selection process was 37 inclusion articles. Details of the selection process can be seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA total of 4 inclusion studies whose study design was a cohort were assessed for risk of bias using the New Castle Ottawa Scale. Only one study showed a moderate risk of bias, namely the study by Carra et al. (2023). The other three studies showed a low risk of bias. The risk of bias assessment heatmap can be seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThere were 33 studies that had a cross-sectional study design that were analysed using CASP. All studies analysed using this instrument showed a low risk of bias, although there were some aspects of the questions that showed doubt or vagueness, especially in question 6 relating to the control of confounding variables. The results of the CASP analysis can be seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Synthesis\u003c/h2\u003e \u003cp\u003eThere were 37 studies conducted across five continents, South America (Brazil), North America (United States), Europe (Norway, Finland, Hungary, France, Spain, Germany, Italy and Czech Republic), Asia (Israel, Iran, Saudi Arabia, Jordan, Hong Kong, Pakistan and South Korea) and Africa (South Africa). The study collectively involved a total of 302,948 participants, covering a wide range of age groups (10 years to over 80 years). The participants came from various backgrounds, such as students, college students, military veterans, patients with specific health conditions (e.g. HIV/AIDS, cleft lip and palate, asthma), and the general population. The religions studied were categorized into broad groups, including Christianity (e.g., Catholic, Protestant, and Orthodox), Islam (both religious and non-religious Muslims), Judaism, and secular or non-religious affiliations. Measures of religiosity are largely divided based on organizational religiosity (e.g., attendance at religious services), non-organizational religiosity (e.g., personal religious practices such as prayer), and intrinsic religiosity (e.g., application of faith in life).\u003c/p\u003e \u003cp\u003eOf the studies that examined alcohol use, 19 studies reported a significant negative association between religiosity and alcohol use, with higher religiosity associated with reduced alcohol consumption or abuse. Higher intrinsic religiosity scores significantly reduced alcohol use (p\u0026thinsp;=\u0026thinsp;0.002 [23]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 [24]; p\u0026thinsp;=\u0026thinsp;0.005 [25]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 [26]). Organizational religiosity also showed a significant effect on water pipe smoking (p\u0026thinsp;=\u0026thinsp;0.005 [23]; p\u0026thinsp;=\u0026thinsp;0.009 [24]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 [26]). Non-organizational religiosity had mixed findings, significant in Celestino (2024) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) but not in Queiroz (2015) (p\u0026thinsp;=\u0026thinsp;0.504) [23][26]. Extrinsic religiosity also showed a significant negative association with alcohol use (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [27].\u003c/p\u003e \u003cp\u003eCorrelations between religiosity and drug use show mixed results. A significant negative correlation, higher levels of religious involvement often serve as a protective factor against drug abuse. For example, intrinsic religiosity significantly impacts cannabis use (p\u0026thinsp;=\u0026thinsp;0.001) [28], while extrinsic religiosity shows varying effects. Similarly, a significant negative association between subjective religiosity and cannabis use (b = -0.29, OR = -0.75, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [27]. Everhart (2023) revealed an inverse relationship between strong religious beliefs and cannabis use (β = -0.051, p\u0026thinsp;=\u0026thinsp;0.001) [29]. Rezende-Pinton (2018) noted that organizational religiosity delays the onset of drug use [30].\u003c/p\u003e \u003cp\u003eThe relationship between religiosity and tobacco/cigarette use shows mixed results. Overall, out of 19 stmudies, 12 reported significant findings. Intrinsic religiosity was significantly associated in studies such as Morawa (2018) (p\u0026thinsp;=\u0026thinsp;0.009) and Queiroz (2015) (p\u0026thinsp;=\u0026thinsp;0.004) [25][26]. Non-organizational religiosity was also related to smoking reduction in Nabipour (2017) (p\u0026thinsp;=\u0026thinsp;0.027) but showed weaker significance in Queiroz (2015) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) [26][31]. Organizational religiosity had mixed results; although it significantly reduced smoking with cigarette and water pipe in (p\u0026thinsp;=\u0026thinsp;0.014) [31], organizational religiosity was positively associated with smoking in (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [26].\u003c/p\u003e \u003cp\u003eOf the 5 studies, all reported a significant negative relationship between religiosity and gaming or internet use, indicating that higher religiosity is associated with reduced problem behaviors. For example, Pong (2022) found that spiritual well-being was inversely correlated with dimensions of gaming addiction (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [32], and Nadeem (2019) showed intrinsic religiosity reduced internet use among Muslim students (β=-0.121, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) [33]. Arani (2019) reported a significant negative correlation between spiritual attitudes and addiction potential (r=-0.25, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [34]. However, studies such as Kadar (2023) did not find a significant relationship with video games, suggesting possible cultural or methodological differences [35].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eForest plot\u003c/h2\u003e \u003cp\u003eAs a result of the meta-analysis, religious individuals had an odds ratio (OR) of 2.34 (95% CI: 1.32\u0026ndash;4.15) for avoiding alcohol consumption compared to non-religious individuals. The analysis of drug use found an odds ratio of 3.56 (95% CI: 1.39\u0026ndash;9.08), which was also statistically significant (p\u0026thinsp;=\u0026thinsp;0.008). These results also showed significant variation between studies (I\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;97%). Compared to the alcohol category, heterogeneity between studies was lower (I\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;74%), and the meta-analysis showed that religiosity had a significant association with nicotine use avoidance, with an OR of 1.93 (95% CI: 1.36\u0026ndash;2.73). This category also showed significant results (p\u0026thinsp;=\u0026thinsp;0.0002) and high heterogeneity (I\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;65%). Overall, religious individuals were 2.29 times more likely to avoid unhealthy behaviours (95% CI: 1.61\u0026ndash;3.27) than non-religious individuals. This analysis was significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001), but the level of pooled heterogeneity was high (I\u0026sup2; = 94%), indicating variation in methodology, population, or other factors among the studies analysed. Forest plot of impact religiosity towards substance use can be seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs part of the sensitivity analysis, this meta-analysis was re-run with certain data adjusted or removed to assess the stability and consistency of previous results. The sensitivity analysis regarding the presence or absence of alcohol consumption resulted in an odds ratio (OR) of 2.95 (95% CI: 2.18 to 3.98), which remained statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001). The degree of heterogeneity was significantly reduced to I\u0026sup2; = 62% compared to the main analysis (I\u0026sup2; = 97%). This decrease in heterogeneity is most likely due to the removal of data from Francis (2019) who previously reported different results from other studies. Removing this data will improve consistency across studies. Similarly, in the sensitivity analysis for the no nicotine category, the OR was 1.71 (95% CI: 1.39\u0026ndash;2.10), and the result remained significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001). Heterogeneity in this category decreased significantly to I\u0026sup2; = 0%, indicating that the results were highly consistent across studies after adjustment. This reduction in heterogeneity may be due to the removal of data from Martinez (2021), which previously showed non-significant results (CIs included a value of 1) and contributed to heterogeneity. In the substance use category, there were only two studies, so sensitivity analyses were not conducted. Overall, the odds ratio after sensitivity analysis was 2.51 (95% CI: 1.86\u0026ndash;3.37) and remained significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001). The degree of pooled heterogeneity was slightly reduced compared to the main analysis (I\u0026sup2; = 94%), I\u0026sup2; = 79%. This reduction reflects the positive effect of excluding studies that found different results or outliers. Forest plot of impact religiosity towards substance use after sensitivity analysis can be seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study's results demonstrate that the majority of research indicates a significant negative correlation between religiosity and the use of alcohol, drugs, and tobacco. The influence of religiosity on the reduction of unhealthy behaviors is significant, as evidenced by a meta-analysis indicating that religious individuals are more likely to avoid such behaviors overall (OR 2.29), including alcohol consumption (OR 2.34), drug use (OR 3.56), and nicotine use (OR 1.93). Religiosity manifests through participation in religious activities, encompassing both individual and organized beliefs. Religiosity serves as a framework for human existence, impacting socio-cultural interactions and influencing behavior [36]. Religiosity contributes to stress reduction, fosters a sense of calm, enhances resilience, and offers problem-solving strategies, enabling individuals to confront challenging circumstances [37]. Individuals exhibiting strong religiosity often demonstrate the capacity for delayed gratification and possess effective self-control skills, which contribute to a reduction in reliance on addictive behaviors [37]. In addition, religiosity can prevent risky behaviors such as drug use and others by influencing moral acceptance, reducing attraction to addictive behaviors, limiting opportunities, and increasing self-control [38].\u003c/p\u003e \u003cp\u003eNumerous studies indicate a negligible relationship between religiosity and addictive behaviors, including alcohol, drug, and tobacco use. Potential explanations for this insignificance include sample heterogeneity and the intricate interactions between religiosity and other variables. Variability in sample characteristics, such as age, gender, and education level, may influence outcomes, resulting in non-significant findings or elevated I\u0026sup2; values. Additionally, factors such as environmental context, genetics, and socioeconomic status may obscure the relationship between religiosity and addictive behavior. Addictive behaviors are influenced by the surrounding environment, including familial and social relationships, which can convey beliefs and moral values that deter such behaviors [39]. A person who develops with a poor environment and religiosity can increase the risk of misbehavior [40].\u003c/p\u003e \u003cp\u003eThe five inclusion studies indicated a significant negative correlation between religiosity and internet game addiction; specifically, individuals with lower levels of religiosity are more likely to engage in excessive gaming and internet use. Religiosity may mitigate game and internet addiction by alleviating stress, enhancing self-control, offering a sense of purpose, fostering community support through religious engagement, and promoting the pursuit of more constructive leisure activities [37]. The inclusion studies investigating the relationship between religiosity and gaming/internet could not be subjected to meta-analysis due to a limited number of studies, heterogeneous measurement instruments, and the absence of data such as odds ratios or mean differences.\u003c/p\u003e \u003cp\u003eNine inclusion studies in this research utilized the Duke University Religion Index (DUREL) instrument to measure religiosity. The DUREL measures religiosity through three dimensions: organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiosity (IR). Among the nine inclusion studies, six demonstrate a negative relationship between ORA and addictive behavior, two indicate a negative relationship between NORA and addictive behavior, and eight reveal a relationship between IR and addictive behavior. The data indicates that the dimension of religiosity exhibiting the strongest negative correlation with addictive behavior is IR. IR is assessed through three inquiries: the degree to which an individual perceives God's presence in their life, the correlation between religious beliefs and life experiences, and the endeavors to implement religious teachings across all facets of daily existence [41]. Individuals with elevated intrinsic religiosity who align their lives with religious values, perceive a divine presence, and endeavor to adhere to religious teachings have been identified as a protective factor against addictive behaviors [42].\u003c/p\u003e \u003cp\u003eVarious inclusion studies assess religiosity through diverse instruments and question formats. Examples of instruments utilized include the Religious Commitment Index, which assesses religiosity through ten questions, the Spiritual Well-Being Questionnaire (SWBQ) that evaluates four dimensions of spiritual well-being, Kendler's General Religiosity Scale measuring the intensity of religious beliefs, as well as the assessments of Subjective Religiosity (SR) and Organizational Religiosity (OR), among other tools and inquiries. Many of these instruments classify the research sample into religious and non-religious categories, indicating that a higher score corresponds to a greater level of religiosity. Several inclusion studies examine the correlation between religiosity and addictive behavior through the use of adjusted and unadjusted models. The adjusted model indicates that variables potentially influencing the results, including the sociodemographic characteristics of the sample, will be controlled during data analysis. The unadjusted model indicates that variables potentially influencing the results are not controlled in the data analysis.\u003c/p\u003e \u003cp\u003eThis review represents the inaugural systematic meta-analysis evaluating the role of religiosity in mitigating addictive behaviors, encompassing alcohol, drug, tobacco, and gaming/internet usage. The inclusion studies encompassed research from multiple continents, featuring samples that represented all age groups and diverse backgrounds. The risk of bias assessment for these inclusion studies indicated a low risk of bias, suggesting that the research is both reliable and valid. One study employing a cohort design exhibits a risk of bias score of 6, as it inadequately details the initial conditions of the sample and the follow-up process. Additionally, eight studies employing a cross-sectional design received a score of 0.5 in the confounders controlled domain due to unclear identification of confounding variables. Two studies scored 0.5 in the representative sample domain, as the explanation regarding sample representation and selection is insufficient. Furthermore, two studies attained a score of 0.5 in the reliable outcome measurement domain, as there is a lack of clarity regarding the validity of the instruments used. The meta-analysis exhibits significant heterogeneity attributable to the varied sample characteristics in this study. Subgroup analysis and meta-regression are not feasible because of the insufficient number of studies available for quantitative analysis. This study employs sensitivity analysis to address high sample heterogeneity by excluding data from outlier studies. Specifically, it omits Francis (2019), which reported divergent results compared to other studies, and Martinez (2021), which yielded insignificant results (CI includes a value of 1) and contributed to the observed heterogeneity.\u003c/p\u003e \u003cp\u003eThis review highlights the beneficial role of religiosity in reducing the risk of addiction related to substance use and internet/gaming. These findings suggest that instilling religious values in children from an early age can be advantageous. Additionally, increasing the construction of places of worship may serve to enhance religious engagement within the community.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis review presents evidence highlighting the beneficial impact of religiosity on the prevention of detrimental lifestyle habits, specifically regarding substance use, including drugs, alcohol, and nicotine, as well as addictions to the internet and gaming. Increased religiosity is correlated with a reduction in substance use incidence and may mitigate the risk of future addictions that could lead to harm. Further studies employing uniform methods for presenting results are necessary to facilitate meta-regression and subgroup analyses, thereby yielding more specific outcomes based on sample characteristics.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAll the authors declare that there are no conflicts of interest.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCastaldelli-Maia JM, Bhugra D. Analysis of Global Prevalence of Mental and Substance Use Disorders Within Countries: Focus on Sociodemographic Characteristics and Income Levels. International Review of Psychiatry. 2022;34(1).\u003c/li\u003e\n \u003cli\u003eHani. 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SSM - Population Health. 2021;14:100766.\u003c/li\u003e\n \u003cli\u003eMartinez EZ, Bueno-silva CC, Bartolomeu IM, et al. Undergraduate Health Sciences Students. Trends Psychiatry Psychother. 2021;43(1):17\u0026ndash;22.\u003c/li\u003e\n \u003cli\u003eQueiroz NDR, Portella LF, Abreu AMM. Association between Alcohol and Tobacco Consumption and Religiosity. ACTA Paulista de Enfermagem. 2015;28(6):546\u0026ndash;552.\u003c/li\u003e\n \u003cli\u003eCelestino LC, Fukushiro AP, Cintra FMRN, et al. Religiosity and Alcohol Use in Adolescents with Orofacial Cleft: Correlational Study. Rev Paul Pediatr. 2024;43:e2023265.\u003c/li\u003e\n \u003cli\u003eCelik I. Does Religiosity Matter? The Role of Subjective and Organizational Religiosity on Substance Use Among Adolescents. Child Youth Care Forum. Springer; 2024. p. 909\u0026ndash;930.\u003c/li\u003e\n \u003cli\u003eEverhart RS, Lohr KD, Ramos MS, et al. Perceived Stress, Religiosity, and Substance Use Among African American and Latinx College Students with Asthma in the USA. J Relig Health. 2023;62(2):1050\u0026ndash;1069.\u003c/li\u003e\n \u003cli\u003eJokela M, Laakasuo M. Health Trajectories of Individuals Who Quit Active Religious Attendance: Analysis of Four Prospective Cohort Studies in the United States. Soc Psychiatry Psychiatr Epidemiol. 2024;59(5):871\u0026ndash;878.\u003c/li\u003e\n \u003cli\u003eK\u0026aacute;d\u0026aacute;r BK, P\u0026eacute;ter L, Paksi B, et al. Religious Status and Addictive Behaviors: Exploring Patterns of Use and Psychological Proneness. Compr Psychiatry. 2023;127.\u003c/li\u003e\n \u003cli\u003eKaur A, Lal R, Sen MS, et al. Psychosocial Correlates of Recovery Capital in Alcohol and Opioid-Dependent Patients: A Cross-Sectional Comparative Study. Indian J Soc Psychiatry. 2023;39(1):36\u0026ndash;41.\u003c/li\u003e\n \u003cli\u003eGuimar\u0026atilde;es MO, de Lima Guimar\u0026atilde;es G, da Silva JWR, et al. Does Religiosity Impact Binge Drinking Among Early Adolescents? A Cross-Sectional Study in A City in Southeastern Brazil. Ciencia e Saude Coletiva. 2022;27(9):3669\u0026ndash;3678.\u003c/li\u003e\n \u003cli\u003eIshaq B, \u0026Oslash;stby L, Johannessen A. Muslim Religiosity and Health Outcomes: A Cross-Sectional Study Among Muslims in Norway. SSM Popul Health. 2021;15.\u003c/li\u003e\n \u003cli\u003eBrito MA, Amad A, Rolland B, et al. Religiosity and Prevalence of Suicide, Psychiatric Disorders and Psychotic Symptoms in the French General Population. Eur Arch Psychiatry Clin Neurosci. 2021;271(8):1547\u0026ndash;1557.\u003c/li\u003e\n \u003cli\u003eLivne O, Wengrower T, Feingold D, et al. Religiosity and Substance Use in U.S. Adults: Findings from A Large-Scale National Survey. Drug Alcohol Depend. 2021;225.\u003c/li\u003e\n \u003cli\u003eDoolittle BR, McGinnis K, Ransome Y, et al. Mortality, Health, and Substance Abuse by Religious Attendance Among HIV Infected Patients from the Veterans Aging Cohort Study. AIDS Behav. 2021;25(3):653\u0026ndash;660.\u003c/li\u003e\n \u003cli\u003eBuchtova M, Malinakova K, Kosarkova A, et al. Religious Attendance in A Secular Country Protects Adolescents from Health-Risk Behavior Only in Combination with Participation in Church Activities. Int J Environ Res Public Health. 2020;17(24):1\u0026ndash;13.\u003c/li\u003e\n \u003cli\u003eFrancis JM, Myers B, Nkosi S, et al. The Prevalence of Religiosity and Association Between Religiosity and Alcohol Use, Other Drug Use, and Risky Sexual Behaviours Among Grade 8-10 Learners in Western Cape, South Africa. PLoS One. 2019;14(2).\u003c/li\u003e\n \u003cli\u003eCharro Baena B, Meneses C, Caperos JM, et al. The Role of Religion and Religiosity in Alcohol Consumption in Adolescents in Spain. J Relig Health. 2019;58(5):1477\u0026ndash;1487.\u003c/li\u003e\n \u003cli\u003eNordfj\u0026aelig;rn T. Religiosity and Alcohol Use: Is Religiosity Important for Abstention and Consumption Levels in the Second Half of Life? Subst Use Misuse. 2018;53(14):2271\u0026ndash;2280.\u003c/li\u003e\n \u003cli\u003eIsralowitz R, Reznik A, Sarid O, et al. Religiosity as a Substance Use Protective Factor Among Female College Students. J Relig Health. 2018;57(4):1451\u0026ndash;1457.\u003c/li\u003e\n \u003cli\u003eMohammadpoorasl A, Ghahramanloo AA, Allahverdipour H, et al. Substance Abuse in Relation to Religiosity and Familial Support in Iranian College Students. Asian J Psychiatr. 2014;9:41\u0026ndash;44.\u003c/li\u003e\n \u003cli\u003eJokela M, Laakasuo M. Health Trajectories of Individuals Who Quit Active Religious Attendance: Analysis of Four Prospective Cohort Studies in the United States. Soc Psychiatry Psychiatr Epidemiol. 2024;59(5):871\u0026ndash;878.\u003c/li\u003e\n \u003cli\u003eReza Karimirad M, Khodadoust B, Gholami A, et al. Substance Use and its Related Factors Among Iranian University Students [Internet]. Article in Pakistan Journal of Medical \u0026amp; Health Sciences. 2021. Available from: https://www.researchgate.net/publication/350823036.\u003c/li\u003e\n \u003cli\u003eBurdette AM, Hill TD, Webb NS, et al. Religious Involvement and Substance Use Among Urban Mothers.\u003c/li\u003e\n \u003cli\u003eDebnam KJ, Milam AJ, Mullen MM, et al. The Moderating Role of Spirituality in the Association between Stress and Substance Use among Adolescents: Differences by Gender. J Youth Adolesc. 2018;47(4):818\u0026ndash;828.\u003c/li\u003e\n \u003cli\u003eBahr SJ, Hoffmann JP. Parenting Style, Religiosity, Peers, and Adolescent Heavy Drinking*. Stud. Alcohol Drugs. 2010.\u003c/li\u003e\n \u003cli\u003eHill TD, Bostean G, Upenieks L, et al. (Un)holy Smokes? Religion and Traditional and E-Cigarette Use in the United States. J Relig Health. 2024;63(2):1334\u0026ndash;1359.\u003c/li\u003e\n \u003cli\u003eRajab TM, Saquib J, Rajab AM, et al. The Associations of Religiosity and Family Atmosphere with Lifestyle among Saudi Adolescents. SSM Popul Health. 2021;14.\u003c/li\u003e\n \u003cli\u003eMartinez EZ, Bueno-Silva CC, Bartolomeu IM, et al. Relationship between Religiosity and Smoking among Undergraduate Health Sciences Students. Trends Psychiatry Psychother. 2021;43(1):17\u0026ndash;22.\u003c/li\u003e\n \u003cli\u003eAl-Shatnawi SF, Alzoubi KH, Khabour OF. Withdrawal Symptoms among Cigarette and Waterpipe Smokers: A Study in Natural Setting. Clinical Practice \u0026amp; Epidemiology in Mental Health. 2021;17(1):114\u0026ndash;120.\u003c/li\u003e\n \u003cli\u003eMartinez EZ, Giglio FM, Terada NAY, et al. Smoking Prevalence Among Users of Primary Healthcare Units in Brazil: The Role of Religiosity. J Relig Health. 2017;56(6):2180\u0026ndash;2193.\u003c/li\u003e\n \u003cli\u003eAllahverdipour H, Abbasi-Ghahramanloo A, Mohammadpoorasl A, et al. Cigarette Smoking and its Relationship with Perceived Familial Support and Religiosity of University Students in Tabriz.\u003c/li\u003e\n \u003cli\u003eShim JY. Christian Spirituality and Smartphone Addiction in Adolescents: A Comparison of High-Risk, Potential-Risk, and Normal Control Groups. J Relig Health. 2019;58(4):1272\u0026ndash;1285.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Islam Maulana Malik Ibrahim","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Religiosity, Smoking, Alcohol, Drug Use, and Internet/Gaming Addiction","lastPublishedDoi":"10.21203/rs.3.rs-6538335/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6538335/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAddiction to substances and gadgets is still a global problem. Not only among teenagers, even adults are also vulnerable to getting trapped in it. When addiction occurs, more problems can occur such as impulsive behaviour and loss of self-control. This is why preventive steps should be the first choice over rehabilitative ones. One of the preventive measures that can be taken from an early age is to instil religious behaviour in oneself. The purpose of this study is to determine the effectiveness of religiosity on reducing the incidence of substance use and games/internet that potentially cause addiction. This review was conducted based on PRISMA 2020 checklist. Forest plot was made using Review manager v5.4 with Odds ratio as measure effect. The inclusion study characteristics and findings from each study were summarised in an extraction table and then synthesised qualitatively. Overall, both qualitative and quantitative synthesis showed a significant reduction in substance use in the religious group (Pooled OR= 2.29, 95% CI [1.61, 3.27], p\u0026lt;0.00001, I²=94%). Likewise, with the use of games/internet, there was a decrease in the tendency of addiction in the religious group. Higher levels of religiosity were shown to be associated with a decrease in the incidence of substance use and may prevent future addictions that have the potential to cause harm. However, further studies with consistent methods of presenting results are needed so that meta-regression and subgroup analyses can be conducted to obtain more specific result based on sample characteristics.\u003c/p\u003e","manuscriptTitle":"The Power of Faith: A Systematic Review and Meta-Analysis on Religiosity’s Influence on Smoking, Alcohol, Drug Use, and Internet/Gaming Addiction","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-29 07:28:02","doi":"10.21203/rs.3.rs-6538335/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1a3e1d9c-51c1-4d0d-b54a-7c2c3cc6d2a5","owner":[],"postedDate":"April 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47736109,"name":"Psychology"},{"id":47736110,"name":"Sociology"}],"tags":[],"updatedAt":"2025-04-29T07:28:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-29 07:28:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6538335","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6538335","identity":"rs-6538335","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}