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This self-administered mail survey study conducted along the US-Mexico border replicates and expands on research conducted in Florida regarding the prevalence of juramento use as an intervention technique for alcohol misuse. Juramentos are pledges to abstain from alcohol use for a time determined by the user. The pledge is usually to the Virgin of Guadalupe and is often done in the presence of a Roman Catholic Priest. As in Florida, the majority of Priests along the border reported they were familiar with the practice of juramentos and had already witnessed at least one. The majority of Priests who had done juramentos viewed them as effective. Since the vast majority of Priest indicated that they would begin or continue witnessing juramentos, this makes juramentos and Roman Catholic Priests a viable culturally sensitive aide for treatment among Hispanics, in particular those of Mexican descent.
Disparities in seeking, accessing, and completing substance abuse treatment among Hispanics when compared to Whites and in some instances Blacks, even when court ordered, has been extensively documented (Alegria et al., 2006; Arroyo, Westerberg, & Tonigan, 1998; Bluthenthal, Jacobson, & Robinson, 2007; Caetano, 1993; Canino, Anthony, Freeman, Shrout, & Rubio-Stipec, 1993; Evans, Jaffe, Uranda, & Anglin, 2012; Guerrero et al. 2013; Guerrero, Marsh, Khachikian, Amaro, & Vega, 2013; Hoffman, 1994; Lundgren, Amodeo, Ferguson, & Davis, 2001; Schmidt, Ye, Greenfield, & Bond, 2007; Spence, Wallisch, & Smith, 2007; US Department of Health and Human Services, 2001; Wells, Klap, Koike, & Sherbourne, 2001). Culturally relevant factors to Hispanics living in an Anglo-dominant society have been presented as explanations for the disparities. Among the prevalent factors given are: 1) difficulty or resistance on the part of the user in admitting they have a problem, 2) aversion to bringing shame to the family, 3) concerns about stigma and community disapproval, 4) distrust of public agencies, 5) lack of economic resources and/or insurance, and 6) lack of or low proficiency in English (Altarriba & Santiago-Rivera, 1994; Arredondo, Weddige, Justice, & Fitz, 1987; Canino, Anthony, Freeman, Shrout, & Rubio-Stipec, 1993; Cuadrado & Lieberman, 2002; Delgado, 1998; Finn, 1994; Gloria & Peregoy, 1996; Kail & Elberth, 2002; Panitz, McConchi, & Sauber, 1983; Perron et al., 2009; Saloner & Lé Cook, 2013; Shorkey, Cambraia, & Spence, 2009; Zemore, Mulia, Borges, & Greenfield, 2009).
While the importance of family for Hispanics has become a defining characteristic, religion and/or spirituality are also a prominent component of 2 Hispanic life and values. According to the Pew Hispanic Center (2007, p. 17) “more than nine-in-ten Hispanics identify with a specific religion.” Furthermore, they state that “...Latinos appear to be different [from the rest of the U.S. population], both in the intensity of their beliefs and in how they practice those beliefs” (Pew Hispanic Center, 2007, p. 17). Most Hispanics continue to identify themselves as Roman Catholic, although the number has dropped to 55% (Pew Research Religion and Public Life Project, 2014).
Clergy have been found to be among the top resources Hispanics report they have used (or would use) if they needed help for a family problem (Bermudez, Kirkpatrick, Hecker, & Torres-Robles, 2010), in case of domestic violence, in particular among women (Hancock, Ames, & Behnke, 2014; Vaaler, 2008) and for substance abuse problems (Perron et al., 2009). Kane & Williams (2000) and Kane (2003) asked subjects whom they would seek help from (nobody, Priest, Priest with helping profession degree or lay professional) regarding 11 moral, emotional, family and personal situations, where one of the situations was “personal alcohol abuse.” In the first study Anglos were found to be more likely to seek help from a layperson credentialed in a helping profession while Hispanics preferred Priests (with or without credentials) in all the situations. In the second study, which compared the perceptions of Priests and parishioners regarding who would be best to seek assistance from, both Hispanic Priests and Hispanic parishioners were more likely than their Anglo counterparts to perceive Priests as the best source for help.
Given the documented disparities for Hispanics regarding substance abuse treatment and their apparent preference for use of clergy in times of trouble it makes exploring treatment alternatives that use faith and clergy a worthy effort if the disparity gap is to be closed. One possible alternative to formal substance abuse treatment, particularly for alcohol misuse/abuse, is the use of juramentos.
Juramentos, a widely used abstinence mechanism created in Mexico, are pledges made to a Saint, very often the Virgin of Guadalupe, to abstain from consuming alcohol (or other drugs) for a specific amount of time determined by the user. These pledges are made usually in front of a Priest or other witness (Cuadrado & Lieberman, 2011; Puleo, 2012; Zabicky and Solis, 2000). Juramentos are not to be confused with Mandas where the person pledges to sacrifice in some way (e.g. not cut their hair, dress in white robes for a year or more, abstain from engaging in certain behavior, etc.) in exchange for the granting of a request. As indicated by Brandes (2002, pp. 36-37) “juramentos differ from Mandas in the way the supplicant reciprocates. When an alcoholic makes a juramento and becomes sworn against liquor, no gift is presented to the Saint other than the faithfulness of the vow. The ability to control oneself, at the risk of divine retribution for failing, seems to provide reward enough for the Virgin.”
This present study replicates and expands on a study conducted among Roman Catholic Priests in Florida regarding the use of juramentos (Cuadrado & Lieberman, 2011). In the Florida study, using relevant diocese webpage information, a mail survey was sent to Priests in parishes located in counties where at least 10% of the population was Hispanic according to the US Census 2004. Counties with at least 10% Hispanic population in 2004 were Miami-Dade, Hendry, Hardee, Osceola, Desoto, Collier, Orange, Okeechobee, Hillsborough, Broward, Monroe, Glades, Palm Beach, Highlands and Seminole. The questionnaire in the Florida survey asked Priests about their awareness of and participation in juramentos, characteristics of the juramentos and jurados (those making the juramento), willingness of the Priest to begin/continue witnessing juramentos, whether the Priest self-identified as Hispanic, and about his fluency in Spanish. The present study while focusing on the same questions (see Methods section below) expands on the Florida study by exploring the extent to which juramentos are used in 4 states along the US-Mexico border (Texas, New Mexico, Arizona and California) and adds questions regarding the views of the Priests regarding the effectiveness of this practice. Given that individuals of Mexican origin constitute 63% of the group we refer to as Hispanic in the United States (US Census, 2011) understanding this practice from the point of view of Roman Catholic Priest, who serve as witness to the pledge, can provide insights on a culturally sensitive way of closing the substance abuse treatment disparity gap.
Using name and address information obtained from the web pages of dioceses along the US-Mexico border (Texas to California), a survey packet containing a consent letter and questionnaire (both in English and Spanish) was mailed to each Roman Catholic Priest located at each Church listed within the dioceses. The 14-item questionnaire contained a brief definition of a juramento and asked if the Priest were aware of juramentos and had ever served as a witness in one. Among the questions asked of Priests who had witnessed a juramento were the usual length of time of juramentos, who the pledge was made to, about family involvement, and their perception regarding the effectiveness of juramentos. All Priests were asked whether they identified themselves as Hispanic, about their fluency in Spanish, and whether they would continue (or begin if asked) to witness juramentos. Of 508 packets mailed 489 were successfully delivered (i.e., the packet was not returned by the Post Office or the Church indicating that the Priest was no longer there). Of the 489 packets delivered 196 (40%) surveys were completed and returned. The completion rate for this study was higher than was achieved in the Florida study where only 33% of contacted Priests completed and returned the survey.
This study was approved by the Institutional Review Board at the University of Texas at El Paso on July 29,2011 under #165347-2. The data was analyzed using SPSS for Mac Version 21 Descriptive Statistics (Frequencies and Crosstabs with Pearson Chi-Square).
Of the 196 Priests who responded to the survey, 39% responded in the affirmative when asked “Do you consider yourself Hispanic?” While 52% of the Priests reported being fluent in Spanish, almost a third (28.9%) reported having only “a little” or no Spanish fluency.
Sixty percent of the Priests responding to the survey reported that they had heard of juramentos or something similar with 53% reporting having heard specifically of juramentos. Of those Priests who had heard about juramentos, 72% reported having been a witness at least once. In the Florida study less than half (45.7%) of the Priests had heard of juramentos or something similar and only 60% had witnessed a juramento. Since juramentos originate from Mexico the greater incidence of Priests along the border witnessing a juramento is likely due to a greater concentration of Hispanics, in particular those of Mexican American descent, in this area than was found in the counties studied in Florida (Pew Research Center's Hispanic Trends Project, 2013). The number of juramentos witnessed by each Priest along the border ranged from 1 to over 100 juramentos, with an average of 17 juramentos per Priest. The most common response provided on number of juramentos witnessed was three. No significant difference in the characteristics of the Priest (i.e., being Hispanic, Spanish fluency, or willingness to participate in juramentos) was found among Priests who had participated in an above number average (18 plus) of juramentos.
According to the Priests, 70% of the jurados (person doing the pledge) were men, of an estimated average age of 35. Indicative of the involvement and relevance of the family among Hispanics, 43% of the Priest reported being approached by a family member (mainly parent and/or spouse) to do the juramento for the person in need. Although some pledges were made to more than one deity, the majority of the pledges involved the Virgin of Guadalupe (51.3%) followed by pledges involving God (43.6%) and then pledges involving God (46.6%) and then pledges involving Jesus (35.5%).
The reason reported for doing the juramentos was mainly alcohol, reported by 98.7 % of the Priests (51.9% only alcohol, 27.8% alcohol in combination with drugs, 5.1% alcohol in combination with cigarettes, and the remaining 13.9% being various combinations of alcohol, drugs, cigarettes and “other” reasons, such as infidelity). The most commonly reported length of time for abstinence requested in the juramentos was “10-12 months” (34.2% of jurados), followed by “more than 1 year” (32.9%) and then “4-9 months” (23.3%). Only 9.6% of those seeking juramentos were reported to request 3 months or less. These long periods of abstinence as a goal in the juramentos were also reported by the Priests in the Florida study where 46.3% of jurados were reported to pledge for “10-12 months”, 31.7% for “more than a year”, and only 22% for “6 months or less” (Cuadrado & Lieberman, 2011). This tendency towards goals involving long periods of abstinence appears to deny any possible arguments that juramentos are done in order to “opt-out” from true commitment to abstinence as would be required if entering formal substance abuse treatment or even a joining a self-help group. Apparently the reason for choosing juramentos as a substance use intervention technique is not related to the possibility of returning to drinking within a short period of time.
It is reasonable to expect that Priests with greater fluency in Spanish and those who identified themselves as Hispanic may garner a greater likelihood of having been approached to witness a juramento. These assumptions were confirmed by the data. We found that Priests with conversational knowledge or fluent in Spanish were almost four times as likely to have witnessed a juramento than those with little or no knowledge of the language (52.6% versus 14.5%, p < .0001). In addition we found that Priests who self-identified as Hispanic were over twice as likely than non-Hispanic Priests to report witnessing a juramento (62.2% versus 27.8%, p < .001). Speaking Spanish appears to be a more important factor than being Hispanic in whether a Priest will be approached to witness a juramento. This is an interesting finding given the current efforts being made by Roman Catholic Priests to embrace the cultural diversity and language of parishioners in order to build bridges (USCCB, 2014). As Priests, regardless of their ethnicity, increasingly speak Spanish to their Hispanic parishioners to better deliver the message of the Church they may also be increasing the comfort level and likelihood of having a constituent approach them to witness a juramento.
Priests who had participated in at least one juramento were asked to comment on their view regarding the effectiveness of juramentos, 84.5% of these Priests provided a comment. An important caveat about this question is that it was not asked as a means of evaluating whether juramentos are effective but again to capture the view of Priests who are participating in the practice and as a means of measuring a possible factor contributing to the Priest's willingness to witness juramentos. Responses to the question “What are your impressions of the effectiveness of the juramentos in which you have participated?” were coded in 4 distinct categories (see Table 1). The comments contained in each category are illustrated by the following responses: 1) “not effective”, “somewhat effective”, “effective less than half the time”; 2) “effective, if with self-help program”, “effective, if followed by treatment”, “effective, if family is committed to helping”, “effective, if the person's faith is deep”; 3) “effective”, “effective in majority of cases”, “effective for time pledged”, “can be effective for long periods of time if pledge is renewed”; 4) “do not know”, “did not follow-up on person's situation”.
As presented in Table 1, two-thirds (66.7%) of the Priests viewed juramentos as effective in helping the substance abuser. A small percentage of the Priests thought juramentos are not effective (8.3%), while a quarter (25%) reported not knowing about the juramentos’ outcome. Upon reviewing the comments provided by Priests who did not have a view on whether juramentos were effective we found that in 15 of 18 cases they explained that they had not formed an opinion because the people asking for juramentos were not regular members of the Church, they had never seen the men before or since, or the Parish was too large to keep track of any one individual.
All Priests were asked, “Would you be willing to witness (or continue to witness) a juramento if asked?” Seventy-nine percent of the Priests responded that they would be willing to participate in juramentos if asked. When we examined factors that may impact the Priests’ likelihood to engage in a juramento we found that being Hispanic (87.1% among Hispanics versus 73.9% among non-Hispanics, p < .05), having greater fluency in Spanish (88.5% for fluent Spanish speakers versus 22.1% for no Spanish, p <. 001), and having witnessed a juramento in the past (97.4% of those who had done a juramento versus 65.7% of those who had not, p < .001,) were factors that increased the likelihood of continuing to witness a juramento or be willing to start doing juramentos if approached.
The Priest's impression of whether a juramentos was effective had no impact on the willingness to continue to serve as a witness with 97.1% indicating that they would. Even 80% of those indicating that they did not view juramentos as effective indicated that they would continue to participate in the practice if asked. Apparently Priests are open to participating in the juramento practice despite their personal opinion if it could be helpful. This in following the doctrine of helping those in need, in particular, when the Priest is being asked directly by the person.
This study explored the prevalence of juramento use along the US-Mexico border (Texas to California) via self-administered mail surveys completed by Roman Catholic Priests. As in a similar study conducted in Florida we found that juramentos are commonly used along the border by men, in their mid thirties, who are seeking to abstain from alcohol use for periods of 10 months or longer. Of interest in both studies, is the high percentage of Priests who reported being aware of the practice and being willing to witness a juramento. This makes this practice a feasible option for substance misusers who may opt to use juramentos as an ancillary to other treatment modalities, as well as for substance misusers who are not yet ready to enter formal treatment or commit to any self-help group. In addition to being a form of intervention that Hispanics (in particular those of Mexican descent) are seeking, substance abuse treatment providers should be aware of juramentos for they appear to have features that make them of value in addressing some of the barriers to treatment found for Hispanics. That is, juramentos 1) do not require that the individual formally or openly admit to a layperson that they have a problem, thereby, avoiding the issues of public shame for self and the family; 2) they allow for seeking of help in an environment that is familiar (within a Church with a Priest) instead of a detached public agency or treatment facility; 3) for Hispanics with low income and no insurance there is little or no cost in doing a juramento; and, 4) juramentos can done in Spanish.
Given that disparity in accessing substance abuse treatment still exists among Hispanics and that Priests are aware of juramentos and are willing to witness them simply because the individual has asked for help makes it reasonable to conclude that juramentos and Roman Catholic Priests should be added to the arsenal of culturally sensitive tools that substance abuse treatment programs can use to reach out to and reduce the existing gap in serving Hispanics with substance abuse problems, in particular those of Mexican descent. Treatment providers interested in serving Hispanics should explore how to use the willingness of Hispanic parishioners to seek help from a Priest and the willingness we have found in the Priests to help when asked. Among possible collaborations that can be formed between willing Priests and substance abuse treatment providers are: 1) educating Priests on how to provide information about different treatment programs to the person/family seeking their help with substance abuse. A perceived endorsement by the Priest may serve as an effective method of reaching out to a resistant person/family at some point; 2) making Priests available to conduct juramentos as an ancillary to current treatment will show interested Hispanic clients that the program is sensitive to their cultural and religious beliefs thereby perhaps impacting the likelihood of treatment retention; and 3) making use of Priests and juramentos as part of the treatment aftercare program for interested individuals can add another method available toward reaching the goal of reducing the likelihood of relapse.
Among the limitations of this study is the method used to gather information on this fairly unknown subject: self-administered survey. While this method allowed us to achieve the basic goal of the study, which was to explore the prevalence of use of juramentos along the US-Mexico border, it did not allow for a more detailed understanding of the topic. In-depth interviews with Priests who have participated in juramentos will likely fill in many gaps in understanding Priest's involvement that could not be filled by this study. Another important limitation is that although we were able to tap the views of the Priests regarding the effectiveness of juramentos this view does not truly answer the question on whether juramentos are effective. In order to better answer questions on the effectiveness of juramentos studies involving the jurados (those making the pledge) and perhaps even their families should be conducted.