The current work investigated the complex link between religion and health in youth with asthma. The current study points to preliminary beneficial relationships between religious behavior, positive religious coping, and positive mood, via vigor. Furthermore, the results indicate that religious coping is a unique coping strategy employed by youth that is more closely related to avoidance-oriented strategies than approach-oriented strategies. Finally, it identifies family environment as an important variable that affects the relationship between religious coping and health, including both psychological and physical health. In risky family environments, positive and negative religious coping was linked to greater negative mood; however, engaging in high amounts of positive religious coping is associated healthier HPA axis functioning. This work hints that positive religious coping strategies may not be related to better mood in the short term but associated with better biologically-based outcomes that may provide long term health benefits. Taken together, prior research highlighting the use of religious coping by youth to manage stress associated with health conditions and the current work pointing to both detrimental and favorable relationships with religious coping and health speaks to the importance of assessing for spiritual or religious struggles and how discussions of religious coping may be integrated into routine health care for those who identify it as an important factor in their daily lives