Background: The rates of cigarette smoking among patients with schizophrenia are two to four times the rates observed in the community. Spirituality and religiousness have been shown to be associated with lower smoking rates in the general population.
Aims: This study assessed the role of religion in cigarette smoking among patients with schizophrenia or schizo-affective disorder.
Methods: Some 115 stabilized outpatients from Geneva's public psychiatric facilities were included. Interviews were conducted to investigate spiritual and religious beliefs, religious practices and religious coping. Cigarette smoking was assessed through interviews and medical records.
Results: Some 58% of patients were smokers. Two-thirds of the total sample considered spirituality as very important or essential in their every day life. Religiosity was negatively associated with tobacco use: there were more current smokers without religious affiliation than non-smokers (p < 0.05). For non-smokers, the support of their faith community was significantly more important and they reported more frequent group religious practices than smokers ( p < 0.05). This relation persisted after controlling for demographic confounders (gender, age, ethnicity, education, civil status).
Conclusion: In patients with schizophrenia, religion and spirituality seem to be related to smoking behaviour. Similar results were previously found in the general population. These results underscore the need for a systematic exploration of religious issues in the care of smokers with schizophrenia.
Addington, J., El-Guebaly, N., Addington, D. & Hodgins, D. (1997) Readiness to stop smoking in schizophrenia. Canadian Journal of Psychiatry, 42, 49-52.
2.
Adelekan, M.L., Abiodun, O.A., Imouokhome-Obayan, A.O., Oni, G.A. & Ogunremi, O.O. (1993) Psychosocial correlates of alcohol, tobacco and cannabis use: findings from a Nigerian university . Drug and Alcohol Dependence, 33, 247-256.
3.
Ahmed, F., Brown, D.R., Gary, L.E. & Saadatmand, F. (1994) Religious predictors of cigarette smoking: findings for African American women of childbearing age . Behavioral Medicine, 20, 34-43.
4.
American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
5.
Barnes, M., Lawford, B.R., Burton, S.C., Heslop, K.R., Noble, E.P., Hausdorf, K. & Young, R.M. (2006) Smoking and schizophrenia: is symptom profile related to smoking and which antipsychotic medication is of benefit in reducing cigarette use? Australian and New Zealand Journal of Psychiatry, 40, 575-580.
6.
Beratis, S., Katrivanou, A. & Gourzis, P. (2001) Factors affecting smoking in schizophrenia. Compr Psychiatry, 42, 393-402.
7.
Booth, J. & Martin, J.E. (2001) Spiritual and religious factors in substance use, dependence, and recovery. In Handbook of Religion and Mental Health (ed. H.G. Koenig). New York: Academic Press.
8.
Bradby, H. & Williams, R. (2006) Is religion or culture the key feature in changes in substance use after leaving school? Young Punjabis and a comparison group in Glasgow. Ethnicity and Health, 11, 307-324.
9.
Bron, C., Zullino, D., Besson, J. & Borgeat, F. (2000) Le tabagisme en psychiatrie: un problème négligé . Praxis, 89,1695-1699.
10.
Brown, D.R. & Gary, L.E. (1994) Religious involvement and health status among African-American males. Journal of the National Medical Association, 86, 825-831.
11.
Campo-Arias, A. (2006) The prevalence of nicotine-dependency in some populations: a systematic review. Revista Panamericana de Salud Pública (Bogota), 8, 98-107.
12.
Carosella, A.M., Ossip-Klein, D.J. & Owens, C.A. (1999) Smoking attitudes, beliefs, and readiness to change among acute and long term care inpatients with psychiatric diagnoses. Addictive Behaviors, 24, 331-344.
13.
Chen, C.Y., Dormitzer, C.M., Bejarano, J. & Anthony, J.C. (2004) Religiosity and the earliest stages of adolescent drug involvement in seven countries of Latin America. American Journal of Epidemiology, 159, 1180-1188.
14.
Cornuz, J. (2002) Smoking cessation intervention in clinical practice . Onkologie, 25, 413-418.
15.
De Leon, J., Becona, E., Gurpegui, M., Gonzalez-Pinto, A. & Diaz, F.J. (2002) The association between high nicotine dependence and severe mental illness may be consistent across countries. Journal of Clinical Psychiatry, 63, 812-826.
16.
De Leon, J., Dadvand, M., Canuso, C., White, A.O., Stanilla, J.K. & Simpson, G.M. (1995) Related schizophrenia and smoking: an epidemiological survey in a state hospital. American Journal of Psychiatry , 152, 453-455.
17.
De Leon, J. & Diaz, F.J. (2005) A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophrenia Research, 76, 135-157.
18.
Di Clemente, C.C. (1991) Motivational interviewing and the stages of change . In Motivational Interviewing: Preparing People for Change (eds W.R. Miller & S. Rollnick). New York: Guilford Press.
19.
Etter, M., Mohr, S., Garin, C. & Etter, J.F. (2004) Stages of change in smokers with schizophrenia or schizoaffective disorder and in the general population. Schizophrenia Bulletin, 30, 459-68.
20.
Fetzer Institute. (1999). Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research (ed. Fetzer, J.E. Institute). Kalamazoo, MI: Fetzer Institute.
21.
Francis, L.J. & Mullen, K. (1993) Religiosity and attitudes towards drug use among 13-15 year olds in England. Addiction, 88, 665-672.
22.
George, T.P., Ziedonis, D.M., Feingold, A., Pepper, W.T., Satterburg, C.A., Winkel, J., Rounsaville, B.J. & Kosten, T.R. (2000) Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. American Journal of Psychiatry, 157, 1835-1842.
23.
Ghouri, N., Atcha, M. & Sheikh, A. (2006) Influence of Islam on smoking among Muslims. British Medical Journal, 332,291-294.
24.
Gorsuch, R.L. (1976). Religion as a significant predictor of important human behaviour. In Research in Mental Health and Religious Behaviour (ed. W.J. Donaldson, Jr.). Atlanta, GA: Psychological Studies Institute.
25.
Holmberg, S.K. & Kane, C. (1999) Health and self-care practices of persons with schizophrenia. Psychiatric Services, 50, 827-829.
26.
Huguelet, P., Mohr, S., Borras, L., Gillieron, C. & Brandt, P.Y. (2006) Spirituality and religious practices among outpatients with schizophrenia and their clinicians. Psychiatric Services , 57: 366-372.
27.
Kay, S.R., Fiszbein, A. & Opler, L.A. (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 262-273.
28.
Kelly, C. & McCreadie, R.G. (1999) Smoking habits, current symptoms, and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland. American Journal of Psychiatry, 156, 1751-1757.
29.
Koenig, H.G., McCullough, M.E. & Larson, D.B. (2001) Handbook of Religion and Mental Health. Oxford: Oxford University Press.
30.
Koenig, H.G., Parkerson Jr, G.R. & Meador, K.G. (1997) Religion index for psychiatric research. American Journal of Psychiatry, 154: 885-886.
31.
Lorch, B.R. & Hughes, R.H. (1985) Religion and youth substance use. Journal of Religion and Health, 24, 197-208.
32.
Lucksted, A., Dixon, L.B. & Sembly, J.B. (2000) A focus group pilot study of tobacco smoking among psychosocial rehabilitation clients. Psychiatric Services , 51, 1544-1548.
33.
McCreadie, R.G. (2002) Scottish Comorbidity Study Group: use of drugs, alcohol and tobacco by people with schizophrenia: case-control study. British Journal of Psychiatry, 181, 321-325.
34.
Menza, M.A., Grossman, N., Van Horn, M., Cody, R. & Forman, N. (1991) Smoking and movement disorders in psychiatric patients . Biological Psychiatry, 30, 109-115.
Mohr, S., Brandt, P.Y., Borras, L., Gillieron, C. & Huguelet, P. (2006) Toward an integration of spirituality and religiousness into the psychosocial dimension of schizophrenia. American Journal of Psychiatry, 163, 1952-1959.
37.
Mohr, S., Gillieron, C., Borras, L., Brandt, P.Y. & Huguelet, P. (2007) The assessment of spirituality and religiousness in schizophrenia. Journal of Nervous and Mental Disease, 195, 247-253.
38.
Mohr, S. & Huguelet, P. (2004) The relationship between schizophrenia and religion and its implications for care. Swiss Medical Weekly, 134, 369-376.
39.
National Institute of Mental Health. (1976 ) CGI Clinical Global Impression. ECD-EU Assessment for Psychopharmacology . Rockville, IN: National Institute of Mental Health.
40.
Pargament, K.I. (ed.) (1997) The Psychology of Religion and Coping. New York: The Guildford Press.
41.
Richmond, R. & Zwar, N. (2003) Review of bupropion for smoking cessation. Drug and Alcohol Review, 22, 203-220.
42.
Spring, B., Pingitore, R. & McChargue, D.E. (2003) Reward value of cigarette smoking for comparably heavy smoking schizophrenic, depressed, and nonpatient smokers. American Journal of Psychiatry, 160, 316-322.
43.
Van Oort, F.V., Van Der Ende, J., Crijnen, A.A., Verhulst, F.C., Mackenbach, J.P. & Joung, I.M. (2006) Determinants of daily smoking in Turkish young adults in the Netherlands. BMC Public Health, 6, 294.
44.
World Health Organization. (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization.
45.
Yang, Y.K., McEvoy, J.P., Wilson, W.H., Levin, E.D. & Rose, J.E. (2003) Reliabilities and intercorrelations of reported and objective measures of smoking in patients with schizophrenia. Schizophrenia Research, 60, 9-12.
