Schizophrenia Research
Volume 76, Issue 2 , Pages 135-157 , 15 July 2005

A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors

  • Jose de Leon

      Affiliations

    • Mental Health Research Center at Eastern State Hospital, 627 West Fourth St., Lexington, KY 40508, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 859 246 7487; fax: +1 859 246 7019.
    • ,
  • Francisco J. Diaz

      Affiliations

    • Department of Statistics, Universidad Nacional, Medellin, Colombia

Received 11 April 2004 ,Revised 11 February 2005 ,Accepted 16 February 2005.

References 

  1. Aguilar MC, Gurpegui M, Diaz FJ, de Leon J. Complex interactions between nicotine dependence and symptoms in schizophrenia: a naturalistic study. Br. J. Psychiatry. 2005;186:225–231
  2. Al-Habeeb TA, Qureshi NA. Smoking among male psychiatric outpatients in Saudi Arabia. Ann. Saudi Med. 2000;20:218–223
  3. Arias-Horcajadas F, Padín-Calo JJ, Fernández-González MA. Consumo y dependencia de drogas en la esquizophrenia. Actas Luso Esp. Neurol. Psiquiatr. 1997;25:379–389
  4. Bejerot S, Nylander L. Low prevalence of smoking in patients with autism spectrum disorders. Psychiatry Res. 2003;119:177–182
  5. Benowitz NL. Pharmacologic aspects of cigarette smoking and nicotine addiction. N. Engl. J. Med. 1988;319:1318–1330
  6. Benowitz NL, Perez-Stable EJ, Fong I, Modin G, Herrera B, Jacob P. Ethnic differences in N-glucuronidation of nicotine and cotinine. J. Pharmacol. Exp. Ther. 1999;291:1196–1203
  7. Beratis S, Katrivanou A, Gourzis P. Factors affecting smoking in schizophrenia. Compr. Psychiatry. 2001;42:393–402
  8. Breslau N, Johnson EO, Hiripi E, Kessler R. Nicotine dependence in the United States: prevalence, trends and smoking persistence. Arch. Gen. Psychiatry. 2001;58:810–816
  9. Brown S, Birtwistle J, Roe L, Thompson C. The unhealthy lifestyle of people with schizophrenia. Psychol. Med. 1999;29:697–701
  10. Calabresi M, Casu G, Dalle Luche R. La prevalenza del fumo di tabacco nei pazienti psichiatrici. Minerva Psichiatr. 1991;32:89–92
  11. Campo A, Díaz LA, Rueda GE, Rueda M, Farelo D. Prevalencia de consumo de cigarrillo en pacientes de la consulta psiquiátrica de Bucaramanga. Colomb. Med. 2004;35:69–74
  12. Campo-Arias A, Haydar-Ghisays R, Bermudez-de-León A, Suárez-Jiménez M, Ayola Gómez C. Tabaquismo en pacientes psiquiátricos ambulatorios. Revista ABP-APAL. 1998;20:71–74
  13. Campo-Arias A, Suárez-Jiménez M, Haydar-Ghisays R. Severidad del tabaquismo en pacientes de la consulta psiquiátrica. Rev. Argent. Psiquiatr. Biol. 1999;6:21–24
  14. Campo-Arias A, Díaz-Martínez LA, Rueda-Jaimes GE. Anxiety and depressive symptoms among smokers: a population study. Medunab. 2004;7:4–8
  15. Caraballo RS, Giovino GA, Pechacek TF, Mowery PD, Richter PA, Strauss WJ. Racial and ethnic differences in serum cotinine levels of cigarette smokers. JAMA. 1998;280:135–139
  16. Carvajal C, Passig VC, San Martin RE, Zuñiga SA. Prevalencia del consumo de cigarrillos en pacientes psiquiatricos. Acta Psiquiatr. Psicol. Am. Lat. 1989;35:145–151
  17. Casella G, Berger RL. Statistical Inference. Second Edition. Pacific Grove, CA: Duxbury; 2002;
  18. Centers for Disease Control and Prevention (CDC) . Cigarette smoking among adults—United States, 1992, and changes in the definition of current cigarette smoking. MMWR. 1994;43:342–346
  19. Centers for Disease Control and Prevention (CDC) . Cigarette smoking among adults—United States, 1993. MMWR. 1994;43:925–930
  20. Centers for Disease Control and Prevention (CDC) . State-specific prevalence among adults of current cigarette smoking and smokeless tobacco use and per capita tax-paid sales of cigarettes—United States, 1997. MMWR. 1998;47:922–926
  21. Centers for Disease Control and Prevention (CDC) . State-specific prevalence of current cigarette smoking among adults, and policies and attitudes about secondhand smoking—United States, 2000. MMWR. 2001;50:1101–1106
  22. Challis GB. Level of activity and prevalence of smoking in psychiatric patients. Can. J. Psychiatry. 1999;44:711;(Letter)
  23. Chiles JA, Cohen S, Maiuro R, Wright R. Smoking and schizophrenic psychopathology. Am. J. Addict. 1993;2:315–319
  24. Chong SA, Choo HL. Smoking among Chinese patients with schizophrenia. Aust. N. Z. J. Psychiatry. 1996;30:350–353
  25. Cohen M, Dembling B, Schorling J. The association between schizophrenia and cancer: a population-based mortality study. Schizophr. Res. 2002;57:139–146
  26. Combs DR, Advokat C. Antipsychotic medication and smoking prevalence in acutely hospitalized patients with chronic schizophrenia. Schizophr. Res. 2000;46:129–137
  27. Corrao MA, Guindon GE, Sharma N, Shokoohi DF. Tobacco Control Country Profiles. Atlanta, GA: American Cancer Society; 2000;
  28. Covey LS, Hughes DC, Glassman AH, Blazer DG, George LK. Ever-smoking, quitting, and psychiatric disorders: evidence from the Durham, North Carolina, and Epidemiological Catchment Area. Tob. Control. 1994;3:222–227
  29. Cytel Software Co. . Logxact-4 User Manual. Cambridge, MA: Cytel Software Co.; 2000;
  30. Dalack GW, Healy D, Meador-Woodruff JH. Nicotine dependence in schizophrenia: clinical phenomena and laboratory findings. Am. J. Psychiatry. 1998;155:1490–1501
  31. de Leon J. Smoking and vulnerability for schizophrenia. Schizophr. Bull. 1996;22:405–409
  32. de Leon J, Diaz FJ. Smoking in bipolar and schizophrenic patients. J. Clin. Psychiatry. 2002;63:368–369(Letter)
  33. de Leon J, Dadvand M, Canuso C, White AO, Stanilla J, Simpson GM. Schizophrenia and smoking: an epidemiological survey in a state hospital. Am. J. Psychiatry. 1995;152:453–455
  34. de Leon J, Tracy J, McCann E, McGrory A, Diaz FJ. Schizophrenia and tobacco smoking: a replication study in another US psychiatric hospital. Schizophr. Res. 2002;56:55–65
  35. de Leon J, Diaz FJ, Rogers T, Browne D, Dinsmore L. Initiation of daily smoking and nicotine dependence in schizophrenia and mood disorders. Schizophr. Res. 2002;56:47–54
  36. de Leon J, Becoña E, Gurpegui M, Gonzalez-Pinto A, Diaz FJ. The association between high nicotine dependence and severe mental illness may be consistent across countries. J. Clin. Psychiatry. 2002;63:812–816
  37. de Leon J, Diaz FJ, Becoña E, Gurpegui M, Jurado D, Gonzalez-Pinto A. Exploring brief measures of nicotine dependence. Addict. Behav. 2003;28:1481–1486
  38. de Leon J, Diaz FJ, Rogers T, Browne D, Dinsmore L, Ghosheh O, et al. Plasma cotinine, 3′-hydroxycotinine and their glucuronides in Caucasian and African American smokers. J. Clin. Psychopharmacol. 2003;23:209–211(Letter)
  39. Diaz, F.J., Jané, M., Saltó, E., Pardell, H., Salleras, Ll., Pinet, C., de Leon, J., in press. A brief measure of high nicotine dependence for busy clinicians and large epidemiological surveys. Aust. N. Z. J. Psychiatry 39, 161–168.
  40. Diwan A, Castine M, Pomerlau C, Meador-Woodruff JH, Dalack GW. Different prevalence of cigarette smoking in patients with schizophrenia vs. mood disorders. Schizophr. Res. 1998;33:113–118
  41. Einat H. Dr. Einat replies. J. Clin. Psychiatry. 2002;63:369;(Letter)
  42. El-Guebaly N, Hodgins DC. Schizophrenia and substance abuse: prevalence issues. Can. J. Psychiatry. 1992;37:704–710
  43. Etter M, Mohr S, Garin C, Etter F. Stages of change in smokers with schizophrenia or schizoaffective disorder and in the general population. Schizophr. Bull. 2004;30:359–468
  44. Fagerstrom KO, Kunze M, Schoberberger R, Breslau N, Hughes JR, Hurt RD, et al. Nicotine dependence versus smoking prevalence: comparison among countries and categories of smokers. Tob. Control. 1996;5:52–56
  45. Fowler IL, Carr VJ, Carter NT, Lewin TJ. Patterns of current and lifetime substance use and abuse. Schizophr. Bull. 1998;24:443–455
  46. Freedman R, Coon H, Myles-Worsley M, Orr-Urtreger A, Olincy A, Davis A, et al. Linkage of a neurophysiological deficit in schizophrenia to a chromosome 15 locus. Proc. Natl. Acad. Sci. U. S. A. 1997;94:587–592
  47. Gerber GJ, Krupa T, Eastabrook S, Gargaro J. Substance use among persons with serious mental illness in eastern Ontario. Can. J. Community Ment. Health. 2003;22:113–128
  48. Ghisays RH, Gómez CA, Campo A, Suárez M, Bermúdez A. Prevalencia de tabaquismo en pacientes de la consulta psiquiátrica. Biomédica. 1996;16:52–57
  49. Giovino GA, Schooley MW, Zhu B-P, Chrismon JH, Tomar SL, Peddicord JP, et al. Surveillance for selected tobacco-use behaviors—United States, 1900–1994. MMWR. 1994;43:1–43
  50. Glynn SM, Sussman S. Why patients smoke. Hosp. Comm. Psychiatry. 1990;41:1027–1028(Letter)
  51. Goff DC, Henderson DC, Amico E. Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects. Am. J. Psychiatry. 1992;149:1189–1194
  52. Gonzalez-Pinto A, Gutierrez M, Ezcurra J, Aizpuru F, Mosquera F, Lopez P, et al. Tobacco smoking and bipolar disorder. J. Clin. Psychiatry. 1998;59:225–228
  53. Gurpegui M, Martinez-Ortega JM, Aguilar MC, Diaz FJ, Quintana HM, de Leon J. Smoking initiation and schizophrenia: a replication study in a Spanish sample. Schizophr. Res. 2005;76(1):
  54. Haddock CK, Lando H, Klesges RC, Talcott GW, Renaud EA. A study of the psychometric and predictive properties of the Fagerström Test for Nicotine Dependence in a population of young smokers. Nicotine Tob. Res. 1999;1:59–66
  55. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br. J. Addict. 1991;86:1119–1127
  56. Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, Robinson J. Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes per day. Br. J. Addict. 1998;84:791–800
  57. Henningfeld JE, Cohen C, Slade J. Is nicotine more addictive than cocaine?. Br. J. Addict. 1991;86:565–569
  58. Herrán A, de Santiago A, Sandoya M, Fernández MJ, Díez-Manrique JF, Vázquez-Barquero JL. Determinants of smoking behavior in outpatients with schizophrenia. Schizophr. Res. 2000;41:373–381
  59. Himelhoch S, Lehman A, Kreyenbuhl J, Daumit G, Brown C, Dixon L. Prevalence of chronic obstructive pulmonary disease among those with serious mental illness. Am. J. Psychiatry. 2004;161:2317–2319
  60. Hymowitz N, Jaffe FE, Gupta A, Feuerman M. Cigarette smoking among patients with mental retardation and mental illness. Psychiatr. Serv. 1997;48:100–102
  61. Hughes JR. Distinguishing nicotine dependence from smoking: why it matters to tobacco control and psychiatry. Arch. Gen. Psychiatry. 2001;58:817–818
  62. Hughes JF, Hatsukamy DK, Mitchell JE, Dahlgren LA. Prevalence of smoking among psychiatric outpatients. Am. J. Psychiatry. 1986;143:993–997
  63. Itkin O, Nemets B, Einat H. Smoking habits in bipolar and schizophrenic outpatients in southern Israel. J. Clin. Psychiatry. 2001;62:269–272
  64. Kelly C, McCreadie RG. Smoking habits, current symptoms, and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland. Am. J. Psychiatry. 1999;156:1751–1757
  65. Kendler KS, Neale MC, MacLean CJ, Heath AC, Eaves LJ, Kessler RC. Smoking and major depression: a casual analysis. Arch. Gen. Psychiatry. 1993;50:36–43
  66. Kopala LC, Good KP, Morrison K, Bassett AS, Alda M, Honer WG. Impaired olfactory identification in relatives of patients with familial schizophrenia. Am. J. Psychiatry. 2001;158:1286–1290
  67. Kozlowski LT, Porter CQ, Orleans CT, Pope MA, Heatherton T. Predicting smoking cessation with self-reported measures of nicotine dependence: FTQ, FTND, and HIS. Drug Alcohol Depend. 1994;34:211–216
  68. Lasser K, Boyd JW, Woolhandler S, Himmelstein DD, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. JAMA. 2000;284:2606–2610
  69. Leonard S, Gault J, Hopkins J, Logel J, Vianzon R, Short M, et al. Association of promoter variants in the α7 nicotine acetylcholine receptor gene with an inhibitory deficit found in schizophrenia. Arch. Gen. Psychiatry. 2002;59:1085–1096
  70. Liao DL, Yang JY, Lee SM, Chen H, Tsai SJ. Smoking in chronic schizophrenic inpatients in Taiwan. Neuropsychobiology. 2002;45:172–175
  71. LLerena A, de la Rubia A, Peñas-Lledó EM, Diaz FJ, de Leon J. Schizophrenia and tobacco smoking in a Spanish psychiatric hospital. Schizophr. Res. 2003;60:313–317
  72. Lohr JB, Flynn K. Smoking and schizophrenia. Schizophr. Res. 1992;8:93–102
  73. Luchins DJ, Goldman MB, Lieb M, Hanrahan P. Repetitive behaviors in chronically institutionalized schizophrenic patients. Schizophr. Res. 1992;8:119–123
  74. Lyons MJ, Bar JL, Kremen WS, Toomey R, Eisen SA, Goldberg J, et al. Nicotine and familial vulnerability to schizophrenia: a discordant twin study. J. Abnorm. Psychology. 2002;111:687–693
  75. McCreadie RG on behalf of Scottish Comorbidity Study Group. Use of drugs, alcohol, and tobacco by people with schizophrenia: case-control study. Br. J. Psychiatry. 2002;181:321–325
  76. Mackay J, Eriksen M. Tobacco Atlas. Geneva: World Health Organization; 2002;
  77. Margolese HC, Malchy L, Negrete JC, Tempier R, Gill K. Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences. Schizophr. Res. 2004;67:157–166
  78. Masterson E, O'Shea B. Smoking and malignancy in schizophrenia. Br. J. Psychiatry. 1984;145:429–432
  79. McChargue DE, Gulliver SB, Hitsman B. Would smokers with schizophrenia benefit from a more flexible approach to smoking treatment?. Addiction. 2002;97:785–793
  80. McEvoy JP, Brown S. Smoking in first-episode patients with schizophrenia. Am. J. Psychiatry. 1999;156:1120–1121(Letter)
  81. Ministerio de Sanidad y Consumo de España . Encuesta Nacional de Salud, 1995. Madrid: Ministerio de Sanidad y Consumo; 1996;
  82. MinisteriodeSanidadyConsumodeEspaña . Encuesta Nacional de Salud, 1997. Madrid: Ministerio de Sanidad y Consumo; 1999;
  83. Mori T, Sasaki T, Iwanami A, Araki T, Mizuno K, Kato T, et al. Smoking habits in Japanese patients with schizophrenia. Psychiatry Res. 2003;120:207–209
  84. O'Farrell TJ, Connors GJ, Upper D. Addictive behaviors among hospitalized psychiatric patients. Addict. Behav. 1983;8:329–333
  85. Olincy A, Young DA, Freedman R. Increased levels of nicotine metabolite cotinine in schizophrenic smokers compared to other smokers. Biol. Psychiatry. 1997;42:1–5
  86. Patkar A, Gopalakrishan R, Lundy A, Leone FT, Certa KM, Weinstein SP. Relationship between tobacco smoking and positive and negative symptoms of schizophrenia. J. of Nerv. Ment. Dis. 2002;190:604–610
  87. Payne TJ, Smith PO, McCracken LM, McSherry WC, Antony MM. Assessing nicotine dependence: a comparison of the Fagerström Tolerance Questionnaire (FTQ) with the Fagerström Test for Nicotine Dependence (FTND) in a clinical sample. Addict. Behav. 1994;19:307–317
  88. Perez-Stable EJ, Herrera B, Jacob P, Benowitz NL. Nicotine metabolism and intake in black and white smokers. JAMA. 1997;280:152–156
  89. Physicians for a Smoke-free Canada . Smoking in Canada. Accessed in January 2002. Physicians for a Smoke-free Canada. 2002;www.smoke-free.ca
  90. Pomerleau CS, Carton SM, Lutzke ML, Flessland KA, Pomerlau OF. Reliability of the Fagerström Tolerance Questionnaire and the Fagerström Test for Nicotine Dependence. Addict. Behav. 1994;19:33–39
  91. Poirier M-F, Canceil O, Baylé F, Millet B, Bourdel M-C, Moatti C, et al. Prevalence of smoking in psychiatric patients. Prog. Neuro-psychopharmacol. Biol. Psychiatry. 2002;26:529–537
  92. Reddy R, Keshavan M, Yao JK. Reduced plasma antioxidants in first-episode patients with schizophrenia. Schizophr. Res. 2003;62:205–212
  93. Salokangas, R.K.R., Stengård, E., Honkonen, T,. Koivisto, A.-M., Saarinen, S., 2000. Sairaalasta yhteiskuntaan. Seurantatutkimus sairaalasta kotiuttamisen vaikutuksista skitsofreniapotilaan elämään ja hoitotilanteeseen. (From hospital to the community. Follow-up studies on the effects of discharge from hospital to the life and treatment situation of patients with schizophrenia; in Finnish) STAKES, Raportteja 248, Helsinki.
  94. Sandyk R, Kay SR. Tobacco addiction as a marker of age at onset of schizophrenia. Int. J. Neurosci. 1991;57:259–262
  95. Simon JL. Resampling Stats User's Guide. Arlington, VA: Resampling Stats, Inc.; 1999;
  96. SPSS Inc. . SPSS 9.0, Applications Guide. Chicago, IL: SPPS Inc.; 1999;
  97. Srinivasan TN, Thara R. Smoking in schizophrenia—all is not biological. Schizophr. Res. 2002;56:67–74
  98. SNRT Subcommittee on Biochemical Verification . Biochemical verification of tobacco use and cessation. Nicotine Tob. Res. 2002;4:149–159
  99. Steinberg ML, Williams JM, Steinberg HR, Krejci JA, Ziedonis DM. Applicability of the Fagerstrom Test for Nicotine Dependence in smokers with schizophrenia. Addict. Behav. 2005;30:49–59
  100. Steinert T, Wolfersdorf M, Thoma H, Marpert M. Beeinfluβt Dauerhospitalisierung die kardiovasculäre Morbidität bei Schizophrenen? (Does long-term hospitalization modify cardiovascular morbidity in schizophrenic patients?). Fortschr. Neurol. Psychiatr. 1996;64:212–220
  101. Suárez M, Haydar R, Campo A, Bermúdez A, Ayola C. Tabaquismo y trastornos mentales. Acta Médica Colombiana. 1996;21:317–321
  102. Taiminen T, Raimo KR, Salokangas SS, Heikki N, Heikki L, Virpi A, et al. Smoking and cognitive deficits in schizophrenia : a pilot study. Addict. Behav. 1998;23:263–266
  103. Tanskanen A, Viinamaki H, Koivuma-Honkanen H-T, Jaaskelainen J, Lehtonen J. Smoking among psychiatric patients. Eur. J. Psychiatry. 1998;12:109–118
  104. Tracy J, de Leon J, Querishi G, McCann E, Josiassen R. Repetitive behaviors in schizophrenia: discrete symptoms or single disturbance. Schizophr. Res. 1996;20:221–229
  105. Uzun O, Cansever A, Basoglu C, Ozsahin A. Smoking and substance abuse in outpatients with schizophrenia: a 2-year follow-up study in Turkey. Drug Alcohol Depend. 2003;70:187–192
  106. Vanable PA, Carey MP, Carey KB, Maisto SA. Smoking among psychiatric outpatients: relationship to substance use, diagnosis, and illness severity. Psychol. Addict. Behav. 2003;17:259–265
  107. Weiser M, Reichenberg A, Grotto I, Yasvitzky R, Rabinowitz J, Lubin G, et al. Higher rates of cigarette smoking in male adolescents before the onset of schizophrenia. Am. J. Psychiatry. 2004;161:1219–1223
  108. Wilcox RR. Fundamentals of Modern Statistical Methods. New York: Springer-Verlag; 2001;
  109. World Health Organization (WHO), 1997. Tobacco or health: a global status report. Country profiles by region. Office on Smoking and Health of the CDC's National Center for Chronic Disease Prevention and Health promotion, Geneva.
  110. Zammit S, Allebeck P, Dalman C. Investigating the association between cigarette smoking and schizophrenia in a cohort study. Am. J. Psychiatry. 2003;160:2216–2221
  111. Ziedonis DM, Kosten TR, Glazer WM, Frances RJ. Nicotine dependence and schizophrenia. Hosp. Comm. Psychiatry. 1994;45:204–206

PII: S0920-9964(05)00075-7

doi: 10.1016/j.schres.2005.02.010

Schizophrenia Research
Volume 76, Issue 2 , Pages 135-157 , 15 July 2005

Article Tools