Table 1.
Quantitative study characteristics and key findings.
| First author; year of publication; country | Study aims | Total sample size; N of relevant groups; sample size and group composition | Age in years (SD) | N male (%) | Assessment of barrier | Key findings | QualSyst score (%) |
|---|---|---|---|---|---|---|---|
| Baker; 2007; Australia | To describe demographic and clinical characteristics, smoking behaviors, stage of change, and reasons for smoking and quitting in community-residing smokers with a psychotic disorder; and to compare smoking behaviors in this sample with data reported for other samples. | 298; 3 groups; G1 = 298 (56.7% schizophrenia/ schizoaffective disorder, 9.1% bipolar disorder with mania, 6.4% severe depression with psychosis, 27.9 other psychosis), G2 = 387 (General population from Pederson et al. study), G3 = 1,215 (volunteer sample of smokers in smoking cessation study from Curry et al. study) | G1 = 37.24 (11.09), G2/G3 unknown | G1 = 156 (52.3%), G2/G3 unknown | Reasons for Smoking Questionnaire; Reasons for Quitting scale; Readiness and Motivation to Quit Smoking Questionnaire | Reasons for smoking: Stress reduction: G1 > G2; Stimulation: G1 > G2; Addiction G1 > G2; Reasons for quitting: Desire for self-control G1 > G3; Desire for immediate reinforcement: G1 > G3; Social influence G1 > G3; Health concerns G1 = G3. |
83 |
| Briskman; 2012; Israel | To compare preventative intervention and treatment rates for comorbidities in hospitalized patients with psychiatric illness with patients without psychiatric illness. | 192; 2 groups; G1 = 93 (88% schizophrenia/ schizoaffective disorder, 8% bipolar disorder, 4% other), G2 = 99 (100% hospitalized patients without psychiatric illness) | G1 = 53.3 (15.1), G2 = 55.2 (14.3) | G1 = 47 (51%), G2 = 55 (56%) | Reported receipt of instruction to quit smoking | Received physician instruction to quit: G1 < G2. | 58 |
| Brown; 2015; USA | To examine effectiveness of psychiatrists implementing the 5 A's on smoking rates among clinic patients diagnosed with serious mental illness. | 49; 1 group; G1 = 49 (100% mental health clinicians) | NA | NA | Clinicians' attitudes and beliefs regarding smoking cessation treatments and the 5 A's | Main perceived barriers to carrying out 5A's: Lack of interest among patients about smoking and/or smoking cessation; Too many demands on staff already to begin a new practice; Too time demanding to carry out 5 A's; Staff skepticisms of 5 A's. |
79 |
| Brunette; 2017; USA | To examine age differences on smoking habits and examine age, gender, attitudes and beliefs, social norms, and perceived behavioral control in smokers with schizophrenia in relation to intention to quit and use of cessation treatment. | 184; 1 group; G1 = 184 (100% schizophrenia) | 42.96 (12.7) | 132 (71.4%) | Attitudes toward smoking scale; Self-developed theory of planned behavior questionnaire; Stigma of smoking questionnaire; Stages of Change questionnaire | Perceived adverse effects of smoking were greater than benefits and pleasures of smoking. Positive attitude to NRT or smoking cessation medication associated with higher intention to quit. |
79 |
| Coletti; 2015; USA | To assess smoking-related knowledge and the effects of health messages on smoking knowledge and behavior. | 148; 2 groups; G1 = 69 (100% schizophrenia), G2 = 79 (100% healthy controls) | G1 = 22.67 (5.2), G2 = 27.97 (5.6) | G1 = 55 (79.7%), G2 = 30 (38.0%) | Self-developed smoking knowledge questionnaire; Valence and Arousal items of Self-Assessment Manikin | Health concerns: G1 < G2 Smoking warning's effectiveness: G1 = G2. |
83 |
| Duffy; 2012; USA | To estimate the prevalence of tobacco use and receipt of cessation services among Veterans Affair patients with mental illness, and determine the clinical, treatment, and demographic factors associated with receipt of cessation services. | 224,193; 2 groups; G1 = 1,430 (100% smokers with schizophrenia), G2 = 27,652 (100% smokers without mental disorder) | Total sample = 3.4% < 45 years, 37.4% 45 to 64, 59.2% ≥65 | NA | Reported receipt of advice to quit smoking by physician, provision of medication, and discussion of quitting methods | Received physician advice to quit: G1 < G2 Recommendations for smoking cessation medications: G1 = G2; Physician discussed quitting methods: G1 = G2. |
71 |
| Filia; 2011; Australia | To examine CHD-related behavioral risk factors in smokers with schizophrenia, their reasons for engaging in risky behaviors, and level of motivation and confidence to change. | 43; 1 group; G1 = 43 (100% schizophrenia) | 36.3 (8.42) | 25 (58.1%) | Reasons for Smoking Questionnaire; Reasons for Quitting scale; Readiness and Motivation to Quit Smoking Questionnaire | Reason for smoking: Addiction: 52.5%; Reasons for quitting, from highest to lowest: Health concerns; Desire for self-control; Perceived immediate reinforcement; Social influence; Received physician advice to quit: 81.4%. |
82 |
| Filia; 2014; Australia | To examine gender differences in perceived risks and benefits of quitting smoking in people diagnosed with psychosis presenting for a smoking cessation intervention study and compare risks and benefits with smokers in the general population. | 200; 5 groups; G1 = 79 females (43% schizophrenia, 33% bipolar disorder, 24% other psychotic disorder), G2 = 121 males (67% schizophrenia, 17% bipolar disorder, 17% other psychotic disorder), G3 = 273 females (100% smokers in general population seeking cessation treatment), G4 = 300 males (100% smokers in general population seeking cessation treatment), G5 = 188 (non-treatment seeking smokers in general population) | G1 = 42.67 (9.93), G2 = 40.53 (11.76), G3-G5 = NA | G1 = 0 (0%), G2 = 121 (100%), G3 = 0 (0%), G4 = 300 (100%), G5 = NA | Perceived Risks and Benefits Questionnaire | Total risks: G1 < G3, G2 < G4, G1/G2 = G5; Weight gain: G1 < G3, G2 < G4, G1/G2 = G5; Increased negative affect: G1 = G3, G2 < G4, G1/G2 > G5; Poorer attention or concentration: G1 < G3, G2 < G4, G1/G2 = G5; Social ostracism: G1 < G3, G2 < G4, G1/G2 = G5; Loss of enjoyment: G1 < G3, G2 < G4, G1/G2 < G5; Increased cravings: G1 < G3, G2 < G4, G1/G2 = G5; Total benefits: G1 < G3, G2 < G4, G1/G2 = G5; Improved health: G1 < G3, G2 < G4, G1/G2 = G5; Improved wellbeing: G1 < G3, G2 < G4, G1/G2 > G5; Improved self-esteem: G1 < G3, G2 < G4, G1/G2 > G5; Improved finances: G1 < G3, G2 < G4, G1/G2 = G5; Greater physical appeal: G1 < G3, G2 < G4, G1/G2 > G5; Greater social approval G1 < G3, G2 < G4, G1/G2 = G5. |
88 |
| Forchuk; 2002; Canada | To determine whether individuals with schizophrenia were motivated to smoke to relieve psychiatric symptoms and relieve medication side-effects. | 100; 1 group; G1 = 100 (100% schizophrenia) | 36.2 (10.90) | 72 (72%) | Modified Smoking Motives Questionnaire; Written responses to qualitative questions | Strongest motivators to smoke, from highest to lowest: Sedative effect; Control negative symptoms; Addiction; Control side effects of medication. | 82 |
| Himelhoch; 2009; USA | To determine whether individuals with schizophrenia and type 2 diabetes who smoke received appropriate care related to managing modifiable risk-factors associated with heart disease. | 199; 2 groups; G1 = 61 (100% smokers with schizophrenia and diabetes), G2 = 34 (100% smokers with no serious mental illness and diabetes) | G1 = 48.6 (8.7), G2 = 49.9 (8.4) | G1 = 33 (54.1%), G2 = 18 (52.9%) | Reported receipt of smoking cessation counseling | Received physician advice to quit: G1 = G2 | 79 |
| Hippisley-Cox; 2007; England | To determine whether coronary heart disease patients with schizophrenia were less likely than patients without mental illness to receive good quality care in accordance with UK agreed national standards. | 127,932; 2 groups; G1 = 332 (100% schizophrenia), G2 = 127,231 (100% without mental illness) | Modal age groups = G1 = 65–74 years (30.7%), G2 = 75 years+ (44.9%) |
G1 = 175 (52.7%), G2 = 75,283 (59.2%) | Clinician reported receipt of smoking cessation advice in past 15 months in smokers | Received physician advice to quit: G1 = G2 | 83 |
| Kelly; 2012: USA | To compare knowledge and perception of smoking risks and motivation for quitting in smokers with and without schizophrenia | 200; 2 groups; G1 = 100 (100% schizophrenia), G2 = 100 (no mental disorder) | G1 = 43.3 (11.4), G2 = 37.1 (10.6) | G1 = 71 (71%), G2 = 65 (65%) | Smoking Consequences Questionnaire; Reasons for Quitting Scale; Stages of Change Questionnaire | Reasons for quitting: Desire for self-control G1 = G2; Desire for immediate reinforcement: G1 < G2; Social pressure G1 > G2; Health concerns G1 < G2: Perceived smoking consequences: Stimulation: G1 > G2; Health risks: G1 < G2; Social facilitation: G1 > G2; Reduce negative affect: G1 = G2; Taste manipulation: G1 = G2; Appetite/weight control: G1 = G2; Craving/addiction: G1 = G2; Negative physical feelings: G1 = G2; Reduce boredom: G1 = G2; Social impression: G1 = G2. |
83 |
| Kourakos; 2014; Greece | To examine mental health patients' attitudes regarding smoking habits in the inpatient setting. | 80; 1 group; G1 = 80 (65% schizophrenia/ schizoaffective disorders, 8% bipolar disorder, 28% other psychiatric illnesses) | 52.55 (12.91) | 54 (68%) | Patients' self-reported attitudes toward smoking | Received physician advice to quit: 25%; Staff should be able to smoke on the ward: 62.5% agreed; Visitors should be able to smoke with patients: 62.5% agreed; Seeing other patients smoke makes it difficult to quit: 62.5% agreed; Staff should encourage smokers to quit: 65% agreed. |
50 |
| Krishnadas; 2012; Scotland | To examine clinical variables associated with schizophrenia in an epidemiologically defined geographical area. | 131; 2 groups; G1 = 70 (100% smokers with schizophrenia), G2 = 61 (100% non-smokers with schizophrenia) | G1 = 49.61 (14.48), G2 = 57.79 (17.21) | G1 = 47 (67.1%), G2 = 25 (41%) | Semi-structured questionnaire about smoking, smoking benefits and intentions of quitting | Reasons for smoking: Stress reduction: 60%; Manage depression or anxiety: 31%; Relieve loneliness: 16%; Socialize better: 14%. |
83 |
| Mann-Wrobel; 2011; USA | To understand the relationship between smoking and quit history, negative consequences due to smoking, stage of change, smoking temptation, and self-efficacy in people with schizophrenia participating in a smoking cessation trial. | 41; 1 group; G1 = 41 (100% schizophrenia) | 49.22 (8.0) | 34 (82.9%) | Smoking Consequences Questionnaire; University of Rhode Island Change Assessment-Maryland |
Perceived negative consequences of smoking, from highest to lowest: Health risks; Craving/addiction; Negative social impression. Perceived positive expectancies of smoking, from highest to lowest: Boredom reduction; Negative affect reduction; Social facilitation. |
73 |
| Spring; 2003; USA | To test two hypotheses: that patients with schizophrenia find smoking more rewarding then patients with depression; and, that patients with schizophrenia and patients with depression find smoking more rewarding than smokers without a psychiatric disorder other than nicotine dependence. | 78; 3 groups; G1 = 26 (100% schizophrenia), G2 = 26 (100% depressive disorder), G3 = 26 (100% no psychiatric disorder) | G1 = 40.00 (10.85), G2 = 35.31 (11.13), G3 = 26.20 (11.69) | G1 = 19 (73%), G2 = 13 (50%), G3 = 21 (81%) | Decisional Balance Scale; Self-developed tool of preferences for engaging in smoking vs. other rewarding activities and magnitude of reward felt necessary for quitting | Decisional balance (pros minus cons): G1 = G2, G1/G2 > G3; Pros of smoking: G1 = G2, G1/G2 > G3; Cons of smoking G1 = G2 = G3; Alternative rewards were less favorable than smoking: G1 = G2, G1/G2 > G3; More rewards required to quit: G1 = G2, G1/G2 > G3 |
79 |
| Tanriover; 2013; Turkey | To examine the frequency of smoking, smoking status, and smoking dependence in inpatients with schizophrenia, bipolar disorder, and major depression disorder. | 160; 2 groups; G1 = 80 (53% schizophrenia, 31% bipolar disorder, 16% depressive disorder), G2 = 80 (100% no psychiatric diagnosis) | G1 = 36.83 (12.18), G2 = 37.65 (12.26) | G1 = 44 (55%), G2 = 39 (49%) | Self-developed tool to measure reason for tobacco use | Habit: G1 = 15%, G2 = 7.5% Addiction: G1 = 0%, G2 = 2.5%; Don't know: G1 = 1.3%, G2 = 1.3%; Society: G1 = 0%, G2 = 5%; Need: G1 = 1.3%, G2 = 0%; Desire to experiment: G1 = 1.3%, G2 = 17.5%; Boredom: G1 = 31.3%, G2 = 17.5%; Loneliness: G1 = 8.8%, G2 = 0%; Pleasure: G1 = 11.3%, G2 = 3.8% |
63 |
| Tidey; 2009; USA | To compare expected positive and negative smoking outcomes in smokers with schizophrenia, schizoaffective disorder, and equally-nicotine dependent smokers without psychiatric disorder, and to examine relationships between expected outcomes and intentions to quit smoking. | 152; 3 groups; G1 = 46 (100% schizophrenia), G2 = 35 (100% schizoaffective disorder), G3 = 71 (no psychiatric disorder) | G1 = 45.1 (7.7), G2 = 43.9 (8.5), G3 = 44.5 (12.2) | G1 = 35 (76%), G2 = 19 (54%), G3 = 39 (55%) | Smoking Effects Questionnaire | Positive social effects: G1 = G2, G1 = G3, G2 > G3, G2 participants who did not intend to quit in 6 months > G2 participants who intended to quit in 6 months; Negative psychosocial effects: G1 = G2, G1 = G3, G2 > G3; Negative physical effects: G1 < G2, G1 = G3, G2 > G3 |
83 |
| Tidey.; 2014; USA | To compare craving and withdrawal symptoms in smokers with schizophrenia and without schizophrenia across a 72-h period of abstinence, compare reinforcing effects of nicotine before and after abstinence, compare latency to smoking lapse, and examine predictors of lapse | 55; 2 groups; G1 = 28 (100% schizophrenia, G2 = 27 (100% no psychiatric disorder) | G1 = 44.0 (10.6), G2 = 43.9 (10.8) | G1 = 16 (57%), G2 = 17 (63%) | Questionnaire on Smoking Urges—Brief form; Minnesota Nicotine Withdrawal Scale; Hedonic Rating Scale | Anticipated relief of negative affect: G1 > G2; Change in desire to smoke and withdrawal symptoms over 72 h abstinence: G1 = G2 |
83 |
| Tulloch; 2016; Canada | To better understand the quit experience of smokers with and without psychiatric illness. | 732; 2 groups; G1 = 302 (100% no psychiatric disorder), G2 = 18 (100% psychotic disorders) | G1 = 48.54 (11.01), G2 = 48.61 (10.83) | G1 = 188 (62.3%), G2 = 15 (83.3%) | List of reasons for relapsing smoking and motives and concerns about quitting | Cravings a concern for quitting: G1 < G2 (aOR = 4.16, 95%CI = 1.44, 12.06); Boredom a concern for quitting: G1 < G2 (aOR = 8.03, 95% CI = 2.25, 28.69) | 67 |
ANOVA, analysis of variance; aOR, adjusted odds ratio; CI, confidence intervals; G, group; N, number; NA, Not available; NRT, nicotine replacement therapy; SD, standard deviation; USA, United States of America.