Frequency of attendance at religious services and cigarette smoking in American women and men: The Third National Health and Nutrition Examination Survey

Background. Data are lacking from representative samples of total populations and Hispanic Americans on the association of cigarette smoking and religiousness/spirituality, a protective factor for mortality, and on the validity of self-reported smoking data for religious research. Methods. The Third National Health and Nutrition Examination Survey (NHANES III) included 18,774 persons aged 20 years and over with complete data on self-reported frequency of attendance at religious services, and cigarette smoking. Results. After stratifying by age, gender, and ethnic group, and adjusting for age, education, region, and health status, infrequent attenders (<24 times/year) were much more likely to be smokers than frequent attenders; odds ratios (95% confidence limits) ranged from 1.74 (1.45–2.10) to 3.06 (1.86–5.03). Among current smokers, frequent attenders smoked an average of 1–5 fewer cigarettes per day. Using serum cotinine ≥14 ng/mL as the gold standard for current smoking, under-reporting of smoking did not vary appreciably with frequency of attendance: false negative percentage for never smokers 3.1% in frequent attenders, 4.2% in others. Conclusions. Greater frequency of attendance at religious services was associated with lower smoking prevalence by self-report or serum cotinine in a national, multi-ethnic sample.