Ziasma Haneef Khan a, P. J. Watson b & Zhuo Chen c a Department of Psychology, University of Karachi, University

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1 This article was downloaded by: [University of Tennessee Chattanooga], [P. J. Watson] On: 06 January 2014, At: 10:25 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: Registered office: Mortimer House, Mortimer Street, London W1T 3JH, UK Mental Health, Religion & Culture Publication details, including instructions for authors and subscription information: Smoking, Muslim religious commitments, and the experience and behaviour of Ramadan in Pakistani men Ziasma Haneef Khan a, P. J. Watson b & Zhuo Chen c a Department of Psychology, University of Karachi, University Road, Karachi, 75270, Pakistan b Department of Psychology, University of Tennessee at Chattanooga, #2803, 350 Holt Hall 615 McCallie Avenue, Chattanooga, TN, 37403, USA c University of TN at Chattanooga, Chattanooga, USA Published online: 14 Aug To cite this article: Ziasma Haneef Khan, P. J. Watson & Zhuo Chen (2013) Smoking, Muslim religious commitments, and the experience and behaviour of Ramadan in Pakistani men, Mental Health, Religion & Culture, 16:7, , DOI: / To link to this article: PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the Content ) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &

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3 Mental Health, Religion & Culture, 2013 Vol. 16, No. 7, , Smoking, Muslim religious commitments, and the experience and behaviour of Ramadan in Pakistani men Ziasma Haneef Khan a, P.J. Watson b * and Zhuo Chen c a Department of Psychology, University of Karachi, University Road, Karachi 75270, Pakistan; b Department of Psychology, #2803, 350 Holt Hall 615 McCallie Avenue, University of Tennessee at Chattanooga, Chattanooga, TN, 37403, USA; c University of TN at Chattanooga, Chattanooga, USA (Received 25 June 2012; final version received 13 July 2012) This study examined the possibility that smoking may interfere with Muslim commitments in general and with the experience and behaviour of Ramadan in particular. During Ramadan, a sample of 29 smoking and 46 non-smoking Pakistani men responded to measures of smoking, Religious Orientation, Religious Interest, Positive and Negative Ramadan Experience, and Ramadan Behaviour. Various indices of smoking predicted a disinterest in religion, less of an Intrinsic Religious Orientation, lower levels of Positive Ramadan Experience, higher Negative Ramadan Experience, and reductions in Ramadan Behaviour. These data offered preliminary support for the suggestion that smoking presents a challenge to Muslim beliefs and practices, especially during Ramadan. Keywords: Smoking; Ramadan experience; Ramadan behaviour; religious orientations; religious interest Beyond its well-documented health risks, smoking for Muslims can also have negative religious implications. More popular guides to Islamic beliefs and practices sometimes identify smoking as haram, or forbidden, because smoking leads to disease, threatens the health of others through passive smoking, and wastes money (Bu yu kçelebi, 2005; Maqsood, 2003). Whether smoking is unambiguously haram can be questioned, however, because neither the Qur an nor the sunnah mention tobacco use, which becomes possible only later in history. For this reason, smoking is sometimes designated as tahriman makrooh, which means strictly abominable (S ahin, 2010). The implication, nevertheless, remains clear. Smoking as a practice is not in conformity with Islamic ideals. More generally as well, Islam wants the Muslim to stand out among people, readily distinguished by his appearance, dress, decent behaviours and good deeds, so that he will be a good example (Al Hashimi, 1999, p. 27), and smoking fails to set a good example (Maqsood, 2003). Does smoking present a challenge for Muslim beliefs and practices? One purpose of this study was to begin answering that question by examining how smoking correlates with broader Muslim commitments as assessed by Religious Orientation (McPherson & Gorsuch, 1989) and Religious Interest measures. The Intrinsic Religious Orientation theoretically reflects a sincere form of faith in which religion serves as the ultimate *Corresponding author. paul-watson@utc.edu ß 2013 Taylor & Francis

4 664 Z.H. Khan et al. motivation in an individual s life. An Extrinsic-Personal Orientation represents the use of religion as a means to personal well-being as the end. Research in Muslim societies connects both of these motivations with religious and psychological adjustment (Ghorbani, Watson, & Khan, 2007). Smoking as haram or tahriman makrooh, therefore, should correlate negatively with the Intrinsic and Extrinsic-Personal orientations and also with Religious Interest. An Extrinsic-Social Orientation reflects the use of religion as a means to social ends and has ambiguous implications in Muslim samples (Ghorbani et al., 2007). The relevance of smoking to setting a good example, nevertheless, suggested that smoking might predict lower levels of this orientation. Smoking may present special problems during Ramadan. Smoking is typically among the behaviours proscribed during the dawn-to-dusk fast of Ramadan. Describing the distress of smoking during Ramadan, a taxi driver from Ramallah once complained, This cigarette is burning me alive. I don t want it to be the reason for me burning in the afterlife (Laub & Nammari, 2008). More formal evidence suggests that Muslim smokers experience lower self-esteem (C aliyurt, Molla, Vardar, & Abay, 2005) and greater irritability (Kadri et al., 2000) during Ramadan. Efforts to use Ramadan as a reason for Muslims to quit smoking have also attracted attention (e.g., Aveyard, Begh, Sheikh, & Amos, 2011; White, Bush, Kai, Bhopal, & Rankin, 2006). Recently developed psychological scales make it possible to explore the implications of smoking during Ramadan more formally (Khan & Watson, 2010). The Positive Ramadan Experience Scale assesses the perceived psychological benefits of Ramadan (e.g., I fast to get closer to Allah ), in contrast to the possible distress reactions recorded by Negative Ramadan Experience (e.g., During fasting I easily express my anger with people in my surroundings ). The Ramadan Behaviour Scale assesses involvement in activities typically associated with Ramadan, including, for example, prayer and making recitations from the Qur an. The obvious expectation was that smoking would correlate negatively with Positive Ramadan Experience and Ramadan Behaviour and positively with Negative Ramadan Experience. In summary, this study served as a preliminary attempt to clarify the implications of smoking for Muslims. Procedures made it possible to test two broad sets of hypotheses: First, Smokers should on average score lower than Non-Smokers on the three Religious Orientations, Religious Interest, Positive Ramadan Experience, and Ramadan Behaviour. They should also display higher levels of Negative Ramadan Experience. Second, indices of greater smoking should correlate negatively with all three Religious Orientations, Religious Interest, Positive Ramadan Experience, and Ramadan Behaviour and positively with Negative Ramadan Experience. Method Participants Participants included 75 men with an average age of 24.8 years (SD ¼ 8.8). Of this total, 64 were students at the University of Karachi, with all others coming from the wider community. Sampling procedures included women, but no women smokers could be identified. Data analyses consequently focused only on men. Measures English versions of all measures appeared in a single questionnaire booklet. After obtaining background information, this booklet presented an array of instruments that

5 Mental Health, Religion & Culture 665 included assessments of Religious Interest, Religious Orientation, Ramadan Experience and Behaviour, and smoking. Religious interest and orientations Participants indicated their interest in religion by responding along a scale that ranged from not at all (1) to extremely (7). The Gorsuch and McPherson (1989) single-item indices of religious orientation used strongly disagree (1) to strongly agree (7) response options. The Intrinsic item said, My whole approach to life is based on my religion. Reflecting the Extrinsic-Personal Orientation was the assertion, What religion offers me most is comfort in times of trouble and sorrow. Expression of the Extrinsic- Social Orientation substituted activities associated with my religion for church in order to make the original item more appropriate for the Pakistani context: I go to activities associated with my religion because I enjoy seeing people I know there. Validity of these single-item measures has been documented in previous Pakistani studies (e.g., Khan & Watson, 2004; Khan, Watson, & Chen, 2011; Khan, Watson, & Habib, 2005). Ramadan experience and behavior Each of the 10-item Positive and Negative Ramadan Experience Scales used a strongly disagree (1) to strongly agree (5) Likert scale. The 8-item Ramadan Behaviour Scale presented 0 to 5 response options that assessed the frequency or strength of Ramadan relevant behaviours (Khan & Watson, 2010; Khan, Watson, Chen, Iftikar, & Jabeen, 2012). While Negative Ramadan Experience displayed an acceptable internal reliability ( ¼ 0.81), Positive Ramadan Experience ( ¼ 0.28) and Ramadan Behaviour ( ¼ 0.52) did not. Creation of more psychometrically sound instruments resulted from the elimination of two Positive Ramadan Experience ( ¼ 0.79) and three Ramadan Behaviour ( ¼ 0.61) items. Representative of Negative Ramadan Experience was the self-report, During Ramadan, my time passes with much difficulty. Positive Ramadan Experience appeared, for example, in the claim, Fasting strengthens my will power. Illustrating Ramadan Behaviour was a question that asked, Do you give alms/sadaqah during Ramadan? Responses ranged from never (1) to always (5). Smoking Four questions assessed smoking relevant behaviours. A YEARS SMOKING item asked participants to indicate the number of years that they had smoked on a daily basis. The BIGGEST DIFFICULTY item said, While I am fasting, the biggest difficulty is to resist the urge to smoke. Participants responded using a strongly disagree (1) to strongly agree (5) Likert scale. A PRE-SEHRI SMOKING measure asked, During Ramadan, how often do you find it necessary to smoke before sehri? A similar POST-IFTARI SMOKING question asked, During Ramadan, how often do you find it necessary to smoke after iftari? Possible answers ranged from never (1) to all of the days (5). Sehri is the meal eaten before dawn when fasting begins, and iftari refers to the meal eaten after sunset when it ends.

6 666 Z.H. Khan et al. Table 1. Correlations among non-smoking religious measures in Pakistani men (N ¼ 75). Correlations Variable M SD Intrinsic Orientation * 0.23* 0.43*** 0.44*** Extrinsic-Personal * Extrinsic-Social * ** Religious Interest ** 0.23* Positive Ramadan ** 0.12 Experience 6. Negative Ramadan Experience 7. Ramadan Behaviour Note: *p , **p , ***p Procedures During Ramadan in 2011, students from a research class obtained a sample from among friends and acquaintances. Data collection occurred in interactions with both single individuals and small groups. Participation in the project was voluntary, confidential, and in full conformity with institutional rules for ethical research. Final Ramadan Experience and Behaviour scores involved the computation of an average response per item. Participants who self-reported a YEARS SMOKING score greater than 0 became part of a Smoker Group to be compared with a Non-Smoker Group in a multivariate analysis of variance (MANOVA) that examined all of the religious and Ramadan measures. A further analysis of the full sample then followed with the four smoking items correlated with the Religious Orientation, Religious Interest, and Ramadan variables. Given that hypotheses specified the direction of all these smoking relationships, procedures used one-tailed tests to determine significance. Results Relationships among the Religious Orientation, Religious Interest, and Ramadan measures appear in Table 1. The Intrinsic Orientation correlated positively with the two other religious orientations and with Religious Interest, which in turn displayed a direct linkage with the Extrinsic-Social Orientation. Positive Ramadan Experience predicted higher Intrinsic, Extrinsic-Personal, and Religious Interest scores and lower levels of Negative Ramadan Experience. Negative Ramadan Experience also correlated positively with the Extrinsic-Social Orientation and negatively with Religious Interest. No significant relationships appeared for Ramadan Behaviour. Smokers reported an average YEARS SMOKING of 10.0 (SD ¼ 10.5). The 29 individuals with YEARS SMOKING scores greater than 0 constituted the Smoker group, with the 46 other participants defining the Non-Smoker Group. The MANOVA comparing these two groups yielded no significant overall effect, Wilks Lambda ¼ 0.861, F(7,67) ¼ 1.54, p ¼ In the smoker group, means for the other smoking measures were 2.62 (SD ¼ 1.79) for BIGGEST DIFFICULTY, 2.85 (SD ¼ 1.83) for PRE-SEHRI SMOKING, and 3.81 (SD ¼ 1.47) for POST-IFTARI SMOKING. Among the 26 smokers, BIGGEST

7 Mental Health, Religion & Culture 667 Table 2. Correlations of smoking with non-smoking religious measures in Pakistani men (N ¼ 75). Smoking Measures Religion measures YEARS SMOKING BIGGEST DIFFICULTY PRE SEHRI SMOKING POST-IFTARI SMOKING Correlations Intrinsic Orientation * 0.15 Extrinsic-Personal Extrinsic-Social Religious Interest 0.28** 0.21* 0.34** 0.33** Positive Ramadan Experience 0.19* 0.31** 0.33** 0.27* Negative Ramadan Experience *** 0.39*** 0.27* Ramadan Behaviour 0.28* * Note: *p , **p , ***p DIFFICULTY correlated positively with PRE-SEHRI SMOKING (0.52, p ) and POST-IFTARI SMOKING (0.66, p ), with these latter two scores also displaying a direct relationship (0.42, p ). YEARS SMOKING failed to correlate with BIGGEST DIFFICULTY ( 0.08, p ¼ 0.65), PRE-SEHRI SMOKING (0.35, p ¼ 0.08), or POST-IFTARI SMOKING (0.25, p ¼ 0.22). Table 2 presents correlations of the smoking items with the Religious Orientation, Religious Interest, and Ramadan measures. With regard to the broader indices of religious commitment, all four smoking items correlated negatively with Religious Interest, and an inverse linkage also appeared between the Intrinsic Orientation and PRE-SHERI SMOKING. Each index of smoking predicted lower levels of Positive Ramada Experience, and all but YEARS SMOKING correlated positively with Negative Ramadan Experience. YEARS SMOKING and POST-IFTARI SMOKING correlated negatively with Ramadan Behaviour. Discussion Results of this investigation confirmed that smoking may present a challenge to Muslim beliefs and practices. In this sample of Pakistani men, all four smoking items predicted a general disinterest in religion, and PRE-SEHRI SMOKING correlated negatively with the Intrinsic Orientation. Smoking items also displayed inverse associations with Positive Ramadan Experience, and all but YEARS SMOKING correlated positively with Negative Ramadan Experience. Inverse linkages also appeared between Ramadan Behaviour and both YEARS SMOKING and POST-IFTARI SMOKING. These correlations, therefore, offered clear and consistent evidence suggesting that smoking interfered with Muslim commitments in general and with the religiously appropriate experience and behaviour of Ramadan in particular. Smoker and Non-Smoker Groups did not differ on the religious and Ramadan measures. Significant correlations, nevertheless, revealed that methodological factors likely explained this failure to observe an overall significant group effect. One obvious difficulty was a small sample size that reduced the power of this analysis. In addition, categorisation of participants into these two groups rested upon use of a YEARS

8 668 Z.H. Khan et al. SMOKING item that seemed to be a relatively insensitive index of smoking. YEARS SMOKING was the only smoking measure that failed to correlate positively with Negative Ramadan Experience, and perhaps more importantly, YEARS SMOKING within the Smoker Group failed to display significant linkages with any of the other smoking items. Future investigations would presumably discover average group differences between Smokers and Non-Smokers with the use of larger sample sizes and/or more sensitive criteria for differentiating between the two groups. Significant relationships among the religious commitment and Ramadan measures largely paralleled previous findings (Ghorbani et al., 2007). The Intrinsic Orientation once again predicted a generally sincere form of Muslim faith. A direct relationship with Positive Ramadan Experience further confirmed the constructive adjustment implications of the Extrinsic-Personal motivation. A similar conclusion seemed evident for Religious Interest in its linkages with the two Ramadan Experience measures. The negative relationship between Positive and Negative Ramadan Experience also seemed congruent with logical expectations. Complexities, nevertheless, appeared in findings for the Extrinsic-Social Orientation. In addition to correlating positively with the Intrinsic Orientation and Religious Interest, this motivation predicted higher rather than lower levels of Negative Ramadan Experience. Such data supported the previous conclusion that the Extrinsic-Social Orientation can have ambiguous implications in Muslim samples (Ghorbani et al., 2007). Deeper interpretative issues may also emerge with the realisation that some Negative Ramadan Experience items refer to social motivations. One item asserts, for example, I fast so that people consider me more pious, whereas another claims, I fast to gain respect from others. Again, Muslims are encouraged to set a good example (Al Hashimi, 1999). Could the direct linkage with Negative Ramadan Experience point instead toward an adaptive Extrinsic-Social desire to set a good example? This possibility seems unlikely given that Negative Ramadan Experience proved to be an internally consistent index of religious maladjustment. Perhaps, the social elements of Negative Ramadan Experience reflected efforts of the individual to comply with social pressures to conform. Such considerations may spotlight a complexity in the social motivations of Muslims. Future research may need to differentiate between a personal responsiveness to disturbing pressures to conform versus sincere Muslim motivations to set a good example. Strong emphasis should be placed on the very preliminary nature of these findings. Procedures examined a relatively small sample of only Pakistani men. Future studies clearly need to include women, and larger samples need to be examined in Pakistan and in other societies in which Islam is a minority as well as the majority religion. The present investigation also used single-item indices of religious orientation in order to make it easier for researchers to obtain data during Ramadan. The use of full scales could yield stronger results, and smoking should also be evaluated in relationship with other more specifically Muslim measures of commitment (e.g., Abu Raiya, Pargament, Mahoney, & Stein, 2008). More sophisticated operationalisations of smoking would presumably be useful as well. Finally, the present correlation results obviously cannot support causal inferences. It cannot be concluded that smoking interfered with Muslim commitments, nor that reduced levels of Muslim beliefs and practices caused smoking. Some unexamined variable could also have produced these relationships. The question of causality is an important one, but will require a direct analysis using, for example, longitudinal designs or perhaps experiments that attempt to enhance Muslim commitments as the independent variable and smoking as the dependent variable.

9 Mental Health, Religion & Culture 669 In conclusion, this project presented suggestive evidence that smoking may interfere with Muslim beliefs and practices. Previous researchers have emphasised that Ramadan may be an especially good time to encourage Muslims to quit smoking (e.g., Aveyard et al., 2011), but they have also noted that such efforts do not appear to be especially effective (White et al., 2006). The present study perhaps identified one factor that may work against success. Smoking may predict a basic disinterest in religion and may occur within the context of smoking being unrelated to or incompatible with sincere religious motivations. Religious rationales for quitting smoking during Ramadan, therefore, may not be especially compelling within the less robust religious frameworks of Muslim smokers. In combination with other interventions, efforts to strengthen Muslim commitments and to promote deeper positive experiences of Ramadan could perhaps help encourage Muslims to quit smoking. Smoking is a noteworthy physical and mental health concern for Muslims (e.g., C aliyurt et al., 2005; Kadri et al., 2000); so, the issues explored in this very preliminary investigation clearly deserve additional research attention. References Abu Raiya, H., Pargament, K.I., Mahoney, A., & Stein, C. (2008). A psychological measure of Muslim religiousness: Development and evidence for reliability and validity. The International Journal for the Psychology of Religion, 18, Al Hashimi, M.A. (1999). The ideal Muslim: The true Islamic personality as defined in the Qur an and the Sunnah (Rev. 2nd ed.). Riyad: International Islamic Publishing House. Aveyard, P., Begh, R., Sheikh, A., & Amos, A. (2011). Promoting smoking cessation through smoking reduction during Ramadan. Addiction, 106, Bu yu kc elebi, I. (2005). Living in the shade of Islam. Somerset, NJ: The Light. C aliyurt, O., Molla, S., Vardar, E., & Abay, E. (2005). U niversite O g rencilerinde Ramazan Do nemi Oruç Tutma Davramis inin Benlik Saygisi, Sigara ve Alkol Kullanimina Etkileri [Effects of Ramadan fasting on self esteem, cigarette and alcohol use in college students]. Bag imlik Dergisi, 6, 3 8, Abstract retrieved from PsycInfo database. (Accession No ). Ghorbani, N., Watson, P.J., & Khan, Z.H. (2007). Theoretical, empirical, and potential ideological dimensions of using Western conceptualizations to measure Muslim religious commitments. Journal of Muslim Mental Health, 2, Gorsuch, R.L., & McPherson, S.E. (1989). Intrinsic/extrinsic measurement: I/E revised and singleitem scales. Journal for the Scientific Study of Religion, 28, Kadri, N., Tilane, A., El Batal, M., Taltit, Y., Tahiri, S., & Moussaoui, D. (2000). Irritability during the month of Ramadan. Psychosomatic Medicine, 62, Khan, Z.H., & Watson, P.J. (2004). Religious orientation and the experience of Eid-ul-Azha among Pakistani Muslims. Journal for the Scientific Study of Religion, 43, Khan, Z.H., & Watson, P.J. (2010). Ramadan experience and behavior: Relationships with religious orientation among Pakistani Muslims. Archive for the Psychology of Religion, 32, Khan, Z.H., Watson, P.J., & Chen, Z. (2011). Differentiating religious coping from Islamic identification in patient and non-patient Pakistani Muslims. Mental Health, Religion, & Culture, 14, Khan, Z.H., Watson, P.J., Chen, Z., Iftikhar, A., & Jabeen, R. (2012). Pakistani religious coping and the experience and behavior of Ramadan. Mental Health, Religion, & Culture, 15, Khan, Z.H., Watson, P.J., & Habib, F. (2005). Muslim attitudes toward religion, religious orientation, and empathy among Pakistanis. Mental Health, Religion, & Culture, 8, Laub, K. & Nammari, D. (2008, September 22). Ramadan fast means hard times for Muslim smokers. USA Today. Retrieved 12 June, 2012 from smoking-ramadan_N.htm

10 670 Z.H. Khan et al. Maqsood, R.W. (2003). Teach yourself Islam. London: Hodder Headline. S ahin, A. (2010, February 16). Is smoking haram? [Online forum comment] Retrieved 6 July, 2012 from White, M., Bush, J., Kai, J., Bhopal, R., & Rankin, J. (2006). Quitting smoking and experience of smoking cessation interventions among UK Bangladeshi and Pakistani adults: The views of community members and health professionals. Journal of Epidemiology and Community Health, 60,