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Cigarette smoking among Turkish high school students1
JOURNAL OF ADOLESCENT HEALTH 2002;30:7– 8
LETTER TO THE EDITOR
Cigarette Smoking Among Turkish High School Students
To the Editor: We performed a study to profile patterns of cigarette use among high school students living in Istanbul, the largest city of Turkey, and to identify important factors associated with current cigarette use in order to plan effective health promotion strategies. This study was part of a cross-sectional study that was conducted to determine the health status and health behaviors in high school students. The sample composed of 4153 randomly selected 9th through 11th grade students attending 26 randomly selected high schools from 19 districts. The international version of “Health Behavior in School Age Children (HBSC) 1997/1998” survey questionnaire was used in this study with the permission of the representative of the World Health Organization regional office for Europe during the 1997/1998 survey [1]. Questionnaire was administered in the classroom in the presence of one of the researchers, a trained surveyor, and the class/homeroom teacher. Students’ participation was voluntary. Data were collected during the second semester between March 2000 to April 2000. Students who reported smoking at least one cigarette during their lifetime were described as an “experimental user.” Students were asked “How often do you smoke cigarettes at present?” A “current user” was one who even smoked less than once a week at present. Chi-square tests and Spearman correlation test were used in univariate analyses as appropriate. Forward stepwise multiple regression model was used to determine the independent variables influencing smoking behavior after adjustment for gender and grade. Forty-four percent (n⫽1811) of students were experimental users. Male students from 9th and 11th grade were significantly more likely than female students in the same grades to have experimented This research was supported by grants from Erkim I˙lac¸ Sn A. And Nova Nordics Saglık Urunleri Tic. Ltd. Sti.
cigarette smoking (in 9th grade: 28% of females, 37% of males; in 10th grade: 46% of females, 48% of males; in 11th grade: 47% of females, 56% of males) (p ⬍ .001 for each comparison). A significant increase was observed in cigarette experimentation rate across grades for both female and male students (females; r ⫽ .24, p ⬍ .001; males; r ⫽ .15, p ⬍ .001). Twentythree percent of the students (n⫽951) reported that they were current users. Boys were more likely than girls to report current cigarette smoking in each grade (in 9th grade: 11% of females, 19% of males; in 10th grade: 20% of females, 26% of males; in 11th grade: 27% of females, 35% of males) (p ⬍ .05 for each comparison). In addition, current use of cigarette tended to gradually increase by grade level, reaching 35% of boys and 27% of girls in 11th grade (females r ⫽ .17, p ⬍ .0001; males r ⫽ .16, p ⬍ .0001). Fourteen percent of the students (n⫽597) reported that they smoked cigarettes daily. Boys were more likely than girls to report smoking daily at each grade (in 9th grade: 5% of females, 11% of males; in 10th grade: 11% of females, 17% of males; in 11th grade: 16% of females, 26% of males) (p ⬍ .001 for each comparison). There was a significant increase in daily smoking rate across grades for both genders (females r ⫽ .14, p ⬍ .0001; males r ⫽ .16, p ⫽ .0001). Multiple logistic regression analyses showed that lower maternal educational level, higher socioeconomic status, difficulty in talking to father, making new friends easily, spending more time with friends after school and in the evening, poor academic achievement, being truant more often, not feeling healthy and happy and feeling lonely more often, being drunk at least once during lifetime, drinking tea/coffee at least once a day and exercising less than once a week were all significantly associated with current cigarette use. Slightly less than half of the students’ had experimented with smoking and nearly one-quarter of adolescents were current smokers. Compared to female students, male students were more likely to
© Society for Adolescent Medicine, 2001 Published by Elsevier Science Inc., 655 Avenue of the Americas, New York, NY 10010
1054-139X/02/$–see front matter PII S1054-139X(01)00380-9
8
ALIKASIFOGLU ET AL.
experiment with, and be current user of, cigarettes. A national study in 1998 found that 62% of female and 68% of male high school students in Istanbul were experimental smokers and that 31% of female students and 33% of male students had smoked cigarettes on greater than or equal to 1 of the 30 days preceding the survey [2]. Despite the differences in methodologies used in these studies, the prevalence of both experimentation and current use in our study was lower than that reported in the 1998 survey. In contrast to the prevalence rates found in most European countries, the prevalence of smoking among male adolescents in Istanbul was higher than females [1]. This finding was also reported in Portugal and the United States. [1,3]. This largest known study on correlates of adolescent smoking in Turkey yielded findings similar to those of other countries [1,3,4]. Thus, we may be justified in claiming that correlates of smoking do not appear to differ from culture to culture. Because smoking is common in our high school youth and cigarette smoking during adolescence often results in a life-long pattern of nicotine dependence, development and widespread implementation of tobacco prevention programs should be given priority in schools and in the community. Our findings suggest that these programs should begin as early as possible, and address family and peer influence. Respectfully submitted, Mujgan Alikasifoglu, M.D. Pediatrician Department of Pediatrics Division of Adolescent Medicine
JOURNAL OF ADOLESCENT HEALTH Vol. 30, No. 1
Ethem Erginoz, M.D., Ph.D. Department of Public Health Oya Ercan, M.D. Professor of Pediatrics Department of Pediatrics Division of Adolescent Medicine ¨ mer Uysal, Ph.D. O Department of Biostatistics Istanbul University Cerrahpasa Medical Faculty Deniz Kaymak-Albayrak, Ph.D. Bogazici University Department of Educational Science ¨ zdemir Ilter, M.D. O Professor of Pediatrics Department of Pediatrics Istanbul University Cerrahpasa Medical Faculty
References 1. Currie C, Hurrelmenn K, Settertobulte W, et al. Health behaviour in school aged children: A WHO cross-National study. International report. WHO 2000; Health policy for children and adolescents series No 1. ¨ gel K, Tamar D, Evren C et al. Tobacco, alcohol and drug use 2. O among high school students. Turkish J Psychiatry 2001;12:47– 52. 3. Azevedo A, Machado AP, Barros H. Tobacco smoking among Portuguese high-school students. Bulletin 1999;77:509 –14. 4. Resnick MD, Bearman PS, Blum RW, et al. Protecting adolescents from harm. JAMA 1997;278:823–32.
LETTER TO THE EDITOR
Cigarette Smoking Among Turkish High School Students
To the Editor: We performed a study to profile patterns of cigarette use among high school students living in Istanbul, the largest city of Turkey, and to identify important factors associated with current cigarette use in order to plan effective health promotion strategies. This study was part of a cross-sectional study that was conducted to determine the health status and health behaviors in high school students. The sample composed of 4153 randomly selected 9th through 11th grade students attending 26 randomly selected high schools from 19 districts. The international version of “Health Behavior in School Age Children (HBSC) 1997/1998” survey questionnaire was used in this study with the permission of the representative of the World Health Organization regional office for Europe during the 1997/1998 survey [1]. Questionnaire was administered in the classroom in the presence of one of the researchers, a trained surveyor, and the class/homeroom teacher. Students’ participation was voluntary. Data were collected during the second semester between March 2000 to April 2000. Students who reported smoking at least one cigarette during their lifetime were described as an “experimental user.” Students were asked “How often do you smoke cigarettes at present?” A “current user” was one who even smoked less than once a week at present. Chi-square tests and Spearman correlation test were used in univariate analyses as appropriate. Forward stepwise multiple regression model was used to determine the independent variables influencing smoking behavior after adjustment for gender and grade. Forty-four percent (n⫽1811) of students were experimental users. Male students from 9th and 11th grade were significantly more likely than female students in the same grades to have experimented This research was supported by grants from Erkim I˙lac¸ Sn A. And Nova Nordics Saglık Urunleri Tic. Ltd. Sti.
cigarette smoking (in 9th grade: 28% of females, 37% of males; in 10th grade: 46% of females, 48% of males; in 11th grade: 47% of females, 56% of males) (p ⬍ .001 for each comparison). A significant increase was observed in cigarette experimentation rate across grades for both female and male students (females; r ⫽ .24, p ⬍ .001; males; r ⫽ .15, p ⬍ .001). Twentythree percent of the students (n⫽951) reported that they were current users. Boys were more likely than girls to report current cigarette smoking in each grade (in 9th grade: 11% of females, 19% of males; in 10th grade: 20% of females, 26% of males; in 11th grade: 27% of females, 35% of males) (p ⬍ .05 for each comparison). In addition, current use of cigarette tended to gradually increase by grade level, reaching 35% of boys and 27% of girls in 11th grade (females r ⫽ .17, p ⬍ .0001; males r ⫽ .16, p ⬍ .0001). Fourteen percent of the students (n⫽597) reported that they smoked cigarettes daily. Boys were more likely than girls to report smoking daily at each grade (in 9th grade: 5% of females, 11% of males; in 10th grade: 11% of females, 17% of males; in 11th grade: 16% of females, 26% of males) (p ⬍ .001 for each comparison). There was a significant increase in daily smoking rate across grades for both genders (females r ⫽ .14, p ⬍ .0001; males r ⫽ .16, p ⫽ .0001). Multiple logistic regression analyses showed that lower maternal educational level, higher socioeconomic status, difficulty in talking to father, making new friends easily, spending more time with friends after school and in the evening, poor academic achievement, being truant more often, not feeling healthy and happy and feeling lonely more often, being drunk at least once during lifetime, drinking tea/coffee at least once a day and exercising less than once a week were all significantly associated with current cigarette use. Slightly less than half of the students’ had experimented with smoking and nearly one-quarter of adolescents were current smokers. Compared to female students, male students were more likely to
© Society for Adolescent Medicine, 2001 Published by Elsevier Science Inc., 655 Avenue of the Americas, New York, NY 10010
1054-139X/02/$–see front matter PII S1054-139X(01)00380-9
8
ALIKASIFOGLU ET AL.
experiment with, and be current user of, cigarettes. A national study in 1998 found that 62% of female and 68% of male high school students in Istanbul were experimental smokers and that 31% of female students and 33% of male students had smoked cigarettes on greater than or equal to 1 of the 30 days preceding the survey [2]. Despite the differences in methodologies used in these studies, the prevalence of both experimentation and current use in our study was lower than that reported in the 1998 survey. In contrast to the prevalence rates found in most European countries, the prevalence of smoking among male adolescents in Istanbul was higher than females [1]. This finding was also reported in Portugal and the United States. [1,3]. This largest known study on correlates of adolescent smoking in Turkey yielded findings similar to those of other countries [1,3,4]. Thus, we may be justified in claiming that correlates of smoking do not appear to differ from culture to culture. Because smoking is common in our high school youth and cigarette smoking during adolescence often results in a life-long pattern of nicotine dependence, development and widespread implementation of tobacco prevention programs should be given priority in schools and in the community. Our findings suggest that these programs should begin as early as possible, and address family and peer influence. Respectfully submitted, Mujgan Alikasifoglu, M.D. Pediatrician Department of Pediatrics Division of Adolescent Medicine
JOURNAL OF ADOLESCENT HEALTH Vol. 30, No. 1
Ethem Erginoz, M.D., Ph.D. Department of Public Health Oya Ercan, M.D. Professor of Pediatrics Department of Pediatrics Division of Adolescent Medicine ¨ mer Uysal, Ph.D. O Department of Biostatistics Istanbul University Cerrahpasa Medical Faculty Deniz Kaymak-Albayrak, Ph.D. Bogazici University Department of Educational Science ¨ zdemir Ilter, M.D. O Professor of Pediatrics Department of Pediatrics Istanbul University Cerrahpasa Medical Faculty
References 1. Currie C, Hurrelmenn K, Settertobulte W, et al. Health behaviour in school aged children: A WHO cross-National study. International report. WHO 2000; Health policy for children and adolescents series No 1. ¨ gel K, Tamar D, Evren C et al. Tobacco, alcohol and drug use 2. O among high school students. Turkish J Psychiatry 2001;12:47– 52. 3. Azevedo A, Machado AP, Barros H. Tobacco smoking among Portuguese high-school students. Bulletin 1999;77:509 –14. 4. Resnick MD, Bearman PS, Blum RW, et al. Protecting adolescents from harm. JAMA 1997;278:823–32.