1. TOBACCO CONTROL in TURKEY: NGOs EFFORTS for CONTROL and PREVENTION
Prof. Hikmet PEKCAN, MD
Turkish Public Health Association (TPHA)

2. SMOKING IS AN EPIDEMIC PROBLEM
THE SMOKING IS AN EPIDEMIC PROBLEM
SMOKING IS AN EPIDEMIC PROBLEM

3. GLOBAL TOBACCO CONTROL IS A MAJOR CHALLENGE FOR THE
PUBLIC HEALTH.

4. In developing countries; communities are increasingly subjected
to intense direct and indirect marketing of tobacco products.

5. WE ARE IN THE CIGARETTE BUSSINESS. WE ARE NOT IN THE SPORTS BUSSINESS.
WE USE SPORTS AS AN AVENUE FOR
ADVERTISING OUR PRODUCTS.
R.J. REYNOLDS EXECUTIVE, 1989

6. Tobacco prevention success requires;
cross-sector platforms
and long-term cooperative
partnerships.

7. Government’s Role strong political commitment
presidental, ministreal leadership
multinational agreements

8. Universities’ Role Ongoing researches Evolving tobacco preventive and
control strategies
Tobacco burden and outcome
measurement

9. Media’s Role Support and challenge human resources
Political support/ change of norms
Multinational collaboration

10. Non-Governmental Organizations (NGOs) Role
Continuous strong advocacy
Real-time surveillance
Internet organization tools
Steering wheel tools

11. Studies done in Turkey
Studies were done to estimate the burden of tobacco use on mortality and morbidity.
In Turkey;
17 million cigarette users
Can et al. Sigarayı Bırakma Tedavisi

12. DEATHS DUE TO SMOKING 70-100 000 deaths annually (daily 200-250
8% of total adult deaths/year were due
to cigarette smoking.
Can et al. Sigarayı Bırakma Tedavisi

13. 2% of the smoking of the World takes place in Turkey
2% of the smoking of the World takes place in Turkey. 14% of the smoking of the region is in Turkey.
World Bank, 2001

14. Smoking rate is increasing in Turkey.
State Monopol and State Institute of Statistics

15. Prevalence of smoking is very high
Prevalence of smoking is very high. Smoking is accepted as a social normal behaviour and attitude in Turkey, 1996.
Bilir et al, 1997 Smoking Behavior and Attitudes, Ankara-Turkey

16. Initiation ages of smoking are 12,13, 14 years. Ankara/Turkey, 1996.
Bilir et.al, Smoking Behavior and Attitudes, Ankara-Turkey

17. Old generation had initiated smoking more later. Ankara-Turkey, 1996
Source: Bilir et al Smoking Behavior and Attitudes,
Ankara-Turkey.

18. People are feeling remorse for smoking Ankara-Turkey, 1996
Bilir et.al, 1997 Smoking Behavior and Attitudes, Ankara-Turkey.

19. Tobacco creates addiction, it is hard to quit.
Bilir et al, 1997 Smoking Behavior and Attitudes, Ankara-Turkey

20. Some of the smokers don’t know that they need help to quit
Bilir et al Smoking Behavior and Attitudes, Ankara-Turkey

21. In most of the countries smoking is prevalent in poor people; but in Turkey it is not the case. Rate of smoking increases with the increase in the income!
Bilir et al Smoking Behavior and Attitudes, Ankara-Turkey.

22. The rate of smoking is high among educated people.
Bilir et al Smoking Behavior and Attitudes. Ankara-Turkey

23. Lack of knowledge and awareness of the mothers
Lack of knowledge and awareness of the mothers! The mothers and the grandmothers are smoking more heavily,1996. %
In all age groups, one out of three mothers are smoking.
Out of total, 31% of the mothers are smoking.
Smoking is much prevalent among young mothers.
Age (years)
Bilir et al Smoking behavior and attitudes, Ankara-Turkey.

24. Smoking status of mothers and teachers
Daily amount of cigarettes (number)
Bilir et al Smoking Behavior and Attitudes, Ankara-Turkey

25. Lack of knowledge and awareness in smoking Nobody is mentioning of passive smoking. Why are we poisoning our children?
Bilir et al Smoking behavior and attitudes, Ankara-Turkey

26. What do the smokers say and do in Turkey?
99% of the teachers who are smoking, are against smoking in front of the students
But; 68% are smoking in front of the students
97% of the medical doctors are against smoking in front of their patients
But; 68% are still smoking in the office
98% of the smoking mothers are against of that teachers should not smoke in front of the students
But; 85% are smoking in front of their children.
Bilir et al Smoking Behavior and Attitudes, Ankara-Turkey

27. Why does NGOs involve in tobacco control?
To prevent smoking in children
Initiation age of smoking is decreasing
The adolescents are not aware of
the risks
To prevent the passive smoking
Passive smoking is dangerous as smoking
Most of the adults are smoking in front
of their children
./.

28. Why should NGOs involve in tobacco control? (cont.)
To present logical alternatives for adults
Generally the smokers feel remorse
for initiating smoking
Smokers are spending most of their
budget for tobacco
To support the ones to quit smoking
Tobacco is addictive and smokers need
help
Smokers do not know that they need help
To arrange smoking quit programmes

29. WHO classifies interventions into two major groups, those aimed at reducing the demand for tobacco
• price and tax measures
• protection from exposure to second-hand tobacco smoke
• regulation and disclosure of the contents of tobacco products
• packaging and labelling
• education, communication, training and public awareness-raising
• comprehensive bans and restriction on tobacco advertising, promotion and sponsorship
• tobacco-dependence cessation measures;

30. AS THE PRICE AND THE TAX OF CIGARETTE INCREASE,
THERE WOULD BE A DECREASE IN SMOKING RATE
HIGH TAX

31. Cigarette Smoking Habits Among Men and Women in Turkey: A Meta Regression Analysis
Of the 92 researches related to smoking habits conducted from 1981 to 2003 in Turkey, 60 were deemed appropriate for the application of Meta analysis.
men and women.
The proportions of men and women smoking cigarettes were 0.51 and 0.35, respectively.
The proportion of men smoking cigarette in 1996 and the years before it was 0.52, and for women as 0.35.
However, the figures for the years following 1996 were 0.41 for men, and 0.32 for women.
Mutlu et al. Iranian J Publ Health, 2006, 35:2:7-15.

32. Smoking in school children-1997
Cross-sectional study
A self-completed questionnaire was given
Students in grades 2 through 5 (ages 7 to 13 years)
1093 students
Prevalence of ever smokers was 11.7%
(14% among boys and 9% among girls)
The highest ever smoker rate was obtained in children aged ≤ 8 years (19.6%)
Either one or both parents of 710 of 1080 children (65.7%) were smokers.
The prevalence of ever smokers was significantly higher among children whose parents smoke, than those with nonsmoking parents (4.8% vs 15.3%)
Seydioğulları M. Tobacco and cigarette year book 1996 in Turkey

33. Global Youth Tobacco Survey (GYTS)
Cross-sectional study
Data obtained from youth.
Prevalence and determinants of cigarette smoking were examined.
Males and high-school students have higher odds of being susceptible to smoking
Exposure to parent, teacher, and peer smoking, anti-tobacco curricula, cigarette promotions, and perceived ease of access to cigarettes are all significant predictors of being susceptible to smoking

34. The results reveal the importance of early prevention programmes, which should begin before high school, and targeting efforts towards male students and all students who are not yet smokers but susceptible to smoking.
Ertaş N. The European Journal of Public Health
Advance Access published online on July

35. AS THE PRICE AND THE TAX OF CIGARETTE ARE INCREASED, QUITING RATE OF SMOKING ALSO INCREASES.
CIGARETTE TAXES WERE INCREASED BY 25%.

36. TOBACCO CONTROL EFFORTS
There is only one way to combat this epidemic,
that is by implementing a comprehensive, continuous,
sustainable and adequately funded tobacco
control strategy.
Tobacco control efforts should be focused on several fronts:
• preventing people from taking up tobacco consumption;
• promoting cessation
• protecting non-smokers from the exposure to tobacco smoke
• regulating tobacco products.

37. “Cigarette producers, due to the ban of selling cigarettes containing high tar and high nicotine are sent to the market of the developing countries…”
WHO

38. Role of TPHA for Implementation of Tobacco Control
LEADERSHIP
by sending a clear message to their national counterparts that tobacco control is at the top of the agenda
to provide support to national organization efforts
to encourage and support their members to be role
models by not using tobacco and by promoting a tobacco-free culture.
include tobacco control in the agenda of all relevant health-related congresses and conferences.

39. Role of TPHA in Research for Implementation of Tobacco Control
Interacts with national and international
institutions and foster the production of
scientific knowledge in
prevention of initiation of smoking among
adolescents
decreasing tobacco use among smokers
decreasing passive smoking exposure
among women and kids
developing successful smoking cessation
tools

40. What is TPHA Doing, In Terms of Advocacy to Increase Tobacco Control Capacity?
Influence health institutions and educational centres such as universities to;
include tobacco control in their health
professionals’ curricula through continued
education and other training programmes.
Curriculum development at medical schools
Maintaining a smoke free campus

41. Actively participate in “World No Smoking Day” every 31 May.
Participate in the tobacco-control activities of health professional networks.
Support campaigns for tobacco-free public places.

42. Media advocacy for tobacco laws and
implementation
Emphasis: Non-smokers rights to a
smoke-free environment. In addition to
awareness issues.
Radio and TV talks by experts, with
youth contests for prizes based on
their knowledge of the right answers.
Development of drama, songs and
TV spots for use by national media and
other NGO’s

43. As a NGO
our aim is
no smoking community

44. In Turkey, “The Prevention of the Harms of Tobacco Products Law (Date: and No. 4207) should be protected.
Law and Our Gain
- ban for advertisements
- smoking is forbidden
in bus journeys between provinces
in trains
in domestic and international
flights
Difficulties
actions to pierce the ban for advertisements
implementation of law is not satisfactory

45. Campaigns of Increasing the Awareness of the Public
Media is trying to keep the issue a current event.
In the previous years campaigns as “Quit and Gain” were done.
In the 31st of May “NO SMOKING DAY” activities on different topics were issued. Such as;
Tobacco makes you poor.
Quit smoking.
etc.

46. “5As” Approach Ask about tobacco use Advise all users to quit
The Treating Tobacco Use and Dependence – Clinical Practice Guideline, issued by the United States Department of Health and Human Services recommends the 5As approach:
“5As” Approach
Ask about tobacco use
Advise all users to quit
Assess willingness to make a quit
attempt
Assist the patient to quit
Arrange follow-up contact

48. Wind does not help you,
if you do not know the bay you want to
go.
Montaigne
Thinking is easy, doing something is
difficult. But the most difficult thing
in the world is to make, what you
think.
Goethe

49. KNOWLEDGE FOR AWARENESS AWARENESS FOR KNOWLEDGE
FOR TOBACCO CONTROL
KNOWLEDGE FOR AWARENESS
AWARENESS FOR KNOWLEDGE
ARE IMPORTANT
WISHES ARE;
A SMOKE-FREE WORLD