Understanding political priority development for public health issues in Turkey: lessons from tobacco control and road safety.

BACKGROUND: Tobacco use and road traffic injuries are major public health problems in Turkey. During the last decade, the former issue received political priority in the country, while the latter did not despite the immense health and economic burden that road traffic injuries pose on the Turkish population. Political priority can facilitate the attainment of public health goals. Unfortunately, however, limited cross-case analyses exist to help us understand why it emerges for certain public health issues but fails to develop for others in low- and middle-income countries. METHODS: This study utilised Kingdon's Multiple Streams Framework to explore the political priority development process in Turkey. A cross-case analysis was conducted, using data gathered from three different sources, namely key informant interviews (n = 42), documents (n = 307) and online self-administered surveys (n = 153). The Wilcoxon-Mann-Whitney test was also employed to examine whether the relationships within the tobacco control and road safety networks differed significantly. RESULTS: In Turkey, political priority emerges when four streams - problem, policy, political and global - converge while a policy window is open. While these findings are largely consistent with the Multiple Streams Framework, this study also shed light on (1) the need to consider global health treaties for urgent public health issues as these instruments can accentuate global norms and standards, (2) the disproportionate strength of the political stream, (3) the need to develop in-depth understanding of national political context, (4) the importance of fostering meaningful ties between global and domestic health networks, and (5) the need for policy network cohesion. CONCLUSIONS: Findings from this study can be used by advocates striving to promote public health issues in other similar contexts.

Traffic climate and driver behaviors: The moderating role of driving skills in Turkey and China.

INTRODUCTION: While road traffic accidents and fatalities are a worldwide problem, the rates of road traffic accidents and fatalities show differences among countries. Similarly, driver behaviors, traffic climate, and their relationships also show differences among countries. The aim of the current study is to investigate the moderating effect of driving skills on the relationship between traffic climate and driver behaviors by country. (Turkey and China). METHOD: There were 294 Turkish drivers and 292 Chinese drivers, and they completed the Traffic Climate Scale, the Driving Skills Inventory, and the Driver Behavior Questionnaire. The moderated moderation analyses were conducted with Hayes PROCESS tool on SPSS. RESULTS: The results showed that safety skills moderated the relationship between internal requirements and violations both in Turkey and China. Safety skills also moderated the relationship between internal requirements and errors only in China and the relationship between functionality and violations in Turkey. Perceptual-motor skills moderated the relationships between external affective demands and errors, and also the relationship between internal requirements and positive driver behaviors in Turkey. It can be inferred that driving skills has different influences on traffic climate-driver behaviors relationship in different cultures and there might be cultural differences in the evaluation of drivers' own driving skills. Practical Applications: Among driving skills, safety skills have a more critical role to increase road safety by decreasing number of violations. Interventions to increase safety skills of drivers might be promising for road safety.

Cross-cultural differences in pedestrian behaviors in relation to values: A comparison of five countries.

This study compared pedestrian behaviors in five countries (Estonia, Greece, Kosovo, Russia, and Turkey) and investigated the relationships between these behaviors and values in each country. The study participants were 131 pedestrians for Estonia, 249 for Greece, 112 for Kosovo, 176 for Russia, and 145 for Turkey. The principal component analyses revealed that the four-factor structure of the Pedestrian Behavior Scale (PBS) was highly consistent across the five countries. ANCOVA results revealed significant differences between countries on the PBS items and scale scores. Specifically, Greek and Turkish participants reported transgressive pedestrian behaviors more frequently than Estonian, Kosovar, and Russian pedestrians while Kosovar participants reported transgressive pedestrian behaviors less frequently than Estonian pedestrians. In addition, Turkish and Russian pedestrians reported lapses and aggressive behaviors more frequently than Estonian, Greek, and Kosovar pedestrians. Finally, Turkish and Estonian pedestrians reported positive behaviors more frequently than Kosovar pedestrians. Unexpectedly, the regression analyses showed that values have varying effects on pedestrian behavior in the five countries. That is, context or country may determine the effect of values on pedestrian behaviors. The results are discussed in relation to the previous literature.

The Relationship Between Hofstede's Cultural Dimensions, Schwartz's Cultural Values, and Obesity.

According to the World Health Organization, obesity is a major public health issue. In 2014, there were more than 600 million obese people around the world. According to the data of the World Health Organization, obesity rates differ among countries. One possible underlying reason of the difference can be culture, more specifically shared cultural values. The strategies and policies regarding obesity were developed; however, the effect of culture is not adequately considered. The aim of the study is to investigate the relationship between obesity rates of countries, Hofstede's cultural dimensions, Schwartz's values, and Gross National Income per capita per country. The data consist of obesity ranking (i.e., the percentage of the population with a body mass index of 30 kg/m2 or higher), Gross National Income per capita for each country, and cultural variables (i.e., Hofstede's cultural dimensions for 54 nations and Schwartz's cultural values for 57 nations). Hierarchical regression analysis results revealed that Gross National Income per capita was not a significantly related obesity at the aggregated level. Among Hofstede's dimensions, individualism and uncertainty avoidance were positively associated with obesity, and long-term orientation was negatively associated with obesity. The relationship between Schwartz's cultural values and obesity was not found to be significant. Findings suggest that Hofstede's cultural dimensions should be considered when developing national level strategies and campaigns to decrease obesity.

"Quitting like a Turk:" How political priority developed for tobacco control in Turkey.

In recent years, tobacco control emerged as a political priority in Turkey and today the country is widely regarded as one of the global leaders in tackling tobacco use. Although political priority is considered a facilitating factor to the success of addressing public health issues, there is a paucity of research to help us understand how it is developed in middle-income countries. The primary aim of this study is to understand the process and determinants of how tobacco control became a political priority in Turkey using the Multiple Streams Framework. A mixed-methods case study approach was used whereby data were gathered from three different sources: in-depth interviews (N = 19), document reviews (N = 216), and online self-administered surveys (N = 61). Qualitative data were collected for the purpose of understanding the processes and determinants that led to political prioritization of tobacco control and were analyzed using deductive and inductive coding. Quantitative data were collected to examine the actors and were analyzed using descriptive statistics and network nominations. Data were triangulated. Findings revealed that tobacco control achieved political priority in Turkey as a result of the development and convergence of multiple streams, including a fourth, separate global stream. Findings also shed light on the importance of Turkey's foreign policy in the transformation of the political stream. The country's desire for European Union accession and global visibility helped generate a political environment that was receptive to global norms for tobacco control. A diverse but cohesive network of actors joined forces with global allies to capitalize on this opportunity. Results suggest (1) the importance of global-agenda setting activities on political priority development, (2) the utility of aligning public health and foreign policy goals and (3) the need to build a strong global incentive structure to help entice governments to take action on public health issues.