Water pipe smoking among public versus private university students in Ankara, Turkey: an online survey.

BACKGROUND: Water pipe smoking has become a global public health problem as its popularity increased over time, especially among youth. The objective of our study was to estimate water pipe tobacco smoking prevalence and to assess socioeconomic factors associated with ever water pipe smoking by public and private university students in Ankara, Turkey. METHODS: This descriptive study was based on a survey conducted among public (n=2685) and private (n=2485) university students via an online questionnaire on demographics and water pipe consumption patterns. For every student in the sample, a socioeconomic status index was calculated using principal component analysis. Binary logistic regressions for the outcome variable of ever-using water pipe yielded estimates of adjusted odds ratios (aORs) for the associated factors such as the respondent's age, gender, university type, and socioeconomic status. RESULTS: The prevalence of ever use of water pipe was 69.1% (95% CI: 67.2-70.9%) among private and 59.1% (95% CI: 57.2-60.9%) among public university students. A substantial share of ever users were current users (25.5% in private versus 21.6% in public, p=0.008). On average, private university students had higher socioeconomic status than public university students (for example, access to a car (51.7% versus 35.8%, p=0.008), financial support from family (71.5% versus 65.1%, p<0.001)), also demonstrated by a higher socioeconomic status index. Being a private university student (aOR 1.57, 95% CI: 1.38-1.79), older (aORs 1.50 to 2.39, p<0.001), male (aOR 2.36, 95% CI:2.06-2.70), as well as having greater financial resources, such as having access to a car (aOR 1.24, 95% CI:1.07-1.42), or having income support from family (aOR 1.32, 95% CI:1.13-1.54), were associated with ever-using water pipe. A higher SES index was significantly associated with higher odds of ever using water pipe among both private (aOR 1.13, 95% CI:1.06,1.20) and public university (aOR 1.12, 95% CI:1.06,1.19) students. CONCLUSIONS: Water pipe smoking was common in both public and private universities; however, private university students had higher odds of ever using water pipe. There is an urgent need to implement evidence-based interventions, taking into account the socioeconomic status of young adults, to prevent them from water pipe smoking.

Eating disorders and needs of disabled children at primary school.

AIM: The aim of this study was to provide current information on the eating disorders, needs and confronted problems of children with disabilities during their school hours at primary schools. BACKGROUND: Eating disorders and needs of disabled children are important in their participation in school life, cognition, and academic achievement. RESULTS: In this study, It was aimed to reach all children with disabilities attending at 72 primary schools located in low, medium and high socio-economic districts in Ankara, capital of Turkey; 404 parents voluntarly accepted to participate in the study. This study has revealed that students with disabilities experienced eating disorders such as forget to eat foods at feeding time, cannot go to canteen to buy food, have sucking and/or chewing problems, lack of self-care skills and need support while eating at schools. The percentage of children who had breakfast at school was 18.1%. The percentage of those who indicated that their child had lunch at school was 59.0%. The children from low socio-economic district had the highest percentage of adequate nutrition at schools in the last week. Families whose children having lack of self-care skills (50.0%), were picky eaters (38.5%), having lack of appetite (42.1%), experienced from constipation frequently (50.0%), have reflux problem (29.0%) considered that their children needed feeding supports at school. CONCLUSION: Families whose children having eating disorders at schools considered that their children needed feeding supports. Fulfilling the needs of children with disability and providing them support as positive discrimination would ensure healthy development and participation in school life and generate positive effects on their academic achievement. The school health policies have to encompass nutritional needs of vulnerable children to benefit from right to education in an adequate and effective manner.

Are the health needs of children with disabilities being met at primary schools?

The aim of this study was to provide current information about the health profile and needs of mainstreamed primary school children with disabilities and special educational needs during their school hours. The Study population is composed of students with special educational needs and disabilities attending mainstream primary schools located in three selected Turkish districts with low, moderate, and high socioeconomic status and literacy rates separately. Parents of 404 students from 72 primary schools constituted the research sample. The study showed that 13.4% of the students with disabilities had chronic illnesses and 8.9% had health problems requiring access to emergency medical care when the condition recurs (such as epileptic seizures, fainting, or falling). Of the students with disabilities, 39.9% usually or sometimes needed medical care during school hours in the previous week. Health needs of nearly half of the students with disabilities were met at school. Special health needs and risks of children with disabilities also continue at school along with other possible health concerns.

Perceptions of Obesity Prevention Policies: Socioeconomic Assessment in the Turkish Capital.

PURPOSE: The purpose of this study was to inform public policy opportunities to reduce childhood obesity by identifying parents' perceptions of factors contributing to childhood obesity, attribution of responsibility, and the extent of their support for public prevention policies with attention to socio-economic status. DESIGN AND METHODS: In 2015, 2066 parent-child dyads across socio-economic strata from 43 randomly selected schools in Ankara completed surveys and measurements to examine perceptions, attribution, and prevention policies related to childhood obesity. RESULTS: Parents across the socio-demographic spectrum recognized obesity as a serious problem. Unhealthy food availability was identified as the leading cause of while industry and media were credited with having the greatest responsibility for childhood obesity. There was strong public support for policy strategies targeting schools, marketing, and the built environment, though support tempered as socio-economic status and parental education decreased. CONCLUSIONS: This survey provided insight into parents' knowledge and beliefs surrounding childhood obesity as well as their endorsement of related prevention strategies. Educational messages that address variations in SES to describe the causes of childhood obesity and connect those causes to actionable community prevention strategies may improve community support for enhanced policy actions within and beyond school settings.

Risk factors for prelacteal feeding in sub-Saharan Africa: a multilevel analysis of population data from twenty-two countries.

OBJECTIVE: To examine the risk factors of prelacteal feeding (PLF) among mothers in sub-Saharan Africa (SSA). DESIGN: We pooled data from Demographic and Health Surveys in twenty-two SSA countries. The key outcome variable was PLF. A multilevel logistic regression model was used to explore factors associated with PLF. SETTING: Demographic and Health Surveys in twenty-two SSA countries. SUBJECTS: Mother-baby pairs (n 95348). RESULTS: Prevalence of PLF in SSA was 32·2 %. Plain water (22·1 %), milk other than breast milk (5·0 %) and sugar or glucose water (4·1 %) were the predominant prelacteal feeds. In the multivariable analysis, mothers who had caesarean section delivery had 2·25 times the odds of giving prelacteal feeds compared with mothers who had spontaneous vaginal delivery (adjusted OR=2·25; 95 % CI 2·06, 2·46). Other factors that were significantly associated with increased likelihood of PLF were mother's lower educational status, first birth rank, fourth or above birth rank with preceding birth interval less than or equal to 24 months, lower number of antenatal care visits, home delivery, multiple birth, male infant, as well as having an average or small sized baby at birth. Mothers aged 20-34 years were less likely to give prelacteal feeds compared with mothers aged ≤19 years. Belonging to the second, middle or fourth wealth quintile was associated with lower likelihood of PLF compared with the highest quintile. CONCLUSIONS: To achieve optimal breast-feeding, there is a need to discourage breast-feeding practices such as PLF. Breast-feeding promotion programmes should target the at-risk sub-population groups discovered in our study.

Cigarette prices and smoking prevalence after a tobacco tax increase--Turkey, 2008 and 2012.

Raising the price of tobacco products has been shown to reduce tobacco consumption in the United States and other high-income countries, and evidence of this impact has been growing for low- and middle-income countries as well. Turkey is a middle-income country surveyed by the Global Adult Tobacco Survey (GATS) twice in a 4-year period, in 2008 and 2012. During this time, the country introduced a policy raising its Special Consumption Tax on Tobacco and implemented a comprehensive tobacco control program banning smoking in public places, banning advertising, and introducing graphic health warnings. The higher tobacco tax took effect in early 2010, allowing sufficient time for subsequent changes in prices and smoking to be observed by the time of the 2012 GATS. This report uses data from GATS Turkey to examine how cigarette prices changed after the 2010 tax increase, describe the temporally associated changes in smoking prevalence, and learn whether this smoking prevalence changed more in some demographic groups than others. From 2008 to 2012, the average price paid for cigarettes increased by 42.1%, cigarettes became less affordable, and smoking prevalence decreased by 14.6%. The largest reduction in smoking was observed among persons with lower socioeconomic status (SES), highlighting the potential role of tax policy in reducing health disparities across socioeconomic groups.

Urinary cotinine and breath carbon monoxide levels among bar and restaurant employees in ankara.

INTRODUCTION: Hospitality sector employees constitute one of the key groups with respect to their secondhand tobacco smoke exposure at work. This study aimed to detect urinary cotinine and breath carbon monoxide (CO) levels among bar and restaurant employees in Ankara, as well as the employees' opinions on the new antitobacco law, changes in smoking behavior, and subjective health status before and after the law entered into force. METHODS: This before-after study was conducted in 19 premises, with the participation of 65 employees before implementation and 81 employees 3 months after implementation of the new antitobacco law in the hospitality sector. Data in both phases were collected through face-to-face surveys, breath CO measurements, and urinary cotinine analysis. Descriptive statistics were used to summarize data, whereas chi-square test, paired and unpaired t tests, and analysis of variance were used to compare groups. RESULTS: Most of the restaurant and bar employees were male and below 35 years old. Before-after comparison showed that health complaints of the hospitality sector employees such as watering and itching in the eyes, difficulty in breathing, and cough (p < .001), as well as breath CO (p < .001) and urinary cotinine levels (p < .001) decreased significantly 3 months after implementation of the law. Among the smoking employees, mean number of cigarettes smoked was also found to decrease (p = .012). Majority of the employees (83.8%) were found to support the smoking ban in enclosed public places. CONCLUSIONS: Results of this study provide solid evidence on the positive health effects of smoke-free laws and employees' support for smoke-free workplaces.

Adolescents living in orphanages in Ankara: psychological symptoms, level of physical activity, and associated factors.

AIM: Adolescents living in orphanages are at a disadvantage with respect to mental health. The aim of this study was to assess the distribution of psychological symptoms and their association with the level of physical activity (PA) in adolescents living in orphanages. METHOD: The study group consisted of 13-16-year-old adolescents (N=166) living in orphanages in Ankara, Turkey. Data were collected cross-sectionally in 2008 via questionnaires, including the Brief Symptom Inventory and Kiddo-KINDL Health-Related Quality of Life Questionnaire. Descriptive statistics were used to summarize data, whereas chi-square, ANOVA, Mann-Whitney U, Kruskal-Wallis, and t tests were used to compare groups. RESULTS: Median age of the participants was 16.0 years and 65.7% were male. Female gender, not going to school or work, dissatisfaction with school, contact with the family, chronic disease, chronic medication use, sleep problems, regular tobacco use, chronic disease in the family, and low quality of life score were associated with increased risk (GSI-Global Symptom Index>1 SD) for mental disorders. Physically active adolescents' use of tobacco, alcohol, other substances, and medications, as well as GSI and depression scores were lower and their quality of life scores were higher than those of their less active counterparts. CONCLUSION: Prevalence of psychological symptoms in adolescents living in orphanages were higher than in the general adolescent population. Physically active adolescents' mental health indices and abstinence behaviors with regard to tobacco, alcohol, and substances were more favorable. Encouraging adolescents to participate in sports and improving sports facilities in orphanages are interventions that can promote mental health.

Addressing early childhood development in primary health care: experience from a middle-income country.

OBJECTIVE: This study aimed to evaluate the efficacy of a national training program in Turkey in improving primary health providers' knowledge and perceived competence about the promotion of early childhood development and prevention, early identification and management of developmental problems; and barriers to implementation and sustainability of skills gained. METHODS: A pre-post intervention design was used. Tools measuring perceived competence and knowledge about childhood development were administered to primary health providers before and after training. Immediate skills were observed, and implementation and sustainability of skills were determined using individual surveys and focus group discussions 1 year after training. RESULTS: The training was provided in 5 provinces. Of the 148 primary health providers trained, 90% had >5 years experience in providing primary care. Median knowledge test scores were 13 pretraining and increased to 22 posttraining (p < 0.001). Median perceived competence scores increased from 159 to 222 (p < 0.001). A year after the training, the program and materials were reported to be valued and remembered but used limitedly. Patient load, insufficient time allocated to primary care, lack of reimbursement, and ineffective referrals to pediatricians who had knowledge gaps regarding child development were identified as important barriers to implementation and sustainability of skills gained. CONCLUSIONS: In Turkey and potentially other countries with similar health systems, short-term inservice training on child development can improve primary health providers' knowledge, perceived competence and skills related to child development. To decrease the disparities between high- and low- and middle-income countries in addressing child development, significant barriers within health systems need to be identified and addressed.

What influences physical activity among elders? A Turkish experience from Ankara, Turkey.

Although the physical activity is a very basic lifestyle activity, the physical inactivity has been estimated to cause 1.9 million deaths worldwide annually, according to the 2002 World Health Organization (WHO) Report. In this cross-sectional study, we aimed to determine the frequency of and factors influencing regular exercise among elders living in the catchment area (CA) of a primary health care unit (PHCU) of a district in Ankara. The district has 7 subregions and 50 people were interviewed from each region. From the total number of elderly in the region, these 350 were selected for the study sample. Five of the authors collected data by a self-administered questionnaire. The dependent variable of the study was "doing physical activity", and there were various independent variables including sociodemographic characteristics and risky health behaviors, etc. Significantly positive associations were determined between "not doing regular exercise" and age of 65 years of older (odds ratio (OR)=1.059, 95% confidence interval (CI)=1.010-1.110; p=0.018), female gender (OR=1.992, 95% CI=1.245-3.185; p=0.004), presence of a chronic disease (OR=2.704, 95% CI=1.444-5.066; p=0.002), and lower/higher body mass index (BMI) (OR=2.568, 95% CI=1.573-4.192; p<0.001).

Need assessment for HIV/AIDS education: the level of knowledge about transmission in some risk groups in Turkey.

BACKGROUND: Every year, the number of HIV/AIDS cases increases twice as much as the year before in Turkey. The authors anticipate that the actual numbers of HIV/AIDS cases in Turkey are higher than the number of cases diagnosed and reported. SUBJECTS AND METHODS: This review summarizes the results of some previous studies that were conducted among various risk groups, such as high school and university students, barbers, hair dressers, nurses, pharmacists and doctors, men and women engaged in the sex trade, and security workers in different regions of the country. The responses of participants to similar questions of the studies on the transmission of HIV/AIDS were evaluated in this review. RESULTS: The studies that have been conducted among different risk groups in different regions have shown that in spite of the low prevalence of HIV/AIDS in Turkey, many risk groups still do not have adequate or correct information on the prevalence and transmission of the disease. CONCLUSION: Effective and extensive health education on HIV/AIDS, and the practice of healthy lifestyle would change the epidemiology of the disease in Turkey.