Linking Global Youth Tobacco Survey (GYTS) data to tobacco control policy in Turkey--2003 and 2009.

OBJECTIVE: The purpose of this paper is to use data from the Global Youth Tobacco Survey (GYTS) conducted in Turkey in 2003 and 2009 to examine changes in tobacco use and important tobacco control measures. METHODS: The GYTS were conducted in grades 7-9 in 2003 and 7-10 in 2009 in Turkey. Data in this paper are limited to 13 to 15 year old students. A total of 15,957 students from 202 schools participated in 2003 and 5,054 students from 69 schools participated in 2009. The overall response rate was 92.1% in 2003 and 87.5% in 2009. RESULTS: Between 2003 and 2009 current cigarette smoking did not change significantly for either boys (9.4% to 10.2%) or girls (3.5% to 5.3%). Current cigarette smoking was higher among boys than girls in 2003 and in 2009. In 2009, half of students reported they had been exposed to second hand smoking (SHS) at home and 80% reported they had been exposed to SHS in public places. Three in ten students reported they had been exposed to pro-tobacco advertising in newspapers or magazines; one in ten had an object with a cigarette brand logo on it; and 7% had been offered free cigarettes by a cigarette company representative. Two-thirds of current cigarette smokers reported that they wanted to stop smoking; and almost two-thirds had been taught in school in the past year about the dangers of smoking. CONCLUSION: Passing and implementing the Law No. 4207 on Prevention of Hazards of Tobacco Products, ratifying the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), raising tax on tobacco, and requiring pictorial warning labels were important steps forward for tobacco control in Turkey. However, as to the tobacco control much work yet to be accomplished including developing an effective enforcement plan for all tobacco control efforts.

Effect of policy changes on cigarette sales: the case of Turkey.

BACKGROUND: In 1996, Turkey made tobacco control a health priority. The tobacco control effort was extended in July 2009 with the expansion of the smoke-free law to include all enclosed workplaces and public places and, in January 2010, with a 20% increase in the Special Consumption Tax on Tobacco. METHODS: Sales data were averaged, by month, for the period January 2005 through June 2009 to establish an 'expected' monthly sales pattern. This was the period when no new tobacco control measures were implemented. The overall monthly average was then calculated for the same period. The expected monthly sales pattern was then graphed against the overall monthly sales average to delineate a seasonal sales pattern that was used to evaluate the divergence of actual monthly sales from the 'expected' pattern. RESULTS: A distinct seasonal pattern was found with sales above average from May through August. Comparison of actual cigarette sales to the 'expected' monthly sales pattern following the implementation of the expanded smoke-free law in July resulted in a 5.2% decrease. Cigarettes sales decreased by 13.6% following the January 2010 Special Consumption Tax. Since the implementation of the expanded smoke-free law in July 2009 and the tax increase in January 2010, cigarette sales in Turkey decreased by 10.7%. CONCLUSION: The effect of recent Turkish tobacco control policies could contribute to a reduction in the number of premature deaths related to tobacco use. Evidence has shown that periodic tax increases and strong enforcement of all tobacco control policies are essential to further decrease tobacco consumption.

Tobacco use, exposure to secondhand smoke, and cessation counseling among health professions students: greek data from the global health professions student Survey (GHPSS).

We conducted the GHPSS (Global Health Professions Student Survey) to obtain information regarding health profession students' smoking habits and perceptions, exposure to secondhand smoke (SHS) as well as level of knowledge and training on tobacco use and smoking cessation counseling. GHPSS is a survey for third-year students in the following fields: health visitors, dentistry, medicine, nursing and/or pharmacy. The highest tobacco use prevalence rate and exposure to SHS were recorded among health visitor students with 46.4% and 33.3% respectively. The majority of the respondents believed that their profession serves as a role model for their patients. Formal training on cessation counseling ranged between 10.7% for health visitor students to 22.4% for nursing students. The relatively high percentage of health profession students who currently smoke and the alarmingly high percentage of those exposed to SHS indicate lack of concerted efforts for implementation and effective enforcement of the anti-tobacco policy measures. Despite its significance, formal training on cessation counseling for students is strikingly low. These results indicate the urgent need to train health professional students on tobacco cessation counseling and educate them on the dangers of tobacco use, SHS and the positively influential role they can play to affect their patients' smoking habits.

Nursing education and beliefs towards tobacco cessation and control: a cross- sectional national survey (GHPSS) among nursing students in Greece.

BACKGROUND: Within the healthcare system, nurses have the ability to influence their patients' smoking habits through counselling. Therefore, it is of great importance to appropriately train health professionals on smoking cessation strategies with the aim to help them provide advice to their patients. In light of the above, the objective of this study was to assess the association between Greek nursing students' beliefs towards tobacco control/smoking cessation and the professional training received. METHODS: During February 2009, we conducted a cross sectional national survey among all 3rd year nursing students of the two university based nursing departments in Greece (University of Athens, University of the Peloponnese). The Global Health Professional Student Survey (GHPSS) questionnaire was applied and following written informed consent 73% provided a completed questionnaire (n = 192/263 enrolled students). RESULTS: Overall, 33% were current active smokers, while 74% reported ever to experiment smoking. In regards to their beliefs towards tobacco control policies, non smokers were more positive in regards to banning smoking in restaurants (94% vs. 61%, p < 0.001), in bars and cafes (82% vs. 34%, p < 0.001), and all public places (93% vs. 51%, p < 0.001) when compared to current smokers. In comparison with students who had not received training on the importance of asking patients about their smoking habits, those that did were more likely to believe that nurses should have a role in smoking cessation and should act as role models for their patients. CONCLUSIONS: Resources should be invested in improving the quality of undergraduate education in nursing departments in Greece with respect to tobacco control and smoking cessation.

Tobacco use, exposure to secondhand smoke, and cessation counseling training of dental students around the world.

The Global Health Professions Student Survey (GHPSS) has been conducted among third-year dental students in schools in forty-four countries, the Gaza Strip/West Bank, and three cities (Baghdad, Rio de Janeiro, and Havana) (all called "sites" in this article). In more than half the sites, over 20 percent of the students currently smoked cigarettes, with males having higher rates than females in thirty sites. Over 60 percent of students reported having been exposed to secondhand smoke in public places in thirty-seven of forty-eight sites. The majority of students recognized that they are role models in society and believed they should receive training on counseling patients to quit using tobacco, but few reported receiving formal training. Tobacco control efforts must discourage tobacco use among dentists, promote smoke-free workplaces, and implement programs that train dentists in effective cessation-counseling techniques.

Tobacco use, exposure to secondhand smoke, and cessation counseling among medical students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2008.

BACKGROUND: GHPSS is a school-based survey that collects self-administered data from students in regular classroom settings. GHPSS produces representative data at the national or city level in each country. This study aims to investigate the prevalence of tobacco use, exposure to secondhand smoke, and cessation counseling among medical students using the GHPSS data. METHODS: The Global Health Professions Student Survey (GHPSS) was conducted among 3rd year medical students in 47 countries and the Gaza Strip/West Bank from 2005-2008 to determine the prevalence of tobacco use and amount of formal training in cessation counseling. RESULTS: In 26 of the 48 sites, over 20% of the students currently smoked cigarettes, with males having higher rates than females in 37 sites. Over 70% of students reported having been exposed to secondhand smoke in public places in 29 of 48 sites. The majority of students recognized that they are role models in society (over 80% in 42 of 48 sites), believed they should receive training on counseling patients to quit using tobacco (over 80% in 41 of 48 sites), but few reported receiving formal training (less than 40% in 46 of 48 sites). CONCLUSION: Tobacco control efforts must discourage tobacco use among health professionals, promote smoke free workplaces, and implement programs that train medical students in effective cessation-counseling techniques.

Understanding worldwide youth attitudes towards smoke-free policies: an analysis of the Global Youth Tobacco Survey.

BACKGROUND: Smoke-free policies (SFPs) in public places are increasing globally, but developing countries are lagging behind. Understanding youth attitudes towards SFPs can inform SFP initiatives. METHODS: A multilevel logistic regression analysis of data collected from youth aged 13-15 years (2000-2006) who completed the Global Youth Tobacco Survey (GYTS) in 115 countries, primarily in the developing world, was conducted. The analysis examined relationships between support for SFPs and individual-level measures related to smoking status, and exposure to secondhand smoke (SHS), controlling for demographic and environmental factors of interest and country-level policy factors. RESULTS: In all, 77.3% of 356,395 youth in 115 countries favoured SFPs, including majorities of non-smokers (78.7%) and smokers (63.6%). In the multivariable analysis knowledge of smoke harm was the strongest predictor of favouring SFPs (OR 2.42, 95% CI 2.27 to 2.67). Exposure to countermarketing (OR 1.40, 95% CI 1.25 to 1.57) and school anti-smoking education (OR 1.22, 95% CI 1.13 to 1.31) were also positively associated. Current smoking (OR 0.48, 95% CI 0.41 to 0.53), susceptibility to smoking (OR 0.46, 95% CI 0.40 to 0.52) and exposure to tobacco promotion were negatively associated. Significant country-level variation was observed. The presence of any national smoke-free legislation in a country was positively associated with youth favouring such policies. CONCLUSIONS: The majority of youth worldwide support, yet lack, smoke-free policies in public places, while being regularly exposed to SHS. Youth support of SFPs is most positively associated with knowledge of the harmful effects of tobacco smoke. Redoubling education efforts represents an opportunity to establish smoke-free environments and improve health of children in developing countries.

Children's loss of autonomy over smoking: the Global Youth Tobacco Survey.

BACKGROUND: Empirical data suggest that children with infrequent tobacco use have difficulty quitting smoking. METHODS: Data were obtained from the nationally representative Global Youth Tobacco Survey of middle-school students in Cyprus and Greece. Regression analyses examined associations between smoking frequency (smoking days per month or cigarettes smoked per day) and loss of autonomy (difficulty refraining from smoking). RESULTS: The prevalence of lost autonomy was 40% among subjects who smoked 1 or 2 days/month and 41% among subjects who averaged less than one cigarette/day and increased in a dose-response pattern. Regression models derived from the Cyprus data were replicated by the Greek data. CONCLUSIONS: Two national surveys confirm previous reports of difficulty with smoking cessation with infrequent smoking. Since loss of autonomy is universally recognised as a core feature of addiction, our data indicate that young adolescents experience symptoms of nicotine addiction with infrequent tobacco use.

The role of family background on cigarette smoking among adolescent school children in Slovakia: findings from the 2007 Slovakia Global Youth Tobacco Survey.

OBJECTIVES: To analyse Global Youth Tobacco Survey (GYTS) data to determine the role of family background on cigarette smoking among adolescents in Slovakia. METHODS: The GYTS is a school-based survey of students aged 13-15 years developed by the World Health Organization and the Centers for Disease Control and Prevention. The GYTS was conducted in Slovakia in 2007. RESULTS: Students from families where one or more parents were smokers were significantly more likely to report lifetime smoking, current cigarette smoking and signs of nicotine dependence (only girls). Socioeconomic status of parents as measured by parent educational level and employment status was not statistically associated with students' smoking status. Girls from families with lower socioeconomic status showed more frequently positive attitudes regarding smoking of their peers. CONCLUSIONS: Considering family background, parental smoking plays the most important role in smoking of their children regardless of employment status and educational level. The findings suggest that the tobacco control program effort in Slovakia needs to focus on implementation and enforcement for those policies already in place as well as expansion into additional measures.

Results of global youth tobacco surveys in public schools in Bogotá, Colombia.

BACKGROUND: The purpose of this paper is to use data from the Global Youth Tobacco Survey (GYTS) conducted in Bogotá, Colombia, in 2001 and 2007 to examine changes in tobacco use among youth 13-15 years of age. The current tobacco control effort in Bogotá will be accessed relative to Colombia ratifying the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in 2008. METHODS: GYTS was implemented in public schools in Bogotá, Colombia, by the Colombian National Cancer Institute. Data were collected from students in classrooms using self-administered procedures. RESULTS: Between 2001 and 2007, ever having smoked cigarettes decreased along with exposure to secondhand smoke (SHS) at home, having an object with a tobacco logo on it, and having been offered free cigarettes by a tobacco company representative. Prevalence of current cigarette smoking did not change from 2001 to 2007 (32.9% and 29.9%). Exposure to pro-tobacco advertising increased, reaching 71.4%, and 73.4% respectively, in 2007. Having been taught about the harmful effects of tobacco use did not change over time. CONCLUSIONS: The government of Colombia ratified the WHO FCTC in 2008. However, Colombia has one of the highest levels of cigarette smoking among 13-15 year olds in the Region of the Americas. The tobacco control effort in Colombia has much work to do, including recognition that the levels of smoking among adolescents are already as high as those of adults. Future declines in tobacco use among adolescents in Bogotá will likely depend on development of a comprehensive tobacco control program.

Tobacco use and cessation counseling among health professional students: Lebanon Global Health Professions Student Survey.

INTRODUCTION: The number of deaths attributable to tobacco use is rising globally. Health professionals can help reduce tobacco use by providing advice to patients regarding smoking cessation. Very few studies have collected information on tobacco use and cessation counseling training among health professional students. The purpose of this paper is to examine these issues using data from the 2005 Lebanon Global Health Professions Student Survey (GHPSS). METHODS: The 2005 Lebanon GHPSS includes nationally representative estimates of third-year students in all dental, medical, nursing, and pharmacy schools in Lebanon. RESULTS: Current cigarette use ranged from 14.8% for pharmacy students to 26.9% for nursing students and 27.4% for medical students. Current waterpipe use ranged from 20.6% for medical students to 44.9% for nursing students. About 8 in 10 students in all four disciplines were exposed to second-hand smoke in public places. More than 8 in 10 students in medical, nursing, and pharmacy schools believed that health professionals have a role in giving advice or information on smoking cessation to patients. More than 9 in 10 students in all four disciplines believed that health professionals should receive training on smoking cessation techniques. However, those who received training ranged from 19.8% of pharmacy students to 43.7% of nursing students. CONCLUSION: Tobacco use (cigarettes and water-pipe) is high among third-year health professional students in Lebanon. Students are willing to provide smoking-cessation counseling but lack training. The Ministry of Public Health, the Ministry of Education, and educational institutions in Lebanon should work together with other interested partners in developing, testing, and implementing successful patient cessation counseling training programs for health professionals.

Evolution of the Global Tobacco Surveillance System (GTSS) 1998-2008.

Tobacco use is one of the leading preventable causes of morbidity and mortality worldwide. Given that country-specific international data on tobacco use were limited or nonexistent, in 1998, the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the Canadian Public Health Association (CPHA) initiated the Global Tobacco Surveillance System (GTSS) to assist countries in establishing tobacco control surveillance and monitoring programs. GTSS includes collection of data through three school-based surveys: the Global Youth Tobacco Survey (GYTS) for youth; the Global School Personnel Survey (GSPS), and the Global Health Professions Student Survey (GHPSS) for adults; and one household survey: the Global Adult Tobacco Survey (GATS) for adults. The GTSS provides a globally implemented and consistent framework for conducting surveillance including standard sampling procedures, core questionnaire items, training in field procedures and analysis of data consistent across all GTSS countries. The GTSS also enhances the role of the nongovernmental sector by supporting participation of civil society agencies in surveillance, monitoring, and policy and program development. The synergy between countries passing tobacco control laws, regulations or decrees, ratifying and complying with the WHO Framework Convention on Tobacco Control, and conducting GTSS surveys offers a unique opportunity to develop, implement, and evaluate comprehensive tobacco control policy that can be helpful to each country document the development, growth, and collaboration in sustaining the GTSS. The report highlights countries' involvement in tobacco control measures and the establishment of comprehensive tobacco control programs worldwide. This report can assist countries in prioritizing and developing tobacco control programs, including surveillance, evaluation, and policy development.

Change in tobacco use among 13-15 year olds between 1999 and 2008: findings from the Global Youth Tobacco Survey.

Tobacco use is the leading preventable cause of death and disease in the world; yet little is known about the levels or patterns of youth tobacco use on a global basis. The purpose of this paper is to focus on change in youth tobacco use using data from 100 sites that have conducted repeat Global Youth Tobacco Surveys (GYTS). The GYTS is a school-based survey that collects data from students aged 13-15 years using a standardized methodology for constructing the sample frame, selecting schools and classes, and processing data. GYTS is conducted in school classes using self-administered anonymous data collection. The GYTS sample produces representative, independent, cross-sectional estimates for each sampling frame. Of the 100 sites surveyed, 61 reported no change over time in prevalence of cigarette smoking, likewise in 50 of the 97 sites with data on use of other tobacco products there was no change. However, 34 sites reported an increase in other tobacco use. This appears to be attributed to waterpipe, an emerging trend in tobacco use. Evidence was found supporting the idea that tobacco use among adolescent girls is likely increasing. The global tobacco control effort continues to face many challenges in reversing the tobacco epidemic. Few countries have implemented comprehensive tobacco control legislation laid out by the World Health Organization. The few countries that have adopted some of these proven policies can serve as examples in achieving positive results in curbing the tobacco epidemic.

Tobacco use among institutionalized adolescents in Turkey: does social environment affect the risk?

OBJECTIVES: The study aimed to estimate smoking prevalence and associated risk factors among Turkish adolescents residing in orphanages and to investigate whether "institutionalization" (i.e., factors leading to institutionalization and/or those present in the institutional environment) makes adolescents more prone "to try" and/or "continue" smoking. METHODS: An institution-based survey was conducted in all orphanages in Turkey and included 6,220 adolescents. Effects of institutionalization on smoking were further evaluated based on comparisons with external data obtained from an earlier survey of non-institutionalized Turkish students. RESULTS: Of the participants: 57% had ever smoked cigarettes; 29.3% were current cigarette smokers; and exposure to secondhand smoke (SHS) was above 80.0%. Compared to non-institutionalized adolescents, institutionalized adolescents seem to be more prone to start and continue smoking; have higher access to tobacco; know less about the health hazards of smoking; and have higher prevalence of addiction, especially among girls. CONCLUSIONS: Smoking prevalence among institutionalized adolescents is quite high; they have an environment favoring smoking and the gender gap in smoking rates is closing. An effective tobacco-control program based on evidence, tailored to the specific needs, and combined with a motivating environment is required to decrease tobacco consumption among institutionalized youngsters.

Prevalence of youth cigarette smoking and selected social factors in 25 European countries: findings from the Global Youth Tobacco Survey.

OBJECTIVES: To present Global Youth Tobacco Survey (GYTS) data on the prevalence of cigarette smoking and selected social factors among students aged 13-15 years in 25 European countries. METHODS: The GYTS is a school-based survey of students aged 13-15 years. The GYTS was conducted in 25 European countries (2002-2005) and produced representative data for each country. RESULTS: In 25 European countries studied, 22% of boys and 18% of girls smoked cigarettes. In 17 of 25 countries, current cigarette smoking did not differ between boys and girls. Exposure to secondhand smoke is very high throughout the 25 countries. Exposure to pro-tobacco indirect advertising (having tobacco company logos on promotional items and being given free cigarettes) is frequent throughout the countries. CONCLUSIONS: Intensified efforts to lessen harm caused by tobacco use among youth in 25 European countries included in this study are urgently needed. These countries need to develop and implement comprehensive tobacco control programs including public education campaigns, cessation programs, enforcement of existing measures, and related policy efforts. The WHO FCTC provides a useful framework for implementing such a comprehensive approach.

Tobacco use among Palestine refugee students (UNRWA) aged 13-15.

OBJECTIVE: The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has made tobacco use prevention a primary health issue. UNRWA provides education, health, relief and social services in five fields of operation: Jordan, Lebanon, Syria, Gaza Strip and the West Bank. The purpose of this paper is to compare tobacco use among Palestine refugee students and students in the general population of the five fields of operation. METHODS: Global Youth Tobacco Survey (GYTS) data were collected from representative samples of students in UNRWA schools in each of the five fields of operation in 2008. For comparison, previous data are included from GYTS conducted in Gaza Strip, Lebanon, and the West Bank (2005) and in Jordan and Syria (2007). Data are presented for three groups of students: refugees attending schools within and outside the camps and non-refugee students in the general population. RESULTS: In each of the five fields of operation, there was no difference in current cigarette smoking, current use of shisha, or susceptibility to initiate smoking among the three groups of students. Cigarette smoking and susceptibility was lowest in the Gaza Strip and highest in the West Bank; shisha use was lowest in the Gaza Strip but over 30% in Lebanon, Syria, and the West Bank. Exposure to secondhand smoke in public places was greater than 60% in almost all sites. Exposure to indirect advertising was almost 10%. CONCLUSIONS: The similarity in tobacco use among the three groups of students suggests that a coordinated plan between the UNRWA and the governmental authority could be most beneficial in reducing the burden of tobacco-related morbidity and mortality.

Exposure to and attitudes regarding secondhand smoke among secondary students in Taiwan.

The 2003 School Health Act of Taiwan stipulated that school campuses of senior high and below should be smoke free, but data from the Global Youth Tobacco Survey show that the majority of students are exposed to smoke in public and at home. More than 50% of nonsmokers indicated that they had been exposed to secondhand smoke (SHS) in public places, with the exposure rate as high as 90% among smokers. More than 40% of junior and senior high school students were exposed to SHS at home. Support for banning smoking in public places ranged from almost 60% to almost 80%. More than 60% of current smokers and almost 90% of never smokers think that smoke from others is harmful to them. With a clear body of evidence detailing the harmful effects, reduction and eventual elimination of exposure to SHS should be the goal of the tobacco control community.

Main determinants of cigarette smoking in youth based on the 2006 Cyprus GYTS.

OBJECTIVE: The goal of the study is to identify predictors of current cigarette smoking in adolescents within the school, home, and broader social environment. METHOD: A two stage cluster sample design was used to select a representative sample of students from all middle and high schools in Cyprus in 2005-2006. Standardized Global Youth Tobacco Survey (GYTS) methodology was employed in administering the questionnaires and processing the results. Analyses were conducted using logistic regression with the outcome variable being current smoking. RESULTS: After adjusting for the effect of other predictors in the model, the strongest predictor of adolescent smoking was smoking peers. Having parents and grandparents that smoke, concerns about weight, access to pocket money, ease of buying cigarettes, owning an item with a cigarette logo on it, the belief that smokers are less attractive, and the false consensus effect all remain statistically significant predictors. CONCLUSION: In designing smoking prevention programs, factors pertaining to the school, social and familial circle of adolescents as well as misconceptions on the link between smoking and physical appearance need to be considered. Such programs can act as empowering tools to complement legal measures which need to be firmly enforced and constantly revised to be effective.

Tobacco use, exposure to secondhand smoke, and training on cessation counseling among nursing students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2009.

The Nursing Global Health Professions Student Survey (GHPSS) has been conducted in schools in 39 countries and the Gaza Strip/West Bank (identified as "sites" for the remainder of this paper). In half the sites, over 20% of the students currently smoked cigarettes, with males having higher rates than females in 22 sites. Over 60% of students reported having been exposed to secondhand smoke in public places in 23 of 39 sites. The majority of students recognized that they are role models in society, believed they should receive training on counseling patients to quit using tobacco, but few reported receiving any formal training. Tobacco control efforts must discourage tobacco use among health professionals, promote smoke free workplaces, and implement programs that train health professionals in effective cessation-counseling techniques.