Smoking Habits and the Related Sociodemographic Characteristics in University Students

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1 DOI: /ttd ORIGINAL INVESTIGATION Smoking Habits and the Related Sociodemographic Characteristics in University Students Hilal Özcebe 1, Bahar Güçiz Doğan 2, Ebru İnal 3, Dilek Haznedaroğlu 4, Münevver Bertan 4 1 Department of Public Health, Hacettepe University, Public Health Institute, Ankara, Turkey 2 Department of Public Health, Hacettepe University Faculty of Medicine, Ankara, Turkey 3 Division of Medical Services and Techniques, Gümüşhane University Kelkit Health Services, Gümüşhane, Turkey 4 International Children s Centre, Ankara, Turkey Abstract OBJECTIVES: Smoking is an important public health issue in Turkey. This study set out to investigate the smoking prevalence among first and fourth grade university students as well as the associated socio-demographic variables. MATERIAL AND METHODS: A survey was carried out by the International Children s Centre (ICC) in the faculties of Science and Literature, Education and Medicine of nine Turkish Universities to determine the knowledge and life styles of the 1st and 4th grade university students in adolescence (2009). A total of students were evaluated. Data were analysed using SPPS statistical package program. RESULTS: The first grade students with illiterate mothers (23.0%), those who were living alone at home (37.7%) and those who considered receiving inadequate pocket money (24.9%) had a higher level of smoking prevalence (p<0.05). The fourth grade students with illiterate mothers (34.9%), those who were living with their friends (34.0%), those who perceived their economic situation bad (37.7%) and those who considered receiving inadequate pocket money (36.3%) had a higher level of smoking prevalence (p<0.05). CONCLUSION: A relationship between smoking habits of university students and some socio-demographic characteristics was found. We believe that more priority should be given to health promotion interventions among university students, especially among those of low socioeconomic status. On the other hand, in order to monitor the efficacy of smoking-related interventions among young people, there is a need for early detection of young individuals who are at risk and urgent interventions should be carried out. KEY WORDS: University students, smoking, sociodemographic characteristics Received: Accepted: Available Online Date: INTRODUCTION The World Health Organization defines adolescence as the period between 10 and 19 years and youth as the period between 15 and 24 years [1]. Adolescence is a specific process with the highest rate of growth and development of an individual and it is the transition from childhood to adulthood. This process is a period including physical and sexual growth and development accompanied by numerous social changes. Quest for identity and effort to gain acceptance are experienced intensively in adolescence [2-4]. It is expected that the changes occurring in adolescence would be completed and the plans for the future would be developed in youth. Numerous behaviours that determine the life style are also gained in youth. Whilst some of these behaviours are positive, some of them negatively influence the health. Accidents, suicide, sexually transmitted infections, violence and substance abuse that are brought along with behavioural problems negatively influence health in youth. Behaviours acquired from family, as well as the effects of the social environment and friends, have a role in forming these behaviours [5]. Studies demonstrate that the majority of smokers in many countries begin smoking before the age of 18 years [6,7]. According to the 2008 data of the World Health Organization, approximately one fourth of smokers get acquainted with cigarettes for the first time before the age of 10 years. This causes the individual to start smoking in young ages and thus have substantial health problems resulting from long-term cigarette smoking. It is known that risk for addiction is enhanced particularly with starting smoking at a young age [6-8]. Smoking habit is defined as an important heath problem also in Turkey [9,10]. Whilst worldwide five million people die due to smoking-related health problems each year, approximately 100 thousand smoking-related deaths occur each year in Turkey [10]. According to the Global Adult Tobacco Survey performed in Turkey in 2008, prevalence of 42 Address for Correspondence: Ebru İnal, Division of Medical Services and Techniques, Gümüşhane University Kelkit Health Services, Gümüşhane, Turkey Phone: ebruinal34@hotmail.com Copyright 2014 by Turkish Thoracic Society - Available online at

2 daily smoking was 21.7% in year-age group, 34.9% in males and 9.1% in females. The same survey revealed that 39.3% of every day smokers started smoking in ages between15 and 17 years [11]. Growth of the tobacco epidemic in the world obliged authorities to take legal measures, and the Framework Convention on Tobacco Control has been opened for signature for tobacco control in 2003 by the WHO. This convention has been put into force in 2004 in Turkey. By this way, tobacco control intervention that began in Turkey in 1996 has been developed by the Framework Convention on Tobacco Control and expanded on the scope of law in 2008 [12-15]. In Turkey, Law No on the Prevention and Control of Harmful Effects of Tobacco Products enables planning and implementing studies for tobacco control and allows for important interventions within the scope of protection of particularly the young people. The Law comprises interventions on the prevention of young people from being affected from advertisement, presentation and promotion campaigns that encourage the use of tobacco products, protection of the right to breath clean air, prohibition of tobacco sell, and development of a norm of a tobacco-free life [12]. It is expected that these interventions would have positive effects on starting and quitting cigarette smoking [15]. However, it is necessary to perform periodical assessments to determine the effects of interventions and to determine the socio-demographic risk factors that lead to tobacco use. International Children s Centre coordinated a research project on students at the 1 st and 4 th grades of nine universities to assess the change in behaviours that influence health in adolescence during university years. Socio-economic status of the family is an important factor among the causes of starting cigarette smoking in young people. Relevant data of the abovementioned research were used to assess the relation between smoking behaviour in young people and social structure of the family. The present study aimed to determine the prevalence of smoking among the 1 st and 4 th grade university students, to explore socio-demographic factors associated with smoking, and to make a contribution to the programs designed for preventive measures. MATERIAL AND METHODS International Children s Centre conducted this study under the topic of Determination of Knowledge and Life Styles of the 1 st and 4 th Grade University Students in Adolescence among 1 st and 4 th grade students of nine universities in The study was carried out in the faculties of Science and Literature, Education, and Medicine of Dokuz Eylül, Fırat, Harran, Karadeniz Technical, Kırıkkale, Kocaeli, Mersin, Osmangazi and Yüzüncü Yıl universities. The 1 st and 4 th grade students of the above-mentioned faculties formed the study universe. The study is a descriptive study and data were collected between February and June According to data obtained from the students affair office in the beginning of the study, the total number of 1 st grade students was 10,134 and the total number of 4 th grade students was 9,543. Based on a frequency of 0.5, used in situations where the prevalence is unknown, the sample size was determined to be 385 for each of the 1 st and 4 th grade. Considering dropouts due to various reasons, it was targeted to include a total of 400 students from each grade and the sample size was proportionally distributed among faculties within each university. At the end of data collection period, a total of 6,038 students were reached; but analysis was made on a total of 5,221 students, since some questionnaires were excluded during data collection and analysis procedures due to various reasons. The questionnaire that had been developed by the research team in 2005 and performed in 3,101 1 st grade university students was used as data collection form in the present study. Approvals were obtained from the local ethics committees and permissions were obtained from the Deanship of relevant universities. Participation in the study was based on voluntariness. Statistical Analysis Data were analysed by Statistical Package for the Social Sciences (SPSS) statistical package program. Chi-square test was used to assess the relation between the variables, and the p value was set at RESULTS Of the students participated in the study, 62.8% were 1 st grade students. The mean age of the 1 st grade students was 20.0±1.17 years, whereas the mean age of the 4 th grade students was 22.8±1.27 years. The number of male students (46.5%), married (1.8%) students, students whose mothers/fathers were primary school graduates, (40.5%-30.9%), and students living at home with friends during university education (43.4%) was significantly higher among 4 th grade students as compared to the 1 st grade students (p<0.05). Although the number of students that had lived in the centre of the county until the age of 14 years (33.0%) and with self-perceived moderate economic status (60.6%) was found to be higher among 4 th grade versus 1 st grade students, the difference was not statistically significant (Table 1). The mean age of starting smoking was 14.7±3.5 years (median=15 years) among 1 st grade students and 15.5±4.2 years (median=12 years) among 4 th grade students. Of the 4 th grade and 1 st grade students, 28.6% and 19.7% respectively stated that they were current smokers at the time of the study (p<0.001) (Table 2). Among the 1 st grade students, prevalence of smoking was higher in those with illiterate mothers, those living in rental housing alone during university education, and those considering that their pocket money was less for them (p<0.05). No relation was found between paternal education status, selfperceived economic status and the prevalence of smoking behaviour among 1 st grade students. Among 4 th grade students, the prevalence of smoking was found higher in those with illiterate mothers, living in a rental housing together with friends during university education, with self-perceived poor economic status, and those considering that their pocket money was less for them (p<0.05) (Table 3). 43

3 Özcebe et al. University Stuents and Smoking Habits Table 1. Socio-demographic characteristics of students participated in the study (Dokuz Eylül, Fırat, Harran, Karadeniz Technical, Kırıkkale, Kocaeli, Mersin, Osmangazi, Yüzüncü Yıl Universities, 2009) Gender 1 st Grade 4 th Grade Number Percentage Number Percentage p Male Female Total Marital Status Single Married Total * Maternal Education Status Illiterate Literate Primary School Graduate Intermediate School Graduate High School Graduate University Graduate Unknown Total 3274* * Paternal Education Status Illiterate Literate Primary School Graduate Intermediate School Graduate High School Graduate University Graduate Unknown Total 3265* * The residential area where the student lived the longest until the age of 14 years Province County Village Abroad Total 3276* People that have been lived with during school years Family At home alone At home with friends University hostel Private hostel Other** Total Self-perceived economic status of family Very good Good Moderate Poor Very poor Total *There are different numbers of students that did not give an answer **Governmental hostel, training centre, student hostel, community hostel, at home with relative, at home with sibling.

4 Table 2. Distribution of students participated in the study among school grades (Dokuz Eylül, Fırat, Harran, Karadeniz Technical, Kırıkkale, Kocaeli, Mersin, Osmangazi, Yüzüncü Yıl Universities) Smoking status 1 st Grade* 4 th Grade* Number Percentage Number Percentage p Never smoked Tried once Smoked for a while, currently not smoking Occasionally smoking Regularly smoking Total *There are different numbers of students that did not give an answer DISCUSSION Tobacco use is a behaviour that negatively influences human health. It is known that tobacco use enhances morbidity and mortality rates. Most of the health-related behaviours are developed during childhood and youth [16]. Whilst the rate of current smokers was 19.7% among the 1 st grade university students, it was 28.6% among the 4 th grade students. The prevalence of smoking was higher in 4 th grade students. According to the Turkey Adult Tobacco Survey in 2008, the prevalence of tobacco use in year-age group was 21.7% [11]. Comparing the results of this study with that of the Global Adult Tobacco Survey (2008); the prevalence of smoking among 1 st grade students was lower, whereas the prevalence of smoking among 4 th grade students was higher than the national average. However, the narrower age range in this study as compared to the Global Tobacco Survey might have led to this difference. On the other hand, Turkey Youth Sexual and Reproductive Health Survey (2007) reported that 37.4% of the young people in year-age group were smokers [17]. Comparing with the results of such a comprehensive study that represented Turkey-wide young population, it was determined that the prevalence of smoking in this study was lower than the general population. Lower smoking prevalence in the present study group may be attributed to the inclusion of university students in the study group. In the Assessment of Knowledge on Adolescence and Life Style of the 1 st Grade University Students Survey (2005), which was conducted using the same methodology with the present study, the prevalence of smoking was found to be 22.2% in students at the first grade [18]. Based on all these results, it can be anticipated that prevalence of smoking has been decreased among those beginning university. This raises the thought that expansion of the article of law on tobacco use in 2008 has contributed to the decrease in smoking habits of university students. However, this hypothesis must be verified in the future with further researches. The present study determined that the prevalence of smoking varies among the faculties, at which the students are being educated. Webb et al. [19] conducted a study in university students in England and found that the prevalence of smoking showed variation among faculties. In the above-mentioned study, the highest prevalence of smoking was determined in those educated in the fields of art and social sciences, whereas the lowest prevalence was found in those educated in engineering, medicine and veterinary faculties. Likewise, in the present study, the lowest prevalence of smoking was found among students of faculty of medicine. However, the fact that one out of four 4 th grade students of medical faculty have been smoking is a conspicuous result for a student group, in which a high level of awareness on this subject is expected. Doctors are indirectly (through creating a role model) and directly (through treatment and preventive medicine interventions) involved in human health. Studies conducted in medical faculties also reported that prevalence of smoking was higher than 20% in this group [20-22]. Consistent with many studies, the present study also found the prevalence of smoking to be higher (prevalence of current smokers is 21.0% among 1 st grade and 28.7% among 4 th grade students) in the faculty of education, which is in the scope of social sciences [19,23,24]. Prevalence of smoking is expected to be lower among teacher candidates, who should be a role model for the students. For this purpose, beginning from university years, interventional studies aiming at developing norms and values are needed to avoid cigarette smoking. Prevalence of smoking among youth shows difference also between genders. Among young people who were interviewed for the Global Youth Tobacco Survey (2003), 21.5% of girls and 34.9% of boys aged between 13 and 15 years reported that they tried smoking cigarette and 5.0% of girls and 11.9% of boys stated that they were current smokers. In the second Global Youth Tobacco Survey (2008), the prevalence of smoking was found to be 10.2% in boys and 5.3% in girls [11]. In the Assessment of Knowledge on Adolescence and Life Style of the 1 st Grade University Students Survey (2005), the prevalence of smoking was determined to be 29.9% in boys and 14.3% in girls [18]. In the present study as well, smoking is more prevalent in male versus female students of the 1 st and 4 th grade. There are numerous studies consistent with this result [25-29]. The difference between genders in terms of smoking behaviour may suggest that the opinion smoking is considered as a male behaviour due to the role given by the population to males and females is still being supported. However, in the recent years, promotion interventions aiming at girls have been enhanced by the tobacco industry. 45

5 Özcebe et al. University Stuents and Smoking Habits Table 3. Percent distributions of smoking status among students according to some characteristics (Dokuz Eylül, Fırat, Harran, Karadeniz Technical, Kırıkkale, Kocaeli, Mersin, Osmangazi, Yüzüncü Yıl University) Faculty Gender 1 st Grade 4 st Grade Never Smoked but Currently Never Smoked but Currently smoked quitted smoking Total p smoked quitted smoking Total p Education Science-Literature Medicine Female Male Maternal education status Illiterate Literate Primary school graduate Intermediate school graduate High school graduate University graduate Paternal education status Illiterate Literate Primary school graduate Intermediate school graduate High school graduate University graduate Economic status Good Moderate Poor Pocket money Adequate Partially adequate Inadequate People that have been lived with during education period With family At home alone At home with friends University hostel Private hostel Government hostel Smoking status of friends All Most of Some of None Global Youth Survey conducted in 2008 in Turkey also found evidence of increase in the prevalence of smoking among girls. In this study, although it appears that prevalence of smoking has not increased among girls as compared to 2005, it should be closely monitored in the years ahead. Although self-perceived economic status is a relative indicator, it is accepted as a determinant of economic status. According to the results of the present study, the prevalence of smoking is high among students with self-reported poor economic status. However, this contrasts with the fact

6 that it is more difficult for the people with poor economic status to buy cigarettes. As was mentioned in the Framework Convention on Tobacco Control and in MPOWER package developed by the World Health Organization, increasing the taxes of tobacco products is among the intervention practices of tobacco control programs. This intervention is particularly important to control popularity and accessibility of tobacco products among young people. Special consumption tax on cigarettes has been increased by 20% in January 2010 in Turkey and it was determined that the amount of cigarettes sold was 25% lower in the first four months of 2010 as compared to the same period of 2009 [11]. However, despite high taxes on tobacco, cigarette prices are still lower in Turkey as compared to many countries. The World Bank s classification of cigarette prices according to the income groups is as follows: whilst average price of a cigarette is 3.23 American Dollars in highincome countries, the average price of a cigarette in Turkey is 0.75 American Dollars [30]. The price of the most popular cigarette brand is 5.73 International Dollars in France, 5.01 Dollars in Germany and 3.91 Dollars in Italy [31]. Lower domestic market prices as compared to the world market are considered among the barriers in decreasing cigarette consumption [32]. Not only the tax but also the base prices of cigarettes must be increased. Önder demonstrated that an increase by 10% in cigarette prices decreases the demand for cigarettes by 1.9% [30]. Necessity of re-evaluating the strategies to further increase cigarette prices must be in the fore front among interventions aiming at young people [33]. For this purpose, it is necessary to put various interventions and policies into practice, to perform social researches on the accessibility of cigarette brands for various age groups and social classes to obtain data to advance the practices, and to carry out studies to monitor interventions. The data obtained demonstrate that although paternal education level is not associated with smoking, maternal education level is. In the present study, it was determined that the prevalence of smoking increases as the maternal education level decreases. This may be explained by lower guidance, monitoring, and control behaviour of the mother with low education status. In line with the results of the present study, there are studies that found a significant correlation between maternal education status and smoking status of the students [34,35]. Social, cognitive and emotional development in the childhood of life occurs in the family environment. Along with the socialization process, friends start to have more influence on young people. Environmental and friendship factors can be determinative in smoking as is in all kinds of habit. The smoking habit of a close friend enhances the likelihood of smoking of a young individual 3-4 fold [11]. In the present study as well, the prevalence of smoking was found to be higher among students that have smoker friends. This may arise from mutual interaction, related to with whom the young individual is living or spends time. Among 1 st grade students, prevalence of smoking was the highest in those who were living alone. Such an increase might have resulted from separation from the family home, as well as togetherness with smoker friends among the students that began university education after high school. Among 4 th grade students, the prevalence of smoking was high among young people living with friends. This suggests that peer effects remain as an important relationship factor in terms of increasing the prevalence of smoking. The present study has some limitations. The study s being conducted in some faculties and comprising only students that could be attained suggest that care must be taken in interpreting the results. On the other hand, as interviews were only carried out with university students, the study results cannot represent all individuals at the mentioned age group. In conclusion, in Turkey, making the law on tobacco control in 1996 and expanding the scope of this law in 2008 have made substantial contributions in decreasing the prevalence of cigarette smoking. This law provides an opportunity in terms of prevention of young people to acquaint with new tobacco products and to reduce the accessibility to tobacco products. The present study indicates that smoking is prevalent also in university students and requires urgent intervention. Young people with low maternal education status and low family income and those living with friends are particularly more prone to gain smoking habit during university education. University life needs appropriate environment for the improvement of health of future generation and interventions that would develop personal skills. Keeping in mind that each university student will be a role model in the future, particularly teacher and doctor candidates must be made aware of smoking issue and contribution must be made to the struggle against smoking. education. University life needs appropriate environment for Ethics Committee Approval: Ethics committee approval was received for this study from the ethics committees of Dokuz Eylül, Fırat, Harran, Karadeniz Technical, Kırıkkale, Kocaeli, Mersin, Osmangazi and Yüzüncü Yıl Universities. Informed Consent: Written informed consent was obtained from patients who participated in this study. Peer-review: Externally peer-reviewed. Author Contributions: Conception - H.Ö., B.G.D., E.İ., D.H., M.B.; Design - H.Ö., B.G.D., E.İ., D.H., M.B.; Supervision - H.Ö., B.G.D., E.İ., D.H., M.B.; Fundings - H.Ö., B.G.D., D.H., M.B.; Data Collection and/or Process- ing - H.Ö., B.G.D., D.H., M.B.; Analysis and/or Interpretation - H.Ö., B.G.D., E.İ., D.H., M.B.; Literature Review - H.Ö., B.G.D., E.İ., D.H., M.B.; Writer - H.Ö., B.G.D., E.İ., D.H., M.B.; Critical Review - H.Ö., B.G.D., E.İ., D.H., M.B. Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study has received no financial support. REFERENCES 1. WHO. The Health of Young People: A Challenge and a Promise. Geneva. 1993:

7 Özcebe et al. University Stuents and Smoking Habits 2. Kınık E. Physical growth and Sexual Development in adolescent period. Katkı Pediatrics Journal 2000;21: Çuhadaroğlu F. Characteristics of psychological development in puberty. Katkı Journal 2000;21: Kanbur NÖ. Physical growth and Sexual Development in adolescents. In: Derman O. Kanbur NÖ. Akgül S; eds. Health of Adolescent. Aydoğdu Ofset. Ankara. 2012:6. 5. Özcebe H. Being Youth and Risks. In: Ulukol B; eds. Turkiye Klinikleri J Pediatr Sci 2008;4: World Health Organization (WHO). The Tobacco Atlas. Accessed Date: Warren W, Riley L, Asma S. et al. Tobacco use by youth: A surveillance report from the global youth tobacco survey project. Bull World Health Organ 2000;78: Özcebe H. Effective methods for preventing accessibility of youth. 5th National Smoking and Health Congress. Abstract Booklet; 8-11 May 2011; Kocaeli; 2011.p Karlıkaya C, Öztuna F, Solak Z. et al. Tobacco Control. Thoracic Journal 2006;7: Bilir N, Çakır B, Dağlı E. et al. Policies of tobacco control in Turkey. WHO Turkey Office. WHO Publication. Danimarka. 2010: Republic of Turkey Ministry of Health General Directorate Of Health Services. Global Adult Tobacco Survey Turkey Report Anıl Matbaacılık. Publication No: : Law on Prevention and Control of Hazards of Tobacco Products, number: /01/2008 dated Official Gazette of the Republic of Turkey. 13. Law on Prevention and Control of Hazards of Tobacco Products. Official Gazette of the Republic of Turkey :22829 ( zuat.adalet.gov.tr/html/875.html. Accessed Date: ) 14. World Health Organization Law on the Approval of World Health Organization Framework Convention on Tobacco Control. Official Gazette of the Republic of Turkey. 30 November 2004:25656 ( gov.tr/main.aspx?home= basbakanlik.gov.tr/eskiler/2004/11/ htm&main= rega.basbakanlik.gov.tr/eskiler/2004/11/ htm. Accessed Date: ) 15. Bilir N, Özcebe H, Ergüder T. Mauer-Stender K. Tobacco control in Turkey-story of commitment and leadership. WHO Regional Office for Europe. WHO Publication. Denmark. 2012: Özcebe H. Risky behaviours in adolescents. In: Derman O. Kanbur NÖ. Akgül S; eds. Ergen Sağlığı. Aydoğdu Ofset. Ankara. 2012: Özcebe H, Ünalan T, Türkyılmaz S, Coşkun Y. Research on sexual health and reproductive health in youth in Turkey UNFPA and Nüfusbilim Derneği. Ankara. 2007: Bertan M, Özcebe H, Güçiz Doğan B. et al. Research on knowledge on adolescent period and lifestyle of first-year university students. ICC. Department of Public Health of Hacettepe University Medical Faculty. Adnan Menderes University. Harran University. Kocaeli University. Mersin University. On dokuz Mayıs University. Osmangazi University and Yüzüncü Yıl University. Meteksan Matbaacılık. 2007: Webb E, Ashton H, Kelly P, Kamali F. Patterns of alcohol consumption. Smoking and illicit drug use in British university students: Interfaculty Comparisons. Drug Alcohol Depend 1997;47: [CrossRef] 20. Kuyumcu G, İdil A, Kırılmaz A. Smoking and Alcohol Use in the first and sixth year Ankara University Medical Faculty students. 12th National Public Health Congress. Abstract Booklet; October 2008; Ankara; 2008.p Oğur R, Yeşildal F, Kara K. et al. Evaluation of knowledge, attitude, and behaviour of last year medical faculty students and nurses in charge in hospital on the new law and regulations on use of tobacco products. 12th National Public Health Congress. Abstract Booklet; October 2008; Ankara; 2008.p Vatan İ, Ocakoğlu H, İrgil E. Evaluation of Smoking Status in Uludağ University Medical Faculty students. TAF Preventive Medicine Bulletin. 2009;8: Çayır E, Özcebe H, Acar VN. et al. Sociodemographic characteristics, behaviour for life and health, and evaluation of exposure to violence and smoking status of students in various faculties of Hacettepe University. 13th National Public Health Congress. Abstract Booklet; October 2010; İzmir; 2010.p Doğan M, Günay O. Attitudes of students in Erciyes University towards legal regulations on smoking. 13th National Public Health Congress. Abstract Booklet; October 2010; İzmir;2010.p Bayrak U, Gram E, Mengeş E. et al. The knowledge and attitude of university students about health habitude and cancer. DEU Medical Faculty Journal 2010;24: Akçay Ş, Dilektaşlı Görek A, Budakoğlu İ. et al. Attitudes and knowledge for smoking among university students. Türkiye Klinikleri J Med Science 2009;29: Tanrıkulu Çetin A, Çarman BK, Palancı Y. et al. The Prevalence of Cigarette Smoking among University Students in Kars and Risk Factors. Turkish Thoracic Journal 2009;11: Pıçakçıefe M, Keskinoğlu P, Bayar B, Bayar K. Smoking Prevalence Among Muğla School of Health Sciences Students and Causes of Leading Increase in Smoking. TAF Prev Med Bull 2007;6: Yüksel S, Cücen Z, Konuralp N. et al. Smoking habits of students at Fatih University Ankara Campus. MYO-ÖS National Vocational Schools Students Symposium October 2010-Düzce. MYO_OS_8034.pdf. Accessed Date: Önder Z. The Economics of tobacco in Turkey: New Evidence and Demand Estimates. World Bank. Economics of Tobacco Discussion Papers. 2002;2: World Health Organization Global Tobacco Epidemic Report Accessed Date: Dikmen N. Cigarette consumption and factors affecting this consumption in Turkey: A model study. Journal of Economics and Administrative Sciences. April 2005;1: WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package. Geneva. World Health Organization ( Accessed Date: ) 34. Çalışır ZE, Yıldız AK, Çöl M. Evaluation of Smoking Habits, addiction level and pattern in the last year students of Ankara University Medical Faculty. 8th Public Health Days. Abstract Booklet; 2003; Sivas; 2003.p Mayda SA, Tufan N, Baştaş S. Attitudes Towards Smoking and Frequency of Smoking Among Students of Düzce Medical School. TAF Prev Med Bull 2007;6: