Abstract
Objective
Türkiye has an alarming trend in smoking rates in recent years. Therefore, our study aimed to evaluate the motivation of people in Türkiye to start and continue smoking, as well as the nicotine addiction levels among smokers.
Material and Methods
The study was conducted using an electronic survey on participants who received care at the cardiology outpatient clinic for any reason. In the study, participants were asked questions about age, gender, income level, education level, chronic disease history, and 6 additional questions that constitute the Fagerstrom scoring, which is the nicotine addiction assessment index. Furthermore, the study examined the reasons behind patients’ initiation of smoking, the factors that contributed to their continuing smoking, and their overall perceives towards smoking.
Results
Three-hundred-ten participants, 168 men and 142 women, were included and the average age of starting smoking was 19.5. Age, education level, income level and chronic disease history are statistically significant between addiction levels (p-value: 0.014, <0.001, 0.039 and <0.001, respectively). 42% of smokers have low, 52% moderate and 6% high nicotine addiction, and an average of 14 cigarettes are smoked per a day. While 79.4% of the participants agree that smoking is very harmful, only 34.8% plan to cessastion soon.
Conclusion
Türkiye has a concerning prevalence of smoking. Our research reveals the prevalence of nicotine addiction, levels of cigarette consumption, and the underlying motivations for both initiation and continuation. The main factors that contribute to the persistence of the smoking habit are the level of nicotine addiction and the pleasurable sensation acquired through smoking.
Keywords: Smoking, nicotine addiction, Fagerstrom test, cardiovascular risk, smoking cessation
References
Peto R, Lopez AD, Boreham J, Thun M, Heath C Jr. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet. 1992;339:1268-1278.
Kondo T, Nakano Y, Adachi S, Murohara T. Effects of Tobacco smoking on cardiovascular disease. Circ J. 2019;83(10):1980-1985.
World Health Organization The tobacco atlas. Available from: http://www.tobaccoatlas.org/ (accessed March 15, 2019).
WHO global report on trends in prevalence of tobacco use 2000-2025, fourth edition. WHO, Geneva, 2021
Dai X, Gakidou E, Lopez AD. Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action. Tob Control. 2022;31(2):129-137.
Multiple sources compiled by World Bank (2024) – processed by Our World in Data. “Prevalence of current tobacco use (% of adults)” [dataset]. World Health Organization (via World Bank), “World Development Indicators”
Summers AD, Sirin H, Palipudi K, Erguder T, Ciobanu A, Ahluwalia IB. Changes in prevalence and predictors of tobacco smoking and interest in smoking cessation in Turkey: Evidence from the Global Adult Tobacco Survey, 2008-2016. Tob Prev Cessat. 2019;8:35.
Pomerleau CS, Carton SM, Lutzke ML, Flessland KA, Pomerleau OF. Reliability of the fagerstrom tolerance questionnaire and the fagerstrom test for nicotine dependence. Addict Behav. 1994;19(1):33-39.
Uysal MA, Kadakal F, Karşidağ C, Bayram NG, Uysal O, Yilmaz V. Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis. Tuberk Toraks. 2004;52(2):115-121.
Prijić Ž, Igić R. Cigarette smoking and medical students. J BUON. 2021;26(5):1709-1718.
Ishida M, Sakai C, Kobayashi Y, Ishida T. Cigarette smoking and atherosclerotic cardiovascular disease. J Atheroscler Thromb. 2024;31(3):189-200.
Messner B, Bernhard D. Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis. Arterioscler Thromb Vasc Biol. 2014;34(3):509-515.
WHO. Age-standardized estimates of current tobacco use, tobacco smoking and cigarette smoking (Tobacco control: Monitor). Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/gho-tobacco-control-monitor-current-tobaccouse-tobaccosmoking-cigarrettesmoking-agestd-tobagestdcurr
Gnys M, Shiffman S. 1991, March. Familial contributions to nicotine dependence. In: Shiffman S, Chair. Chippers: Studies of Non-dependent Cigarette Smokers. Symposium conducted at the Annual Meeting of the Society of Behavioral Medicine, Washington, DC.
Selby K, Marti J, Durand MA. We are all choice architects: using behavioral economics to improve smoking cessation in primary care. J Gen Intern Med. 2022;37(7):1783-1785.
