Metot: Bu çalışmada 613 sigarayı bırakan üniversite öğrencisi yer almıştır. Katılanlar 17 farklı fakülteden çok aşamalı örneklem yoluyla seçilmiştir. Veriler yüzyüze görüşülerek uygulanan anket yoluyla elde edilmiştir. İstatistiksel analiz için ki-kare testi kullanılmıştır.

Sonuç: Sigarayı bırakanların çoğunluğu (%98) sigaraya 21 yaş altında başlamıştı ve %70’i sigaranın zararlı etkileri hakkında bilgiye sahipti. Sigara bırakmada en etkin yol olarak aniden bırakma tespit edildi (%55.7).

Netice: Türkiye’de sigara içme alışkanlığı önemli bir halk sağlığı problemidir. Etkili ve kapsamlı bir ulusal sigara control programına acilen ihtiyaç vardır.

The most effective programs start from the principle that youth have to learn skills to resist pro-smoking pressure from peers, family, media, and advertising ^12,13. Anti-smoking school education can postpone smoking initiation by some year. One possible measure to reduce the percentage of youth smokers is introducing an age limit for tobacco sales. This has been adopted by many countries, most setting the age limit at 18 years of age ¹².

Nicotine, a key ingredient in tobacco products, is an addictive drug. The difficulties in smoking cessation are suggested to be related to nicotine ¹⁴. Addiction to nicotine involves the interaction of psychological, physical, behavioral, and social factors ^3,4,15. Current health education activities against smoking should be continued and extended to the young population to further reduce the prevalence of smoking and its health consequences ^16-18. If a smoker has been thinking about giving up, advice from health care professionals can encourage him to stop ^4,19.

The WHO has estimated that the number of deaths each year from smoking-attributable disease will increase to 10 million within the next 30 years or so, of which 70 % will occur in developing countries ^20-22. Prevention and treatment of tobacco use have been targeted by the WHO as a priority in developing countries. However, such efforts are difficult because tobacco companies have applied active marketing and economic pressure to these countries, which are enticed by increased revenues provided by tobacco use ²³. Thus tobacco consumption is decreasing by 1 % per year in industrialized nations and increasing by about 2% per year in developing countries ²⁴.

Cigarette smoking not only increases risk of death among older adults but also affects quality of life and physical functioning ²⁵. Smoking cessation at any age reduces the overall risk of death ²⁶. Smoking cessation also decreases the risk of developing lung and other cancers ²⁷.

Psychological and behavioral factors affecting the success in quitting smoking must be established. ²³. Health promotion at schools was considered very important because people usually start smoking before the age of 20. Therefore, focusing attention on smoking cessation among the university students is an immediate and urgent priority for public health professionals ^26,28.

Ever- smokers were defined as those who had smoked 100 cigarettes and now smoked either every day (i.e., daily smokers) or some days (i.e., some-day smokers). Ex- smokers had smoked at least 100 cigarettes in their lives but did not currently smoke. The minimum quitting period for the ex-smokers was accepted as 6 months. Never-smokers were defined as those who had never smoked.

This special questionnaire included 44 items and contained the students’ socio-demographic characteristics, opinions related to smoking cessation, the status of smoking in family, and the effects of TV programs on smoking cessation. Participants answered questions on the following factors:

Socio-demographic characteristics: gender, marital status, age, faculty, class, place of living, place of residence, participation in sport activities, the use of another addictive substance, Family characteristics: father’s occupation, mother’s occupation, father’s and mother’s educational level, the status of smoking in family.

Opinions related to smoking cessation: the reason of smoking cessation, the effect of TV programs on smoking cessation, the way of smoking cessation, effectiveness of TV programs related harmful effects of smoking, reactions to TV programs related smoking.

Smoking-related habits before quitting smoking: the initiation age of smoking, duration of smoking, the reason to start smoking, believing the hazards of smoking, being under effect of the advertisements related with smoking.

DATA ANALYSIS
The data were entered into a personal computer using the SPSS statistical package. Chi-square and analysis of variance were used to test for baseline differences in demographic and smoking-history variables. Statistical significance was defined as p< 0.05.

Of the students in this study 33.1% (n=203) were female, 66.9% (n=410) were male, 92.3% (n=566) were single, and 7.7% (n=47) were married. The age interval of participants was 17-31 years. The majority of students (90.2%) were not using another addictive substance. Socio- demographic characteristics of study subjects were shown in Table I. In this study, the mothers’ educational levels were intermediate and low (92.3 %). In this paper, the smoking prevalence of fathers was 38.3%. 72.9% of family members were smoking (only father, only mother, brothers, or both parents).

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Table I: Socio-demographic characteristics

The most important reason of smoking-cessation was knowledge of harmful effects of smoking (51.1%). In the majority of participants (40.6 %), there was a negative opinion that TV programs on smoking-cessation were ineffective. The best way of smoking-cessation was sudden quitting (55.7 %). The majority of participants (56.7 %) had believed that effective TV programs related harmful effects of smoking were lacking. Approximately 88.8% of ex-smokers were watching TV programs related smoking. Table II shows opinions related with smoking cessation.

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Table II: Opinions related with smoking cessation

We found that 3 % of ex-smokers began smoking before 9 years of age, 17 % of this group began smoking at 10-13 years of age. In the majority of ex-smokers (78.1 %) the initiation age of smoking was between 14-21 years. The most important reason to start smoking was social factors (environment, friend groups, etc) (39.1 %).Later, distress and anxiety were found (30.5 %) More than 70.7 percent of ex-smokers were believing the hazards of smoking. The majority of ex -smokers (65.4 %) have not ever wanted their children to smoke. Smoking-related habits before quitting smoking were shown in Table III. Differences of some parameters between smokers and ex-smokers were shown in table IV.

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Table III: Smoking-related habits before quitting smoking

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Table IV: Differences between ever-smokers and ex-smokers at different parameters

Unfortunately, the mass media have not been used adequately in Turkey to combat smoking. In the last census, total population was 67 million in Turkey. Turkish population is predominantly young; with 40.6 million above 15 years of age. Turkish laws are inadequately enforced to combat smoking. There is a light legislation against tobacco, including a ban on many forms of advertising, restrictions on smoking in many public places, prohibition to buy cigarette under 18 aged. Therefore, smoking rates in adolescents have continued to rise in recent years ³¹. Alikasifoğlu et al. also reported that the prevalence of smoking among Turkish high school students gradually increased. A significant increase was observed in cigarette experimentation rate across grades for both female and male students. Twenty- three percent of the students reported that they were current users ³². In this study, although the prevalence of ex-smokers was 13.6%, the prevalence of ever-smokers was 36 %.This high ratio was similar to other studies. Recent data from 1997 Youth Risk Behavior Survey suggest that youth smoking rates are increasing. The prevalence of smoking among high school seniors increased from 27.5% in 1991 to 36.4% in 1997 in USA ^33,34.

Scientific data demonstrate that tobacco use is the leading preventable cause of death and illness. Smoking is a known cause of cancer, heart disease, stroke, and chronic obstructive pulmonary disease. The prevalence of ever-smokers among Turkish adolescents was higher than US, European and other developed countries. Despite the tobacco companies have been aggressively expanding its markets in Asia, Turkey, Middle East, and other undeveloped countries, a small group of students had succeeded to stop smoking. In this paper, we found that the prevalence of ex-smokers was 13.6%. The Saudi Smoking Control Charitable Society reported that smoking cessation rate was 13% ²⁰. This rate was 24.8% in USA ³⁵. There was a significant difference. This may be of the because of the more effective smoking cessation protocols, educational programs at schools, anti-tobacco advertising, heavy laws to ban tobacco use. Tobacco use recently is the single, most important health disorder in Turkey. Thus, urgent effective cessation programs must be established.

Having close friends and family members who smoked were strong factors for smoking ^7,32. We found that the risk was highest when the father was a smoker. Parental smoking may cause children to view smoking as an acceptable adult behavior that is engaged in by those they most admire ³³. In this paper, the smoking prevalence of fathers was 38.3 %. Unfortunately, 72.9 % of family members were smoking (only father, only mother, brothers, or both parents). Because of this high smoking ratio of family members, a wide health educational program for everybody must be arranged.

Adolescents often attend to the health advice from their doctors than from parents or other adults ³³. Both doctors and teachers can play an important role in preventing tobacco use among children by adopting and modeling effective prevention strategies.

Young smokers listed 3 factors that would motivate them to try to stop smoking:

1-the tobacco-related death or illness of a close relative,
2-a request from their boyfriend or girlfriend,
3-advice from their doctor ³⁶

We found that the most important reason of smoking cessation was knowledge of harmful effects of smoking (51.1 %). Later, health problems (13.9%) were appeared. These findings showed that health education, positive motivation, and effective cessation programs offered by health services could play an important role to quit smoking.

The majority of participants (40.6%) hadn’t believed that TV programs on smoking-cessation were effective and sufficient. As much as possible, a measure’s effectiveness is quantified in terms of declines in tobacco consumption and smoking prevalence among youth (12). Unfortunately, because of insufficient laws, everybody can buy cigarette in our country.

When we retrospectively examined former lifestyle of ex-smokers, the initiation age of smoking was under 21 years (98%). The most important reason to start smoking was social factors (environment, friend groups, etc.) This rate was 39.1%. Second major reason was distress and anxiety (30.5%). The majority of ex-smokers (70.7%) have believed the hazards of smoking. This belief positively influenced to stop smoking. Research and theory must be directed towards understanding why some individuals smoke and others do not ^37,38. Further researches on the etiology of smoking in young people must be performed.

Approximately 53.6% of ex-smokers were being under effect of the advertisement related with smoking. Fortunately, 65.4% of ex-smokers haven’t ever wanted their children smoke. Thus, the concept of a tobacco-free society must promote through involvement in anti-tobacco activities and educational projects in their local communities, organizations and educational institutions.

We found that men were more susceptible than women to both smoking and quit smoking. This finding was in accordance with other studies ^20,39. Although the causes are multifactorial, age, gender, having classmates, parents, teachers who smoked were very important¹⁹. The decision to stop smoking can be a long process which is established on behavioral change model. Smoking cessation is a dynamic process that occurs before, during and after the person quit ⁹.

There was a meaningful relation with smoking and alcohol in our study. Among the ex-smokers the using ratio of alcohol was significantly lower than ever-smokers (p=0.001). In the faculties of social sciences, the rate of quitting smoking was significantly higher than the others (p=0.000). Tot et al. also reported that cigarette smoking was associated with alcohol use ¹⁰. Because of the rules of dormitories, residence at a dormitory was significantly more effective to quit smoking than the others (p=0.000).

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