title: Tobacco use among institutionalized adolescents in Turkey: does social environment affect the risk?
abstract: OBJECTIVE
  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.
authors.affiliation: Primary Health Care General Directorate, Ministry of Health, Ankara, Turkey. tokererguder@gmail.com
authors.forename: Toker
authors.initials: T
authors.lastname: Erguder
authors.forename: Banu
authors.initials: B
authors.lastname: Cakir
authors.forename: Nihal
authors.initials: N
authors.lastname: Babalioglu
authors.forename: Hasim
authors.initials: H
authors.lastname: Dogusan
authors.forename: Eyup
authors.initials: E
authors.lastname: Turkoral
authors.forename: Charles W
authors.initials: CW
authors.lastname: Warren
mesh_terms: D000293:Adolescent; D005260:Female; D006306:Health Surveys; D006801:Humans; D007326:Institutionalization; D008297:Male; D019372:Orphanages; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology*; D012927:Social Control, Informal; D012931:Social Environment; D014421:Turkey / Q000453:epidemiology
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