Tobacco use among institutionalized adolescents in Turkey: does social environment affect the risk?
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.
Erguder
Toker
T
Primary Health Care General Directorate, Ministry of Health, Ankara, Turkey. tokererguder@gmail.com
Cakir
Banu
B
Babalioglu
Nihal
N
Dogusan
Hasim
H
Turkoral
Eyup
E
Warren
Charles W
CW
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
BMC Public Health. 2007 Jan 08;7:3
17207291
Eur J Public Health. 2007 Apr;17(2):155-61
16837517
BMC Public Health. 2008 Dec 15;8 Suppl 1:S4
19091047
Soz Praventivmed. 2006;51(2):110-6
18027789
J Sch Health. 2005 Jan;75(1):15-24
15779140
MMWR Morb Mortal Wkly Rep. 2006 May 26;55(20):553-6
16723965
East Mediterr Health J. 2008 Nov-Dec;14(6):1290-300
19161104
Ann N Y Acad Sci. 2004 Jun;1021:175-97
15251888
Lancet. 2006 Mar 4;367(9512):749-53
16517275
Am J Health Behav. 2008 Jul-Aug;32(4):438-45
18092904
Soz Praventivmed. 2006;51(2):91-8
18027787
Turk Psikiyatri Derg. 2008 Fall;19(3):235-46
18791876
Health Commun. 2008 Nov;23(6):526-37
19089700
MMWR Surveill Summ. 2008 Jan 25;57(1):1-28
18219269