Türkiye'de Tütün Tüketimini Şekillendiren Sosyoekonomik ve Demografik Faktörler: Sosyoekonomik ve Demografik Değişkenlerin Rolü ve Politika Önerileri

Abstract

Tütün kullanımı, zararlı ve yaşamı tehdit eden sonuçları nedeniyle küresel ölçekte önemli bir halk sağlığı sorunudur. Bu çalışmada, Türkiye'deki bireyler ve hanelerden elde edilen sosyoekonomik, psikolojik, kültürel ve sağlık bilgilerini içeren kapsamlı bir veri seti kullanılarak sigara içme davranışı incelenmiştir. Çalışmada Türkiye İstatistik Kurumu (TÜİK) tarafından yürütülen 2016 Türkiye Sağlık Araştırması verileri kullanılmıştır. Ülke çapında yapılan bu araştırma 15 yaş ve üzeri 17.242 bireyi kapsamakta ve detaylı sosyo-demografik, ekonomik, kültürel, sağlık ve psikolojik bilgiler içermektedir. Türkiye'de çeşitli faktörlerin günlük tütün kullanımı üzerindeki etkisini değerlendirmek için Sıfır Şişirilmiş Negatif Binom (ZINB) modeli kullanılmıştır. Analiz sonucunda yaş, eğitim düzeyi, sigaraya maruz kalma, kronik sağlık sorunları, yalnızlık, çalışma durumu, küçük çocuk sahibi olma, hane geliri, cinsiyet, depresyon endeksi ve hane büyüklüğü sigara tüketimini etkileyen önemli faktörler olarak belirlenmiştir. Hem sigara içmeye başlama hem de sigara içme miktarı bu faktörlerin karmaşık etkileşimi ile şekillenmektedir. Bulgular, sigara içme davranışının belirlenmesinde gelir, cinsiyet, aile yapısı, sosyal ilişkiler, yaş, eğitim ve sağlığın önemini vurgulamaktadır.

Keywords

• Tütün Tüketimi
• Tütün Bırakma Politikası
• Sıfır Şişirilmiş Negatif Binom Regresyon (ZINB) Modeli

Socioeconomic and Demographic Factors Shaping Tobacco Consumption in Turkey: The Role of Socioeconomic and Demographic Variables and Policy Recommendations

Abstract

Tobacco use is a major public health issue globally due to its harmful and life-threatening consequences. This study examined smoking behavior using a comprehensive dataset of socioeconomic, psychological, cultural, and health information from individuals and households across Turkey. The study utilized data from the 2016 Turkey Health Survey conducted by the Turkish Statistical Institute (TUIK). This nationwide survey includes 17,242 individuals aged 15 and over, with detailed socio-demographic, economic, cultural, health, and psychological information. The Zero Inflated Negative Binomial (ZINB) model was employed to assess the impact of various factors on daily tobacco use in Turkey. The analysis identified age, education level, exposure to smoking, chronic health issues, loneliness, employment status, having young children, household income, gender, depression index, and household size as significant factors influencing cigarette consumption. Both the initiation and amount of smoking are shaped by a complex interplay of these factors. The findings underscore the importance of income, gender, family structure, social relationships, age, education, and health in determining smoking behavior.

Keywords

• Tobacco Consumption
• Tobacco Cessation Policy
• Zero Inflated Negative Binomial Regression (ZINB) Model

References

1. Alkan, Ö. & Abar, H. (2020). Determination of factors influencing tobacco consumption in Turkey using categorical data analyses. Archives of Environmental & Occupational Health, 75(1), 27–35. https://doi.org/10.1080/19338244.2018.1556200
2. Al-Sahab, B., Saqib, M., Hauser, G. & Tamim, H. (2010). Prevalence of smoking during pregnancy and associated risk factors among Canadian women: A national survey. BMC Pregnancy and Childbirth, 10(1), 1–9. https://doi.org/10.1186/1471-2393-10-24/TABLES/2
3. Amiri, S. (2022). Unemployment associated with major depression disorder and depressive symptoms: a systematic review and meta-analysis. International Journal of Occupational Safety and Ergonomics, 28(4), 2080–2092. https://doi.org/10.1080/10803548.2021.1954793
4. Bilgic, A., Florkowski, W. J. & Akbay, C. (2010). Demand for cigarettes in Turkey: An application of count data models. Empirical Economics, 39(3), 733–765. https://doi.org/10.1007/S00181-009-0320-8/METRICS
5. Boffetta, P. & Straif, K. (2009). Use of smokeless tobacco and risk of myocardial infarction and stroke: Systematic review with meta-analysis. BMJ, 339(7719), 502. https://doi.org/10.1136/BMJ.B3060
6. Brown, S. L. & Rinelli, L. N. (2010). Family structure, family processes, and adolescent smoking and drinking. Journal of Research on Adolescence, 20(2), 259–273. https://doi.org/10.1111/J.1532-7795.2010.00636.X
7. Cantrell, J., Vallone, D. M., Thrasher, J. F., Nagler, R. H., Feirman, S. P., Muenz, L. R., He, D. Y. & Viswanath, K. (2013). Impact of tobacco-related health warning labels across socioeconomic, race and ethnic groups: Results from a randomized web-based experiment. PLOS ONE, 8(1), e52206. https://doi.org/10.1371/JOURNAL.PONE.0052206
8. Casetta, B., Videla, A. J., Bardach, A., Morello, P., Soto, N., Lee, K., Camacho, P. A., Hermoza Moquillaza, R. V. & Ciapponi, A. (2016). Association between cigarette smoking prevalence and income level: A systematic review and meta-analysis. Nicotine & Tobacco Research, ntw266. https://doi.org/10.1093/ntr/ntw266

9. Çebi Karaaslan, K. (2022). Assessment of sociodemographic indicators of tobacco expenditure: an application of the censored regression model. Journal of Substance Use, 28(3), 441–446. https://doi.org/10.1080/14659891.2022.2060142
10. Chung, W., Lim, S. & Lee, S. (2010). Factors influencing gender differences in smoking and their separate contributions: Evidence from South Korea. Social Science & Medicine, 70(12), 1966–1973. https://doi.org/10.1016/J.SOCSCIMED.2010.02.025
11. Cox, L. S., Feng, S., Cañar, J., Ford, M. M. G. & Tercyak, K. P. (2005). Social and behavioral correlates of cigarette smoking among mid-atlantic Latino primary care patients. Cancer Epidemiology Biomarkers and Prevention, 14(8), 1976–1980. https://doi.org/10.1158/1055-9965.EPI-05-0141
12. De Vogli, R. & Santinello, M. (2005). Unemployment and smoking: Does psychosocial stress matter?. Tobacco Control, 14(6), 389–395. https://doi.org/10.1136/TC.2004.010611
13. Dilmaghani, M. (2021). Education, smoking and health: evidence from Canada. Education Economics, 29(5), 490–508. https://doi.org/10.1080/09645292.2021.1918641
14. Eek, F., Stergren, P. O., Diderichsen, F., Rasmussen, N. K., Andersen, I., Moussa, K. & Grahn, M. (2010). Differences in socioeconomic and gender inequalities in tobacco smoking in Denmark and Sweden; A cross sectional comparison of the equity effect of different public health policies. BMC Public Health, 10(1), 1–13. https://doi.org/10.1186/1471-2458-10-9/TABLES/4
15. Ekpu, V. U. & Brown, A. K. (2015). The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence. Tobacco Use Insights, (8). https://doi.org/10.4137/TUI.S15628
16. Foulstone, A. R., Kelly, A. B. & Kifle, T. (2017). Partner influences on smoking cessation: A longitudinal study of couple relationships. Journal of Substance, 22(5), 501–506. https://doi.org/10.1080/14659891.2016.1255791
17. Gallus, S., Lugo, A., Liu, X., Behrakis, P., Boffi, R., Bosetti, C., Carreras, G., Chatenoud, L., Clancy, L., Continente, X., Dobson, R., Effertz, T., Filippidis, F. T., Fu, M., Geshanova, G., Gorini, G., Keogan, S., Ivanov, H., Lopez, M. J., … Fernandez, E. (2021). Who smokes in Europe? Data from 12 European countries in the TackSHS survey (2017–2018). Journal of Epidemiology, 31(2), 145–151. https://doi.org/10.2188/JEA.JE20190344
18. Gao, K. & Khoshgoftaar, T. M. (2007). A comprehensive empirical study of count models for software fault prediction. IEEE Transactions on Reliability, 56(2), 223–236. https://doi.org/10.1109/TR.2007.896761
19. Gilman, S. E., Rende, R., Boergers, J., Abrams, D. B., Buka, S. L., Clark, M. A., Colby, S. M., Hitsman, B., Kazura, A. N., Lipsitt, L. P., Lloyd-Richardson, E. E., Rogers, M. L., Stanton, C. A., Stroud, L. R. & Niaura, R. S. (2009). Parental smoking and adolescent smoking initiation: An intergenerational perspective on tobacco control. Pediatrics, 123(2), e274–e281. https://doi.org/10.1542/PEDS.2008-2251
20. Guignard, R., Andler, R., Quatremère, G., Pasquereau, A., Du Roscoät, E., Arwidson, P., Berlin, I. & Nguyen-Thanh, V. (2021). Changes in smoking and alcohol consumption during COVID-19-related lockdown: A cross-sectional study in France. European Journal of Public Health, 31(5), 1076–1083. https://doi.org/10.1093/EURPUB/CKAB054
21. Hiscock, R., Judge, K. & Bauld, L. (2011). Social inequalities in quitting smoking: what factors mediate the relationship between socioeconomic position and smoking cessation?. Journal of Public Health, 33(1), 39–47. https://doi.org/10.1093/PUBMED/FDQ097
22. Homish, G. G. & Leonard, K. E. (2005). Spousal influence on smoking behaviors in a US community sample of newly married couples. Social Science & Medicine, 61(12), 2557–2567. https://doi.org/10.1016/J.SOCSCIMED.2005.05.005
23. Hong, Q. Y., Wu, G. M., Qian, G. S., Hu, C. P., Zhou, J. Y., Chen, L. A., Li, W. M., Li, S. Y., Wang, K., Wang, Q., Zhang, X. J., Li, J., Gong, X. & Bai, C. X. (2015). Prevention and management of lung cancer in China. Cancer, 121(S17), 3080–3088. https://doi.org/10.1002/CNCR.29584
24. Iglesias, R. M., Szklo, A. S., de Souza, M. C. & De Almeida, L. M. (2017). Estimating the size of illicit tobacco consumption in Brazil: Findings from the global adult tobacco survey. Tobacco Control, 26(1), 53–59. https://doi.org/10.1136/TOBACCOCONTROL-2015-052465
25. Jha, P. & Chaloupka, F. J. (2000). Tobacco control in developing countries. Tobacco Control in Developing Countries.
26. Jha, P. (2011). Avoidable deaths from smoking: A global perspective. Public Health Reviews, 33(2), 569–600. https://doi.org/10.1007/BF03391651
27. Kahar, P., Misra, R. & Patel, T. G. (2016). Sociodemographic correlates of tobacco consumption in rural Gujarat, India. BioMed Research International, 2016. https://doi.org/10.1155/2016/5856740
28. Kilic, D. & Ozturk, S. (2014). Gender differences in cigarette consumption in Turkey: Evidence from the global adult tobacco survey. Health Policy, 114(2–3), 207–214. https://doi.org/10.1016/J.HEALTHPOL.2013.05.019
29. Liu, S., Zhang, M., Yang, L., Li, Y., Wang, L., Huang, Z., Wang, L., Chen, Z. & Zhou, M. (2017). Prevalence and patterns of tobacco smoking among Chinese adult men and women: Findings of the 2010 national smoking survey. J Epidemiol Community Health, 71(2), 154–161. https://doi.org/10.1136/JECH-2016-207805
30. Lozano, P. & Homan, S. (2021). Disparities in smoking behavior by race/ethnicity in 10 diverse communities in Chicago: Findings from Sinai community health survey 2.0. Journal of Immigrant and Minority Health, 23(6), 1206–1213. https://doi.org/10.1007/S10903-021-01155-1/FIGURES/3
31. Mays, D., Gilman, S. E., Rende, R., Luta, G., Tercyak, K. P. & Niaura, R. S. (2014). Parental smoking exposure and adolescent smoking trajectories. Pediatrics, 133(6), 983–991. https://doi.org/10.1542/PEDS.2013-3003
32. Merzah, M., Kósa, Z., Sándor, J., Natae, S., Pikó, P., Ádány, R. & Fiatal, S. (2021). Roma socioeconomic status has a higher impact on smoking behaviour than genetic susceptibility. International Journal of Environmental Research and Public Health 2021, Vol. 18, Page 3206, 18(6), 3206. https://doi.org/10.3390/IJERPH18063206
33. Mohamed, S. F., Juma, P., Asiki, G. & Kyobutungi, C. (2018). Facilitators and barriers in the formulation and implementation of tobacco control policies in Kenya: A qualitative study. BMC Public Health, 18(1), 1–14. https://doi.org/10.1186/S12889-018-5830-X/TABLES/4
34. Nketiah-Amponsah, E., Afful-Mensah, G. & Ampaw, S. (2018). Determinants of cigarette smoking and smoking intensity among adult males in Ghana. BMC Public Health, 18(1), 1–10. https://doi.org/10.1186/S12889-018-5872-0/TABLES/7
35. Nolte-Troha, C., Roser, P., Henkel, D., Scherbaum, N., Koller, G. & Franke, A. G. (2023). Unemployment and substance use: An updated review of studies from North America and Europe. Healthcare, 11(8), 1182. https://doi.org/10.3390/HEALTHCARE11081182
36. Nystedt, P. (2006). Marital life course events and smoking behaviour in Sweden 1980–2000. Social Science & Medicine, 62(6), 1427–1442. https://doi.org/10.1016/J.SOCSCIMED.2005.08.009
37. Palipudi, K. M., Gupta, P. C., Sinha, D. N., Andes, L. J., Asma, S. & McAfee, T. (2012). Social determinants of health and tobacco use in thirteen low and middle income countries: Evidence from global adult tobacco survey. PLOS ONE, 7(3), e33466. https://doi.org/10.1371/JOURNAL.PONE.0033466
38. Pampel, F. C. (2003). Age and education patterns of smoking among women in high-income nations. Social Science & Medicine, 57(8), 1505–1514. https://doi.org/10.1016/S0277-9536(02)00543-9
39. Pearson, M. & Michell, L. (2000). Smoke rings: Social network analysis of friendship groups, smoking and drug-taking. Drugs: Education, Prevention and Policy, 7(1), 21–37. https://doi.org/10.1080/DEP.7.1.21.37
40. Pearson, M., Sweeting, H., West, P., Young, R., Gordon, J. & Turner, K. (2006). Adolescent substance use in different social and peer contexts: A social network analysis. Drugs: Education, Prevention and Policy, 13(6), 519–536. https://doi.org/10.1080/09687630600828912
41. Prochaska, J. J., Das, S. & Young-Wolff, K. C. (2017). Smoking, mental illness, and public health. Annual Review of Public Health, 38, 165–185. https://doi.org/10.1146/ANNUREV-PUBLHEALTH-031816-044618
42. Raghupathi, V. & Raghupathi, W. (2020). The influence of education on health: An empirical assessment of OECD countries for the period 1995-2015. Archives of Public Health, 78(1), 1–18. https://doi.org/10.1186/S13690-020-00402-5/FIGURES/17
43. Sahan, C., Gunay, T., Simsek, H., Soysal, A. & Ergor, G. (2018). Socioeconomic factors associated with tobacco smoking in Turkey: A cross-sectional, population-based study. Eastern Mediterranean Health Journal, 24(08), 705–713. https://doi.org/10.26719/2018.24.8.705
44. Singh, A., & Ladusingh, L. (2014). Prevalence and Determinants of Tobacco Use in India: Evidence from recent global adult tobacco survey data. PLOS ONE, 9(12), e114073. https://doi.org/10.1371/JOURNAL.PONE.0114073
45. Smith, P. H., Mazure, C. M., & McKee, S. A. (2014). Smoking and mental illness in the US population. Tobacco Control, 23(e2), e147–e153. https://doi.org/10.1136/TOBACCOCONTROL-2013-051466
46. Summers, A. D., Sirin, H., Palipudi, K., Erguder, T., Ciobanu, A., & Ahluwalia, I. B. (2022). Changes in prevalence and predictors of tobacco smoking and interest in smoking cessation in Turkey: Evidence from the global adult tobacco survey, 2008–2016. Tobacco Prevention & Cessation, 8(September). https://doi.org/10.18332/TPC/152748
47. Yuda, M. (2013). The impacts of recent smoking control policies on individual smoking choice: The case of Japan. Health Economics Review, 3(1), 1–13. https://doi.org/10.1186/2191-1991-3-4/TABLES/4