Non-Price Tobacco Control Measures: Evidence from Turkey

Öz

Turkey introduced the public-place and workplace smoking regulation in 2008, which was expanded in 2009, including hotels, restaurants, bars, and teahouses. We study the predictors of smoking status, smoking intensity, and exposure to environmental tobacco smoke (ETS) at home in Turkey. We then examine the relationship between the smoking bans and exposure to ETS at workplaces, home, and public places such as restaurants, teahouses, bars, and public transportation, including taxis using data from Turkey’s Health Surveys about respondents’ ETS exposure. Our multivariate reg-ression analyses indicate that age, gender, marital status, employment status, income, and education have a statistically significant relationship with smoking status and smoking intensity. T-test results indicate that there has been an increase in exposure to ETS in public places between 2010 and 2012, which indicates weak enforcement of the law in the early years. Besides, exposure to ETS at workplaces have declined between 2010 and 2012. We also find that the public smoking ban did not lead to ETS displacement to private homes. We encourage policymakers to take more severe steps to enforce the law, especially in public places.

Anahtar Kelimeler

• cigarette consumption
• environmental tobacco smoking
• tobacco control
• Turkey

Fiyat Dışı Tütün Kontrol Önlemleri ve Çevresel Tütün Dumanına Maruz Kalma: Türkiye Örneği

Öz

Türkiye, 2009 yılında kapsamı genişletilerek otel, restoran, bar ve kahvehaneleri kapsayan halka açık yerlerde ve işyerinde sigara içme yönetmeliğini 2008 yılında yürürlüğe koymuştur. Türkiye'de evde sigara içme durumu, sigara içme yoğunluğu ve çevresel tütün dumanına (ETS) maruz kalmanın faktörlerini araştırıyoruz. Ardından, ankete katılanların ETS'ye maruz kalma durumları hakkındaki Türkiye Sağlık Anketlerinden elde edilen verileri kullanarak işyerlerinde, evlerde ve restoranlar, kahvehaneler, barlar ve toplu taşıma gibi halka açık yerlerde sigara içme yasakları ile ETS'ye maruz kalma arasındaki ilişkiyi inceliyoruz. Çok değişkenli regresyon analizlerimiz, yaş, cinsiyet, medeni durum, istihdam durumu, gelir ve eğitimin sigara içme durumu ve sigara içme yoğunluğu ile istatistiksel olarak anlamlı bir ilişki olduğunu göstermektedir. T-testi sonuçları, 2010 ile 2012 arasında halka açık yerlerde ETS'ye maruz kalma durumunda bir artış olduğunu göstermektedir. Bu durum ilk yıllarda yasanın uygulanma noktasında zayıf kaldığını göstermektedir. Ayrıca, işyerlerinde ETS'ye maruz kalma 2010 ve 2012 yılları arasında azalmıştır. Ayrıca, kamuya açık sigara yasağının yer değiştirme etkisine yol açarak ETS'nin evlere taşınmasına yol açmadığını da saptadık. Bulduğumuz sonuçlar ışığında politika belirleyicileri, özellikle halka açık yerlerde, yasanın daha güçlü uygulanması için daha caydırıcı adımlar atmaya teşvik ediyoruz.

Anahtar Kelimeler

• sigara tüketimi
• çevresel tütün dumanı
• tütün kontrolü
• Türkiye

Kaynakça

1. Adda, J., & Cornaglia, F. (2006). Taxes, cigarette consumption, and smoking intensity. American Economic Review, 96(4), 1013-1028.
2. Adda, J., & Cornaglia, F. (2010). The effect of bans and taxes on passive smoking. American Economic Journal: Applied Economics, 2(1), 1-32.
3. Ahluwalia, I. B., Grummer-Strawn, L., & Scanlon, K. S. (1997). Exposure to environmental tobacco smoke and birth outcome: increased effects on pregnant women aged 30 years or older. American journal of epidemiology, 146(1), 42–47. https://doi.org/10.1093/oxfordjournals.aje.a009190
4. Anger, S., Kvasnicka, M., & Siedler, T. (2011). One last puff? Public smoking bans and smoking behavior. Journal of health economics, 30(3), 591-601.
5. Argüder, E., Pempeci, S., Karalezli, A., & Hasanoğlu, H. C. (2019). The factors that ınfluence smoking initiation. Addicta: The Turkish Journal on Addictions, 6(4), 116-129.http://dx.doi.org/10.5152/addicta.2020.19099
6. Aristei, D., & Pieroni, L. (2008). A double-hurdle approach to modelling tobacco consumption in Italy. Applied economics, 40(19), 2463-2476. https://doi.org/10.1080/00036840600970229
7. Bardsley, P., & Olekalns, N. (1999). Cigarette and tobacco consumption: Have anti‐smoking policies made a difference?. Economic Record, 75(3), 225-240.
8. Bilir, N., Çakır, B., Dağlı, E., Ergüder, T., & Önder, Z. (2009). Tobacco control Turkey. Copenhagen: World Health Organization.

9. Blas, E., & Kurup, A. S. (Eds.). (2010). Equity, social determinants and public health programmes. World Health Organization.
10. Borland, R., Chapman, S., Owen, N., & Hill, D. (1990). Effects of workplace smoking bans on cigarette consumption. American Journal of Public Health, 80(2), 178-180.
11. Carpenter, C., Postolek, S., & Warman, C. (2011). Public-place smoking laws and exposure to environmental tobacco smoke (ETS). American Economic Journal: Economic Policy, 3(3), 35-61.
12. Chaloupka, F. J., & Pacula, R. L. (1999). Sex and race differences in young people's responsiveness to price and tobacco control policies. Tobacco Control, 8(4), 373-377. DOI: 10.1002/hec.3009
13. Chilmonczyk, B. A., Salmun, L. M., Megathlin, K. N., Neveux, L. M., Palomaki, G. E., Knight, G. J., Pulkkinen, A. J., & Haddow, J. E. (1993). Association between exposure to environmental tobacco smoke and exacerbations of asthma in children. The New England journal of medicine, 328(23), 1665–1669. https://doi.org/10.1056/NEJM199306103282303
14. Coultas D. B. (1998). Health effects of passive smoking. 8. Passive smoking and risk of adult asthma and COPD: an update. Thorax, 53(5), 381–387. https://doi.org/10.1136/thx.53.5.381
15. Fichtenberg, C. M., & Glantz, S. A. (2002). Effect of smoke-free workplaces on smoking behaviour: systematic review. Bmj, 325(7357), 188.
16. Fong, G. T., Hyland, A., Borland, R., Hammond, D., Hastings, G., McNeill, A., ... & Howell, F. (2006). Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/U.K. Survey. Tobacco control, 15(suppl 3), iii51-iii58.
17. Glantz, S. A., & Parmley, W. W. (1995). Passive smoking and heart disease. Mechanisms and risk. JAMA, 273(13), 1047–1053.
18. Hackshaw, A. K., Law, M. R., & Wald, N. J. (1997). The accumulated evidence on lung cancer and environmental tobacco smoke. BMJ (Clinical research ed.), 315(7114), 980–988. https://doi.org/10.1136/bmj.315.7114.980
19. Hirayama, T. Lung cancer and other diseases related to passive smoking: a large-scale cohort study. In: Gupta, P.C. et al., ed. Control of tobacco-related cancers and other diseases. Bombay, Oxford University Press, 1992.
20. Hosseinpoor, A. R., Parker, L. A., d'Espaignet, E. T., & Chatterji, S. (2011). Social determinants of smoking in low-and middle-income countries: results from the World Health Survey. PloS one, 6(5).
21. Jacobs, D. R., Adachi, H., Mulder, I., Kromhout, D., Menotti, A., Nissinen, A., & Blackburn, H. (1999). Cigarette smoking and mortality risk: twenty-five–year follow-up of the seven countries study. Archives of internal medicine, 159(7), 733-740.
22. Jones, A. M., Laporte, A., Rice, N., & Zucchelli, E. (2015). Do public smoking bans have an impact on active smoking? Evidence from the U.K. Health economics, 24(2), 175-192.
23. Keeler, T. E., Hu, T. W., Barnett, P. G., & Manning, W. G. (1993). Taxation, regulation, and addiction: a demand function for cigarettes based on time-series evidence. Journal of health economics, 12(1), 1-18.
24. Kelishadi, R., Reza Mokhtari, M., Tavasoli, A. A., Khosravi, A., Ahangar-Nazari, I., Sabet, B., ... & Amini, A. (2007). Determinants of tobacco use among youths in Isfahan, Iran. International journal of public health, 52(3), 173-179.
25. Khanal, V., Adhikari, M., & Karki, S. (2013). Social determinants of tobacco consumption among Nepalese men: findings from Nepal Demographic and Health Survey 2011. Harm reduction journal, 10(1), 40.
26. 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.
27. Köse, T. (2019). Smoking quit attempts in Turkey: An analysis of gender differences. Addicta: The Turkish Journal on Addictions, 6(4), 130-146.http://dx.doi.org/10.5152/addicta.2020.19108
28. Leuenberger, P., Schwartz, J., Ackermann-Liebrich, U., Blaser, K., Bolognini, G., Bongard, J. P., Brandli, O., Braun, P., Bron, C., & Brutsche, M. (1994). Passive smoking exposure in adults and chronic respiratory symptoms (SAPALDIA Study). Swiss Study on Air Pollution and Lung Diseases in Adults, SAPALDIA Team. American journal of respiratory and critical care medicine, 150(5 Pt 1), 1222–1228. https://doi.org/10.1164/ajrccm.150.5.7952544
29. Levy, D. T., Chaloupka, F., & Gitchell, J. (2004). The effects of tobacco control policies on smoking rates: a tobacco control scorecard. Journal of Public Health Management and Practice, 10(4), 338-353.
30. Liang, L., & Chaloupka, F. J. (2002). Differential effects of cigarette price on youth smoking intensity. Nicotine & Tobacco Research, 4(1), 109-114.
31. McCormick, M. C., Shapiro, S., & Starfield, B. (1984). High-risk young mothers: infant mortality and morbidity in four areas in the United States, 1973-1978. American journal of public health, 74(1), 18–23. https://doi.org/10.2105/ajph.74.1.18
32. Öberg, M., Jaakkola, M. S., Woodward, A., Peruga, A., & Prüss-Ustün, A. (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. The lancet, 377(9760), 139-146.
33. Official Journal. (1996, November 26). The Law No. 4207 “The Prevention of Harmful Effects of Tobacco Products”. https://www.resmigazete.gov.tr/arsiv/22829.pdf
34. Rachiotis, G., Siziya, S., Muula, A. S., Rudatsikira, E., Papastergiou, P., & Hadjichristodoulou, C. (2010). Determinants of exposure to environmental tobacco smoke (ETS) among non smoking adolescents (aged 11-17 years old) in Greece: results from the 2004-2005 GYTS Study. International journal of environmental research and public health, 7(1), 284-290.
35. Shapiro, S., McCormick, M. C., Starfield, B. H., Krischer, J. P., & Bross, D. (1980). Relevance of correlates of infant deaths for significant morbidity at 1 year of age. American journal of obstetrics and gynecology, 136(3), 363–373. https://doi.org/10.1016/0002-9378(80)90863-7
36. 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).
37. Spitzer, W. O., Lawrence, V., Dales, R., Hill, G., Archer, M. C., Clark, P., Abenhaim, L., Hardy, J., Sampalis, J., & Pinfold, S. P. (1990). Links between passive smoking and disease: a best-evidence synthesis. A report of the Working Group on Passive Smoking. Clinical and investigative medicine. Medecine clinique et experimentale, 13(1), 17–46.
38. Steenland K. Passive Smoking and the Risk of Heart Disease. JAMA. 1992;267(1):94–99. doi:10.1001/jama.1992.03480010102033
39. Tauras, J. A. (2006). Smoke‐free air laws, cigarette prices, and adult cigarette demand. Economic Inquiry, 44(2), 333-342.
40. Tepehan Eraslan, S., Demirkıran, S., & Duran, S. (2019). Factors affecting cigarette consumption: The case of the Keşan and İpsala districts of Edirne. Addicta: The Turkish Journal on Addictions, 6(4), 87-98. http://dx.doi.org/10.5152/addicta.2020.19070
41. Trédaniel, J., Boffetta, P., Saracci, R., & Hirsch, A. (1993). Environmental tobacco smoke and the risk of cancer in adults. European journal of cancer (Oxford, England : 1990), 29A(14), 2058–2068. https://doi.org/10.1016/0959-8049(93)90471-q
42. Trédaniel, J., Boffetta, P., Saracci, R., & Hirsch, A. (1994). Exposure to environmental tobacco smoke and adult non-neoplastic respiratory diseases. The European respiratory journal, 7(1), 173–185. https://doi.org/10.1183/09031936.94.07010173
43. Warren, C. W., Erguder, T., Lee, J., Lea, V., Sauer, A. G., Jones, N. R., & Bilir, N. (2012). Effect of policy changes on cigarette sales: the case of Turkey. The European Journal of Public Health, 22(5), 712-716.
44. Wells A. J. (1991). Breast cancer, cigarette smoking, and passive smoking. American journal of epidemiology, 133(2), 208–210. https://doi.org/10.1093/oxfordjournals.aje.a115859
45. Wilson, N., & Thomson, G. (2002). Still dying from second-hand smoke at work: a brief review of the evidence for smoke-free workplaces in New Zealand. The New Zealand medical journal, 115(1165), U240.
46. World Health Organization. Regional Office for Europe. (‎2000)‎. Air quality guidelines for Europe, 2nd ed. Copenhagen : WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/107335
47. World Helath Organization. (2020, May 27). Tobacco. https://www.who.int/news-room/fact-sheets/detail/tobacco
48. Yanbaeva, D. G., Dentener, M. A., Creutzberg, E. C., Wesseling, G., & Wouters, E. F. (2007). Systemic effects of smoking. Chest, 131(5), 1557-1566.
49. Yazıcı, H., Camadan, F., & Kahveci, G. (2017). Adapting the Smoking Expectancy Scale for Adolescents (SESA) to Turkish culture. Addicta: The Turkish Journal on Addictions, 4, 207–220. http://dx.doi.org/10.15805/addicta.2017.4.2.0009
50. Yıldız, F. (2020). Determinants of cigarette consumption in Turkey: An ARDL bounds testing approach. Addicta: The Turkish Journal on Addictions, Online first publication.http://dx.doi.org/10.5152/addicta.2020.19045.