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THE EFFECT OF TOBACCO USE AND PASSIVE SMOKING ON EXERCISE TOLERANCE, COVİD-19 FEAR AND LEVEL OF PHYSICAL ACTIVITY LEVEL IN YOUNG ADULTS

Yıl 2024, Cilt: 11 Sayı: 2, 491 - 503, 02.08.2024

Öz

Objective: This study was designed to examine the effects of tobacco usage and secondhand smoke on exercise tolerance, fear of COVID-19 and physical activity level in young adults.
Materials and Methods: The 126 participants who met the inclusion criteria were divided into 3 groups according to their smoking status as never exposed (n=28), passive smokers (n=69) and active smokers (n=29). Participants' functional capacity was assessed with the 6-minute walk test, COVID-19 fear levels with the Fear of COVID-19 Scale, and physical activity levels with the International Physical Activity Questionnaire.
Results: The 6-minute walk test distances of the groups were similar (p=0.978). The groups were statistically different in terms of Fear of COVID-19 Scale scores (p=0.004), and post-hoc analysis revealed that this difference was due to the difference between passive smokers and active smokers (p=0.004). As a result of the International Physical Activity Questionnaire analysis, it was determined that there was a statistically significant difference between the groups in terms of moderate-intensity activity, walking, total score and sitting time (p<0.05).
Conclusion: It was determined that passive smokers were more affected by tobacco exposure status in terms of the fear of COVID-19 and physical activity level in young adult university students. These results revealed the negative effects of tobacco even in young university students with very low tobacco exposure. We thought that developing and maintaining smoking cessation politics and clean air space practices will be effective in preventing social health problems.

Etik Beyan

Bu çalışma Tübitak 2209-A kapsamında gerçekleştirilmiştir.

Destekleyen Kurum

Tübitak

Proje Numarası

1919B012108254

Teşekkür

Bu çalışma TÜBİTAK 2209-A kapsamında finansal olarak desteklenmiştir.

Kaynakça

  • ABo, S. (2012). Australian health survey: first results, 2011-12. Canberra: Australian Bureau of Statistics.
  • Adatia, A., Wahab, M., Shahid, I., Moinuddin, A., Killian, K. J., & Satia, I. (2021). Effects of cigarette smoke exposure on pulmonary physiology, muscle strength and exercise capacity in a retrospective cohort with 30,000 subjects. PLoS One, 16(6), e0250957.
  • Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2020). The fear of COVID-19 scale: development and initial validation. International Journal of Mental Health and Addiction, 1-9.
  • Akbaba, Y., & Zirek E. (2019). Comparison of health-related components in active and passive smokers. Indian Journal of Applied Research, 9(2):40-2.
  • American Thorax Society Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. (2002). ATS statement: guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine, 166, 111-117.
  • An, H. Y., Chen, W., Wang, C. W., Yang, H. F., Huang, W. T., & Fan, S. Y. (2020). The relationships between physical activity and life satisfaction and happiness among young, middle-aged, and older adults. International Journal of Environmental Research and Public Health, 17(13), 4817.
  • Argüder, E., Karalezli, A., Hezer, H., Kılıç, H., Er, M., Hasanoğlu, H. C., & Demir, P. (2013). Sigara bırakma başarısını etkileyen faktörler. Türk Toraks Dergisi, 14(3), 81-87.
  • Bakioğlu, F., Korkmaz, O., & Ercan, H. (2021). Fear of COVID-19 and positivity: Mediating role of intolerance of uncertainty, depression, anxiety, and stress. International Journal of Mental Health and Addiction, 19, 2369-2382.
  • Berlin, I., Thomas, D., Le Faou, A. L., & Cornuz, J. (2020). COVID-19 and smoking. Nicotine and Tobacco Research, 22(9), 1650-1652.
  • Cardoso, J. P. P., Afonso, M. V. R., Mendes, B. F., Vieira, E. R., Pereira, W. D. F., Dias-Peixoto, M. F., ... & Andrade, E. F. (2023). Fear of COVID-19 influences physical activity practice: a study in a Brazilian sample. Psychology, Health & Medicine, 28(1), 232-240.
  • Çelik, O. (2021). Fiziksel aktivite düzeyi ile covid-19 korkusu arasındaki ilişkinin incelenmesi. Kafkas Üniversitesi Spor Bilimleri Dergisi, 1(1), 17-25.
  • Conway, T. L., & Cronan, T. A. (1992). Smoking, exercise, and physical fitness. Preventive Medicine, 21(6), 723-734.
  • de Borba, A. T., Jost, R. T., Gass, R., Nedel, F. B., Cardoso, D. M., Pohl, H. H., ... & Paiva, D. N. (2014). The influence of active and passive smoking on the cardiorespiratory fitness of adults. Multidisciplinary Respiratory Medicine, 9(1), 1-8.
  • Durutürk, N., & Acar, M. (2016). Üniversite öğrencilerinde sigara tüketiminin egzersiz kapasitesi ve sağlıkla ilgili fiziksel uygunluk düzeyi üzerine etkisi. Başkent Üniversitesi Sağlık Bilimleri Fakültesi Dergisi-BÜSBİD, 1(2).
  • Gallo, L. A., Gallo, T. F., Young, S. L., Moritz, K. M., & Akison, L. K. (2020). The impact of isolation measures due to COVID-19 on energy intake and physical activity levels in Australian university students. Nutrients, 12(6), 1865.
  • Gold, A. K., Hoyt, D. L., Milligan, M., Hiserodt, M. L., Samora, J., Leyro, T. M., ... & Otto, M. W. (2021). The role of fear of COVID-19 in motivation to quit smoking and reductions in cigarette smoking: a preliminary investigation of at-risk cigarette smokers. Cognitive Behaviour Therapy, 50(4), 295-304.
  • Gordon, D. J., Leon, A. S., EKELUND, L. G., Sopko, G., Probstfield, J. L., Rubenstein, C., & Sheffield, L. T. (1987). Smoking, physical activity, and other predictors of endurance and heart rate response to exercise in asymptomatic hypercholesterolemiec men: The lipid research clinics coronary primary prevention trial. American Journal of Epidemiology, 125(4), 587-600.
  • Gupta, A. K., Nethan, S. T., & Mehrotra, R. (2021). Tobacco use as a well-recognized cause of severe COVID-19 manifestations. Respiratory Medicine, 176, 106233.
  • Haase, A., Steptoe, A., Sallis, J. F., & Wardle, J. (2004). Leisure-time physical activity in university students from 23 countries: associations with health beliefs, risk awareness, and national economic development. Preventive Medicine, 39(1), 182-190.
  • Haktanir, A., Seki, T., & Dilmaç, B. (2022). Adaptation and evaluation of Turkish version of the fear of COVID-19 scale. Death Studies, 46(3), 719-727.
  • Hayran, M., & Hayran, M. (2011). Sağlık Araştırmaları İçin Temel İstatistik (1. Basım). Omega Araştırma. Ankara. Institute for Health Metrics and Evaluation. (2018). Findings from the global burden of disease study 2017. https://www.healthdata.org/sites/default/files/files/policy_report/2019/GBD_2017_Booklet.pdf
  • Leung, J. M., Yang, C. X., Tam, A., Shaipanich, T., Hackett, T. L., Singhera, G. K., ... & Sin, D. D. (2020). ACE-2 expression in the small airway epithelia of smokers and COPD patients: implications for COVID-19. European Respiratory Journal, 55(5).
  • Lum, L. H. W., & Tambyah, P. A. (2020). Outbreak of COVID-19–an urgent need for good science to silence our fears?. Singapore Medical Journal, 61(2), 55.
  • Luo, F., Ghanei Gheshlagh, R., Dalvand, S., Saedmoucheshi, S., & Li, Q. (2021). Systematic review and meta-analysis of fear of COVID-19. Frontiers in Psychology, 12, 661078.
  • Mustafaoglu, R., Dilektaslı, A. G., Demir, R., Zirek, E., Birinci, T., Mutlu, E. K., ... & Ozdincler, A. R. (2022). Exercise capacity, lung and respiratory muscle function in substance use disorders. Pulmonology.
  • Plotnikoff, R. C., Costigan, S. A., Williams, R. L., Hutchesson, M. J., Kennedy, S. G., Robards, S. L., ... & Germov, J. (2015). Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 12(1), 1-10.
  • Reznik, A., Gritsenko, V., Konstantinov, V., Khamenka, N., & Isralowitz, R. (2021). COVID-19 fear in Eastern Europe: validation of the fear of COVID-19 scale. International Journal of Mental Health and Addiction, 19, 1903-1908.
  • Saad, H. B., Babba, M., Boukamcha, R., Ghannouchi, I., Latiri, I., Mezghenni, S., ... & Rouatbi, S. (2014). Investigation of exclusive narghile smokers: deficiency and incapacity measured by spirometry and 6-minute walk test. Respiratory Care, 59(11), 1696-1709.
  • Saglam, M., Arikan, H., Savci, S., Inal-Ince, D., Bosnak-Guclu, M., Karabulut, E., & Tokgozoglu, L. (2010). International physical activity questionnaire: reliability and validity of the Turkish version. Perceptual and Motor Skills, 111(1), 278-284.
  • Savcı, F. D. S., Öztürk, U. F. M., & Arıkan, F. D. H. (2006). Üniversite öğrencilerinin fiziksel aktivite düzeyleri. Türk Kardiyoloji Derneği Arşivi, 34(3), 166-172.
  • Silva, R. R., Santos, D. A. T., Costa, B. A., Júnior, N. C. F., Braz, A. G., Costa, G. D. C. T., ... & de Lira, C. A. B. (2023). Prevalence of fear of COVID-19, depression, and anxiety among undergraduate students during remote classes. Acta Neuropsychiatrica, 1-11.
  • Sözeri, B., Altun, Ö., Tüzün, M., Korkusuz, F., & Atımtay, A. (2008). 18-25 yaş grubundaki sağlıklı erkek bireylerde aktif ve pasif sigara içiminin kısa vadede fiziksel etkilerinin incelenmesi. Gazi Beden Eğitimi ve Spor Bilimleri Dergisi, 13(2):3-12.
  • Tello, A., Marı́n, F., Roldán, V., Lorenzo, S., Moltó, J. M., & Sogorb, F. (2005). Influence of smoking habit on cardiac functional capacity and diastolic function in healthy people. International Journal of Cardiology, 98(3), 517-518.
  • US Department of Health and Human Services. (2014). The health consequences of smoking—50 years of progress: a report of the Surgeon General.
  • Vardavas, C. I., & Nikitara, K. (2020). COVID-19 and smoking: A systematic review of the evidence. Tobacco Induced Diseases, 18.
  • Wakashima, K., Asai, K., Kobayashi, D., Koiwa, K., Kamoshida, S., & Sakuraba, M. (2020). The Japanese version of the Fear of COVID-19 scale: Reliability, validity, and relation to coping behavior. PloS One, 15(11), e0241958.
  • World Health Organization (2018). WHO global report on trends in prevalence of tobacco smoking 2000-2025. https://iris.who.int/bitstream/handle/10665/330221/9789240000032-eng.pdf?sequence=1
  • Wright, L. J., Williams, S. E., & Veldhuijzen van Zanten, J. J. (2021). Physical activity protects against the negative impact of coronavirus fear on adolescent mental health and well-being during the COVID-19 pandemic. Frontiers in Psychology, 12, 580511.

Genç Erişkin Bireylerde Tütün Kullanımı ve Pasif Maruziyetin Egzersiz Toleransı, Covid-19 Korkusu ve Fiziksel Aktivite Düzeyi Üzerine Etkisi

Yıl 2024, Cilt: 11 Sayı: 2, 491 - 503, 02.08.2024

Öz

Amaç: Bu çalışma genç erişkin bireylerde tütün kullanımı ve pasif içiciliğin egzersiz toleransı, COVİD-19 korkusu ve fiziksel aktivite düzeyi üzerine etkisini incelemek üzere planlanmıştır.
Gereç ve Yöntem: Dahil edilme kriterlerini karşılayan 126 katılımcı sigara kullanım durumlarına göre hiç maruziyeti olmayan (n=28), pasif içici (n=69) ve aktif içici (n=29) olarak 3 gruba ayrılmıştır. Katılımcıların fonksiyonel kapasiteleri 6 dakika yürüme testi, COVİD-19 korku düzeyleri Koronavirüs Korku Ölçeği ve fiziksel aktivite düzeyleri Uluslararası Fiziksel Aktivite Anketi ile değerlendirildi.
Bulgular: Grupların 6 dakika yürüme testi mesafeleri benzerdir (p=0,978). Grupların KKÖ skorları açısından istatistiksel olarak farklı olduğu (p=0,004), post-hoc analizde bu farkın pasif içiciler ile aktif sigara kullananlar arasındaki farktan kaynaklandığı belirlendi (p=0,004). Uluslararası Fiziksel Aktivite Anketi analizi sonucunda ise grupların orta şiddetli egzersiz, yürüme, toplam skor ve oturma süreleri arasında istatistiksel olarak anlamlı fark olduğu belirlendi (p<0,05).
Sonuç: Tütün maruziyet durumunun genç erişkin üniversite öğrencilerinin COVİD-19 korkusu ve fiziksel aktivite düzeyi bakımından pasif içicilerin daha çok etkilendiği belirlenmiştir. Bu sonuçlar, tütün maruziyet miktarı oldukça düşük olan genç üniversite öğrencilerinde dahi, tütünün olumsuz etkilerini göstermektedir. Sigara bırakma politikalarının ve temiz hava sahası uygulamalarının geliştirilerek sürdürülmesi, toplumsal sağlık sorunlarının önlenmesinde etkili olacağını düşünmekteyiz.

Proje Numarası

1919B012108254

Kaynakça

  • ABo, S. (2012). Australian health survey: first results, 2011-12. Canberra: Australian Bureau of Statistics.
  • Adatia, A., Wahab, M., Shahid, I., Moinuddin, A., Killian, K. J., & Satia, I. (2021). Effects of cigarette smoke exposure on pulmonary physiology, muscle strength and exercise capacity in a retrospective cohort with 30,000 subjects. PLoS One, 16(6), e0250957.
  • Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2020). The fear of COVID-19 scale: development and initial validation. International Journal of Mental Health and Addiction, 1-9.
  • Akbaba, Y., & Zirek E. (2019). Comparison of health-related components in active and passive smokers. Indian Journal of Applied Research, 9(2):40-2.
  • American Thorax Society Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. (2002). ATS statement: guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine, 166, 111-117.
  • An, H. Y., Chen, W., Wang, C. W., Yang, H. F., Huang, W. T., & Fan, S. Y. (2020). The relationships between physical activity and life satisfaction and happiness among young, middle-aged, and older adults. International Journal of Environmental Research and Public Health, 17(13), 4817.
  • Argüder, E., Karalezli, A., Hezer, H., Kılıç, H., Er, M., Hasanoğlu, H. C., & Demir, P. (2013). Sigara bırakma başarısını etkileyen faktörler. Türk Toraks Dergisi, 14(3), 81-87.
  • Bakioğlu, F., Korkmaz, O., & Ercan, H. (2021). Fear of COVID-19 and positivity: Mediating role of intolerance of uncertainty, depression, anxiety, and stress. International Journal of Mental Health and Addiction, 19, 2369-2382.
  • Berlin, I., Thomas, D., Le Faou, A. L., & Cornuz, J. (2020). COVID-19 and smoking. Nicotine and Tobacco Research, 22(9), 1650-1652.
  • Cardoso, J. P. P., Afonso, M. V. R., Mendes, B. F., Vieira, E. R., Pereira, W. D. F., Dias-Peixoto, M. F., ... & Andrade, E. F. (2023). Fear of COVID-19 influences physical activity practice: a study in a Brazilian sample. Psychology, Health & Medicine, 28(1), 232-240.
  • Çelik, O. (2021). Fiziksel aktivite düzeyi ile covid-19 korkusu arasındaki ilişkinin incelenmesi. Kafkas Üniversitesi Spor Bilimleri Dergisi, 1(1), 17-25.
  • Conway, T. L., & Cronan, T. A. (1992). Smoking, exercise, and physical fitness. Preventive Medicine, 21(6), 723-734.
  • de Borba, A. T., Jost, R. T., Gass, R., Nedel, F. B., Cardoso, D. M., Pohl, H. H., ... & Paiva, D. N. (2014). The influence of active and passive smoking on the cardiorespiratory fitness of adults. Multidisciplinary Respiratory Medicine, 9(1), 1-8.
  • Durutürk, N., & Acar, M. (2016). Üniversite öğrencilerinde sigara tüketiminin egzersiz kapasitesi ve sağlıkla ilgili fiziksel uygunluk düzeyi üzerine etkisi. Başkent Üniversitesi Sağlık Bilimleri Fakültesi Dergisi-BÜSBİD, 1(2).
  • Gallo, L. A., Gallo, T. F., Young, S. L., Moritz, K. M., & Akison, L. K. (2020). The impact of isolation measures due to COVID-19 on energy intake and physical activity levels in Australian university students. Nutrients, 12(6), 1865.
  • Gold, A. K., Hoyt, D. L., Milligan, M., Hiserodt, M. L., Samora, J., Leyro, T. M., ... & Otto, M. W. (2021). The role of fear of COVID-19 in motivation to quit smoking and reductions in cigarette smoking: a preliminary investigation of at-risk cigarette smokers. Cognitive Behaviour Therapy, 50(4), 295-304.
  • Gordon, D. J., Leon, A. S., EKELUND, L. G., Sopko, G., Probstfield, J. L., Rubenstein, C., & Sheffield, L. T. (1987). Smoking, physical activity, and other predictors of endurance and heart rate response to exercise in asymptomatic hypercholesterolemiec men: The lipid research clinics coronary primary prevention trial. American Journal of Epidemiology, 125(4), 587-600.
  • Gupta, A. K., Nethan, S. T., & Mehrotra, R. (2021). Tobacco use as a well-recognized cause of severe COVID-19 manifestations. Respiratory Medicine, 176, 106233.
  • Haase, A., Steptoe, A., Sallis, J. F., & Wardle, J. (2004). Leisure-time physical activity in university students from 23 countries: associations with health beliefs, risk awareness, and national economic development. Preventive Medicine, 39(1), 182-190.
  • Haktanir, A., Seki, T., & Dilmaç, B. (2022). Adaptation and evaluation of Turkish version of the fear of COVID-19 scale. Death Studies, 46(3), 719-727.
  • Hayran, M., & Hayran, M. (2011). Sağlık Araştırmaları İçin Temel İstatistik (1. Basım). Omega Araştırma. Ankara. Institute for Health Metrics and Evaluation. (2018). Findings from the global burden of disease study 2017. https://www.healthdata.org/sites/default/files/files/policy_report/2019/GBD_2017_Booklet.pdf
  • Leung, J. M., Yang, C. X., Tam, A., Shaipanich, T., Hackett, T. L., Singhera, G. K., ... & Sin, D. D. (2020). ACE-2 expression in the small airway epithelia of smokers and COPD patients: implications for COVID-19. European Respiratory Journal, 55(5).
  • Lum, L. H. W., & Tambyah, P. A. (2020). Outbreak of COVID-19–an urgent need for good science to silence our fears?. Singapore Medical Journal, 61(2), 55.
  • Luo, F., Ghanei Gheshlagh, R., Dalvand, S., Saedmoucheshi, S., & Li, Q. (2021). Systematic review and meta-analysis of fear of COVID-19. Frontiers in Psychology, 12, 661078.
  • Mustafaoglu, R., Dilektaslı, A. G., Demir, R., Zirek, E., Birinci, T., Mutlu, E. K., ... & Ozdincler, A. R. (2022). Exercise capacity, lung and respiratory muscle function in substance use disorders. Pulmonology.
  • Plotnikoff, R. C., Costigan, S. A., Williams, R. L., Hutchesson, M. J., Kennedy, S. G., Robards, S. L., ... & Germov, J. (2015). Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 12(1), 1-10.
  • Reznik, A., Gritsenko, V., Konstantinov, V., Khamenka, N., & Isralowitz, R. (2021). COVID-19 fear in Eastern Europe: validation of the fear of COVID-19 scale. International Journal of Mental Health and Addiction, 19, 1903-1908.
  • Saad, H. B., Babba, M., Boukamcha, R., Ghannouchi, I., Latiri, I., Mezghenni, S., ... & Rouatbi, S. (2014). Investigation of exclusive narghile smokers: deficiency and incapacity measured by spirometry and 6-minute walk test. Respiratory Care, 59(11), 1696-1709.
  • Saglam, M., Arikan, H., Savci, S., Inal-Ince, D., Bosnak-Guclu, M., Karabulut, E., & Tokgozoglu, L. (2010). International physical activity questionnaire: reliability and validity of the Turkish version. Perceptual and Motor Skills, 111(1), 278-284.
  • Savcı, F. D. S., Öztürk, U. F. M., & Arıkan, F. D. H. (2006). Üniversite öğrencilerinin fiziksel aktivite düzeyleri. Türk Kardiyoloji Derneği Arşivi, 34(3), 166-172.
  • Silva, R. R., Santos, D. A. T., Costa, B. A., Júnior, N. C. F., Braz, A. G., Costa, G. D. C. T., ... & de Lira, C. A. B. (2023). Prevalence of fear of COVID-19, depression, and anxiety among undergraduate students during remote classes. Acta Neuropsychiatrica, 1-11.
  • Sözeri, B., Altun, Ö., Tüzün, M., Korkusuz, F., & Atımtay, A. (2008). 18-25 yaş grubundaki sağlıklı erkek bireylerde aktif ve pasif sigara içiminin kısa vadede fiziksel etkilerinin incelenmesi. Gazi Beden Eğitimi ve Spor Bilimleri Dergisi, 13(2):3-12.
  • Tello, A., Marı́n, F., Roldán, V., Lorenzo, S., Moltó, J. M., & Sogorb, F. (2005). Influence of smoking habit on cardiac functional capacity and diastolic function in healthy people. International Journal of Cardiology, 98(3), 517-518.
  • US Department of Health and Human Services. (2014). The health consequences of smoking—50 years of progress: a report of the Surgeon General.
  • Vardavas, C. I., & Nikitara, K. (2020). COVID-19 and smoking: A systematic review of the evidence. Tobacco Induced Diseases, 18.
  • Wakashima, K., Asai, K., Kobayashi, D., Koiwa, K., Kamoshida, S., & Sakuraba, M. (2020). The Japanese version of the Fear of COVID-19 scale: Reliability, validity, and relation to coping behavior. PloS One, 15(11), e0241958.
  • World Health Organization (2018). WHO global report on trends in prevalence of tobacco smoking 2000-2025. https://iris.who.int/bitstream/handle/10665/330221/9789240000032-eng.pdf?sequence=1
  • Wright, L. J., Williams, S. E., & Veldhuijzen van Zanten, J. J. (2021). Physical activity protects against the negative impact of coronavirus fear on adolescent mental health and well-being during the COVID-19 pandemic. Frontiers in Psychology, 12, 580511.
Toplam 38 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Fizyoterapi
Bölüm Makaleler
Yazarlar

Soner Akgül 0009-0004-8032-8213

Elif Yılmaz 0009-0007-4101-5267

Hümeyra Yetişen 0009-0009-6192-899X

Fatıma Nur Bozkurt 0009-0000-1536-6919

İsmail Okur 0000-0002-5019-7185

Proje Numarası 1919B012108254
Erken Görünüm Tarihi 24 Temmuz 2024
Yayımlanma Tarihi 2 Ağustos 2024
Gönderilme Tarihi 10 Kasım 2023
Kabul Tarihi 20 Şubat 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 11 Sayı: 2

Kaynak Göster

APA Akgül, S., Yılmaz, E., Yetişen, H., Bozkurt, F. N., vd. (2024). Genç Erişkin Bireylerde Tütün Kullanımı ve Pasif Maruziyetin Egzersiz Toleransı, Covid-19 Korkusu ve Fiziksel Aktivite Düzeyi Üzerine Etkisi. Hacettepe University Faculty of Health Sciences Journal, 11(2), 491-503. https://doi.org/10.21020/husbfd.1388998