Smoking among Nurses in Turkey: Comparison with Other Countries

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INTRODUCTION

The prevalence of smoking among nurses in Turkey is substantially higher than that among adult female population (1-6). Similar results were reported from Spain (7), Italy (8), and Japan (9) during the last two decades. Comparable results were also reported in the USA (10) and in the UK (11,12) during the 1970s. The last two decades have witnessed a downward trend in the prevalence of smoking among nurses in many industrialized countries. Consequently, the reported rates of prevalence among nurses from these countries now remain at or below the prevalence of smoking among the adult female population (13,14). The currently-reported decline in the prevalence of smoking among nurses has failed to keep pace with physicians and dentists in those countries. Although the prevalence of smoking among physicians in the USA, the UK, Australia, and Canada is [less than or equal to]4% (14), the prevalence of smoking among nurses in these countries is 13-26% (15-19).

Because of their higher rates of smoking, nurses--especially those in countries like Turkey--are exposed to a higher risk of tobacco use-related morbidity and mortality. It is intuitive that a nurse can effectively counsel patients on cessation of smoking during clinical interactions (20) and that being a smoker can prevent a nurse from being active in smoking-cessation activities (15,21). Therefore, we attempted to obtain baseline information on smoking, cessation of smoking, and related factors among nurses for the purpose of building a smoke-free nurses initiative. The period when nurses started to smoke was also focused on.

MATERIALS AND METHODS

We attempted to contact, in person, all 301 nurses working for the Cumhuriyet University Hospital in Sivas, Turkey, to complete an anonymous questionnaire. The questionnaire was previously validated on 15 hospital nurses and was modified to improve the comprehensibility of the text. Confidentiality was assured through person-to-person communication. Each unit of the hospital was visited three times in the first three months of 2002, and 239 nurses (79%) were reached who all completed the questionnaire. The remaining 62 (21%) nurses were followed up by telephone and were asked two simple questions on the classification of their smoking status. These were the questions originally used in the National Health Interview Surveys of the US (23), and they were also included in our questionnaire survey. The questions were as follows: (a) Have you ever smoked 100 cigarettes in your entire life? and (b) Do you smoke cigarettes now?

The subjects responding 'no' to the first question were classified as non-smokers, while those answering 'yes' to the first question and 'no' to the second question were classified as former smokers. Those who responded 'yes' to both the questions were classified as current smokers. Ever-smokers included both former smokers and current smokers. Participants who responded--"yes, I smoke every day"--to the second question were defined as daily current smokers, while those who responded--"I don't smoke every day, but I smoke on some days"--to the second question were defined as some-day current smokers. To identify when they smoked most of their first 100 cigarettes, participants were asked two questions. In the questionnaire, age, marital status, type of nursing school, and presence of any other smokers in the household were the variables for which an association with smoking and/or quitting was sought. To describe the smoking situation in the hospital, nurses were asked how often they saw doctors smoking in some places (e.g. rooms for nurses, rooms for doctors in inpatient services) of the hospital.

Data were collected in 2002, and SPSS for Windows was used for obtaining results and for conducting statistical analysis. The chi-square test, the Cochrane test (24), one-way analysis of variance, and the Bonferroni test (for post-hoc comparisons) were conducted to determine statistical significance. …