Factors that Influence Support towards Secondhand Tobacco Smoke legisla:on in Turkey Angela Aherrera1, Jolie Susan1,2, Asli Çarkoğlu3, Gül Ergör4, Mutlu Hayran5, Toker Egrüder6, Bekir Kaplan7, Joanna Cohen2,8, Ana Navas-­‐Acien1,2,9 1Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Bal:more MD, USA, 2Ins:tute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Bal:more MD, USA, 3Department of Psychology, Kadir Has University, Istanbul, Turkey, 4Izmir Dokuz Eylül School of Medicine, Izmir, Turkey 5Hace[epe University Cancer Ins:tute, Ankara, Turkey, 6World Health Organiza:on Country Office, Çankaya, Ankara, Turkey, 7Ministry of Health, General Directorate of Health Research, Ankara, Turkey, 8Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Bal:more, Maryland, USA, 9Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Bal:more MD, USA RATIONALE INTRODUCTION Turkey enacted smoke-­‐free legisla:on in 2008 that was extended to hospitality venues in 2009. Current law prohibits indoor smoking in all workplaces, including bars, restaurants, and nightclubs. Assessing the level of compliance with the smoke-­‐free legisla:on is key to reduce secondhand smoke (SHS) exposure. OBJECTIVE To iden:fy sociodemographic and other factors that influence support and enforcement of the smoke-­‐free legisla:on, including smoking status and quinng behavior METHODS STUDY POPULATION •  Secondhand Smoke Evalua:on of Legisla:on in Turkey (SHELT) study, Phase 2 was carried out between May and September 2014 •  430 par:cipants: 300 venue employees, 100 venue owners, 30 school directors •  Interviews were conducted across 7 ci:es: Adana, Ankara, Gaziantep, Istanbul, Izmir, Trabzon, Van DATA COLLECTION AND ANALYSIS Sociodemographic informa:on; smoking behavior; knowledge of health effects of smoking; knowledge and opinions about the smoke-­‐free legisla:on in Turkey; enforcement behavior Descrip(ve analysis •  Demographic variables stra:fied by smoking status •  Par:cipant’s knowledge, support, enforcement of the ban stra:fied by smoking status Logis(c Regression Models •  Odds ra:o of support and enforcement of the ban by sociodemographic characteris:cs, knowledge of health effects of smoking, smoking behavior RESULTS
ParEcipant characterisEcs straEfied by smoking category Table 1: Current smokers were more likely to be male than never smokers. Never smokers had the highest percentage of educa:onal a[ainment compared to former and current smokers. Characteristics*
Category*
N**
Age!
Mean!(SD)!
Male!
Female!!
Primary!School!or!
less!
Secondary!School!!
High!School!!
University!!
Gender!
Education!Level!
Occupation!
Cigarettes!Smoked!
daily!
428!
387!
42!
98!
Total*
(N=430)*
31.8!(11.5)!
90.2!
9.8!
22.9!
Never*
(N=105)*
32.1!(12.3)!
81.9!
18.1!
16.4!
Former*
(N=44)*
36.9!(12.4)!
90.9!
9.1!
29.5!
Current*
(N=*281)*
30.8!(10.9)!
93.2!
6.8!
24.2!
73!
162!
95!
17.0!
37.8!
22.1!
15.4!
35.6!
31.7!
9.1!
34.1!
27.3!
18.9!
39.1!
17.8!
Venue!Employee!!
300!
68.8!
66.7!
52.3!
73.7!
Venue!Owners!!
100!
23.2!
20.0!
29.5!
23.5!
School!Directors!
30!
7.0!
13.3!
18.2!
2.8!
Mean!(SD)!!
277!
Q!
Q!
19.3!(11)!
!
Enforcement of the smoking legislaEon Table 3: 94 par:cipants (22%) reported that they enforce the legisla:on. Compared to never smokers, former smokers were more likely to enforce the ban (odds ra:o 2.34, 95%CI 1.05, 5.20). Compared to venue employees, school directors were more likely to enforce the ban before and aoer similar adjustment (both odds ra:os above 2.7). University-­‐educated par:cipants were more likely to enforce the ban !
Knowledge of the legislaEon and health effects of smoking and 100% of school directors have an •  99% of hospitality owners and employees excellent knowledge on the extent of the Turkish smoke-­‐free legisla:on •  Nearly all indicated that smoking is dangerous to non-­‐smokers’ health (97.3%) •  Fewer par:cipants indicated smoking causes cancer in non-­‐smokers (77.2%) with current smokers indica:ng the lowest (73.3%) Support for the smoking legislaEon than 50% but varied by smoking status with Table 2: Support for the legisla:on was more current smokers suppor:ng the lowest (62.9%). Compared to venue employees, school directors were more likely to support the ban aoer adjustment. Current smokers: Smoking Behavior •  Those who smoke less since the implementa:on of the ban were more likely to support and enforce the ban before and aoer adjustment •  Those who also smoke rela:vely fewer cigare[es per day were also more likely to support the ban before and aoer adjustment (both odds ra:os below 0.96). Table 4a: Smoking behavior by support for the legisla:on Table 4b: Smoking behavior by enforcement of the legisla:on CONCLUSIONS •  While overall support towards the ban is high, addiEonal efforts are needed to increase knowledge and support among subpopulaEons Ø  SubpopulaEons: older aged individuals, women, individuals working in hospitality venues, and current smokers •  Enforcement of the law is carried out more oMen by higher educated individuals and former smokers •  EducaEonal intervenEons are needed to improve the implementaEon of the smoke-­‐free law and reduce unwanted secondhand smoke exposure All authors of this poster have read the definition of Financial Conflict of Interest, and certify that there are no financial conflicts of interests to declare