The Society for Health Promotion and Tobacco Control
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Effects of smoking on atherogenic plasma index, lipid profile, and systemic immune-inflammation index in individuals with chronic diseases
Background: This study aimed to investigate the effects of daily smoking on lipid profile, atherogenic plasma index (API), and systemic immune-inflammation index (SII) in individuals with chronic diseases such as diabetes, hypertension, hyperlipidemia, and hypothyroidism. Methods: This descriptive study included 49 participants from a total of 150 individuals who applied to the Kayseri Melikgazi Healthy Life Center Nutrition and Diet Clinic between September 2024 and September 2025. Participants had at least one chronic disease (diabetes, hypertension, hyperlipidemia, hypothyroidism), complete biochemical data, and provided written informed consent. Occasional smokers, former smokers, individuals with chronic obstructive pulmonary disease (COPD), asthma, malignancy, or those using immunosuppressive drugs were excluded. Participants were divided into two groups: daily smokers (n = 34) and non-smokers (n = 15). Fasting lipid profile and complete blood count were measured, and API and SII values were calculated. Between-group comparisons were performed using the t-test or Mann–Whitney U test. Results: In the smoking group (n=34; 23 males, mean age 56.9 ± 11.3 years; 11 females, mean age 51.2 ± 10.5 years), compared with the non-smoking group (n=15; 6 males, mean age 57.0 ± 11.2 years; 9 females, mean age 49.8 ± 10.1 years), HDL-cholesterol was significantly lower (41.9 ± 12.0 mg/dL vs. 52.9 ± 14.1 mg/dL; p = 0.013) and SII was significantly higher (644 ± 383 vs. 422 ± 181; p = 0.028). In participants with diabetes mellitus (n = 32), SII was significantly higher in smokers compared with non-smokers (725.9 ± 472.4 vs. 419.8 ± 187.5; p = 0.035). Additionally, API values were higher in smokers than non-smokers and across all chronic disease subgroups, although the differences were not statistically significant. Conclusion: In individuals with chronic diseases, daily smoking is associated with lower HDL-cholesterol levels and higher SII values. The findings highlight the impact of smoking on systemic inflammation and underscore the importance of evaluating smoking status in the management of chronic diseases. In addition, incorporating composite indices such as SII and API into clinical practice may allow for a more sensitive assessment of cardiometabolic risk.
Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
E-cigarettes and the myth of harm reduction: A critical evidence review
This review aims to examine the tobacco and nicotine industry’s “harm reduction” narrative through historical, toxicological, behavioral, and environmental dimensions, and to critically evaluate whether electronic cigarettes can genuinely be considered a harm-reduction tool within tobacco control. This review was designed as a critical narrative and analytical synthesis. A structured literature search was conducted in the PubMed, Scopus, and Web of Science databases to identify English-language studies published between 2010 and 2025. The search strategy included the terms “electronic cigarettes,” “vaping,” “electronic nicotine delivery systems (ENDS),” “heated tobacco products,” “nicotine pouches,” “harm reduction,” “dual use,” “youth initiation,” and “tobacco industry.” To capture respiratory health outcomes, additional keywords such as “lung,” “pulmonary,” “airway,” “respiratory,” “EVALI,” and “vaping-associated lung injury” were incorporated. Studies reporting findings in favor of harm reduction, particularly those funded by or affiliated with the tobacco or nicotine industry, were critically appraised and systematically contrasted with independent research to assess potential sources of bias and divergence in interpretation. Historically, tobacco has been legitimized through narratives suggesting it is a “less harmful” or even “protective” product—an approach that is currently replicated for e-cigarettes, heated tobacco products, snus, and nicotine pouches. Although some toxic chemicals in e-cigarette aerosol appear lower than those in combustible cigarettes, device and liquid heterogeneity, the high addiction potential of nicotine salts, and the biological effects of flavorings sustain significant uncertainty regarding their true toxicological profile. Cohort studies and meta-analyses indicate that e-cigarette use does not increase smoking cessation success; rather, it promotes dual use and prolonged nicotine dependence. Among youth, e-cigarette use increases the likelihood of subsequent cigarette smoking by approximately 3.5–4 times, and passive exposure—especially among children—poses measurable health risks. Additionally, disposable e-cigarettes, lithium batteries, and mixed material components contribute to a growing source of electronic waste and environmental toxicity. Current evidence does not support the widespread adoption of e-cigarettes as a reliable harm-reduction tool within tobacco control. Given the absence of product standardization, increased addiction risk, rising youth uptake, persistence of dual use, and mounting environmental burden, policy development should prioritize independent, methodologically robust evidence over industry-driven optimistic claims. Overall, the review highlights the need for precautionary regulatory approaches that prioritize youth protection, environmental safeguards, and independence from industry influence.
Evaluation of tobacco and tobacco product content in the top 100 most popular music videos on YouTube Turkey between february 3-9, 2025 and may 5-11, 2025
Introduction: Tobacco use is a major public health problem, and every factor influencing its use needs to be evaluated. Media exposure plays a critical role, particularly in the iniation and normalization of tobacco use among young people. Frequently used media platforms also play an important role in the visibility of tobacco products. The aim of this study was to examine the presence or use of tobacco and tobacco products in the top 100 most viewed music videos on YouTube Türkiye during the weeks of February 3–9 and May 5–11, 2025. Materials and Methods: In this descriptive study, official music videos of the top 100 songs on YouTube Music Türkiye were analyzed for the weeks of February 3–9 and May 5–11, 2025. The direct or indirect presence of tobacco products in the videos and song lyrics was evaluated using a systematic data collection form; the data obtained were analyzed using SPSS version 26.0. Results: Direct visual depictions of tobacco were found in 24.2% of the videos in the week of February 3–9, 2025, and in 13.0% of the videos in the week of May 5–11, 2025. Direct mentions of tobacco in the song lyrics were observed in 7.0% of the videos in both periods. Rap and pop songs were the genres with the highest concentration of tobacco representations. Tobacco users were mostly male artists. Expressions related to tobacco were more frequently observed in songs themed around sadness, love, and rebellion. Music videos with tobacco references in their lyrics also contained visual depictions (p<0.05). Conclusion: Tobacco representations are frequently encountered in the most popular music videos on YouTube Türkiye. This may constitute a risk factor that contributes to the normalization of tobacco use, increased intention to use tobacco, and earlier initiation among young people. . It is important to engage in advocacy for tobacco control and to strengthen educational measures on online platforms such as social media.
Investigation of Medical Students’ Awareness of Thirdhand Cigarette Smoke Medical Students’
Objective: Thirdhand smoke refers to the residual tobacco smoke that remains in the environment after tobacco use, which continues to persist and exert harmful effects by forming hazardous compounds through various reactions. This study aimed to evaluate the awareness of medical faculty students regarding thirdhand smoke. Methods: This descriptive cross-sectional study was conducted between January 23 and February 28, 2025. Necessary permissions and ethical committee approval were obtained prior to the study. The sample size was calculated as 278 students using the OpenEpi program, and the study was completed by administering a questionnaire under supervision to 280 students. The questionnaire included sociodemographic questions, smoking status, questions related to smoking and thirdhand smoke, as well as the Beliefs About Thirdhand Smoke Scale (BATHS). Data were analyzed using the IBM SPSS Statistics 22.0 software package. Accordingly, the Mann–Whitney U test and Kruskal–Wallis variance analysis were applied for statistical analyses. A p-value of < 0.05 was considered statistically significant in all evaluations. Results: Of the students, 55.0% were female and 23.2% were first-year students. In the study group, 19.4% reported smoking, and 82.5% stated that they had not heard the term “thirdhand smoke” before. A total of 58.6% of the students reported that smoking was not allowed in their living environment, while 71.8% stated that smoking was not permitted in the vehicles they used or traveled in. When asked about the diseases that THS could cause, 67.5% mentioned respiratory diseases, 56.4% reported an increased risk of cancer, and 55.0% indicated cardiovascular diseases. The median total score of the Beliefs About Thirdhand Smoke Scale (BATHS) among students was 37 (range: 9–45). There were no statistically significant differences in the median total and subscale BATHS scores according to gender, place of residence, year of study,economic status, smoking status, or whether smoking occurred in their living environment (p > 0.05). Conclusion: A significant proportion of the students stated that they had not heard the term THS before. Moreover, various sociodemographic variables and smoking status did not significantly influence their beliefs regarding thirdhand smoke.
A bibliometric analysis of graduate theses conducted in smoking cessation clinics in Türkiye
Background: Smoking cessation clinics play a key role in tobacco control efforts, and graduate theses conducted in these settings reflect academic priorities and research trends. This study aimed to examine the characteristics and trends of graduate theses conducted in smoking cessation clinics in Türkiye. Methods: A bibliometric analysis was conducted on graduate theses completed between 1999 and 2024. Data were obtained from the National Thesis Center (YÖKTEZ) database using a two-stage search strategy with the keywords “smoking” and “cessation” and “smoking” and “cessation intervention.” A total of 757 theses were identified and screened according to predefined inclusion and exclusion criteria. After excluding studies not conducted in smoking cessation outpatient clinics, removing duplicate records, and applying eligibility criteria, 145 theses were included in the final analysis. The study selection process was conducted systematically and presented using a flow diagram. Results: The majority of the theses were medical specialty dissertations (86.8%), predominantly conducted within the Department of Family Medicine (71.7%). The University of Health Sciences accounted for the largest proportion of theses (29%), and nearly half of the studies were published in the last five years. Most studies employed descriptive and cross-sectional designs, while experimental and qualitative approaches were relatively limited. The most frequently investigated topic was factors associated with smoking cessation success. Geographically, theses were concentrated in major metropolitan areas, with no recorded studies from 59 provinces. Conclusions: Although academic output related to smoking cessation clinics in Türkiye has increased in recent years, research remains limited in terms of methodological diversity and regional representation. Future research should prioritize experimental, qualitative, and multidisciplinary approaches to strengthen evidence-based contributions to tobacco control efforts.
Sigara paylaşımı (başkasına sigara ikramı) ve sigara bırakma ile ilişkisi
Ağır ruhsal hastalığı olanlar için sigara bırakma: Sistematik gözden geçirme ve meta-analiz
"Türkiye Geneli Kaçak Tütün Ürünleri Tüketimi Saha Araştırması Bulguları ve Vergi Politikası Zorlukları Çalıştayı" Açılış Konuşmaları
Digital tedavinin küresel düzeyde tütün kullanımını azaltmaya katkısı
Copyright © 2025 The Author(s) https://creativecommons.org/licenses/by/4.0
Medical students’ tobacco product and e-cigarette usage habits: An assessment of their relationship with types of addiction and depression
Background: Tobacco use remains one of the leading preventable causes of disease and death, while the rising use of e-cigarettes among young adults creates new public health challenges. Medical students, as future physicians, are a key group in which tobacco-related behaviors, addiction patterns, and psychological correlates should be examined. This study aimed to determine the prevalence of tobacco and e-cigarette use among medical students, assess associated sociodemographic and lifestyle factors, and evaluate addiction profiles and depression. Methods: A cross-sectional survey was conducted among 496 medical students at the Gülhane Faculty of Medicine in 2025. Data were collected through a structured questionnaire including sociodemographic characteristics, tobacco and e-cigarette use, self-reported addiction, and the Beck Depression Inventory. In the data analysis, Student’s t-test or Mann–Whitney U test was used for numerical variables, while Pearson’s chi-square, Yates’ corrected chi-square, and Fisher’s exact tests were used for categorical variables. A multivariable binary logistic regression analysis was conducted to determine independent predictors of tobacco use. p<0.05 accepted as statistically significant. Results: The mean age of participants was 22.6 years; 50% were male. Overall, 26% reported current tobacco use and 5.2% reported e-cigarette use. Cigarettes (98.4%) and e-cigarettes (20.2%) were the most common products. Tobacco use was significantly higher in males and those with higher BMI or family history of tobacco use. All tobacco users described themselves as addicted. The most frequent reasons for e-cigarette use were pleasant taste and the desire to quit smoking. Chronic disease prevalence was higher among e-cigarette users. Median depression scores indicated minimal symptoms, with no significant difference between users and non-users. Conclusions: Tobacco and e-cigarette use remain widespread among medical students and are strongly linked to sociodemographic and lifestyle factors. The very high rate of self-reported addiction may reflect the addictive nature of nicotine, even in a medically educated population. Misconceptions about e-cigarette safety underscore potential gaps in awareness for targeted prevention, effective university tobacco control policies, and integration of addiction awareness into medical education.
Changes in tobacco use and associated risk factors: An evaluation of findings from the Türkiye household health survey on noncommunicable disease risk factor prevalence 2017-2023 (WHO steps)
Background: Tobacco and other addictive substances are among the leading preventable causes of mortality worldwide. In Turkey, the Household Health Survey on Noncommunicable Disease Risk Factor Prevalence (The WHO STEPwise approach to NCD risk factor surveillance, STEPS) was first conducted in 2017, providing standardized monitoring of risk factors associated with noncommunicable diseases (NCDs). The repetition of the survey in 2023 offered an opportunity to assess temporal changes in tobacco, alcohol, and illicit drug use, as well as passive exposure and public attitudes toward tobacco control legislation. Methods: This study compared the 2017 and 2023 STEPS data for Turkey, supported by Turkish Statistical Institute (TurkStat) datasets. Descriptive statistical analyses were performed, and Microsoft Excel and OpenEpi were used, with the significance level set at p<0.05. Findings were analyzed by sex and age groups under the headings of tobacco use, alcohol use, illicit drug use, passive exposure at home and in the workplace, and attitudes toward tobacco control legislation. Results: Tobacco use increased from 31.5% in 2017 to 34.8% in 2023. The increase was 15.1% in men and 30.3% in women, with a significant sex difference (p<0.001). Alcohol consumption rose from 8.0% to 10.2%, with the highest increase observed among women aged 30–44 years (112.2%). The prevalence of not using illicit drugs increased from 97.0% to 97.4%, with a greater rise among men. Passive exposure to tobacco smoke at home rose from 27.5% to 37.8%, and workplace exposure increased from 21.9% to 29.1%, with higher exposure particularly among younger age groups. Support for tobacco control legislation remained high (88.1% in 2017 and 88.5% in 2023) but was relatively lower among younger groups. Conclusions: This study revealed increasing trends in tobacco and alcohol use, widespread passive exposure to tobacco smoke, and consistently high support for tobacco control legislation in Turkey, while highlighting vulnerabilities particularly among women and younger populations. The findings underscore the need to revisit existing tobacco and alcohol control policies, develop gender-sensitive strategies, and strengthen protective measures for younger groups.
Online smoking cessation outpatient clinic: A case study from Şişli Hamidiye Etfal Training and Research Hospital Family Medicine Clinic
Bibliometric analysis of studies on the concept of third-hand smoke
Aim: Studies on thirdhand smoke (THS) have been steadily increasing in the literature. This study aimed to examine the scientific development of the THS concept, as well as the prominent authors, journals, and research trends. Methods: This bibliometric study was conducted using the Web of Science Core Collection database. The search strategy included the combinations: “third hand smoking,” “thirdhand smoking,” “third-hand smoking,” “thirdhand smoke,” “third-hand smoke,” and “third hand smoke.” Only articles and review articles written in English were included. A total of 316 publications on THS, authored by 251 researchers from 43 countries, were identified between 2009 and 2025. Data were analyzed and visualized using VOSviewer. Results: The concept first appeared in 2009. The highest number of publications was in 2021 (n = 41), while the lowest was in 2009 (n = 2). These publications received 6888 citations in total, excluding 4529 self-citations. The average number of citations per publication was 21,8, with an H-index of 41. Nicotine & Tobacco Research published the most THS-related articles (n = 19), whereas Tobacco Control was the most cited journal (n = 105; TLS = 4343). The United States, China, and Türkiye were the leading contributors. The most cited author was Matt, G.E. (n = 92; TLS = 3385). Common keywords co-occurring with THS included “tobacco”, “secondhand smoke”, “passive smoking”, “oxidative stress” and “smoking”. Conclusion: Research on THS has grown significantly over the past 15 years. It is recommended that future studies on tobacco control address the concept of thirdhand smoke.
Evaluation of scientific studies on electronic cigarettes in the last five years
Electronic cigarettes are not as harmless as claimed and contain substances known to be hazardous to human health. E-cigarettes include chemicals similar to those found in conventional cigarettes, such as formaldehyde, acetaldehyde, acrolein, diethylene glycol, nickel, chromium, and lead. In recent years, their use has become increasingly widespread in Türkiye, as in many other countries. The characteristics of these devices, their effects on human health, and their potential role in smoking cessation have attracted global attention. In this context, general information about e-cigarette devices and their usage, as well as studies conducted on these devices, have been reviewed. The studies in this area include surveys, clinical observational studies, and both clinical and interventional research investigating potential harmful effects. Currently, there is insufficient scientific evidence regarding the safety of e-cigarettes. Although it is often claimed that these products do not contain tobacco, they do contain nicotine, which is known to cause addiction. The aim of this review article is to highlight the characteristics of electronic cigarettes, their impact on human health, their global use, and to provide an objective perspective by examining the existing literature on the subject.
Assessment of psychological tobacco dependence among medical students: a cross-sectional study
Introduction: Smoking addiction is a multidimensional process resulting from the combination of many factors that mutually influence and reinforce each other. Physical addiction to cigarettes progresses through stages of craving, longing, and need, with increased addiction levels making cigarette cravings more difficult to resist. This progression in physical dependence is accompanied by a corresponding increase in heightened psychological dependence, which constitutes an additional dimension of tobacco addiction. The stressful environment of medical education necessitates examining the nicotine dependence of students. In our study, we aimed to assess nicotine dependence in medical students by examining both the physical and psychological dimensions of smoking behavior within this population. Methods: This is a cross-sectional study conducted with 169 medical students enrolled at a medical school in Turkey. Data were collected using a questionnaire including sociodemographic information, the Fagerström Test for Nicotine Dependence (FTND), and the Test to Assess the Psychological Dependence on Smoking (TAPDS). Categorical variables are reported as n (%), and continuous variables as mean ± SD or median (IQR). The Kolmogorov-Smirnov test was employed to assess the normality of the distribution. For group comparisons based on normal distribution, independent samples t-test, one-way ANOVA, Mann-Whitney U test, and Kruskal-Wallis test were used. Multiple linear regression analysis was performed to identify independent predictors of the TAPDS score. Results: The median score on the FTND was 3.0 (IQR 1.0-6.0). The mean TAPDS score was 49.40 ± 9.98.The age at smoking initiation was significantly higher in females compared to males (p=0.039), while the number of cigarettes smoked per day was significantly lower (p=0.015).A moderate positive correlation was found between FTND and TAPDS scores (r=0.459, p<0.001). In the multiple linear regression model including number of cigarettes smoked per day, age at smoking initiation and FTND scores, only FTND score remained significantly associated with TAPDS score (B=1.668; p<0.001) Conclusions: An increase in one form of dependence affects the other as well. In our study, a significant association was found between TAPDS and FTND scores. This highlights the importance of holistic approaches targeting both physical and psychological components in interventions for smoking dependence.
The effect of secondhand smoke exposure on treatment outcomes in children hospitalized for community-acquired pneumonia
Background: Secondhand smoke exposure remains a major yet preventable contributor to pediatric respiratory illness, especially in low- and middle-income countries. Despite public regulations limiting tobacco use, secondhand smoke exposure within homes remains a persistent threat to children’s health. This study aimed to assess the impact of secondhand smoke exposure on clinical outcomes among children hospitalized for community-acquired pneumonia. Methods: A cross-sectional observational study was conducted at Adana City Training and Research Hospital, enrolling 563 pediatric patients aged 1 month to 18 years hospitalized with community-acquired pneumonia between July 2019 and June 2020. Secondhand smoke exposure was defined as the presence of at least one smoker in the child’s household. The primary outcome was length of hospital stay. Secondary outcomes included admission to the pediatric intensive care unit, use of invasive or non-invasive mechanical ventilation, PICU length of stay, and history of hospitalization due to lower respiratory tract infection. Results: Among the patients, 70.3% were exposed to secondhand smoke at home, and 41.4% lived with two or more smokers. Secondhand smoke exposed children had significantly longer hospital stays (p=0.023), increased rates of pediatric intensive care unit admission (12.1% vs. 6.6%, p=0.032), and a higher frequency of past hospitalizations for lower respiratory tract infection (p<0.001) compared to unexposed peers. However, no statistically significant differences were found in pediatric intensive care unit length of stay or need for mechanical ventilation between the two groups. Exposure to secondhand smoke during pregnancy was also associated with a higher risk of severe respiratory outcomes. Conclusions: Secondhand smoke exposure in household settings is associated with worse clinical outcomes in pediatric patients hospitalized with CAP. These findings underscore the urgent need for targeted public health interventions, including parental education and stricter enforcement of smoke-free home environments. Efforts to reduce household secondhand smoke exposure may substantially decrease pediatric morbidity associated with pneumonia.
Cardiovascular disease and chronic nicotine addiction: A qualitative analysis of smoking behaviour after post-cardiac event
Background: Despite significant advances in cardiovascular care, smoking remains a critical risk factor for recurrent cardiovascular events in myocardial infarction (MI) survivors. Primary percutaneous coronary intervention (PCI) is a lifesaving procedure; however, its long-term success is often compromised by patients’ continued smoking. Objective: This qualitative study aims to explore the experiences, perceptions, and barriers faced by individuals who continue smoking after undergoing primary PCI for MI, providing insights into the psychological, social, and behavioral factors that hinder smoking cessation. Methods: A qualitative research design was adopted, involving semi-structured interviews with post-MI patients who continued smoking. Thematic analysis was employed to identify and interpret key themes related to smoking behaviors, challenges in quitting, and the effectiveness of current cessation interventions. Results: Participants acknowledged the health risks of smoking, linking it to their MI, yet highlighted significant barriers to cessation, including stress management, emotional reliance on smoking, and ingrained habits. Social influences and cultural norms were also contributing factors. While healthcare professionals provided critical advice, participants reported limited success with available cessation methods, emphasizing the need for comprehensive, personalized support. Conclusions: Smoking cessation remains a significant challenge for post-MI patients, driven by a complex interplay of addiction, emotional dependence, and social influences. Effective interventions should incorporate stress management, tailored support systems, and innovative cessation tools to address these barriers. Promoting smoking cessation is essential to enhancing the long-term outcomes of PCI and reducing cardiovascular risks. Further research should focus on scalable, patient-centered approaches to empower MI survivors in overcoming smoking addiction.
The relationship between smoking and sociodemographic and biochemical characteristics in hemodialysis patients
Background: This study was conducted to determine the prevalence of smoking among patients receiving hemodialysis in a state hospital, to compare the sociodemographic characteristics of smokers and non-smokers, and to evaluate the effects of smoking on selected biochemical parameters. Methods: This descriptive cross-sectional study was carried out in a hemodialysis unit between April 15 and June 30, 2025, including a total of 80 voluntary patients. Data were collected through a structured questionnaire and hospital records, and analyzed using SPSS version 25.0. Results: The mean age of participants was 56.96±15.17 years, and the mean duration of dialysis was 1212.40 months. Among the participants, 21.3% were current smokers, 23.8% were former smokers, and 55.0% had never smoked. Among smokers, the mean duration of smoking was 27.66±14.52 years, with an average daily consumption of 23.69±21.15 cigarettes and a mean Fagerström Test score of 7.00±1.87. The average time since quitting among former smokers was 16.26±13.22 years. While 58.8% believed that smoking negatively affected their disease course, only 6 individuals were considering quitting. Alcohol and substance use were reported by 8.8% and 2.2% of participants, respectively. The most common dialysis-related complications were hypertension (11.3%), hypotension (6.3%), and bleeding (2.5%). The comorbidity rate was 87.5%. Smoking was significantly more common among males (p=0.006), individuals with freelance occupations and those unemployed (p=0.011). Hospitalization within the past year (p=0.039), particularly due to infections (p=0.022), was also more frequent among smokers. In terms of biochemical parameters, serum phosphorus levels were significantly higher in smokers (5.24±1.54 mg/dL) compared to non-smokers (4.49±1.40 mg/dL) (p=0.037). Conversely, bicarbonate levels were significantly lower in the smoking group (p=0.003). Conclusion: Smoking may increase the risk of complications in hemodialysis patients, potentially by suppressing the immune system and increasing susceptibility to infections. Despite acknowledging its negative effects, only a small proportion of smokers expressed willingness to quit, highlighting that behavioral change requires not just knowledge but also motivation and supportive interventions. Smoking in hemodialysis patients represents a significant health concern with serious clinical and biochemical consequences. Integrating structured smoking cessation counseling and intervention programs into dialysis care is crucial for improving patient survival and quality of life.
Legal regulations on electronic nicotine delivery systems (ENDS), electronic non nicotine delivery systems (ENNDS), heated tobacco products (HTPs) and vapes (E-cigarettes) in Türkiye: current status and recommendations
Türkiye has established a strong legislative framework for tobacco control within the scope of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). In 2008, the General Directorate of Pharmaceuticals and Pharmacy of the Ministry of Health issued a statement classifying nicotine-containing cartridges of electronic cigarettes as medicinal products and devices as medical devices; none have been authorized for market placement. In 2013, through an amendment to Law No. 4207 on the Prevention and Control of the Harms of Tobacco Products, electronic cigarettes, heated tobacco products, and vapes were explicitly brought under the legal definition of “tobacco product.” Pursuant to Law No. 4733, the production, distribution, marketing, and sale of these products without authorization or license from the Ministry of Agriculture and Forestry is strictly prohibited. Furthermore, the high-capacity requirements stipulated for manufacturing effectively make legal domestic production impossible. In 2020, a Presidential Decree banned the importation of electronic cigarettes and their derivatives. This article summarizes these legislative provisions, evaluates the current situation, and presents recommendations for strengthening implementation.
Hemoptysis following e-cigarette inhalation: A toxicological concern in vaping-related lung injury
Introduction: Electronic cigarettes were developed in 2003 with the aim of providing a safer alternative for nicotine consumption and reducing the harms associated with conventional cigarette smoking. The diagnostic criteria for E-cigarette or vaping product use-associated lung injury include: onset of symptoms within 90 days of electronic cigarette use, radiological evidence of pulmonary infiltrates, absence of an underlying infectious cause, and exclusion of alternative causes of respiratory failure. Case Report. A 35-year-old male patient presented to the emergency department with a complaint of massive hemoptysis following heavy electronic cigarettes use. Flexible bronchoscopy was performed, and the bleeding was successfully controlled. However, the patient was readmitted after discharge due to recurrent massive hemoptysis. This time, bronchial artery embolization was performed, resulting in effective control of the symptoms. Discussion: In terms of treatment, aside from corticosteroid therapy, management is generally supportive and includes oxygen supplementation. The purpose of presenting this case is to highlight a rare clinical manifestation of E-cigarette or Vaping product use-Associated Lung Injury, distinct from the commonly reported presentations. Specifically, we report a patient who presented with two separate episodes of massive hemoptysis, a presentation that has been rarely documented in the literature. In the first episode, the bleeding was controlled with flexible bronchoscopy, while in the second episode, bronchial artery embolization was required. To the best of our knowledge, no other case with recurrent massive hemoptysis associated with E-cigarette or vaping product use-associated lung injury has been reported in the literature to date.
The relationship between oral health status and passive smoking and related factors in children aged 3–10 years
Background: Passive smoking, or exposure to environmental tobacco smoke, remains a significant public health concern worldwide, particularly affecting children’s systemic and oral health. Previous research has identified associations between passive smoking and increased dental caries risk, but local evidence integrating clinical and behavioral factors in Türkiye is limited. This study aimed to evaluate the relationship between passive smoking and oral health outcomes in children aged 3–10 years considering sociodemographic characteristics, oral hygiene behaviors, and fluoride use. Methods: A descriptive cross-sectional study was conducted with 136 children attending the Department of Pediatric Dentistry, Gülhane Faculty of Dentistry, University of Health Sciences. The case group included children with smoking parents (n=72) and the control group children with non-smoking parents (n=72). Data were collected via structured parental questionnaires on demographics, smoking habits, and oral health-related behaviors, alongside clinical examinations assessing the decayed, missing, and filled teeth (DMFT/dmft), pulpal involvement, ulceration, fistula, abscess (PUFA/pufa), and Simplified Oral Hygiene Index (OHI-S) indices. Statistical analyses included Pearson’s chi-square test, Fisher’s exact test, Student’s t-test, Mann–Whitney U test, and logistic regression to determine factors associated with high dmft scores (p<0.05). Results: Children of smoking parents were 3.56 times more likely to have high dmft scores than those of non-smoking parents (p=0.011). High dmft prevalence was also associated with younger parental age (<40 years; OR=2.78, p=0.025), low toothbrushing frequency (never vs. twice daily; OR=6.68, p=0.053), and frequent sugar/chocolate consumption (several times/day vs. ≤once/week; OR=4.06, p=0.012). Protective factors included parental knowledge about fluoride (p<0.001), use of fluoride-containing toothpaste (p=0.007), and professional fluoride applications (p=0.042). No significant association was found between dmft levels and smoking in the child’s immediate presence or in the car. Conclusions: Passive smoking is strongly associated with increased dental caries prevalence among children aged 3–10 years. Modifiable behaviors—such as improving oral hygiene, reducing sugar intake, and promoting fluoride use—can mitigate the adverse impact of tobacco smoke exposure. These findings underscore the need for integrated public health interventions combining tobacco control with oral health promotion strategies targeting parents and caregivers.
Küresel sigara pazarı: DSÖ Bölgelerine göre satış eğilimleri, fiyatlandırma ve fiyat esnekliği (2008-2022)
Bilgiyle, Kararlılıkla, Dayanışmayla: Tütünsüz Bir Geleceğe Doğru
Evaluation of the relationship between smoking status at home and health literacy
Objective: This study aims to evaluate the relationship between smoking at home and health literacy levels. Materials and Methods: Our study is a cross-sectional analytical study. It was conducted with 164 volunteers aged 18 and over. Sociodemographic data, home smoking status, the Fagerström Test for Nicotine Dependence, and the Turkish Health Literacy-32 (TSOY-32) questionnaire were applied through face-to-face interviews. Results: The mean age of the 164 participants was 42.1 ± 12.8 years (range: 19–75), with a male-to-female ratio of 1.2:1. While 54.9% reported smoking at home, 75.7% of those who did not smoke at home stated that they smoked on an open balcony or terrace. The median smoking history was 22.2 pack-years. The Fagerström score was significantly higher in those who smoked at home (p=0.021). The presence of children was significantly lower among home smokers (p=0.011). Monthly income was lower in home smokers than in non-smokers (p=0.009). Those who smoked only on a balcony/terrace had significantly lower TSOY-32 scores (p=0.024) and monthly income (p<0.001) compared to non-smokers. TSOY-32 scores differed significantly by education level (p=0.035). Post-hoc analysis showed that individuals with a university degree or higher had significantly higher TSOY-32 scores than those with primary education or lower (p=0.032). TSOY-32 scores were negatively correlated with age (p=0.001) and smoking amount (p=0.006) but positively correlated with monthly income (p=0.023). Conclusion: Among individuals attending a Smoking Cessation Clinic, those who did not smoke even on a balcony/terrace had higher health literacy scores than smokers. Improving health literacy in society may serve as an important model for tobacco control by helping individuals reduce harm to themselves and others and supporting smoking cessation efforts.
Effect of COVID-19 pandemic on cigarette sales: The case of Türkiye
Background: Considering the extraordinary situation of COVID-19, Türkiye government alongside with civil organizations used this opportunity to inform people about harmful effects of smoking during pandemic period and to encourage them for cessation. Accordingly, the primary aim of this paper is to compare cigarette sales data pre- and post- COVID-19 pandemic in Türkiye. Methods: The cigarette sales in January – June 2020 were compared with the same months in 2019. Permutation Wilcoxon Signed-Rank Test was used for data analysis. A 6-month prediction was made for the remaining months in 2020 using the Box Jenkins ARIMA (Auto Regressive Integrated Moving Average) time series model. The monthly cigarette sales were graphed against the expected monthly cigarette sales (average cigarette sales in 2019) to determine pattern pre- and post-COVID-19. Results: There was a significant decrease in manufactured cigarette sales in January – June 2020 comparing with the same months in 2019. The cigarette sales in February – May 2020 were below the expected monthly cigarette sales. If this trend continues, cigarette sales will drop to 10,002,121,177 sticks/month by the end of 2020. Conclusions: Governments and organizations should use this pandemic period to strengthen the implementation of existing tobacco control policies and increase smoking cessation campaigns.
Relationships between smoking and sleep quality, depression, and anxiety among medical students: A cross-sectional study in Türkiye
Background: Tobacco consumption continues to be a primary contributor to preventable illness and death globally, especially among young adults. Medical students experience high stress levels and inadequate sleep, potentially increasing tobacco consumption, depression, and anxiety. Methods: This cross-sectional study recruited 273 medical students from a A medical school in Türkiye. Data were collected via a sociodemographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Fagerström Test for Nicotine Dependence (FTND). Mann-Whitney U and chi-square tests were employed to compare smokers (n=70) and nonsmokers (n=203). Linear regression analyses examined the impact of smoking status on PSQI, BDI, and BAI scores, whereas logistic regression identified predictors of smoking. Results: Overall, 53.1% of the students had tried smoking at least once in their lifetime, and 25.6% reported current tobacco use. Smokers exhibited significantly higher median PSQI (9 vs. 6), BDI (17 vs. 10), and BAI (15 vs. 11) scores (p<0.05). Chi-square analyses indicated that poor sleep quality and moderate-to-severe depression were more prevalent among smokers. Linear regression revealed that smoking predicted an average increase of 2.36 points in PSQI, 6.01 in BDI, and 3.97 in BAI (p<0.01). FTND scores showed a positive correlation with PSQI and BAI, but not with BDI. Logistic regression demonstrated that each 1-point increase in PSQI elevated the odds of current smoking by 26.6% (OR=1.266). Conclusions: Current smoking was associated with reduced sleep quality, elevated depression, and increased anxiety symptoms in medical students. These results highlight the need for integrated interventions focusing on smoking cessation and mental health support to improve the well-being of future physicians.
Parents’ awareness of third-hand smoke and smoking behaviors
Objective: Third-hand smoke is a serious threat to health. This study aimed to guide the fight against tobacco by determining parents’ awareness about third-hand smoke and smoking behaviors. Methods: 244 volunteer parents with children under the age of 18, who applied to the outpatient clinics of a hospital in Ankara between 16.7.2022 and 15.9.2022, were included in the descriptive, analytical study. A 28-question data collection form, including questions on sociodemographic characteristics and smoking behaviors, the Fagerström nicotine dependence test, and the awareness scale about third-hand smoke, was applied face-to-face to the participants. Data were analyzed with IBM SPSS 22.0. p<0.05 was considered statistically significant. Findings: Participants were between the ages of 18-65, 30.33% were fathers, 69.67% were mothers, 52.05% smoked (50% of them were with their children), 9.45% did not smoke at home, and 88.93% had never heard of third-hand smoke. The total score of the awareness scale about third-hand smoke was found to be high in those aged 31-45 (55%), those who quit smoking, those who had previously heard of the concept of third-hand smoke, and those who were married, and increased with education level (p<0.001). The Fagerström nicotine addiction level was low in 53.97% of the parents. Results: It was determined that the awareness of third-hand smoke was higher in middle-aged, highly educated, ex-smokers, married and those who had heard third-hand smoke. It was found that the rate of parents smoking was high, third-hand smoke knowledge was insufficient and children were exposed to third-hand smoke, especially in their own homes. Education about third-hand smoke can reduce exposure by increasing awareness and encourage smoking cessation. This study can guide the fight against tobacco.