Journal of Addictive Behaviors,Therapy & RehabilitationISSN: 2324-9005

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Research Article, J Addict Behav Ther Rehabil Vol: 3 Issue: 3

Knowledge Level of Kocaeli�s Population Regarding Smoking and Smoking Cessation

Fusun Yildiz, Serap Argun Baris*, Hasim Boyaci, and Ilknur Basyigit
Kocaeli University, Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli, Turkey
Corresponding author : Dr. Serap Argun Baris
Kocaeli University, Faculty of Medicine, Department of Pulmonary Diseases, Umuttepe, Kocaeli, Turkey
Tel: +902623037211
E-mail: [email protected]
**The study presented as a discussion poster in 13th Annual Congress of the Turkish Thoracic Society
Received: March 20, 2014 Accepted: June 10, 2014 Published: June 13, 2014
Citation: Yildiz F, Baris SA, Boyaci H, Basyigit I (2014) Knowledge Level of Kocaeli’s Population Regarding Smoking and Smoking Cessation. J Addict Behav Ther Rehabil 3:3. doi:10.4172/2324-9005.1000123

Abstract

Knowledge Level of Kocaeli’s Population Regarding Smoking and Smoking Cessation

Background: A questionnaire was designed and administered to people living in Kocaeli province, Turkey, in order to determine their level of knowledge about smoking before the initiation of a social responsibility project aimed at increasing the smoking cessation rates in Kocaeli. Material-Method: The sample selection was made on the basis of the population sizes of 12 counties in Kocaeli province; participants over the age of 18 completed the questionnaire over the phone. Results: A total of 2721 participants were included in the study. It was found that the knowledge level about smoking-related diseases was quite high, and the conditions mentioned most frequently by the participants were lung diseases, cancer, and cardiac diseases. Only 2.8% of the subjects reported that they had no information about the harmful effects of smoking. Knowledge level was not different among age groups or educational levels of the participants. The percentage of subjects who believed that smoking cessation was a matter of personal will power was 49%, while only 8.4% reported that medical support was required. The most recalled anti-smoking activities were the recent law prohibiting smoking in enclosed areas and commercials about smoke-free air.

Keywords: Smoking, smoking cessation, knowledge level

Keywords

Smoking; Smoking cessation; Knowledge level

Introduction

Smoking addiction is a very important social problem in our country and all over the world. Each year, 5.5 billion cigarettes are produced, and 1.2 billion people smoke worldwide. This number is equal to one-third of the world’s population over age 15. In 2030, the number of smokers worldwide is expected to reach 2 billion [1]. Approximately 80% of smokers live in developing countries [2].
Turkey ranks third in Europe and seventh in the world in cigarette consumption [3], and there are several studies assessing the prevalence of smoking in our country [4-6]. According to the Global Adult Tobacco Survey, nearly one-third (31.2%) of adults over 15 years of age are smokers. Smoking prevalence is higher among men (47.9%) than in women (15.2%) [6].
Smoking is defined as a major cause of disease and premature death in both developing and developed countries by the World Health Organization. In the twentieth century, approximately 100 million deaths attributable to smoking occurred in developed countries [7]. The expected lifetime of cohort of smokers lost an average of 20 years [8]. Smoking causes serious illness among an estimated 8.6 million persons, costs $157 billion annually in medical costs and lost productivity, and kills approximately 440,000 people each year [9,10].
A growing body of evidence documents the effectiveness of public health and clinical interventions in reducing cigarette consumption [11,12]. The basic components of tobacco control and prevention are the submission of taxation that raises the price of tobacco products, creating smoke-free air space, media campaigns, expansion of educational efforts, and prevention of the tobacco industry’s advertising campaigns [13]. In Turkey, the latest law banning of smoking in indoor spaces in 2009 was aimed to decrease of smoking prevalence, to prevent the harmful effects passive smokers and to increase the rates of quitting among smokers. The components mentioned above was referred in this law including the media campaigns, radio and television commercials to increase the harmful effects of smoking as well as smoking cessation outpatient clinics and telephone quit lines to offer psychological support to increase the rates of smoking cessation.
A social responsibility project was initiated for the purpose of increasing consumer awareness of the risks of tobacco, as well as treatments for smoking cessation in Kocaeli province. The aim of the study was to determine the smoking habits and knowledge level about smoking among people in our city before the initiation of a social responsibility project.

Materials and Methods

The sample selection was made on the basis of population numbers in 12 districts of Kocaeli. The phone numbers were taken from the Turkish Telecommunication Centre. The selection of the phone numbers was random and at least 200 people of rural and urban areas of the each district were enrolled. A representative sample of the population was determined to be a limit of ±7% margin of error for each of the determined number of samples. To achieve a representative sample of each district, the sample group was based on all the urban and rural area neighborhoods. The results were weighted according to the populations of the districts in urban areas, in order to prevent a possible influence on the results by the populations of larger or smaller districts than the rest of Kocaeli province.
A questionnaire that includes demographic characteristics, smoking habits, daily consumption, attempts at smoking cessation, and knowledge level about diseases associated with smoking was administered to all participants above 18 years of age who were accepted to join the study. The questionnaire was administered by phone and all of the participants were fully informed of the objectives and requirements of the study, and their oral consent was obtained. So, only volunteers answered the questions. The participants were divided into groups according to age, gender, and education level. Participants divided into 6 groups according to age (18-24, 25-34, 35- 44, 45-54, 55-64, +65 years old ) and 3 groups according to education level (no education/primary school, secondary school/high school and university).
The study was approved in 2013 by the Kocaeli University Medical Faculty Ethical Committee (Project No: 2013/ 190, İAEK: 15/12).
Statistical analysis of the data was performed with the SPSS 13.0 program. Differences among groups (according to age, gender, education level, and town) were evaluated by the Bonferroni method. A p-value of less than 0.05 was considered significant.

Results

A total of 2,721 participants were included in the study. There were 1350 (49.6%) female and 1371 (50.4%) male participants. The overall prevalence of active smokers was 32.3% (n=902), and of exsmokers was 21.5% (n= 587). Demographic characteristics of the study population were shown in Table 1. The percentage of current smokers was 42.5% in the male population, which was significantly higher than females (21.8%). The highest prevalence of smoking was found between the ages of 35 and 44 years (41.2%), while the lowest prevalence was observed in subjects older than 55 years (19.8%).
Table 1: Demographic characteristics of participants.
The mean age of starting smoking was 19 years (17–20), and daily cigarette consumption was 17 sticks. Previous attempts of quitting smoking were found in 67.7% of current smokers. The mean number of smoking cessation attempts was three, and the mean duration of cessation was five months.
The most common reason for smoking cessation was reported as health issues (Figure 1), which was the predominant reason for smoking cessation in both genders, all of the age groups and educational levels. It was found that the knowledge level about the diseases associated with smoking was quite high, and that lung disease, cancer, and cardiac disease were expressed most frequently by the participants. Only 2.8% of the participants reported that they had no information about the harmful effects of smoking (Figure 2). The knowledge level was not different among age groups, gender, or education level of the participants. The percentage of subjects who believed that smoking cessation was a matter of personal will power was 49%, while only 8.4% stated that medical support (such as nicotine replacement, behavioral therapy and pharmacological treatment including bupropion and varenicline) was required (Figure 3).
Figure 1: Reasons for smoking cessation.
Figure 2: Smoking-related diseases.
Figure 3: What can we do for smoking cessation?.
Medical support was not frequently endorsed as a means or aid to smoking cessation among any age groups in the study population. However, the number of participants who thought medical support might be useful for smoking cessation was higher in the 18–24 age group than in the other age groups. In addition, the ratio of participants who thought medical support might be useful for smoking cessation was related to higher education level.
When the participants were asked about their thoughts regarding doctor aid for smoking cessation, 76.4% said that it was useful, and 10.4% were undecided. The statement “doctor aid was useful for smoking cessation” was higher in nonsmokers than in smokers and ex-smokers (Figure 4).
Figure 4: Thoughts about doctor aid for smoking cessation.
The most common information sources of smoking cessation were television (29.9%), doctor suggestion (17.7%), and the internet (15%) (Table 2). The most frequently recalled anti-smoking activities were the recent law that prohibited smoking in indoor areas and commercials for smoke-free air (Figure 5). In addition, 8.6% of the subjects reported that they had attended a community education conference about smoking previously.
Table 2: Information sources about smoking and smoking cessation.
Figure 5: Most frequently recalled anti-smoking activities.

Discussion

Results of this study revealed that knowledge about the diseases associated with smoking was quite high across all of the age groups and education levels of the study participants.
Tobacco use is one of the most important public health problems worldwide, and the detrimental effects of smoking and tobacco use on health have been investigated for over 50 years. Although earlier studies reported that smoking cigarettes caused lung cancer, the findings of recent studies around the world have proved that the most common diseases among humans, such as coronary heart disease, chronic lung disease, and other types of cancer result from the adverse effects of smoking [14]. Owusu-Dabo et al. reported that there was generally good knowledge about health risks posed by smoking. Among their participants, awareness of the diseases caused by smoking was heart disease 97%, lung cancer 82%, stroke 71%, mouth and throat cancer 72%. Similarly, awareness of health risks was higher among those over 20 years of age and among females [15]. Elena et al. asked questions about the association of smoking with five major diseases by using a true–false response format. For three diseases—bronchitis, lung cancer, and emphysema—more than three quarters of Chinese men (80%, 78%, and 75%, respectively) knew that smoking is a causal factor. For the other two diseases—throat or mouth cancer and heart disease–only about half of the respondents were knowledgeable (52% for throat or mouth cancer and 50% for heart disease) [16]. In the present study, we found that the knowledge level about smoking related diseases was quite high, and lung diseases, cancer, and cardiac diseases were most frequently mentioned by the participants. Only 2.8% of the participants reported that they had no information about the harmful effects of smoking.
Tobacco use, knowledge, and attitudes of populations have been evaluated in the past [13,17,18]. Nabile et al. suggested that the knowledge of the risks associated with smoking was significantly higher in subjects who were more educated and in ex-smokers compared to current smokers [17]. Lim et al. evaluated tobacco use, knowledge, and attitude among Malaysians aged 18 and above. They reported that the findings indicated that knowledge and attitude differed according to smoking status; smokers had less knowledge and more positive attitudes compared to non-smokers. Education level was also strongly associated with knowledge and attitude scores [18]. Also Demaio et al. suggested that the level of awareness about the health risks of smoking was generally very high among the population but the more educated and the older participants tended to have a higher level of awareness of the health risks of tobacco smoking [19]. In our study, the knowledge level about the harmful effects of smoking on health was not different among age groups, gender, or education level of the participants. But the ratio of participants who thought medical support might be useful for smoking cessation was related to higher education level. The statement “doctor aid was useful for smoking cessation” was higher in nonsmokers than in smokers and ex-smokers. These findings indicate the importance of education and the target population of educational programs for smoking cessation should be primarily current and ex-smokers.
The health problem was the most common reason of smoking cessation in recent studies. Primarily, the reason of smoking cessation was the fear of deterioration of health (44%) in a study by Argüder et al. [20]. Among health-related reasons, current health problems was the most frequently cited reason for quitting (46.6%) in our study, followed by general concern about health (15.7%). These results were consistent with the results of another recent study, in which those reasons were reported, on average, by 57% and 32% of subjects, respectively [21].
The Framework Convention on Tobacco Control was adopted by Turkey in 2004, and it sought to provide a standardized process for the government to limit smoking, with the overall aim of improving the health of the general population [3]. Various attempts have been made to prevent Turkish youth from starting smoking, to facilitate cessation attempts, and to prevent smokers from harming others. The earliest law was passed in 1996 (Law Nr 4207 on “Prevention of Harmful Effects of Tobacco Products”). Its scope was broadened to include the banning of smoking in indoor spaces in 2008 by Law Nr 5727, “Law Amending the Law on Prevention of Harmful Effects of Tobacco Products.” The full implementation of these laws occurred on July 19, 2009. In our study, the most recalled anti-smoking activities were the latest law (46.9%), which prohibits smoking in enclosed areas, as well as commercials for smoke-free air.
The mass media played a key role in the historical increases and decreases in tobacco use globally, and they remain a powerful tool for public health advocates, as an avenue for promoting health-related messages [22]. In our study, the most common information source for smoking cessation was the television. The majority of the participants (84%) reported that awareness of public health advertisements warning about the health effects of smoking, typically on the radio or television in Owusu-Dabo et al’s study [15]. Similarly, in a study conducted by Hammond et al. in the USA, the UK, Canada, and Australia, involving a total of 9,058 individuals, television (87.7%), cigarette packages (64.6%), and the written media (64.1%) were the most frequent information sources [23]. These sources seem to be important means of emphasizing the need for medical support in quitting smoking and of attracting public attention.
The overall prevalence of active smokers was 32.3% in our study, which was similar to the Global Adult Tobacco Survey results [6]. Previous attempts at quitting smoking were reported by 67.7% of current smokers. The mean number of smoking cessation attempts was three times. The survey showed that “willpower” was the most common approach to quitting smoking in the study population, which was similar to the situation reported in other countries [24-26]. One explanation for such a high prevalence of self-quitting might be that smokers do not perceive smoking cessation assistance as effective [27]. On the other hand, some studies have shown that the long-term success rate is about 5% when smokers try to quit on their own [24]. Professional assistance increased the success rate of smoking cessation to 33% [28]. Lower awareness of smoking cessation outpatient clinics and traditional believing that smoking cessation is a matter of will-power among the population might be associated with lower rate of seeking for medical assistance in quitting attempts. Another reason for such a high rate of unaided quitting in Kocaeli might be the relatively high cost of nicotine replacement therapy, bupropion or varenicline, which seems to be an important barrier to use of these drugs, even if patients believe in their efficacy. On the other hand, physicians lean to underestimate the benefit of psychological intervention which is both cost-effective and has no side effects [29]. We suggested that psychological intervention alone and/or combination with pharmacological treatment might increase the rates of quit smoking and might also decrease the economical cost of smoking cessation programs.
In conclusion, knowledge about the harmful effects of smoking is quite high; however, information about the methods of smoking cessation and the role of medical support is not sufficient. It is suggested that community education programs and appropriate medical support should be planned in order to increase the smoking cessation rates.

Competing of interest

The authors declare that they have no competing interests.

Authors’ contribution

HB participated in the design of the study and coordination
SAB performed data collection and writing
İB performed the data collection and analysis
FY conceived of the study and participated in its design

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