Because of lack of a comprehensive prevalence study representing whole Turkey since 1988, local studies like this one are important. According to the PIAR study in 1988, the smoking prevalence in subjects older than 15 years old was found to be 43% (63% of the men and 24% of the women)
2. In 1993, a study conducted by BIGTAS for Ministry of Health with 26,546 individuals showed that 58% of men and 14% of women over the 20 years of age were smokers. In this study, the highest smoking prevalence was in the Thrace region with 39%. The lowest smoking prevalence was found to be in the Southeastern Anatolia with 29%
10. In a more recent study it was reported that 51% of men and 11% of women (≥ 20 years of age) were smokers
3. In a study by Çan et al.
11 in an Eastern Black Sea sample the prevalence in men was 52% and in women was 20%.
In this study in Edirne City Center, the smoking prevalence in men was found to be 68% and in women 54%, and in the total 58%. These data, as was indicated in the BIGTAS study, suggest that cigarette consumption is higher in the region of Thrace than the country's average and are consistent with the Eastern Europe region epidemiologic data6. The highest rate of smoking in women in our country is also likely to be in Edirne. The rate of cigarette smoking in women according to the Turkish Demographic Health Survey in 1998 was 18%, but it was 28% in 20037. According to these data the prevalence of cigarette smoking in women in Edirne Province center is nearly twice that of the national average. In developed countries, because a large percentage of men have quitted, the women and men's smoking prevalence are similar and about 20%. In Turkey, smoking is more prevalent in men than women, constantly. This was also stated by Çan et al.11 and they related this situation to the cultural and societal pressure. This situation may be different in Edirne, and probably in Thrace region in general, because of a difference in general cultural make-up and we suggest that there is not gender distinction for this subject in Thrace region. The effect of the tobacco industry's marketing strategy may also have had an influence on this cultural change.
The Turkish Gypsies in Edirne have a higher prevalence of unemployment, smoking and alcohol use. This may be an important clue in the planning of smoking cessation services to the society. In studies conducted in western societies it has been determined that low socioeconomic groups have higher tobacco use constantly12.
The high prevalence of cigarette smoking in Edirne is an indicator that there is also a very high level of environmental tobacco smoke. According to the 2001 Turkish Global Youth Tobacco Research (GYTS) 89% of the young people who participated in the study are exposed to passive cigarette smoke at home and 90% in places open to the public; 68.8% of their fathers and 39.7% of their mothers smoked cigarettes in their homes13.
Another significant result obtained in this study was the quit rates. The health benefits for those who quit smoking are significant. The earlier they can quit smoking the greater the benefits. The benefits provided by quitting in the adult population can also have some decreasing effect of starting smoking because of prevention of smoking adults serving as wrong role models for young people. The quit rate was 13% in general, 16.1% in men, 11.7% in women. Our National Tobacco Control Program had targeted the determination of quit rates in society by the year 2007 and to raise the quit rate to 40% by 2010; to raise the quit rate among health professionals to 50% by 2008, to raise the quit rates among teachers, religious leaders and administrators, and members of professions to 50% by 2010; and to raise the quit rates during pregnancy to 90% by 20087. However we are not aware of any planned, official program aimed at implementation to achieve these targets. The quit rates in the entire population of our country is not known. According to local studies, quit rate is about 20%7. In the US, the quit rate was 29.6% in 1965, and as a result of a 20-year effort it was reported to have risen to 44.8%14. When these values are compared it is clear how far behind we are and how much effort is needed. The high rate of quitting in the older age groups, in particular, in this study suggests that those who have quit had health problems causing increased awareness and quitting efforts. At the societal level, educational, economic, clinical and legislative measures are urgently needed to increase the quit rates. Because of potent addictive nature of smoking, quitting effort must be supported by pharmacologically and/or behaviorally. There is a significant lack of health services available in our country to help people stop smoking7. In fact, smoking cessation services are suggested to be one of the most cost effective health interventions15,16. Education of health professionals for smoking cessation can significantly increase public health services for cessation.
In conclusion, smoking is a growing problem in Edirne since smoking prevalence, particularly in women, is one of the highest of Turkey, and quit rates are far from behind the national goals. And lack of smoking cessation services is the major problem. Urgent efforts focused especially on socioeconomically deprived groups like unemployed people and gypsies are needed.