Estimating the impact of achieving Turkey's non-communicable disease policy targets: A macro-simulation modelling study.

BACKGROUND: The Burden of non-communicable disease (NCDs) has continued to rise globally, particularly in low- and middle-income countries. In Turkey, NCDs account for 89% of all deaths, with nearly one in five deaths occurring before age 70. This study investigates the number of NCD deaths that could be prevented if Turkey met national and international targets for major modifiable NCD risk factors. METHODS: Preventable deaths were estimated using the World Health Organization (WHO) 'Preventable Risk Integrated ModEl' (PRIME), by combining: 1) Baseline exposure data for risk factors, referenced from national surveillance and cohort studies; 2) Aetiological associations from published meta-analyses; and 3) Demographic and mortality statistics obtained from the Turkish Statistical Institute (TurkStat). Confidence intervals were estimated using Monte Carlo simulations. FINDINGS: If Turkey met its NCD risk factor targets for reducing tobacco and salt consumption by 30%, and physical inactivity by 10% in 2017, an estimated 19,859 deaths (95%CI: 12,802 to 26,609) could have been prevented. Approximately two thirds of these preventable deaths were in men, and one in three were in adults below 75 years. A 30% relative reduction in the consumption of alcohol, tobacco, and salt, as well as physical inactivity, would prevent 180 (107 to 259); 4,786 (3,679 to 5,836); 13,112 (5,819 to 19,952); and 7,124 (5,053 to 9,212) deaths, respectively. INTERPRETATION: Among major modifiable NCD risk factors, population-level reductions in salt intake and physical inactivity present the greatest opportunity for reducing NCD mortality in Turkey. These findings can help Turkey prioritise interventions to meet the Sustainable Development Goal target of reducing NCD mortality by one third, by 2030

Evaluation of the use of Global Youth Tobacco Survey (GYTS) data for developing evidence-based tobacco control policies in Turkey

Introduction The tobacco control effort in Turkey has made significant progress in recent years. Turkey initiated its tobacco control effort with the passing of Law 4207 (The Prevention of Harmful Effects of Tobacco Products) in 1996 and ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in 2004. It is important to base policy decisions on valid and reliable evidence from population-based, representative studies that are periodically repeated to enable policy makers to monitor the results of their interventions and to appropriately tailor anti-tobacco activities towards future needs. Methods The Global Youth Tobacco Survey (GYTS) was developed to track tobacco use among young people and enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programs. Turkey conducted the GYTS in 2003 and data from this survey can be used as baseline measures for evaluation of the tobacco control programs implemented by the Ministry of Health (MOH) of the Turkish government. Results The GYTS was conducted in 2003 on a representative sample of students aged 13 to 15 years. It indicated that almost 3 in 10 students in Turkey had ever smoked cigarettes, with significantly higher rates among boys. Current cigarette smoking rates were lower, at 9% for boys and 4% for girls. The prevalence of current use of other tobacco products was about half these figures for each gender. About 80% were exposed to secondhand smoke. Exposure to pro-smoking media messages was not rare. Almost half of the smokers 'usually' bought their tobacco from a store, despite the law prohibiting this. Exposure to teaching against smoking in schools was not universal. Conclusion Findings from the GYTS, with periodic repeats of the survey, can be used to monitor the impact of enforcing various provisions of the present law (No: 4207), the progress made in achieving the goals of the WHO FCTC, and the effectiveness of various preventive interventions against smoking. Such data would inform and help in the development of public health strategy.PubMedWoSScopu

Exploring educational inequalities in hypertension control, salt knowledge and awareness, and patient advice : insights from the WHO STEPS surveys of adults from nine Eastern European and Central Asian countries

Objective: To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician’s advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. Design: Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. Settings: Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). Participants: Nationally representative samples of 30 455 adults aged 25–65 years. Results: HBP awareness, treatment and control varied substantially by education. The coverage of physician’s advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician’s advice on salt reduction. Conclusions: There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries

The perspectives of politicians on tobacco control in Turkey

Background Tobacco use is a leading but preventable cause of non-communicable diseases and premature death. The legislature has a key role in setting tobacco control policies. Smoking trends are decreasing thanks to the introduction of effective tobacco control policies in Turkey and these policies may have been shaped by how politicians' interpreted social problems that were prominent during the development and implementation of tobacco regulations. This paper explores the long-term national relationship between tobacco consumption, tobacco control policies and the associated political discourse in Turkey, considering the varying influences through national leadership on this important public health agenda. This relationship is studied by comparing a time series analysis of tobacco consumption trends with a policy analysis of the minutes of deliberations at the Grand National Assembly of Turkey (GNAT)

Contrasting trends of smoking cessation status: insights from the stages of change theory using data from the global adult tobacco survey

Background Quitting tobacco use can reduce smokers' risks for disease and premature death. We used the trans-theoretical behavior change model to examine temporal differences in readiness to quit smoking among adults in five countries. Methods We analyzed two independent samples from the Global Adult Tobacco Survey, a standardized national adult household survey of persons aged ≥15 years, for five countries: Mexico (2009, 2015), Philippines (2010, 2016), Thailand (2009, 2011), Turkey (2008, 2012), and Vietnam (2010, 2016). Response rates ranged 82.5%-96.3% and sample sizes ranged 8,996-20,606. Current smokers were defined as adults who smoked tobacco on a daily or non-daily basis. Using responses to questions assessing intention to quit cigarette smoking, we categorized current smokers into the following stages of change: pre-contemplation, contemplation, and preparation. Relative change was compared using z-tests ( p < 0.05). Results No significant change in smoking prevalence between wave 1 and 2 occurred for Mexico (15.9% to 16.4%), Thailand (23.7% to 24.0%), or Vietnam (23.8% to 22.5%). In contrast, smoking prevalence declined for Philippines (28.2% to 22.7%) and Turkey (31.2% to 27.1%). There was an increase in the proportion of smokers in the pre-contemplation stage in Thailand (76.1% to 85.4%) and Vietnam (70.8% to 82.3%), while a decline occurred in Turkey (31.2% to 27.1%); no significant change occurred in Mexico or Philippines. The proportion of smokers in the contemplation stage declined in Thailand (17.6% to 12.0%) and Vietnam (21.6% to 14.1%), but increased in Turkey (21.2% to 26.9%); no significant change occurred in Mexico or Philippines. The proportion in the preparation stage declined in Thailand (6.3% to 2.6%) and Vietnam (7.6% to 3.6%); no significant changes occurred in, Mexico, Philippines, or Turkey. Conclusions Using the stages of change model, smokers' readiness to quit varies by country. Tailored interventions towards specific stages of cessation might help motivate quitting behavior

Factors that influence attitude and enforcement of the smoke-free law in Turkey: a survey of hospitality venue owners and employees

Introduction In 2009, Turkey extended the smoke-free legislation to hospitality venues. Compliance, however, remains low in some hospitality venues. We identified characteristics associated with knowledge of health effects that can be prevented by the smoke-free law, the attitude towards and enforcement of the law

Experience of workplace violence during medical speciality training in Turkey

Aims To determine the type, extent and effects of workplace violence among residents during postgraduate speciality training in various departments of medical schools in Turkey

Cigarette Prices And Smoking Prevalence After A Tobacco Tax Increase — Turkey, 2008 And 2012

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