International Journal of Public Health

, Volume 59, Issue 2, pp 251–260 | Cite as

Socioeconomic inequalities in current daily smoking in five Turkish regions

  • Hur HassoyEmail author
  • Isil Ergin
  • Anton E. Kunst
Original Article



To assess whether socioeconomic inequalities in smoking in five regions across in Turkey have the same pattern as observed in southern Europe.


Cross-sectional data of the World Health Survey 2002 from Turkey were analyzed (5,951 women and 4,456 men) to evaluate the association of smoking with wealth and education. Age-standardized prevalence rates and odds ratios were calculated separately by sex, region and age groups.


Smoking prevalence was 16.7 % for women and 51.4 % for men. Smoking risk was increased in higher wealth and education groups among women in all regions and for both younger and older generations. In the East, Middle and Black Sea regions this female pattern was most pronounced. For men, smoking was less prevalent in the two highest wealth groups. Unlike among women, socioeconomic differences in smoking were approximately equally large in all regions.


Patterns of inequalities in smoking across the five regions strongly resemble those observed in southern Europe. This fits the patterns predicted by the smoking epidemic model. Particular attention should be given to highly educated women, who may perceive smoking as a symbol of modernity, emancipation and independence.


Socioeconomic inequalities Current daily smoking Wealth Education 


Conflict of interest

None declared.


  1. Afifi RA, Nakkash RT, Khawaja M (2010) Social capital, women’s autonomy and smoking among married women in low-income urban neighborhoods of Beirut, Lebanon. Women’s Health Issues 20:156–167PubMedCrossRefGoogle Scholar
  2. Amos A, Haglund M (2000) From social taboo to ‘‘torch of freedom’’: the marketing of cigarettes to women. Tob Control 9:3–8PubMedCentralPubMedCrossRefGoogle Scholar
  3. Anderson SJ, Glantz SA, Ling PM (2005) Emotions for sale: cigarette advertising and women’s psychosocial needs. Tob Control 14:127–135PubMedCentralPubMedCrossRefGoogle Scholar
  4. Çan G, Çakırbay H, Topbaş M et al (2007) Doğu Karadeniz Bölgesi’nde sigara içme prevalansı. Tüberküloz ve Toraks Dergisi 55:141–147Google Scholar
  5. Cavelaars AEJM, Kunst AE, Geurts JJ et al (2000) Educational differences in smoking: International comparisons. BMJ 320:1102–1107PubMedCentralPubMedCrossRefGoogle Scholar
  6. Dincer B, Ozaslan M, Kavasoglu T (2003) Socioeconomic development order of provinces and regions in Turkey. State Planning Organization, AnkaraGoogle Scholar
  7. Ergin I, Hassoy H, Kunst AE (2012) Socioeconomic inequalities in overweight among adults in Turkey: a regional evaluation. Public Health Nutr 15:58–66PubMedCrossRefGoogle Scholar
  8. Erler MY, Edinsel K (2011) Tobacco production in Samsun (1788–1919). J Intern Soc Res 4:230–247Google Scholar
  9. General directorate on the status of women (2008) Policy document women and education, Ankara Accessed 15 June 2012
  10. Giskes K, Kunst AE, Benach J et al (2005) Trends in smoking behaviour between 1985 and 2000 in nine European countries by education. J Epidemiol Community Health 59:395–401PubMedCentralPubMedCrossRefGoogle Scholar
  11. Global Adult Tobacco Survey (GATS) (2010) Global Adult Tobacco Survey Turkey Report, Ministry of Health Accessed 11 June 2012
  12. Helasoja VV, Lahelma E, Prättälä RS et al (2006) Determinants of daily smoking in Estonia, Latvia, Lithuania, and Finland in 1994–2002. Scand J Public Health 34:353–362PubMedCrossRefGoogle Scholar
  13. Hitchman SC, Fong GT (2011) Gender empowerment and female-to-male smoking prevalence ratios. Bull World Health Organ 89:195–202PubMedCentralPubMedCrossRefGoogle Scholar
  14. Hosseinpoor AR, Parker LA, Tursan d’Espaignet E, Chatterji S (2012) Socioeconomic inequality in smoking in low-income and middle-income countries. Results from the World Health Survey. PLoS ONE 7(8): e42843Google Scholar
  15. Huisman M, Kunst AE, Mackenbach JP (2005a) Inequalities in the prevalence of smoking in the European Union: comparing education and income. Prev Med 40:756–764PubMedCrossRefGoogle Scholar
  16. Huisman M, Kunst AE, Mackenbach JP (2005b) Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tob Control 14:106–113PubMedCentralPubMedCrossRefGoogle Scholar
  17. Leinsalu M, Tekkel M, Kunst AE (2007) Social determinants of ever initiating smoking differ from those of quitting: a cross-sectional study in Estonia. Eur J Public Health 17:572–578PubMedCrossRefGoogle Scholar
  18. Leinsalu M, Kaposvári C, Kunst AE (2011) Is income or employment a stronger predictor of smoking than education in economically less developed countries? A cross-sectional study in Hungary. BMC Public Health 11:97PubMedCentralPubMedCrossRefGoogle Scholar
  19. Lopez AD, Collishaw NE, Piha T (1994) A descriptive model of the cigarette epidemic in developed countries. Tob Control 3:242–247PubMedCentralCrossRefGoogle Scholar
  20. Mckay J, Amos A (2003) Women and tobacco. Respirology 8:123–130CrossRefGoogle Scholar
  21. Murphy NT, Price CJ (1988) The influence of self-esteem, parental smoking and living in a tobacco production region on adolescent smoking behaviours. J Sch Health 58:401–405PubMedCrossRefGoogle Scholar
  22. Ökten Ş (2009) Gender and power: the system of gender in South eastern Anatolia. J Intern Soc Res 2:302–312Google Scholar
  23. Patrick DL, Cheadle A, Thompson DC et al (1994) The validity of self-reported smoking: a review and meta-analysis. Am J Public Health 84:1086–1093PubMedCentralPubMedCrossRefGoogle Scholar
  24. Pomerleau J, Gilmore A, McKee M et al (2004) Determinants of smoking in eight countries of the former Soviet Union: results from the living conditions, lifestyles and health study. Addiction 99:1577–1585PubMedCrossRefGoogle Scholar
  25. Pudule I, Grinberga D, Kadziauskiene K et al (1999) Patterns of smoking in the Baltic Republics. J Epidemiol Community Health 53:277–282PubMedCentralPubMedCrossRefGoogle Scholar
  26. Rebagliato M (2002) Validation of self reported smoking. J Epidemiol Community Health 56:163–164PubMedCentralPubMedCrossRefGoogle Scholar
  27. Schaap MM, Kunst AE (2009) Monitoring of socio-economic inequalities in smoking: learning from the experiences of recent scientific studies. Public Health 123:103–109PubMedCrossRefGoogle Scholar
  28. Schaap MM, Van Agt HME, Kunst AE (2008) Identification of socioeconomic groups at increased risk for smoking in European countries: looking beyond educational level. Nicotine Tob Res 10:359–369PubMedCrossRefGoogle Scholar
  29. Schaap MM, Kunst AE, Leinsalu M et al (2009) Female ever-smoking, education, emancipation and economic development in 19 European countries. Soc Sci Med 68:1271–1278PubMedCrossRefGoogle Scholar
  30. Sozmen K, Baydur H, Simsek H, Unal B (2012) Decomposing socioeconomic inequalities in self assessed health in Turkey. Intern J Equity Health 11:73CrossRefGoogle Scholar
  31. Stronks K, van de Mheen HD, Mackenbach JP (1998) A higher prevalence of health problems in low income groups: does it reflect relative deprivation? J Epidemiol Community Health 52:548–557PubMedCentralPubMedCrossRefGoogle Scholar
  32. Studts JL, Ghate SR, Gill JL et al (2006) Validity of self-reported smoking status among participants in a lung cancer screening trial. Cancer Epidemiol Biomarkers Prev 15:1825–1828PubMedCrossRefGoogle Scholar
  33. Suadicani P, Hein HO, Gyntelberg F (1994) Serum validated tobacco use and social inequalities in risk of ischaemic heart disease. Int J Epidemiol 23:293–300PubMedCrossRefGoogle Scholar
  34. Thrasher JF, Niederdeppe J, Farrelly MC et al (2004) The impact of anti-tobacco industry prevention messages in tobacco producing regions: evidence from the US truth campaign. Tob Control 13:283–288PubMedCentralPubMedCrossRefGoogle Scholar
  35. Turkish Statistical Institute (2003) Database for population census 2000 population statistics. Accessed 20 July 2010
  36. Turkish Statistical Institute (2011) Women in Statistics 2011, Publication no: 3660 Accessed 15 November 2011
  37. Van Loon AJ, Tijhuis M, Picavet HS et al (2003) Survey non-response in the Netherlands: effects on prevalence estimates and associations. Ann Epidemiol 13:105–110PubMedCrossRefGoogle Scholar
  38. Vartiainen E, Seppälä T, Lilsunde P et al (2002) Validation of self reported smoking by serum cotinine measurement in a community-based study. J Epidemiol Community Health 56:167–170PubMedCentralPubMedCrossRefGoogle Scholar
  39. Vasankari T, Jousilahti P, Knekt P et al (2011) Serum cotinine predicts bronchial obstruction regardless of self-reported smoking history. Scand J Public Health 39:547–552PubMedCrossRefGoogle Scholar
  40. Wagenknecht LE, Burke GL, Perkins LL et al (1992) Misclassification of smoking status in the CARDIA study: a comparison of self-report with serum cotinine levels. Am J Public Health 82:33–36PubMedCentralPubMedCrossRefGoogle Scholar
  41. World Health Organization (1998) Guidelines for controlling and monitoring the tobacco epidemic, GenevaGoogle Scholar
  42. World Health Survey (2002) Sampling Guidelines for Participating Countries. Switzerland, GenevaGoogle Scholar
  43. World Health Survey Report of Turkey (2012) Accessed 20 September 2012
  44. Yürekli A, Önder Z, Elibol M et al (2010) The Economics of Tobacco Control and Tobacco Taxation: Challenges & Opportunities for a Tobacco Free Turkey. Accessed 10 November 2011

Copyright information

© Swiss School of Public Health 2013

Authors and Affiliations

  1. 1.Department of Public HealthEge University School of MedicineIzmirTurkey
  2. 2.Department of Public Health, Academic Medical Centre (AMC)University of AmsterdamAmsterdamThe Netherlands

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