İktisadi, İdari ve Sosyal Bilimler Fakültesi

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Citation - WoS: 15
Citation - Scopus: 17
Biomarkers of Secondhand Smoke Exposure in Waterpipe Tobacco Venue Employees in Istanbul Moscow and Cairo
(Oxford University Press, 2018) Moon, Katherine A.; Rule, Ana M.; Magid, Hoda; Ferguson, Jacqueline; Susan, Jolie; Sun, Zhuolu; Torrey, Christine; Abubaker, Salahaddin; Levshin, Vladimir; Çarkoğlu, Aslı; Radwan, Ghada Nasr; El-Rabbat, Maha; Cohen, Joanna E.; Strickland, Paul; Breysse, Patrick N.; Navas-Acien, Ana
Background: Most smoke-free legislation to reduce secondhand smoke (SHS) exposure exempts waterpipe (hookah) smoking venues. Few studies have examined SHS exposure in waterpipe venues and their employees. Methods: We surveyed 276 employees of 46 waterpipe tobacco venues in Istanbul Moscow and Cairo. We interviewed venue managers and employees and collected biological samples from employees to measure exhaled carbon monoxide (CO) hair nicotine saliva cotinine urine cotinine urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and urine 1-hydroxypyrene glucuronide (1-OHPG). We estimated adjusted geometric mean ratios (GMR) of each SHS biomarker by employee characteristics and indoor air SHS measures. Results: There were 73 nonsmoking employees and 203 current smokers of cigarettes or waterpipe. In nonsmokers the median (interquartile) range concentrations of SHS biomarkers were 1.1 (0.2 40.9) mu g/g creatinine urine cotinine 5.5 (2 15) ng/mL saliva cotinine 0.95 (0.36 5.02) ng/mg hair nicotine 1.48 (0.98 3.97) pg/mg creatinine urine NNAL 0.54 (0.25 0.97) pmol/mg creatinine urine 1-OHPG and 1.67 (1.33 2.33) ppm exhaled CO. An 8-hour increase in work hours was associated with higher urine cotinine (GMR: 1.68 95% CI: 1.20 2.37) and hair nicotine (GMR: 1.22 95% CI: 1.05 1.43). Lighting waterpipes was associated with higher saliva cotinine (GMR: 2.83 95% CI: 1.05 7.62). Conclusions: Nonsmoking employees of waterpipe tobacco venues were exposed to high levels of SHS including measurable levels of carcinogenic biomarkers (tobacco-specific nitrosamines and PAHs).
Citation - WoS: 35
Citation - Scopus: 39
Compliance With Smoke-Free Legislation Within Public Buildings: a Cross-Sectional Study in Turkey
(World Health Organization, 2016) Navas-Acien, Ana; Çarkoğlu, Aslı; Ergör, Gül; Hayran, Mutlu; Ergüder, Toker; Kaplan, Bekir; Susan, Jolie; Magid, Hoda; Pollak, Jonathan; Cohen, Joanna E.
ObjectiveTo investigate public compliance with legislation to prohibit smoking within public buildings and the extent of tobacco smoking in outdoor areas in Turkey. Methods Using a standardized observation protocol we determined whether smoking occurred and whether ashtrays cigarette butts and/or no-smoking signs were present in a random selection of 884 public venues in 12 cities in Turkey. We visited indoor and outdoor locations in bars/nightclubs cafes government buildings hospitals restaurants schools shopping malls traditional coffee houses and universities. We used logistic regression models to determine the association between the presence of ashtrays or the absence of no-smoking signs and the presence of individuals smoking or cigarette butts. Findings Most venues had no-smoking signs (629/884). We observed at least one person smoking in 145 venues most frequently observed in bars/nightclubs (63/79) hospital dining areas (18/79) traditional coffee houses (27/120) and government-building dining areas (5/23). For 538 venues we observed outdoor smoking close to public buildings. The presence of ashtrays was positively associated with indoor smoking and cigarette butts adjusted odds ratio aOR: 315.9
Citation - WoS: 1
Digital Epidemiology: Can Google Trends Give Some Information About Electronic Cigarette Usage in Turkey?
(European Respiratory Soc Journals Ltd, 2018) Uysal, Mehmet Atilla; Niksarlioglu, Yelda; Çarkoğlu, Aslı; Uysal, Omer; Kutluk, Ali Cevat; Karadag, Bulent
[Abstract Not Available]
Electronic Cigarette and Quit Smoking Quest in Twitter: Preliminary Study
(European Respiratory Soc Journals Ltd, 2018) Uysal, Mehmet Atilla; Çarkoğlu, Aslı; Kurnaz, Ahmet
Aims: Use of electronic cigarettes has dramatically increased in last few years. Although the sales of e-cigarettes were banned since 2013, they can still be easily purchased via online sales, and its' advertisement is rife in the social media. We aimed to take a closer look at the contents of the shared information about e-cigarettes on one such media outlet, Twitter. Methods: We tracked twitter for 102 days (from 25.09.2017-26.01.2018) searching for Turkish key words “electronic cigarettes”, “ ecigarettes”, or “e-cigarettes” using R software. This data was classified using unsupervised topic modelling. Resulting dataset was reduced and classified and 15 topics were established. Results: First 10 terms under each of the 15 topics were prioritized for this presentation. Words such as tobacco, dependence, cancerogen, substance, containing, waterpipe, liquid, liver indicated a general “harms of e-cigarettes” idea. Terms such as liquid, atomiser, IQS, health, aroma, variety, price, e-cigarette device pointed to “product advertising and marketing”. Text under topic 8 was more concerned with legalization issues, indicated by text such as “Iqos”(6) “omnibus bill”, “legal”. Text under topics 9 and 10 and the videos under topic 11 were mostly related to constraints in use and safety issues. Conclusion: Results of the study showed that chatter in the Turkish social media is mostly focused on those smokers contemplating quitting due to health risks involved in smoking. This points to an important opportunity for tobacco control community in Turkey to further inform the public on healthy ways to quit smoking and work to make cessation services more accessable Footnotes Cite this article as: European Respiratory Journal 2018 52: Suppl. 62, PA4544. This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
Citation - WoS: 6
Citation - Scopus: 11
Engaging Nurses in Smoking Cessation: Challenges and Opportunities in Turkey
(Elsevier Ireland Ltd., 2018) Nichter, Mimi; Çarkoğlu, Aslı; Nichter, Mark; Ozcan, Seyda; Uysal, Mehmet Atilla
This paper discusses the training of nurses in smoking cessation as part of routine patient care in Turkey. Formative research was carried out prior to training to identify challenges faced by smokers when trying to quit. Site visits to government hospitals and cessation clinics were conducted to observe health care provider-patient interactions involving behavior change. Four culturally sensitive cessation training workshops for nurses (n=54) were conducted in Istanbul. Following training nurses were debriefed on their experiences delivering cessation advice. Challenges to cessation counseling included lack of time and incentives for nurse involvement, lack of skills to deliver information about the harm of smoking and benefits of quitting, the medicalization of cessation through the use of pharmaceuticals, and hospital policy which devalues time spent on cessation activities. The pay-for-performance model currently adopted in hospitals has de-incentivized doctor participation in cessation clinics. Nurses play an important role in smoking cessation in many countries. In Turkey hospital policy will require change so that cessation counseling can become a routine part of nursing practice incentives for providing cessation are put in place and task sharing between nurses and doctors is clarified. Nurses and doctors need to receive training in both the systemic harms of smoking and cessation counseling skills. Opportunities challenges and lessons learned are highlighted. (C) 2017 Elsevier B.V. All rights reserved.
Citation - WoS: 9
Citation - Scopus: 13
Evaluation of Secondhand Smoke Using Pm2.5 and Observations in a Random Stratified Sample in Hospitality Venues From 12 Cities
(MDPI, 2019) Kaplan, Bekir; Çarkoğlu, Aslı; Ergör, Gül; Hayran, Mutlu; Sureda, Xisca; Cohen, Joanna E.; Navas-Acien, Ana
Background: Turkey passed a law banning smoking in all indoor public places in 2008. In response to the indoor smoking restriction many smokers may have relocated to outdoor areas of venues. The aim of this study was to evaluate air pollution related to SHS exposure in indoor and outdoor areas of hospitality venues in 12 cities in Turkey. Method: In this cross-sectional study we evaluated hospitality venues in 12 cities in Turkey. In each visited venue we evaluated a pre-specified number of study locations such as the outdoor area of the main entrance indoor areas and patios or other outdoor dining areas completely or partially covered with window walls. We measured particulate matter 2.5 (PM2.5) in those areas. Results: The fieldworkers visited 72 randomly selected hospitality venues and measured PM2.5 concentrations in 165 different locations (indoor outdoor and patios) of those venues. Overall 2573 people were observed 909 of them smoking. The median (IQR) PM2.5 concentrations were 95 (39-229) g/m(3) indoors 25 (13-48) g/m(3) outdoors and 31 g/m(3) (16-62) in the patios (p < 0.001). After adjustment each additional smoker was associated with a 2% increase in PM2.5 concentrations in patio air (GMR (95% CI): 1.02 (1.00 1.05) and a 4% increase in indoor air (GMR (95% CI): 1.04 (1.02 1.05). Conclusions: There were unhealthy levels of smoking-caused PM2.5 concentrations not only indoors but also in the patios of hospitality venues. Legislative efforts to expand the smoke-free legislation to outdoor areas adjacent to indoor public places and an action plan to increase compliance with the smoke-free policy are urgently needed in Turkey.
Citation - WoS: 10
Citation - Scopus: 13
Factors That Influence Attitude and Enforcement of the Smoke-Free Law in Turkey: a Survey of Hospitality Venue Owners and Employees
(Bmj Publishing Group, 2017) Aherrera, Angela; Çarkoğlu, Aslı; Hayran, Mutlu; Ergör, Gül; Ergüder, Toker; Kaplan, Bekir; Susan, Jolie; Zheng, Laura; Cohen, Joanna E.; Navas-Acien, Ana
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. Methods In 2014 we conducted 400 interviews with hospitality venue owners and employees in 7 cities in Turkey. The venues were identified based on a random sampling strategy in a previous phase of the study. Results Over one-third (37.3%) of hospitality owners and employees had adequate knowledge of the health effects from secondhand smoke (SHS) 71.3% had a positive attitude towards the law and 19.5% had personally enforced the law. Participants who worked 70 hours or more per week were more likely to have a positive attitude towards the law. Older individuals women participants working in bars/nightclubs venue owners receiving fines for non-compliance and current smokers were less likely to have a positive attitude towards the law. Participants working in traditional coffee houses former smokers and participants with a high school education or greater were more likely to enforce the law. Smokers who quit or reduced smoking because of the law were more likely to enforce the law compared with those who were not influenced by the law. Conclusions Although the attitude towards the law was positive interventions are needed to increase knowledge on the health effects of SHS and facilitate enforcement of the law particularly among subgroups less likely to have a positive attitude and enforce the law.
Factors That Influence Support and Enforcement of the Smoke-Free Law in Turkey
(Oxford University Press, 2016) Hayran, Mutlu; Aherrera, Angela; Çarkoğlu, Aslı; Ergör, Gül; Ergüder, Toker; Kaplan, Bekir; Susan, Jolie; Zheng, Laura; Cohen, Joanna E.; Navas-Acien, Ana
[Abstract Not Available]
Citation - Scopus: 5
For Whose Sake Is It Anyway? Evaluation of Explicit Family Policies in Turkey
(Springer New York, 2014) Çarkoğlu, Aslı; Kafescioğlu, Nilüfer
Family policies impact the life of every citizen in a society at a very private level. Their content as well as the processes through which they are formed and altered documents the powers that shape the lives of families at the macrolevel. In this chapter we aim to document the current state as well as the change processes of the family policies in Turkey a country of socioeconomic variety and rapid change. Here we will give precedence to the aspects of family policy that are explicitly linked to the formation and daily life of families such as the Civil Code the Labor and Social Security Laws as well as the laws and regulations concerning family violence. However we will be leaving out many other rules and regulations that impact families more implicitly through the conditions they present to individual members of families such as the Penal Code and its regulations. © Springer Science+Business Media New York 2014.
Citation - WoS: 23
Citation - Scopus: 26
Secondhand Smoke in Waterpipe Tobacco Venues in Istanbul Moscow and Cairo
(Academic Press Inc Elsevier Science, 2019) Moon, Katherine A.; Magid, Hoda; Torrey, Christine; Rule, Ana M.; Ferguson, Jacqueline; Susan, Jolie; Sun, Zhuolu; Abubaker, Salahaddin; Levshin, Vladimir; Çarkoğlu, Aslı; Radwan, Ghada Nasr; El-Rabbat, Maha; Cohen, Joanna E.; Strickland, Paul; Navas-Acien, Ana; Breysse, Patrick N.
Objective: The prevalence of waterpipe tobacco smoking has risen in recent decades. Controlled studies suggest that waterpipe secondhand smoke (SHS) contains similar or greater quantities of toxicants than cigarette SHS which causes significant morbidity and mortality. Few studies have examined SHS from waterpipe tobacco in real-world settings. The purpose of this study was to quantify SHS exposure levels and describe the characteristics of waterpipe tobacco venues. Methods: In 2012-2014 we conducted cross-sectional surveys of 46 waterpipe tobacco venues (9 in Istanbul 17 in Moscow and 20 in Cairo). We administered venue questionnaires conducted venue observations and sampled indoor air particulate matter (PM2.5) (N=35) carbon monoxide (CO) (N=23) particle-bound polycyclic aromatic hydrocarbons (p-PAHs) (N=31) 4-methylnitrosamino)-1-(3-pyridy1)-1-butanone (NNK) (N-43) and air nicotine (N=46). Results: Venue characteristics and SHS concentrations were highly variable within and between cities. Overall we observed a mean (standard deviation (SD)) of 5 (5) waterpipe smokers and 5 (3) cigarette smokers per venue. The overall median (25th percentile 75th percentile) of venue mean air concentrations was 136 (82 213) mu/m(3) for PM2.5 3.9 (1.7 22) ppm for CO 68 (33 121) ng/m(3) for p-PAHs 1.0 (0.5 1.9) ng/m(3) for NNK and 5.3 (0.7 14) mu g/m(3) for nicotine. PM2.5 CO and p-PAHs concentrations were generally higher in venues with more waterpipe smokers and cigarette smokers although associations were not statistically significant. Conclusion: High concentrations of SHS constituents known to cause health effects indicate that indoor air quality in waterpipe tobacco venues may adversely affect the health of employees and customers. (C) 2015 Elsevier Inc. All rights reserved.
Citation - WoS: 9
Citation - Scopus: 9
Smoke-Free Turkey: Evaluation of Outdoor Areas of Public Places
(Academic Press Inc Elsevier Science, 2019) Kaplan, Bekir; Grau-Perez, Maria; Çarkoğlu, Aslı; Ergör, Gül; Hayran, Mutlu; Navas-Acien, Ana; Cohen, Joanna E.
Significance: Secondhand tobacco smoke (SHS) exposure is a major cause of morbidity and mortality around the world. The objective of this study was to evaluate the presence of smoking in outdoor areas of public places in three largest Turkish cities (Istanbul Ankara and Izmir). Method: For this cross-sectional observational study the Turkish Statistical Institute randomly selected 10 sampling points in each city. Around each sampling point fieldworkers visited the closest bars/nightclubs cafes government buildings hospitals restaurants schools shopping malls traditional coffee houses universities children's playgrounds parks and open markets. We observed smoking ashtrays and cigarette butts at the outdoor areas of public venues within the urban districts of each city. The fieldwork was conducted in April–May 2016. Results: 477 venues were observed covering 1017 outdoor locations in which 17737 people were observed. Smoking in outdoor areas ranged from 3.7% around schools to 90% in open markets. Ashtrays were almost ubiquitous in hospitals (95.6%) shopping malls (92.0%) and universities (90.9%). Cigarette butts were more often observed in open markets (100%) shopping malls (96%) universities (95.5%) and parks (93.3%). Smoking at outdoor areas around schools was significantly lower than around other venues. Conclusion: Smoking in outdoor areas was common in most public places in Turkey except schools. The current indoor SHS legislation should be extended to cover adjacent outdoor areas of public venues in order to effectively protect people from SHS exposure in Turkey. © 2019 The Authors
Citation - WoS: 22
Citation - Scopus: 24
Waterpipe Tobacco Smoke: Characterization of Toxicants and Exposure Biomarkers in a Cross-Sectional Study of Waterpipe Employees
(Pergamon-Elsevier Science Ltd, 2019) Kaplan, Bekir; Sussan, Thomas; Rule, Ana M.; Moon, Katherine A.; Grau-Perez, Maria; Olmedo, Pablo; Chen, Rui; Çarkoğlu, Aslı; Levshin, Vladimir; Wang, Lanqing; Watson, Clifford; Blount, Benjamin; Calafat, Antonia M.; Jarrett, Jeffery; Caldwell, Kathleen; Wang, Yuesong; Breysse, Patrick N.; Strickland, Paul; Cohen, Joanna E.; Biswal, Shyam; Navas-Acien, Ana
Introduction: Few studies have comprehensively characterized toxic chemicals related to waterpipe use and secondhand waterpipe exposure. This cross-sectional study investigated biomarkers of toxicants associated with waterpipe use and passive waterpipe exposure among employees at waterpipe venues. Method: We collected urine specimens from employees in waterpipe venues from Istanbul Turkey and Moscow Russia and identified waterpipe and cigarette smoking status based on self-report. The final sample included 110 employees. Biomarkers of exposure to sixty chemicals (metals volatile organic compounds (VOCs) polycyclic aromatic hydrocarbons (PAHs) nicotine and heterocyclic aromatic amines (HCAAs)) were quantified in the participants' urine. Results: Participants who reported using waterpipe had higher urinary manganese (geometric mean ratio (GMR): 2.42 95% confidence interval (CI): 1.16 5.07) than never/former waterpipe or cigarette smokers. Being exposed to more hours of secondhand smoke from waterpipes was associated with higher concentrations of cobalt (GMR: 1.38 95% CI: 1.10 1.75). Participants involved in lighting waterpipes had higher urinary cobalt (GMR: 1.43 95% CI: 1.10 1.86) cesium (GMR: 1.21 95% CI: 1.00 1.48) molybdenum (GMR: 1.45 95% CI: 1.08 1.93) 1-hydroxypyrene (GMR: 1.36 95% CI: 1.03 1.80) and several VOC metabolites. Conclusion: Waterpipe tobacco users and nonsmoking employees of waterpipe venues had higher urinary concentrations of several toxic metals including manganese and cobalt as well as of VOCs in a distinct signature compared to cigarette smoke. Employees involved in lighting waterpipes may have higher exposure to multiple toxic chemicals compared to other employees.

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