Learning How to Smoke: Explorations on Tobacco Use by Turkish Youth

This study identified social and cultural factors that influence smoking behavior of rural/urban youth, age 15-17, who attend high school in Dursunbey, a small town in Turkey's Aegean region. Methods consisted of a cross-sectional, school-based survey of all 10th graders (N=211) in 5 high schools in Dursunbey, augmented by qualitative semi-structured interviews with 42 10th grade students, 10 other students, 14 adult educators, and 4 other adults. The survey identified several risk factors for current smoking of adolescents (any smoking within the last 30 days): the number of close smoking friends and teacher smoking, male gender, age, and academic achievement. Urban/rural origin, pocket money, family smoking behavior, and school type were not statistically significant. Exposure to teachers who smoked was associated with increased smoking risk. Males were at 12 times the risk of smoking. Both adolescents and adults say that "everybody smokes." Interview data revealed an adolescent need to fit in with a group, a sense of shared excitement in transgressing the rules imposed by adult authority, and pressure resulting from a strong association of smoking with Turkish male identity.