The United States (US) and Turkey have shared a
friendly coexistence throughout the modern era as two
relatively new countries. A similar culture is something
they do not share, however, and perhaps it is that difference,
whether historical, religious or cultural that is
clear especially when it comes to the habit of smoking.
In fact, it is one of the first things a foreigner might notice
in Turkey. An attention grabbing development in the
country regarding the increase in female tobacco use has
particularly begun to cause concern and ignite attempts at
explaining the reasoning behind this development, especially
when other countries such as the United States have
experienced decreases in female tobacco use. Women are
increasingly playing a major part in the tobacco reliant
Turkish culture, possibly as a byproduct of their increasing
independence. As both the US and Turkey collaborate
on international and national approaches to the detriments
of tobacco, they encounter similarities such as the challenges
presented by the tobacco industries’ heavily female
oriented target marketing, yet they are distinguished by
their differences in traditional and popular culture.
In this paper, the patterns and dynamics of women’s
tobacco consumption in both US and Turkey will be discussed.
PATTERNS
Smoking prevalence in developing countries
The United States and Turkey differ in their level of
development on a global scale and this fact alone explains
the differences observed in their trends of female
tobacco use. Countries are classified as either developed
or developing, and development is measured based on a
modern physical and institutional infrastructure as well as
prolific economic system[1]. The United States is a major
world power and one of the strongest economic and
military forces on the globe, thus it has been classified as
developed[2]. Turkey’s status is more uncertain because
of its entrance as an emerging market and rapidly expanding
economy, therefore it is classified as one of the more
developed developing countries[3].
Today, developing countries contain 75% of the
world’s smokers and even with an overall prevalence decrease
of 1%, the number of female smokers is predicted
to reach 259 million in 2025 from 218 million in 2000[4,5]. By 2030 70% of deaths from tobacco related diseases
will be in developing countries. Currently, 22% of
females in developed countries and 9% of females in developing
countries smoke and these statistics are quickly
changing so that females in developing nations will reach
those in developed nations[6]. Unless smoking patterns
change, the future health of women in developing countries
like Turkey is looking more and more grim as conditions
on this front in the US improve.
US and Turkey smoking prevalence
There are 1.3 billion smokers worldwide, a number
representing over one sixth of the world population[7]. A
staggering 45.3 million American smokers help comprise
an even larger portion of that figure[8]. Despite there being
nearly double the number of smokers in the United
States, 30% of the Turkish population are purposefully inhaling
tobacco fumes on a daily basis, faring higher than
the US with a 23.4% smoking population[9]. To provide
another point of comparison, one may look at both genders
for a greater perspective and learn that in 2005 the
prevalence amongst females over 15 years of age was
found to be 21.5% in the US and 19.2% in Turkey and for
males over 15 years of age, 26.3% in the US and 51.6%
in Turkey[10].
An increasing economic independency in Turkish
women may provide an explanation to the increasing
prevalence of female smokers. Some of the main determinants
of economic independency are marital status,
level of education, use of earnings, presence of income,
and area of residence. These factors can be assumed as
largely cultural, as they are often driven not by economic
influences but by social influences. Key data was correlated
from these determining factors so that the common
characteristics of female smokers could thus be assessed
based on the 2003 Turkey Demographic and Health Survey
results of 10,836 households and 8,075 ever-married
women ages 15-49[11].
From the following statistics, interrelated characteristics
can be determined. Of the ever-married women
surveyed 95% were still married, 3% divorced and 2%
widowed. Being that almost all these women had experienced
marriage and were still currently married, it shows
the likelihood that Turkish women will be married or stay
married. Thus, leading a single lifestyle after reaching an
age in which marriage is appropriate or even later in life
appears infrequently. Perhaps, it is incongruous with a
typical Turkish lifestyle and culture. The same cannot be
said of the United States.
A great shift is being experienced in the level of education
being attained by younger female generations of
Turkey, yet the disparity between male and female education
is unfortunately still old news. While 28.1% of urban
men have achieved a high school or higher education,
only 18.8% of urban women have and in rural areas the
comparison is 10.1% of men to only 4.4% of women. In
terms of imbalance between genders, these figures report
a travesty of the education system in Turkey. Although
both male and female numbers in education call for improvement,
the gap between the two groups suggest a
cultural inclination to withhold women from school and
favor men’s educational career ambitions.
Yet, upon closer look at the different rates amongst
women, more nuanced conclusions may be reached.
21.8% of all the women surveyed were reported to have
had no education, 53.7% had a first level primary education,
7.4% second level primary education and 17.0% a
high school education or higher. These figures aren’t anything to boast about, yet even they shed some hope for the
future. In fact, the amount of women who have received
second level primary education increased from 15 percent
to 24 percent in a span of ten years in 2003, a roughly 60
percent increase. The predicament of one in five Turkish
women receiving no education is actually seen as a positive
shift in direction for women compared to the past.
The Data also exhibits a steady increase in women with
higher education and decrease in women with no education
with each younger age group. For example, 24.5% of
women in the ages 24-29 have had high school or higher
education, compared to 17.8% between the ages 30-34,
15.5% between the ages of 35-39, 14.8% between the
ages of 40-44 and 12.5% between the ages of 45-49. What
this displays is an increase and spread in higher education
opportunities with every year, and more career fields
opening their doors to women as time goes on. Not only
are more women attending high school, but they are also
being accepted into more universities, successfully graduating
and entering the workforce in areas where usually
only men were previously found[12].
This leads to data regarding residence, particularly
those of women living in urban areas. Of the urban women
surveyed, 21.8% had received a high school or higher
education and 18% had received no education. Of rural
women, on the other hand, only 5% of them had received
a high school or higher education and 31% had received
no education. Women living in the East of Turkey were
noted to have the lowest levels of education, and women
in the northwest, the highest levels of education in the
country. There is a great inequity in the dispersion of education
throughout the different regions, which inhibits
unified progress and results in different parts of the country
progressing at different rates. This can promote internal
conflicts within Turkey if all regions do not receive
the same attention from national systems.
Receiving education ensures a more promising future
with the higher likelihood of not only employment in the
individual, but an enhanced family income. What has
come to pass in today’s society is that with a stable sufficient
income, a woman is supplied with a more comfortable
stable and therefore personally satisfying lifestyle.
Looking at the data regarding employment, there is a significant variance between employment rates of women
of differing marital status. Thus, a strong association was
found to exist between employment and marital status, indicating
that either the need, desire or both, to be economically
self-sufficient and hold an occupation is stronger
in single Turkish women or, that once married, women
discontinue work. Correlating with this matter however is
the fact that employed women do not necessarily control
their own earnings and this matter too shows variance.
When employed urban and rural women were compared,
as could be guessed, employed urban women were found
to have more control of their earnings. When comparing
employed women of differing education levels, independent
decision making was least common among women
with less education. Only 1% of high school or higher
educated women had absolutely no say in their earnings,
compared to the 22% of women with no education that
had no say in their earnings. When looking at marital status
and its relationship with women’s control of earnings,
predictably a vast 84.6% majority of non-married women
were in sole control of their earnings, compared to 32%
of married women.
What this reveals is that an economically independent
Turkish woman statistically lives in an urban residence,
controls her earnings, holds a high school or higher education,
and increases her chances of this independency by
being single. The typical characteristics of this prototype
of woman strongly clash with the traditional role of the
Turkish female. This phenomenon of women picking
up smoking as they gain economic independence could
provide a solid explanation behind the increase in female
smoking prevalence in European countries. Of European
countries surveyed, Turkey was determined to be tenth
from the bottom in this category. While being on the bottom
half of the list does not sound alarming in itself, this
indicates that women are not traditionally smokers and
what this low percentage of female smokers essentially
does is distract from the increase in the prevalence. Also
the high percentage of male and low percentage of female
smokers makes the gender gap in smoking prevalence
very wide. Turkey is eighth from the top in this category
in European countries. Turkey’s having such a high gap
coincides with previously mentioned gaps within Turkey
such as educational backgrounds[13]. The causes of these gaps are undoubtedly tied to Turkey’s cultural tendency
to view actions like smoking and attending school to be
more masculine habits.
The United States female smoking prevalence has
been steadily dropping. The number of female smokers is
decreasing at separate rates amongst different ethnicities
and socioeconomic levels throughout the country. These
rates are notably determined in cohorts in which women
smokers are classified into their birth years and judged
from there[1]. According to the 2001 Surgeon General’s
Report, women born in the 1920’s and 1940’s were found
to have the highest prevalence in the 20th century. Set off
by a major decline starting from 1974, the prevalence of
current smoking reached a low of 22% in 1998 and continues
to steadily decrease in women[14]. From this, it is
evident that American culture is experiencing a decline in
the desire or will to smoke despite its history of women
smoking for quite some time.
The numbers of American and Turkish smokers today
are important figures to consider, yet it is the prevalence
trends of these two countries that chiefly demand attention.
An increase or decrease in prevalence marks the
public health progress of a nation. This progress suggests
the country’s either positive or negative direction in terms
of its tobacco prevention programs, strength of its antismoking
legislation and effectiveness of tobacco industry
restrictions. If these components are being effectively implemented,
the prevalence appropriately receives a drop.
Also, from these details not only can we ascertain that the
number of smokers does not reveal a country’s increasing
or decreasing smoking prevalence rate but also, based
on the size of the gap in gender smoking prevalence, the
two countries obviously differ in the relationship between
gender roles and smoking.
An increase in female smoking prevalence is an especially
worrisome topic in Turkey and other developing
countries as their habits have very dramatic effects on
their families[15]. As the primary caregivers in the home,
when their health suffers, the entire family likely suffers
along with them. People in low-income families are found
to quit less often and cannot afford the healthcare required
for tobacco related diseases, thus leaving them with even
more financial burden[5]. Additionally low-income occupations commonly require physical labor and demand
healthy bodies to carry out work. Smoking is pushing
those in developing countries even further into the ground
by using up what little resources they have and causing
health defects that inhibit them from being able to sustain
themselves economically. Thus, those that are the least
able to afford such losses in productivity and health are
succumbing to the tobacco industry’s messages[16].
DYNAMICS
Cultural influences
Women have personal reasons unique to those of men
for taking up smoking like weight control, increasingly
high stress due to responsibilities of caring for children,
growing careers, female physical health issues and dealing
with the hectic nature of urban lifestyles[17]. Turkey is
also a nation in a state of cultural fluctuation and change.
The traditional past of Turkish history containing specific
male and female dynamics is up against a modern world
of new developments such as economic globalization and
the free exchange of liberal ideas and beliefs through media
outlets and the internet. The balancing of old with new
directly relates to the differing lifestyle habits shifting between
men and women.
This all points to a positive chain of events that must
continue for further progress, but is also resulting in dramatic
cultural changes of traditional female roles in Turkey.
What was, is no longer. Turkish women are feeling
the winds of empowerment, fueled by their education and
employment. It is giving them strong foundations to build
a self-sufficient lifestyle, which is affecting their marital
status and control of monetary earnings. This could lead
to a country of more economically independent women,
which ultimately would lead to national change and consequently,
traditional gender behavioral shifts. In becoming
or wanting to become economically independent, more
women are opening up to the experiences of personal decision
making, as well as feelings of expanded freedoms
and emancipation from traditional female roles. Hence,
the idea of the ‘Turkish Modern woman’ is becoming a
mainstream goal for younger generations with the aid of
progressive social developments in the country. It must be added here however, that certainly not all segments of
Turkish society view this as a positive development. Centuries
of patriarchal culture do not disappear in a decade
or even one generation. On a negative note, the increase
in cigarette consumption amongst Turkish females may
possibly prove to be an unfortunate serious side effect of
this growing economic independence[18].
This isn’t to say that a number of modern economically
self sufficient women in the United States don’t smoke
for similar reasons, but a link between independence and
tobacco hasn’t been made due to the fact that prevalence
is decreasing. Also, American women have been breaking
traditional gender stigmas and barriers with a louder force
for many years. Feminist literary works and organizations
have pushed for all sorts of women’s rights like birth control
information, contraceptive availability and workplace
non-discrimination that have endowed many American
women with the feeling that their independence is encouraged
and more importantly, that this will not be judged
as a negative thing[19]. Thus, cigarette smoking in the
United States is seen not as a stamp of independence, but
simply as a harmful habit for which the prevalence is decreasing,
than it does perhaps in Turkey where prevalence
is increasing.
Tobacco industry marketing
Tobacco marketing strategists recognize a cultural
shift in developing countries, and have responded with
cleverly designed advertisements that implant manipulative
ideas of consumerism and false ideas of the necessity
of cigarettes to becoming independent. Advertisements are
often similar or identical between the US and Turkey because
Turkey’s tobacco industry will copy its competitors
in hope of staying afloat in new target markets. Cigarettes
have been conveyed in advertisements of both countries
as a main component of an image that women ought to
covet. This image goes something like this: an extremely
slim, attractive young woman in an expensive suit with a
briefcase in hand, standing confidently in an affluent city
avenue, is smoking a cigarette as an attractive man slowly
passes her by with a hungry eye. The objectives that tobacco
advertisements wants to achieve through these sorts
of marketing strategies is to strike at women’s vulnerabilities.
These vulnerabilities typically found in women who have been fueled by the new global economy and the opportunities
for freedom and independence, are the wish
to be thin, attractive, financially successful, independent,
and therefore socially and sexually desirable. Women in
developing countries typically experience gender inequities
on heavier levels than those in developed countries so
these women are also more affected by marketing messages[20].
The United States has certainly had its share of shrewd
advertisement slogans. US Tobacco advertising has been
geared towards women as early as the 1920’s with messages
like, ‘’Reach for a Lucky (brand name) instead of
a sweet,’’ leading women to believe cigarettes should be
smoked to maintain a slim figure when no connection has
been definitively made, though studies on the link between
weight and smoking continue. Even if cigarettes
were determined to be an effective weight loss aid, such
a claim would be comparable to encouraging millions
of women to ingest a daily poison for mostly superficial
causes. Yet, these deceitful and manipulative tobacco slogans
have been distributed for almost a hundred years.
This message was quite effective in that it produced a
300% increase in sales that year. Virginia Slims cigarettes
have employed, ‘’It’s a woman thing,’’ to their cigarettes
which feed women the idea that they should smoke just as
much or more than men. Once more the silent competition
or rivalry with men is slipped into the images associated
with tobacco consumption. Virginia Slims also used
‘’You’ve come a long way, baby’’ to denote success and
women empowerment and ‘’Find Your Voice’’ another
absurd overstatement dwells on women’s empowerment
once again[21]. The effect female consumers can have
on sales is astounding and gathers the interest of not only
tobacco industries, but a majority of other industries as
well.
By craftily taking advantage of the shifting attitudes
in Turkish women towards smoking, Turkey has an even
greater leverage to pull in new female smokers. As a
country it need not even put in as much effort for tobacco
advertising as the United States does, being that the
use of tobacco has already long been established as part
of their culture. Tobacco reached Turkey roughly in the
16th century and took hold immediately as a favorite past time, though primarily in men. Before the Turkish Revolution,
the Ottoman Turks perfected methods of growing
and using tobacco with Macedonian seeds imported from
Greece[22]. ‘Hookah’ a multi-stemmed water pipe used
for smoking, has been around for centuries and grew in
popularity 500 years ago when it made its way to Turkey[23]. When tobacco has been engrained in the society’s
culture for hundreds of years it becomes even harder
to eliminate a traditional Turkish comfort. Both countries
are re-introducing the concept of hookah smoking
to women as a more enjoyable, social activity that feels
like going back into time and enables them to taste sweet
non-caloric flavors like cappuccino, peach and banana[24]. Because the hookah, what Turks also call ‘nargile’
or ‘shisha’ is an already prevalent and well known form
of tobacco use amongst Turkish people, its resurgence as
a popular activity throughout Eastern Europe was less of
a marketing triumph on Turkey’s standpoint but more of a
profitable utilization of the country’s traditional past and
the younger generations’ eagerness to connect with their
ancestral heritage[25].
The US Surgeon General report of 2001 named advertisements
as a primary influential factor in female
smoking because of their recognition and success of taking
advantage of women’s desires and playing with their
notions of self-esteem. There is irony to be found that
marketing advertisements and their counterpoint pro ban
propaganda are both so successful, despite their opposing
aims. Female adolescents are found to be extremely
susceptible to marketing ploys and yet, they are also quite
responsive to a lack of cigarette marketing[26]. Whatever
advertisements feed or do not feed, young women act like
sponges to media influence. A national study on the sales
of cigarettes found that tobacco consumption experiences
a 16% decline after a country enforces advertising bans[27]. What is most troubling though is how malleable the
female market is when it comes to anything, as the studies
prove.
Role models and the media
Another explanation for the differing smoking patterns
among the female population of the United States
and Turkey may have to do with none other than Hollywood.
The rich and famous that set the trends, are celebrities who often have an influence on what direction the
youth take by dictating what is ‘cool’. Young Americans
look up to celebrities and the decrease of young American
women smoking might be due to their healthier choice of
role models.
Role models are figures that children or even adults
look up to or follow for guidance, especially through emulation
of their particular social and moral behaviors. A
role model does not necessarily engage in exemplary actions
and can be idolized for an infinite array of reasons.
One may take interest in studying the psychological reasoning
behind a society, community or individual’s role
model choices and find among other things, that there is
an perverse propensity for human nature to be fascinated
by role models of both ‘socially praised’ and ‘socially
condemned’ behavior. While the title of a role model generally
connotes morality and advancement, role models
can earn their popularity through partaking in a hazardous
or self-destructive act or lifestyle pattern, like smoking.
Whatever the reasons behind this conflicting duality, there
lies the answer to why women choose to emulate figures
that encourage smoking and similar harmful behavior in
some countries and not in others.
In the past ten years, a health craze has set upon the
American public. In supermarkets, all groceries, drinks
and food products now broadcast in loud print antioxidant
contents, heart benefits, cancer fighting ingredients and
other health benefiting promises. The American population,
spurred by an aging baby boomer population which
hopes to never grow old, has demanded stricter government
control over food and health products which in turn
has led to industries devoted to better health. There is a sort
of obsession with health in the United States now more
than ever, and Hollywood has undoubtedly aided this. On
television, singers offer personal healthy meal recommendations,
longevity tonic recipes, exercise moves and detox
regimens[28].
The media is full of role models for adolescent girls.
Adolescents are the most vulnerable age group of women
towards not only tobacco, but other influences as well.
At a certain age in which they are no longer under strict
supervision by their parents, they still haven’t acquired
sufficient wisdom and experience to make correct lifestyle choices. Reasonably, young women look to an outside
person who is separate from their family and whom
seems socially popular, in which case the media most conveniently
presents itself with a menu of public figures.
Magazines, television shows, films, fashion and music are
only some of the main media outlets in which females tie
their ideas, beliefs and aspirations.
Smoking is the last thing a wise celebrity would want
to bring up in a magazine or television interview, because
not only is it portrayed as a ‘dirty’ habit in the United
States but cigarette addiction habits have proved to be
extremely detrimental to famous reputations. Celebrities
take great care not to smoke in public in the United
States, hiding their smoking habits or stopping altogether
because of the inconsistency smoking presents with the
image of healthy living considered so attractive particularly
in California.
This topic has achieved much attention in the film industry,
and even stirred movie scripts and projects. Some
motion pictures might have depicted the intensity of the
American public’s attitude against tobacco use and television
characters tossed their cigarettes away, implying
that even the most fashionable, sexy women on television
are done with tobacco. Such is not the case in Turkey,
however, and besides a few celebrities coming out
in public against cigarette smoking, Turkish pop culture
and famous icons are drenched with a public image that
promotes smoking when socializing. Female celebrities
don’t have a social stigma against smoking to worry about
so when a movie premiere interview begins they thoughtlessly
light their cigarettes up. Resultantly, young women
in the United States have a relatively higher chance of
picking a role model that doesn’t publicly smoke than the
young women in Turkey who don’t have to lift their heads
twice to find a celebrity smoker.
Turkey and US tobacco industry
Tobacco companies have moved business away from
developed countries since 1990 by increasing the shares
of world cigarette production and consumption in developing
countries. From 1980 to today, this share has
increased from 50% to 70%[29]. Without change, consumption
in developing countries is predicted to reach
71% by 2010, increasing from 4.2 million tons in 1999 to 5.09 million tons[30]. In addition to Turkey, countries
such as the Dominican Republic, Indonesia and Mexico,
tobacco industries are pressuring the government to block
tax increases and marketing restrictions and support the
tobacco markets in buying majority stakes. As a result,
tobacco companies get away with fallacies and the public
does not know any better to reject the misleading information
that they are being fed[2]. As a matter of fact, 40%
of the world’s population live in countries that do not prevent
use of misleading packaging terms such as ‘’light’’
and ‘’low-tar’’ which are terms that do not reduce health
risk but appear to[31].
Not surprisingly, Turkish cigarette consumption rose
44% between the 1994 and 2000, and increased from 100
billion cigarettes a year to 121 billion in the year 2000.
To further demonstrate Turkey’s alarming situation, from
1990 to 1999 Turkey was the second among countries
with the highest growth in cigarette consumption, trailing
behind Pakistan alone[32]. Turkey also harvested
261,809 metric tons of tobacco and claimed the sixth spot
amongst the largest global tobacco producers in 1998. By
that year, land devoted to tobacco cultivation increased by
66% in a span of thirteen years totaling at 725,000 acres[33]. All this growth signals an industry that is growing
tremendously and shows no sign of stopping soon. Recently
from 2001 to 2006 the tobacco market was noted to
have increased at an annual rate of 3.7%[34]. This rapid
growth in Turkey’s tobacco economy renders the country
even more reliant on tobacco revenue.
As Turkey becomes a contender in the global tobacco
market, this would certainly not be a wise time to invest in
the US tobacco business. Since 1982, the US Tobacco Production,
Consumption, and Export Trends Congress Report
shows that both cigarette consumption and cigarette exports
have been decreasing and consequently, the industry
has seen drops in almost every measured growth trend. The
total number of cigarettes consumed declined from 640 billion
in 1981 to 420 billion in 2002. Interestingly enough,
the world has seen an increase in tobacco exports these past
three decades with the single exception of the United States.
US grown tobacco has been experiencing a decline since
1975 from 1.941 billion pounds to 1.121 billion pounds or
560,500 metric tons in 2001, exhibiting a 42% decrease. The US share in world exports has decreased from 27% in
1969 to 7% in 2002 as other countries’ tobacco industries
like Turkey’s gain strength[35].
The tobacco industries of both United States and Turkey
are important in the scheme of the global economy,
as well as in their own national interest. They manage
multi-billion dollar businesses and their success ensures
jobs for thousands of employees and their employers. As
for the primary tobacco industry in Turkey, it is the sole
manufacturer and distributor of all tobacco products in the
country. Despite all the harmful effects of tobacco use, if
one were to defend the tobacco industries and their hopes
in dragging in more female consumers, one could draw on
the economic importance of those invested in the industry
professionally. Yet, even this would not be a convincing
argument being that in the United States $97.6 billion is
lost every year in productivity due to smoking and the
annual public and private health care expenditures caused
by smoking has amounted to $96.7 billion[36].
The industries, themselves, are at the root of smoking
prevalence and have been up against great opposition ever
since the first General Surgeon’s Report in 1964 brought
in a team of health experts to crush their influence. In
light of this, tobacco users are not the only ones to blame.
Tobacco industries consisting of teams of producers and
manufacturers help indirectly kill 100,000 Turks and
400,000 Americans a year as a by product of their business[37]. Objectively speaking, the cigarette is a unique
product on the market today in that in one aspect, it is unlike
any other legally sold product. A cigarette is the only
legally available consumer product that kills through normal
use and so it is necessary to set restrictions on such
a product being that it is still permitted[38]. There are,
in fact, 599 government approved additives used for the
manufacture of cigarettes that were kept secret for years
by major tobacco companies[39].
In visiting the websites of a major Turkish and American
tobacco company some noticeable differences can
easily be made. The Turkish website does not advertise
any tobacco products, stating, ‘‘In accordance with the
Act No 4207 on Prevention of Harmful Effects of Tobacco
Products, we do not advertise our tobaccos and tobacco
products.’’ The American website does contain several pages in which it flashes pictures of cigarette packs across
the screen and claims no such restriction on its advertisements.
Based on appearance alone, the Turkish company
would appear to be more committed to its consumers’
health due to its web page background of green landscapes
and healthy children. Both websites include a ‘Smoking
and Health’ page. The Turkish ‘Smoking and Health’
website page speaks in a seemingly genuine and honest
manner, showing a wish to stop smoking among younger
generations as it willingly accepts all the facts regarding
harmful effects of tobacco. It even goes as far as claiming
membership in anti-smoking programs in Turkey. It is
difficult to not remain skeptical, however, when names of
anti-smoking programs or further information is lacking
and what harmful effects of tobacco they admit to aren’t
brought up in much detail. The font type is very casual and
cheery, as is the background, and the attitude maintained
throughout is one of nonchalance and even optimism at
the notion of anti-smoking and smoking platforms working
together within the Turkish community, though this is
a seemingly contradictory idea. All this could easily give
the impression that the tobacco company’s concern for
smoker’s health is forced and not to be taken seriously[40]. Turning attention to the American website’s ‘Smoking
and Health’ page, the blatant differences come into
view here. The font of the writing is extremely small and
hard to read and the background colors are a bland and
unpleasant greenish grey tint, as if the web page designer
wanted the reader to become frustrated with the font and
nauseated by the color and stop reading. Nevertheless, the
information provided on the American website is surprisingly
in-depth. Lists of public health information, health
links, surgeon general reports and organizational websites
such as that of the American Heart Association, American
Cancer Society and the CDC are given[41]. From the differences
in the Turkish and American websites, one can
assume that because the United States tobacco industries
have been hit with so many law suits and public defamations
over purposeful distortion of cigarette’s harmful effects
in the past, there has been an increased pressure to
lay everything out on the line very explicitly. In fact this
has been a condition imposed upon the tobacco industry
by the American government, as a compromise to outright
banning the manufacture of cigarettes.
MEASURES FOR PREVENTION
Global approaches
At this point what must be done lies in the hands of
the government and the people, and their cooperative efforts
in making a healthier population both at a national
and global level. The strongest efforts of a solution are undoubtedly
coming from collaborative global organizations
like the World Health Organization (WHO) that has placed
the United States and Turkey in the same boat and enabled
them to work out their problems hand in hand. WHO has
been instrumental on the front of tobacco prevention by
uniting nations all over the globe and supporting two major
projects: The Framework Convention on Tobacco Control
(FCTC) and the Tobacco Free Initiative.
The FCTC is an international project initiated in May
1995 at the 48th World Assembly that presents a treaty
that countries can sign to promise allegiance to certain
tobacco control measures. So far, there are 156 parties and
168 signatures. Turkey became a party member in April of
2004 and ratified the treaty in December of that same year.
In May of 2004 the United States signed on to the FCTC,
as well[42]. Affiliated countries are made aware and responsible
for controlling the female targeted marketing
of tobacco industries. The official FCTC publication updated
in 2005 claimed in the preamble that all parties were
to be alarmed of the increase in female tobacco and strive
for ‘full participation at all levels of policy-making and
implementation and the need for gender specific tobacco
control strategies’. Purposes, obligations, objectives and
measures are subsequently outlined in great detail to join
the parties together on similar issues[43].
The WHO MPOWER outlines six of the most effective
policies that the US and Turkey are recommended to
follow and they are: monitoring tobacco use and prevention,
protecting people from passive smoking, offering
help to those who wish to quit, warning people about the
dangers of tobacco, enforcing bans on tobacco advertising,
and raising taxes on tobacco products[44]. WHO
MPOWER encourages countries to care about the rest of
the world and not be narrow-minded in thinking that their
own national interest is of sole importance. Through collaborative
world progress, every country benefits and no
one gets left behind. For this reason WHO stresses the importance of reaching out to developing countries that
don’t have the resources to control tobacco related problems.
National measures
In both countries, a self-destructive disregard for one’s
own health has become apparent through continued use of
tobacco, revealing that information is simply not enough.
Many specific national measures have been taken to reduce
the use of tobacco products. Through taxation and
price policies, aiming at people’s wallets has proven to be
more of a deterrent strategy than disseminating information
alone. For the United States, the Surgeon General Report
of 1989 estimated every ten percent increase in cigarette
prices to result in an average drop of 4.7 percent in the
number of cigarettes demanded[45]. Many health organizations
put pressure on governments to heavily tax tobacco
products with a preventative motive in mind. The European
Tobacco Control Report presents tables of annual price
variations and tobacco taxation figures in EU countries,
however Turkey was one of the few countries in which no
information was available on these matters. Compared to
other European countries and the United States there is an
inadequate or inferior amount of data collection, recording
and analysis to make parallel observations with Turkey.
Turkey’s cigarettes have apparently experienced waves in
total taxation incidence, or percentages of taxation in the
retail price, though cigarettes still stand at a lower price
than foreign brands. Much of the cigarette taxation in Turkey
is influenced by other factors besides revenue such
as inflation, natural disaster tolls and internal government
changes. Domestic cigarettes purchases in Turkey are notably
less expensive than those in the US and have even
resulted in the transportation and underground reselling of
products for illegal profits. Overall, more affordability is
offered to Turkish smokers[3].
Generally, the public norm is to smoke as one socializes
in Turkey. For this norm to be changed there must be
change in how one socializes. This includes not only the
female smoking population but male population. Changing
the social norms of Turkey starts from the ground
up. In this case, the ground represents the foundation of
smoking education provided for younger generations to
dissuade their smoking inclinations, curiosity and misin- formation. Because habits are so hard to break, smokers
keep at their habits despite a noticeable deterioration in
their health. One needs all the weapons in an arsenal to
combat this habit. There is a highly organized and thoroughly
developed tobacco use prevention infrastructure
and education system found in the United States where
it was found if social influences are directly addressed,
educational programs prevent the onset of smoking in up
to 40% of adolescents[46].
The European Tobacco Control Report of 2007 states
that in Turkey there is no definitive education about the
addiction and health hazards of tobacco use in schools,
public awareness campaigns or counter advertising. This
is a promoting factor for the Turkish smoking culture
and appears as a great national blunder that despite all
of the information on the harmful effects of tobacco and
the reality of Turkey’s smoking reputation, children are
not receiving definitive anti-smoking education. Perhaps
Turkish government officials are afraid that educating the
young will turn them against their smoking parents. The
young are a profoundly positive influence on their parents.
In the United States, many individuals have stopped
because of the constant scolding they received by a son or
daughter presenting them with the facts of the destructive
habit of smoking. The prevention element in an effective
anti-smoking program would minimize this difficulty.
Although there is a general awareness of tobacco use’s
harm, the extent of that harm is not widely known, ignorance
has stubbornly adhered to the minds of those who
do not wish to believe in that harm’s extent and knowledge
is frequently limited and misconstrued.
Yet, Turkey’s perspective on this is that at young ages
in school-going children, exposure of any knowledge or
images of smoking that may promote curiosity of tobacco
should not be permitted. Instead, the hope that parents
will abstain from smoking near their children with the
avoidance of the topic altogether persists as a method for
tobacco prevention for children. This type of outlook may
reflect Turkish culture’s distaste of confrontation between
generations. It would seem to fly in the face of respect for
one’s elders, so much a part of Turkish norms. The idea
that Turkish children will be able to avoid exposure to
tobacco use in their daily lives better if it isn’t presented in the school curriculum, however is truly misguided. Perhaps
in a utopian society, in which every single citizen can
successfully hide their cigarettes, make every advertisement
disappear, and every cigarette on the ground become
invisible in the presence of a child, this method might
work. Unfortunately, young children will be exposed to
forms of tobacco one way or another. Even if their parents
or teachers pretend tobacco doesn’t ‘exist’, the eyes of
children cannot be shielded from the rest of the world.
Non-confrontation has rarely been effective in alleviating
troublesome issues, and thus if children are to see or
hear anything tobacco related it should preferably be a
message that is firmly anti-tobacco and provided through
their education. Smokers will usually try their first cigarette
and become addicted at school-going ages and thus
this presents a major challenge in Turkey[47].
As part of a solution, US anti-smoking programs are
greater in number and are developed to a greater extent
because of their head start, yet this does not undermine
Turkey’s efforts to change. The National Tobacco Control
Program (Ulusal Tütün Kontrol Programý), was first
formed in 2005 with the clear objective of lessening Turkish
reliance on tobacco products and improving the health
of Turkish citizens with emphasis on the years spanning
2008 to 2012[48]. With 130 national counterparts and
stakeholders participating in joint efforts, the program
was presented to the Minister of Health for his approval
and launched in the presence of the Turkish Prime Minister
on December 12, 2007. Turkey has managed the Cigarette
and Health National Committee (Sigara ve Saðlýk
Ulusal Komitesi, SSUK) as well, which aims for a ‘united
tobacco free world’ and holds a National Cigarettes and
Health Congress since 1999[38]. As one of the prominent
anti-smoking organization SSUK are one of the path pavers
for a healthier Turkey that vows for change.
The United States’ head start has enabled the country
to reach all sorts of demographics that tackle issues on every
front, while simultaneously empowering women with
the hope of rejecting tobacco and the means for smoking
cessation. The US Girl Scouts are an outstanding example
of an organization that promotes a sense of well-being and
confidence in young girls and regularly issues publications
that inform girls of the hazards of tobacco use, the manipulative methods of tobacco advertisements, and tobacco
use avoidance. Organizations affiliating themselves with
all sorts of nationalities (The National Smoking Cessation
Campaign for African American Women), religious groups
(Young Women’s Christian Association), state specific organizations
(State of Oregon Prevention and Education
Program), and higher education and research foundations
(the American Nurses Association) leave women with infinite
ways of rejecting this harmful habit. Other United
States programs emphasize the power younger generations
have to direct the course of America’s future. Campaign
for Tobacco Free Kids was firmly established with 130
organizational partners and arranges festivals, fairs and
projects like the thirteenth annual Kick Butts Day on August
of 2008. Additionally, it is trying to pass bills to grant
the Food and Drugs Administration (FDA) more power in
placing more restrictive laws on tobacco products. Over
630 groups have come out to support this legislation,
which reveals just how vast and influential Campaign for
Tobacco Free Kids has been and hopefully will continue to
be[49]. The extensive list of programs have made it a top
priority to combat tobacco issues for many years now and
help provide an explanation to why the prevalence rates
are what they are. Above everything, the United States has
more financial means than Turkey to reach out to areas in
need, thus they are greater global contributor as well, and
able to supply money like the recent sum of 17 million
dollars to developing countries in addition to their national
tobacco preventative measures[50].
Moreover, countries affiliated with the same organizations
do not progress at an equal pace. Only 15 countries,
representing 6% of the world population, mandate
pictorial warnings that cover at least 30% of the principle
area of cigarette packets[51]. Dozens of countries have
implemented laws requiring health warning messages and
demand they be of a certain size, font and location on the
product to attract enough attention. Turkey is one of the
countries that place large warnings on cigarette packs,
while the US has one of the most disappointing health
message warning criteria. Cigarettes in Turkey include
on the front disturbing fact messages that are more direct
and blunt than the US warnings such as, ‘’Smoking
will slow blood flow and cause impotence’’ and ‘’Smoking
can cause a slow and painful death.’’ Such warnings have an increased deterrent effect on smokers and create a
reminder that every cigarette pulled from one’s packet is
causing that warning message to occur. If the US were to
take the next big move in decreasing smoking prevalence
at a faster pace, it should implement stronger warning
messages on cigarette packets.
Not only the smoking population but non-smokers are
affected through passive smoking. In passive smoking the
second-hand smoke, also called environmental tobacco
smoke, from another is inhaled by surrounding people.
The risks associated with smoking like heart disease and
cancer are the same for passive smokers and therefore
smoking restrictions have been set nationwide through
legislation of both of the countries[52]. In the US, smoking
bans have been determined by state law and for this
reason, the times that the bans were put into place vary
from state to state. Yet the US took a much more rapid
approach to the growing information on tobacco health
hazards. The state of Arizona initiated a smoking ban in
public places back in 1973, California followed in 1994
and so other states continued, while even enforcing stricter
rules with time. For instance, in Hawaii state smoking
is prohibited twenty feet from the entrance of a public
building and the same goes for Washington State with its
ban of twenty-five feet[53].
Perhaps the high prevalence of smoking is now even
more noticeable because of a newly implemented smoking
ban of Law 5727 in Turkey forcing everyone to take
their smoking outside or pay the price of 62 YTL[54].
The nationwide smoking ban in health, educational and
public facilities in Turkey was brought into action on May
19 2008 and has become an increasingly hot topic in the
country today[55]. The Turkish Prime Minister and Minister
of Health were among the many that boldly pushed
for this great public health step forward. On January 3,
2008 Turkey passed the Law 4207, which aims to shield
vulnerable citizens like pregnant women, elderly, children
and the ill from the detrimental effects of environmental
smoking. This ban will affect bars and restaurants within
the following year[56]. Although the smoking ban is new
and therefore relatively undetermined in its state of effectiveness
and level of public conformance, the country
shares both a view of optimism in the prospects of a healthier future and a view of skepticism from those who
perceive it as a change too radical and too unlike Turkey.
Turkey is only minimally behind other European nations
that have only just begun to strictly implement bans[57].
Yet the nation’s readiness to adhere to the ban is what sets
their progress apart. The difference in public willingness
to abide by a smoking ban is apparent between the US
and Turkey. According to a poll in Turkey, four-fifths of
Turks support the smoking ban, although a third of them
express heavy doubts of its effectiveness[58]. Whether
smoking directly underneath a doorway, puffing covertly
out a window or carelessly walking in and out of a building
with a cigarette, discrepancies have arose in the midst
of this ban in Turkey that cast a shadow over the public
health progress it purports to represent.
