While smoking was once perceived as a rich man’s habit, smoking prevalence has decreased in high-income countries in recent years and it has drastically risen in lowmiddle income countries. Similarly, little or no education and a low socio-economic status are indicators of smoking prevalence in high, medium and low-income countries [3]. However, this may not be true for adolescents. In most of the studies, adolescents from families of higher socioeconomic status were at greater risk for cigarette, alcohol and substance use than adolescents from families of lower socio-economic status [4,5].

Despite a decline in the prevalence of smoking in some adult populations, the number of young smokers continues to increase [6,7]. The prevalence of smoking is very high in Turkey [8,9]. In a nationwide survey conducted in 2002, the prevalence of smoking was 45.3% among males and 18.3% among females that are 15 years and older [10].

There is an increasing trend of smoking prevalence from the first grade to the last at universities. For example, smoking prevalence was found to be 12.0% among the first year pharmacy students of Hacettepe University and the prevalence increased to 17.5% in the last year [11]. Kocabaş et al. [12] conducted a study at seven medical schools in Turkey and reported the prevalence of daily smoking among first year medical students as 11.8%. The prevalence was 30.2% for the last year. Results from another study at a university located in southern-west part of Turkey, the smoking prevalence among the last year university students was found to be higher (49.8%) than the first year students (34.0%) [13]. All of these prevalence rates underline the fact that early university years are important to carry out anti-smoking activities for preventing students from starting smoking.

Although there are many small-scaled prevalence studies, it might have been a better approach to evaluate smoking issue in a larger population in collaboration with international partners. Based on this rationale, we aimed to determine prevalence and determinants of smoking among first grade students at Hacettepe University in this study. Besides smoking, other health-related life style characteristics of the students such as dieting, safe sex, alcohol drinking, substance use, physical exercise were interviewed in the same questionnaire; however, they are not presented in this paper.

In the 2003-2004 academic year, the total population of the first year students at Hacettepe University was 5917 at nine faculties and 14 vocational high schools. In this study, we included 11 faculties and vocational high schools (Faculty of Dentistry, Faculty of Pharmacy, Faculty of Educational Sciences, Faculty of Science, Faculty of Art, Faculty of Economics, Faculty of Engineering, Faculty of Medicine, School of Nursing). Totally 1050 students participated in the study.

Data were analyzed using Statistical Package for Social Sciences (SPSS)-version 11.0. Analyses included frequency and percent distributions, calculations of means, standard deviations, medians, and percentiles. The significance of differences was assessed with chi-square tests for categorical variables. Multivariate analysis included backward logistic regression modeling for smoking. A probability of less than 0.05 was considered statistically significant. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess the independent effect of predictor variables on outcomes. Participation of males (30.1%) was lower than females (69.9%) in the study; for this reason males and females were analyzed separately in logistic modeling. Smoking status of the students (males and females separately) was adjusted for “alcohol drinking, place of residence, thoughts of students about income per month, students’ selfcare of health, perception about his/her health status, supporting “smoke free” approach at university, agree with the “smoke-free cafeteria” concern at the campus, expect health programs/activities to be organized at the campus”.

Table 1: Selected socio-demographic background characteristics of the students (HU, 2004)

Selected characteristics by sex were shown in table 2. Males were on average about a year older than females (p=0.001). Female students’ fathers were higher educated when compared to males’ fathers (p=0.043). Male students’ self care for their health was higher when compared to females (p=0.019).

Table 2: Selected characteristics of the students by sex (HU, 2004)

In table 3, the characteristics about smoking and alcohol consumption of the students by sex were presented. Almost one out of four subjects (25.1%) reported smoking, and 380 students (38.7%) reported use of alcohol. Males both smoked and drank alcohol more than females. Majority of the students (70.7%) thought that “smoke free” policy at the university should have been supported. The percent of the females (71.8%) who agreed that “smoke-free cafeteria” at the campus to be a priority was higher than the percent of the males (65.0%) (p=0.038).

Table 3: Characteristics about smoking and alcohol consumption of the students by sex (HU, 2004)

In table 4 (males) and 5 (females), we presented associations between the selected risk factors and smoking by using logistic regression modeling. For males, there were significant positive associations between “alcohol consumption (OR=5.0, 95% CI=2.6-10.1; p<0.001)”; “not to look after his health with great attention (OR=2.1, 95% CI=1.1- 4.1; p=0.026)”; “not to agree with the idea 'smoke-free policy at university should be supported' (OR=4.5, 95% CI=2.2-9.2; p<0.001)”; and “not to agree with the idea 'smoke-free cafeteria at the campus as a priority' (OR=2.8, 95% CI=1.4-5.4; p=0.003)”. Similar associations were found for females.

Table 4: ORs and CIs for males’ smoking status according to selected predictors (HU, 2004) (n=255)

Table 5: ORs and CIs for females’ smoking status according to selected predictors (HU, 2004) (n=609)

Prevalence of males’ smoking and alcohol consumption was found to be higher than females’ (Table 3). The results are similar with the other study findings [9,11]. This might have been because of the internalization of “gender” roles by the participants.

The relation between “smoking” and “alcohol consumption” has been well-established for several times since now. Smoking, alcohol drinking, substance use, weapon carrying, sexually risk taking behaviors, etc. are often go together at these ages [15]. In a study conducted by McKee et al. [16] it was found that smokers had higher levels of alcohol use and reported greater subjective effects from the simultaneous use of alcohol and tobacco. In our study, we also found alcohol drinking as an influencing factor of smoking for both sexes (Tables 4 and 5).

Higher rates for smoking occur in adolescents whose parents smoke when compared to those whose parents do not [4]. Kandel and Wu [17] found that both maternal smoking and quality of parent-child interaction influences current smoking. However, in our study, we did not ask parents’ smoking status and for this reason we could not analyze the influence of this variable on the students’ smoking status. Peer influence was another well known risk factor for adolescents’ smoking [11].

Those who had looked after their self-health with great attention were less likely to smoke (Tables 4 and 5). Selfcare is the complex acquired ability to know and meet one’s deliberate continuing requirements for deliberative, purposive action to regulate their own human functioning and development. Self-care varies with respect to an individual’s development, health state, educational experiences, cultural influences, and resources of daily living [18]. Probably, students who declared higher sensitivity for their health were expected to practice healthy life-style activities more frequently.

We did not find a statistically significant difference between smoking level and students’ perception about their health status. This is also a subjective assessment of health and probably does not capture the “real health status” of the students, which may influence their smoking status.

Although adolescents from families of higher socioeconomic status were at greater risk for cigarette, alcohol and substance use than adolescents from families of lower socio-economic status, probably because the former had the finances to obtain these substances, we did not find a statistically significant relationship between income level and smoking status of the students [4,5]. We asked the students’ perception about their income level and this might have not reflected the socio-economic status of the family objectively.

As mentioned for several times tobacco is one of the most important international public health priorities around the world and pre-adolescents, who are in the period where this addiction usually begins, constitute a particularly interesting target group for the implementation of prevention activities [19].

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