1. Reduction of Adult Smoking by using
Comprehensive Approach
Nazmi Bilir MD
Prof. of Public Health
Hacettepe University
Institute of Public Health
nbilir@hacettepe.edu.tr

2. Tobacco facts of Turkey
• Turkey is a tobacco producing country
– Providing 1.7% of world production (before 4%)
• ... has long history and culture of tobacco use
– Since 1600’s
– “coffee-houses” ...
– “exclusive male behavior”
– Offered to the guests
– Children are allowed during ceremonies; wedding, funerals...
– Grandfather offers to grandson !!!
• TEKEL; State Monopoly: no advertisement !!!

3. Before Tobacco Control Law
• 1984: Import of “foreign” cigarettes
– TEKEL has the right to import and sell
• 1986: TEKEL’s right to import “abolished”
– Private companies also has the right to import and sell
– “advertisement” started
• 1991: Multinational tobacco companies has the right
to establish cigarette manufacturing factory

4. Cigarette sales, Turkey, 1925 - 2011
TC Law,
1996
TC Law, 2008
State Monopoly - TEKEL

5. • 1980-2000: Cigarette sales “doubled”
– 58 bn – 112 bn cigaretes /yr.
• 2.5 times of population increase
• 1993: First Symposium on Tobacco Control
• 1995: National Coalition Against Tobacco

6. Tobacco Control Law, 1996
(Prevention of Harms of Tobacco Products)
• Ban smoking in indoor public places
– Health, education, public transport, government office
– “not in hospitality venues”
• Ban all kinds of advertisement and promotion
• Ban selling tobacco products to minors (18 yr.)
• Health warning: “tobacco harms health”
– 14 text warnings: 2005, pictorial warnings: 2010
• TV: 90 min/mo. air time – harms of tobacco use
• Fines
“motivational role of civil society”

7. Tobacco Control Law, 2008
• Expanding smoke-free places:
“all indoor public places, incl. hospitality venues”
• Provincial TC Board:
– Governor; participation of govt. & NGO
– Inspection team:
(police, health pers., municipal police)
• Fines: clearly defined

8. Keys to Success
• Political commitment
– Government, all political parties
• Strong partnership
– Civil society
• Natl. Coalition on T-H
• Health professionals assoc.
– Academia
– International partners
• WHO, CDC, Bloomberg GI, EU, other countries …

9. Major Activities
• National Tobacco Control Program
– 2008-2012 / 2013-2017
• Training
– Government officials, inspection teams
– Health professionals
– Stakeholders; hospitality ind. representatives
– General public; mass media campaigns ...
• Projects; (provide evidence-based data)
– Compliance, indoor air q., health complaints, ...
– Monitoring implementation of FCTC& MPOWER strategies

10. Tobacco Use Prevalence Studies
• Global Adult Tobacco Survey
– GATS 2008
– GATS 2012
• Health Professionals Tobacco Use Survey
– HPTUS 2007
– HPTUS 2011
• Global Medical Students Survey, 2010
• Studies on various adult groups

11. Monitor: Prevalence of current tobacco smoking

12. Protect: Exposure to secondhand smoke in
various places*
* In the past 30
days

13. Raise: Average amount paid for 20 cigarettes*
and total tax shown as a percentage share
of retail price†
*Average amount paid in 2008 was adjusted for inflation for direct comparison to 2012
†Source: Turkey Ministry of Finance, General Directorate of Revenue Policies, 2013

14. Adult Smoking Prevalence in Turkey, 1993-2012
%

15. Conclusion-1
• Turkey achieved remarkable success on TC
– Tobacco use prevalence reduced
– Indoor air quality improved
– Compliance: high
– Public support: high
• Keys to success
– Political stability and whole government approach
– Strong and supportive NGO and academia
– Tax increase
– Comprehensive ad. ban
– Strong mass media campaigns
• TV, press media, billboards …

16. Conclusion-2
Challenging areas
• Tobacco use prevalence is still too high
– 14.8 million smokers
• Violations
– Inspections should be enhanced
• Cigarette price is low
• Cessation services should be increased (PH Care)
• Tobacco industry activities increasing
– Noticing tobacco ad.s increased, among women
– More effective implementation of the fines
• Comprehensive TC policies should be continued

17. “Turkey is the first and, to date, the only country
in the world to attain the highest implementation score for
all of WHO’s MPOWER measures.”
Thank you
nbilir@hacettepe.edu.tr