Introduction The study aims to understand the facilitators and barriers associated with enforcing and complying with Türkiye's smoke-free policy from the perspective of hospitality venue owners and employees. Methods A qualitative open-ended survey was conducted in Istanbul and Ankara in 2021 with 58 respondents from 3 different districts in each city from four types of venues: restaurants, traditional coffee and waterpipe houses, and European-style cafés. The open-ended survey included questions to understand the knowledge, beliefs, and attitudes of respondents about Türkiye's smoke-free policy and their perceptions of the facilitators and/or barriers to smoke-free policy implementation and changes after COVID-19. The data were analyzed using an inductive approach to identify patterns and categorize the data into themes. Results The respondents expressed that the smoke-free policy aimed to protect employees and customers from secondhand smoke (SHS), respect human health, and improve air quality. Findings suggest that the positive attitude of venue owners and staff toward the smoke-free policy serves as a facilitator. However, fear of financial impact, customers’ negative attitudes, difficulties in meeting physical requirements, and insufficient enforcement were found to be barriers to implementing the smoke-free policy. The effects of the COVID-19 pandemic were reported as an initial increase in compliance and awareness among customers and staff, but some respondents noted negative changes due to the emotional and financial effects of prolonged restrictions. These challenges have led to decreased attention on the smoke-free policy among venue owners, staff and customers. Respondents’ suggested improvements were related to building infrastructure, such as the ventilation systems and educating the public on the harmful health effects of smoking. Conclusions Despite the general understanding of the dangers of secondhand smoke and the smoke-free policy, this study highlights the challenges in implementing smoke-free policy measures and the continued need to raise awareness about the importance of a 100% smoke-free venue. A comprehensive approach to addressing the tobacco epidemic as a multifaceted public health issue is essential.

This essay aims to portray the difficulties of doing gender research in a country ruled by an illiberal, anti-gender government. Utilizing Andrea Peto's (2016) idea of polypore state agencies, the essay will outline the process of academic erosion in Turkey and what lies ahead. Similar paths are evident in multiple countries, creating an ominous academic terrain for gender researchers. Subsequently, the essay seeks to direct attention to this erosion and call for solidarity to navigate this historical landscape.

This paper discusses the development and implementation of a smoking cessation training program for diabetes nurse educators. People with diabetes who smoke have a significantly higher risk of morbidity and mortality. Smoking greatly increases diabetes complications. Surveys were conducted to ascertain how frequently nurses counseled patients to quit and their interest in cessation training. Observations of nurse-patient interactions and interviews with diabetes nurses facilitated the development of a culturally sensitive cessation training program. Survey results revealed that diabetes nurse educators recognized the need for training in smoking cessation, as many patients with diabetes do not consider smoking to be harmful for their health. A two-day workshop was developed for nurses on the specific harms of smoking for diabetes patients, including hands-on training in cessation counseling and motivational interviewing. Two months after training, nurses reported that the skills they acquired gave them confidence to counsel patients but identified four challenges to conducting cessation in their clinical settings. Diabetes nurse educators can play a pivotal role in delivering cessation. Training and overcoming challenges to implementation are urgently needed in the time of coronavirus disease 2019 given the dual risks of diabetes and smoking for severe complications.

This study aims to evaluate the monitoring and predictive value of web-based symptoms (fever, cough, dyspnea) searches for COVID-19 spread. Daily search interests from Turkey, Italy, Spain, France, and the United Kingdom were obtained from Google Trends (GT) between January 1, 2020, and August 31, 2020. In addition to conventional correlational models, we studied the time-varying correlation between GT search and new case reports; we used dynamic conditional correlation (DCC) and sliding windows correlation models. We found time-varying correlations between pulmonary symptoms on GT and new cases to be significant. The DCC model proved more powerful than the sliding windows correlation model. This model also provided better at time-varying correlations (r ≥ 0.90) during the first wave of the pandemic. We used a root means square error (RMSE) approach to attain symptom-specific shift days and showed that pulmonary symptom searches on GT should be shifted separately. Web-based search interest for pulmonary symptoms of COVID-19 is a reliable predictor of later reported cases for the first wave of the COVID-19 pandemic. Illness-specific symptom search interest on GT can be used to alert the healthcare system to prepare and allocate resources needed ahead of time.

We aimed to evaluate whether Google search interest for smoking cessation has changed from 2018-2019 to 2020, during the pandemic days. Google trends search interest was examined for 2018, 2019, and 2020. Relative Search Volume Interest (RSV) for the term "quit smoking" was obtained from Google Trends. Statistics were given as median (IQR), and statistical analyses performed using the Mann-Whitney U test. We have found that average median (IQR) RSV values for Turkey were 34.50(28.12-40.00), for the UK were 58.50(51.62-65.00), for France were 43.00(35.00-52.00), for Italy were 56.50(50.12-65.00), and for Germany were 33.00(20.87-45.25) in 2018 and 2019 combined. In 2020, the median values changed to 27.00(23.00-32.00) in Turkey, 55(45.00-61.75) in the UK, 43.00(37,50-55.00) in France, 48.00(41.00-56.75) in Italy, and 36.50(20.00-48.50) in Germany. While the "quit smoking" search interest significantly reduced in Turkey, UK, and Italy in 2020 (p=0.006, p=0.002, p=0.000, respectively), did not significantly change for France and Germany (p=0.506, p=0.428, respectively). Our results show that "quit smoking" search interest mostly decreased in 2020 during the pandemic. We conclude that governmental and tobacco control organizations should focus more on increasing awareness about smoking cessation during the pandemic and afterward. IQR: Interquartile range

Background Smoking is the leading preventable cause of death in the World. Turkey, with a prevalence of 27%, has one of the highest rates of smoking in Europe. Effects of psychosocial factors such as subjective well-being (SWB), negative affect (NA), self-esteem (SE) and religiosity have not been explored at a national level for a high prevalence, Muslim country like Turkey. Objective To investigate the effects of psychosocial risk factors for smoking in Turkey from a nationally representative data set from 2008. Methods A survey aimed to investigate subjective well-being, perception of health and religiosity was administered to 3002 people (mean age: 39.6 ± 14.87 years) from 26 provinces in Turkey. Half of the participants were female (50%), the majority of the sample had a middle-income (64%), and nearly all were Muslim (95.4%). Results Groups’ mean SWB score was 18.6 ± 7.24 out of 35, and mean NA score was 16.2 ± 5.01 out of 30. While 35.8% were regular smokers, 4.8% of the participants were non-regular users, and 60% did not smoke. Logistic regression was utilized to test the association among NA, SBW, religiosity, SE, tolerance for uncertainty and smoking status. The model showed significant effects of NA and SWB on smoking status while religiosity, SE and tolerance for uncertainty had no effect when gender, age, income and alcohol use were controlled for (R2=0.29). Both lower SWB and higher NA increased the likelihood of being a smoker. The model results changed across age groups and gender. The effect of NA was no longer observed in males, and religiosity had a significant effect among people aged 40–54 years. Conclusion The details of the model and its implications for smoking cessation will be further discussed to shed light on the nature of psychosocial risk factors on smoking and cessation.

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) μg/m3 indoors, 25 (13–48) μg/m3 outdoors, and 31 μg/m3 (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.

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.

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 17,737 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.

Turkey has the highest prevalence of diabetes and smoking in Europe (diabetes 13.7%; smoking 44% of men and 18% of women). Smokers with diabetes have a heightened risk of morbidity and mortality. The routine assessment of tobacco use as an essential to prevent smoking or encourage cessation.(ADA,2018) At present, little is known about the cessation services provided by diabetes professionals to their patients in Turkey. A nationwide survey was conducted to gather data on this topic. Utilizing a point prevalence methodology, data was collected from 24 provinces around Turkey. Diabetes nurses from 172 diabetes centers were invited to complete a survey (response rate 28.4%). The survey included 11 questions; patient demographics, type and duration of diabetes, patient smoking status, smoking and cessation behaviors after diabetes diagnosis, cessation recommendation from HCP. The survey with instruction + video about how to complete the survey were sent via e-mail and phone messages to the nurses. Surveys were completed on one clinic day between December 3-7,2018 to all diabetes patients. (Ethics 2018.229.IRB3.162) of patients (n=779), 59,4% is women; 86,3% has type 2 diabetes. Mean duration of diabetes 10,39 years; mean age is 54,97 years. Smoking prevalence is 26,8%. The highest smoking prevalence is 40,4% in men, while 19,0% in women. Of patients,19,3% smokes 10 cigarettes or more in a day; 26,2% is quitter while 10,7% of them quit after diabetes diagnosis; 80,1% believes any amount of smoking is harmful. As opposed to, 7.4% of patients believes 1-2 cigarettes in a day is not harmful, 6,0% believes that there is no relation between smoking and diabetes. Only 11,8% of smokers has quitting advice from HCP relating the risk of smoking for diabetes control. This nation-wide survey reveals the first data on smoking and cessation in Turkish people with diabetes. Findings shows that patients are not aware of the harm of tobacco. Behavior-based smoking cessation trainings will be applied for diabetes professionals in the light of these early data. Disclosure S. Ozcan: None. F. Gorurgoz: None. A. Carkoglu: None. Z. Akbulut: None. M. Nichter: None. M. Nichter: None.

Google Trends (GT) is a service provided by Google to display search trends on Google search. We analyzed the results GT using Turkish "electronic cigarettes" as search terms between 2011-2017, aimed to find out the changes between 2014 and 2017 and predicted the search interest in next two years in Turkey. We used "electronic cigarette" search terms in web, shopping and, youtube in GT between 2011 and 2017 in Turkey. Due to the prohibition of electronic cigarette use in June 2013 and the media had extensive data at that time, trend analysis has been performed since 2014. Examination of the graphs reveals that the relevance of the web is highest in May and June in 2011, and started to rise again in early 2016. Youtube interest has increased markedly since 2016. As a result of the time series analysis, 2018 and 2019, shopping and youtube interest will dramatically increase in 2018. The web interest will rise in 2018 but decline in 2019 (Figure). We found that searches on electronic cigarettes usage on the web, shopping and youtube were statistically higher in 2016 compared to 2011-2014 and 2017 years. Shopping and youtube interest is expected to increase in 2018, but interest in youtube and web use for such searches is expected to decrease in 2019. We believe that measures are inadequate for prohibiting the sales electronic cigarettes online and additional legal regulations are necessary.

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) µg/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). Implications Smoke-free regulation should be extended to waterpipe venues to protect nonsmoking employees and patrons from the adverse health effects of SHS.

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 its9 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

Introduction Turkey is a leader of tobacco control in Europe. However, little is known about cessation implementation, a key component of tobacco control success. This paper discusses the training of nurses in smoking cessation as part of routine practice in Istanbul hospitals. The Turkey project builds and extends on a decade of research and training in developing culturally sensitive cessation education in India and Indonesia (Project Quit Tobacco International). One of the goals of the Turkey project is to provide leadership in the field of nursing in smoking cessation as a foundation for a larger smoking cessation movement within Turkey’s healthcare sector. Material and Methods Prior to training, formative research was conducted with smokers to better understand challenges faced when trying to quit. Site visits to government hospitals and cessation clinics were conducted to observe health care provider-patient interaction. Four culturally sensitive cessation training workshops for nurses (n=54) were held and follow-up debriefing sessions were conducted. Results Challenges to cessation counseling included lack of time and incentives for nurse involvement; lack of information about the harm of smoking and benefits of quitting; and the medicalization of cessation focused on pharmaceutical distribution. The pay for performance model in hospitals has de-incentivized doctors to work in cessation clinics making referrals by nurses unfeasible. Conclusions o involve nurses in tobacco cessation delivery in Turkey, health care providers need to quit smoking, and changes to the health care system need to occur. Cessation needs to be integrated into routine nurse-patient interactions, teamwork between nurses and doctors will need to be established to enable referral in hospitals with and without cessation clinics, and the systemic harms of smoking will need to be integrated into medical and nursing school curriculum. Opportunities for doing so are discussed. Funding Funding was provided by Global Bridges, Mayo Clinic, U.S.

Introduction Smoking during pregnancy is a leading preventable cause of low birth weight and preterm delivery. Infants and children exposed to tobacco smoke in utero and post natally are at increased risk for otitis media, wheezing and asthma, and lower respiratory tract infections. In Turkey, little is known about smoking during pregnancy, although one study revealed that 28% of women smokers continued to do so throughout their pregnancy. This paper reports on formative research conducted with pregnant and postpartum women on smoking behavior and the training of pediatric nurses and midwives in cessation counseling in Turkey. Material and Methods Fifteen interviews with women were conducted to explore smoking behaviors during pregnancy and postpartum, to assess understanding of the harms of smoking, and interest in quitting. Interviews with pediatric nurses and midwives were also conducted to explore their attitudes toward training in cessation counseling. Following data analysis, 18 nurses and midwives were trained on harms of tobacco use during pregnancy and postpartum, the harm of secondhand smoke exposure and cessation counselling skills. Following training, nurses and midwives were debriefed to explore patient’s responses to quit advice and challenges faced during cessation counseling. Results Many women reduced their level of smoking during pregnancy and some were able to quit entirely. However, after delivery, many relapsed to smoking. Women’s understanding of the harm of smoking to their children was limited to respiratory illness. Nurses and midwives felt confident in delivering cessation messages and noted that women were receptive to the importance of quitting once they understood the harm of secondhand smoke to their children. Conclusions Given the prevalence of smoking among women in Turkey, there is a clear need for nurses and midwives to ask and assess smoking status during pregnancy visits and to offer cessation advice to all those for smoke. Funding Funding was provided by Global Bridges, Mayo Clinic, U.S.

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.

Introduction: In 2008, Turkey passed its smoke-free legislation prohibiting smoking in public spaces. However, this legislation does not extend to motor vehicles. This poses significant health risks to secondhand smoke exposure (SHS), especially to non-smokers. Our objective was to identify taxi drivers' attitudes and behaviors in order to assess tobacco consumption and SHS in taxicabs. Methods: From December 2012 to July 2013, we conducted a cross-sectional observational study across 12 cities in Turkey. A systematic sample of 356 taxi commercial vehicles was selected. During trips to and from study venues, fieldworkers observed smoking exposure in taxicabs, such as the presence of cigarette butts or cigarette packs, and interviewed taxicab drivers on their smoking status and smoking policy. Results: 65% (232) of taxi drivers were current smokers. A majority of these current smokers also reported always (14%) and sometimes (29%) smoking inside the taxi. Overall, 62% of drivers allow passengers to smoke inside the taxi and 45% smoke when customers are inside the taxi. Less than 1% of smokers reported being fined by police because of smoking inside their taxi. Conclusions: This study highlights the need to promote public health awareness about the risks of secondhand smoke exposure, especially in motor vehicles. Efforts should be taken to inform the public about the potential health hazards of secondhand smoke exposure in motor vehicles, even under optimal ventilation conditions.

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-pyridyl)-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) µg/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) µg/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.

Introduction: Turkey enacted smoke-free legislation in 2008 that was extended to hospitality venues in 2009. Current law prohibits indoor smoking in all workplaces, including bars, restaurants, and nightclubs. Assessing the level of compliance with the smoke-free legislation is key to reduce secondhand smoke (SHS) exposure. There is a need to identify factors associated with smoking status (current, former, never smoker), which may influence one's support for the legislation, enforcement and quitting behavior. Methods: A study was carried out between May and September 2014 in 7 cities in Turkey. Interviews were conducted with school directors, hospitality venue owners and employees. Descriptive analyses as well as multinomial logistic and logistic regression models were run to estimate the odds ratio of smoking status and of opinions about the legislation by a series of characteristics. These include sociodemographic information, smoking behavior, and knowledge on the health effects of smoking. Results: A total of 430 questionnaires were completed, by105 (25%) never smokers, 44 (10%) former smokers, and 281 (65%) current smokers. Between former and current smokers, former smokers tended to be older (36.9 ± 12.3 vs. 30.8 ± 10.9, p = 0.001). Between never and current smokers, there tended to be more females (18.1% vs. 6.8%, p = 0.001) and individuals with a higher level of education among never smokers (p=0.01). Among never, former, and current smokers, 91.4%, 84%, and 62.9% support the ban, respectively. Those who viewed SHS to causes cancer in nonsmokers were more likely to support the ban (p=0.002), Among current smokers, those who supported the ban were most likely to report smoking less since it was implemented (p

Introduction: Relatively few studies have quantified secondhand tobacco smoke (SHS) exposure in outdoor areas. We evaluated air pollution exposures related to SHS exposure in indoor and outdoor areas of bars/nightclubs in 12 cities in Turkey. Methods: We visited 79 bars/nightclubs between December 2012 and July 2013. They were the closest venues located near 5/10 randomly selected sampling points in each city. In 73 venues, we clandestinely measured air concentrations of particulate matter