International collaboration could reduce smoking prevalence, researchers find

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According to the World Health Organization, approximately 80 percent of the world's more than 1 billion smokers live in low-and middle-income countries, where the burden of tobacco-related illness and death is the heaviest. Despite the high smoking rates in these countries, little research has been completed comparing smoking rates across countries with different economies. In a new study comparing smoking rates and regulations between the U.S. and Turkey, Mansoo Yu, associate professor of social work at the University of Missouri, found the rate of current smoking is higher in Turkey at 27 percent compared to the U.S. at 18 percent. Additionally, he found the cessation rate is higher in the U.S. at 25 percent compared to 22 percent in Turkey. The researchers hope the findings from this comparison can help health officials and policymakers find ways to reduce global tobacco use.

"Tobacco-related illness is a global public health problem," Yu said. "Understanding the variables from country to country will help global health leaders collaborate on effective interventions to further reduce overall prevalence. To compare scale of economies, we chose the U.S. to represent a wealthy nation and Turkey as the low-income nation."

Yu worked with Jenna Wintemberg, assistant teaching professor in the MU School of Health Professions, and Ozge Karadag Caman from Hacettepe University in Turkey. They compared data from the 2012-2013 National Adult Tobacco Survey to gather information for the U.S. and the 2012 Global Adult Tobacco Survey for Turkey.

To understand how to reduce smoking, the researchers also compared tobacco interventions in both countries where viewing health warnings led to decreased . While the U.S. used text labels, Turkey implemented graphic health warning labels on tobacco products in 2010, leading to an increase in people thinking about quitting. Participants in Turkey also were more likely to report seeing a warning on a pack of cigarettes in the past 30 days compared to U.S. participants.

"Given that smoking rates remain prevalent in Turkey despite the graphic warnings, we can guess that people become used to them over time," Yu said. "As a policy, regularly changing the could be one way to make the graphic images more effective in reducing smoking. Likewise, the U.S. could implement graphic images attached to cigarettes instead of text warnings as a tool in tobacco control."

Researchers also found that restricting smoking in personal spaces, such as homes and vehicles, could help prevent people from smoking. Due to Turkey's national law restricting smoking in all public spaces, the country also has more regulations in place to prohibit smoking in personal spaces. For example, Yu says that in Turkey some apartment buildings and cab companies are going smoke-free as a result of the national law.

"Interestingly, Turkey has a national smoke-free law, while the U.S. has no such law and only half the states have comprehensive laws aimed at smoking," Yu said. "Despite the lack of a national law, the U.S. has a lower rate of tobacco use. This could be due to the U.S. having greater access to cessation products and services, which have been found to help people successfully quit."

"Health warnings, smoking rules and : A cross-national comparison of Turkey and the United States," was published in Substance Use and Misuse. The School of Social Work is a department in the MU College of Human Environmental Sciences.


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