Handan İNÖNÜ KÖSEOĞLU, Sibel DORUK, Ünal ERKORKMAZ

Nikotin bağımlılığı ve çevresel tütün dumanı maruziyeti

Bu çalışmada çevresel tütün dumanı (ÇTD) maruziyetine neden olan olguların özelliklerinin belirlenmesi amaçlanmıştır. Sigara bırakma polikliniğine başvuran 145 olgunun (53/92, K/E) genel demografik özellikleri, çalışma durumları, çocukluk çağındaki ÇTD maruziyetleri, kendilerinin ÇTD maruziyetine neden olup olmadıkları soruldu, hastane anksiyete depresyon testi (HADT) ve Fagernström nikotin bağımlılık testi (FNBT) uygulandı. Olguların yaş ortalaması 42.2 yıl idi. Olguların %71'inin çocukluk çağında ÇTD'ye maruz kaldığı, %69'unun ÇTD maruziyetine neden olduğu belirlendi. Bir günde içilen sigara sayısı ve paket/yıl değerinin ÇTD maruziyetine neden olma üzerine etkisi saptanmadı. ÇTD maruziyetine neden olanlar sigara içme yasağı olan yerlerde daha fazla güçlük yaşıyorlardı (p= 0.045) ve FNBT skoru bu olgularda (ortalama= 5.9) diğerlerinden (ortalama= 4.8) yüksek bulundu (p= 0.009). ÇTD maruziyetine neden olan olguların %72'sinde olmayanların %53.3'ünde FNBT skoru ≥ 5 idi (p= 0.045). Yüz on yedi olguya HADT uygulandı, anksiyete ve depresyon ile ilişkili yakınmalar sırasıyla 45 ve 54 olguda saptandı. ÇTD kaynağı olanlarda anksiyete skoru ortalaması daha yüksekti (p= 0.025). ÇTD maruziyetine neden olan ve olmayan olgularda anksiyete ve depresyon ile ilişkili yakınmalar benzer oranlarda saptandı. ÇTD maruziyetine neden olma üzerine cinsiyet, eğitim, çalışma durumu, evde başka sigara içicisinin olması, çocukluk çağındaki ÇTD maruziyeti, pasif sigara içiciliğine ilişkin bilgi sahibi olmanın ve sosyoekonomik düzeyin etkisi saptanmadı. Sigara içmeye başlanarak gelişecek nikotin bağımlılığının engellenmesiyle sigara içenlerin sağlığı korunduğu gibi içmeyenlerin de özellikle ev içi ortam olmak üzere ÇTD maruziyetinin önlenmesi sağlanacaktır.

Nicotine addiction and environmental tobacco smoke exposure

In present study it was aimed to determine the general characteristics of cases who cause environmental tobacco smoke (ETS) exposure. One hundred and forty five cases (53/92, F/M) who admitted to smoking cessation clinic were asked about general demographic characteristics, the history of ETS exposure in childhood and whether they cause of ETS exposure or not. Also Fagernström test for nicotine dependence (FTND) and hospital anxiety depression test (HADT) were performed. The mean age of the cases was 42.2 years. It was determined that 71% of cases exposed ETS in childhood and 69% of cases cause ETS exposure. There was no effect of the number of cigarette smoked per day and the amount of packet/years on to cause ETS exposure. The cases who cause ETS exposure to be forced more than others in places that it is forbidden smoking (p= 0.045), FTND score was higher (mean= 5.9) than others (mean= 4.8) (p= 0.009). The FTND score was ≥ 5 in 72% of cases who cause ETS exposure and in 53.3% of others (p= 0.045). 117 of cases were performed HADT, syptoms related with anxiety and depresion were detected in 45 and 54 of cases respectively. The mean anxiety score was higher in cases who cause ETS exposure (p= 0.025). The sypmptoms related with anxiety and depression were determined similar in cases who cause ETS exposure or not. It was identified that there was no effect of gender, education, business status, another smoker at home, history of ETS exposure in childhood, socioeconomic status and to have knowledge about passive smoking on to cause ETS exposure. Prevention of nicotine addiction to be developed by starting smoking precludes the onset of the diseases related to smoking, and also enables inhibition of ETS exposure especially at home.

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1. WHO Report on The Global Tobacco Epidemic, 2008: The MPOWER Package. Geneva, Switzerland. http://www.who.int/ tobacco/mpower/en/ (alıntı tarihi: 20.06.2010).
2. Bilir N. Türkiye Tütün Kontrolünde Dünyanın Neresinde? Türk Toraks Dergisi 2009; 10: 31-4. 3. T.C. Sağlık Bakanlığı. Ulusal tütün kontrol programı ve eylem planı 2008-2012. Ankara 2008.
4. http://whqlibdoc.who.int/publications/2009/ 9789241563918_eng_full.pdf
5. California Environmental Protection Acency. Health effects of exposure to environmental tobacco smoke. Final Report. California Environmental Protection Agency Office Of Environmental Health Hazard Assessment, 1997. http://oehha. ca.gov/pdf/chapter1.pdf
6. Physicians for a Smoke-Free Canada (PSC). Health effects of second hand smoke. http://www.smoke-free.ca/factsheets/ pdf/ Q&A-healtheffects.pdf; 2006 (alıntı tarihi: 20.06.2010).
7. Gallo V, Neasham D, Airoldi L, Ferrari P, Jenab M, Boffetta P, et al. Second-hand smoke, cotinine levels, and risk of circulatory mortality in a large cohort study of never-smokers. Epidemiology 2010; 21: 207-14.
8. Asomaning K, Miller DP, Liu G, Wain JC, Lynch TJ, Su L, et al. Second hand smoke, age of exposure and lung cancer risk. Lung Cancer 2008; 61: 13-20.
9. US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: US, Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2004.
10. Karlıkaya C, Öztuna F, Solak ZA, Özkan M, Örsel O. Tütün Kontrolü. Toraks Dergisi 2006; 7: 51-64.
11. Tütün Mamullerinin Zararlarının Önlenmesine Dair Kanunda Değişiklik Yapılması Hakkında Kanun. Yayımlandığı Resmi Gazete: Tarih: 28/01/2008 Sayı:26761.
12. Gehrman CA, Hovell MF. Protecting children from environmental tobacco smoke (ETS) exposure: a critical review. Nicotine Tob Res 2003; 5: 289-301.
13. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-70.
14. American Academy of Pediatrics. Environmental tobacco smoke: a hazard to children. Pediatrics 1997; 99: 639-41.
15. Couriel JM. Passive smoking and the health of children. Thorax 1994; 49: 731-4.
16. Karakoç F, Dağlı E, Kut A, Pamukçu A. Çocuklarda pasif sigaraya maruziyetin serum kotinin düzeyi ile belirlenmesi. Türkiye Klinikleri Dergisi 1998; 7: 77-82.
17. Boyaci H, Duman C, Başyiğit I, Ilgazli A, Yıldız F. Determination of environmental tobacco smoke in primary school children with urine cotinine measurements. Tuberk Toraks 2004; 52: 231-6.
18. Ersu R, Arman AR, Save D, Karadag B, Karakoc F, Berkem M, et al. Prevalence of snoring and symptoms of sleep-disordered breathing in primary school children in istanbul. Chest 2004; 126: 19-24.
19. Keskinoglu P, Cimrin D, Aksakoglu G. The impact of passive smoking on the development of lower respiratory tract infections in children. J Trop Ped 2007; 53: 319-24.
20. Sahbaz S, Kilinc O, Gunay T, Ceylan E. The effects of environmental tobacco smoke exposure before starting to smoke on cigarette quitting therapies. Tuberk Toraks 2008; 56: 283-90.
21. Disparities in secondhand smoke exposure-United States, 1988-1994 and 1999-2004. MMWR 2008; 57: 744-47.
22. Bolte G, Fromme H; GME Study Group. Socioeconomic determinants of children’s environmental tobacco smoke exposure and family’s home smoking policy. Eur J Public Health 2009; 19: 52-8.
23. Pellegrini M, Rotolo MC, La Grutta S, Cibella F, Garcia-Algar O, Bacosi A, et al. Assessment of exposure to environmental tobacco smoke in young adolescents following implementation of smoke-free policy in Italy. Forensic Sci Int 2010; 196: 97-100.
24. DiFranza JR, Aligne CA, Weitzman M. Prenatal and postnatal environmental tobacco smoke exposure and children’s health. Pediatrics 2004; 113: 1007-15.
25. Eliopoulos C, Klein J, Chitayat D, Greenwald M, Koren, G. Nicotine and cotinine in maternal and neonatal hair as markers of gestational smoking. Clin Invest Med 1996; 19: 231-42.
26. Pomerleau CS, Carton SM, Lutzke ML, Flessland KA, Pomerleau OF. Reliability of the Fagerstrom Tolerance Questionnaire and the Fagerstrom Test for Nicotine Dependence. Addict Behav 1994; 19: 33-9.
27. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström test for nicotine dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict 1991; 86: 1119-27.
28. Doruk S, Celik D, Etikan I, Inönü H, Yılmaz A, Seyfikli Z. Evaluation of the knowledge and manner of workers of workplaces in Tokat about the ban on restriction of indoor smoking. Tuberk Toraks 2010; 58: 286-92.