Why are Turkish children at risk of exposure to environmental tobacco smoke in their homes?

OBJECTIVES: Children are at greater risk than adults to the effects of inhaling environmental tobacco smoke (ETS) especially in their homes. The aim of this study was to assess parents' knowledge regarding the risks of ETS to the health of their children and the barriers to reducing children's ETS exposure. METHODS: Qualitative research was performed for 50 households in which children were to exposed ETS were selected randomly from the questionnaire respondents for home-based interview. We conducted a total of 53 home-based interviews and collected information from parents regarding their knowledge of ETS effects, smoking behavior at home, barriers to quitting smoking or reducing ETS exposure, social attitudes toward parents who ban smoking, and the impact of the smoke-free legislation. RESULTS: Passive smoking was not a well recognized term but parents recognized that it causes harmful health effects. Some parents reported that their health care professionals did not inform them about the dangers of ETS. Parents restricted smoking in their homes, with a range of spatial restrictions which were frequently modified by family relation factors and the desire to be seen to act in socially and morally acceptable ways. The meaning of hospitality as social habits and traditions were important underlying factors. CONCLUSION: Knowledge levels, relationships with family and friends and the social and cultural context in which families live play important roles in the management of smoke exposure in Turkish homes. Despite these factors, awareness of the risks of ETS and smoke free legislation can provide opportunities to support people attain smoke-free homes.

Risk perception of occupational hazards among dental health care workers in a dental hospital in Turkey.

AIMS: To determine the factors associated with the level of occupational risk perceived by dental health care workers (DHCW), and to define the perceived sources of hazards. DESIGN: Cross-sectional. SETTING: Izmir Dental Hospital in Turkey. PARTICIPANTS: All employees (n = 308) in the hospital. METHODS: Data were collected by a questionnaire in 2007. Respondents rated their degree of individual risk that could be associated with the procedures they perform on a 10-point scale and listed the hazards they faced. Those with a score > or = 9 were classified as a high-risk perception group. We assessed the relation between variables using chi-square test and logistic regression analysis. RESULTS: Response rate was 90.3%. 57.2% of DHCW had a high-risk perception. Having children, job category and management's commitment to safety were related to the risk perception. DHCW who used preventive measures regularly and experienced an occupational accident in the previous year were 2.29 and 2.77 times more likely to have a high-risk perception. The perceived sources of hazards differed by job category. CONCLUSIONS: Risk perception is an initial step in developing procedures to minimise occupational risks and occupation specific risk management approaches should be performed.

Effects of social determinants on food choice and skipping meals among Turkish adolescents.

PURPOSE: To present data that contributes to understanding factors that influence food choice and skipping meals in adolescents. METHODS: A cross sectional study is carried in selected high schools in Bornova. Study sample compromises of 527 students chosen randomly by class from a population of 2410 first year in high school students. Self-administered questionnaires containing sociodemographic determinants, self reported weight and height, food choices and meal patterns were used. FINDINGS: A psychosocial factor that affects almost all of the students is the "taste and sensory perception of food". The second noticable factor is the "health and nutritious value of food". The time conserved and the convenience in the preparation of food is one of the lifestyle factors that affect more than half of the students. The cost of the food was also found to have an effect. Among the third group of factors categorized as "media", the leading factor is advertisement, effective in one third of the students. Among boys and girls, there was no statistical difference in the type of meal skipped. Living in Izmir for more than 10 years compared to less than ten years, being in a nuclear family to extended family, and belonging to the "owner" social class to "wage laborer" class also do not statistically differ with regard to skipping meals. However, the mother's and father's education level and having a working mother are associated with skipping meals. CONCLUSIONS: These results provide important evidence to support opportunities to positively influence the adoption of healthful eating.

Public health education in Ege University Medical Faculty: developing a community-oriented model.

BACKGROUND: Ege University Medical Faculty (EUMF) introduced a community-oriented curriculum in 2001. AIMS: To evaluate the new public health education program in EUMF curriculum. METHOD: The study adopted triangulated methods. Quantitatively, a comparison of the students who were exposed to a community-oriented curriculum (Year 4 in 2007) was made with the students who were exposed to the traditional curriculum (Year 4 in 2005) in terms of their assessment of their achievement of our learning objectives. A total of 255 students in 2005 (80.7%) and 243 students in 2007 (81.5%) were surveyed using a questionnaire. Qualitatively, five focus group- and five individual interviews were performed with the 2007 cohort. RESULTS: Except the one related to teamwork (p > 0.05) all learning objectives yielded significantly higher scores in the 2007 cohort than in the 2005 cohort (p < 0.05). The qualitative analysis supported the achievement of objectives in the 2007 cohort. The students appreciated the relevance of public health education with clinical subjects and interactive methods, but criticized didactic lectures and written assignments. CONCLUSIONS: A community-oriented approach is more effective in achieving a holistic approach to health problems. Improving community-based activities and assessment methods would be more successful in integrating population health into medical training.

Breast cancer awareness and practice of breast self examination among primary health care nurses: influencing factors and effects of an in-service education.

AIM: The purposes of this study were to identify the level of breast cancer and breast self examination practice knowledge of primary health nurses and the factors influencing breast cancer and breast self examination knowledge as well as to investigate the frequency of breast self examination practice of primary health nurses and influencing factors and to evaluate the effects of an in-service training program about breast cancer and breast self examination practice for primary health nurses. BACKGROUND: An increased awareness among nurses about breast cancer prevention would most likely result in a higher number of better educated women about breast cancer and also motivate adherence to screening recommendations. DESIGN AND METHODS: A pre-test and post-test design was implemented to evaluate the effectiveness of a Breast Cancer and Breast Self Examination Education Program for primary health nurses. The program was instructed to 192 of the 215 primary health nurses by two nurse trainers. Pre- and post-tests made available a quantitative evaluation of the level of improvement in breast cancer and breast self-examination knowledge. RESULTS: Mean of total breast cancer knowledge score of primary health nurses prior to the program was 58.51 SD 15.63 whereas, it increased to 75.96 SD 9.53, revealing a statistically significant escalation (p < 0.0001). A significant increase was detected in the number of primary health nurses practising breast self examination as a result of the significant improvement in the mean of self breast self examination practice knowledge score which rose evidently from 71.09 SD 19.31 to 85.02 SD 12.92 (p < 0.0001). CONCLUSION: The in-service education program improved the knowledge about breast cancer and practice of breast self examination in trained primary health nurses. The program model, which involved trained primary health nurse also represented an efficient use of the resources. RELEVANCE TO CLINICAL PRACTICE: It is important that primary health nurses have adequate breast cancer knowledge and practice of breast self examination to contribute effectively to primary health care. Findings of this study can be used to guide the planning efforts on continuous education of primary health nurses about breast cancer and breast self examination issues.

Breast cancer risk assessment and risk perception on nurses and midwives in Bornova Health District in Turkey.

Risk perception is a significant component of awareness of breast cancer risks. It can be helpful to reduce deaths of breast cancer via increasing awareness risk level. This study aimed to discuss the level of perceived and calculated breast cancer risk and to provide data on the practice of breast self-examination and use of mammography among 215 nurses and midwives working in the 23 primary healthcare centers in Turkey. Participants were asked to assess their personal lifetime breast cancer risk by a 4-item Likert scale ("no risk," "usual," "moderate," and "strong" risk), which determined "perceived breast cancer risk." Gail model was used to assess the "calculated breast cancer risk," which was calculated by the tool provided by the National Cancer Institute, version 7. Perceived and calculated risk levels were compared. The relation between sociodemographic and risk factors with "perceived risk" was examined. In addition, the influence of perceived risk on breast cancer screening practice was also assessed. The level of perceived risk of nurses and midwives was higher than that of calculated risk. Considering the fact that participants were healthcare professionals, the use of breast self-examination and mammography practices as a preventive behavior by nurses and midwives was lower than expected. Implications are discussed with regard to breast cancer risk and preventive behavior.

Factors associated with the utilization and content of prenatal care in a western urban district of Turkey.

OBJECTIVE: To define the prenatal care utilization pattern in Bornova and determine the factors affecting the amount and content of prenatal care. DESIGN: Follow-up study. SETTING: Bornova is an urban district in western Turkey. STUDY PARTICIPANTS: Two hundred and forty-five pregnant women registered with primary care settings in Bornova during the year 2000. Response rate was 83.7%. Main outcome measure. We determined the amount of prenatal care using Adequacy of Prenatal Care Utilization Index. Criteria used to assess the content of services include number of checks for maternal weight gain, blood pressure and foetal heart-beat measurements, advice about healthy lifestyles, laboratory examinations, and tetanus immunization. RESULTS: Rates of the women who visited public primary health care settings, private care sources, and public hospitals at least once were 76.0, 57.1, and 54.6%, respectively. As to prenatal care, 64.9% of the participants received an adequate amount and 25.9% an adequate content. Parity (P = 0.00), insurance coverage (P = 0.00), abortion history (P = 0.03), husband's occupation (P = 0.00), maternal age (P = 0.04), and level of educational attainment (P = 0.03) were related to the amount of care. Employment status (P = 0.03), continuous use of private sources (P = 0.00) and public hospitals (P =0.01) were associated with the content. CONCLUSION: This study has highlighted considerable associations between the amount of prenatal care and individual features in addition to those among the content of care, individual features and type of care sources. Causes of variations in prenatal care delivered in urban and relatively wealthy populations of developing countries must be explored using the appropriate criteria.

Evaluation of a dental health education program for midwives.

OBJECTIVE: The aim of the present study was to evaluate the effect of a dental health program for the midwives in primary health care services in Izmir, Turkey. METHODS: One hundred sixty-four midwives participated in the pilot project. The program was evaluated by quantitative and qualitative methods. The quantitative method assessed the improvement of the dental knowledge level, whereas the qualitative method was conducted to determine the assessments of the participants. RESULTS: The percentages of correct responses given to knowledge items were higher after the program. The midwives defined their role as an important first step for dental services. Education atmosphere was the best characteristic of the program, whereas lack of a written document was an important limitation. CONCLUSION: Despite some limitations, the program was an effective way of improving the oral health knowledge of the midwives and their motivation for dental services.