Mixed messages: a qualitative study of the meanings and context of high school students' tobacco use in Turkey.

Although smoking by adults in Turkey is a widely practiced, socially accepted habit, social influences on tobacco uptake by Turkish youth have been studied little. This paper reports findings from interviews (42 10th graders plus 10 other students and 24 adults) and three focus groups in a study with high school students in Dursunbey, Turkey. Interviewees reported that youth smoking is not culturally acceptable, but that contradictory messages and pressures abound. A context in which smoking is embedded in men's and women's social environments influences many youth to become smokers. Smoking is expected of men by the time they enter military service or are economically independent. Smoking by women, especially professionals, is increasingly common. Although virtually all adults disapprove of youth's smoking as age-inappropriate behavior, ubiquitous counter-examples of adult smoking in homes, schools, coffee houses and media dilute tobacco controls. Few youth or adults expressed concern about the relationship of tobacco to health. Sanctions in family and school environments are little enforced. Students' smoking-related attitudes and behaviors appear modeled more after behavior of their teachers than their less-educated parents, and smoking is common by teachers at school. Reduction of smoking by Turkish youth calls for comprehensive, sustained programs to de-normalize tobacco use in family, school and other settings, with special attention to smoking uptake by young women.