The Influence of Family Factors on Smoking Behavior in Turkey


  • Sevgi Yurt Oncel Department of Statistics, Faculty of Arts and Sciences, Kırıkkale University, Kırıkkale, Turkey
  • Fazil Aliev Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA



Clustered logistic regression, Nicotine dependence, Paired data, Smoking status, Siblings, Turkey, FTND (Fagerström Test for Nicotine Dependence)


Aim: The goal of this study is to specify the risks, family and environmental factors affecting smoking behavior and develop suggestions for Turkish individuals by considering sibling data.

Materials and Methods: The data was collected by voluntary senior year students attending Kırıkkale University, Department of Statistics. The sample of 751 families was selected from families with at least two children. Each sibling’s socio-demographic information and behavioral phenotypes were collected using a survey from both siblings. We selected one of siblings randomly as ‘sibling1’ and defined the other sibling as ‘sibling2’. Hypothesis testing and multivariable clustered logistic regression models were used to evaluate the data and find the optimum model by using dependent sibling data.

Results: Out of 1502 (751 pairs) siblings 843 (56.1%) were males, 659 (43.9%) were females. According to the survey results, 508 of the males (67.7%) and 242 of the females (32.3%) were smokers for a month or longer and smoked every day. The risk of smoking was 2.26 times higher in males than in females. Having a smoking sibling increased the risk of smoking 1.95 times, alcohol using increased the risk 2.11 times. We found that when the age difference between siblings is 0-7 years, having a same sex sibling who smokes increases one’s risk 4.7 times in females and 5 times in males; when the siblings are of different sexes, according to these age differences

Conclusion: The survey showed that the gender and sibling’s and parent’s smoking both play a significant role on smoking behavior. But children seem to learn smoking from their siblings more than from parents. Having same sex sibling who smokes plays significant role in smoking behavior for both males and females.

Author Biographies

Sevgi Yurt Oncel, Department of Statistics, Faculty of Arts and Sciences, Kırıkkale University, Kırıkkale, Turkey

Department of Statistics

Fazil Aliev, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA

Department of Psychiatry


Global Adult Tobacco Survey, Republic of Turkey Turkish Statistical Institute 2012. [cited 2014 March 5]: Available from:

Lakier JB. Smoking and cardiovascular disease. Am J Med 1992; 93(1): 8-12. DOI:

Kaynak K, Akgöz B, Demirkaya A, Erşen E, Kara M, Öz B. Akciğer evre I epidermoid karsinomlu olgularda otokrin hareket faktör reseptörü varlığınının sağkalıma etkisi. Turk Gogus Kalp Dama 2007; 15(3): 233-37.

Onat A. Risk factors and cardiovascular disease in Turkey. Atherosclerosis 2001; 156(1): 1-10. DOI:

Pyrgakis VN. Smoking and cardiovascular disease. Hellenic J Cardiol 2009; 50(3): 231-34.

Li MD. The genetics of smoking related behavior: a brief review. Am J Med Sci 2003; 326(4): 168-73. DOI:

Avenevoli S, Merikangas KR. Familial influences on adolescent smoking. Addiction 2003; 98(s1): 1-20. DOI:

Low S, Shortt, JW, Snyder J. Sibling influences on adolescent substance use: The role of modeling, collusion and conflict. Dev Psychopathol 2012; 24(01): 287-300. DOI:

Boyle MH, Sanford M, Szatmari P, Merikangas K, Offord DR. Familial influences on substance use by adolescents and young adults. Can J Public Health 2000; 92(3): 206-209. DOI:

Vink JM, Willemsen G, Boomsma DI. The association of current smoking behavior with the smoking behavior of parents, siblings, friends and spouses. Addiction 2003; 98(7): 923-31. DOI:

Swan AV, Creeser R, Murray M. When and why children first start to smoke. Int J Epidemiol 1990; 19(2): 323-30. DOI:

Wang MQ, Fitzhugh EC, Westerfield RC, Eddy JM. Family and peer influences on smoking behavior among American adolescents: an age trend. J Adolesc Health 1995; 16(3): 200-203. DOI:

Bricker JB, Peterson AV, Andersen MR, Leroux BG, Rajan KB, Sarason IG. Close friends', parents', and older siblings' smoking: reevaluating their influence on children's smoking. Nicotine Tob Res 2006; 8(2): 217-26. DOI:

El-Sharkawy GF. Cigarette smoking among University students: family related and personal risk factors. J Am Sci 2011; 7: 260-8.

Öncel SY, Gebizlioğlu ÖL, Alioğlu FA. Risk factors for smoking behavior among university students. Turk J Med Sci 2011; 41: 1071-80. DOI:

Conrad KM, Flay BR, Hill D. Why children start smoking cigarettes: predictors of onset. Addiction 1992; 87(12): 1711-24. DOI:

Centers for Disease Control and Prevention (CDC). Current cigarette smoking among adults-United States, 2011. MMWR. Morbidity and mortality weekly report 2012; 61(44): 889.

WHO Global Adult Tobacco Survey (GATS), 2011. [cited 2014 March 12]: Available from: surveillance/gats/en/.

WHO Global Youth Tobacco Survey (GYTS), 2013. [cited 2014 March 12]: Available from: surveillance/gyts/en/..

Bozkurt AI, Şahinöz S, Özçırpıcı B et al. Patterns of active and passive smoking, and associated factors, in the South-east Anatolian Project (SEAP) region in Turkey. BMC Public Health 2006; 6(1): 15. DOI:

Uysal MA, Kadakal F, Karşidağ C, Bayram NG, Uysal O, Yilmaz V. Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis. Tuberk Toraks 2004; 52(2): 115-21.

Fagerström KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav 1978; 3(3): 235-41. DOI:




How to Cite

Oncel, S. Y., & Aliev, F. (2014). The Influence of Family Factors on Smoking Behavior in Turkey. International Journal of Statistics in Medical Research, 3(2), 116–125.



General Articles