Journal of Traditional Medical Complementary Therapies

.: REVIEW
Elektronik Sigara Kullanımı ve Sağlık Üzerine Etkileri
Usage of Electronic Cigarette and its Effects on Health
Serpil ÖZDEMİRa, Leyla YAMAN ÜZÜMCÜa
aHalk Sağlığı Hemşireliği ABD, Sağlık Bilimleri Üniversitesi Gülhane Hemşirelik Fakültesi, Ankara, TÜRKİYE
J Tradit Complem Med. 2019;2(3):142-50
doi: 10.5336/jtracom.2019-70721
Article Language: TR
Full Text
ÖZET
Sigara kullanımında mevcut eğilimlerin devam ettiği öngörüldüğünde, 2030 yılına kadar tüm dünyada sigaraya bağlı ölümlerin 8 milyona ulaşacağı tahmin edilmektedir. E-sigaralar, geleneksel sigaraların kullanımını azaltmaya ve/veya tamamen bırakmaya yardımcı olmak için bir alternatif olarak teşvik edilmiş ürünlerdir, ancak sigarayı bırakmayı ne derecede etkilediği henüz açıkça ortaya konulamamıştır. Tütün ve yanma süreci içermediği hâlde inhalasyon yoluyla tüketildiği için E-sigaralar, geleneksel sigara içme şeklini taklit etmektedir. Yapılan çalışmalarda, E-sigara kullanıcılarının; geleneksel sigarayı bırakmaya yardımcı olması, geleneksel sigara tüketimini ve maliyetini azaltması, sigara içmenin yasak olduğu yerlerde kullanılabilmesi ve geleneksel sigaradan daha az zararlı olması gibi gerekçelerle E-sigarayı tercih ettikleri bildirilmektedir. E-sigaralarda, buhar üretmek için kullanılan sıvılarda çeşitli miktarlarda kimyasal ajanlar bulunmaktadır ve üreticiler, bu kimyasalların birbirleriyle etkileşimi ve güvenliği konusunda yeterli bilgi birikimine sahip değildir. Yüksek ısılarda, E-sigaralarda bulunan bitkisel gliserinin ve propilen gliserolün parçalandığı belirlenmiştir. Kullanıcının nefes almasıyla birlikte E-sigaradaki sıvı bileşim ısıtılarak buharlaştırmaktadır. Bu ısıtma aşaması, fiziksel değişimler ve kimyasal reaksiyonlara yol açarak E-sigara buharının inhalasyonunda toksik bileşenlere dönüşebilmektedir. E-sigaraların sağlığa etkileri ve henüz bilinmeyen yönleri nedeni ile sigarayı bırakmadaki yeri uzmanlar tarafından sıklıkla tartışılan konulardan biridir. Yeni nesil tütün kullanımının son şekli olan E-sigara kullanımının hem ülkemizde hem de dünyada yaygınlaşması nedeni ile, hemşirelerin bu konudaki farkındalıklarının ve bilgilerinin artırılması, bununla birlikte geleneksel sigarayı bırakmada E-sigara kullanımının sonuçları hakkında yeterli bilgiye sahip olmaları gerekmektedir.

Anahtar Kelimeler: Elektronik sigara; sigara bırakma; tütün
ABSTRACT
Cigarette smoking is estimated to increase to eight million deaths due to smoking in the world by 2030 when it is estimated that the current trends continue. E-cigarettes are encouraged products as an alternative to help reduce or completely quit the use of conventional cigarettes; however, the extent to which it affects smoking cessation has not yet been clearly established. E-cigarettes mimic the conventional form of smoking because they are consumed by inhalation, although they do not contain tobacco and combustion processes. In the studies, E-cigarette users; it is reported that they prefer E-cigarettes because they help to quit conventional cigarettes, reduce the consumption and cost of conditional cigarettes, use it in places where smoking is prohibited and be less harmful than conditional cigarettes. In E-cigarettes, there are various amounts of chemical agents in liquids used to generate steam, and manufacturers do not have sufficient knowledge of the interaction and safety of these chemicals. It was determined that the vegetable glycerin and propylene glycerol in E-cigarettes were degraded at high temperatures. With the breathing of the user, the liquid composition in the E-cigarette vaporizes by heating. This heating phase can turn into toxic components in the inhalation of E-cigarette vapor by causing physical changes and chemical reactions. The role of E-cigarettes in smoking cessation due to its health effects and yet unknown aspects is one of the topics frequently discussed by experts. Due to the widespread use of E-cigarettes, the latest form of new generation tobacco use both in our country and in the world, it is necessary to increase awareness and knowledge of nurses on this issue and in addition to have sufficient information about the usage results of E-cigarettes in quitting conventional cigarettes.

Keywords: E-cigarette; smoking cessation; tobacco
REFERENCES:
  1. Musk AW, de Klerk NH. History of tobacco and health. Respirology. 2003;8(3):286-90. [Crossref]  [PubMed] 
  2. Seydioğulları M. [The history of tobacco in the world and Turkey, production, trade and fundamental policies]. Karadağ M, Bilgiç H. editörler. Toraks Kitapları, Tütün ve Tütün Kontrolü. Türk Toraks Derneği. Sayı: 10. İstanbul: Aves Yayıncılık; 2010. p.3-20.
  3. Aslan D. [In the world and Turkey began a new era in tobacco control: the framework convention on tobacco control]. STED. 2005;14(1):19-21.
  4. Bekki K, Uchiyama S, Ohta K, Inaba Y, Nakagome H, Kunugita N. Carbonyl compounds generated from electronic cigarettes. Int J Environ Res Public Health. 2014;11(11):11192-200. [Crossref]  [PubMed]  [PMC] 
  5. World Health Organization (WHO). World Health Organization report on the global tobacco epıdemıc monitoring tobacco use and prevention policies. Geneva: World Health Organization; 2017. p.1-46. Erişim adresi: https://apps.who.int/iris/bitstream/handle/10665/255874/9789241512824eng.pdf;jsessionid=4202A1875F929CD350CAFD2C49BAA735?sequence=1 Erişim tarihi: 14.05.2019.
  6. Drope J. Prevalence. In: Drope J, Schluger NW, eds. The Tobacco Atlas. 6th ed. China: RR Donnelley; 2018. p.20-1. Erişim Adresi: https://tobaccoatlas.org/wp-content/uploads/2018/03/TobaccoAtlas_6thEdition_LoRes_Rev0318.pdf. Erişim Tarihi:10.05.2019.
  7. Chan G, Leung J, Gartner C, Yong HH, Borland R, Hall W. Correlates of electronic cigarette use in the general population and among smokers in Australia-Findings from a nationally representative survey. Addict Behav. 2019;95:6-10. [Crossref]  [PubMed] 
  8. Farsalinos KE, Poulas K, Voudris V, Le Houezec J. Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries. Addiction. 2016;111(11):2032-40. [Crossref]  [PubMed] 
  9. Abrams DB, Glasser AM, Pearson JL, Villanti AC, Collins LK, Niaura RS. Harm minimization and tobacco control: reframing societal views of nicotine use to rapidly save lives. Annu Rev Public Health. 2018;39(1):193-213. [Crossref]  [PubMed] 
  10. Bullen C, McRobbie H, Thornley S, Glover M, Lin R, Laugesen M. Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and control, withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tob Control. 2010;19(2):98-103. [Crossref]  [PubMed] 
  11. Breland A, Soule E, Lopez A, Ramôa C, El-Hellani A, Eissenberg T. Electronic cigarettes: what are they and what do they do? Ann N Y Acad Sci. 2016;1394(1):5-30. [Crossref]  [PubMed]  [PMC] 
  12. Wang B, King BA, Corey CG, Arrazola RA, Johnson SE. Awareness and use of non-conventional tobacco products among U.S. students, 2012. Am J Prev Med. 2014;47(2 Suppl 1):S36-52. [Crossref]  [PubMed]  [PMC] 
  13. Besaratinia A, Tommasi S. Electronic cigarettes: the road ahead. Prev Med. 2014;66:65-7. [Crossref]  [PubMed] 
  14. Wang X, Zhang X, Xu X, Gao Y. Electronic cigarette use and smoking cessation behavior among adolescents in China. Addict Behav. 2018;82:129-34. [Crossref]  [PubMed]  [PMC] 
  15. Hajek P, Etter JF, Benowitz N, Eissenberg T, McRobbie H. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction. 2014;109(11):1801-10. [Crossref]  [PubMed]  [PMC] 
  16. El-Hellani A, El-Hage R, Baalbaki R, Salman R, Talih S, Shihadeh A, et al. Free-base and protonated nicotine in electronic cigarette liquids and aerosols. Chem Res Toxicol. 2015;28(8):1532-7. [Crossref]  [PubMed]  [PMC] 
  17. Etter JF, Bullen C. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction. 2011;106(11):2017-28. [Crossref]  [PubMed] 
  18. El Dib R, Suzumura EA, Akl EA, Gomaa H, Agarwal A, Chang Y, et al. Electronic nicotine delivery systems and/or electronic non-nicotine delivery systems for tobacco smoking cessation or reduction: a systematic review and meta-analysis. BMJ Open. 2017;7(2):e012680. [Crossref]  [PubMed]  [PMC] 
  19. Etter JF. Characteristics of users and usage of different types of electronic cigarettes: findings from an online survey. Addiction. 2016;111(4):724-33. [Crossref]  [PubMed] 
  20. Abramovitz A, McQueen A, Martinez RE, Williams BJ, Sumner W. Electronic cigarettes: the nicotyrine hypothesis. Med Hypotheses. 2015;85(3):305-10. [Crossref]  [PubMed] 
  21. Chu KH, Colditz JB, Primack BA, Shensa A, Allem JP, Miller E, et al. JUUL: spreading online and offline. J Adolesc Health. 2018;63(5):582-6. [Crossref]  [PubMed]  [PMC] 
  22. David T, Tharyan P. Electronic cigarettes for smoking cessation and reduction. Summary of the evidence and implications for public health programmes. Clinical Epidemiology and Global Health. 2016;4(3):146-50. [Crossref] 
  23. Barrington-Trimis JL, Gibson LA, Halpern-Felsher B, Harrell MB, Kong G, Krishnan-Sarin, et al. Type of E-cigarette device used among adolescents and young adults: findings from a pooled analysis of eight studies of 2166 vapers. Nicotine Tob Res. 2017;20(2):271-4. [Crossref]  [PubMed]  [PMC] 
  24. Lerner CA, Sundar IK, Yao H, Gerloff J, Ossip DJ, McIntosh S, et al. Vapors produced by electronic cigarettes and e-juices with flavorings induce toxicity, oxidative stress, and inflammatory response in lung epithelial cells and in mouse lung. PLoS One. 2015;10(2):e0116732. [Crossref]  [PubMed]  [PMC] 
  25. Talih S, Balhas Z, Eissenberg T, Salman R, Karaoghlanian N, El Hellani A, et al. Effects of user puff topography, device voltage, and liquid nicotine concentration on electronic cigarette nicotine yield: measurements and model predictions. Nicotine Tob Res. 2014;17(2):150-7. [Crossref]  [PubMed]  [PMC] 
  26. Brown J, Beard E, Kotz D, Michie S, West R. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction. 2014;109(9):1531-40. [Crossref]  [PubMed]  [PMC] 
  27. Bell K, Keane H. Nicotine control: E-cigarettes, smoking and addiction. Int J Drug Policy. 2012;23(3):242-7. [Crossref]  [PubMed] 
  28. Gravely S, Fong G, Cummings KM, Yan M, Quah AC, Borland R, et al. Awareness, trial, and current use of electronic cigarettes in 10 countries: findings from the ITC project. Int J Environ Res Public Health. 2014;11(11):11691-704. [Crossref]  [PubMed]  [PMC] 
  29. Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med. 2016;4(2):116-28. [Crossref] 
  30. Mark KS, Farquhar B, Chisolm MS, Coleman-Cowger VH, Terplan M. Knowledge, attitudes, and practice of electronic cigarette use among pregnant women. J Addict Med. 2015;9(4):266-72. [Crossref]  [PubMed] 
  31. Evans-Polce RJ, Patrick ME, Lanza ST, Miech RA, O'Malley PM, Johnston LD. Reasons for vaping among U.S. 12th graders. J Adolesc Health. 2018;62(4):457-62. [Crossref]  [PubMed]  [PMC] 
  32. Patrick ME, Miech RA, Carlier C, O'Malley PM, Johnston LD, Schulenberg JE. Self-reported reasons for vaping among 8th, 10th, and 12th graders in the US: nationally-representative results. Drug Alcohol Depend. 2016;165:275-8. [Crossref]  [PubMed]  [PMC] 
  33. Centers for Disease Control and Prevention (CDC) E-Cigarette Use Among Youth and
  34. Young Adults: a Report of the Surgeon General. Centers for Disease Control & Prevention; 2016. p.7-8. Erişim adresi: https://www.cdc.gov/tobacco/data_statistics/sgr/ecigarettes/pdfs/2016_SGR_Front_Matter_508. Erişim tarihi: 08.05.2019.
  35. Jamal A, Gentzke A, Hu SS, Cullen KA, Apelberg BJ, Homa DM, et al. Tobacco use among middle and high school students-United States, 2011‐2016. MMWR Morbid Mortal Wkly Rep. 2017;66(23):597-603. [Crossref]  [PubMed]  [PMC] 
  36. Glantz SA, Bareham DW. E-cigarettes: use, effects on smoking, risks, and policy implications. Annu Rev Public Health. 2018;39(1):215-35. [Crossref]  [PubMed]  [PMC] 
  37. Fu M, Castellano Y, Tigova O, Mons U, Agar T, Kyriakos CN, et al. Smoking in public places in six European countries: findings from the EUREST-PLUS ITC Europe Survey. Tob Induc Dis. 2018;16(Suppl 2):A18. [Crossref] 
  38. Börekçi Ş, Bilir N, Karlıkaya C; TUSAD Tobacco Working Group. A new area to fight: electronic cigarette. Eurasian J Pulmonol. 2015;17:80-4. [Crossref] 
  39. Ogan N, Baha A, Coşkun O, Eylem Akpınar E. Use of and awareness about electronic cigarette among medical school students. EJMO. 2019;3(1):6-13. [Crossref] 
  40. Tütün Ürünlerinin Zararlarının Önlenmesi ve Kontrolü Hakkında Kanun (6487 sayılı Kanun ile değişik hali). Kanun Numarası: 4207, Kabul Tarihi: 07.11.1996, Yayımlandığı Resmi Gazete Tarihi: 26.11.1996, Yayımlandığı Resmi Gazete Sayısı: 22829. Erişim adresi: http://www.mevzuat.gov.tr/MevzuatMetin/1.5.4207-20130524. Erişim Tarihi: 01.05.2019
  41. King BA, Alam S, Promoff G, Arrazola R, Dube SR. Awareness and ever-use of electronic cigarettes among U.S. adults, 2010-2011. Nicotine Tob Res. 2013;15(9):1623-7. [Crossref]  [PubMed]  [PMC] 
  42. Tierney PA, Karpinski CD, Brown JE, Luo W, Pankow JF. Flavour chemicals in electronic cigarette fluids. Tob Control. 2015;25(e1):e10-5. [Crossref]  [PubMed]  [PMC] 
  43. Varlet V, Farsalinos K, Augsburger M, Thomas A, Etter JF. Toxicity assessment of refill liquids for electronic cigarettes. Int J Environ Res Public Health. 2015;12(5):4796-815. [Crossref]  [PubMed]  [PMC] 
  44. Kosmider L, Sobczak A, Fik M, Knysak J, Zaciera M, Kurek J, et al. Carbonyl compounds in electronic cigarette vapors: effects of nicotine solvent and battery output voltage. Nicotine Tob Res. 2014;16(10):1319-26. [Crossref]  [PubMed]  [PMC] 
  45. Barrington-Trimis JL, Urman R, Berhane K, Unger JB, Cruz TB, Pentz MA, et al. E-cigarettes and future cigarette use. Pediatrics. 2016;138(1):e20160379. [Crossref]  [PubMed]  [PMC] 
  46. Soneji S, Barrington-Trimis JL, Wills TA, Leventhal AM, Unger JB, Gibson LA, et al. Association between ınitial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis. JAMA Pediatr. 2017;171(8):788-97. [Crossref]  [PubMed]  [PMC] 
  47. McConnell R, Barrington-Trimis JL, Wang K, Urman R, Hong H, Unger J, et al. Electronic cigarette use and respiratory symptoms in adolescents. Am J Respir Crit Care Med. 2017;195(8):1043-9. [Crossref]  [PubMed]  [PMC] 
  48. Alzahrani T, Pena I, Temesgen N, Glantz SA. Association between electronic cigarette use and myocardial infarction. Am J Prev Med. 2018;55(4):455-61. [Crossref]  [PubMed]  [PMC] 
  49. Krishnan-Sarin S, Jackson A, Morean M, Kong G, Bold KW, Camenga DR, et al. E-cigarette devices used by high-school youth. Drug Alcohol Depend. 2019;194:395-400. [Crossref]  [PubMed] 
  50. Saffari A, Daher N, Ruprecht A, De Marco C, Pozzi P, Boffi R, et al. Particulate metals and organic compounds from electronic and tobacco-containing cigarettes: comparison of emission rates and secondhand exposure. Environ Sci Processes Impacts. 2014;16(10):2259-67. [Crossref]  [PubMed] 
  51. Kandra KL, Ranney LM, Lee JG, Goldstein AO. Physicians' attitudes and use of e-cigarettes as cessation devices, North Carolina, 2013. PLoS One. 2013;9(7):e103462. [Crossref]  [PubMed]  [PMC] 
  52. Steinberg MB, Giovenco DP, Delnevo CD. Patient-physician communication regarding electronic cigarettes. Prev Med Rep. 2015;2:96-8. [Crossref]  [PubMed]  [PMC] 
  53. Antin TMJ, Hunt G, Kaner E, Lipperman-Kreda S. Youth perspectives on concurrent smoking and vaping: implications for tobacco control. Int J Drug Policy. 2019;66:57-63. [Crossref]  [PubMed] 
  54. Adkison SE, O'Connor RJ, Bansal-Travers M, Hyland A, Borland R, Yong HH, et al. Electronic nicotine delivery systems: international tobacco control four-country survey. Am J Prev Med. 2013;44(3):207-15. [Crossref]  [PubMed]  [PMC] 
  55. McMillen RC, Gottlieb MA, Shaefer RM, Winickoff JP, Klein JD. Trends in electronic cigarette use among U.S. adults: use is increasing in both smokers and nonsmokers. Nicotine Tob Res. 2014;17(10):1195-202. [Crossref]  [PubMed] 
  56. Martinez RE, Dhawan S, Sumner W, Williams BJ. On-line chemical composition analysis of refillable electronic cigarette aerosol-measurement of nicotine and nicotyrine. Nicotine Tob Res. 2014;17(10):1263-9. [Crossref]  [PubMed] 
  57. Benowitz NL, Burbank AD. Cardiovascular toxicity of nicotine: implications for electronic cigarette use. Trends Cardiovasc Med. 2016;26(6):515-23. [Crossref]  [PubMed]  [PMC] 
  58. Giovenco DP, Delnevo CD. Prevalence of population smoking cessation by electronic cigarette use status in a national sample of recent smokers. Addict Behav. 2018;76:129-34. [Crossref]  [PubMed]  [PMC] 
  59. Adriaens K, Van Gucht D, Declerck P, Baeyens F. Effectiveness of the electronic cigarette: an eight-week flemish study with six-month follow-up on smoking reduction, craving and experienced benefits and complaints. Int J Environ Res Public Health. 2014;11(11):11220-48. [Crossref]  [PubMed]  [PMC] 
  60. Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016;14(9):CD010216. [Crossref]  [PMC] 
  61. Berry KM, Reynolds LM, Collins JM, Siegel MB, Fetterman JL, Hamburg NM, et al. E-cigarette initiation and associated changes in smoking cessation and reduction: the population assessment of tobacco and health study, 2013-2015. Tob Control. 2019;28(1):42-9. [Crossref]  [PubMed]  [PMC] 
  62. Brose LS, Hitchman SC, Brown J, West R, McNeil A. Is the use of electronic cigarettes while smoking associated with smoking cessation attempts, cessation and reduced cigarette consumption? A survey with a 1-year follow-up. Addiction. 2015;110(7):1160-8. [Crossref]  [PubMed]  [PMC] 
  63. Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013;382(9905):1629-37. [Crossref] 
  64. Grana RA, Popova L, Ling PM. A longitudinal analysis of electronic cigarette use and smoking cessation. JAMA Intern Med. 2014;174(5):812-3. [Crossref]  [PubMed]  [PMC] 
  65. Hitchman SC, Brose LS, Brown J, Robson D, McNeill A. Associations between E-cigarette type, frequency of use, and quitting smoking: findings from a longitudinal online panel survey in Great Britain. Nicotine Tob Res. 2015;17(10):1187-94. [Crossref]  [PubMed]  [PMC] 
  66. Lozano P, Arillo-Santillán E, Barrientos-Gutiérrez I, Zavala-Arciniega L, Reynales-Shigematsu LM, Thrasher JF. E-cigarette use and its association with smoking reduction and cessation intentions among Mexican smokers. Salud Publica Mex. 2019;61(3):276-85. [Crossref]  [PubMed] 
  67. Martínez Ú, Martínez-Loredo V, Simmons VN, Meltzer LR, Drobes DJ, Brandon KO, et al. How does smoking and nicotine dependence change after onset of vaping? A retrospective analysis of dual users. Nicotine Tob Res. 2019 Mar 18. Doi: 10.1093/ntr/ntz043. [Epub ahead of print]. [Crossref]  [PubMed] 
  68. Kulik MC, Lisha NE, Glantz SA. E-cigarettes associated with depressed smoking cessation: a cross-sectional study of 28 European Union Countries. Am J Prev Med. 2018;54(4):603-9. [Crossref]  [PubMed]  [PMC] 
  69. Pepper JK, Brewer NT. Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review. Tob Control. 2014;23(5):375-84. [Crossref]  [PubMed]  [PMC] 
  70. Johnson M, Pennington N. Adolescent use of electronic cigarettes: an emergent health concern for pediatric nurses. J Pediatr Nurs. 2015;30(4):611-5. [Crossref]  [PubMed] 
  71. Skotsimara G, Antonopoulos AS, Oikonomou E, Siasos G, Ioakeimidis N, Tsalamandris S, et al. Cardiovascular effects of electronic cigarettes: a systematic review and meta-analysis. Eur J Prev Cardiol. 2019;26(11):1219-28. [Crossref]  [PubMed] 
  72. Pagano T, DiFrancesco AG, Smith SB, George J, Wink G. Rahman, et al. Determination of nicotine content and delivery in disposable electronic cigarettes available in the united states by gas chromatography-mass spectrometry. Nicotine Tob Res. 2015;18(5):700-7. [Crossref]  [PubMed]  [PMC] 
  73. Kosmider L, Sobczak A, Prokopowicz A, Kurek J, Zaciera M, Knysak J, et al. Cherry-flavoured electronic cigarettes expose users to the inhalation irritant, benzaldehyde. Thorax. 2016;71(4):376-7. [Crossref]  [PubMed]  [PMC] 
  74. Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control. 2014;23(2):133-9. [Crossref]  [PubMed]  [PMC] 
  75. Ghosh S, Drummond MB. Electronic cigarettes as smoking cessation tool: are we there? Curr Opin Pulm Med. 2017;23(2):111-6. [Crossref]  [PubMed]  [PMC] 
  76. Göney G, Çok İ, Tamer U, Burgaz S, Şengezer T. Urinary cotinine levels of electronic cigarette (e-cigarette) users. Toxicol Mech Methods. 2016;26(6):441-8. [Crossref]  [PubMed] 
  77. Stepanov I, Fujioka N. Bringing attention to e-cigarette pH as an important element for research and regulation. Tob Control. 2014;24(4):413-4. [Crossref]  [PubMed] 
  78. Goniewicz ML, Hajek P, McRobbie H. Nicotine content of electronic cigarettes, its release in vapour and its consistency across batches: regulatory implications. Addiction. 2014109(3):500-7. [Crossref]  [PubMed] 
  79. Grana RA. Electronic cigarettes: a new nicotine gateway? J Adolesc Health. 2013;52(2):135-6. [Crossref]  [PubMed] 
  80. Dağlı E. [New generation tobacco and nicotine products]. STED. 2016;25(Özel Sayı):2-6.
  81. Asaria P, Chisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. Lancet. 2007;370(9604):2044-53. [Crossref] 
  82. Türkmen E, Badır A, Ergün A. [Coronary artery diseases risk factors: role of nurses on primary and secondary prevention]. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi. 2012;3(4):223-31.
  83. Sheffer CE, Barone C, Anders ME. Training nurses in the treatment of tobacco use and dependence: pre- and post-training results. J Adv Nurs. 2010;67(1):176-83. [Crossref]  [PubMed]  [PMC] 
  84. Bialous SA, Sarna L, Wells MJ, Brook JK, Kralikova E, Pankova A, et al. Impact of online education on nurses' delivery of smoking cessation ınterventions with implications for evidence-based practice. Worldviews Evid Based Nurs. 2017;14(5):367-76. [Crossref]  [PubMed] 
  85. Rice VH, Heath L, Livingstone-Banks J, Hartmann-Boyce J. Nursing interventions for smoking cessation. Cochrane Database Syst Rev. 2017;15(12):CD001188. [Crossref]  [PMC] 
  86. Pardavila-Belio MI, García-Vivar C, Pimenta AM, Canga-Armayor A, Pueyo-Garrigues S, Canga-Armayor N. Intervention study for smoking cessation in Spanish college students: pragmatic randomized controlled trial. Addiction. 2015;110(10):1676-83. [Crossref]  [PubMed] 
  87. Terazawa T, Mamiya T, Masui S, Nakamura M. [The effect of smoking cessation counseling at health checkup]. Sangyo Eiseigaku Zasshi. 2001;43(6):207-13. [Crossref]  [PubMed] 
  88. Canga N, De Irala J, Vara E, Duaso MJ, Ferrer A, Martinez-Gonzalez MA. Intervention study for smoking cessation in diabetic patients: a randomized controlled trial in both clinical and primary care settings. Diabetes Care. 2000;23(10):1455-60. [Crossref]  [PubMed] 
  89. Patel D, Davis KC, Cox S, Bradfield B, King BA, Shafer P, et al. Reasons for current E-cigarette use among U.S. adults. Prev Med. 2015;93:14-20. [Crossref]  [PubMed]  [PMC] 
  90. Leventhal AM, Strong DR, Kirkpatrick MG, Unger JB, Sussman S, Riggs NR, et al. Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence. JAMA. 2015;314(7):700-7. [Crossref]  [PubMed]  [PMC] 

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.: Manuscript Editing Department

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E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com