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Issue: 2017, March, Volume 11, No 1
issue id: 2017_3_11_1
article id: 2017_3_11_1_1

Letter to the Editor

Cigarette, A Child!
Sigara, Bir Evlat!

Onur Öztürk1*

Loneliness pushes the person to seek solutions. When smokers are asked, unfortunately cigarette smoking is regarded as a way to cope with loneliness. An elderly male patient without children regarded cigarette as his own child. Therefore, he could not even think of quitting smoking. In resisting cases, firstly the etiology of smoking addiction should be determined, then psychotherapeutic support should be provided.
Key words: Child, cigarette smoking, loneliness

Yalnızlık, kişiyi çözüm yolları aramaya iter. Sigara, maalesef içicilere sorulduğunda yalnızlıkla başa çıkma yollarından biri olarak görülmektedir. Çocuğu olmayan yaşlı bir hastamız sigarayı kendi evladı yerine koymaktadır. Bu yüzden sigarayı bırakmayı henüz düşünmemektedir. Dirençli vakalarda önce sigara bağımlılığının etyolojisi saptanmalı, sonra psikoterapi desteği sağlanmalıdır.
Anahtar kelimeler: Evlat, sigara kullanma, yalnızlık

Received / Geliş tarihi: 30.12.2016
Accepted / Kabul tarihi: 17.02.2017
1Samsun Asarcik Family Healthcare Center
* Address for Correspondence / Yazışma Adresi: Onur Öztürk, Asarcik Family Healthcare Center, Samsun-Turkey
* E-mail: dr.onurozturk@yahoo.com
Öztürk O. Cigarette, A Child!, TJFMPC, 2017;11(1): 1-3.
DOI: 10.21763/tjfmpc.295607

Dear Editor,
Loneliness is defined as an undesired and unpleasant experience, which is mostly evaded and accompanied with anxiety, anger, sadness and the feeling of being different from other people.[1] This experience causes people to look for an escape from the feeling of isolation from life and to react.2 The person may find the escape in various ways and cigarette smoking is one of them. Several studies have reported a significant correlation between cigarette smoking and loneliness.[3,4] It should be kept in mind that this relationship could also be vice versa.[5] The use of smoking for self-medication is especially emphasized in the literature.
      A 76-year-old male patient applied to our family health center and requested painkillers and vitamin medication in December 2016. The patient, a retired worker and married for 58 years, had no children. That was his first application to the clinic for the last two years. In his medical history, the patient said that his general health status is quite good and he rarely goes to the hospital. Because of the intense cigarette smoke odor, he was immediately inquired about whether he smokes or not. The patient said that he smokes since he was siz years old (for 70 years). He initially smoked a few cigarettes/day when he was young. He increased to three boxes/year during his military duty. Then, he continued to smoke 2-3 boxes/day and now he smokes 10-12 cigarettes/day since the last one year. He was rolling his own cigarettes. He said 'I can not speak everything with my wife. I am feeling very lonely. I regard cigarette as my child. I am seeking refuge in cigarette when I feel alone. I do not want to quit smoking. I do not believe I can quit'.
      In detailed medical history, he did not mention any complaints except for occasional indigestion and knee pain. He was neither diagnosed with a chronic disease nor using a long-term medication. His wife was a 74-year-old healthy non-smoker. His family history was noncontributory. The score of the Fagerstrom nicotine dependence test (FNDT) of the patient was determined as 8/10. Besides, University of California, Los Angeles Loneliness Scale (UCLA-LS) score was 57/80.
      The FNDT and UCLA-LS scores of the patient were high. These test scores showed that the patient feels lonely and has a high level of smoking addiction, which confirmed the medical history. The relationship between loneliness and smoking in certain cohorts who often feel lonely has been studied in the literature. As loneliness increased, smoking was observed to increase.[6] Mayda et al. observed that the reason for starting smoking was loneliness in 20.6% of college students and students living alone were smoking more cigarettes.[7] Moreover, Seyfikli et al. showed that the reasons for starting smoking were associated with loneliness in 17.6% of housewives.[8] In another study conducted on Indian workers laboring in Arabia, it was observed that loneliness is an important risk factor for cigarette smoking among these immigrant workers.[9] Similarly, a study conducted on adolescents living in orphanage showed that the prevalence of smoking reached almost 50%, while feeling of loneliness was higher in smoking adolescents compared to non-smokers.[10] Chou and Chi showed that the feeling of loneliness is significantly high in elderly people without children.[11]
      It was asserted by smokers that cigarette confronts loneliness by several mechanisms. Having a role as a pharmaceutical agent12 and being a socialising tool13 are the most stated ones among these mechanisms. To regard the cigarette as a replacement for a child may intensify the addiction and therefore may cause resistance to smoking cessation. In such cases, firstly the etiology of smoking addiction should be determined, then psychotherapeutic support should be provided.

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