Introduction:
Turkey is a leader of tobacco control in Europe. However, little is known about cessation implementation, a key component of tobacco control success. This paper discusses the training of nurses in smoking cessation as part of routine practice in Istanbul hospitals. The Turkey project builds and extends on a decade of research and training in developing culturally sensitive cessation education in India and Indonesia (Project Quit Tobacco International). One of the goals of the Turkey project is to provide leadership in the field of nursing in smoking cessation as a foundation for a larger smoking cessation movement within Turkey’s healthcare sector.

Material and Methods:
Prior to training, formative research was conducted with smokers to better understand challenges faced when trying to quit. Site visits to government hospitals and cessation clinics were conducted to observe health care provider-patient interaction. Four culturally sensitive cessation training workshops for nurses (n=54) were held and follow-up debriefing sessions were conducted.

Results:
Challenges to cessation counseling included lack of time and incentives for nurse involvement; lack of information about the harm of smoking and benefits of quitting; and the medicalization of cessation focused on pharmaceutical distribution. The pay for performance model in hospitals has de-incentivized doctors to work in cessation clinics making referrals by nurses unfeasible.

Conclusions:
o involve nurses in tobacco cessation delivery in Turkey, health care providers need to quit smoking, and changes to the health care system need to occur. Cessation needs to be integrated into routine nurse-patient interactions, teamwork between nurses and doctors will need to be established to enable referral in hospitals with and without cessation clinics, and the systemic harms of smoking will need to be integrated into medical and nursing school curriculum. Opportunities for doing so are discussed.

Funding:
Funding was provided by Global Bridges, Mayo Clinic, U.S.