Electronic cigarette use after the adoption of a tobacco-free campus policy

A three wave assessment of a tobacco free campus policy within a minority serving institution

OBJECTIVE

This study assessed changes (in relation to smoking status) in tobacco use, attitudes toward TFC policies, and tobacco use risk knowledge by applying a three Wave repeated cross-sectional assessment.

PARTICIPANTS

Participants were students at Wave 1 (n = 2,169), Wave 2 (n = 2,576), and Wave 3 (n = 2,169) and faculty at Wave 1 (n = 256), Wave 2 (n = 204), and Wave 3 (n = 180).

METHODS

Measures regarding sociodemographics, tobacco use, attitudes toward TFC policies, and tobacco use risk knowledge were completed.

RESULTS

Compared with Wave 1, more students reported having quit smoking within the last six months at Waves 2 and 3. The negative attitudes toward TFC policies of those who reported quitting in the last six months aligned with those of nonsmokers.

CONCLUSIONS

Study findings suggest smoking status as a relevant covariate to focus on to further strengthen and refine existing TFC policies.

Components in tobacco-free school policies-A coding tool for assessment

OBJECTIVE

To develop an instrument to examine tobacco-free campus policy components.

PARTICIPANTS

Missouri two- and four-year, specialized/technical, and religious colleges and universities (N = 76). Methods: The instrument was informed via literature review and expert interviews. Coder agreement was strong (κ = .80). Qualitative policy language examples were identified.

RESULTS

Model policy components including consideration for population, prohibited products, location restrictions, enforcement, consequences, promotions, communications, cessation, designated smoking areas and exemptions; comprehensive policies included all populations, for all tobacco products, and at all locations on the campus. Nineteen campuses had comprehensive tobacco-free policies, five had comprehensive smoke-free policies (cigarettes and e-cigarettes), and no policy included all model components. Fifty-two were non-comprehensive.

CONCLUSIONS

This instrument can allow campuses to identify components for comprehensive and model tobacco-free campus policies and assist officials in improving policy language. Future research can use this instrument to examine the effectiveness of components and their impact on tobacco use outcomes.

Tobacco-free university campus policies: A systematic review

Objective: This systematic review aims to provide an update of the scientific evidence regarding tobacco-free/smoke-free campus policies (TFC/SFC), using a complex interventions approach.

PARTICIPANTS/METHODS

We searched the PubMed, Scopus and Web of Science databases using a combination of 'tobacco-free' or 'smoke-free', 'campus', 'university or college' and 'policy' search terms on all indexed articles published up until June 2023. Studies were included if they presented research on pre-/post-implementation of TFC/SFC or policy components. Two coders extracted and synthesized the data and assessed the risk of bias.

RESULTS

A total of 113 studies were included, reporting data from 2005 to 2023 across 17 countries. The data was categorized into three of the four phases of the Medical Research Council (MRC) framework, i.e. "feasibility (n=24), "implementation" (n=34), and "evaluation" (n=69). This review finds that a policy draft, communication, enforcement strategies, and cessation services are critical policy components. TCF/SFC are effective for reducing tobacco use and secondhand smoke exposure, but they also increase vaping. Little research has investigated the effect of TFC/SFC on smokeless tobacco use.

CONCLUSION

This review addresses remaining uncertainties in evidence on the TFC/SFC implementation process. We go on to provide a series of recommendations for university administrators.

What are the effects of smoke-free and tobacco-free university campus policies, and how can they be assessed? A systematic review

OBJECTIVE

This article looks at the evaluation of smoke-free (SF) and tobacco-free (TF) university campus policies that ban smoking (and often vaping) both indoors and outdoors. To assess the effectiveness of these policies, we performed a systematic literature review to answer the following questions: what is the effect of SF/TF policies on campus users' behaviors/norms/perceptions around smoking? Are the SF/TF policies an effective measure for reducing smoking among young adults? What methods and indicators can we use to assess the impact of SF/TF campus policies? What is the theoretical model underpinning the influence of SF/TF policies on the behavior of campus users?

METHODS

Three databases (PubMed, Scopus, and Web of Science) were searched over the period from January 2005 to December 2022. The article selection process included 54 articles published in scientific journals that analyzed the post-implementation impact of SF/TF campus policies. The quality of these articles was analyzed using six ad hoc indicators based on the Critical Appraisal Skills Program checklist and Joanna Briggs Institute scoping tools.

RESULTS

Most of the research on SF/TF campus policies has been conducted in the United States using quantitative methodologies. Most of these studies show that SF/TF policies reduce positive beliefs about smoking and its acceptability, influence smoking behavior (reducing smoking initiation and increasing the number of quits and quit attempts), and reduce exposure to passive smoking and pollution from cigarette butts. User acceptability of SF/TF policies is generally high. Limitations of SF/TF campus policies include difficulty for smokers to comply with them, persistence of passive smoking around campuses, and limited uptake of on-campus cessation support services provided to smokers.

DISCUSSION

The various mediating and moderating variables identified in the literature have made it possible to propose a model of the potential influence of SF/TF policy on campus users, based on the theory of planned behavior. Based on this review, we provide health professionals and higher education institutions wishing to implement a SF/TF campus policy with a set of indicators that can serve to assess the impact of a SF/TF campus policy (attitudes, acceptability, beliefs, norms, exposure to passive smoking and pollution, changes in smoking behavior).

CONCLUSION

Based on scientific evidence, the implementation of SF/TF campus policies in France is an important measure to help combat smoking in young adults.

Understanding college students' experiences using e-cigarettes and marijuana through qualitative interviews

OBJECTIVE

To investigate the contexts in which college students use e-cigarettes and marijuana, perceptions about the benefits and harms, and health effects of use.

PARTICIPANTS

College student e-cigarette and marijuana ever users (n = 20; 18-21 years old) from the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS).

METHODS

Participants completed a one-hour long online interview about their experiences using e-cigarettes and marijuana. Thematic content analysis in NVivo identified prominent themes.

RESULTS

Vaping nicotine and marijuana were preferred and perceived as normal, trendy and useful in circumventing smoke-free campus policies. Preference for nicotine versus marijuana fluctuates during the academic school year in response to campus restrictions and work and school-related activities. College students commonly experienced health effects (shortness of breath, wheezing) attributed to vaping, did not perceive their use as very harmful, and perceived their use as a college-related phase.

CONCLUSIONS

Findings have implications for college-based health education, resources, and smoke-free policies.

Displacement imposition scale assesses reactions of cigarette and e-cigarette users impacted by a campus-wide smoking ban

OBJECTIVE

The present study developed a measure assessing the emotional responses, "Displacement Imposition," of cigarette and e-cigarette users on a college campus with a smoking/vaping ban. It also examined the relationship between Displacement Imposition and readiness to quit smoking/vaping, and how this relationship differed between cigarette and e-cigarette users.

PARTICIPANTS

Participants (N = 297) were from a large, Midwestern university.

METHODS

Participants completed online questionnaires assessing demographics, cigarette and e-cigarette use, Displacement Imposition, and readiness to quit.

RESULTS

All six Displacement Imposition items loaded onto a single factor. A significant interaction emerged between Displacement Imposition and product use in predicting readiness to quit. At high levels of Displacement Imposition, cigarette users were less ready to quit than e-cigarette users.

CONCLUSIONS

Findings suggest restrictions imposed on cigarette and e-cigarette users were associated with reduced readiness to quit. Findings inform tobacco control policies as tobacco denormalization may increase the burden placed on tobacco users.

Marijuana use behaviors on Texas college campuses

There is limited contemporary research examining marijuana use behaviors that occur on college campuses.

PURPOSE

This study aimed to determine: (1) What is the prevalence of marijuana use on college campuses, (2) where are students commonly using marijuana on college campuses, (3) what are the sociodemographic characteristics of students most likely to use marijuana on a college campus, and (4) how do these findings vary between modes of marijuana use (i.e., vaped versus another mode)?

METHODS

Participants were 14,005 college students (aged 18-25) enrolled in 19 Texas colleges during spring 2022 (Mean age = 20.16; 65.81% female; 30.85% non-Hispanic white, 42.08% Hispanic/Latino, 27.07% another race/ethnicity; 75.81% heterosexual).

RESULTS

Nearly 40% of students ever used marijuana and of these students, over 26% ever used marijuana on their college campus. Although the most common mode for marijuana use was smoking, the majority of students that used marijuana on a college campus reported vaping marijuana (64.89%). Students that ever vaped marijuana on campus were 2.35 times more likely than those that used marijuana via other modes to use marijuana in a public location on campus (i.e., not in a dormitory).

CONCLUSIONS

Findings indicate that marijuana use on college campuses is common and suggest that the ability to vape marijuana may increase marijuana use on college campuses, including in public locations such as classrooms and libraries. College campuses may consider increasing anti-marijuana enforcement efforts, especially those aimed at decreasing electronic vaping device use in general, in order to prevent and decrease marijuana use.

Student tobacco use, secondhand smoke exposure, and policy beliefs before and after implementation of a tobacco-free campus policy: Analysis of five U.S. college and university campuses

The adoption of comprehensive tobacco policies by colleges and universities may help reduce student tobacco use. To this end, The American Cancer Society's Tobacco-Free Generation Campus Initiative (TFGCI) awarded grants to 106 higher learning institutions to adopt 100% tobacco-free campus policies. This study measured changes in student tobacco use, reported exposure to secondhand smoke, and support for types of tobacco policies among five TFGCI grantee institutions who implemented 100% tobacco-free policies. Students at five U.S. TFGCI grantee institutions completed two independent cross-sectional online surveys regarding tobacco use, exposure to secondhand smoke, and policy attitudes, once before (n = 2499) and once after (n = 1667) their campuses adopted a tobacco-free policy. Students were less likely to report current cigarette smoking (aOR: 0.73, 95% C.I.: 0.63, 0.85) and exposure to secondhand smoke on campus (aOR: 0.42, 95% C.I.: 0.23, 0.76) following the policy change. In contrast, students were more likely to report past 30-day use of electronic nicotine delivery systems (ENDS) (aOR: 2.16, C.I.: 1.77, 2.63) following the policy change, despite the policy's inclusion of all tobacco and nicotine products. Tobacco-free campus policies can be associated with decreases in tobacco product use and environmental smoke exposure. The extent of their effectiveness may vary by product and the inclusion of tailored messaging, cessation support, and enforcement approaches. To discourage use of these products among students, colleges and universities should adopt 100% tobacco-free policies, monitor product use trends, offer cessation support and messaging customized for specific groups and products, and utilize a comprehensive enforcement strategy.

Non-compliance with university tobacco-free policies: A qualitative exploration

INTRODUCTION

Though university smoke-free and tobacco-free campus policies have been proliferating across the US, compliance and enforcement remain challenges. This study examined perceptions and behaviors of employees and students who used tobacco products on tobacco-free campuses, to better understand policy non-compliance.

METHODS

Students (n=56) and employees (n=20) from two tobacco-free 4-year public universities in Southern California who self-reported using tobacco products on campus participated in focus groups, stratified by university and student or employee (faculty and staff) status, to discuss attitudes toward campus tobacco policies and on-campus smoking. Focus group discussions were transcribed and analyzed after structured coding and subcoding.

RESULTS

Participants were generally aware that smoking and vaping were not allowed on campus, though few could correctly identify their campus as tobacco-free. Attitudes toward the policy varied by subgroup and by campus, with students and employees at different universities expressing varying levels of support. Non-compliance was a unique interaction of individual, institutional, and interpersonal factors including a desire to smoke or vape to reduce stress, lack of formal enforcement or penalty for violating the policy, and efforts to smoke or vape in ways that reduce harm to others as a way of rationalizing non-compliance.

CONCLUSIONS

Attitudes toward university tobacco-free policies are campus- and constituency-specific, with similarities in individual, institutional, and interpersonal factors underlying non-compliance. Interventions to increase compliance should address individual, institutional, and interpersonal influences on non-compliance through efforts tailored to specific campus constituencies based on their particular knowledge and attitudes towards tobacco-free policies.

Evaluation of a smoke- and tobacco-free campus policy: The issue of displacement

Objective This study evaluates the effectiveness of a smoke- and tobacco-free campus policy by examining the volume, density, and location of discarded cigarette butts before and after the implementation of the policy. Participants: Student, staff, and faculty volunteers collected and recorded the location of discarded cigarette butts in April 2017 and October 2018. Methods: The Smoke and Tobacco Free Environment policy was effective September 1, 2017. A campus-wide collection of cigarette butts was conducted 5 months before, and 13 months after it came into effect. Results: The number of cigarette butts on campus decreased after policy implementation, especially in areas with formal enforcement. There was evidence of displacement of smoking behavior from the campus center to its periphery where parking lots and staff buildings are located. Conclusions: Formal enforcement is key to increasing the efficacy of the policy. Interventions should be directed to the locations where smoking behavior is concentrated.

Local and State Policy Action Taken in the United States to Address the Emergence of E-Cigarettes and Vaping: A Scoping Review of Literature

INTRODUCTION

In response to rising rates of youth vaping and e-cigarette use, states and localities in the United States have adopted various tobacco control policies and have extended their utility to these emerging products. However, the extent to which these policies have been evaluated for their impact on youth use is unknown.

METHOD

Two databases (PubMed, Google Scholar) were searched for English language peer-reviewed articles pertaining to electronic cigarette policy evaluation between 2009 and 2020. Primary articles of interest were journal articles that evaluated an e-cigarette policy. Secondary articles of interest were journal articles that identified any e-cigarette policy action without a formal evaluation component, those that evaluated tobacco policy, or those that described e-cigarette behaviors and trends. Tertiary articles included gray literature that provided context for e-cigarette trends and additional policy identification.

RESULTS

The final sample consisted of 12 relevant articles with an e-cigarette policy evaluation component and 62 relevant articles without such component, and 19 gray literature sources. Findings were synthesized based on policy type: product classification, age restrictions, smoke-free policies, flavor bans, sales restrictions, taxation, packaging, and advertising.

CONCLUSION

Policies that address access and use of e-cigarettes are common on the federal, state, and local level, are mostly reactionary, and mimic tobacco control efforts. Few policies have been formally evaluated for their effectiveness in reducing or preventing youth vaping. Strengthening the evidence base should be a priority for researchers going forward, given the potential of these policies to intervene on social and environmental conditions that affect youth initiation and uptake.

Campus Smoking Policies and Smoking-Related Twitter Posts Originating From California Public Universities: Retrospective Study

Background

The number of colleges and universities with smoke- or tobacco-free campus policies has been increasing. The effects of campus smoking policies on overall sentiment, particularly among young adult populations, are more difficult to assess owing to the changing tobacco and e-cigarette product landscape and differential attitudes toward policy implementation and enforcement.

Objective

The goal of the study was to retrospectively assess the campus climate toward tobacco use by comparing tweets from California universities with and those without smoke- or tobacco-free campus policies.

Methods

Geolocated Twitter posts from 2015 were collected using the Twitter public application programming interface in combination with cloud computing services on Amazon Web Services. Posts were filtered for tobacco products and behavior-related keywords. A total of 42,877,339 posts were collected from 2015, with 2837 originating from a University of California or California State University system campus, and 758 of these manually verified as being about smoking. Chi-square tests were conducted to determine if there were significant differences in tweet user sentiments between campuses that were smoke- or tobacco-free (all University of California campuses and California State University, Fullerton) compared to those that were not. A separate content analysis of tweets included in chi-square tests was conducted to identify major themes by campus smoking policy status.

Results

The percentage of positive sentiment tweets toward tobacco use was higher on campuses without a smoke- or tobacco-free campus policy than on campuses with a smoke- or tobacco-free campus policy (76.7% vs 66.4%, P=.03). Higher positive sentiment on campuses without a smoke- or tobacco-free campus policy may have been driven by general comments about one’s own smoking behavior and comments about smoking as a general behavior. Positive sentiment tweets originating from campuses without a smoke- or tobacco-free policy had greater variation in tweet type, which may have also contributed to differences in sentiment among universities.

Conclusions

Our study introduces preliminary data suggesting that campus smoke- and tobacco-free policies are associated with a reduction in positive sentiment toward smoking. However, continued expressions and intentions to smoke and reports of one’s own smoking among Twitter users suggest a need for more research to better understand the dynamics between implementation of smoke- and tobacco-free policies and resulting tobacco behavioral sentiment.

An Experimental Test of the Relationship between Electronic Nicotine Delivery System Use and Alcohol Consumption

BACKGROUND

Increasing research shows that the use of electronic nicotine delivery systems (ENDS) is associated with a higher rate and quantity of alcohol consumption.

METHODS

The present study used a 2-session, within-subjects design to experimentally examine the relationship between ENDS use and laboratory ad libitum alcohol consumption. A total of N = 31 (mean age = 28.71, SD = 11.17; 45.2% women; 54.8% White/Caucasian) healthy adults from the community who use ENDS and endorsed liking beer completed the study, which included a beer consumption taste-test task that assessed the volume of beer consumed by the participants across 2 counterbalanced sessions: 1 in which concurrent ENDS use was allowed and 1 in which it was not. All analyses controlled for age, race, and gender.

RESULTS

The effect of ENDS condition on the volume of beer consumed was not statistically significant, F(1, 30) = 0.03, p = 0.86). Results of linear mixed modeling showed that ENDS puffs were significantly related to alcohol sips (estimate = 0.23, SE = 0.07, p = 0.002) across the ad libitum session.

CONCLUSIONS

Overall, ENDS use did not increase alcohol consumption; however, the data suggest that ENDS puffs might act as a prime for beer sips or that these 2 behaviors are linked through habit. Future studies should more fully measure and compare global and event-level data on ENDS and alcohol use as they might show disparate patterns of relationships.

Five-year changes in support for tobacco control policy options among students, faculty and staff at a public university

Over 2500 U.S. colleges and universities have instituted smoke-free (prohibiting combustible tobacco) or tobacco-free (prohibiting all tobacco) campus policies, and support for such policies by students, faculty and staff is an essential ingredient for successful implementation. Cross-sectional studies have found that these policies are well supported, but longitudinal studies that track change in support over time are rare. The present study reports on two campus-wide web-based surveys conducted five years apart, 2013 and 2018, at a public university campus for which a smoke-free policy was in effect. The 2013 samples included 5691 students (26% response rate) and 2051 faculty and staff (43% response rate); the 2018 samples included 4883 students (21% response rate) and 1882 faculty/staff (37% response rate). Question wordings and procedures were largely consistent across the two surveys. Changes in support among students and faculty/staff for both a smoke-free and a tobacco-free campus were measured, including separate analyses for past-month tobacco users and non-users. Chi-square tests revealed that support for both policy options by all respondent groups (student tobacco users and non-users; faculty/staff tobacco users and non-users) increased significantly and substantially, with the exception of student non-users' support of a smoke-free campus, which was already high in 2013 (83.7% support) and remained relatively unchanged. Increases in support for the tobacco-free option were particularly large. Results are discussed in light of theories of social norm change. These findings provide evidence from one university that tobacco control policies, especially those making a campus fully tobacco-free, increase in popularity over time.

Development and evaluation of smoke-free or tobacco-free policies in university settings: a systematic scoping review

We conducted a systematic scoping review to map the available evidence on smoke-free or tobacco-free (SF/TF) university policies globally. We specifically looked at (i) how policies were developed and communicated and (ii) what indicators were used to evaluate their impact. We searched for peer-reviewed literature, published up to January 2020, across 10 multi-disciplinary databases. We followed a duplicate, independent data selection, and charting process. We inductively categorized the studies according to the research design and objective of 'process' and 'impact evaluation'. We identified 75 unique studies across 23 countries conducted between 1993 and 2019. Most studies were conducted in the United States (46/75, 61.3%), were based on quantitative research design and focused on impact evaluations; a third (n = 28) reported both process and impact evaluations (37.3%). Community engagement and multi-channel communication strategies were mostly used to disseminate SF/TF policies. The impact was determined by a wide range of indicators for knowledge, attitudes and behaviors related to policies. There is a mature, relevant body of literature describing the development and evaluation of SF/TF policies in universities. Future reviews could quantify the impact of the bans and may consider process indicators as moderating factors to explain the potential heterogeneity of results.

Electronic nicotine delivery system use is related to higher odds of alcohol and marijuana use in adolescents: Meta-analytic evidence

Research suggests that electronic nicotine delivery system (ENDS) use is associated with other substance use in adolescents; however, the magnitude of this association and whether this differs between adolescents and adults is not yet well understood. This meta-analysis aimed to quantify the extent to which ENDS use is associated with alcohol and marijuana use among adolescents and to compare the odds across adolescent samples and a comparison group of adult samples. A comprehensive literature review was conducted examining the relationship between ENDS use and alcohol (adolescent k = 40 from 19 independent studies; adult k = 35 from 12 independent studies) and marijuana (adolescent k = 24 from 14 independent studies; adult k = 6 from 3 independent studies) use. Adolescents who use ENDS had greater odds of reporting co-occurring alcohol use (OR = 4.50, p < .001), particularly binge drinking (OR = 4.51), and marijuana use (OR = 6.04, p < .001) than adolescent who did not use ENDS. Adults who use ENDS were also more likely to use alcohol (OR = 1.57, p < .001) and marijuana (OR = 2.04, p < .001) than those who did not use ENDS. ENDS use was associated with significantly greater odds of alcohol use (log odds ratio; LOR = 0.96 (OR = 2.61), p < .001) and a trend of greater marijuana use (LOR = 0.93 (OR = 2.53), p = 0.08) in adolescents than in adults. Effects were large in adolescents and small in adults. Findings suggest that ENDS use should be assessed in adolescents in both research and clinical settings. Importantly, ENDS use is strongly associated with co-occurring alcohol or marijuana use in adolescents.