College smoking policies and smoking cessation programs: results of a survey of college health center directors

How effective are campus-wide smoking bans? A comparison of two small colleges

Objective The current study tracked attitudinal and behavioral changes related to a campus-wide smoking ban. Participants: Students from 2 colleges in Massachusetts (N = 418; April 2014; N = 640 April 2018). Methods: Surveys tracked students' smoking habits, beliefs about smoking, and attitudes before and four years after the implementation of a campus-wide smoking ban. Results: While student smoking rates and secondhand exposure did drop following the campus-wide ban, they did not drop at a significantly higher rate than the control. However, attitudes toward smoking, perceived smoking, and attitudes toward a campus-wide smoking ban did improve at rates significantly above any improvements shown at the control campus. Conclusions: Campus-wide smoking bans may lower the frequency of smoking on small college campuses, but not necessarily more than other smoking cessation efforts. They do appear to uniquely influence general attitudes and the visibility of smoking on campus.

Developing a targeted e-cigarette health communication campaign for college students

BACKGROUND

E-cigarette use among college students has increased over the last several years, however, there are few published studies on e-cigarette interventions designed to prevent the initiation and escalation of e-cigarette use and to empower cessation for this population.

METHODS

We developed an e-cigarette health communication campaign for a large Midwestern university through collaboration between academic and student service departments. We conducted focus group discussions (7 groups; 4-25 per group; n = 98) to (a) understand the context of e-cigarette use on campus and (b) solicit feedback on sample messaging. We conducted thematic analysis using focus group notes and used findings to design final campaign messages and materials.

RESULTS

Six themes emerged: (a) vaping as a popular social activity, (b) progression to and perceptions of addiction, (c) cessation, (d) health effects and uncertainty, (e) intervention points, and (f) individual agency and message tone. Final campaign messages addressed the most salient points from the focus groups and were designed to increase the perceived susceptibility to and severity of risks of e-cigarette use and to increase perceived efficacy for quitting in accord with the Extended Parallel Processing Model (EPPM). Campaign messages and materials were integrated into wellness programming and disseminated across the university and community.

CONCLUSIONS

Our focus group discussions allowed campaign messages and materials to be tailored to college students. Collaborative approaches between academic and wellness programs can leverage scientific expertise and student services infrastructure to enhance programming on college campuses.

Predictors of Abstinence from Smoking: A Retrospective Study of Male College Students Enrolled in a Smoking Cessation Service

There were high smoking rates among young male college students in Korea. We aimed to investigate the prevalence of and factors affecting abstinence from smoking following smoking cessation service attendance in this population. Data were collected between 1 August 2015 and 20 August 2018. Participants were administered more than nine face-to-face and telephone counseling sessions by trained tobacco cessation specialists for six months. Follow-up assessments were conducted at 4, 6, and 12 weeks, and 6 months after the quit date. A total of 3978 male college student smokers were enrolled; their mean age was 23.17 (±3.45) years. Almost one-third of the participants (64.9%) reported that they had attempted to quit during the past year. The number of cigarettes smoked per day, CO ppm, and Fagerström Test of Nicotine Dependence score at the baseline were negatively associated with abstinence, while motivational variables-importance, confidence, and readiness-were positively associated with abstinence. Our results suggest that provision of visiting smoking cessation services can be an active intervention platform for college student smokers who need professional assistance or support. Active and accessible support should be provided to such people. Visiting a smoking cessation service may result in increased long-term abstinence rates in such students.

A Review of Tobacco Policies on University of California Campuses

Background and Purpose

College and university tobacco control programs have historically neglected cessation. In 2012, the University of California Office of the President (UCOP) released a Smoke and Tobacco Free policy that became effective in January 2014. The policy provided for a comprehensive education and outreach campaign that included resources and referrals for cessation. We sought to determine whether all University of California (UC) campuses met UCOP standards.

Methods

We reviewed the Smoke & Tobacco Free policies created by UCOP and posted at ten UC campuses, searched the tobacco free websites of each campus for cessation resources, and contacted tobacco-free task forces.

Results

We found that all UC campuses met the UCOP standard by addressing tobacco cessation in their campus policies. The provision of cessation services and resources was limited and varied substantially by campus, and no campuses reported collecting data on the use of cessation programs.

Conclusion

Consistent with concerns that college and university tobacco policies neglect cessation, UC campuses mentioned tobacco cessation resources and programs but did not provide consistent services. These campuses also did not report on the use of tobacco cessation resources, making it difficult to assess the effects of offering different types of cessation programs.

Adoption of Tobacco- and Smoke-Free Policies in a US National Sample of Postsecondary Educational Institutions

OBJECTIVES

To examine the institutional characteristics associated with the adoption of tobacco- and smoke-free policies among US postsecondary educational institutions.

METHODS

In 2017, we collected information on tobacco policy types and institutional characteristics of a national sample of US postsecondary educational institutions (n = 605) attended by the participants of the NEXT Generation Health Study. We used logistic regression to examine the relationships between these variables.

RESULTS

Overall, 35.2% of these institutions adopted tobacco-free policies (i.e., prohibit all tobacco product use on campus), 10.1% had smoke-free policies (i.e., prohibit smoking but not other tobacco product use on campus), and 53.7% did not have tobacco- or smoke-free policies. Proprietary (privately owned, for-profit) institutions (vs public institutions) were the least likely to have tobacco- or smoke-free policies (P < .05), which were disproportionately attended by racial/ethnic minority students. Adoption of these policies also varied by census region (P < .05).

CONCLUSIONS

Prevalence of tobacco- and smoke-free policies among US postsecondary educational institutions is low. Public Health Implications. Wide dissemination of evidence-based interventions to accelerate adoption of tobacco-free policies in all postsecondary educational institutions is warranted.

Student Experiences With Community-Based Enforcement of a Smoke-Free University

A common approach to enforcing a university smoke-free policy is through “community-based” enforcement, in which the entire campus community is responsible for asking smokers in violation to abide by the policy. The purpose of the study was to explore university students’ experiences with this strategy of enforcing a smoke-free policy. A total of 43 undergraduate students were interviewed regarding their experiences and opinions of community enforcement. The interviews were transcribed and analyzed using phenomenological methods, in which six major themes emerged from the data: Fear (alarm that smokers might respond with verbal insults or physical violence), Situational (enforcing the policy depended on violators’ distance, group settings, strangers vs. peers), Protect Image (not wanting to be viewed as annoying, judgmental, or offensive), Lack of Authority (feeling a lack of authority to enforce the smoking policy), Compassion (empathy that violators smoke due to physical/emotional needs), and Enforcer (willingness to confront a policy violator). These findings reflected previous studies regarding people’s fear to ask a smoker to extinguish a cigarette, feelings of a lack of authority, and so on. The study demonstrated that using only a community-based approach to enforcement may not be a realistic responsibility to impose on an entire campus community.

College anti-smoking policies and student smoking behavior: a review of the literature

Background

Currently, most college campuses across the U.S. in some way address on-campus cigarette smoking, mainly through policies that restrict smoking on campus premises. However, it is not well understood whether college-level anti-smoking policies help reduce cigarette smoking among students. In addition, little is known about policies that may have an impact on student smoking behavior. This study attempted to address these issues through a literature review.

Methods

A systematic literature review was performed. To identify relevant studies, the following online databases were searched using specific keywords: Ovid MEDLINE, PsycINFO, PubMed, and Google Scholar. Studies that met the exclusion and inclusion criteria were selected for review. Studies were not excluded based on the type of anti-smoking policy studied.

Results

Total 11 studies were included in the review. The majority of the studies (54.5%) were cross-sectional in design, 18% were longitudinal, and the rest involved counting cigarette butts or smokers. Most studies represented more women than men and more Whites than individuals of other ethnic/racial groups. The majority (54.5%) of the studies evaluated 100% smoke-free or tobacco-free campus policies. Other types of policies studied included the use of partial smoking restriction and integration of preventive education and/or smoking cessation programs into college-level policies. As far as the role of campus smoking policies on reducing student smoking behavior is concerned, the results of the cross-sectional studies were mixed. However, the results of the two longitudinal studies reviewed were promising in that policies were found to significantly reduce smoking behavior and pro-smoking attitudes over time.

Conclusion

More longitudinal studies are needed to better understand the role of college anti-smoking policies on student smoking behavior. Current data indicate that stricter, more comprehensive policies, and policies that incorporate prevention and cessation programming, produce better results in terms of reducing smoking behavior.

The spatial distribution of smoking violations on a no-smoking campus: Implications for prevention

OBJECTIVE

The present study extends research on campus smoking bans by examining where smokers are violating the policy at a large university in the southeastern region of the United States.

PARTICIPANTS

The data collection was conducted by one graduate student from the university in August of 2014.

METHODS

A global positioning system device was used to collect the geo-coordinates of littered cigarette butts as a proxy measure for smoking violations.

RESULTS

A hot spot analysis found a number of spatial concentrations on campus, largely around classroom and administrative buildings along with parking lots and garages.

CONCLUSIONS

The implications of such findings can direct enforcement to target these areas in order to reduce offenses and fulfill the initial goals of policy-makers and university administrators who support smoke-free campuses.

Smoking and attitudes toward smoking policy at a University in Egypt

To assess smoking behavior, knowledge of smoking harm, and attitudes toward campus smoking policy at an Egyptian university, an online survey of students, staff, and faculty was conducted (N = 992). The smoking prevalence of 38% among men was in line with Egypt's national average, but the smoking prevalence among women of 20% was much higher than the national average. Smoking status influenced beliefs about smoking harm and attitudes toward smoking policy, with nonsmokers having stronger beliefs about the harm of smoking and showing stronger support for smoking regulations than smokers. Smokers were more knowledgeable about smoking policy than were nonsmokers and differed slightly in their preferences for smoking policy enforcement strategies. These findings contribute to our understanding of how to tailor college smoking policy and programs to an Egyptian context.

An Extended Theory of Planned Behavior (TPB) Used to Predict Smoking Behavior Among a Sample of Iranian Medical Students

BACKGROUND

Smoking among the youth is an important public health concern. Although several studies have investigated the correlates of smoking behavior, no theory-based study has particularly assessed this problem among medical students.

OBJECTIVES

This study aimed to evaluate the efficacy of the extended theory of planned behavior (TPB) to predict smoking behavior among a sample of Iranian medical students.

PATIENTS AND METHODS

This is a cross-sectional study carried out in Ahvaz, Iran, 2014. The data were collected through a self-administered questionnaire, which included items on demographics, smoking behavior, and components of the TPB model (attitude, subjective norms, perceived behavior control, and intention), and an added construct on smoking refusal skill. Data were analyzed using descriptive correlation, and linear regression statistics by SPSS, version 16.

RESULTS

One hundred and seventy medical students with a mean age of 21.25 (SD = 2.9) years were enrolled in the study. Of them, 24 (13.5%) students were smokers. All components of the TPB model and smoking refusal skill were statistically significant as to intention to smoke (P < 0.001). The TPB constructs with and without smoking refusal skill accounted for 77% (adjusted R2) and 78% of the variance observed for intention to smoke, respectively. The results also revealed the highest weight for perceived behavior control (β= -0.40).

CONCLUSIONS

The findings of this study indicated that all TPB variables are useful tools for prediction of the smoking behaviors among students. Particularly, students' perceived behavioral control and attitudes towards smoking were found to be important determinants of smoking intentions. Thus, the findings could be used for planning effective tobacco control programs targeting University students.

Smoke-free policies in New Zealand public tertiary education institutions

The Framework Convention on Tobacco Control mandates the creation of smoke-free environments to protect non-smokers from second-hand smoke and reduce demand for tobacco. We aimed to examine the extent and nature of smoke-free campus policies at tertiary education institutions throughout New Zealand, and examine the policy development process. Stage one comprised an audit and content analysis of smoke-free policies. In stage two, semi-structured telephone interviews were conducted to investigate the process of developing and implementing policies. Qualitative content analysis was undertaken on interview notes. Policies were identified for most institutions (n = 26/29), though varied widely in nature. Only nine mandated 100% smoke-free campuses without exceptions and few prohibited the sale of tobacco on campus, or connections with the tobacco industry. During interviews (n = 22/29), cited barriers to developing a 100% smoke-free policy included enforcement challenges and anticipated opposition from staff and students. However, participants from institutions with 100% smoke-free policies reported having encountered few challenges. Varying levels of compliance with 100% smoke-free policies were reported yet, overall, these policies were viewed as being effective. Smoke-free campus policies could be strengthened to better reflect a completely tobacco-free organization. Other institutions and workplaces could use these findings to develop 100% smoke-free policies.

Social contingencies and college quit and win contest: a qualitative inquiry

OBJECTIVES

To investigate the social contingencies associated with participation in a college Quit and Win contest to promote smoking cessation.

METHODS

Six focus groups (N = 27) were conducted with college students who participated in a Quit and Win research trial.

RESULTS

Themes included: (1) participants reluctant to disclose quit decision; (2) perception of little support in their quit attempt, and (3) the social environment as a trigger for relapse.

CONCLUSIONS

Although Quit and Win contests appear to motivate an initial quit attempt, the reluctance of smokers to disclose their quit attempt limits the potential positive impact of social support when utilizing this public service campaign.

Screening and Counseling for Tobacco Use in Student Health Clinics: Reports of Health Care Providers

PURPOSE

To assess tobacco screening and counseling in student health clinics, including facilitators, barriers, and associations with campus- and state-level variables.

DESIGN

We conducted a mixed-methods study with an online survey and qualitative interviews.

SETTING

Study setting was student health clinics on college campuses.

SUBJECTS

Subjects included 71 clinic directors or designees from 10 Southeastern states (quantitative survey) and 8 directors or designees from 4 Southeastern states (qualitative interviews).

MEASURES

Quantitative measures included demographics, screening and counseling practices, clinic-level supports for such practices, perceptions of tobacco on campus, institution size, public/private status, state tobacco farming revenue, and state tobacco control funding. Qualitative measures included barriers and facilitators of tobacco screening and counseling practices.

ANALYSIS

Logistic and linear regression models assessed correlates of screening and counseling. Qualitative data were analyzed using multistage interpretive thematic analysis.

RESULTS

A total of 55% of online survey respondents reported that their clinics screen for tobacco at every visit, whereas 80% reported their clinics offer counseling and pharmacotherapy. Barriers included lack of the following: time with patients, relevance to chief complaint, student self-identification as a tobacco user, access to pharmacotherapy, and interest in quitting among smokers. In multivariable models, more efforts to reduce tobacco use, student enrollment, and state-level cash receipts for tobacco were positively associated with clinic-level supports.

CONCLUSION

This study highlights missed opportunities for screening. Although reports of counseling were higher, providers identified many barriers.

Compliance monitoring of prohibition of smoking (under section-4 of COTPA) at a tertiary health-care institution in a smoke-free city of India

Background:

India enacted a comprehensive tobacco control law known as cigarettes and other tobacco products act (COTPA) in 2003. However, enforcement of the provisions under the law is still a matter of concern. Compliance survey is an effective tool to measure the status of implementation of the law at various public places. Smoke-free hospital campus demonstrates commitment to good health and sends a pro-healthy signal to the community.

Objective:

The objective of this study was to assess the compliance to the prohibition of smoking at public places (under section-4 of COTPA) in a tertiary health-care institution in a smoke-free city of India.

Materials and Methods:

An observational cross-sectional study was conducted at 40 different venues within a tertiary health-care institution in a smoke-free city of India. These places were observed for certain parameters of assessment by a structured checklist, which included evidence of active smoking, evidence of recent smoking, display of signages, presence of smoking aids, cigarette butts and bidi ends.

Results:

Overall compliance rate for section-4 of COTPA was found to be mere 23%. Evidence of active smoking was observed in 21 (52.5%) venues. Signages were seen at only 8 places (20%). Butt ends and other smoking aids were seen in 37 (92.5%) and 26 (65%) places respectively.

Conclusion:

These dismal findings suggest non-compliance to the provisions under COTPA, which calls for a sensitization workshop and advocacy for all the stakeholders.

Efficacy of an experiential, dissonance-based smoking intervention for college students delivered via the internet

OBJECTIVE

College represents a window of opportunity to reach the sizeable number of cigarette smokers who are vulnerable to lifelong smoking. The underutilization of typical cessation programs suggests the need for novel and more engaging approaches for reaching college smokers. The aim of the present study was to test the efficacy of a dissonance-enhancing, Web-based experiential intervention for increasing smoking cessation motivation and behavior.

METHOD

We used a 4-arm, randomized design to examine the efficacy of a Web-based, experiential smoking intervention (Web-Smoke). The control conditions included a didactic smoking intervention (Didactic), a group-based experiential intervention (Group), and a Web-based nutrition experiential intervention (Web-Nutrition). We recruited 341 college smokers. Primary outcomes were motivation to quit, assessed immediately postintervention, and smoking abstinence at 1 and 6 months following the intervention.

RESULTS

As hypothesized, the Web-Smoke intervention was more effective than control groups in increasing motivation to quit. At 6-month follow-up, the Web-Smoke intervention produced higher rates of smoking cessation than the Web-Nutrition control intervention. Daily smoking moderated intervention outcomes. Among daily smokers, the Web-Smoke intervention produced greater abstinence rates than both the Web-Nutrition and Didactic control conditions.

CONCLUSION

Findings demonstrate the efficacy of a theory-based intervention delivered over the Internet for increasing motivation to quit and smoking abstinence among college smokers. The intervention has potential for translation and implementation as a secondary prevention strategy for college-aged smokers. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Cigarette smoking among Asian American and Pacific Islander college students: implications for college health promotion

Asian Americans (AA) and Pacific Islanders (PI) are an understudied population for health and tobacco use, which is alarming for a fast growing U.S. population. Research in smoking among AA and PI college students is limited, despite 50% of AA and 20% of PI having obtained a college degree. A cross-sectional tobacco survey was administered in a large racially diverse Southern California university (N = 490) that examined smoking behavior, psychosocial, and perceptual factors related to smoking among AA and PI compared with Caucasians. Overall, 19% of participants were smokers. The prevalence of current smoking by race was 26% PI, 19% AA, and 17% Caucasian. AA and PI are light, infrequent smokers who smoke mainly for social reasons and in social locations. Most AA and PI made quit attempts and reported intention to quit smoking. Low to moderate risk perceptions for addiction, disease and difficulty in quitting were observed. Social norms center on family influences, therefore it is recommended that cessation approaches target cigarette smoking norms within this social environment to increase perceptual risks of smoking. Smoking cessation should be placed in college health outreach programs based on culturally tailored approaches for AA and PI that target their unique smoking characteristics.

Tobacco-free Take Action!: Increasing Policy Adherence on a College Campus

INTRODUCTION

One in five college students report tobacco use, thus universities are making strides to reduce tobacco use by adopting smoke- or tobacco-free policies.

PURPOSE

Describe an innovative ambassador program to increase adherence with a tobacco-free campus policy.

METHODS

The Tobacco-Free Take Action! (TFTA!) Ambassador program was created to form an environment of compliance. Hot spots were targeted by Ambassadors, who were trained to use scripted messages. Ambassadors completed an online documentation form to assess the number of violators observed and approached. The Tobacco-Free Compliance Assessment Tool (TF-CAT) was used to collect pre- and post-cigarette butt data at each hot spot.

RESULTS

During the 4-week intervention period, Ambassadors approached 332 violators (529 observed), of which 68% responded positively and complied with the policy. The number of cigarette butts declined by 25%.

DISCUSSION

Adherence with campus tobacco-free policies remains a challenge. Lessons learned from this innovative approach will benefit those currently implementing and planning tobacco-free campus policies.

A review of multicomponent interventions to prevent and control tobacco use among college students

OBJECTIVE

Multicomponent tobacco control programs have been implemented at the state and community levels and have led to a reduction in tobacco use. The purpose was to review the public health research literature on tobacco prevention and control programs on college campuses and derive evidence-based implications for comprehensive program implementation.

METHODS

MEDLINE, PsycINFO, ERIC, and PubMed databases were used to search the research literature concerning tobacco prevention and control programs conducted on college campuses published between 2000 and 2009.

RESULTS

No studies were found that implemented all 5 recommended components of a comprehensive program. Tobacco control programs containing policy and prevention education were used the most and promotion of tobacco-free environments and banning sales of tobacco products were used the least.

CONCLUSION

The review suggests that despite the recommendation of comprehensive tobacco control programs to reduce tobacco use on college campuses, few institutions have implemented and evaluated programs consisting of multiple components.

Assessment of college and university campus tobacco-free policies in North Carolina

OBJECTIVE

To develop a reliable and efficient method for assessing prevalence and strength of college/university tobacco-related policies.

PARTICIPANTS

North Carolina (NC) public universities, community colleges, and private colleges/universities (N = 110).

METHODS

A census of policies using campus handbooks and Web sites was conducted in March 2011.

RESULTS

The rating tool is reliable and valid. Ninety-nine percent of NC college/university campuses are smoke-free in all indoor areas. The majority (94/110 [85%]) of colleges and universities regulate smoking and/or tobacco in some or all outdoor areas. Less than 20% of campuses had restrictions for industry marketing, promotion, and sales.

CONCLUSIONS

Clean indoor air policies are present at all but 1 NC college/university campus, and a growing number have enacted broad outdoor limits to protect students, faculty, and staff from secondhand smoke. Policy census approaches across all other states would quantify the national tobacco-free college campus policy environment and facilitate adoption of tobacco-free campus policies.

An assessment of America's tobacco-free colleges and universities

OBJECTIVE

This study examined the extent to which US campuses identified as "100% tobacco-free" by the American Lung Association of Oregon adhered to the American College Health Association's the most recent guidelines and recommendations promoting tobacco-free environments in colleges and universities.

PARTICIPANTS

A key informant from 162 of 175 institutions (92.6% response rate) completed an online survey between January 2010 and February 2010.

METHODS

The variables under study were assessed via a cross-sectional research design. Participants completed a 35-item survey regarding their school's tobacco policies, procedures, and enforcement practices.

RESULTS

Although the vast majority of schools had written policies and procedures in place, schools with current policies were the most compliant. Numerous opportunities for improved adherence were identified in the results.

CONCLUSIONS

Findings from this study may help institutions in the development and implementation of a new tobacco policy, as well as strengthen policies among existing tobacco-free schools.

Evidence-based smoking cessation for college students

Despite a strong stance by the American College Health Association and years of prevention and control efforts on US college campuses, smoking and exposure to secondhand smoke remain a problem among college students. This article provides an overview of what is known about cigarette smoking in this population as well as existing interventions for smoking prevention, cessation, and exposure to secondhand smoke on college campuses. Strategies to reduce tobacco use are presented, many of which have been demonstrated to be effective in the short-term.

College student reactions to smoking bans in public, on campus and at home

We examined college student reactions to a statewide public smoke-free policy, campus policies and private restrictions through an online survey among 2260 students at a 2-year college and a university and 12 focus groups among smokers. Among survey participants, 34.6% smoked in the past month (35.0% daily, 65.0% non-daily). Correlates of receptivity to public policies included attending the university, not living with smokers and non-smoker status (versus daily and non-daily smoking). Correlates of receptivity to outdoor campus policies included being a university student, unmarried, without children, from homes where parents banned indoor smoking and a non-smoker. Correlates of having home restrictions included not living with smokers, no children, parents banning indoor smoking and non-smoker status. Correlates of having car restrictions included attending the university, not living with smokers, having children, parents banning indoor smoking and non-smoker status. Qualitative findings indicated support for smoke-free policies in public (albeit greater support for those in restaurants versus bars) and on campus. Participants reported concern about smokers' and bar/restaurant owners' rights, while acknowledging several benefits. Overall, 2-year college students and smokers (non-daily and daily) were less supportive of smoke-free policies.

Abstinence and relapse rates following a college campus-based quit & win contest

OBJECTIVE

To conduct and evaluate Quit & Win contests at 2 2-year college and 2 4-year university campuses.

PARTICIPANTS

During Spring semester, 2006, undergraduates (N = 588) interested in quitting smoking signed up for a Quit & Win 30-day cessation contest for a chance to win a lottery prize.

METHODS

Participants (N = 588) completed a baseline survey, provided a urine sample to verify smoking status before joining the contest, and completed a follow-up survey at contest end to assess abstinence. Participants reporting continuous 30-day abstinence were surveyed again 2 weeks post contest to assess relapse.

RESULTS

Participants smoked an average of 9.8 +/- 6.7 cigarettes/day on 26.7 +/- 5.7 days/month. Among participants completing a follow-up survey (74%), 72.1% reported abstinence during the entire contest period (Intent-to-Treat Analysis = 53.2%). 55.3% of those abstinent at the end of contest had resumed smoking 2 weeks post contest.

CONCLUSIONS

Campus Quit & Win contests appear feasible, acceptable, and effective at facilitating short-term abstinence. Further research is needed to identify strategies to prevent postcontest relapse.

Cigarette smoking and associated health risks among students at five universities

INTRODUCTION

While most college students and other young adults who smoke fall into the light and intermittent smoking (LITS) category, they remain at risk for tobacco dependence and other adverse health effects from their smoking. This study examines smoking patterns, tobacco dependence, and other health variables among students at five universities to better understand how to identify and address tobacco use and related risks in a college health clinic setting.

METHODS

A health screening survey was completed by 2,091 college and graduate student volunteers seeking routine care at their university health centers or participating in a health class. Independent health variables were analyzed descriptively and in regression analyses with three levels of smoking (none, non-daily, and daily) and tobacco dependence to determine predictors and associated risks.

RESULTS

Nearly a quarter of students reported any current smoking, 41% of whom reported smoking less than 1 cigarette/day (cpd). Of the daily smokers, 80% smoked less than 10 cpd but 45% met criteria for tobacco dependence. Any smoking was associated with high-risk alcohol use, risky driving, relational abuse, depression, less exercise, and utilization of emergency and mental health services. In regression analyses, students who experienced depression had more than double the odds of being dependent smokers (odds ratio [OR] = 2.32), as did those who reported abuse (OR = 2.07) or sought mental health counseling (OR = 2.09).

DISCUSSION

Student health providers should be alerted to the multiple risks and comorbidities that occur among all smokers, including LITS, and intervene concurrently to help prevent or mitigate adverse outcomes that result from these conditions and behaviors.

Young adult smoking: what factors differentiate ex-smokers, smoking cessation treatment seekers and nontreatment seekers?

The present study investigated demographic and psychosocial correlates of smoking status and predictors of smoking cessation among young adults, ages 18-30 years old. Young adults (n=294) completed a self-report survey regarding their health habits and smokers were offered the opportunity to enroll in a smoking cessation program. Substitute reinforcers were greater among ex-smokers compared to nontreatment-seeking smokers, treatment-seeking smokers who did participate in a smoking cessation program and treatment-seeking smokers who did not subsequently participate in a smoking cessation program. Greater complementary reinforcers and delay discounting rates differentiated nontreatment-seeking smokers from ex-smokers and treatment-seeking smokers who subsequently attended a smoking cessation program. Nontreatment seekers were less likely to have higher depression symptoms than ex-smokers. Treatment seekers who did not attend a smoking cessation program tended to live in a household with another smoker, to not be college educated, and to be non-white. Young adult smokers who increased their substitute reinforcers across treatment were almost two times more likely to be quit at treatment end. These results highlight variables that may be important to consider in recruitment strategies and treatment components for smoking cessation interventions for young adult smokers.

A prospective study of cigarette smoking initiation during college: Chinese and Korean American students

OBJECTIVE

The present study was a prospective investigation of baseline influences on initial smoking and transition to established smoking among college students who had not smoked prior to college.

DESIGN

Included were 267 participants in a longitudinal study of tobacco use. Students of Chinese (52%) or Korean (48%) descent were enrolled during their freshman year in college. Data for the present study were collected during four annual in-person interviews.

MAIN OUTCOME MEASURES

(1) Initial use of a cigarette reflected having first smoked a cigarette (more than a puff) during college. (2) Established smoking was defined as having smoked at least 100 cigarettes.

RESULTS

Over the course of the study, 25% of baseline never-smokers tried their first cigarette, and 9% became established smokers. Overall, men were significantly more likely to experiment and progress to established smoking. Baseline alcohol and drug use, behavioral undercontrol, and parental smoking predicted smoking experimentation but not established smoking. Students of Korean ethnicity were more likely to become established smokers. However, acculturation was not a significant predictor of experimentation or established smoking after accounting for the effects of other predictors.

CONCLUSION

These findings suggest a need for efforts to prevent smoking uptake among Asian American college students.

Enforcing an outdoor smoking ban on a college campus: effects of a multicomponent approach

OBJECTIVES

Data on effective strategies to enforce policies banning outdoor smoking are sparse. This study tested the effects of an enforcement package implemented on a college campus.

PARTICIPANTS

Thirty-nine observers recorded compliance of 709 outside smokers.

METHODS

Smoking within 25 feet of buildings was noncompliant. The intervention included moving receptacles, marking the ground, improving signage, and distributing reinforcements and reminder cards.

RESULTS

The proportion of smokers complying with the ban was 33% during the baseline observation period, increased to 74% during the intervention week, and was at 54% during the follow-up. Differences across conditions was statistically significant (chi2(2, N = 709) = 6.299, p <.001). Compliance proportions varied by location in all conditions.

CONCLUSIONS

Enforcing an outdoor smoking ban using a multiple component package increased compliance with the nonsmoking policy on a college campus.

Internet and mobile phone text messaging intervention for college smokers

OBJECTIVE

The authors developed a smoking cessation program using mobile phone text messaging to provide tailored and stage-specific messages to college smokers.

PARTICIPANTS AND METHODS

The authors recruited 31 daily smokers who desired to quit from a college campus and asked them to use an Internet and mobile phone text messaging program to quit smoking.

RESULTS

Six weeks after program initiation, 45% reported abstinence with 42% abstinent based on cotinine verification. Continued smokers reported significantly reduced smoking rates and dependence. Overall, participants accepted the text messages.

CONCLUSIONS

These results replicate findings from an earlier study and indicate that mobile phone text messaging is a potentially efficacious and easily disseminated method for providing cessation interventions to young adult smokers.

Factors related to smoking in college women

Cigarette smoking among American women attending college has increased dramatically since the 1980's. To develop effective smoking prevention and cessation programs, a better understanding of factors associated with smoking in college women is needed. Therefore, the purpose of this study was to examine if selected factors (stress, stress management, nutrition, physical activity, alcohol consumption, and race) were related to smoking in college women. A sample of 354 college women in a southeastern state, 18-22 years of age, participated in the study. Logistic regression analysis indicated that White race (p = < .001), alcohol consumption (p = .0013), and limited physical activity (p = .0078) were significantly associated with smoking. Physically active college women were 2 times less likely to be smokers. However, physical activity mediated the effect of stress and stress management on smoking. Additionally, stress management confounded the effect of stress on smoking. Therefore, in addition to alcohol avoidance, exercise (as a stress management strategy) may be an important component of primary prevention and smoking cessation programs for college women.

"Look at your health": outcomes associated with a computer-assisted smoking cessation counseling intervention for community college students

Community college students represent 44% of all students enrolled in U.S. higher education facilities. To our knowledge, no previous smoking cessation intervention has targeted community college students. Previous studies suggest that a motivational smoking cessation intervention could be successful for young adult smokers. Combining motivational interviewing sessions with personalized health feedback is likely to increase participants' motivation to quit and movement through the stages of change. The purpose of this study was to evaluate the impact of a smoking cessation program based on these premises. We designed a computer-assisted, counselor-delivered smoking cessation program that addresses personal health risks and readiness to change smoking behavior among community college students. A group-randomized, controlled trial was used to assess the intervention in a sample of 426 students (58.5% females; mean age, 22.8+/-4.7 years) from 15 pair-matched campuses. At the 10-month follow-up assessment, the cotinine-validated smoking cessation rates were 16.6% in the experimental condition and 10.1% in the standard care condition (p=0.07). Our results indicate that our computer-assisted intervention holds considerable promise in reducing smoking among community college students.

A closer look at smoking among young adults: where tobacco control should focus its attention

OBJECTIVES

We sought to fill gaps in knowledge of smoking behaviors among college-educated and non-college-educated young adults.

METHODS

We used data from the 2003 Tobacco Use Supplement of the Current Population Survey to analyze smoking behaviors among young adults aged 18-24 years and older young adults aged 25-34 years by college status (enrolled, or with a degree, but not enrolled) and other measures of socioeconomic position.

RESULTS

Current smoking prevalence among US young adults aged 18-24 years who are not enrolled in college or who do not have a college degree was 30%. This was more than twice the current smoking prevalence among college-educated young adults (14%). Non-college-educated young adults were more likely than were college-educated young adults to start smoking at a younger age and were less likely to have made a quit attempt, although no differences were found in their intentions to quit. Higher rates of smoking in the non-college-educated population were also evident in the slightly older age group.

CONCLUSIONS

Non-college-educated young adults smoke at more than twice the rate of their college-educated counterparts. Targeted prevention and cessation efforts are needed for non-college-educated young adults to prevent excess morbidity and mortality in later years.

Smoking-cessation counseling practices of college/university health-care providers--a theory-based approach

OBJECTIVE

The author's purpose in this study was to examine the relation between smoking cessation counseling self-efficacy, knowledge of smoking cessation counseling, motivation to counsel smokers, and barriers to performing smoking cessation counseling, relative to the smoking cessation counseling stage of change.

PARTICIPANTS AND METHODS

Members of The American College Health Association, who are health-care providers (N=296), completed a survey measuring the predictor variables of knowledge, motivation, self-efficacy and perceived barriers, and the members' readiness for conducting smoking-cessation counseling with students.

RESULTS

The majority reported that they were knowledgeable about smoking-cessation counseling practices, they were motivated to conduct counseling, and they had the confidence (self-efficacy) to perform smoking-cessation counseling effectively. Significant barriers to performing smoking cessation counseling included the lack of reimbursement for counseling, lack of training in smoking-cessation counseling, and lack of resources for follow-up. The author found a moderate negative correlation between self-efficacy for smoking-cessation counseling and barriers to performing smoking-cessation counseling.

CONCLUSION

The results suggest that researchers should address the barriers that prevent health-care providers from performing smoking-cessation counseling. Interventions on increasing healthcare providers' counseling self-efficacy may be instrumental in moving them further along the stage continuum and increase their readiness to perform smoking cessation counseling.

Predictors of participation in a smoking cessation program among young adult smokers

This study investigated the predictors of participation in a smoking cessation trial for young adults ages 18 to 30 years old. Eligible smokers (n = 164) completed a telephone survey that measured demographic, smoking history, and psychosocial variables before the initiation of smoking cessation treatment. Young adult smokers who attended at least one smoking cessation session were compared with those who did not attend any sessions. Logistic regression analysis indicated that race and age were statistically significant multivariate predictors of participation. Caucasians were over six times (odds ratio, 6.03; 95% confidence interval, 2.41-15.05) more likely to participate in the smoking cessation program compared with non-Caucasians (61% versus 19%). For every SD increase in age (SD, 2.45), there was about a 2-fold increase in the likelihood that a young adult smoker participated in the smoking cessation program (odds ratio, 1.82; 95% confidence interval, 1.23-2.71). Future research should investigate how to promote participation in smoking cessation programs among smokers in emerging adulthood and among non-Caucasian young adult smokers to prevent a lifelong habit associated with disproportionate morbidity and mortality.

A case-based clinician training program for treating tobacco use in college students

Tobacco use rates are high among college students, and while many of them try to quit every year, only a small percentage are successful at maintaining abstinence. Most colleges have campus health centers that offer treatment for tobacco cessation, but few students access these resources. Little is known about how to motivate young adult college students to seek treatment or assist them in their attempts to quit smoking. In the context of a comprehensive, group-randomized intervention study to decrease smoking among college students, a case-based tobacco cessation training program for campus health center providers and staff was developed and conducted at 14 intervention colleges during the 2003-2004 academic year. Six case studies were created for this training, using responses from 39 student elicitation interviews conducted at 12 colleges in Spring 2002. Common themes relating to smoking, quitting, and relapse experiences reported by students in the elicitation interviews were woven into the cases and integrated into the training program.

The use of contingency management to reduce cigarette smoking among college students

The current study tested the feasibility of using contingency management to reduce cigarette smoking among college students. Eighty-eight undergraduate smokers were enrolled in a 3-week ABA study. During the baseline weeks, participants earned noncontingent monetary payments for attending data collection sessions. During the intervention week, participants earned monetary payments contingent on demonstrating recent abstinence. Participants were randomly assigned to either a low- or a high-reinforcer magnitude condition that controlled the amount of money that could be earned during the intervention week. Cigarette smoking was significantly reduced during the intervention week relative to the baseline weeks, and greater reductions were achieved under the high-reinforcer magnitude condition. These results suggest that cigarette smoking among college students is responsive to contingency management procedures.

College campus smoking policies and programs and students' smoking behaviors

Background

Although tobacco use in the United States has declined over the past 20 years, cigarette use among college students remains high. Additional research is thus needed to determine how university tobacco control policies and preventive education programs affect college students' smoking behaviors.

Methods

Approximately 13,000 undergraduate students at 12 universities or colleges in the state of Texas completed a web-based survey. College smoking policies were obtained from a survey of college administrators and from college websites. Logistic regression analyses were conducted to estimate the effects of individual smoking policies and programs on the odds of cigarette smoking.

Results

Of the individual programs, only having a preventive education program on campus was associated with lower odds of smoking. The existence of smoking cessation programs and designated smoking areas were associated with higher odds of smoking. Policies governing the sale and distribution of cigarettes were insignificantly associated with smoking.

Conclusion

Rather than focusing on policies restricting cigarette sales and use, college administrators should consider implementing or expanding tobacco prevention and education programs to further reduce student smoking rates.

Smoking prevalence and attitudes toward tobacco among student and staff nurses in Niigata, Japan

The present study investigated smoking prevalence and attitudes toward smoking in student and staff nurses, and activities to promote tobacco intervention by staff nurses. A total of 743 student nurses in 2 colleges and one university and 490 staff nurses in the university hospital in Niigata, Japan participated in the study and filled in self-administered anonymous questionnaires focused on smoking habits, attitudes toward smoking, and activities to promote tobacco intervention. The smoking prevalence among student nurses was 6% and increased with the year of study, whereas that of among staff nurses was 16% and increased by employment up to 3-5 years. Almost half of the student nurse smokers started the habit before admission to higher education facilities, and more than half of staff smokers also started smoking in their school years, in high school or college. Nicotine dependence, as defined by over 11 cigarettes per day and the first cigarette within 30 min after getting up, was high in smokers who started smoking before admission to college or university, but not in those who took up the habit thereafter. Thirty-six percent of student nurses and 25% of staff nurses agreed with the statement that "nurses should not smoke." Only 12% of staff nurses were involved in anti-tobacco interventions routinely, partly due to lack of broad knowledge and the necessary skills. Greater efforts are needed as a high priority to educate student and staff nurses systematically and comprehensively about the range of tobacco interventions available in Japan.

Tobacco on campus: industry marketing and tobacco control policy among post-secondary institutions in Canada

OBJECTIVE

Post-secondary institutions provide a unique opportunity to implement and evaluate leading edge tobacco policies, while influencing a key group of young adults. To date, however, we know little about the tobacco control environment at post-secondary institutions outside the USA.

DESIGN

Telephone surveys were conducted with campus informants from 35 post-secondary institutions in Canada to evaluate tobacco control policies and the presence of tobacco marketing on campus.

MAIN OUTCOME MEASURES

Tobacco marketing on campus, tobacco control policies, and attitudes towards tobacco control.

RESULTS

The findings indicate that tobacco marketing is prevalent among post-secondary institutions in Canada. Every university and half of all colleges surveyed had participated in some form of tobacco marketing in the past year. Among universities, 80% had run a tobacco advertisement in their paper and 18% had hosted a tobacco sponsored nightclub event. Tobacco control policies varied considerably between institutions. Although several campuses had introduced leading edge policies, such as campus wide outdoor smoking restrictions and tobacco sales bans, there is a general lack of awareness of tobacco issues among campus decision makers and fundamental public health measures, such as indoor smoke-free policies, have yet to be introduced in many cases.

CONCLUSIONS

Post-secondary institutions in Canada remain tobacco friendly environments. Without increased direction and support from the public health community, post-secondary institutions will continue to lag behind, rather than lead current policy standards.

A review of interventions to reduce tobacco use in colleges and universities

BACKGROUND

Interventions have been designed to reduce the prevalence of smoking in college/university students. This review presents a summary and synthesis of the interventions published in English from 1980 to the present.

METHODS

Seven databases were searched for relevant published articles, and reference lists were examined for additional published studies. The studies were categorized as (1) individual approaches, such as on-campus cessation programs, and (2) institutional approaches, such as smoke-free policies. The studies were categorized by type of institution and geographic location, study design, sample demographics, and outcomes.

RESULTS

Fourteen studies were identified; only five received a "satisfactory" rating based on evaluation criteria. Most studies were based on convenience samples, and were conducted in 4-year institutions. Seven studies used comparison groups, and three were multi-institutional. Individual approaches included educational group sessions and/or individual counseling that were conducted on campus mostly by healthcare personnel. None used nicotine replacement or other medications for cessation. The quit rates for both smokeless tobacco and cigarette users varied, depending on definitions and duration of follow-up contact. Institutional interventions focused mainly on campus smoking restrictions, smoke-free policies, antitobacco messages, and cigarette pricing. Results indicated that interventions can have a positive influence on student behavior, specifically by reducing tobacco use (i.e., prevalence of cigarette smoking and use of smokeless products, amount smoked) among college students, and increasing acceptability of smoking policies and campus restrictions among both tobacco users and nonusers.

CONCLUSIONS

While some promising results have been noted, rigorous evaluations of a wider range of programs are needed, along with studies that address cultural and ethnic diversity on campuses.

College-student smoking: an initial test of an experiential dissonance-enhancing intervention

This study was designed as an initial test of whether an experiential learning intervention, based on cognitive dissonance theory, would increase college-student smokers' intentions to quit smoking. One hundred forty-four college smokers were asked to prepare educational videos about (1) the risks of smoking or (2) the feasibility of quitting (in a 2 x 2 factorial design). Main effects for the experimental manipulations were not found. However, an interaction suggested that intentions to quit smoking were increased by either manipulation, but that the effects were not additive. In addition, risk perceptions were increased by the health-risk manipulation alone, but not when quitting feasibility was also targeted. As predicted, smoking history and smoking-related expectancies were both correlated with magnitude of dissonance. Moreover, dissonance magnitude was associated with the reported use of dissonance-reducing strategies, including intending to quit smoking and believing that tobacco use was out of their control due to nicotine addiction. The findings from this initial analogue study suggest that attitudes and intentions to quit smoking can be influenced by a brief experiential intervention.

Development and process evaluation of a web-based smoking cessation program for college smokers: innovative tool for education

Smoking cessation interventions are needed for young adults. Innovative approaches to behavior change for this population should be tested. Formative research and process evaluation of those approaches would result in more effective programs. This paper presents the development process and process evaluation of a web-based smoking cessation program. A description of the stages of development is presented with formative research, development of the web-based intervention, formative evaluation, and process evaluation. The smokers reported high usage of the intervention and satisfaction with the intervention in that it helped to raise their consciousness about quitting, encouraged them to set behavioral goals, provided stages of change feedback, and offered interactivity in presenting information and strategies about quitting. The Internet may be a promising tool for patient education according to the process results.

Importance of tobacco cessation services at higher education public institutions in Texas

While rates of tobacco use on university campuses rose over the past decade, little is known about what institutions are doing to address this rising concern. Health center directors at public institutions of higher education across the state of Texas were surveyed (n = 42) regarding the perceived importance of smoking cessation, prevalence of interventions on their campuses, and perceived success of intervening efforts. While most health center directors regarded smoking cessation as important, over half of the directors indicated that their sites did not offer tobacco cessation services of any kind. Furthermore, of those offering smoking cessation, most believed that their smoking cessation programs were only somewhat or not at all effective. Findings revealed that there is a noticeable gap between perceived importance and actual implementation of smoking cessation programs within university-based health centers. Recommendations include implementing innovative cessation methods, such as those that are Web-based and highly accessible to students.

Students' opinion of tobacco control policies recommended for US colleges: a national survey

OBJECTIVE

Comprehensive tobacco control policies for US colleges and universities have been proposed by several groups in order to counter the rising use of tobacco by students enrolled in these institutions. Student opinion of these policies is not known, and concern about student opposition is one barrier that deters administrators from adopting the policies. This study measured student support for recommended college tobacco control policies.

DESIGN

Mailed survey of US college students (2001 Harvard School of Public Health College Alcohol Study).

SETTING

119 nationally representative, four-year colleges and universities in the USA.

PARTICIPANTS

10,904 randomly selected undergraduate students enrolled at participating schools.

MAIN OUTCOME MEASURES

Students' opinion of 7 proposed tobacco control policies.

RESULTS

A majority of students supported each policy. Over three quarters of students favoured smoke-free policies for all college buildings, residences, and dining areas, while 71% supported prohibiting tobacco advertising and sponsorship of campus social events, 59% favoured prohibiting tobacco sales on campus, and 51% supported smoke-free campus bars. All policies had more support among non-smokers than smokers (p < 0.001). Among smokers, support for policies was inversely related to intention to quit and intensity of tobacco consumption. Because college students' tobacco consumption is low, a majority of smokers favoured banning smoking in college buildings and dining areas and prohibiting tobacco marketing on campus.

CONCLUSIONS

Student support for proposed campus tobacco control policies is strong, even among smokers, and broadly based across demographic subgroups. These findings should provide reassurance to college administrators who are considering adopting these policies.

Smoking on the rise among young adults: implications for research and policy

This paper investigates hypotheses regarding the cause of the recent apparent increase in young adult smoking, compares trends in smoking among young adults with trends in the use of other substances, and considers the implications for youth tobacco control research and policy. Time series analyses of national data suggest that the recent observed increase in smoking among young adults is primarily an artefact of the almost simultaneous increase in smoking among high school students. In addition, however, it also appears that there have been real changes in smoking patterns among young adults. While many questions remain regarding recent trends in tobacco and other drug use among adolescents and young adults, what is known leads to a clarion call for increased intervention and policy action for the prevention and control of tobacco use among young adults in the USA.

Cigarette use among Canadian undergraduates

OBJECTIVE

To describe the prevalence of daily cigarette use among Canadian undergraduates. Estimates are also compared to earlier Ontario surveys.

METHODS

Data are drawn from the Canadian Campus Survey, a national mail survey, conducted in the fall of 1998, with a random sample of 7,800 students from 16 universities.

RESULTS

Overall, 17.1% reported daily cigarette smoking and 10.4% reported occasional smoking. Rates of daily smoking differed significantly by region (with rates above average among those attending university in the Atlantic and below average among those attending university in British Columbia and the Prairies), residence (those residing off campus without family reported the highest prevalence rate), and year of study (those in the final year typically reported lower rate of use).

INTERPRETATION

University campuses represent an environment with potential gains to be made by tobacco control policies.

US public universities' compliance with recommended tobacco-control policies

To address the rise in tobacco use among college students, several national health organizations, including the American College Health Association, recommend that colleges enact smoking bans in and around all campus buildings, including student housing, and prohibit the sale, advertisement, and promotion of tobacco products on campus. Key informants at 50 US public universities, one from each state, were interviewed during the 2001/2002 academic year to assess the prevalence of these recommended policies. More than half (54%) of the colleges banned smoking in all campus buildings and student residences, 68% had no tobacco sales on campus, and 32% of the schools' newspapers did not accept tobacco advertising. Regional differences in adoption of these campus tobacco-control policies were present. Although this national sample of public universities had implemented some of the recommended policies, they must take further actions to comply fully with campus tobacco-control guidelines.

Tobacco use by Massachusetts public college students: long term effect of the Massachusetts Tobacco Control Program

OBJECTIVE

To assess tobacco use among Massachusetts public college students and compare students who attended high school in Massachusetts and were exposed to the Massachusetts Tobacco Control Program (MTCP) with students who attended high school outside Massachusetts and were unexposed to the programme.

DESIGN

Analysis of the 1999 Massachusetts College Alcohol Survey.

SETTING

Four year public colleges and universities in Massachusetts (n = 11).

SUBJECTS

1252 randomly selected students (response rate 56%).

MAIN OUTCOME MEASURES

Self report of current (past 30 day), past year, and lifetime use of cigarettes, cigars, and smokeless tobacco.

RESULTS

One third of students had used a tobacco product in the past month and 46.4% had used tobacco in the past year. Cigarettes accounted for most of this tobacco use. Total tobacco use was higher among males than females but cigarette smoking did not differ by sex. Tobacco use was lower among athletes and higher among students who used alcohol or marijuana. Current tobacco use was lower among public college students who had attended high school in Massachusetts compared with those who attended high school in another state (31.5% v 42.6%, p = 0.006). This difference persisted after adjustment for age, sex, race, parental education, and students' college residence (adjusted odds ratio (OR) 0.67, 95% confidence interval (CI) 0.46 to 0.97, p = 0.034).

CONCLUSION

Tobacco use is common among Massachusetts public college students. Students who were exposed to the MTCP during high school are less likely to use tobacco than their peers who were not exposed to this programme. The MTCP may have reduced tobacco use among this group of young adults.