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Geindreau D, Girault A, Gallopel-Morvan K. Tobacco-free university campus policies: A systematic review. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-12. [PMID: 38917353 DOI: 10.1080/07448481.2024.2367999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 06/09/2024] [Indexed: 06/27/2024]
Abstract
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.
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Affiliation(s)
- Diane Geindreau
- EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U 1309, Rennes University, Rennes, France
| | - Anne Girault
- EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U 1309, Rennes University, Rennes, France
| | - Karine Gallopel-Morvan
- EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U 1309, Rennes University, Rennes, France
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2
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Jazwa A, Heath E, Jivani S, Redmon P, Sinha B. Lessons learned about post-secondary institution tobacco policy change by Tobacco-Free Generation Campus Initiative Grantees, 2018-2020. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2016-2024. [PMID: 34379574 DOI: 10.1080/07448481.2021.1953032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 06/16/2021] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The Tobacco-Free Generation Campus Initiative (TFGCI) granted funding to U.S. post-secondary institutions to assist with creating 100% smoke- and tobacco-free campus policies to prevent young adult tobacco use. This study assessed grantee experiences working on campus tobacco policy change. Participants: Sixty U.S. post-secondary institutions completing TFGCI funded work between 2018 and 2020. Methods: An online survey assessment was completed by each institution at the end of their 18-month grant period to share facilitators and barriers to policy change, lessons learned, and advice for future efforts. Results: Many institutions faced challenges of time and capital constraints and pushback from campus constituents. Collaboration, diverse constituent engagement, and educational efforts throughout the advocacy process were important facilitators of policy change. Conclusions: Adopting and implementing comprehensive tobacco policy on college campuses is challenging. Regardless of institution type, commitment to the long-term goal and diverse stakeholder support guided movement toward 100% smoke- and tobacco-free campus policies. Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2021.1953032 .
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Affiliation(s)
- Amelia Jazwa
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Erica Heath
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Saiza Jivani
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Pamela Redmon
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Bidisha Sinha
- Domestic Non-Infectious Disease Programs, CDC Foundation, Atlanta, Georgia, USA
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3
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Wong SL, Epperson AE, Rogers J, Castro RJ, Jackler RK, Prochaska JJ. A multimodal assessment of tobacco use on a university campus and support for adopting a comprehensive tobacco-free policy. Prev Med 2020; 133:106008. [PMID: 32027917 PMCID: PMC7396290 DOI: 10.1016/j.ypmed.2020.106008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 01/28/2020] [Accepted: 02/01/2020] [Indexed: 11/19/2022]
Abstract
Many college campuses now prohibit tobacco use. At a private U.S. university, the current study assessed cigarette and e-cigarette use and characterized the climate for adopting a comprehensive tobacco-free policy. Data were gathered January-August 2018 via an: environmental scan; cigarette-urn audit; and representative surveys with campus community members. Despite low prevalence of tobacco (0.5%-8%) and e-cigarette use (0.9%-6%) among all groups, campus cigarette clean-up costs exceeded $114,000 for an estimated >1 million butts left on campus annually. A majority of respondents (63% of N = 2218) favored a campus-wide tobacco-free policy, 16% opposed, and 21% abstained. Most respondents endorsed benefits of supporting health (93%), ensuring tobacco-free air to breathe (92%), reducing litter (88%), preventing tobacco use (84%) and fires (83%), and helping tobacco users quit (65%). Identified challenges included policy enforcement (69%) and stigmatization of smoking (57%); 30% viewed a policy as compromising personal freedoms. In a model explaining 35% of variance in policy support, those more likely to favor comprehensive tobacco-free campus policy were Asian respondents; diagnosed with asthma; exposed to secondhand smoke on campus; who viewed campus cigarette butt litter as problematic; and identified health, prevention, and cessation benefits of a tobacco-free campus. Those less likely in favor were students, those who smoke, and those perceiving impingement upon personal freedoms, stigmatization, and broader (slippery slope) implications. Findings indicate low tobacco use prevalence among the campus community, yet a large volume of butt litter and high tobacco clean-up costs. Predictors of policy support can inform campus outreach efforts.
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Affiliation(s)
- Samantha L Wong
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, USA
| | - Anna E Epperson
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, USA
| | - Jayna Rogers
- Health Improvement Program, Stanford University, USA
| | - Ralph J Castro
- Office of Alcohol Policy & Education, Stanford University, USA
| | - Robert K Jackler
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, USA.
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4
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Yin X, Dylan B. Recommendation algorithm based comparative education matching model. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2019. [DOI: 10.3233/jifs-179149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Xinzhen Yin
- Yunnan Technology and Business University, Kunming Yunnan, China
| | - Baker Dylan
- Department of Environmental Engineering, University of Management and Technology, USA
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5
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Linnansaari A, Schreuders M, Kunst AE, Rimpelä A, Lindfors P. Understanding school staff members' enforcement of school tobacco policies to achieve tobacco-free school: a realist review. Syst Rev 2019; 8:177. [PMID: 31324212 PMCID: PMC6642528 DOI: 10.1186/s13643-019-1086-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND School tobacco policies (STPs) that aim to achieve a tobacco-free environment require consistent enforcement by school staff. However, little is known about why staff choose whether or not to enforce STPs. Therefore, we investigated staff members' responses to STPs that determine enforcement. Furthermore, we examined how these responses depend on contextual factors at the individual, interpersonal, school, implementation, and national levels. METHODS We performed a realist review (RR), which synthesizes existing primary evidence into a programme theory demonstrating key causal pathways through Context-Mechanism-Outcome configurations (CMOs). These CMOs link contextual factors to outcomes (i.e. staff enforcement) by explaining the underlying generative mechanisms (i.e. staff members' cognitive, psychosocial, and behavioural responses). A systematic literature search for the period 2000-2016 was performed using Academic Search Premier, PsycInfo, and MEDLINE. Forty English-language articles were identified for the synthesis. RESULTS Our programme theory demonstrated three CMOs: when contextual factors make staff members experience STP enforcement as part of their professional role and duties, it may lead to staff members showing responsibility for STP enforcement (CMO1); when contextual factors make staff members feel their contribution is leading to positive outcomes, it may lead to staff members showing motivation to enforce STPs (CMO2), and when contextual factors make staff members feel that they are able to deal with students' responses, it may lead to staff members showing confidence in STP enforcement (CMO3). Moreover, the programme theory provided more precise insights into what contextual factors contribute to triggering the individual mechanisms and the consequent outcomes. CONCLUSIONS By applying a realist approach, we have been able to detect three CMOs explaining staff members' STP enforcement. The findings provide useful insights explaining how stakeholders can support staff members' STP enforcement and consequently improve the impact of STPs on adolescent smoking.
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Affiliation(s)
- Anu Linnansaari
- Faculty of Social Sciences, Health Sciences, Tampere University, P.O. Box 100, 33014, Tampere, Finland
| | - Michael Schreuders
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Arja Rimpelä
- Faculty of Social Sciences, Health Sciences, Tampere University, P.O. Box 100, 33014, Tampere, Finland.,PERLA-Tampere Centre for Childhood, Youth and Family Research, Tampere University, 33014, Tampere, Finland.,Department of Adolescent Psychiatry, Pitkäniemi Hospital, Tampere University Hospital, 33380, Nokia, Finland
| | - Pirjo Lindfors
- Faculty of Social Sciences, Health Sciences, Tampere University, P.O. Box 100, 33014, Tampere, Finland.
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6
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Heinze C, Hjort AV, Elsborg P, Maindal HT, Klinker CD. Smoke-free-school-hours at vocational education and training schools in Denmark: attitudes among managers and teaching staff - a national cross-sectional study. BMC Public Health 2019; 19:813. [PMID: 31234822 PMCID: PMC6591894 DOI: 10.1186/s12889-019-7188-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco is the main cause of non-communicable disease and premature death globally. Implementing restrictive school tobacco policies such as smoke-free-school-hours (SFSH) may have the potential to reduce smoking among Vocational Education and Training (VET) school students. To be effective, school tobacco policies that largely involve strict and consistent enforcement by both managers and teaching teaching staff must be implemented. This study investigated the attitudes towards the implementation of SFSH among the managers and teaching staff at Danish VET schools. METHODS The analyses were based on cross-sectional survey data collected with an online survey among managers and teaching staff at Danish VET schools. The data was collected from March to June 2017. RESULTS Managers and teaching staff (n = 571) from 71 out of 87 Danish VET schools (81.6%) took part in the survey. In the adjusted analysis, teaching staff were twice as likely as managers to have a favourable attitude towards SFSH. Furthermore, being female and of increasing age correlated with having a favourable attitude. A trend towards schools in favour of SFSH having more health promotion facilities, policy and practice, was identified. CONCLUSION AND IMPLICATIONS Existing health promotion facilities and activities at the schools were associated with a favorable attitude among the management towards implementing SFSH. Thus, implementing other health promotion activities and policies might be an important first step to establish readiness to implement SFSH.
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Affiliation(s)
- Clara Heinze
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens vej 6, 2820, Gentofte, Denmark.
| | - Anneke Vang Hjort
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens vej 6, 2820, Gentofte, Denmark
| | - Peter Elsborg
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens vej 6, 2820, Gentofte, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens vej 6, 2820, Gentofte, Denmark.,Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Charlotte Demant Klinker
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens vej 6, 2820, Gentofte, Denmark
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Huey J, Apollonio DE. A Review of Tobacco Policies on University of California Campuses. CALIFORNIAN JOURNAL OF HEALTH PROMOTION 2019; 17:24-30. [PMID: 34113223 DOI: 10.32398/cjhp.v17i1.2221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Jocelyn Huey
- Department of Clinical Pharmacy, University of California, San Francisco
| | - Dorie E Apollonio
- Department of Clinical Pharmacy, University of California, San Francisco
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8
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Rath JM, Pitzer L, Carnegie B, Shinaba M, Vallone D, Parks I, Tertzakian K, Smith D, Stewart-Reid C, Hair EC. Building capacity to implement tobacco-free policies in college and university settings with underserved populations. Tob Prev Cessat 2019; 5:14. [PMID: 32411878 PMCID: PMC7205066 DOI: 10.18332/tpc/105677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study aimed to facilitate the process of policy adoption and implementation across community colleges and Historically Black Colleges and Universities (HBCUs) to develop, adopt, and implement a 100% smoke- or tobacco-free policy. METHODS In total, 135 community colleges and HBCUs took part in the program. This multiple-site case study analyzed each institution's online self-reported surveys every 6 months to record progress on each of five core project elements. Data were analyzed in June 2017. RESULTS Overall, 77 of 135 institutions adopted a smoke- or tobacco-free policy during the college initiative program that led to a broader public health impact of more than 717000 students and employees protected from the harms of smoking and secondhand smoke. A regression analysis also found that ongoing/completed policy activities and perceived importance of having a 100% smoke- or tobacco-free policy presented greater odds of an institution passing or adopting a policy. CONCLUSIONS Population-level impact and total number of people reached by this initiative is notable, though moving smoking off campus can have unintended impacts. This suggests policy change should include cessation efforts, policy compliance and policies into the broader community when possible through community partnerships.
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Affiliation(s)
- Jessica M. Rath
- Schroeder Institute at Truth Initiative, Washington, DC, United States
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lindsay Pitzer
- Schroeder Institute at Truth Initiative, Washington, DC, United States
| | - Brittany Carnegie
- Schroeder Institute at Truth Initiative, Washington, DC, United States
| | - Muftau Shinaba
- Schroeder Institute at Truth Initiative, Washington, DC, United States
| | - Donna Vallone
- Schroeder Institute at Truth Initiative, Washington, DC, United States
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- College of Global Public Health, New York University, New York, NY, United States
| | - Ines Parks
- Truth Initiative, Washington, DC, United States
| | | | | | | | - Elizabeth C. Hair
- Schroeder Institute at Truth Initiative, Washington, DC, United States
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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9
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Gatto A, Powell SE, Walters EF, Zamani S, Sales LB, DeBate R. A Mixed-Methods Assessment of a Peer-Enforced Tobacco- and Smoke-Free Policy at a Large Urban University. J Community Health 2019; 44:365-376. [PMID: 30542969 DOI: 10.1007/s10900-018-0593-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The study aims to evaluate the enforcement, opinions, and effectiveness of the University of South Florida's tobacco free policy one year following implementation. By assessing readiness to change and using geographic information system (GIS) mapping this study sought to introduce a unique and effective way of evaluating college tobacco free policies. A cross-sectional survey was administered to students, faculty, and staff to assess knowledge of policy and resources, tobacco use observations, stage change regarding policy enforcement, self-efficacy to enforce, and policy impact on perceived campus tobacco use (n = 5242). Additionally, using ArcGIS Collector (in: ESRI, ArcGIS desktop: release 10, Environmental Systems Research Institute, Redlands, 2011) volunteers collected geospatial data on tobacco use continuing to occur on campus following policy implementation. Overall there was moderate knowledge of the current policy and low beliefs for policy enforcement. Majority of respondents were not approaching violators to remind them of the policy and did not plan to do so in the future. There were statistically significant differences between smokers and non-smokers as well as between students and faculty and staff. The mapping of observed violations revealed continued tobacco use on campus with 158 data points. From both the geospatial results as well as the survey findings, the current policy is ineffective in reducing tobacco use across campus. With rapidly increasing numbers of smoke and tobacco free universities, new and innovative evaluation tools are needed so institution leaders can efficiently evaluate their implementation.
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Affiliation(s)
- Amy Gatto
- University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Sarah E Powell
- University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Emily F Walters
- University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Shahriar Zamani
- University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Liberty B Sales
- University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Rita DeBate
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL, 33612, USA.
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Kreitzberg DS, Herrera AL, Loukas A, Pasch KE. Exposure to tobacco and nicotine product advertising: Associations with perceived prevalence of use among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:790-798. [PMID: 29565753 DOI: 10.1080/07448481.2018.1454925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/20/2018] [Accepted: 03/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the relationship between exposure to tobacco marketing and perceptions of peer tobacco use among college students. PARTICIPANTS Participants were 5,767 undergraduate students from 19 colleges/universities in the State of Texas. METHODS Students completed an online survey, in the spring of 2016, that assessed past 30 day exposure to e-cigarette, cigar, smokeless tobacco, and traditional cigarette advertising across multiple marketing channels, past 30 day use of each product, and perceived prevalence of peer use. Multi-level linear regression models were run to examine the associations between exposure to tobacco advertising and perceptions of peer tobacco use controlling for age, gender, race/ethnicity, use and school. RESULTS Greater exposure to advertising was associated with greater perceived prevalence of peer use. CONCLUSIONS Given the normative effects of advertising on perceived peer tobacco use, college tobacco initiatives should include descriptive norms education to counteract inaccurate perceptions.
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Affiliation(s)
- Daniel S Kreitzberg
- a Department of Kinesiology and Health Education , The University of Texas , Austin , Texas , USA
| | - Ana Laura Herrera
- a Department of Kinesiology and Health Education , The University of Texas , Austin , Texas , USA
| | - Alexandra Loukas
- a Department of Kinesiology and Health Education , The University of Texas , Austin , Texas , USA
| | - Keryn E Pasch
- a Department of Kinesiology and Health Education , The University of Texas , Austin , Texas , USA
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Braverman MT, Geldhof GJ, Hoogesteger LA, Johnson JA. Predicting students' noncompliance with a smoke-free university campus policy. Prev Med 2018; 114:209-216. [PMID: 30049663 DOI: 10.1016/j.ypmed.2018.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
The adoption of university campus smoke-free and tobacco-free policies has risen dramatically, but research on effective implementation is scant. Significant challenges exist regarding policy implementation, particularly enforcement. This study examined college students' noncompliance with a recently implemented smoke-free campus policy at a public university. The sample included students who reported past-month smoking of tobacco or e-cigarettes in a 2013 web-based survey, 9 months after a smoke-free campus policy took effect. Ordinal logistic regression was used to examine predictors of students' having smoked on campus since the policy began (n = 1055). Predictor variables included past-month use of cigarettes, e-cigarettes, smokeless tobacco, and non-cigarette tobacco products, secondhand smoke (SHS) exposure, support for a smoke-free campus, tobacco-related social norms, use of strategies to deal with smoking urges, and other variables. In multivariate analysis, policy violation was positively associated with past-month use of cigarettes and non-cigarette combustible tobacco, SHS exposure on campus, living on campus, and use of nicotine gum/patches to handle urges. Violation was negatively associated with smoke-free campus support, age, estimates of student policy support and cigarette smoking, and self-reported absence of smoking urges. Results suggest that nicotine dependence may be an underlying influence on policy violation. Several recommendations are offered. First, upon policy adoption, campuses should ensure student smokers' access to cessation support and assistance with dealing with nicotine cravings. Second, campus information campaigns should focus particularly on younger students and those living on campus. Third, campuses should establish strong anti-tobacco norms, monitor SHS exposure, and communicate levels of students' policy support.
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Affiliation(s)
- Marc T Braverman
- School of Social and Behavioral Health Sciences, Oregon State University, Corvallis, OR 97331, USA.
| | - G John Geldhof
- School of Social and Behavioral Health Sciences, Oregon State University, Corvallis, OR 97331, USA.
| | | | - Jessica A Johnson
- Southern Nevada Health District, Office of Chronic Disease Prevention and Health Promotion, 280 S. Decatur Blvd., Las Vegas, NV 89107, USA.
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Record RA. Tobacco-Free Policy Compliance Behaviors among College Students: A Theory of Planned Behavior Perspective. JOURNAL OF HEALTH COMMUNICATION 2017; 22:562-567. [PMID: 28494210 DOI: 10.1080/10810730.2017.1318984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to examine the theory of planned behavior (TPB) as a framework for understanding tobacco-free policy compliance behaviors. Undergraduate student smokers (n = 479) on a college campus with a tobacco-free policy were randomly selected to report their tobacco-free compliance behaviors and respond to TPB items. A path analysis found all constructs of the TPB model to be significantly related to tobacco-free policy compliance behaviors. The results obtained from this study fill gaps in the mostly atheoretical literature regarding our understanding of tobacco-free policy compliance behaviors as well as extend our knowledge of the TPB. Implications for this study provide recommendations for universities, health organizations, and government agencies currently attempting to enforce compliance with a tobacco-free policy.
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Affiliation(s)
- Rachael A Record
- a Department of Communication , San Diego State University , San Diego , California , USA
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13
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Exploring Support for 100% College Tobacco-Free Policies and Tobacco-Free Campuses Among College Tobacco Users. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 22:29-39. [PMID: 25859902 DOI: 10.1097/phh.0000000000000262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tobacco-free campus policy is identified as an effective means to address tobacco use on college campuses; however, the prevalence of tobacco-free policies (TFPs) in the United States remains low. This study explores college tobacco users' support for a university's TFP and tobacco-free campuses (TFCs) in general. METHODS A standardized and structured questionnaire was administered to 790 college tobacco users recruited in a university located in a tobacco-growing region of the United States, during April-May 2011, to collect information on support for TFPs and TFCs and sociodemographic-political characteristics. Descriptive and multivariable logistic regression analyses were conducted to identify key factors associated with support for TFPs and TFCs. RESULTS Approximately 2 of 5 tobacco users favored TFPs and TFCs. Multivariable logistic regression models showed that demographic factors were mostly not significantly associated with attitudes of the college tobacco users. Instead, while knowledge about harmful effects of exposure to secondhand tobacco smoke significantly increased support for both TFPs and TFCs, parental and peer smoking and exposure to tobacco industry promotions significantly decreased the likelihoods of support compared with respective referent groups. CONCLUSION Study findings suggest that campus advocacy and education campaigns for campus tobacco policies to pay attention to tobacco use behavior of familial relations, tobacco industry activities, and other political determinants of tobacco users' attitudes. Thus, this study should inform national initiatives to promote TFPs nationwide such as the Tobacco-Free College Campus Initiative.
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Record RA, Harrington NG, Helme DW, Savage MW. Using the Theory of Planned Behavior to Guide Focus Group Development of Messages Aimed at Increasing Compliance With a Tobacco-Free Policy. Am J Health Promot 2017; 32:143-152. [DOI: 10.1177/0890117116687467] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This study details the persuasive message development for a theory-based campaign designed to increase compliance with a university’s tobacco-free policy. Approach: The theory of planned behavior (TPB) guided message design and evaluation for focus group–tested messages that were adapted to the context of complying with a tobacco-free policy. Setting: The study was conducted at a university located in the tobacco belt. Participants: Undergraduate focus group participants (n = 65) were mostly male (69%), white (82%), and freshman (62%) who smoked at least 1 cigarette in the last 30 days; on-campus smoking percentages were never/rare (60%), occasionally (23%), and often/frequently (16%). Method: Data analysis used a theoretical thematic approach to identify how the TPB constructs related to perceptions of message effectiveness. Results: Participants responded favorably to attitudinal strategies about health, respect, and university figures; they rejected approaches they considered juvenile and offensive. They also discussed the impact of noncompliance and avoiding overgeneralized statements for addressing subjective norms, suggesting shortening text, adjusting picture location, and emphasizing the importance of compliance to increase perceptions of behavioral control. Conclusion: Applying theory to preexisting messages is challenging. The design approach in this study is an evidence-based strategy that can be used as a universal process for message adaptation. Results offer health promotion suggestions for designing messages aimed at improving undergraduate smokers’ willingness to comply with tobacco-free campus policies.
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Affiliation(s)
- Rachael A. Record
- School of Communication, San Diego State University, San Diego, CA, USA
| | | | - Donald W. Helme
- Department of Communication, University of Kentucky, Lexington, KY, USA
| | - Matthew W. Savage
- School of Communication, San Diego State University, San Diego, CA, USA
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Bresnahan MP, Sacks R, Farley SM, Mandel-Ricci J, Patterson T, Lamberson P. Going tobacco-free on 24 New York City university campuses: A public health agency's partnership with a large urban public university system. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2016; 64:343-347. [PMID: 26700322 DOI: 10.1080/07448481.2015.1107836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The New York City Department of Health and Mental Hygiene partnered with the nation's largest university system, the City University of New York (CUNY), to provide technical assistance and resources to support the development and implementation of a system-wide tobacco-free policy. This effort formed one component of Healthy CUNY-a larger initiative to support health promotion and disease prevention across the university system and resulted in the successful introduction of a system-wide tobacco-free policy on all CUNY campuses. Glassman et al (J Am Coll Health. 2011;59:764-768) published a blueprint for action related to tobacco policies that informed our work. This paper describes the policy development and implementation process and presents lessons learned from the perspective of the Health Department, as a practical case study to inform and support other health departments who may be supporting colleges and universities to become tobacco-free.
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Affiliation(s)
- Marie P Bresnahan
- a NYC Department of Health and Mental Hygeine , Queens , New York , USA
| | - Rachel Sacks
- a NYC Department of Health and Mental Hygeine , Queens , New York , USA
| | - Shannon M Farley
- a NYC Department of Health and Mental Hygeine , Queens , New York , USA
| | | | - Ty Patterson
- b National Center for Tobacco , Springfield , Missouri , USA
| | - Patti Lamberson
- c Central Office of Student Affairs, City University of New York , New York , New York , USA
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Forden CL, Carrillo AM. Smoking and attitudes toward smoking policy at a University in Egypt. J Ethn Subst Abuse 2015; 15:329-345. [PMID: 26643975 DOI: 10.1080/15332640.2015.1066288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Carie L Forden
- a Department of Sociology , Anthropology and Egyptology , Cairo , Egypt
| | - Amy M Carrillo
- b Department of Psychology , William Jessup University , Rocklin , California
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Robertson LA, Marsh L. Smoke-free policies in New Zealand public tertiary education institutions. HEALTH EDUCATION RESEARCH 2015; 30:347-58. [PMID: 25686846 DOI: 10.1093/her/cyv004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
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.
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Affiliation(s)
- Lindsay A Robertson
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - L Marsh
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Ickes MJ, Rayens MK, Wiggins AT, Hahn EJ. A tobacco-free campus ambassador program and policy compliance. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2015; 63:126-33. [PMID: 25612060 PMCID: PMC4334676 DOI: 10.1080/07448481.2014.990972] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 11/07/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Assess impact and feasibility of a Tobacco-Free Ambassador Program on campus policy compliance. PARTICIPANTS Trained Ambassadors made 253 visits to campus sites over 15 months to observe and/or approach violators. METHODS Policy violators were observed at 23 locations during Wave 1 (April-June 2012) and/or Wave 2 (April-June 2013). For locations with at least 5 visits, average violators per visit were compared between the 2 waves using a paired t test. Attributes of violators were summarized. Cigarette butts were collected over 3-day periods in 4 campus hotspots during each wave. Personnel time and cost to implement the program were determined. RESULTS There were declines in observed violators per Ambassador visit and number of cigarette butts over time. Rate of violators per visit declined from 5.47 to 1.93, a 65% decrease. Personnel time was equal to 1.5 full-time equivalents annually. CONCLUSIONS The Ambassador Program was a feasible and potentially effective strategy to increase policy compliance.
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Affiliation(s)
- Melinda J Ickes
- a Department of Kinesiology and Health Promotion, College of Education, University of Kentucky , Lexington , Kentucky
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Roditis ML, Wang D, Glantz SA, Fallin A. Evaluating California campus tobacco policies using the American College Health Association guidelines and the Institutional Grammar Tool. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2014; 63:57-67. [PMID: 25257333 PMCID: PMC4268277 DOI: 10.1080/07448481.2014.963108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To measure comprehensiveness of California campus tobacco policies. PARTICIPANTS Sixteen campuses representing different regions, institution types, and policies. Research occurred June-August 2013. METHODS Comprehensiveness was scored using American College Health Association's (ACHA) Position Statement on Tobacco. The Institutional Grammar Tool was used to breakdown policy statements into Strategies, Norms, or Rules. Differences in ACHA score and number of Strategies, Norms, and Rules were assessed by region, policy, and institution type. RESULTS Median ACHA score was 0.35 (scale of 0-1). Schools with 100% tobacco-free policies had highest ACHA scores, but failed to address relationships between schools and tobacco companies. Less than half the schools assessed (7/16) had Rules (enforceable penalties related to policies). In 67% of the policy statements, individuals doing the action were implied (not specifically stated). CONCLUSION Campuses should address ACHA recommendations related to campus relationships with tobacco companies, include enforceable rules, and specify individuals and entities covered by policy.
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Affiliation(s)
- Maria L Roditis
- a Center for Tobacco Control Research and Education University of California, San Francisco San Francisco , California
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Ickes M, Gokun Y, Rayens MK, Hahn EJ. Comparing Two Observational Measures to Evaluate Compliance With Tobacco-Free Campus Policy. Health Promot Pract 2014; 16:210-7. [DOI: 10.1177/1524839914561060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite potential benefits of tobacco-free campus policies, compliance remains a challenge. Observational measures hold the most promise in determining compliance with these policies. There is need for further study to determine validity of observational measures of compliance with tobacco-free campus policies. The purpose of this study was to determine the validity of two observational measures of compliance with a tobacco-free campus policy: direct observation of violators and cigarette butts. Data collection took place over a 1-year time period. Direct observation was operationally defined as the number of observed violators in hot spots. A cigarette butt protocol previously found to be reliable was used to count the number of butts in campus hot spots. Results indicated a positive relationship between number of violators observed per visit and number of cigarette butts collected. Although most of the hot spots exhibited two or fewer violators per visit and 100 butts or fewer per collection, the data points outside this range supported a positive association between observed violators per visit and cigarette butts. The findings support that direct observation of violators is a valid measure of compliance compared to cigarette butts. Given available resources, using one or the other as evaluation measures is warranted.
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Affiliation(s)
- Melinda Ickes
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Yevgeniya Gokun
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J. Hahn
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY, USA
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Burns S, Bowser N, Smith J, Jancey J, Crawford G. An exploratory study of smokers' and stakeholders' expectations of the implementation of a smoke-free policy in a university setting. Health Promot J Austr 2014; 25:129-35. [PMID: 24987909 DOI: 10.1071/he13044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 04/12/2014] [Indexed: 11/23/2022] Open
Abstract
ISSUES ADDRESSED Smoke-free policies restricting tobacco use in public places are common in many middle- and high-income countries. Implementation of a smoke-free policy does not automatically result in a smoke-free environment, and appropriate enforcement procedures must be clearly communicated and implemented. Safety and restrictions in private spaces, especially student housing, are also issues that need to be explored. This research explored perceptions and attitudes of staff and student smokers and key stakeholders before the implementation of a complete campus ban on smoking at a large Australian university. METHODS Interviews were conducted with staff and student smokers (n=9) and stakeholders (n=9). The interviews explored attitudes towards a completely smoke-free policy in the university environment, perceptions relating to enforcement of and compliance with a completely smoke-free policy, and support needed from the university for smokers. RESULTS Participants generally supported a complete smoke-free policy. Key themes associated with the policy implementation included health implications, stigmatisation and labelling, liberty, and enforcement. CONCLUSION Smoke-free policies require careful planning, evaluation, and appropriate enforcement to ensure maximum impact. Further research is needed to improve compliance with smoke-free policies in outdoor environments and diverse spaces. SO WHAT? A better understanding of attitudes and intentions towards a smoke-free policy before implementation may provide useful insight into the potential challenges and provide guidelines for the development of strategies to improve policy readiness and adherence. University support for smokers to quit is essential when implementing a smoke-free policy.
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Affiliation(s)
- Sharyn Burns
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Nicole Bowser
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Jenny Smith
- School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Jonine Jancey
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Gemma Crawford
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia
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Jancey J, Bowser N, Burns S, Crawford G, Portsmouth L, Smith J. No smoking here: examining reasons for noncompliance with a smoke-free policy in a large university. Nicotine Tob Res 2014; 16:976-83. [PMID: 24532382 DOI: 10.1093/ntr/ntu012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION A large Australian university introduced a campuswide smoke-free policy in 2012. Almost 1 year after implementation, reasons for noncompliance among people observed smoking on campus were examined. METHODS Six smoking locations on campus were identified after a campuswide audit of smoking indicators (i.e., discarded cigarette butts packets and people observed smoking). At these locations, those observed smokers were interviewed. Interview responses were examined to elicit underlying themes. RESULTS Fifty people were seen smoking during the observation period. Those smokers interviewed comprised staff (27%) and students (73%) aged between 18 and 24 (45.9%). The majority of the students were international students (51.8%). All respondents acknowledged their awareness of the smoke-free policy. Five explanatory themes for noncompliance emerged: defiance against the policy's perceived threat to self-governance; inconvenience to travel off campus to smoke; smoking as a physiological necessity; unintentional noncompliance through unawareness or confusion of policy boundaries; and ease of avoidance of detection or exposing others to cigarette smoke. CONCLUSIONS Creating a culture of compliance at the university remains a significant challenge, especially considering the size of the campus, the high proportion of international students, and the logistics associated with monitoring smoking behavior in outdoor areas and on-campus student housing.
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Affiliation(s)
- Jonine Jancey
- School of Public Health, Western Australian Centre for Health Promotion Research, Curtin University, Perth, Western Australia, Australia
| | - Nicole Bowser
- School of Public Health, Western Australian Centre for Health Promotion Research, Curtin University, Perth, Western Australia, Australia
| | - Sharyn Burns
- School of Public Health, Western Australian Centre for Health Promotion Research, Curtin University, Perth, Western Australia, Australia
| | - Gemma Crawford
- School of Public Health, Western Australian Centre for Health Promotion Research, Curtin University, Perth, Western Australia, Australia
| | - Linda Portsmouth
- School of Public Health, Western Australian Centre for Health Promotion Research, Curtin University, Perth, Western Australia, Australia
| | - Jennifer Smith
- School of Public Health, Western Australian Centre for Health Promotion Research, Curtin University, Perth, Western Australia, Australia
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Ickes MJ, Hahn EJ, McCann M, Kercsmar S. Tobacco-free Take Action!: Increasing Policy Adherence on a College Campus. WORLD MEDICAL & HEALTH POLICY 2013; 5:47-56. [PMID: 23936747 DOI: 10.1002/wmh3.20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Melinda J Ickes
- Assistant Professor in the Department of Kinesiology and Health Promotion at the University of Kentucky. She is Director of University of Kentucky's Tobacco-free Take Action!
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Fennell R. Should college campuses become tobacco free without an enforcement plan? JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2012; 60:491-4. [PMID: 23002796 DOI: 10.1080/07448481.2012.716981] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Tobacco-free campuses are a great public health initiative. Healthy People 2020 and Healthy Campus 2020 address tobacco use and young adults including college students. Sources indicate that of the more than 6,000 colleges and universities in the United States, less than 800 are either smoke free or tobacco free. An increasing number of college campus policy makers in the United States are implementing smoke-free or tobacco-free policies, including procedures for violators of these policies. However, without a clearly defined and actionable enforcement component, these policies serve little purpose. This has become a policy enforcement issue that campus leaders should address. Should colleges and universities become tobacco free, if enforcement is not implemented? College and university administrators should demonstrate leadership by having violators of tobacco-free campus policies held to the same standard as those who violate other policies.
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