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

Tobacco-free university campus policies: A systematic review

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

PARTICIPANTS/METHODS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

DISCUSSION

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

CONCLUSION

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

The prevalence and sociodemographic determinants of tobacco and nicotine use among students in healthcare disciplines in Saudi Arabian universities: a cross-sectional survey

Background

Tobacco smoking is one of the most significant health-related problems worldwide. However, the prevalence and sociodemographic determinants of tobacco and nicotine use among students on healthcare courses in Saudi Arabia are limited.

Methods

This cross-sectional study used a questionnaire that was distributed via SurveyMonkey between November 2022 and June 2023 to all student universities offering healthcare courses. Data are presented as frequency and percentages. The associated sociodemographic factors with current tobacco and nicotine use were subjected to logistic regression.

Results

Overall, 5,012, of whom 3,872 (77.25%) were males, responded to the online survey. The prevalence of current tobacco and nicotine use was 3,553 (71%). The majority of users used electronic nicotine delivery systems (1,622: 32.36%). The current use of cigarettes (AOR: 1.75 (1.42 to 2.15)), e-cigarettes (AOR: 1.17 (1.01 to 1.37)), and smokeless tobacco substances (AOR: 1.35 (1.02 to 1.90)) were more pronounced among males compared to female students. However, the current use of a hookah was less among males (AOR: 0.74 (95% CI: 61 to 0.91)). Smoking cigarettes was practiced less among students living in other regions compared to the Central Region. However, smokeless tobacco substances seem to be more prevalent in the Western, Southern, and Northern Regions, (AOR: 1.57 (95% CI: 1.09 to 2.26)), (AOR: 1.43 (95% CI: 1.04 to 1.95)), and (AOR: 1.57 (95% CI: 1.09 to 2.26)), respectively.

Conclusion

Smoking is prevalent among students in the healthcare disciplines, with electronic nicotine delivery systems being the most used product. Several sociodemographic factors were associated with higher tobacco or nicotine use.

Use of a Living Lab Approach to Implement a Smoke-Free Campus Policy

While universities have increasingly become tobacco-/smoke-free, to our knowledge, no campus has reported 100% policy compliance. Innovative approaches to encourage compliance and ongoing data collection are needed. This paper describes actions undertaken, framed within a Living Lab (LL) approach, to implement smoke-free campus policies in an Irish university. The action research comprised student-collected data on observed smoking on campus to evaluate adherence and compliance, first to a smoke-free zones policy (June 2016-March 2018), and then to a smoke-free campus policy (March 2019-February 2020). From June 2016-February 2020, 2909 smokers were observed. Adherence, defined as the average reduction in number of observed smokers from baseline in May 2016, reduced by 79% from 5.7 to 4.9 . Compliance, defined as the proportion of smokers who complied when reminded of the policy, was 90% (2610/2909). Additional activities included development of a broader health promotion programme; identification of a pattern of 'social smoking'; and promoting increased awareness of the environmental harms of tobacco. Ongoing policy implementation is essential for smoke-free policies and should include data collection and evaluation. Actions framed within the characteristics of a LL achieved fewer observed smokers. A LL approach is recommended to encourage policy adherence and compliance.

Tobacco-free policy reduces combustible tobacco byproduct on a large university campus

Policy drives community-level behavior change, so behavior analysts should aid empirical policy development. University campus regulation is a useful proxy for broader policy initiatives and thus is a convenient inroad for behavior analyst involvement. This paper examines behavior analytic contributions to the planning and evaluation of a university tobacco-free initiative. We provided resources and guidance throughout early planning, and we then evaluated faculty and student compliance via byproduct (e.g., cigarette butts) counts taken at four high-traffic sites (as flagged by preliminary surveying of campus faculty, staff, and students). Visual analysis and supplementary statistical testing support notions of (a) a meaningful and sustained reduction of combustible tobacco byproducts in all locations, and (b) a demonstrative example of behavior analytic involvement with university policy planning and evaluation.

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

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