No smoking here: examining reasons for noncompliance with a smoke-free policy in a large university

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.

Examining the correlates of cigarette smoking, e-cigarette use and dual use among Canadian post-secondary students

Many Canadians use nicotine products such as cigarettes and e-cigarettes. A particular subpopulation of concern is post-secondary students given they have a higher prevalence of use. Many correlates of cigarette smoking and e-cigarette use have been identified. However, less focus has been on examining the correlates of cigarette smoking, e-cigarette use and dual use. This study explores the correlates of different nicotine modality use in post-secondary students. Using data from the Canadian Campus Wellbeing Survey (CCWS; n = 27,164), a multi-level nominal regression assessed the correlates of nicotine modality use. In comparison to individuals who were <20, individuals 20-24 (OR = .448, 95% CI .321, .625), 25-29 (OR = .140, 95% CI .093, .212), 30-34 (OR = .076, 95% CI .046, .125) and over 35 (OR = .041, 95% CI .024, .071) had lower odds of e-cigarette use compared to cigarette smoking. Identifying as a woman (OR = 1.553, 95% CI 1.202, 2.006), non-heterosexual (OR = .642, 95% CI = .485,0.851), current cannabis user (OR = 1.651, 95% CI 1.296, 2.104), and being an international student (OR = .350, 95% CI .251, .487) also impacted the odds of e-cigarette use vs only cigarette smoking. When considering dual use vs cigarette smoking, individuals aged 20-24 (OR = .491, 95% CI .337, .717), 25-29 (OR = .221, 95% CI .137, .357), 30-34 (OR = .163, 95% CI .091, .292) and over 35 (OR = .122, 95% CI .065, .230) had lower odds than individuals <20. Current cannabis use (OR = 1.680, 95% CI = 1.209, 2.138), binge drinking (OR = 1.885, 95% CI 1.384, 2.568), and international student status (OR = .689, 95% CI .476, .996) also impacted cigarette smoking vs dual-use. Overall, a minority of young adults (11.5%) at post-secondary institutions in our sample use nicotine products, and the higher prevalence of e-cigarette use warrants continued monitoring. Health promotion campaigns addressing e-cigarette use are required. Additionally, tailored intervention efforts could prioritize the treatment needs of international students studying in Canada.

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.

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.

Use of heated tobacco products where their use is prohibited

INTRODUCTION

Stealth use implies using tobacco products where their use is prohibited. This paper aimed to investigate stealth use of heated tobacco products (HTPs) in terms of its prevalence and associated factors.

METHODS

An online survey was conducted to investigate the use of HTPs in 7000 randomly selected participants (2300 men and 4700 women, aged 20-69 years) from the database registered with an online-research company; we used a sex ratio of 1:2, considering a low female prevalence of tobacco use in Korea. Of total participants, 574 (8.2%) were current HTP users. Among them, we identified the participants who had practised HTPs stealth use, and evaluated associated factors using multivariable Poisson regression.

RESULTS

A total of 574 participants were identified as current HTP users, and 455 (79.2%) reported stealth use of HTPs during the month before the survey. Stealth use was more frequent in dual cigarette users (HTPs and electronic cigarettes (ECs); adjusted prevalence ratio (aPR) 1.33, 95% CI 1.16 to 1.52) and triple users (HTPs, ECs and combustible cigarettes; aPR 1.18, 95% CI 1.04 to 1.33), as compared with single-HTP users. Stealth use was more prevalent among participants who agreed with allowing indoor HTP use (aPR 1.18, 95% CI 1.11 to 1.26).

CONCLUSION

Stealth use was prevalent among current HTP users, especially among the poly-users of tobacco products. Considering the positive relationship between an agreement with allowing indoor use of HTPs and stealth use, a campaign to promote change in attitudes of HTP users about their indoor use may be warranted to protect non-users.

Assessing Smoking Habits, Attitudes, Knowledge, and Needs among University Students at the University of Milan, Italy

BACKGROUND

College campuses and universities are valuable settings for smoking prevention programs targeting young adults.

AIM

To investigate smoking habits, electronic cigarette (e-cig) and heated tobacco product (HTP) use, exposure to passive smoke, compliance with smoking bans on campus, attitudes toward the anti-smoking policies, and educational needs among students at the University of Milan, Italy.

METHODS

A validated questionnaire was web-submitted to 64,801 students in the period May-July 2021. For each item, the frequency was calculated and χ² test with Bonferroni correction was used to compare differences among the 10 faculties of the University.

RESULTS

7162 students participated in the survey, while 6605 questionnaires were included in this report (62% female, 84% aged 18-25 years). Sixty-four percent of participants were never smokers, 19% were smokers, 2.8% were e-cig or HTP users, 3.7% were dual smokers, 10% were former smokers, and 66% reported routinely spending free time with smokers. Almost all students were aware of the dangers of active and passive smoking of cigarettes, while about 20% did not have an opinion on the dangers of e-cigs/HTPs. Only 49% were aware of the smoking ban in the outdoor areas of the university. Students from the faculties of Law and Political, Economic, and Social Sciences smoked more frequently and were more frequently exposed to passive smoke than other students. Medicine students were the most aware of the dangers of passive smoking and using e-cigs/HTPs.

CONCLUSIONS

This is the first study in Italy involving the entire student population of a university and highlighting differences among faculties in terms of active and passive smoking and opinions. The results suggest that prevention campaigns addressed to students should consider their specific study curricula and give information tailored to the different educational needs to efficiently support health promotion.

Impact of a smoke-free policy on smoking prevalence on hospital grounds: A before-after study

INTRODUCTION

Studies on the impact of smoke-free policies (SFPs) on hospitals grounds on on-site smoking are scarce. On 1 October 2019, an SFP was implemented on the grounds of the Amsterdam UMC hospital in the Netherlands, including measures for sustained enforcement. This study assessed the impact of this SFP on smoking prevalence on hospital grounds up to 18 months after implementation.

METHODS

Observations were systematically conducted 7 weeks before and after the SFP was implemented, and at 5 and 18 months afterwards. A total of 32 sites were included in the study, divided over two hospital locations. On each site, the number of smokers was systematically observed and categorized into staff, patient, student, or visitor. Smoking prevalence on hospital grounds was calculated by the number of observed smokers as a proportion of all people observed. Bubble maps were created to visualize changes in the geographical distribution of smokers.

RESULTS

Smoking prevalence on hospital grounds decreased significantly from 17.4% before to 3.3% after implementation of the SFP. Following implementation, the largest decrease was observed in smoking among staff (-96.7%) and patients (-92.3%). The decrease in smoking prevalence was sustained 18 months after implementation (5.0%). The number of smokers decreased on nearly all sites.

CONCLUSIONS

The substantial and sustained decrease in smoking prevalence found in this study highlights the potential of SFPs on hospital grounds to protect people from exposure to (secondhand) smoking. Continued enforcement of these SFPs seems essential to ensure ongoing compliance.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Tobacco Tracker: A New Tool to Support College Smoke and Tobacco Free Policies

INTRODUCTION

University community members are critical to the success of their smoke and tobacco free (STF) policies. The present study evaluates changes in social enforcement-related attitudes and behaviors following introduction of a new online Tobacco Tracker tool in two university settings.

METHODS

Campus wide surveys were administered to current students, faculty, and staff at two California public universities with 100% STF policies before (November 2018; N = 5078) and after (December 2019-January 2020; N = 4853) introduction of Tobacco Tracker in February 2019. Prospective surveillance reports over 12 months from Tobacco Tracker, a GIS tool for the campus community to report tobacco use and related litter that displays crowdsourced maps of hotspots, were analyzed. Outcomes included awareness and self-reported use of a tobacco reporting tool, readiness for policy social enforcement, an Intellectual Social Affective (ISA) Engagement scale, and environmental surveillance reports from Tobacco Tracker.

RESULTS

In campus surveys, awareness of a tobacco reporting tool doubled (8.0%-16.9%, p < .0001), use of an online reporting tool tripled (1.1%-3.2%, p < .0001), and readiness to enforce the policy increased (p = .0008). ISA engagement did not change (p = .72). In Tobacco Tracker campus reports (N = 1163), active tobacco use was reported more frequently than tobacco-related litter.

CONCLUSIONS

Tobacco Tracker is a promising tool for college communities to support STF policy. Introduction of Tobacco Tracker was associated with an increase in campus awareness and utilization of a reporting tool, readiness to enforce policy, and campus tobacco surveillance. Future research should determine how Tobacco Tracker may improve policy compliance.

IMPLICATIONS

Tobacco Tracker is a promising tool for college communities to support smoke and tobacco free (STF) policy through active surveillance of smoking, vaping, and related litter on campus. Introduction of Tobacco Tracker was associated with changes in social enforcement-related attitudes and behaviors critical to realizing the preventive potential of STF policies. A crowdsourcing-based tool for monitoring tobacco use on college campuses can address a major barrier to social enforcement: discomfort confronting tobacco users. Further, it provides an alternative to punitive enforcement approaches and promises a sustainable solution to an infrastructure issue faced by many universities lacking resources to collect data on campus tobacco use and related litter.

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

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

The Development of a Web-Based Tobacco Tracker Tool to Crowdsource Campus Environmental Reports for Smoke and Tobacco-Free College Policies: Mixed Methods Study

BACKGROUND

College campuses in the United States have begun implementing smoke and tobacco-free policies to discourage the use of tobacco. Smoke and tobacco-free policies, however, are contingent upon effective policy enforcement.

OBJECTIVE

This study aimed to develop an empirically derived web-based tracking tool (Tracker) for crowdsourcing campus environmental reports of tobacco use and waste to support smoke and tobacco-free college policies.

METHODS

An exploratory sequential mixed methods approach was utilized to inform the development and evaluation of Tracker. In October 2018, three focus groups across 2 California universities were conducted and themes were analyzed, guiding Tracker development. After 1 year of implementation, users were asked in April 2020 to complete a survey about their experience.

RESULTS

In the focus groups, two major themes emerged: barriers and facilitators to tool utilization. Further Tracker development was guided by focus group input to address these barriers (eg, information, policing, and logistical concerns) and facilitators (eg, environmental motivators and positive reinforcement). Amongst 1163 Tracker reports, those who completed the user survey (n=316) reported that the top motivations for using the tool had been having a cleaner environment (212/316, 79%) and health concerns (185/316, 69%).

CONCLUSIONS

Environmental concerns, a motivator that emerged in focus groups, shaped Tracker's development and was cited by the majority of users surveyed as a top motivator for utilization.

Association between smoke-free legislation in hospitality venues and smoking behavior of young people: a systematic review

INTRODUCTION

While evaluations of indoor smoke-free legislation have demonstrated major public health benefits among adults, their impact on smoking behavior of young people remains unclear. Therefore, we performed a systematic review of the association between smoke-free legislation in hospitality venues and smoking behavior of young people.

METHODS

A systematic search was conducted in PubMed, Scopus, and Embase in June 2020. We searched for studies that assessed the association of any form of smoke-free legislation in any hospitality venue (e.g. bar, restaurant) with a smoking behavior outcome (e.g. initiation, current smoking) among young people (aged 10-24 years).

RESULTS

Our search yielded 572 articles of which 31 were screened based on full-text and 9 were included in the analysis. All studies were published between 2005 and 2016. The majority of studies used a quasi-experimental design. Four studies evaluated smoke-free legislation in hospitality venues specifically. Two studies reported that comprehensive, but not weaker, smoke-free legislation decrease progression to established smoking. Two other studies provided mixed results on which level of comprehensiveness of legislation would be effective, and which smoking outcomes would be affected. Five studies evaluated legislation that also included other workplaces. Out of these five studies, three studies found significant decreases in current smoking, smoking frequency, and/or smoking quantity, while two other studies did not.

CONCLUSION

Most studies found that smoke-free legislation in hospitality venues is associated with a decrease in smoking behavior among young people. Their results indicate the need for comprehensive smoke-free legislation without exemptions.

IMPLICATIONS

This is the first systematic review to provide insight in the relationship between smoke-free legislation in hospitality venues and smoking behavior of young people. Our findings show that there is a need for comprehensive smoke-free legislation without exemptions (such as designated smoking areas).

Students' perceptions of a university 'No Smoking' policy and barriers to implementation: a cross- sectional study

OBJECTIVES

Effective policies are an important tool for reducing tobacco use. We examine student perceptions of the existing no-smoking policy in the country's largest national university and identify perceived barriers to its implementation. We explore student support for a 100% tobacco-free campus policy.

DESIGN

We conducted a cross-sectional survey using a self-administered on-line questionnaire.

SETTING

This study was conducted at Qatar University (QU), the largest national institution of higher education in Qatar.

PARTICIPANTS

A total of 199 students participated out of a stratified random sample of students aged ≥18 years with active registration in the Spring 2020 semester.

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed students' knowledge of and attitudes towards QU's current no-smoking policy, the perceived barriers to its implementation, and support for a 100% tobacco-free policy.

RESULTS

Only 26% (95% CI 19.97 to 32.03) and 16.6% (95% CI 11.70 to 22.49) of respondents correctly identified the current policy on traditional and electronic cigarettes, respectively. Less than 30% of respondents held positive attitudes towards policy enforcement, and more male respondents reported positive attitudes towards compliance than women. Support for a 100% tobacco-free policy was at 77.2%, but it was significantly lower among tobacco users compared with non-users (35.9% and 91.8%, respectively; p<0.001). Failure to establish clear penalties, opposition from smoking students, and lack of cessation services were perceived as major barriers to implementation.

CONCLUSIONS

Clear and comprehensive tobacco-free policies are important tools for creating environments conducive to rejecting smoking and seeking cessation support. The findings underscore the need to increase awareness about the policy, advocate for clear penalties for violations, and promote cessation services on campus. Qualitative research is needed to further understand perceived barriers to successful enforcement of the policy.

Implementation of an outdoor smoke-free policy at sports clubs: Critical situations and determinants influencing implementation

BACKGROUND

Outdoor smoke-free policies (SFPs) at sports clubs have significant potential to reduce adolescent smoking. However, the realization of this potential may be strongly dependent on how these policies are implemented in practice. The aim of this study is to explore the perceptions of key stakeholders at different sports clubs in the Netherlands concerning how outdoor SFPs are implemented in practice and which determinants influence implementation.

METHODS

Semi-structured interviews were held with 46 key stakeholders at eight Dutch sports clubs (i.e., field hockey, soccer, tennis, korfball) with an outdoor SFP. A thematic approach was used for the analysis of the transcripts.

RESULTS

Overall, respondents perceived the implementation of an outdoor SFP at sports clubs as feasible. The SFP is often enforced, people who smoke react positively when they are approached, the SFP has led to less (visible) smoking at the venue, and a nonsmoking norm is reinforced. However, we identified three 'critical situations' in which implementation is less than optimal: 1) when children are not present at the sports club, 2) when alcohol is involved, and 3) when people who smoke relocate to the entrance of the sports club. Several determinants influenced implementation in those critical situations: 1) determinants related to individual smokers and club members (i.e., support, communication towards people who smoke), 2) determinants related to the SFP itself (i.e., clarity of the policy), 3) determinants related to the sports club (i.e., communication of the policy, characteristics of the sports club), and 4) determinants related to the wider community (i.e., change of social norm with regard to smoking, support from local and national organizations).

CONCLUSION

Implementation of an outdoor SFP at sports clubs is feasible because there is a high level of support and experiences are mainly positive. Nevertheless, some situations present challenges to compliance and enforcement. We identified a number of determinants that may facilitate implementation of an outdoor SFP at sports clubs.

Going smoke-free: University staff and students' qualitative views about smoking on campus during the implementation of a smoke-free policy

Background

Despite many Australian universities introducing smoke-free policies on campus, there is little information about staff and students understanding of smoking on campus in the context of the implementation of a smoke-free policy.

Objective

This research explores the qualitative views of university staff and students about smoking on campus during the implementation of a smoke-free policy.

Methods

In 2016, an electronic survey was distributed to all current staff and students of a large university in Queensland, Australia during the implementation of a smoke-free policy. The survey consisted of multiple-choice questions about demographics, tobacco use, attitudes towards smoking, awareness of and attitudes towards the policy, and intentions to quit smoking. The final question asked for a short, open-ended response: “Would you like to comment on the issue of smoking on QUT* campuses?” This question was extracted from the survey and analysed using inductive thematic analysis. This paper reports the findings from this question. *Queensland University of Technology.

Results

The survey was completed by 641 staff and students. There were 351 responses to the final question. Five inductive themes emerged about smoking on campus during the implementation of a smoke-free policy: 1) the watering down of the policy, if it is not enforced, 2) the creation of hot spots on campus boundaries affecting those who pass by, 3) concern, especially by those who don’t smoke, about the impact on smokers emotional health and welfare, 4) disagreement about the value of designated smoking areas and 5) suggestions about how to better implement the policy.

Conclusion

Overall, participants views about smoking on campus during the implementation of a smoke free policy suggest broad agreement but reflect concerns about enforcement, boundaries, non-smokers and designated areas. Consistent and systematic processes for implementation, maintenance and enforcement of policy goals, and cessation support, is needed to create a non-smoking culture on university campuses.

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

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

Prevalence of and factors associated with violations of a campus smoke-free policy: a cross-sectional survey of undergraduate students on a university campus in the USA

OBJECTIVE

The aim of this study is to estimate the prevalence of smoking behaviour on campus and to identify the key factors that influence adherence to a campus smoke-free policy.

DESIGN & PARTICIPANTS

This study employed a cross-sectional, self-administered survey of undergraduate students at the University of Mississippi. A random sample of all available undergraduate classes was recruited for data collection. Students were provided a survey that included questions on demographics, alcohol use, smoking status, policy awareness, policy attitudes, smoking attitudes, policy support, barriers to policy success and policy violations.

RESULTS

The prevalence of past 30-day smoking was 23%. More than 63% of current smokers report ever smoking on campus, but less than 10% ever received a warning or a ticket for their violation. Nearly all respondents (92.5%) reported witnessing someone smoking on campus, and 22% reported witnessing someone receiving a ticket. Barriers to policy success include lack of reminders about the policy, lack of support from students and University administrators, and insufficient fines. Smoking behaviour (OR: 7.96; 95% CI: 5.13 to 12.36), beliefs about policy adherence (OR: 0.52; 95% CI: 0.40 to 0.69), support for the policy (OR: 0.71; 95% CI: 0.55 to 0.91) and attitudes against smoking behaviour (OR: 0.35; 95% CI: 0.25 to 0.49) were all significantly associated with self-reported policy violations.

CONCLUSIONS

This study found that violations of the campus smoke-free policy were fairly frequent and the policy has been largely ineffective, indicating a need for other interventions. Approaches to improve adherence to the policy should address barriers such as reminders about the policy, better policy enforcement and support from the administration.

Mapping the visibility of smokers across a large capital city

BACKGROUND

Smoking visibility may affect smoking norms with implications for tobacco initiation, particularly amongst youths. Understanding how smoking is distributed across urban environments would contribute to the design and implementation of tobacco control policies. Our objective is to estimate the visibility of smokers in a large urban area using a novel GIS-based methodological approach.

METHODS

We used systematic social observation to gather information about the presence of smokers in the environment within a representative sample of census tracts in Madrid city in 2016. We designed a GIS-based methodology to estimate the visibility of smokers throughout the whole city using the data collected in the fieldwork. Last, we validated our results in a sample of 40 locations distributed across the city through direct observation.

RESULTS

We mapped estimates of smokers' visibility across the entire city. The visibility was higher in the central districts and in streets with a high density of hospitality venues, public transportation stops, and retail shops. Peripheral districts, with larger green areas and residential or industrial land uses, showed lower visibility of smokers. Validation analyses found high agreement between the estimated and observed values of smokers' visibility (R = 0.845, p=<0.001).

DISCUSSION

GIS-based methods enable the development of novel tools to study the distribution of smokers and their visibility in urban environments. We found differences in the visibility by population density and leisure, retail shops and business activities. The findings can support the development of policies to protect people from smoking.

A protocol for measuring the impact of a smoke-free housing policy on indoor tobacco smoke exposure

BACKGROUND

Tobacco remains a leading cause of preventable death in the U.S., responsible for more than 440,000 deaths each year. Approximately 10% of these deaths are attributable to exposure of non-smokers to secondhand smoke (SHS). Residents living in public multi-unit housing (MUH) are at excess risk for SHS exposure compared to the general population. On November 30, 2016, the U.S. Department of Housing and Urban Development (HUD) passed a rule requiring all public housing agencies to implement smoke-free housing (SFH) policies in their housing developments by July 30, 2018.

METHODS

As part of a larger natural experiment study, we designed a protocol to evaluate indoor SHS levels before and after policy implementation through collection of repeat indoor air samples in non-smoking apartments and common areas of select high-rise NYCHA buildings subject to the HUD SFH rule, and also from socio-demographically matched private-sector high-rise control buildings not subject to the rule. A baseline telephone survey was conducted in all selected buildings to facilitate rapid recruitment into the longitudinal study and assess smoking prevalence, behaviors, and attitudes regarding the SFH policy prior to implementation. Data collection began in early 2018 and will continue through 2021.

DISCUSSION

The baseline survey was completed by 559 NYCHA residents and 471 comparison building residents (response rates, 35, and 32%, respectively). Smoking prevalence was comparable between study arms (15.7% among NYCHA residents and 15.2% among comparison residents). The majority of residents reported supporting a building-wide smoke-free policy (63.0 and 59.9%, respectively). We enrolled 157 NYCHA and 118 comparison non-smoking households into the longitudinal air monitoring study and performed air monitoring in common areas. Follow up surveys and air monitoring in participant households occur every 6 months for 2.5 years. Capitalizing on the opportunity of this federal policy rollout, the large and diverse public housing population in NYC, and robust municipal data sources, this study offers a unique opportunity to evaluate the policy's direct impacts on SHS exposure. Methods in this protocol can inform similar SFH policy evaluations elsewhere.

Australian university smoke-free policy implementation: a staff and student survey

Issue addressed Universities represent important settings for the implementation of public health initiatives such as smoke-free policies. The study aimed to assess staff and student attitudes towards policy enforcement and compliance as well as the acceptability of the provision of cessation support in this setting. Methods A cross-sectional study was conducted following the introduction of a designated-areas partial smoke-free policy at two campuses of one Australian university in 2014. Staff (n=533) and students (n=3060) completed separate online surveys assessing attitudes towards smoke-free policy enforcement and compliance, and acceptability of university-provided cessation support. Results Students held significantly stronger beliefs than staff that the smoke-free policy required staff enforcement (69% vs 60%) and violation penalties (67% vs 60%; both P's <0.01); however, most staff (66%) did not believe enforcement was part of their role. Only 55% of student smokers were aware that the university provided any cessation support. 'Free or cheap nicotine replacement therapy' (65%) and 'free stop smoking counselling service' (60%) were the most popular strategies student smokers thought the university should provide. Conclusions University staff and students hold conflicting views over the need for policy enforcement and who is responsible for enforcement roles. Students view the university as an acceptable setting for the provision of smoking cessation support. So what? Where staff are expected to enforce smoke-free policies, specific education and training should be provided. Ongoing monitoring of compliance and enforcement behaviour appears necessary to avoid the pervasive kind of non-compliance to smoke-free policies that have been seen in other settings.

Non-compliance and associated factors against smoke-free legislation among health care staffs in governmental hospitals in Addis Ababa, Ethiopia: an observational cross-sectional study

Background

In 2014, the Ethiopian government passed a new smoking legislation that banned smoking in public and workplaces including health care facilities. However, data’s on level of non-compliance and associated factors with non-compliance towards smoke-free legislation in hospital settings of the country has not been studied yet.

Methods

Hospital-based Cross-sectional study design triangulated with observational study was conducted in five hospitals. Data were collected through direct observation and interviews using checklist, structured and pre-tested questionnaires for observational study and survey of hospital employee respectively. Nine data collectors and one supervisor were involved in data collection. Three hundred fifty (350) health care staffs were interviewed. Fifteen (15) buildings were purposively observed for observational non-compliance in the selected hospitals. Data were entered by Epi Info and analyzed using SPSS version 21 software. Logistic regression was used to compute the crude and adjusted odds ratios for the factors affecting employee non-compliance with the legislation. A p-value of < 0.05 at 95% CI was considered to be statistically significant.

Results

Anti-smoking signs were absent from a high proportion of hospital areas (97% overall) although visible cigarette butts were generally not observed in most areas of the hospitals. Non-compliance level among health care staffs was 50(10.3%).Associated factors affecting to the non-compliance level of the staff were: being male (AOR = 5.89, p value = 0.001), having poor knowledge (AOR = 2.71, p-value = 0.022) and having Unfavorable attitudes (AOR = 6.15, p-value = 0.000).

Conclusions

Non-compliance level was high and needs careful implementation for 100% smoke-free legislation in addressing knowledge and attitudes of health care staffs.

Predicting students' noncompliance with a smoke-free university campus policy

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.

Signs, Fines and Compliance Officers: A Systematic Review of Strategies for Enforcing Smoke-Free Policy

Background. Smoke-free environment policies limit or eliminate the use of smoke-producing tobacco in designated areas thereby reducing second hand smoke. Enforcement is perceived as critical to the successful adoption of a smoke-free policy. However, there is limited guidance available regarding effective enforcement strategies. A systematic review was conducted to examine the effectiveness of enforcement strategies at increasing compliance with and enforcement of smoke-free policies; and to determine circumstances other than enforcement strategies that are associated with compliance with smoke-free policies. Design. Medline, Medline in Process, The Cochrane Library, Embase, PsycInfo and CINAHL databases were searched using MeSH and keywords for relevant studies published between January 1980 and August 2017. A narrative synthesis and methodological quality assessment of included studies was undertaken. Results. Policy promotion and awareness-raising activities, signage, enforcement officers, and penalties for violations were the enforcement strategies most frequently cited as being associated with successful policy enforcement. Additionally, awareness of the laws, non-smoking management and lower staff smoking rates, and membership of a network guiding the policy enforcement contributed to higher compliance with smoke-free policies. Conclusions. There is weak evidence of the effectiveness of strategies associated with compliance with smoke-free policies. Given the evidence base is weak, well-designed trials utilizing appropriate evaluation designs are needed. Overall enforcement strategies associated with total smoke-free bans resulted in higher levels of compliance than strategies for policies that had only partial smoke-free bans.

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.

Employee Adherence to a Tobacco-Free Executive Order in Kentucky

PURPOSE

Examine predictors of short- and long-term adherence to a tobacco-free policy prohibiting all tobacco use inside and outdoors on Executive Branch property in Kentucky.

DESIGN

Cross-sectional online surveys administered at 2 time points.

SETTING

Commonwealth of Kentucky.

PARTICIPANTS

27 000 employees of the Kentucky Executive Branch were invited to participate in 2 online surveys: March 2015, 4 months postpolicy (N = 4854) and August 2015, 9 months postpolicy (N = 3522).

INTERVENTION

Executive order prohibiting tobacco use on Executive property implemented November 2014.

MEASURES

Tobacco use, tobacco users' adherence to the tobacco-free policy, and personal characteristics were assessed.

ANALYSIS

Two separate logistic regression models used to determine predictors of short- and long-term adherence to the policy.

RESULTS

In the short term, employees who had seen others violate the policy ( P < .001) and had more tobacco-using friends ( P = .020) were less likely to adhere to the policy. At 9 months after the policy, employees who were older ( P = .038) and those who had seen others violate the policy ( P < .001) were less likely to report adherence to the policy. Tobacco-using employees who worked in a county with a comprehensive smoke-free ordinance ( P = .047) were more likely to adhere to the policy.

CONCLUSION

This study indicates the need for strong policy compliance procedures, employer-based tobacco treatment programs accompanying tobacco-free policy change, and smoke-free workplace laws to promote prohealth norms.

Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up

The effectiveness of outdoor smoking bans on smoking behavior among adolescents remains inconclusive. This study evaluates the long-term impact of outdoor school ground smoking bans among adolescents at secondary schools on the use of conventional cigarettes, e-cigarettes (with/without nicotine) and water pipes. Outdoor smoking bans at 19 Dutch secondary schools were evaluated using a quasi-experimental design. Data on 7733 adolescents were obtained at baseline, and at 6 and 18-month follow-up. The impact of outdoor smoking bans on ‘ever use of conventional cigarettes’, ‘smoking onset’, ‘ever use of e-cigarette with nicotine’, ‘e-cigarette without nicotine’, and ‘water pipe’ was measured. Multilevel logistic regression analysis was used. At schools with a ban, implementation fidelity was checked. At schools where a ban was implemented, at 18-month follow-up more adolescents had started smoking compared to the control condition. No effect of implementation of the ban was found for smoking prevalence, e-cigarettes with/without nicotine, and water pipe use. Implementation fidelity was sufficient. No long-term effects were found of an outdoor smoking ban, except for smoking onset. The ban might cause a reversal effect when schools encounter difficulties with its enforcement or when adolescents still see others smoking. Additional research is required with a longer follow-up than 18 months.

Smoking Habits among Greek University Students after the Financial Crisis

Background:

University students worldwide seem to have increased rates of smoking, alcohol abuse, binge drinking episodes and harmful consumption trends, raising a serious public health issue. The aim of the present study was to investigate university students’ smoking habits and exposure to secondary smoke amid a financial crisis.

Methods:

The present descriptive, correlational analysis was conducted at the University of Peloponnese.

Results:

The average age of the sample (n=203) was 24.9 years (±7.6 years) with 36.0% of the participants (n=73) being postgraduate students. Some 51.2% (n=104) of the participants said they didn’t smoke and 46.3% (n=94, p=0.003) reported no secondary smoke exposure during the past week at home. The majority of the remainder initiated smoking at age 16-17 (48.5%, n=48), and 64.6% (n=42) said the financial crisis did not lead them to change their smoking habits.

Conclusions:

The majority of students support smoking ban laws in enclosed public spaces, but also their replies highlighted poor implementation on behalf of the state and the authorities. The financial crisis did not appear to have affected student smoking habits.

The carrot and the stick? Strategies to improve compliance with college campus tobacco policies

OBJECTIVE

Tobacco-free policies are being rapidly adopted nationwide, yet compliance with these policies remains a challenge. This study explored college campus key informants' experiences with tobacco policies, and their perceived benefits, drawbacks, and outcomes.

PARTICIPANTS

The sample for this study was 68 key informants representing 16 different California universities with varying tobacco policies (no smoking indoors and within 20 feet of entrances, designated smoking areas, 100% smoke-free, and 100% tobacco-free).

METHODS

Qualitative, descriptive study. Semistructured interviews were transcribed verbatim and analyzed using content analysis.

RESULTS

Strategies to improve compliance ranged from a social approach to a heavy focus on punitive enforcement. Key informants from campuses using a social approach alone reported barriers to improving compliance, including a perceived lack of efficacy of the approach. However, these campuses found it challenging to incorporate enforcement through campus police or security.

CONCLUSIONS

College campus decision makers should explore using a combined approach (social approach as well as formal enforcement), with enforcement primarily the responsibility of nonpolice university channels (eg, Student Affairs, employee supervisors).

Supportive of a smoke-free campus but opposed to a 100% tobacco-free campus: Identification of predictors among university students, faculty, and staff

Many universities are adopting campus tobacco policies, but little research has explored factors influencing the choice between the policy options of smoke-free versus 100% tobacco-free. Students, faculty, and staff at a U.S. state university participated in a web-based survey in 2013, approximately one year after adoption of a smoke-free policy. Respondents who expressed support for the policy were included in an analysis to examine their opinions regarding a 100% tobacco-free policy. The samples included 4138 students and 1582 faculty/staff. Bivariate analyses and multivariate logistic regression were used to identify predictors of opposition to a tobacco-free campus. Independent variables included strength of support for a smoke-free campus, past-month tobacco use (cigarettes, smokeless tobacco, e-cigarettes, non-cigarette combustible tobacco products), campus exposure to secondhand smoke, perceptions of tobacco-related behaviors and norms, and demographics. Of these supporters of a smoke-free campus, 14.3% of students and 10.2% of faculty/staff were opposed to a tobacco-free campus. In the multivariate analyses, in both samples, smokeless tobacco use predicted opposition while smoke-free policy support and female gender predicted support. In addition, among students, current or former cigarette smoking and non-cigarette combustible tobacco use predicted opposition; international student status and secondhand smoke exposure predicted support. Among faculty/staff, age over 55 predicted support. Future research should examine why current and former smokers might oppose policies restricting non-combustible tobacco products, even when they support smoke-free policies. In policy planning, campus administrators should communicate actual tobacco usage levels. International students who do not use tobacco may be a source of policy support.

Facilitators and Barriers of Smokers' Compliance with Smoking Bans in Public Places: A Systematic Review of Quantitative and Qualitative Literature

Background: Environmental tobacco smoke (ETS) exposure is associated with an increased risk of many diseases. Many countries have ratified a national smoking ban in public places, but studies on factors related to smoking issues in public places post-ban are lacking. Aim: To identify facilitators and barriers that influenced smokers’ compliance with smoking bans in public places. Methods: Using PubMed, MEDLINE, and the Web of Science database, we conducted a systematic search of English articles published before June 2015 on factors of smokers’ compliance with the smoking bans in public places. Results: A total of 390 references were identified, among which seventeen articles (twelve quantitative studies, two qualitative studies, three mixed-method studies) were included in this review. These studies focused on four types of public places including recreational venues (n = 7), hospital (n = 5), school (n = 4), and workplace (n = 1). Factors at the  individual-, interpersonal-, and organizational-level were identified: at the individual level, nicotine dependence, insufficiency of tobacco-related knowledge, and the negative attitudes towards smoking bans were the most commonly identified barriers; at the interpersonal level, the smoking behaviors of people around, close relatives, and friends’ approval were the main barriers; and at the organizational level, the main barriers were inefficient implementation of the bans and the inconvenience of the designative smoking areas. Conclusions: This synthesis of the literature provided evidence of the identified barriers and facilitators of smokers’ compliance with the smoking bans. It will be beneficial for the policy-maker to consider interventions on multiple levels of factors to overcome the barriers and enhance smokers’ compliance with the smoking bans in public places.

Impact of institutional smoking bans on reducing harms and secondhand smoke exposure

BACKGROUND

Smoking bans or restrictions can assist in eliminating nonsmokers' exposure to the dangers of secondhand smoke and can reduce tobacco consumption amongst smokers themselves. Evidence exists identifying the impact of tobacco control regulations and interventions implemented in general workplaces and at an individual level. However, it is important that we also review the evidence for smoking bans at a meso- or organisational level, to identify their impact on reducing the burden of exposure to tobacco smoke. Our review assesses evidence for meso- or organisational-level tobacco control bans or policies in a number of specialist settings, including public healthcare facilities, higher education and correctional facilities.

OBJECTIVES

To assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health-related outcomes.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE, EMBASE, and the reference lists of identified studies. We contacted authors to identify completed or ongoing studies eligible for inclusion in this review. We also checked websites of state agencies and organisations, such as trial registries. Date of latest searches was 22nd June 2015.

SELECTION CRITERIA

We considered studies that reported the effects of tobacco bans or policies, whether complete or partial, on reducing secondhand smoke exposure, tobacco consumption, smoking prevalence and other health outcomes, in public healthcare, higher educational and correctional facilities, from 2005 onwards.The minimum standard for inclusion was having a settings-level policy or ban implemented in the study, and a minimum of six months follow-up for measures of smoking behaviour. We included quasi-experimental studies (i.e. controlled before-and-after studies), interrupted time series as defined by the Cochrane Effective Practice and Organization of Care Group, and uncontrolled pre- and post-ban data.

DATA COLLECTION AND ANALYSIS

Two or more review authors independently assessed studies for inclusion in the review. Due to variation in the measurement of outcomes we did not conduct a meta-analysis for all of the studies included in this review, but carried out a Mantel-Haenszel fixed-effect meta-analysis, pooling 11 of the included studies. We evaluated all studies using a qualitative narrative synthesis.

MAIN RESULTS

We included 17 observational studies in this review. We found no randomized controlled trials. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before-and-after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before-and-after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group.The four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking-related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (risk ratio (RR) 0.71, 95% confidence interval ( CI) 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking-related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16).We judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational.

AUTHORS' CONCLUSIONS

We found evidence of an effect of settings-based smoking policies on reducing smoking rates in hospitals and universities. In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported. However, we rated the evidence base as low quality. We therefore need more robust studies assessing the evidence for smoking bans and policies in these important specialist settings.

A cross sectional evaluation of a total smoking ban at a large Australian university

BACKGROUND

Total smoking bans have been found to contribute positively to the health of non-smokers by reducing exposure to second-hand smoke, and to enhance the likelihood of cessation among smokers.

METHODS

Two cross-sectional electronic surveys of staff and students at a large Australian university were conducted prior (n = 969) and 1 year post (n = 670) the implementation of a smoke free campus policy. Demographics, tobacco use, intention to quit, attitudes towards smoking and smoking restrictions and awareness of and attitudes towards the campus smoking policy were measured.

RESULTS

Exposure to second-hand smoke (SHS) reduced significantly (p < 0.001) one year after policy implementation. Smoking prevalence was similar at both time periods (T1 9.3 %; T2 8.4 %) and over half of smokers indicated they were planning to quit smoking in the future (T1 65.5 vs T2 62.3 %). There was a significant increase in positive responses to the statement the campus should be totally smoke free including all outdoor areas at T2 compared to T1 (T1 60.8 vs T2 71.4 %; p < 0.001), however respondents felt there should be places on campus for smokers to smoke (T1 53.6 vs T2 47 %; p < 0.05).

CONCLUSIONS

This study found a significant positive difference in exposure SHS after implementation of the total ban. Although prevalence of smoking in this study was low, the proportion of respondents who were contemplating smoking cessation suggests support for smokers would be beneficial. Continued awareness raising, education and enforcement is likely to enhance the long term outcomes of the total ban.

A tobacco-free campus ambassador program and policy compliance

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.

Enforcing a tobacco-free campus through an ambassador-based program: a phenomenology

OBJECTIVE

This phenomenology explored the experiences of those involved in a campus-based Ambassador program that enforced a tobacco-free policy at a public university in Montana.

PARTICIPANTS

During the program's initial implementation (spring 2014), researchers observed and interviewed 21 Ambassadors and 19 policy violators.

METHODS

Researchers observed and recorded field notes of Ambassadors promoting the policy to the campus community and interacting with policy violators. Researchers invited Ambassadors and violators to be interviewed regarding their experiences with the program.

RESULTS

Although Ambassadors enjoyed promoting the policy and sensed an increase in recognition by others, they also felt uncomfortable and had mixed feelings regarding their level of authority. Violators also felt uncomfortable, yet the majority described the experience with the program as positive.

CONCLUSIONS

The findings from the study can be used to inform those considering the implementation of an Ambassador program on their campus.