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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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Mullin M, Allwright S, McGrath D, Hayes CB. Use of a Living Lab Approach to Implement a Smoke-Free Campus Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5354. [PMID: 37047968 PMCID: PMC10094473 DOI: 10.3390/ijerph20075354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
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.
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Affiliation(s)
- Martina Mullin
- College Health, Trinity College Dublin, College Green, D02 PN40 Dublin, Ireland
| | - Shane Allwright
- Public Health & Primary Care, Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, D24 DH74 Dublin, Ireland
| | - David McGrath
- College Health, Trinity College Dublin, College Green, D02 PN40 Dublin, Ireland
| | - Catherine B. Hayes
- Public Health & Primary Care, Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, D24 DH74 Dublin, Ireland
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Fujita S, Marteache N. Evaluation of a smoke- and tobacco-free campus policy: The issue of displacement. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:598-606. [PMID: 32432986 DOI: 10.1080/07448481.2020.1758705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/21/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Shuryo Fujita
- Department of Criminal Justice, California State University, San Bernardino, California, USA
| | - Nerea Marteache
- Department of Criminal Justice, California State University, San Bernardino, California, USA
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Bardus M, El Boukhari N, Nakkash R. Development and evaluation of smoke-free or tobacco-free policies in university settings: a systematic scoping review. HEALTH EDUCATION RESEARCH 2020; 35:306-351. [PMID: 32702134 DOI: 10.1093/her/cyaa009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- M Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, PO Box 11-0236, Riad El Sohl 1107 2020, Beirut, Lebanon
| | - N El Boukhari
- Department of Health Promotion and Community Health, Faculty of Health Sciences, PO Box 11-0236, Riad El Sohl 1107 2020, Beirut, Lebanon
| | - R Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, PO Box 11-0236, Riad El Sohl 1107 2020, Beirut, Lebanon
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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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Seitz CM, Ragsdale TL. Student Experiences With Community-Based Enforcement of a Smoke-Free University. Health Promot Pract 2018; 20:188-195. [DOI: 10.1177/1524839918782700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Ickes MJ, Rayens MK, Wiggins A, Hahn EJ. Students' Beliefs About and Perceived Effectiveness of a Tobacco-Free Campus Policy. Policy Polit Nurs Pract 2017; 18:17-25. [PMID: 28558518 DOI: 10.1177/1527154417700633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Tobacco-free (TF) college campus policies have potential to be a high-impact tobacco control strategy. The purposes of the study presented here were to (a) determine the demographic and personal characteristics associated with students' beliefs about and perceived effectiveness of a TF campus policy and (b) assess whether tobacco use status and exposure to secondhand smoke (SHS) predicted beliefs and perceived effectiveness. Five thousand randomly selected students from a large southeastern university were invited by e-mail to participate in an online survey in April 2013, three and a half years after policy implementation. Students held positive beliefs about the policy (average rating 84% of the maximum possible score). Sixty-one percent believed that the policy was successful at reducing SHS exposure; and 40% thought the policy encouraged quitting. Males were less likely than females to believe the policy was effective in reducing SHS exposure and encouraging quitting. Lower undergraduates were more likely to perceive the policy as less effective in reducing SHS exposure; international students were more likely than domestic students to perceive the policy as more effective at encouraging quitting. Students most exposed to SHS were less likely to perceive the policy was effective. Compared with nonusers, those who smoked cigarettes were less likely to perceive the policy as effective in encouraging quitting. Tailored messaging regarding policy benefits are necessary. Perceived effectiveness of TF policies may be related to compliance with the policy and should be further investigated. Objective measures of effectiveness and tobacco use behaviors are needed to fully measure the success of TF campus policies.
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Affiliation(s)
- Melinda J Ickes
- 1 Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA.,2 BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- 2 BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA.,3 College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Amanda Wiggins
- 2 BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA.,4 College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J Hahn
- 2 BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA.,3 College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
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Bennett BL, Deiner M, Pokhrel P. College anti-smoking policies and student smoking behavior: a review of the literature. Tob Induc Dis 2017; 15:11. [PMID: 28163669 PMCID: PMC5286782 DOI: 10.1186/s12971-017-0117-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/21/2017] [Indexed: 12/04/2022] Open
Abstract
Background Currently, most college campuses across the U.S. in some way address on-campus cigarette smoking, mainly through policies that restrict smoking on campus premises. However, it is not well understood whether college-level anti-smoking policies help reduce cigarette smoking among students. In addition, little is known about policies that may have an impact on student smoking behavior. This study attempted to address these issues through a literature review. Methods A systematic literature review was performed. To identify relevant studies, the following online databases were searched using specific keywords: Ovid MEDLINE, PsycINFO, PubMed, and Google Scholar. Studies that met the exclusion and inclusion criteria were selected for review. Studies were not excluded based on the type of anti-smoking policy studied. Results Total 11 studies were included in the review. The majority of the studies (54.5%) were cross-sectional in design, 18% were longitudinal, and the rest involved counting cigarette butts or smokers. Most studies represented more women than men and more Whites than individuals of other ethnic/racial groups. The majority (54.5%) of the studies evaluated 100% smoke-free or tobacco-free campus policies. Other types of policies studied included the use of partial smoking restriction and integration of preventive education and/or smoking cessation programs into college-level policies. As far as the role of campus smoking policies on reducing student smoking behavior is concerned, the results of the cross-sectional studies were mixed. However, the results of the two longitudinal studies reviewed were promising in that policies were found to significantly reduce smoking behavior and pro-smoking attitudes over time. Conclusion More longitudinal studies are needed to better understand the role of college anti-smoking policies on student smoking behavior. Current data indicate that stricter, more comprehensive policies, and policies that incorporate prevention and cessation programming, produce better results in terms of reducing smoking behavior.
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Affiliation(s)
- Brooke L Bennett
- Cancer Prevention & Control Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, 701 Ilalo St, Honolulu, HI96822 USA
| | - Melodi Deiner
- Cancer Prevention & Control Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, 701 Ilalo St, Honolulu, HI96822 USA
| | - Pallav Pokhrel
- Cancer Prevention & Control Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, 701 Ilalo St, Honolulu, HI96822 USA
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