College campus smoking policies and programs and students' smoking behaviors

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

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

Influence of a University Tobacco-Free Policy on the Attitudes, Perceptions of Compliance, and Policy Benefit Among the University Students: A Pre-Post Investigation

Objective: To evaluate the effectiveness of a university tobacco-free policy by examining differences in students' attitudes, perceptions of compliance and policy benefits, after one year of the policy's implementation. Methods: Cross-sectional studies were undertaken to collect data pre- and 1 year post-policy implementation. The two samples were selected using stratified random sampling. Results: The prevalence of smoking decreased from 26% pre-policy implementation to 21% 1 year after (p = 0.035). The proportion of smokers who thought the policy had contributed to a reduction in smoking frequency increased from 10% to 70% (p < 0.001). Smokers' support for the policy rose from 42 to 58% (p = 0.007). Conclusion: Against the background of a strongly pro-tobacco environment in Lebanon, it is possible to create a positive change in the mindset of smokers at the levels of the education and smoking cessation and more efforts should be expended to bring it about.

Characterizing Self-Reported Tobacco, Vaping, and Marijuana-Related Tweets Geolocated for California College Campuses

Introduction: College-aged youth are active on social media yet smoking-related social media engagement in these populations has not been thoroughly investigated. We sought to conduct an exploratory infoveillance study focused on geolocated data to characterize smoking-related tweets originating from California 4-year colleges on Twitter. Methods: Tweets from 2015 to 2019 with geospatial coordinates in CA college campuses containing smoking-related keywords were collected from the Twitter API stream and manually annotated for discussions about smoking product type, sentiment, and behavior. Results: Out of all tweets detected with smoking-related behavior, 46.7% related to tobacco use, 50.0% to marijuana, and 7.3% to vaping. Of these tweets, 46.1% reported first-person use or second-hand observation of smoking behavior. Out of 962 tweets with user sentiment, the majority (67.6%) were positive, ranging from 55.0% for California State University, Long Beach to 95.8% for California State University, Los Angeles. Discussion: We detected reporting of first- and second-hand smoking behavior on CA college campuses representing possible violation of campus smoking bans. The majority of tweets expressed positive sentiment about smoking behaviors, though there was appreciable variability between college campuses. This suggests that anti-smoking outreach should be tailored to the unique student populations of these college communities. Conclusion: Among tweets about smoking from California colleges, high levels of positive sentiment suggest that the campus climate may be less receptive to anti-smoking messages or adherence to campus smoking bans. Further research should investigate the degree to which this varies by campuses over time and following implementation of bans including validating using other sources of data.

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.

Associations of school tobacco policies and legislation with youth smoking: a cross-sectional study of Danish vocational high schools

BACKGROUND

In vocational high schools, the prevalence of smoking is high (nearly 40% daily smoking in Danish vocational high schools). Schools are increasingly adopting school tobacco policies (STPs) and a national law on smoke-free school grounds has been implemented. Our objective was to explore the extent of STPs in vocational schools and examine the association of STPs and smoke-free school grounds legislation with student smoking.

METHODS

We used data from the cross-sectional Danish National Youth Study 2014, including 5013 vocational high school students (76% male) at 40 campuses. Implementation of STPs was measured by questionnaires to principals and field observations of smoking practices were conducted. Logistic regression models assessed whether STP characteristics were associated with students' current smoking (ie, daily and occasional) compared with non-current smoking. Negative binominal regression models assessed cigarettes per day among daily smokers.

RESULTS

Schools covered by the national law on smoke-free school ground had more comprehensive STPs than schools not covered by the law. Student smoking was observed on 78% of campuses, with less visibility of smoking in schools covered by the national law (69% vs 83%). Current smoking was lower for students attending a school covered by the national law (OR=0.86, 95% CI 0.75 to 0.97). Students who attended schools that allowed teacher-student smoking were more likely to smoke (OR=1.13, 95% CI 1.01 to 1.27).

CONCLUSIONS

A law on smoke-free school grounds was associated with less current smoking in vocational high schools, while school norms that are supportive of teacher-student smoking were associated with greater odds of current smoking. Visibility of student smoking was less prevalent at schools covered by the law on smoke-free school grounds; nevertheless, the visibility of smoking was high. Better enforcement or an extension of the current law on smoke-free school grounds is recommended.

Smoking, health and academic outcomes: evidence from a limited smoking campus policy

Although there is substantial literature on the impact of smoking laws, the number of studies that investigate the impact of such policies on college campuses is sparse. Using a rich data set from various waves of the American College Health Association National College Health Assessment survey for a mid-sized public university in the southern United States, we investigate a possible causal link between a limited smoking policy and smoking behaviours, health and academic outcomes among college students. We employ propensity score matching methods to control for endogeneity of unobservable characteristics. Our results show a significant reduction in the propensity to smoke cigarettes and cigars following the introduction of the policy. Further, we find that the policy has increased academic outcomes; however, it has no significant effect on student health. These findings have important policy implications for schools that are considering instituting comprehensive smoking bans on college.

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.

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

Background

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

Methods

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

Results

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

Conclusion

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

A baseline assessment of attitudes toward tobacco free campus policies in a U.S./México border university

In recent years there has been an increase in the number of smoke/tobacco free settings, including university campuses. Given the benefits associated with the implementation of smoke and tobacco free campus policies, it is important to study attitudes toward these due to their potential association with subsequent implementation issues. The present study assessed potential predictors of attitudes toward tobacco free campus (TFC) policies, tobacco use risk perception, and perceived problematic campus tobacco use at a university located on the U.S./México border. University faculty, staff, and students (N=3002; Mage=30.4; 60% female; 67.1% Hispanic) completed an online survey regarding tobacco use history, attitudes toward TFC policies, tobacco use risk perception, perception of problematic tobacco use on campus, and awareness of the current tobacco use campus policy. Male gender, non Hispanic white ethnicity, smoking behavior (history/current), and identifying the current tobacco use policy were associated with less positive attitudes toward TFC policies and lower tobacco use risk perception. Non Hispanic white ethnicity and current smoking were associated with a lower perception of problematic campus tobacco use. Attitudes toward TFC policies and perceptions were generally positive, yet educating about the risks associated with tobacco use and addressing misconceptions about the dangers of secondhand smoke to potentially promote TFC policies seem warranted.

Smoke-Free Universities Help Students Avoid Establishing Smoking by Means of Facilitating Quitting

BACKGROUND

This study aimed to clarify whether smoke-free policies affect the initiation or the quitting of smoking among young adults.

METHODS

In this natural quasi-experiment study, three universities with different enforcement of smoke-free policies were considered in Kazan City, Russian Federation. Exposure data were collected in 2008-2009 through measurement of particulate matter concentrations in typical sets of premises in each university to distinguish smoke-free universities (SFU) and those not smoke-free (NSFU). All present third year students were surveyed in class in April-June 2011. Number of valid questionnaires equaled 635. The questionnaire was adapted from the Health Professions Students Survey and contained questions on smoking initiation, current tobacco use, willingness to quit, quit attempts, percep-tion of smoke-free policies enforcement, and the demographic data.

RESULTS

Among students of SFU, the percentage of current smokers was smaller than in NSFU: 42% vs. 64% in men and 32% vs. 43% in women. Prevalence of daily smoking was 11-12% in SFU, 26% in NSFU overall and 42% among male students. No advantage of SFU in limiting smoking initiation was found. Percentage of former smokers in SFU was 33% vs. 10% in NSFU. Among current smokers, 57% expressed willingness to quit in SFU and only 28% in NSFU. About 60% of current smokers in SFU attempted to quit within a year and only 36% did so in NSFU with 23% vs. 3% having done three or more attempts.

CONCLUSION

Smoke-free universities help young adults to avoid establishing regular smoking by means of facilitating quitting smoking.

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

OBJECTIVE

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

PARTICIPANTS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Attitude ambivalence, social norms, and behavioral intentions: Developing effective antitobacco persuasive communications

This study assessed the moderating effects of attitude ambivalence on the relationship between social norms, attitudes, and behavioral intentions to use tobacco. It was predicted that people would use social norms to reduce attitude ambivalence, and that reduced ambivalence would lead to changes in attitudes and behavioral intentions. To test this hypothesis, participants (N = 152) were exposed to persuasive communications designed to influence attitude ambivalence and perceived social norms regarding tobacco use. Analysis indicated that providing a social norm antagonistic to tobacco use significantly reduced ambivalence among participants reading the ambivalence message (p < .001). Examining changes in tobacco attitudes from pre- to postpersuasive communications demonstrated a significant decrease in tobacco attitudes only for participants reading the ambivalence message who were provided with the antitobacco use norm (p < .001). Ambivalent message participants also expressed significantly lower intentions to use tobacco when provided with social norms indicating antitobacco sentiments (p < .02), and this significant decrease in intentions was associated with changes in attitudes toward tobacco. These results point to the important role of social norms in mediating the effects of attitude ambivalence on subsequent behavior in preventative programs targeting tobacco use.

A Systematic Review and Meta-analysis of the Acceptability and Effectiveness of University Smoke-Free Policies

OBJECTIVE

Systematically review studies of support for, and effectiveness of, university campuses' smoke-free policies.

PARTICIPANTS/METHODS

A search was carried out for studies in English related to campus smoking bans through June 2013. Eligible studies had outcomes for student or faculty attitudes, or measures of smoking prevalence or secondhand smoke (SHS) exposure.

RESULTS

Nineteen eligible studies were identified, 18 from the United States and 1 from the United Kingdom. A meta-analysis found 58.94% (95% confidence interval [CI] [52.35%, 65.53%]) of students (12 studies) and 68.39% (95% CI [65.12%, 71.67%]) of faculty (7 studies) supported smoke-free policies. Both studies measuring student smoking prevalence indicated a postban reduction (16.5% to 12.8% after 1 year [p < .001] and 9.5% to 7.0% [p = .036] after 3 years). Only 5% of UK universities were smoke-free compared with 25% of US universities.

CONCLUSIONS

A majority of students and faculty support smoke-free campus policies, which may reduce smoking and SHS exposure.

Smoking and membership in a fraternity or sorority: a systematic review of the literature

OBJECTIVE

Fraternity and sorority members have higher rates of smoking than other college students. This systematic review examines studies that included fraternity/sorority membership in their investigation of smoking behaviors.

PARTICIPANTS/METHODS

Studies identified in MEDLINE, PsychInfo, JSTOR, CINAHL, ERIC, and Google Scholar published between 2003 and 2013 were included if they included fraternity and/or sorority membership, were written in English, published in a peer-reviewed journal, and had smoking as an outcome variable. Nineteen studies were identified for the review.

RESULTS

Fraternity/sorority members were more likely to be nondaily smokers. Members who lived in the fraternity/sorority house had higher rates of smoking than members who lived elsewhere. Fraternity/sorority member smoking was associated with alcohol and other substance use. The influence of no-smoking policies on fraternity/sorority member smoking was also examined.

CONCLUSIONS

Fraternity/sorority membership was associated with higher rates of smoking, but this association was influenced by other substance use and environmental factors.

Students' attitude and smoking behaviour following the implementation of a university smoke-free policy: a cross-sectional study

OBJECTIVE

In view of the high-smoking rate among university students in Lebanon and the known adverse effects of second-hand smoking, the American University of Beirut (AUB) decided to implement a non-smoking policy on campus. This study sought to examine the students' compliance and attitudes following the ban.

DESIGN

Cross-sectional study.

SETTING

A private university in Lebanon.

PARTICIPANTS

545 randomly selected students were approached. A stratified cluster sample of classes offered in the spring semester of the 2008/2009 academic year was selected. Students completed a self-administered paper and pencil survey during class time.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main outcomes were compliance with and attitudes towards the ban. Other secondary outcomes were the perception of barriers to implementation of the ban and attitudes towards tobacco control in general.

RESULTS

535 students participated in the study. Smokers were generally compliant with the ban (72.7%) and for some (20%) it led to a decrease in their smoking. Students' attitude towards the ban and the enforcement of a non-smoking policy in public places across Lebanon varied according to their smoking status whereby non-smokers possessed a more favourable attitude and strongly supported such policies compared with smokers; overall, the largest proportions of students were satisfied to a large extent with the ban and considered it justified (58.6% and 57.2%, respectively). While much smaller percentages reported that the ban would help in reducing smoking to a large extent (16.7%) or it would help smokers quit (7.4%). Perceived barriers to implementation of the non-smoking policy in AUB included the lack of compliance with and strict enforcement of the policy as well as the small number and crowdedness of the smoking areas.

CONCLUSIONS

An education campaign, smoking cessation services and strict enforcement of the policy might be necessary to boost its effect in further reducing students' cigarette use.

Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association

BACKGROUND

Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established.

METHODS AND RESULTS

For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies.

CONCLUSIONS

This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.

Secondhand tobacco smoke exposure and associated factors among college students on campus and in the home: a preliminary study

To explore the prevalence of secondhand tobacco smoke (SHS) exposure of college students at two locations, i.e., on campus and in the home, and to identify factors associated with SHS exposure at each location, a preliminary cross-sectional study was conducted on 1754 nonsmoking students from two universities in Korea. In total, 83.1% were exposed to SHS at least once a week on campus or at home; the average SHS exposure was 3.4 times per week. Specifically, 79.7% and 23.5% were exposed to SHS on campus and in the home, respectively. On campus, SHS exposure was significantly more prevalent in freshmen and sophomore students. In the home, SHS exposure was significantly more prevalent among females, those with smokers in their families, and those who rated their health as poor. SHS exposure was common among nonsmoking college students, with more than two-thirds exposed on campus. The prevalence of SHS exposure was greater on campus than in the home; the factors associated with SHS exposure were location-specific.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

College students' response rate to an incentivized combination of postal and web-based health survey

A questionnaire survey on health among students of higher education was planned. To produce a response rate high enough for the analysis in a cost-effective manner, a pilot study was carried out to test various methods of data collection. Electronic invitation by the university messaging system to fill a Web-based questionnaire, invitation by the same means to fill paper-based questionnaires at a predefined place and time with or without conditional incentives yielded response rates below 10%. Therefore, a combination of postal and Internet-based questionnaires was used for data collection enhanced with a small up-front gift and conditional incentives suggested by a student focus group. This modality resulted in a 68.6% response rate (65.2% after data cleaning). Those who responded through the Web were more likely to be males and residing in larger settlements. However, no statistically significant differences were observed on the primary health status variables with respect to modality. Use of Web-based questionnaires is recommended in combination with other data collection methods and incentives.

A group-randomized tobacco trial among 30 Pacific Northwest colleges: results from the Campus Health Action on Tobacco study

INTRODUCTION

We conducted a group-randomized trial to increase smoking cessation and decrease smoking onset and prevalence in 30 colleges and universities in the Pacific Northwest.

METHODS

Random samples of students, oversampling for freshmen, were drawn from the participating colleges; students completed a questionnaire that included seven major areas of tobacco policies and behavior. Following this baseline, the colleges were randomized to intervention or control. Three interventionists developed Campus Advisory Boards in the 15 intervention colleges and facilitated intervention activities. The freshmen cohort was resurveyed 1 and 2 years after the baseline. Two-years postrandomization, new cross-sectional samples were drawn, and students were surveyed.

RESULTS

At follow-up, we found no significant overall differences between intervention and control schools when examining smoking cessation, prevalence, or onset. There was a significant decrease in prevalence in private independent colleges, a significant increase in cessation among rural schools, and a decrease in smoking onset in urban schools.

DISCUSSION

Intervention in this college population had mixed results. More work is needed to determine how best to reach this population of smokers.

Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption

BACKGROUND

Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and smoking behaviour of those populations they affect.

OBJECTIVES

To assess the extent to which legislation-based smoking bans or restrictions reduce exposure to SHS, help people who smoke to reduce tobacco consumption or lower smoking prevalence and affect the health of those in areas which have a ban or restriction in place.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL, Conference Paper Index, and reference lists and bibliographies of included studies. We also checked websites of various organisations. Date of most recent search; July 1st 2009.

SELECTION CRITERIA

We considered studies that reported legislative smoking bans and restrictions affecting populations. The minimum standard was having a ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. We included randomized controlled trials, quasi-experimental studies (i.e. non-randomized controlled studies), 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

Characteristics and content of the interventions, participants, outcomes and methods of the included studies were extracted by one author and checked by a second. Because of heterogeneity in the design and content of the studies, we did not attempt a meta-analysis. We evaluated the studies using qualitative narrative synthesis.

MAIN RESULTS

There were 50 studies included in this review. Thirty-one studies reported exposure to secondhand smoke (SHS) with 19 studies measuring it using biomarkers. There was consistent evidence that smoking bans reduced exposure to SHS in workplaces, restaurants, pubs and in public places. There was a greater reduction in exposure to SHS in hospitality workers compared to the general population. We failed to detect any difference in self-reported exposure to SHS in cars. There was no change in either the prevalence or duration of reported exposure to SHS in the home as a result of implementing legislative bans. Twenty-three studies reported measures of active smoking, often as a co-variable rather than an end-point in itself, with no consistent evidence of a reduction in smoking prevalence attributable to the ban. Total tobacco consumption was reduced in studies where prevalence declined. Twenty-five studies reported health indicators as an outcome. Self-reported respiratory and sensory symptoms were measured in 12 studies, with lung function measured in five of them. There was consistent evidence of a reduction in hospital admissions for cardiac events as well as an improvement in some health indicators after the ban.

AUTHORS' CONCLUSIONS

Introduction of a legislative smoking ban does lead to a reduction in exposure to passive smoking. Hospitality workers experienced a greater reduction in exposure to SHS after implementing the ban compared to the general population. There is limited evidence about the impact on active smoking but the trend is downwards. There is some evidence of an improvement in health outcomes. The strongest evidence is the reduction seen in admissions for acute coronary syndrome. There is an increase in support for and compliance with smoking bans after the legislation.

Are social norms associated with smoking in French university students? A survey report on smoking correlates

Background

Knowledge of the correlates of smoking is a first step to successful prevention interventions. The social norms theory hypothesises that students' smoking behaviour is linked to their perception of norms for use of tobacco. This study was designed to test the theory that smoking is associated with perceived norms, controlling for other correlates of smoking.

Methods

In a pencil-and-paper questionnaire, 721 second-year students in sociology, medicine, foreign language or nursing studies estimated the number of cigarettes usually smoked in a month. 31 additional covariates were included as potential predictors of tobacco use. Multiple imputation was used to deal with missing values among covariates. The strength of the association of each variable with tobacco use was quantified by the inclusion frequencies of the variable in 1000 bootstrap sample backward selections. Being a smoker and the number of cigarettes smoked by smokers were modelled separately.

Results

We retain 8 variables to predict the risk of smoking and 6 to predict the quantities smoked by smokers. The risk of being a smoker is increased by cannabis use, binge drinking, being unsupportive of smoke-free universities, perceived friends' approval of regular smoking, positive perceptions about tobacco, a high perceived prevalence of smoking among friends, reporting not being disturbed by people smoking in the university, and being female. The quantity of cigarettes smoked by smokers is greater for smokers reporting never being disturbed by smoke in the university, unsupportive of smoke-free universities, perceiving that their friends approve of regular smoking, having more negative beliefs about the tobacco industry, being sociology students and being among the older students.

Conclusion

Other substance use, injunctive norms (friends' approval) and descriptive norms (friends' smoking prevalence) are associated with tobacco use.

University-based prevention campaigns should take multiple substance use into account and focus on the norms most likely to have an impact on student smoking.

Socioeconomic correlates of current and regular smoking among college students in Rhode Island

OBJECTIVE

The objective of this study was to determine how sociodemographic variables, in particular socioeconomic status, correlate with current and regular smoking among college students in Rhode Island.

PARTICIPANTS AND METHODS

Over a 4-year period (academic year 2000--2001 to 2003--2004), the authors examined sociodemographic correlates of cigarette use among 3,984 students aged 17 to 24 years from 10 colleges and universities in Rhode Island.

RESULTS

One-third of participants (32.0%) had smoked a cigarette in the 30 days preceding the questionnaire. Findings from a pair of logistic regression models indicated that participants from upper-income families were more likely to be current smokers--although not regular smokers--suggesting that the effect of socioeconomic status on smoking is partly dependent on the level of addiction. In addition, freshmen were more likely to be current and regular smokers than were upperclassmen, and white students were most likely to be regular smokers.

CONCLUSIONS

The frequency of college students who reported that they first tried smoking and first smoked regularly while in college increased from freshman to senior year, indicating that the college years are a vulnerable period for smoking initiation and habituation.

Development of a Web-based questionnaire to collect exposure and symptom data in children and adolescents with asthma

BACKGROUND

Questionnaires are an important component of epidemiologic studies. Maintaining compliance in longitudinal studies is a challenge, particularly from children and adolescents.

OBJECTIVE

To implement a Web-based questionnaire for children and adolescents with asthma for daily self-completion, minimizing recall bias and maximizing compliance.

METHODS

We determined symptoms, exposure to asthma triggers, peak expiratory flow rate, and medications taken, including dose and dose time. The Web-based system can be less time-consuming and a source of fewer errors than paper questionnaires and permits review of the data and compliance during the study. The Web programming of the questionnaire included branching, so that questions deemed irrelevant based on a previous response were not presented to participants, minimizing the completion time.

RESULTS

Sixty-four students with asthma participated nearly daily for between 2 and 4 months. Financial incentives for the participants were calculated in real time based on completion rates. Monitoring of the subject's completion included an extensive administrative hierarchical alert system, enabling the staff to target individuals who fell behind in entries and needed the most encouragement.

CONCLUSIONS

Similar compliance and completion rates were obtained using the Web-based questionnaire as reported for smaller paper questionnaires by parents of children. The Web-based system provides a mechanism to obtain daily responses directly from an age group not often accessible by traditional questionnaire approaches.

Preferred smoking policies at 30 Pacific Northwest colleges

OBJECTIVE

Research shows that restrictive smoking policies on college campuses could discourage smoking onset or help facilitate cessation efforts among students. However, many colleges and universities are reluctant to establish restrictive smoking policies for fear of student objections. Our study examined preferred smoking policies among college students in the Pacific Northwest.

METHODS

We conducted a baseline cross-sectional descriptive study of a grouped randomized controlled trial at 30 four-year colleges and universities in Idaho, Oregon, and Washington.

RESULTS

Of the 14,237 students who responded to the survey, 17.3% were smokers. All respondents were knowledgeable about indoor smoking policies; however, there was incongruence regarding outside policies. Some 88% of never smokers wanted a completely smoke-free indoor policy, while a substantial percentage (58%) of smokers concurred (odds ratio [OR]=0.19, p<0.001). Fewer respondents were supportive of outdoor policies (43.3% for never smokers and 6.9% for smokers). Respondents agreed that the desire to breathe clean air should have priority over the desire to smoke; however, smokers agreed to a lesser extent (97.5% for never smokers and 81.5% for smokers [OR=0.012, p<0.001]).

CONCLUSION

Both non-smokers and smokers have high approval rates for restrictive smoking policies on campus. Administrators can use this information to help enact restrictive campus smoking policies.