Smoking behaviours and attitudes towards campus-wide tobacco control policies among staff and students: a cross-sectional survey at the University of Birmingham

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.

University students' and staff attitudes toward the implementation of a "tobacco-free" policy: A view from Qatar

Objectives

Tobacco-free campus policies are needed to create environments conducive to prevention or quitting in the Eastern Mediterranean Region (EMR), where the use of various tobacco products is on the rise among university students. The objectives of this study were to assess overall support for a 100% tobacco-free campus policy and its predictors among different stakeholder groups at the largest national university in Qatar and to understand attitudes towards specific policy components.

Study design

A cross-sectional online survey of faculty and students.

Methods

We measured sociodemographic variables, tobacco use, and support for components of a 100% tobacco-free campus policy. A total score for support was calculated, and associations with selected predictors were assessed using multivariable linear regression.

Results

413 respondents participated in the survey. A majority of faculty/staff and students (76.6% and 75.5%, respectively) supported the implementation of a 100% tobacco-free campus policy, with a majority supporting extension of the policy beyond cigarettes. Support for other components of the policy varied. Among students, overall support was lower among males and tobacco users and higher among the married. Among faculty and staff, support was lower among Qatari nationals and tobacco users.

Conclusion

In the context of a growing tobacco crisis in the EMR, implementing and understanding the impact of tobacco-free campus policies is essential. This paper underscores the importance of addressing diverse stakeholder attitudes and providing empirical evidence to guide policy implementation and evaluation.

Opportunities to Improve Tobacco Control for State Agency Employees

OBJECTIVE

The aim of the study is to explore tobacco-related knowledge and perceptions at Washington State (WA) agencies.

METHODS

The study used a cross-sectional employee survey and qualitative focus groups with managers/supervisors. We produced descriptive statistics to examine differences in awareness and perceptions of tobacco-control efforts among employees and conducted a rapid thematic analysis of focus group data.

RESULTS

Of employees, only 18% with a history of tobacco use had used their agency's cessation benefits. Employees who did not use tobacco and who had higher education had more favorable attitudes toward tobacco-control efforts. In the focus groups, manager/supervisors described limited tobacco cessation promotion at their agency, barriers to tobacco control implementation, and concerns about the perceived effectiveness of additional tobacco-control efforts.

CONCLUSIONS

State agencies should increase promotion of tobacco control policies and programs to increase awareness and reduce disparities in tobacco use.

Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis

Background

Smoke-free policies are essential to protect people against tobacco smoke exposure. To successfully implement smoke-free policies that go beyond enclosed public places and workplaces, public support is important. We undertook a comprehensive systematic review of levels and determinants of public support for indoor (semi-)private and outdoor smoke-free policies.

Methods

In this systematic review and meta-analysis, six electronic databases were searched for studies (published between 1 January 2004 and 19 January 2022) reporting support for (semi-)private and outdoor smoke-free policies in representative samples of at least 400 respondents aged 16 years and above. Two reviewers independently extracted data and assessed risk of bias of individual reports using the Mixed Methods Appraisal Tool. The primary outcome was proportion support for smoke-free policies, grouped according to location covered. Three-level meta-analyses, subgroup analyses and meta-regression were performed.

Findings

14,749 records were screened, of which 107 were included; 42 had low risk of bias and 65 were at moderate risk. 99 studies were included in the meta-analyses, reporting 326 measures of support from 896,016 individuals across 33 different countries. Support was pooled for indoor private areas (e.g., private cars, homes: 73%, 95% confidence interval (CI): 66-79), indoor semi-private areas (e.g., multi-unit housing: 70%, 95% CI: 48-86), outdoor hospitality areas (e.g., café and restaurant terraces: 50%, 95% CI: 43-56), outdoor non-hospitality areas (e.g., school grounds, playgrounds, parks, beaches: 69%, 95% CI: 64-73), outdoor semi-private areas (e.g., shared gardens: 67%, 95% CI: 53-79) and outdoor private areas (e.g., private balconies: 41%, 95% CI: 18-69). Subcategories showed highest support for smoke-free cars with children (86%, 95% CI: 81-89), playgrounds (80%, 95% CI: 74-86) and school grounds (76%, 95% CI: 69-83). Non-smokers and ex-smokers were more in favour of smoke-free policies compared to smokers. Support generally increased over time, and following implementation of each smoke-free policy.

Interpretation

Our findings suggested that public support for novel smoke-free policies is high, especially in places frequented by children. Governments should be reassured about public support for implementation of novel smoke-free policies.

Funding

Dutch Heart Foundation, Lung Foundation Netherlands, Dutch Cancer Society, Dutch Diabetes Research Foundation and Netherlands Thrombosis Foundation.

Health behavior and health needs of first-year medical and health sciences students

Objective: The aim of this study is to evaluate the health behavior and health needs of medical and health sciences students in order to identify areas that need intervention. Materials and Methods: This descriptive study was conducted with 770 first-year university students. The data were collected with a sociodemographic questionnaire, the Youth Risk Behavior Survey and the Eating Attitudes Test. Body mass index was calculated. Results: Although, only 12.7% of the students were overweight or obese, 25.6% of the students perceived themselves to be overweight or obese. The students said that in the last week, 20.9% had breakfast 1 or 3 times, 5.7% ate no fruits at all, and 11.6% ate no vegetables at all. 48.1% of the students did not engage in any physical activity, and 83.2% spent more than 2 hours inactively in front of a screen. It was observed that 22.3% were current smokers. A propensity for eating behaviors disorder was found in 9.0%. Drinking energyboosting sports drinks 1-6 times in the last week (β: 3.286), smoking (β: 1.875) and eating few vegetable dishes in the last week (β: 0.484) were identified as factors that could be associated with a “tendency for eating behavior disorder.” Conclusion: We can conclude that nutritional issues, negative body weight perception, use of tobacco, and sedentary lifestyle are the main intervention and counselling areas for our study group.

Changes in tobacco and e-cigarette consumption in Spanish university students during the COVID-19 lockdown: Identification of vulnerable groups

INTRODUCTION

The objective of this study was to determine the changes in tobacco consumption in Spanish university students during the lockdown in 2020, and to identify vulnerable groups based on gender, age, and living situation.

METHODS

This was a cross-sectional descriptive study. From a sample of 1540 Spanish university students, 19.9% (n=306; 77.6% women; mean age=30.9 years; SD=8.3) reported having consumed tobacco. The frequency and average daily consumption of cigarettes and electronic nicotine delivery systems (ENDS) before the pandemic and during lockdown were analyzed.

RESULTS

A total of 97.1% of students consumed only cigarettes, 2.9% only ENDS, and 3.3% were dual consumers. During lockdown, cigarette consumption was significantly reduced (5.3 before; 4.0 during; t₍₇₁₎=3.6255; p<0.001) in the youngest group (aged 18-24 years). However, women daily users significantly increased their consumption (t₍₁₄₉₎= -2.5461; p<0.05) and so did the 35-44 years age group (t₍₃₂₎= -2.2285; p<0.05). Cigarette consumption significantly increased in those who were living alone (5.6 to 7.2; Z= -2.351; p<0.05) and with a partner (7.2 to 8.0; t₍₉₇₎= -2.3771; p<0.05), but decreased in those who were living with their parents or other relatives (6.2 to 4.5; t₍₁₀₁₎=3.4298; p<0.001). A total of 17.0% ceased consumption during lockdown, mainly women, younger students (aged 18-24 years), and those who lived with their parents. None of the people who used cigarettes daily during the pre-pandemic period stopped smoking during lockdown.

CONCLUSIONS

Younger university students and those living with their parents decreased their tobacco use during the lockdown. Potentially vulnerable groups at risk of increasing their consumption were women who consumed tobacco daily before the pandemic and students aged 35-44 years who lived alone or with their partner.

Korean college students’ attitudes toward a tobacco-free campus: a cross-sectional descriptive study

Purpose: A tobacco-free campus (TFC) is the most advanced tobacco-control policy for college campuses, but it has rarely been explored in Korea. This study aimed to explore Korean college students’ attitudes toward TFC and related factors.Methods: This cross-sectional descriptive study enrolled college students who were taking an elective course on smoking cessation and a healthy lifestyle at a university located in Incheon, Korea. Data were collected from March 1 to December 31, 2019 using a structured questionnaire, and study participants were recruited using convenience sampling.Results: Data on 309 college students were analyzed. Of those participants, 6.1% supported the TFC policy. Multiple logistic regression analysis showed that female gender (adjusted odds ratio [aOR]=5.80, 95% confidence interval [CI]=1.47-22.95), taking the course to quit smoking oneself (aOR=11.03, 95% CI=1.04-117.05), anxiety in the past month (aOR=4.27, 95% CI=1.06-17.31), and being a current smoker (aOR=0.06, 95% CI=0.01-0.70) were statistically significant independent predictors of TFC support.Conclusion: Women, students taking the course to quit smoking themselves, nonsmokers, and students who felt anxious in the past month were more likely to support TFC. Further research with more representative samples is required to examine the characteristics of people who favor TFC.

Comparison and determination of factors associated with smoking status, smoking knowledge, attitude and practice (S-KAP) between smoke-free and non-smoke-free campuses in public universities in Malaysia: a cross-sectional study

OBJECTIVES

We compared the smoking prevalence, smoking knowledge, attitudes and practices (S-KAP) between smoke-free campuses (SFCs) and non-SFCs (NSFCs) and determined the associated factors of smoking status and S-KAP.

DESIGN

Cross-sectional study.

SETTINGS

The research was conducted in four public universities in Malaysia; two SFCs and two NSFCs.

PARTICIPANTS

Students and staff from SFCs (n=1063) and NSFCs (n=1040).

MAIN OUTCOME MEASURES

Compared the smoking prevalence, S-KAP between SFCs and NSFCs and determined the associated factors.

RESULTS

The prevalence of smokers among the SFC and NSFC respondents was 5.2% and 6.7%, respectively. University type and smoking attitude were significantly related (p=0.02). At the SFCs, the factors associated with becoming a smoker were male gender (p<0.001), monthly income ≥RM3000 (p=0.02), positive smoking attitude (p=0.003) and positive smoking practice (p<0.001); at NSFCs, the associated factors were male gender (p<0.001), low smoking knowledge (p=0.004), positive smoking attitude (p=0.001) and practice (p<0.001). The factors associated with good smoking knowledge were female gender (SFCs: p=0.001; NSFCs: p=0.004), and monthly income ≥RM3000 (NSFCs: p=0.02). Male respondents were likely to have positive smoking attitudes (SFCs: p<0.001; NSFCs: p<0.001) and negative smoking practices (SFCs: p<0.001; NSFCs: p<0.001).

CONCLUSION

Overall, smoking prevalence, knowledge and practice were not much different between SFCs and NSFCs. However, there was a significant relationship between university type and smoking attitude due to the existence of the SFC policy likely rendering smoking a less acceptable social norm. Continual education programmes on smoking harms and smoking cessation strategies are highly recommended to aid the SFC policy in preventing secondhand smoke in universities.

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.

Assessing how a tobacco-free campus leads to attitude change and support among students, faculty, and staff

INTRODUCTION

Universities are increasingly considering tobacco-free campus policies to help promote a healthy learning and working environment. We assessed attitudes of students, faculty, and staff, before and after the implementation of a tobacco-free campus policy at a large, urban university. We also examined individual factors associated with these attitudes.

METHODS

An independent panel design method was used to assess students, faculty and staff about their tobacco product use, attitudes towards tobacco policies, and support for cigarette and e-cigarette bans 3 months before and 7 months after a university-wide policy change to ban tobacco and e-cigarettes on campus. Survey participants before the policy change included 636 students and 1356 faculty/ staff. Survey participants after the policy change included 1000 students and 574 faculty/staff. We conducted separate multiple linear and logistic regression models for students and faculty/staff.

RESULTS

Attitudes towards tobacco-free campus policies did not improve for students, but did for faculty/staff. Support for bans of cigarettes and e-cigarettes on campus increased following the policy change among both students and faculty/staff. Students were more willing to ask their friends to stop vaping post-policy, but did not differ in their willingness to ask friends to stop smoking. Among the individual factors considered, gender and use of cigarettes and e-cigarettes were predictive of attitudes among both students and faculty/staff. Women were more likely to support and have more positive attitudes towards bans, while current tobacco product users were less likely to support tobacco product bans and have less positive attitudes towards tobacco policies.

CONCLUSIONS

Attitudes towards tobacco-free campus policies changed pre- to postpolicy among faculty/staff, but not among students. However, both students and faculty/staff were more supportive of tobacco product bans following the policy change. Individual factors associated with support and attitudes were identified.

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.

Evaluating a tobacco-free university policy: A repeated cross-sectional survey of faculty and staff in Lebanon

INTRODUCTION

A growing body of research has evaluated the effect of university tobacco-free policies on faculty and staff, however, none of these studies has been carried out in the Eastern Mediterranean Region. This study evaluates changes in faculty and staff attitudes, perceptions and smoking behavior, at 1 year post adoption of a tobacco-free policy in a medium-sized university in Lebanon and the region.

METHODS

Two cross-sectional surveys were conducted in 2017 and 2018: baseline and at 1 year post policy implementation. A random sample of 625 and 624 participants took part in the 2017 and 2018 studies, respectively.

RESULTS

Faculty and staff had a positive attitude towards the policy at the two time points. The belief that there should be exceptions to the policy significantly decreased from 79% to 59% (p=0.002) among all smokers, particularly those with lower educational attainment (81% to 57%, p=0.007). Perception of compliance among peer smokers increased from 73% to 87% (p=0.009). The proportion of smokers did not significantly change at 1 year post policy implementation, however, 44% of smokers with lower educational attainment, compared to only 7% of those with higher educational attainment (p<0.001), reported a decrease in their smoking behavior outside campus.

CONCLUSIONS

The policy had a positive effect on the attitude, behavior and perception of policy benefits among smokers with lower educational attainment, who constitute the majority of smokers. Findings from this study inform and support future efforts to develop university and workplace tobacco-free policies.

Prevalence and predictors of smoking, quit attempts and total smoking ban at the University of Turku, Finland

OBJECTIVES

The current study employed socio-demographic, health and lifestyle, and academic variables to assess the prevalence and independent predictors of daily smoking, attempts to quit smoking, and agreement with total smoking ban at university.

METHODS

Students at the University of Turku (1,177) completed an online questionnaire that assessed socio-demographic, health and lifestyle, and academic characteristics, and three smoking variables (smoking, attempts to quit, agreement with total smoking ban at university). Bivariate relationships and multiple logistic regression assessed relationships between student characteristics and the three smoking variables before and after controlling for all other variables.

RESULTS

Slightly < 80% of students never smoked, 16% were occasional, and about 6% were daily smokers, and about 40% had attempted to quit. Nearly half the sample agreed to total smoking ban at university. Physical activity, consuming alcohol, illicit drug/s use and daily smoking were significant independent predictors across > 1 of the three smoking variables. Age, health awareness, importance of achieving good grades, academic performance compared to peers, study burden, and mother's educational level were significant independent predictors of one of the three variables examined.

CONCLUSION

Universities need to assess smoking, with specific focus on the modifiable independent predictors that were associated with > 1 the variables examined, to encourage physical activity and pay attention to reduce alcohol consumption and illicit drug/s and daily smoking, whilst targeting at-risk students. University strategies should be part of the wider country-wide effective tobacco control policies.

Becoming a tobacco-free campus: A survey of student attitudes, opinions and behaviors

INTRODUCTION

The effectiveness of tobacco-free campus policies in preventing and mitigating tobacco use relies on students’ perceptions, opinions, and adherence to clean-air restrictions. The purpose of this study was to gather data regarding student attitudes, opinions and tobacco use behaviors, one year following implementation of the tobacco-free campus initiative.

METHODS

Data were gathered using an anonymous, online survey of graduate and undergraduate students at a public university, one year following implementation of a tobacco-free campus policy. Survey items included tobacco use behaviors, nicotine dependence, opinions towards the policy, challenges in policy adherence among tobacco users, and awareness of tobacco cessation resources for students. Analysis primarily included descriptive statistics.

RESULTS

Of 108 respondents, only 18 were habitual tobacco users with most using: cigarettes, cigars or cigarillos (38%), vaping (17.8%), hookah (11.9%), and smokeless tobacco (11.9%). Several reported multiple use. Common motives for tobacco use were relaxation and mood regulation. Tobacco users rated a moderate level of difficulty in adhering to the policy. Only half of the total respondents were aware of cessation resources, specifically peer counseling. Most tobacco users (71%) believed that they could quit without assistance.

CONCLUSIONS

Preliminary data show 21.8% prevalence of tobacco use within the sample. Information on student opinions and behaviors, including lower risk perception, dual use, and lack of awareness of cessation resources can inform more effective prevention and mitigation strategies, in addition to the tobaccofree campus policy. Further research is needed to monitor policy adherence and changes in student tobacco behaviors.