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.

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 check attendance association with health and study-related factors: a register-based cohort study of Finnish university entrants

Background

General health checks are an established component of preventive health care in many countries. Declining participation rates have raised concerns in health care providers. Understanding the reasons for attendance and non-attendance is necessary to improve the preventive health care system. The aim of this study was to examine health- and study-related factors associated with university entrants’ health check attendance.

Methods

Since 2009, an electronic health questionnaire (eHQ) has been conducted yearly to all Finnish university entrants by the Finnish Student Health Service (FSHS) to screen students for a general health check. The questionnaire comprises 26 questions about health, health habits and studying. The study population consisted of the 3346 entrants from the 2011–2012 academic year who were referred to a health check based on their eHQ responses. The eHQ data were linked with health check attendance information. Multivariable logistic regression was used to study the associations between the questionnaire responses and non-attendance of the health check.

Results

Male sex (OR 1.6, 95% CI % 1.4–1.9) and low engagement with studies (OR 1.5, 95% CI 1.2–2.0) were the variables most strongly associated with non-attendance. Having low state of mind was negatively associated with health check non-attendance thus enhanced the health-check attendance (OR 0.6, 95% CI 0.5–0.8).

Conclusions

The results suggest that providing health checks in student health care may serve as a way of reaching students with health concerns. However, motivating males and smokers to attend general health checks continue to be a challenge also in a university student population. That low engagement with studies associates with health check non-attendance points to need to improve collaboration between universities and student health care.

Supplementary information

The online version contains supplementary material available at https://doi.org/10.1265/ehpm.22-00032.

Health-Promoting Behavior and Lifestyle Characteristics of Students as a Function of Sex and Academic Level

University students frequently engage in unhealthy behaviors. However, there is a lack of studies examining a wide range of their lifestyle characteristics by sex and academic level of study. This cross-sectional survey of students enrolled in BSc, MSc, or PhD programs at one university in Germany (N = 3389) assessed physical activity (PA), sedentary behavior (SB), nutrition, sleep quality, and alcohol, tobacco, and other drug (ATOD) use by sex and academic level and was conducted with EvaSys version 8.0. Chi-squared tests compared categorical variables by sex, and binary logistic regression analyses adjusted for sex with Bonferroni adjustments evaluated differences across academic level. Although 91% of students achieved the aerobic PA guidelines, only 30% achieved the muscle strengthening exercises (MSE) guidelines, and 44% had high SB. Likewise, <10% met the fruit and vegetable consumption (FVC) recommendations, >40% of students experienced impaired sleep, and >30% had hazardous alcohol consumption. Less than 20% of the sample achieved the guideline/recommendation of all three PA, MSE and SB. Some behaviors exhibited significant sex and academic level differences. The identified at-risk groups included males (lower FVC), females (eating more during stress), and BSc students (poorer nutrition/sleep quality, more ATOD use). Given the above findings, multipronged strategies are needed with an overarching focus highlighting the health−academic achievement links. Behavioral interventions and environmental policies are required to raise awareness and promote student health.

Multi-Substance Use Behaviors: Prevalence and Correlates of Alcohol, Tobacco and Other Drug (ATOD) Use among University Students in Finland

Virtually no studies appraised the co-use of alcohol, tobacco, and other drug (ATOD) among Finn undergraduates. We assessed the associations between sociodemographic, health, academic, policy, and lifestyle characteristics (independent variables); and individual, multiple and increasing ATOD use (dependent variables) using regression analyses. Data were collected by online questionnaire at the University of Turku, Finland (1177 students). Roughly 22% of the sample smoked, 21% ever used illicit drug/s, 41% were high frequency drinkers, and 31.4%, 16.3%, and 6.7% reported 1, 2, or 3 ATOD behaviors respectively. Individual ATOD use was significantly positively associated with the use of the other two substances [adjusted odds ratio (Adj OR range 1.893-3.311)]. Multiple ATOD use was negatively associated with being single (p = 0.021) or agreeing with total smoking or alcohol ban policy on campus (p < 0.0001 for each); but positively associated with not living with parents (p = 0.004). Increasing ATOD behaviors were significantly less likely among those agreeing with total smoking or alcohol ban policy on campus (p range 0.024 to <0.0001). Demographics significant to either individual, multiple, or increasing ATOD use included males, being single, not living with their parents during semesters, and to some extent, religiosity. Age, depressive symptoms, perceived stress, self-rated health, health awareness, income sufficiency, and academic variables were not associated with individual, multiple, or increasing ATOD use. Education and prevention efforts need to reinforce abstinence from ATOD, highlight their harmful outcomes, and target risk groups highlighted above. University strategies should be part of the wider country-wide successful ATOD control 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.

Prevalence and Socio-Demographic, Academic, Health and Lifestyle Predictors of Illicit Drug/s Use among University Undergraduate Students in Finland

Illicit drug/s use (IDU) among university students is a public health concern. We assessed the associations between socio-demographic, academic, and health and lifestyle characteristics (independent variables) and regular, occasional or never IDU (dependent variables). Data were collected across seven faculties (1177 students) at the University of Turku (Finland) via an online questionnaire. About 1.5% of the sample had regular IDU, 19% occasional IDU, and 79% never IDU. Independent predictors of ever (lifetime) IDU included males [adjusted odds ratio (AOR) 1.82, P = 0.001], not living with parents (AOR 2.59, P < 0.001), singles (AOR 0.51, P < 0.001), lower religiosity (AOR 1.49, P = 0.022), better self-rated general health (AOR 0.41, P = 0.003), higher health awareness (AOR 1.93, P = 0.014), more depressive symptoms (AOR 1.82, P = 0.004), daily smokers (AOR 3.69, P < 0.001), heavy episodic drinking (AOR 2.38, P < 0.001) and possible alcohol dependency (AOR 2.55, P < 0.001). We observed no independent associations between ever IDU with age, study discipline, perceived stress or academic performance. The 20.5% ever IDU is concerning. The compelling independent predictors of ever IDU included not living with parents, lower religiosity, daily smokers, heavy episodic drinking and possible alcohol dependency (AOR range 2.38-3.69). Education and prevention need to emphasize the negative consequences to reinforce abstinence from IDU. Health promotion could focus on beliefs and expectations about IDU and target students at risk for successful efforts.

Eating Behaviours of British University Students: A Cluster Analysis on a Neglected Issue

Unhealthy diet is a primary risk factor for noncommunicable diseases. University student populations are known to engage in health risking lifestyle behaviours including risky eating behaviours. The purpose of this study was to examine eating behaviour patterns in a population of British university students using a two-step cluster analysis. Consumption prevalence of snack, convenience, and fast foods in addition to fruit and vegetables was measured using a self-report “Student Eating Behaviours” questionnaire on 345 undergraduate university students. Four clusters were identified: “risky eating behaviours,” “mixed eating behaviours,” “moderate eating behaviours,” and “favourable eating behaviours.” Nineteen percent of students were categorised as having “favourable eating behaviours” whilst just under a third of students were categorised within the two most risky clusters. Riskier eating behaviour patterns were associated with living on campus and Christian faith. The findings of this study highlight the importance of university microenvironments on eating behaviours in university student populations. Religion as a mediator of eating behaviours is a novel finding.

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.

Predictors of illicit drug/s use among university students in Northern Ireland, Wales and England

INTRODUCTION

The use of illicit drug/s among university students is a public health concern. Nevertheless, many UK studies investigated a narrow spectrum of variables to explore their association/s with illicit drug/s use.

METHODS

We assessed the associations between a wide range of socio-demographic, health and wellbeing variables (independent variables) and having used illicit drug/s regularly, occasionally or never in life (dependent variables). Data (3706 students) were collected from seven universities in England, Wales, and Northern Ireland, using a self-administered questionnaire.

RESULTS

About 5% of the sample had regularly used illicit drug/s, 25% occasionally, and 70% never. Regular drug use (RDU) was significantly more likely among males aged 21-29 years, daily smokers, those with heavy episodic drinking or possible alcohol dependency (CAGE test), and those who perceived their academic performance better than their peers. RDU was less likely among students with high health awareness and those living with parents. The predictors of occasional drug use (ODU) were similar to those of RDU. However, in addition, students with higher perceived stress were less likely, and students who felt financial burden/s were more likely to report ODU, while no association with academic performance was found. Never use of illicit drug/s was inversely associated with most of the variables listed above, and was positively associated with religiosity. Illicit drug/s use goes along with other substance use (alcohol and smoking). The finding that illicit drug/s use was higher among students reporting good academic performance was surprising and raises the question of whether illicit drug/s may be used as performance enhancing drugs.

CONCLUSION

The factors identified with illicit drug/s use in this study could be utilized to develop appropriate public health policies and preventive measures for the health of students. Multilevel, value based, comprehensive, and strategic long-term intervention plans are required. This could include social interventions aimed at generating recreations alternatives and opportunities for youth, and a critical review for current authorities' interventions and services. Suggestions for coping with problems of campus illicit drug use/abuse also need to be offered.

Food and mental health: relationship between food and perceived stress and depressive symptoms among university students in the United Kingdom

AIMS

The current study assessed, by university and sex, the association between nutritional behaviour (twelve independent variables), and stress and depressive symptoms (dependent variables) in a sample from three UK countries.

METHODS

A cross-sectional survey was undertaken among undergraduates enrolled across seven universities in England, Wales and Northern Ireland (N = 3,706). Self-administered questionnaires included a 12-item food frequency questionnaire, Cohen's Perceived Stress Scale and modified Beck Depression Inventory. Sex and university comparisons were undertaken. Univariable and multivariable regression analyses were computed for each of the two outcomes--perceived stress and depressive symptoms.

RESULTS

The frequencies of consuming of the various food groups differed by university and sex, as did depressive symptoms and perceived stress. Multivariable regression analyses indicated that consuming 'unhealthy' foods (e.g. sweets, cookies, snacks, fast food) was significantly positively associated with perceived stress (females only) and depressive symptoms (both males and females). Conversely, consuming 'healthy' foods (e.g. fresh fruits, salads, cooked vegetables) was significantly negatively associated with perceived stress and depressive symptoms scores for both sexes. There was significant negative association between consuming fish/sea food and depressive symptoms among males only. For males and for females, consuming lemonade/soft drinks, meat/sausage products, dairy/dairy products, and cereal/cereal products were not associated with either perceived stress or depressive symptoms.

CONCLUSIONS

The associations between consuming 'unhealthy' foods and higher depressive symptoms and perceived stress among male and female students as well as the associations between consuming 'healthy' foods and lower depressive symptoms and perceived stress among male and female students in three UK countries suggest that interventions to reduce depressive symptoms and stress among students could also result in the consumption of healthier foods and/or vice versa.

Are students' symptoms and health complaints associated with perceived stress at university? Perspectives from the United Kingdom and Egypt

This cross-sectional survey assessed and compared by country, the levels and correlates of 21 self-reported symptoms/health complaints. We examined the associations between self-reported symptoms and perceived stress. Data was collected from universities in the United Kingdom and Egypt (N = 3706 and 3271 undergraduates, respectively). A self-administered questionnaire assessed a range of self-reported symptoms, perceived stress, sociodemographic (gender, age, marital status, year of study, living arrangements during semester, income sufficiency), lifestyle (tobacco smoking, illicit drug/s use, alcohol consumption frequency), and health variables (subjective health status, health awareness, BMI), along with religiosity, and quality of life. Factor analysis categorized the 21 self-reported symptoms into four components. Correlation analysis and linear regression tested the associations between the self-reported symptoms and stress. Factor analysis of the health symptoms generated four symptom groups for each of the UK and Egypt (psychological; circulatory/breathing; gastrointestinal; and, pains/aches), and factor loadings were quite similar for both countries. Whilst the two samples showed similarities as to the kind of symptoms most frequently reported by students, the Egyptian sample had significantly higher frequency than the UK for every symptom. Frequent complaints (both countries) included difficulties to concentrate, fatigue, headaches, nervousness/anxiety, and back pain (UK) and mood swings (Egypt). Significantly more Egyptian students reported ≥4 symptoms over the past year than the UK. For each of the UK and Egypt, across each of the four symptom groups, there was a stepladder appearance whereby the frequency of symptoms increased with increasing quartiles of perceived stress. Not controlling for other variables, for both countries, there were significant positive correlations between each of the four symptom groups and stress; the highest correlation was for psychological symptoms. After controlling for sex, age country, and other symptom groups, stress was highly and significantly associated with psychological symptoms and also with pain & aches symptoms in both countries. UK students were generally less stressed than their counterparts in Egypt. Age and female gender were also associated with stress; the younger the student was the more likely to suffer from stress. Interactions were not significant. Across both countries, the levels of stress among students and the associations between perceived stress and health complaints suggest the need for a multiple approaches in order to understand the sources of stress; how college students experience stress; and, the coping mechanisms that different students employ to mitigate stress. Interventions aimed at both preventing, treating and caring for students’ distress, and also preventive strategies to help minimize the impact of stressful situations are required. Strategies that address both physical and psychological complaints may be beneficial for this population.

Socio-demographic correlates of six indicators of alcohol consumption: survey findings of students across seven universities in England, Wales and Northern Ireland

Background

This study assessed the prevalence of six alcohol consumption indicators in a sample of university students. We also examined whether students’ sociodemographic and educational characteristics were associated with any of the six alcohol consumption indicators; and whether associations between students’ sociodemographic and educational characteristics and the six alcohol consumption indicators differed by gender.

Methods

A cross-sectional study of 3706 students enrolled at 7 universities in England, Wales and Northern Ireland. A self-administered questionnaire assessed six alcohol consumption measures: length of time of last (most recent) drinking occasion; amount consumed during last drinking occasion; frequency of alcohol consumption; heavy episodic drinking (≥ 5 drinks in a row); problem drinking; and possible alcohol dependence as measured by CAGE. The questionnaire also collected information on seven relevant student sociodemographic characteristics (age, gender, academic year of study, current living circumstances - accommodation with parents, whether student was in intimate relationship, socioeconomic status of parents - parental education, income sufficiency) and two academic achievement variables (importance of achieving good grades at university, and one’s academic performance in comparison with one’s peers).

Results

The majority of students (65% of females, 76% of males) reported heavy episodic drinking at least once within the last 2 weeks, and problem drinking was prevalent in 20% of females and 29% of males. Factors consistently positively associated with all six indicators of alcohol consumption were male gender and perceived insufficient income. Other factors such as living away from home, being in 1^st or 2^nd year of studies, having no intimate partner, and lower academic achievement were associated with some, but not all indicators of alcohol consumption.

Conclusions

The high level of alcohol consumption calls for regular/periodic monitoring of student use of alcohol, and for urgent preventive actions and intervention programmes at the universities in the UK.