School and Community Factors Associated With the Adoption of 100% Smoke-free Policy by California Community Colleges, 2003-2019.

Abstract

Smoke- and tobacco-free policy (SFP) is an effective strategy that can reduce tobacco-related health disparities among young adults. Longitudinal design using administrative, survey, policy data sources, and geocoded tobacco outlet and American Community Survey data. California community colleges (CC) and cities/communities where colleges are located, 2003-2019. 114 California CCs. School-level (i.e., student population and demographics) and community-level data (socio-demographics, local tobacco control policy, tobacco-related norms and availability, and health resources) from 2003 to 2019. Key outcome is the year CC adopted a 100% SFP. Bivariate and multivariate Cox survival models were used to analyze timing of SFP adoption. By 2019, 61 out of 114 (53.5%) CCs were 100% SFP. While community smoking prevalence and tobacco availability were not significant, CCs in rural areas were less likely to be smoke-free. CCs located in cities with stronger tobacco policies (hazard ratio (HR) = 1.08, P < .05), which reported higher student health fees (HR = 2.00, P < .05) and received technical assistance for SFP (HR = 4.59, P < .01) were significantly associated with having 100% SFP. Findings suggest that key community factors (strong city tobacco policies) and school and community resources (student health fees, SFP technical assistance) are associated with the presence of 100% SFP at CCs. Resources from the community or within a college might support remaining CCs in becoming 100% smoke-free.