Tobacco-free Campus Research Articles

Smoke-free and tobacco-free colleges and universities in the United States

ObjectiveTo describe the number and proportion of accredited, degree-granting institutions with 100% smoke-free and 100% tobacco-free protections across the USA and by state.MethodsData on postsecondary education institutions from the US...

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

BackgroundTobacco control policies have potential to be an effective strategy for the reduction of smoking prevalence and secondhand smoke (SHS) exposure in tertiary educational settings worldwide. The aims of this study were to collect baseline data among staff and students, to measure smoking behaviours and attitudes towards introduction of campus-wide tobacco control policies within a UK higher education setting.MethodsCross-sectional study using data collected by web-based questionnaire administered to employed staff and enrolled students (undergraduate/postgraduate) at the University of Birmingham from May 2016 to April 2017. Information was obtained regarding demographic characteristics, tobacco usage patterns and attitudes towards a revised campus tobacco control policy using a 21-item survey tool. Logistic regression analyses were used to explore associations between participant characteristics and support for smoke-free or tobacco-free campus policy options, evaluated by crude and adjusted Odds Radios (OR) after controlling for confounding factors (significance level: P < 0.05).ResultsA total of 934 survey responses were received, of whom 780 participants provided complete information on staff or student status and were included in the present analysis. Current smoking prevalence was 14% (N = 109; 95% confidence interval (CI) 11.6–16.6). Overall, 66.3% (95% CI: 62.9–69.7) of participants supported a smoke-free campus; 68.5% (95% CI: 65.2–71.8) endorsed restrictions for tobacco sales and just under half of respondents (47.3%; 95% CI: 43.8–50.9) supported a ban for electronic cigarettes/vaping device use on campus. Smoking status was an independent predictor of support for tobacco control, with the lowest level of support for a smoke-free campus among daily (adjusted OR 0.02; 95% CI: 0.01–0.05) and intermittent smokers (adjusted OR 0.06; 95% CI: 0.02–0.16).ConclusionsOverall, the majority of staff and students participating in this baseline survey supported implementation of a smoke-free or comprehensive tobacco-free campus policy. These findings may inform the development and future implementation of a revised tobacco control policy at the university which reflects contemporary attitudes and considers a broad range of implementation issues, including behaviour change and environmental adaptations.

Student Tobacco Use Behaviors on College Campuses by Strength of Tobacco Campus Policies.

To examine the association between strength of policy and self-reported tobacco use behavior, controlling for demographic characteristics, polytobacco use, knowledge of campus tobacco policy, and perceived policy compliance by others. Cross-sectional, online survey. Ten participating State University of New York (SUNY) campuses; 5 with designated smoking/tobacco use areas and 5 with 100% tobacco-free policies. Convenience sample of students from SUNY campuses: only tobacco users (N = 576 students) included for analysis. Items assessing tobacco use behaviors on campus, policy knowledge, and observation of others using tobacco on campus. T tests and chi-square tests of association used to compare responses between tobacco users across campuses. Generalized estimating equations modeling used to evaluate predictors of tobacco use on campus; model estimated with students nested within campus. Those on campuses without a comprehensive policy were more likely to report (in the past week) having seen others smoke on campus (98% vs 69%, P < .001), having personally smoked on campus (65% vs 36%, P < .001), and seeing others use tobacco products on campus (88% vs 67%, P < .001), compared to those on tobacco-free campuses. Tobacco-free campus policies provide numerous protective factors for tobacco users and nonusers. However, compliance strategies are imperative for intended policy success.

A multimodal assessment of tobacco use on a university campus and support for adopting a comprehensive tobacco-free policy

Many college campuses now prohibit tobacco use. At a private U.S. university, the current study assessed cigarette and e-cigarette use and characterized the climate for adopting a comprehensive tobacco-free policy. Data were gathered January–August 2018 via an: environmental scan; cigarette-urn audit; and representative surveys with campus community members. Despite low prevalence of tobacco (0.5%–8%) and e-cigarette use (0.9%–6%) among all groups, campus cigarette clean-up costs exceeded $114,000 for an estimated >1 million butts left on campus annually. A majority of respondents (63% of N = 2218) favored a campus-wide tobacco-free policy, 16% opposed, and 21% abstained. Most respondents endorsed benefits of supporting health (93%), ensuring tobacco-free air to breathe (92%), reducing litter (88%), preventing tobacco use (84%) and fires (83%), and helping tobacco users quit (65%). Identified challenges included policy enforcement (69%) and stigmatization of smoking (57%); 30% viewed a policy as compromising personal freedoms. In a model explaining 35% of variance in policy support, those more likely to favor comprehensive tobacco-free campus policy were Asian respondents; diagnosed with asthma; exposed to secondhand smoke on campus; who viewed campus cigarette butt litter as problematic; and identified health, prevention, and cessation benefits of a tobacco-free campus. Those less likely in favor were students, those who smoke, and those perceiving impingement upon personal freedoms, stigmatization, and broader (slippery slope) implications. Findings indicate low tobacco use prevalence among the campus community, yet a large volume of butt litter and high tobacco clean-up costs. Predictors of policy support can inform campus outreach efforts.

How do colleges communicate about E-cigarettes? The presentation of risk, policy, and cessation resources on college websites

Objectives We examine colleges’ current practices for communicating about e-cigarettes in terms of risk, campus policy, and cessation resources based on the American College Health Association (ACHA)’s and other tobacco-free campus policy guidelines. Methods: Websites of 581 universities prohibiting e-cigarette use on campus were analyzed. The relationship between the presence of e-cigarette information and campus characteristics was examined. Results: There was a lack of e-cigarette risk information. Health and other risks of e-cigarette use were rarely or never mentioned. One fifth did not specify e-cigarettes to be prohibited. While many colleges were promoting the health benefit of a tobacco-free policy, the financial/professional benefits were rarely mentioned. Less than half mentioned on-campus tobacco cessation resources and less than one third listed off-campus resources. A few campus characteristics (e.g., the U.S. census region of campus, campus housing, funding type) were associated with presence of e-cigarette information on websites. Conclusion: Our findings suggest the need for colleges to make e-cigarette risk, policy, and cessation information more accessible via official college websites for students and other campus members. This may increase students’ support for vape-free policy and assist successful adoption of complete tobacco-free policies on campus.

Student Attitudes Toward Tobacco Use and Tobacco Policies on College Campuses.

We utilized a mixed methods approach to assess student attitudes towards tobacco use and campus tobacco policies. Interviews (N = 21), focus groups (N = 2 groups, 4-5 participants each), and an online survey (N = 636) were conducted among a sample of students attending a 4-year, urban, public university in the Mid-Atlantic region of the United States. In interviews and focus groups, students expressed skepticism about a tobacco-free campus policy due to perceived violations of personal rights and challenges with enforcement. Of the sample surveyed, 9.2% and 20.6% had used cigarettes or e-cigarettes within the past 30days. The majority of students agreed that colleges have a responsibility to adopt tobacco-free policies that reduce the risk of tobacco addiction (62.4%) and ensure smoke-free air to breathe (81.5%). However, more than half (56.3%) also indicated that a policy allowing for designated smoking areas for cigarettes was best for campus, which runs counter to a comprehensive tobacco-free policy. Academic year, gender, and race/ethnicity were significant factors associated with support for tobacco-free policies. Current smokers and vapers were less likely to support tobacco-free policies that reduce the risk of tobacco addiction (OR = 0.3, 95% CI 0.1, 0.7 for smokers; OR = 0.3, 95% CI 0.1, 0.6 for vapers), but not policies that ensure smoke-free air to breathe. E-cigarettes pose a unique obstacle to tobacco-free policies, as students perceived e-cigarettes to be less harmful than cigarettes. To implement a tobacco-free campus policy, students suggested educational campaigns that focus on the potential health benefits of a tobacco-free campus.

Strengthening a Tobacco-Free College Campus Policy Through Signage: GIS Mapping for Advocacy to Improve Implementation.

Implementing tobacco-free policies on university campuses has become increasingly common. However, promoting policy compliance remains a challenge. It is important to develop strategies that can overcome barriers to successful policy implementation and promote compliance. This Practice Note presents a case study of a practical strategy for addressing poor implementation of a newly adopted tobacco-free policy. Following principles of advocacy research, a team of student researchers and a faculty advisor developed a protocol to identify tobacco-related signage and environmental cues for tobacco use (e.g., cigarette-butt receptacles, designated smoking areas) on campus. Ten months after a tobacco-free campus policy went into effect, we identified 153 signs and 65 environmental cues. Of these, only two signs accurately described the current policy. Mapping signage and cues to use tobacco on campus can be an important advocacy tool to improve the implementation of tobacco-free campus policies. Increased adherence to new policies can be achieved through advocacy and outreach to university administrators.

Heterogeneity of intermittent smokers in a Hispanic college student sample

Hispanics are more likely to be daily light smokers (DLS) and intermittent smokers (ITS) than non-Hispanic whites. Although daily light (≤10 cigarettes per day [CPD]) and intermittent (nondaily) smoking have increased in recent years, few studies have compared DLS and ITS, especially within a Hispanic sample. The primary aims of this study were to investigate differences between DLS and ITS, and within ITS, differences between converted ITS (CITS; previously smoked daily for ≥6 months) and native ITS (NITS; never smoked daily) in a Hispanic college student sample (Mage = 23.74, SD = 5.17; 58.1% male). Analyses were conducted using baseline data from a larger study that evaluated attitudes toward tobacco free campus policies in a U.S. university on the border with México. This study included data from 45 DLS and 216 ITS (CITS: n = 77, NITS: n = 139; N = 261). Compared to DLS, ITS were younger (on average), less likely to identify as smokers, smoked on fewer days in the past month, smoked fewer cigarettes on smoking days, and reported less nicotine dependence. Compared to CITS, NITS were younger, less likely to self-identify as smokers, smoked on fewer days in the past month, smoked fewer CPD on smoking days, and were less dependent on nicotine. Given the similarities between current and past findings (suggesting that CITS are in between DLS and NITS—regarding smoking behavior), these data suggest a similar pattern likely exists also among Hispanic smokers. Additionally, the absence of some previously observed differences is relevant in characterizing this particular Hispanic college sample. These findings provide further insight for the tailoring of interventions that target Hispanic DLS, CITS and NITS).

Electronic cigarette use after the adoption of a tobacco-free campus policy

Electronic (e)-cigarette use has increased markedly across groups in the past few years. For this reason, risk factors associated with e-cigarette use warrant further research. This study presents secondary data analyses on e-cigarette use from a large cross-sectional database assessing attitudes toward a tobacco-free campus (TFC) policy prior to policy implementation (n = 1188), one-month post policy (n = 1442), and one-year post policy(n = 1125). Students from a U.S. university located on the border with Mexico (Mage = 25.02 years, SD = 7.99; 59.2% female) were recruited via email to complete an online assessment of their tobacco use, attitudes toward TFC policies, perceived problematic tobacco use, and knowledge of tobacco use risk. The prevalence of any past-30-day e-cigarette use significantly increased from 4.4% to 26.6% between baseline and one-month post-policy, and reduced to 17.3% between one-month post-policy and one-year post policy. Weekly alcohol use was associated with e-cigarette use at each assessment point. There was some evidence of higher e-cigarette use among younger students and current smokers. Additional studies are needed to understand the influence of comprehensive TFC policies on both e-cigarette use and polysubstance use (i.e., alcohol and combustible cigarettes).

An undergraduate student-faculty collaborative EBP project supporting a campus-wide tobacco free campus

The purposes of this paper are to describe a student-faculty, collaborative team and the evidence-based practice (EBP) project that supported a campus-wide, tobacco-free environment. Two faculty members served as mentors and undergraduate nursing students were selected to participate in a one credit independent study course outside the threaded curricular experiences. Weekly course meetings were used to assess course goals and EBP project progress. After reviewing literature evidence, a baseline campus survey, and focus group data, the best practice strategies were selected by the student-faculty collaborative team for a 3-year plan. The strategies included an orientation session to the tobacco-free campus during student fall orientations and a marketing campaign with social norm messaging. Pre and post-EBP project surveys to determine the effectiveness of the campaign were used to evaluate the outcomes of the team’s efforts. The undergraduate nursing students were effective in planning and implementing the project, and the students reported benefits and challenges to their involvement. The collaborative team was seen as an immensely positive experience despite the increased demands on time. Findings from this EBP project were similar to other literature on smoking abstinence on a college campus. One way to help undergraduate students better appreciate and gain expertise in the EBP process is to engage them in student-faculty collaborative EBP projects within the curriculum. In addition, an emersion experience offers expanded opportunities and greater expertise in EBP to students who can meet the challenge.

Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities - United States, 2016.

Persons with mental or substance use disorders or both are more than twice as likely to smoke cigarettes as persons without such disorders and are more likely to die from smoking-related illness than from their behavioral health conditions (1,2). However, many persons with behavioral health conditions want to and are able to quit smoking, although they might require more intensive treatment (2,3). Smoking cessation reduces smoking-related disease risk and could improve mental health and drug and alcohol recovery outcomes (1,3,4). To assess tobacco-related policies and practices in mental health and substance abuse treatment facilities (i.e., behavioral health treatment facilities) in the United States (including Puerto Rico), CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed data from the 2016 National Mental Health Services Survey (N-MHSS) and the 2016 National Survey of Substance Abuse Treatment Services (N-SSATS). In 2016, among mental health treatment facilities, 48.9% reported screening patients for tobacco use, 37.6% offered tobacco cessation counseling, 25.2% offered nicotine replacement therapy (NRT), 21.5% offered non-nicotine tobacco cessation medications, and 48.6% prohibited smoking in all indoor and outdoor locations (i.e., smoke-free campus). In 2016, among substance abuse treatment facilities, 64.0% reported screening patients for tobacco use, 47.4% offered tobacco cessation counseling, 26.2% offered NRT, 20.3% offered non-nicotine tobacco cessation medications, and 34.5% had smoke-free campuses. Full integration of tobacco cessation interventions into behavioral health treatment, coupled with implementation of tobacco-free campus policies in behavioral health treatment settings, could decrease tobacco use and tobacco-related disease and could improve behavioral health outcomes among persons with mental and substance use disorders (1-4).

Knowledge and Behaviors Associated with a Campus Tobacco-Free Policy

Objective: Nearly half of U.S. colleges/universities have implemented tobacco-free campus policies. This study analyzed knowledge, attitudes, and practices associated with the tobacco-free policy at a large public university. It is important to study public university tobacco policies to determine the most efficient and cost-effective way to reduce tobacco related disease due to tobacco use and exposure. Methods: This study used a cross-sectional, campus-wide electronic survey distributed in November 2016. The primary outcomes of interest included 1) correct knowledge of the tobacco-free policy, 2) community member willingness to approach observed violation of the policy, and 3) a positive opinion of the policy’s effectiveness. Descriptive statistics and logistic regression were used to examine the impact of demographic factors on the outcomes. Results: After analysis, the team found that 23% of university faculty, staff, and students had incorrect knowledge about the campus tobacco-free policy. Almost 70% of the university community reported not having approached a smoking violator. Males were significantly less likely to understand the tobacco-free policy in full, approach a violator, or have a positive opinion about its effectiveness. Staff had better knowledge of the policy, a higher likelihood of approaching a violator, and a better opinion about the policy’s effectiveness compared to graduate and undergraduate students. Conclusions: Interventions are needed to increase awareness and confidence regarding implementation and enforcement of the tobacco-free policy on campus, particularly among faculty and students. This paper expands on the currently increasing knowledge of tobacco-free policy enforcement and benefits. KEYWORDS: Campus; Tobacco Regulation; Tobacco; Secondhand Smoke; Cross-Sectional Survey

Tobacco-free generation campus initiative: a program to increase the number of tobacco-free colleges in the United States

Tobacco-free generation campus initiative: a program to increase the number of tobacco-free colleges in the United States

Effects of a Tobacco-Free Work Site Policy on Employee Tobacco Attitudes and Behaviors, Travis County, Texas, 2010-2012.

BackgroundThe adoption of tobacco-free policies in behavioral health settings is an important step in reducing staff tobacco use as well as the high rates of tobacco use among people with mental illness and behavioral disorders. Studies have demonstrated the importance of staff support when implementing tobacco-free workplace policies, but there is limited research examining tobacco use prevalence among staff and staff attitude before and after policy adoption.Community ContextIntegral Care, a local authority for behavioral health and developmental disabilities in Austin, Texas, and Austin Public Health embarked on a comprehensive planning process before implementing a 100% tobacco-free campus policy. The objectives were 1) assess staff tobacco use and attitudes toward a tobacco-free policy, 2) communicate policy to staff, 3) provide staff education and training, and 4) provide cessation resources.MethodsIntegral Care and Austin Public Health conducted a web-based employee survey 6 months before and 6 and 12 months after implementation of the policy to measure tobacco use prevalence and attitudes among employees.OutcomeEmployees had significant improvements in tobacco use prevalence and attitudes toward the tobacco-free policy from pre-implementation to post-implementation. Tobacco use prevalence among staff decreased from 27.6% to 13.8%, and support for the policy increased from 60.6% to 80.3% at 12 months post-implementation.InterpretationAdoption of 100% tobacco-free campus policies in behavioral health settings can result in significant reductions in staff tobacco use. Leadership should provide staff with education, training, and cessation support before adoption of tobacco-free work site policies to ensure success.

Pilot trial and process evaluation of a multilevel smoking prevention intervention in further education settings

Background Preventing smoking uptake among young people is a public health priority. Further education (FE) settings provide access to the majority of 16- to 18-year-olds, but few evaluations of smoking prevention interventions have been reported in this context to date. Objectives To evaluate the feasibility and acceptability of implementing and trialling a new multilevel smoking prevention intervention in FE settings. Design Pilot cluster randomised controlled trial and process evaluation. Setting Six UK FE institutions. Participants FE students aged 16–18 years. Intervention ‘The Filter FE’ intervention. Staff working on Action on Smoking and Health Wales’ ‘The Filter’ youth project applied existing staff training, social media and youth work resources in three intervention settings, compared with three control sites with usual practice. The intervention aimed to prevent smoking uptake by restricting the sale of tobacco to under-18s in local shops, implementing tobacco-free campus policies, training FE staff to deliver smoke-free messages, publicising The Filter youth project’s online advice and support services, and providing educational youth work activities. Main outcome measures (1) The primary outcome assessed was the feasibility and acceptability of delivering and trialling the intervention. (2) Qualitative process data were analysed to explore student, staff and intervention team experiences of implementing and trialling the intervention. (3) Primary, secondary and intermediate (process) outcomes and economic evaluation methods were piloted. Data sources New students at participating FE settings were surveyed in September 2014 and followed up in September 2015. Qualitative process data were collected via interviews with FE college managers (n = 5) and the intervention team (n = 6); focus groups with students (n = 11) and staff (n = 5); and observations of intervention settings. Other data sources were semistructured observations of intervention delivery, intervention team records, ‘mystery shopper’ audits of local shops and college policy documents. Results The intervention was not delivered as planned at any of the three intervention settings, with no implementation of some community- and college-level components, and low fidelity of the social media component across sites. Staff training reached 28 staff and youth work activities were attended by 190 students across the three sites (&lt; 10% of all eligible staff and students), with low levels of acceptability reported. Implementation was limited by various factors, such as uncertainty about the value of smoking prevention activities in FE colleges, intervention management weaknesses and high turnover of intervention staff. It was feasible to recruit, randomise and retain FE settings. Prevalence of weekly smoking at baseline was 20.6% and was 17.2% at follow-up, with low levels of missing data for all pilot outcomes. Limitations Only 17% of eligible students participated in baseline and follow-up surveys; the representativeness of student and staff focus groups is uncertain. Conclusions In this study, FE settings were not a supportive environment for smoking prevention activities because of their non-interventionist institutional cultures promoting personal responsibility. Weaknesses in intervention management and staff turnover also limited implementation. Managers accept randomisation but methodological work is required to improve student recruitment and retention rates if trials are to be conducted in FE settings. Trial registration Current Controlled Trials ISRCTN19563136. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information. It was also funded by the Big Lottery Fund.

An Experiment Assessing Punitive versus Wellness Framing of a Tobacco-Free Campus Policy on Students' Perceived Level of University Support.

The objective of this study was to examine how different ways of describing a hypothetical tobacco-free campus policy would impact college students’ perceived level of support from the college. In the spring of 2016, we randomized 1885 undergraduate students in a required course to three message conditions in an online survey: control (no message), wellness (emphasizing promoting health and quitting support), and punitive (emphasizing consequences for violating the policy). The dependent variable was perceived organizational support. We selected items previously shown to be relevant for college students (alpha = 0.92 in our data). Given significant non-normality, we used non-parametric Kruskal-Wallis tests with pairwise comparisons to examine differences in perceived organizational support across the three conditions. We examined results by smoking status and if the participant correctly reported the message they received. We found no significant difference in perceived organizational support among students exposed to different tobacco-free campus policy announcements (p = 0.75). We also found no significant difference among smokers (p = 0.66). However, among smokers who correctly reported the message they received, we found significantly lower perceived university support (p = 0.01). Messages about tobacco-free campus policies should focus on the role of policy in supporting a healthy environment instead of punitive enforcement. Campus administrators should use caution when using message frames focusing on consequences of violating newly adopted policies.

Implementing a tobacco-free hospital campus in Ireland: lessons learned.

The Irish Health Service Executive (HSE) had set a target that all HSE facilities should implement the HSE Tobacco Free Campus (TFC) policy by 2015. The aims of this study are to examine hospital staff awareness and to assess the progress of selected HSE health care facilities towards a TFC policy. Three health care facilities that were conveniently located were self-selected in County Cork, namely, an acute hospital, a mental health service and an older person's facility. Three different types of quantitative data were collected between May and September 2016 drawn on Standards 3, 4 and 5 of the European Network for Tobacco Free Health Care Services (ENSH-Global) tools: (1) face-to-face consultation with health care facility managers on their progress towards the HSE TFC policy, (2) self-administered questionnaire to a purposive sample of 153 staff members across three health care facilities and (3) physical observation of signs of smoking and smoking-related information across each health care facility for objective verification of compliance. Of the 153 staff who completed the questionnaire, 64% were females, 39% were nurses, 20% were smokers and 76% agreed with the TFC policy. However, only 26% of the 153 staff had received training on motivational and tobacco cessation techniques. Seventy-seven percent of the 153 staff stated that the campus was not tobacco-free. Physical observation suggested signs of smoking within the campus across all three health care facilities surveyed. Staff awareness of the HSE TFC policy across selected health care facilities in Ireland is positive but is not sufficient. There are gaps in the implementation process of the HSE TFC policy in the health care facilities. Therefore, proper communication on the importance of the ENSH-Global standards and cessation training to all staff is necessary to help reduce smoking rates across the health care facilities and also to move towards a Tobacco Free Campus in Ireland.

A Tobacco-Free Medical Campus Policy Is Associated With Decreased Secondhand Smoke Exposure and Increased Satisfaction Among Military Medical Employees: Results of a Mixed-Methods Evaluation

Tobacco control is an ongoing concern for the U.S. Army. Although tobacco use is currently prohibited within all military hospitals and clinics, known as military treatment facilities (MTFs), no such facility had implemented a tobacco-free medical campus (TFMC) policy before 2012. This evaluation examined the effects of one Army installation's TFMC policy implementation at its medical facilities. Online questionnaires were distributed to medical campus employees, including Active Duty Soldiers, civilians, and contractors, before policy implementation (N = 1,210) and 12 months following policy implementation (N = 1,147). Chi-square analyses, independent t tests, and logistic regression models were utilized to examine pretest/post-test changes in employees' secondhand smoke (SHS) exposure; tobacco use, motivation to quit, and cessation; and health outcomes. Twenty-three focus groups, interviews, and informal discussions with 65 employees and patients were conducted 13 months after initial policy implementation to capture both the intended and unintended policy effects. After controlling for demographic characteristics, the study found that employees had more than twice the odds of exposure to SHS in the workplace at baseline than at 12-month follow-up (odds ratio: 2.06, 95% confidence interval: 1.73-2.46, p < 0.001). Employees also reported a lower prevalence of diagnosis with chronic bronchitis (p < 0.05) at follow up compared to baseline. Although the mean number of sick days taken for respiratory illness decreased over time, results were not significant after controlling for demographic factors. No significant differences existed in tobacco-use prevalence or quit rates among tobacco users over time. Employees reported significantly higher levels of satisfaction with a TFMC policy than the original policy (p < 0.001) though this finding was moderated by smoker status such that smokers reported lower levels of satisfaction with the policy over time. Qualitative findings revealed that the most common policy effect was that the policy caused smokers to change the location of where they used tobacco to off campus. Findings further revealed several unintended policy effects, including safety concerns and greater visibility of smokers in front of the MTF. The first Army MTF TFMC policy was associated with reported reductions in SHS exposure and improvements in some short-term health outcomes. The policy had no observed association with tobacco-use prevalence, motivation to quit, or cessation at 12-month follow-up. Focus group participants discussed several positive and negative policy effects. These policies should be expanded and studied in more depth across military installations, and policy makers should plan mitigation strategies to reduce unintended effects. This is an important step in military tobacco control, but additional efforts will be necessary to curb tobacco use within this population.

Addressing Tobacco Use Among Consumers and Staff at Behavioral Health Treatment Facilities Through Comprehensive Workplace Programming.

Tobacco use is the leading cause of death and disability in the United States; cigarette smoking is the most common form of tobacco use. Smoking has become increasingly concentrated among individuals with behavioral health needs (e.g., persistent mental illness) and has led to increased morbidity and mortality in this group relative to the general population. Comprehensive tobacco-free workplace programs are effective in reducing tobacco use and cigarette smoke exposure among behavioral health consumers and the individuals who serve them. Taking Texas Tobacco-Free (TTTF) represents an academic-community partnership formed to address tobacco use among consumers and employees at behavioral health clinics across Texas via the dissemination of an evidence-based, multicomponent tobacco-free workplace program. Program components of TTTF include tobacco-free campus policy implementation and enforcement, staff education about tobacco use hazards, provider training to regularly screen for and address tobacco dependence via intervention, and community outreach. These components, the nature of the academic-community partnership, the process of behavioral health facility involvement and engagement, and the benefits and challenges of implementation from the perspectives of the project team and participating clinic leaders are described. This information can guide similar academic and community partnerships and inform the implementation of other statewide tobacco-free workplace programming.

Using the Theory of Planned Behavior to Guide Focus Group Development of Messages Aimed at Increasing Compliance With a Tobacco-Free Policy.

This study details the persuasive message development for a theory-based campaign designed to increase compliance with a university's tobacco-free policy. The theory of planned behavior (TPB) guided message design and evaluation for focus group-tested messages that were adapted to the context of complying with a tobacco-free policy. The study was conducted at a university located in the tobacco belt. Undergraduate focus group participants (n = 65) were mostly male (69%), white (82%), and freshman (62%) who smoked at least 1 cigarette in the last 30 days; on-campus smoking percentages were never/rare (60%), occasionally (23%), and often/frequently (16%). Data analysis used a theoretical thematic approach to identify how the TPB constructs related to perceptions of message effectiveness. Participants responded favorably to attitudinal strategies about health, respect, and university figures; they rejected approaches they considered juvenile and offensive. They also discussed the impact of noncompliance and avoiding overgeneralized statements for addressing subjective norms, suggesting shortening text, adjusting picture location, and emphasizing the importance of compliance to increase perceptions of behavioral control. Applying theory to preexisting messages is challenging. The design approach in this study is an evidence-based strategy that can be used as a universal process for message adaptation. Results offer health promotion suggestions for designing messages aimed at improving undergraduate smokers' willingness to comply with tobacco-free campus policies.