Tobacco-Free Is No Panacea
PHOENIX -- A straightforward presentation on how colleges are (or aren't) complying with the American College Health Association's guidelines for tobacco-free campuses sparked a much longer discussion here at ACHA's annual conference Friday, illustrating the challenges health educators face in trying to boot nicotine from the grounds.
Those in the audience identified many of the same problems on their campuses that the presenter cited: inability or unwillingness to enforce the policy; fear of alienating or getting pushback from students and staff who smoke; and shaky transition periods that can result in ineffective procedures.
Beginning in September 2009, Sara Plaspohl, an assistant professor of health sciences at Armstrong Atlantic State University, in Georgia, analyzed the policies and practices of 162 tobacco-free colleges and universities (as identified by the American Lung Association) that responded to her survey. (Fourteen did not participate; as of today, ALA has identified 242 tobacco-free institutions. This is not to be confused with smoke-free institutions, which are twice as common; according to the American Nonsmokers' Rights Foundation, there are at least 500 smoke-free colleges and universities.)
The vast majority of these colleges were on the small end of the spectrum, with fewer than 10,000 students; were located in the Midwest or South; and were either two-year or private institutions. Although most said they followed the ACHA guidelines, which aim to assist colleges with "evaluating progress toward becoming or maintaining tobacco-free living and learning environments," many did not.
Plaspohl found that while nearly all of these colleges had (self-reportedly) developed clear policies that reflect ACHA's best practices, and had comprehensive marketing and signage promoting their policy, fewer offered actual programs or products recommended by ACHA, such as patches in their health centers to aid those quitting smoking, and only one in three had a task force to maintain the policy or adjust it as needed. "About 2/3 of schools established this policy, and it's on autopilot now," she said.
But the most troublesome area was enforcement, both with campus regulars such as students and faculty, and with people who wandered onto the grounds for meetings, events and the like. Three-fourths of colleges reported having consistent consequences or penalties for noncompliance, but only 54.5 percent said they "always" enforce their policy, while 37.5 percent "occasionally" enforce it.
The methods of enforcement and types of penalties issued varied by institution, but for the most part the consequences were soft. Smokers would often get a friendly reminder of the policy, or a warning that they could be cited or lose some sort of privilege after repeated violations. As one audience member from a tobacco-free campus put it, "When they intervene, it's motivational, not confrontational."
This can be problematic, however. Some said students and staff (in many cases, they said, the latter were more resistant) did not take the policies seriously, either because they weren't enforced or because they saw other people smoking. "They smoke right underneath the sign that says 'no smoking,' " one person from a newly smoke-free campus said. "The students see one person smoking and they think, 'Why can't I smoke?' "
Jane Croeker, health and wellness promotion director at the University of North Dakota, said that both enforcement and messaging have been key in reducing tobacco use rates on her campus. "You shouldn't have to have a whole array of separate compliance strategies if it's being held up in the same way as other policies," she said. Supervisors should be charged with ensuring faculty and staff comply, and students should be educated on where they're allowed to use tobacco products.
When attendees raised less-common issues they'd faced at their colleges, such as complaints that tobacco-free policies discriminate against people who are addicted to nicotine or don't have time to leave campus to smoke, Croeker said it's important to stay focused. "Be careful not to be diverted from the main issue, and keep coming back to your key points about health," she said, adding that "focusing too much on secondhand smoke can be a problem because [policies often address] outdoor environments."
Colleges in the survey suggested other strategies for success, as well. Starting planning early and communicating the policy to everyone who will be affected can increase compliance when the tobacco ban does take effect. They also said it helps to enlist key administrators like the president, and student leaders from different campus groups. "If it comes from the students, and the students play an active role, it's most likely going to be much better accepted," Plaspohl said. "You don't have to reinvent the wheel, you just have to know your campus and know what works for you."
On average, colleges complied with 72 percent of the ACHA guidelines, Plaspohl found. In terms of demographics, public institutions and those in the Northeast (there were only four), as well as ones enrolling between 5,000 and 9,999 students, fared the best. There was no difference in compliance between urban, suburban and rural institutions.
Considering their implementation processes, colleges often said they had trouble deciding how quickly to start and how severely to enforce, for fear of resistance. But they offered a bit of advice, which Plaspohl shared at the session: "Just do it," she said. "Don't be afraid. Be diligent, be firm, be patient and be persistent.... It's not about denying [smokers'] rights, it's about promoting and creating a healthy environment for all."