An evaluation of a university-based smoking policy: a student research project.
Abstract: Awareness, compliance, and satisfaction are central constructs to a smoking policy. This study evaluated a new restrictive smoking policy on a university campus. An upper division class of undergraduate health education majors completed the evaluation with a survey of 300 students, faculty, and staff. Eighty-one percent of respondents were aware of the 25 ft smoking policy, and only 10% stated that they comply with the policy at all times. In addition, 42% of respondents were satisfied with the smoking policy and 6% thought the policy needed refinement. Recommendations were to increase awareness and to build a more consistent policy.
Subject: Smoking
Authors: Amerando, Chelsea
Becker, Craig M.
Johnson, Hans
Pub Date: 03/22/2010
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Spring, 2010 Source Volume: 25 Source Issue: 2
Accession Number: 308741502
Full Text: Smoking is the leading preventable cause of death in the United States, resulting in the death of 1 in 5 people (438,000) a year. In 1986, the Environmental Protection Agency (EPA) issued a report on the dangers of secondhand tobacco smoke (Koop, 1986) and in 2006, a follow-up confirming report stated that secondhand smoke causes premature death and disease in children and adults who do not smoke (U.S. Department of Health and Human Services, 2007). Each of these reports provided support for efforts to initiate tobacco use bans in public places. Currently, many states are initiating bans in restaurants, bars, and workplaces to reduce involuntary exposure to environmental tobacco smoke (ETS). (Bratton & Trieu, 2005; Styles & Capewell, 1998).

Smoking policies help manage smoking behaviors by restricting where the behavior can be accomplished. Along with the implementation of smoking policies in bars, restaurants and worksites, college campuses are important sites for smoking policies. Currently, 29% of men and 19% of women in the 18-24 year old age group smoke (Center for Disease Control and Prevention, 2006). Research indicates that smoking rates are high in college-aged individuals because college years are a time of stress and change in students' lives. Smoking policies on college campuses help decrease smoking habits of students (Wechsler, Kelley, Seibring, Kuo, & Rigotti, 2001).

Tobacco policies on college campuses often work to counteract the marketing schemes designed by tobacco companies. Some research has indicated these marketing efforts have increased the number of college-aged people who smoke (Bratton & Trieu, 2005). The Americans with Disabilities Act protects the rights of students who have asthma, and any disability that may be aggravated or made worse by ETS (Hancock, 2001). Smoking policies not only help the smokers but they also benefit the nonsmokers by providing the nonsmokers with cleaner air. Evidence indicates that interventions designed to alter smoking behaviors help people change and that these interventions promote and enforce new restrictive smoking policies (Loukas, Garcia, & Gottlieb, 2006). Research indicates that ETS acts as a "trigger" for former smokers to smoke again; smoke free environments, therefore, help thwart relapses by former smokers (Gerson, Allard, & Towvim, 2005). Implementing smoking policies on college campuses also helps prepare students for the workforce because many workplaces are now smoke free. Workplaces have become smoke free because it is more cost effective and increases worker productivity (Styles & Capewell, 1998).

Fairness and consistency affect smoking policy effectiveness (Styles & Capewell, 1998). Adherence to smoking policies increases when there is a way to monitor the behavior. Students react favorably to positive reinforcement of a desired behavior instead of negative reinforcement (Styles & Capewell, 1998). Positive reinforcement increases the future frequency of a behavior due to the addition of a desired stimulus provided immediately following a behavior. Negative reinforcement increases a behavior due to removing an aversive stimulus immediately following a behavior. For instance, instead of fining or chastising a student for smoking against a policy, negative reinforcement; it has been more effective to provide rewards such as recognition or water bottles as a consequence for adhering to a policy, positive reinforcement. With regard to creating smoking areas in order to move smokers away from nonsmokers, study results indicate creating designated smoking areas are not good when policies prohibit smoking. Problems identified with smoking areas include the belief that they are inconsistent with the smoke free message because they make smoking appear acceptable (Kumar, O'Malley, & Johnston, 2005).

The implementation of smoking policies has begun on college campuses. For example, Ohlone College in Fremont, California became a smoke free campus June 1, 2004. Students may smoke in the general parking lots; however, red signs with white lettering saying "NO SMOKING BEYOND THIS POINT" clearly identify the boundaries. The college also has posted signs around campus advertising their health and wellness center's smoking cessation programs and hot line. A Fun Run promoted the new smoke free policy and recognized the campus's effort in creating a positive health atmosphere (Bratton, n.d.).

Research shows that smoking policies reduce smoking. They foster the acceptance of smoking bans (Styles & Capewell, 1998). Educational campaigns assist with the implementation of smoking programs (Borders, Xu, Bacchi, Cohen, & Sorelle-Miner, 2005). Offering cessation programs increases the compliance with smoking policies. Health education and promotion activities affect smoking policies (Murphy-Hoefer, et. al., 2005). Comprehensive interventions produce better results. For example, comprehensive programs would be those that include education, cessation, and counseling. A smoking cessation class may be best for some while counseling sessions work better for others (Styles & Capewell, 1998). The success of any policy needs to include a cessation program to support the smokers trying to quit and to promote a culture that supports the new policy. Reports indicate that cessation classes increases compliance to the smoking policy as well as satisfaction of the individual (Murphy-Hoefer, et. al., 2005). Overall, consistency enhances the awareness and satisfaction of smoking policies (Weschler, et. al., 2001). A consistent campus wide smoking policy would include residence halls as well as outside areas (Wechsler, et.al. 2001).

Implementation of a Restrictive Smoking Policy

The national average for number of students who smoke on college campuses is 28.5% (Bacchus & Gamma Peer Education Network, n.d.). At the site of this study, a southeastern university, over 30% of students smoke. With the support of the university administration and external funding, a university-wide smoking policy was developed and implemented. The policy prohibited smoking within 25 feet of all buildings.

PURPOSE AND DESCRIPTION OF CLASS PROJECT

An upper division class of undergraduate health education majors completed an evaluation of the new restrictive smoking policy. The classroom-based project helped students learn how to design and complete program evaluations using real-life practical experiences and was an example of how practical learning experiences are facilitated (Becker, Johnson, McNeil, & Warren, 2006). To help students understand the project, faculty involved in implementing the policy assisted students by making class presentations and by being available to assist students. Discussions with faculty members and university administrators and the review of related literature identified the measurement parameters. Upon completion of the evaluation, an academic paper was prepared by the students and the results were presented to all involved parties. The purpose of this paper was twofold, 1) to evaluate a newly implemented restrictive smoking policy, and 2) to describe how this was completed as a class project for upper classmen in a health education and promotion program. This paper is a synthesis of the projects completed by the students.

The goal of the new smoking policy was to support a healthy campus through successful implementation of a restrictive smoking policy on campus. Previously, there was no official tobacco policy on campus because the state of North Carolina had a pre-emption policy that prohibited implementation of a restrictive smoking policy. Although there was no official policy, all buildings were smoke free, tobacco products were not sold on campus, and NCAA regulations prohibited smoking in athletic stadiums. The new policy restricted tobacco use to at least 25 feet away from all buildings. The class project evaluated the awareness, satisfaction, and compliance with the new policy implemented.

First, the students created measurable objectives related to the policy's success. Although class members did not implement the policy, creating objectives helped them understand the function of objectives in evaluation. This process involved discussion with the principles involved with the policy and a review of literature about smoking policies at other universities. These discussions and the literature review concluded with the decision to measure the awareness, compliance, and satisfaction with the new policy (Patterson, Lerman, Kaufmann, Neuner, & Audrain-McGovern, 2004; Unger, Rohrbach, Howard, Cruz, Johnson, & Chen, 1999).

After deciding upon the areas to measure, students developed objectives that contained four necessary components: condition, criterion, target population, and desired outcome (Mckenzie, Smeltzer, 2006). Condition identified when, criterion identified how much, target population identified who, and desired outcome indicated what must happen. When was just prior to the evaluation, March 31, 2008; the how much was individually determined for each objective; who consisted of students, faculty, and staff; and, what must happen was study participant awareness of the policy, compliance with the policy, and satisfaction with the policy. The objectives of the class project were:

1. By March 31, 2008, 75% of students, faculty, and staff on campus will be aware of the new smoking policy.

2. By March 31, 2008, 80% of students, faculty, and staff on campus who smoke will comply with the new smoking policy.

3. By March 31, 2008, 80% of students, faculty, and staff on campus will be satisfied with the new smoking policy.

Students used peer-reviewed literature examples to create the survey questions to use in their evaluation. Six groups of five students each gathered data from 50 people on campus. The combined convenience sample of students, faculty, and staff resulted in 300 completed surveys. Students also collected information by recording notes from personal observations and by asking participants follow-up questions to their recorded survey responses.

METHODS

MEASURES

The surveys included the following measures: gender, status (student year), faculty, or staff, smoking status (smoker, non-smoker, or social smoker), ethnicity. The questionnaires then asked participants about their satisfaction with the 25-foot ban, asked smokers if they comply with this policy, and it asked participants about their knowledge or awareness of the smoking cessation programs. A "yes/no" scale measured compliance, satisfaction, and awareness of the smoking ban of 25 feet from any campus buildings.

ANALYSIS

Students calculated the results by determining response frequencies and calculations of central tendency measures. Limitations of the study included the use of a convenience sample and a self-report data collection format.

RESULTS

A convenience sample of 300 participants (students, faculty, and staff) resulted in 300 completed surveys. Participants were 59% male and 41% female, 15% freshman, 13% sophomore, 23% junior, 35% seniors, 4% graduate students, 3% faculty, and 7% staff. Thirty-four percent of the participants identified themselves as smokers or social smokers and 66% of the participants identified themselves as non-smokers. Sixty-three percent of participants identified themselves as Caucasian, 12% African American, 5% Asian, 5% multi-racial, 4% Native American, 2% Latino, and 8% other.

Eighty-one percent of the respondents indicated awareness of the new smoking policy, thus meeting the objective of 75%. Of those that were aware, 39% received the information from signs and banners, 26% received the information from friends, 9% received emails, and 26% responded other (Table 2). The objective that eighty percent of the campus smoking population would comply with the policy was high. These findings indicated that only 10% stated they comply all the time, 50% stated that they never comply with the policy, and 40% stated they sometimes comply (Table 3).

The objective that eighty percent of the campus population would be satisfied with the policy was high. Forty-three percent of the survey respondents were satisfied with the new smoking policy. Of these only 5% were very satisfied (Table 4). Twenty percent of the participants were very dissatisfied with the new smoking policy, 51% felt the policy violated their rights, and 6% felt the policy needed to be firmer.

The student researchers also recorded findings gathered from follow-up discussions with participants and from on-campus observations. A repeated finding indicated that existing signs displaying the policy were high on buildings and not visible. Many felt the policy should include bus stops and buses because of the number of students smoking while waiting for buses. Many mentioned that additional efforts to increase awareness would be helpful and many recommended using notices through electronic means with Facebook, MySpace, and others. Another strong comment concerned the lack of enforcement and most hoped it could be peer driven enforcement.

DISCUSSION AND IMPLICATIONS

The goal of the smoking policy is to create a healthy campus that facilitates healthy habits for students and is a clean environment for all. Intentions of the smoking policy are to improve the public image of the university, improve the working environment for staff and faculty, and create expectations by altering the social norm. This evaluation found that only one of the objectives was met, the one relating to the awareness of the policy. The findings indicated that additional effort is needed to improve both satisfaction and compliance with the new policy.

Findings indicated that while the majority of respondents were aware of the policy, they were not complying with the policy. Less than half of the respondents were satisfied with the policy and more than half felt that the policy violated their rights. Although most students are aware that there is a smoking policy on campus, results suggest it is difficult to enforce a policy that is only 25 ft from buildings. A preferred approach would be to make the campus smoke-free. For most campuses, a policy banning smoking within 100 feet of buildings and bus stops would effectively make the campus smoke-free. Due to the temporary nature of the 25 ft policy, the signs placed on the doors of the buildings lost their value. In addition, the high placement of signs, so that students would not pull them down, made them difficult to read from a distance. Further, university buses should be included as structures.

This evaluation produced several of suggestions for promoting the awareness of a university-based smoking policy. For example, use a variety of promotion strategies; signs on buildings, create networking sites such as Facebook and MySpace, and print the policy on bags from the student store. Enforcement of the policy is difficult. A suggestion would be to create a group of "Friendly Informers" These individuals should consist of students who canvas the campus. During their canvas, students distribute information cards, to those not complying, stating the smoking policy and a phone number for Quitline, a smoking cessation program available to students who want to quit. This non-confrontational approach informs and does not penalize students.

IMPLICATIONS

Student evaluation projects such as the one described here provide practical experiences and assist campus health promotion efforts. It also should be recognized, health promotion interventions should be continually evaluated to determine their effectiveness and how they can be continually improved.

Implementing a smoking policy on a university campus is challenging with regard to getting the campus population to both adopt and comply with its regulations. These results suggested that student involvement through class projects; clubs, fraternities and sororities; and student government can be helpful to planners and implementers. This project has assisted this campus's effort in understanding how to successfully implement a restrictive smoking policy. The success of this study suggests that campus's can get student involvement through class projects focused on evaluation of campus programs. It also is suggested that student projects include literature reviews, the development of desired objectives for measurement, thorough review of program content, and evaluation of factors related to program success. Findings from this class project indicated that for a smoking policy to be most effective, it is important to target awareness of the policy, compliance with the policy, and satisfaction with the policy.

REFERENCES

Bacchus & Gamma Peer Education Network. (n.d.) Prioritizing tobacco prevention on campus. Retrieved March 4, 2008, from www.tobaccofreeu.org/pdf/stepbystep/cctpi.ppt

Becker, C. M., Johnson, H., McNeil, M. P., & Warren, K. (2006). Creating partnerships on campus to facilitate practical experiences. College Quarterly, 9 (3).

Borders, T. F., Xu, K. T., Bacchi, D., Cohen, L., & Sorelle-Miner, D. (2005). College campus smoking policies and programs and students' smoking behaviors. BMC Public Health, 5. Retrieved February 29, 2008, from http://biomedcentral.com/1471-2458/5/74

Bratton, S., & Trieu, S. L. (2005). Tobacco control: Case study at a California community college. California Journal of Health Promotion, 3, 61-71.

Bratton, S. (n.d.). No smoking at Ohlone college. Retrieved April 10, 2008, from http://www.ohlone.edu/ org/healthctr/smoking.html

Center for Disease Control and Prevention. (2006).Cigarette smoking among adults--United States, MMWR, 56, 1157-1161.

Gerson, M., Allard, J. L., & Towvim, L. G. (2005). Impact of smoke-free residence hall policies: The views of administrators at 3 state universities. Journal of American College Health, 54, 157-165.

Koop, C. E., (1986). The health consequences of involuntary smoking: A report of the surgeon general, 1986. United States. Public Health Service. Office of the Surgeon General, United States, & Office on Smoking and Health.

Kumar, R., O'Malley, P. M., & Johnston, L. D. (2005). School tobacco control policies related to students' smoking and attitudes toward smoking: National survey results, 1999-2005. Health Education & Behavior, 32, 780-794. Retrieved February 29, 2008, from htttp://heb.sagepub.com/cgi/content/ abstract/32/6/780

Loukas, A., Garcia, M. R., & Gottlieb, N. H. (2006). Texas college students' opinions of no-smoking policies, secondhand smoke, and smoking in public places. Journal of American College Health, 55, 27-32.

Murphy-Hoefer, R., Griffith, R., Pederson, L. L., Crossett, L., Lyer, S. R., Hiller, M. D. (2005). A review of interventions to reduce tobacco use in colleges and universities. American Journal of Preventive Medicine, 28, 188-200. Retrieved February 29, 2008, from http://www.sciencedirect.com/science?_ ob=ArticleURL&_udi=B6VHT-4FG3Y0R-7&_us..

Patterson, F., Lerman, C., Kaufmann, V. G., Neuner, G. A., & Audrain-McGovern, J. (2004). Cigarette smoking practices among american college students: Review and future directions. Journal of American College Health, 52(5), 203-212.

Styles, G., & Capewell, S. (1998). No smoking at work: the effect of different types of workplace smoking restrictions on smokers' attitudes, behavior and cessation intentions. Health Education Journal, 57, 385-394. Retrieved February 4, 2008, from http://hej.sagepub.com/cgi/content/abstract/57/4/385

Unger, J. B., Rohrbach, L. A., Howard, K. A., Cruz, T. B., Johnson, C. A., & Chen, X. (1999). Attitudes toward anti-tobacco policy among California youth: Associations with smoking status, psychosocial variables and advocacy actions. Health Education Research, 14(6), 751-763.

U.S. Department of Health and Human Services. (2007). The health effects of involuntary exposure to tobacco smoke: A report of the surgeon general, US Department of Health and Human Services. Retrieved March 3, 2008, from http://www.surgeongeneral.gov/library/secondhandsmoke/factsheets/ factsheet7.html

Wechsler, H., Kelley, K., Seibring, M., Kuo, M., & Rigotti, N. A. (2001). College smoking policies and smoking cessation programs: Results of a survey of college health center directors. Journal of American College Health, 49, 205-212.

Chelsea Amerando

Craig M. Becker, PhD

Hans Johnson, EdD

Chelsea Amerando is a recent graduate of the College of Health & Human Performance at East Carolina University. Address: 3834 Frye Bridge Rd. Clemmons, NC 27012. Telephone: 336-817-5676. Email: camerando@gmail.com. Craig M. Becker, PhD, is an Associate Professor in Health Education & Promotion in College of Health and Human Performance at East Carolina University. Address: 3207 Carol Belk Building, Greenville, NC 27858. Telephone: 252-328-5312, Fax: 252-328-1285 Email: beckerc@ecu.edu. Hans Johnson, EdD., is an Associate Professor in Health Education & Promotion in College of Health and Human Performance at East Carolina University. Address: 3202 Carol Belk Building, Greenville, NC 27858. Telephone: 252-328-1818, Fax: 252-328-1285 Email: johnsonh@ecu.edu. Please address all correspondence to: Craig M. Becker, PhD.
Table 1. Smoking Policy Questionnaire

Please Circle response:

Gender:           Male               Female
Status:           Freshman           Faculty
                  Sophomore Junior   Staff Other
                  Senior
                  Grad

Smoking Status:   Smoker             Not a Smoker        Social
                                                         Smoker

Please indicate # of Cigarettes smoked in last 30 days--

Ethnicity:        Caucasian          Asian American
                  African American   Bi or Multiracial
                  Native American    Hispanic/Latina

Table 2. How Individuals Became Aware

Method          Percent

Signs/Banners     39
Friend            26
Email             9
Other             26

Table 3. Compliance with the Smoking Policy

Compliance Level   Percent

Always Comply        10
Sometimes Comply     40
Never Comply         50

Table 4. Satisfaction with the Smoking Policy

Level of Satisfaction   Percent

Very Satisfied             5
Satisfied                 38
Dissatisfied              37
Very Dissatisfied         20
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