College campus smoking policies and programs and students' smoking behaviors

BMC Public Health College campus smoking policies and programs and students' smoking behaviors Tyrone F Borders 2 K Tom Xu 1 Donna Bacchi 0 Lee Cohen 4 Danielle SoRelle-Miner 3 0 Department of Pediatrics and Center for Tobacco Control and Prevention, Texas Tech University Health Science Center , Lubbock, Texas , USA 1 Division of Health Services Research, Texas Tech University Health Science CenterLubbock , Texas , USA 2 Department of Health Policy and Management, University of Arkansas for Medical Sciences , Little Rock, Arkansas , USA 3 Center for Tobacco Control and Prevention, Texas Tech University Health Science Center , Lubbock, Texas , USA 4 Department of Psychology, Texas Tech University , Texas , USA Background: Although tobacco use in the United States has declined over the past 20 years, cigarette use among college students remains high. Additional research is thus needed to determine how university tobacco control policies and preventive education programs affect college students' smoking behaviors. Methods: Approximately 13,000 undergraduate students at 12 universities or colleges in the state of Texas completed a web-based survey. College smoking policies were obtained from a survey of college administrators and from college websites. Logistic regression analyses were conducted to estimate the effects of individual smoking policies and programs on the odds of cigarette smoking. Results: Of the individual programs, only having a preventive education program on campus was associated with lower odds of smoking. The existence of smoking cessation programs and designated smoking areas were associated with higher odds of smoking. Policies governing the sale and distribution of cigarettes were insignificantly associated with smoking. Conclusion: Rather than focusing on policies restricting cigarette sales and use, college administrators should consider implementing or expanding tobacco prevention and education programs to further reduce student smoking rates. - Background Despite reductions in smoking rates over the past 20 years, tobacco use remains a key public health concern. According to recent estimates from the Centers for Disease Control, smoking is the leading cause of preventable death in the United States [1]. Cigarette use among college students is of particular concern as they have a substantially higher prevalence of smoking relative to the general adult population [1,2]. To curb smoking rates on college campuses, several national organizations recommend that colleges and universities enact stricter tobacco control and prevention pol icies. The American College Health Association (ACHA) and American Cancer Society (ACS) advocate that colleges ban smoking in all campus buildings and residence halls; prohibit the sale, sampling, and advertising of tobacco products; restrict smoking to a minimum of 20 feet from building entrances and air intake units; limit or prohibit spit tobacco use on campus; and implement tobacco prevention/education and cessation programs on campus [3,4]. Many institutions have responded to these recommendations. According to a survey of 50 colleges and universities across the United States, the number of campuses regulating cigarette use in student housing increased from 1% to 54% between 19941995 and 20022003 [5]. A crosssectional survey of college students suggests that campus housing smoking bans are effective in decreasing smoking rates [6]. In addition to policies regulating where students can smoke, many universities have implemented public education campaigns aimed at non-smokers and smoking cessation programs targeting current smokers. According to a survey of health directors at 393 four-year universities across the U.S., 40% of schools offered some type of smoking cessation program [6]. Several studies have shown that anti-smoking messages can reduce smoking rates among younger adults [7-10], but little research has been conducted to assess their effectiveness among college students. While there are some indications that more stringent tobacco policies and greater availability of promotion and prevention programs reduce smoking rates on college campuses, there is a lack of conclusive research in the area. More extensive regulatory policies could have a negative effect if they elicit a rebellious response from students. An additional question which remains insufficiently answered is the degree to which regulatory policies as compared to prevention or education are associated with smoking behaviors. An improved understanding of the relative effects of different types of policies and programs could assist college and university administrators as they consider how to invest resources to curb smoking. Methods Survey sample A web-based survey, which was approved by Texas Tech University Health Sciences Center's institutional review board (IRB), was conducted among college students in Texas. The survey contained questions covering past and current cigarette, cigar, and smokeless tobacco use; knowledge of the risks associated with tobacco use; and responses to tobacco marketing campaigns. The sampling frame and methodology have been discussed elsewhere [11], but are briefly described here. All 72 colleges and universities within the state of Texas were invited to participate in a web-based survey of their undergraduate students' tobacco use. Of the 72 institutions, 27 did not elect to respond to requests to participate in the survey, 3 did not collect e-mail addresses from their students (which was necessary to recruit students), and 29 refused to release students' e-mail addresses. Thus, 13 college and universities agreed to participate in the study, representing 184,559 students. Students from the participating schools were e-mailed and invited to participate in a web-based survey about tobacco use. To encourage participation, students were offered to enroll in a lottery to receive one of five $500 airline gift certificates upon completion of the survey. They were then directed to a web site where they could complete the survey. Approximately 13% of students from the 13 participating schools completed the survey. For the analyses conducted here, one college was excluded because it had a particularly low response rate (approximately 2%). Thus, the final sample represented 13,041 undergraduate students at 12 four-year colleges and universities in Texas. Variables Because we were concerned with the occurrence of smoking over a defined time period, as opposed to the quantity of cigarette consumption, we defined current smoking as having smoked at least one cigarette in the past 30 days. This is the standard method of categorizing persons as current vs. non-current smokers [6,12-14]. College-level campus smoking policies and regulations were obtained through mail surveys of college administrators. College administrators were asked whether their school had specific campus policies which restricted tobacco distribut (...truncated)