Running head: SMOKE-FREE CAMPUS PROPOSAL 1

Smoke-Free Campus Proposal

Abigail Lopez

May 5, 2017

HSCI 660 D
Running head: SMOKE-FREE CAMPUS PROPOSAL 2

Tobacco use continues to be the leading preventable cause of deaths in the United States

(Borders et al., 2005). Among all age groups, young adults between 18-29 years old have the

highest prevalence of tobacco use (Bennett et al., 2017). Previous research has shown that

smokers who quit smoking before the age of 30 dramatically reduce their risk of death due to

smoking-related causes (Bennett et al., 2017). Thus, emphasizing the need for targeted programs

and interventions aimed at young adults.

The proposal initiated by Assemblyman Kevin McCarty to prohibit smoking, including

electronic smoking devices on California State University (CSU) and California Community

Colleges beginning January 1, 2018 will encourage an overall healthier campus. However,

adherence to smoke-free policies on campuses remains a challenge (Ickes et al., 2013). From a

health policy perspective, the new proposal will help work towards reducing smoking rates

among young adults. As a result of the proposal, the CSU and California Community Colleges

will have to implement programs that raise awareness and increase adherence to the policy. The

social determinants of health that will be discussed throughout this paper are health literacy and

environmental conditions.

The definition for the term health literacy goes beyond just being able to read something;

It is determined based on the ability for an individual to access the information, fully

comprehend it, and use the information learned to make positive health behavior decisions

(Nutbeam, 2000). Increasing health literacy is critical in this case, because there is a need for

students to learn about the adverse health outcomes of tobacco use to gain knowledge and

awareness, fully comprehend the information given to quit smoking or empower other students

to quit smoking, and adhere to the smoke-free policy on campus. In addition to addressing health

literacy, the new policy implemented by the bill can improve environmental conditions. There
Running head: SMOKE-FREE CAMPUS PROPOSAL 3

exists a plethora of literature that highlights the harmful effects of second-hand smoke. Thus, by

having a smoke-free campus policy, students will have a decreased exposure to such harmful

effects.

As the Public Health Consultant working for the CSUSB Student Health Center, the first

step prior to the planning and implementation process would be to research the existing body of

literature discussing various approaches that other smoke-free campuses have undertaken to gain

insight into what programs, interventions, and methods have worked or not worked in the past.

The Tobacco-Free Take Action! (TFTA!) Ambassador Program was one approach to

increase policy compliance for a smoke-free campus. One component of the program aimed to

empower students to remind violators of the policy (Ickes et al., 2013). Their approach to the

issue helped reduce cigarette butts around campus hotspots and had a 68% positive response

among violators (Ickes et al., 2013). Based on the success of the TFTA! Ambassador Program,

CSUSB will incorporate some of the components of their program to develop a similar approach

where students working for the Student Health Center will talk to violators to encourage

adherence and promote the available resources on campus. One flaw of the TFTA! Ambassador

Program, was that students reported feeling undertrained when having to confront violators

(Ickes et al., 2013). For this reason, the Student Health Center will provide full training on how

to approach violators and what to say. Additionally, these students will also take on peer

educator roles.

The proposal requires the implementation of positive educational campaigns to raise

awareness of tobacco and the smoke-free policy. The educational component is critical to

behavior change as previous studies have highlighted that students who were exposed to tobacco

education were less likely to smoke than those who were not exposed to campus education
Running head: SMOKE-FREE CAMPUS PROPOSAL 4

(Borders et al., 2005). Emerging studies have looked at the relationship between health literacy

and health education. The article written by Nutbeam (2000) discusses health literacy as one of

the desirable outcomes for health promotion. Increasing health literacy has both individual and

community benefits; It has the capacity to increase program participation through improved

knowledge of risks and influence social norms. The context of such outcomes is dependent on

empowerment (Nutbeam, 2000).

To empower the study body, their involvement in the planning process is important to

identify perceived needs and get a sense of their current knowledge of tobacco. This also allows

for programs to be tailored to their needs to create relevant and engaging programs and

interventions. The idea of empowerment stems from allowing students to have their voice heard

by aiding in the development of the programs.

One approach to raise awareness of tobacco and its harmful effects is through public

service announcements (PSAs). PSAs are a visually appealing way to raise awareness and have a

call to action. The PSAs would be short (maximum length of one minute) so that students remain

interested and engaged. In addition to PSAs, infographics are another way of displaying the

consequences and risks of tobacco use in a visually appealing manner. Aside from marketing

material, campus resources such as cessation programs can be implemented by peer educators.

These peer educators will coordinate the cessation programs and create support groups (both in-

person and online). The online support groups takes into account peoples schedules to still

encourage participation even when schedules may conflict. The association between cessation

programs and health literacy is not well documented. However, few studies have shown that low

health literacy has resulted in undesirable smoking cessation outcomes (Stewart et al., 2013).
Running head: SMOKE-FREE CAMPUS PROPOSAL 5

Thus, increasing the health literacy of students can increase policy effectiveness with the

ultimate goal of reducing smoking rates among young adults.

While the proposal does not take effect until January 1, 2018, it is important to start the

educational and awareness efforts at least six months prior to the effective date. This will allow

enough time for campuses to inform students of the upcoming changes to have a smooth

transition once the policy is in effect. Promotion of the smoke-free proposal can include the use

of mass e-mails and text alerts to students to inform them about the new policy. Peer educators

can also post signs on current designated smoking areas and throughout campus. As stated on the

proposal, violators will be fined with the proceeds to be allocated for all educational and

awareness efforts that were previously discussed.

To conclude, further research is recommended to fully understand the impact of anti-

smoking policies on student smoking behaviors. Furthermore, additional research on new

approaches to reducing smoking rates on campuses is highly encouraged. Expanding the

literature on tobacco use especially among young adults in college can help guide health

professionals during the planning process to identify ideas and actions needed to work towards

reducing smoking rates with the sole purpose of meeting specific health goals for young adults

(ages 18-29). The ideas and actions suggested for the smoke-free campus proposal strives to

empower students, which in turn can create a sense of dedication to the overall health of the

campus to motivate others to adhere to the policy implemented by the bill and encourage a

healthier lifestyle rid of tobacco. Overall, implementing a smoke-free campus policy can

positively impact CSU and California Community College campuses by improving

environmental conditions by decreasing second-hand smoke exposure and increase health

literacy to enable a smoke-free lifestyle.

Running head: SMOKE-FREE CAMPUS PROPOSAL 6

References

Bennett, B. L., Deiner, M., & Pokhrel, P. (2017). College anti-smoking policies and student

smoking behavior: a review of the literature. Tobacco Induced Diseases, 15(1).

doi:10.1186/s12971-017-0117-z

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(1). doi:10.1186/1471-2458-5-74

Ickes, M. J., Hahn, E. J., McCann, M. and Kercmar, S. (2013), Tobacco-free Take Action!:

Increasing Policy Adherence on a College Campus. World Medical & Health Policy, 5:

4756. doi: 10.1002/wmh3.20

Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health

education and communication strategies into the 21st century. Health Promotion

International, 15(3), 259-267. doi:10.1093/heapro/15.3.259

Stewart, D. W., Adams, C. E., Cano, M. A., Correa-Fernndez, V., Li, Y., Waters, A. J., Vidrine,

J. I. (2013). Associations Between Health Literacy and Established Predictors of

Smoking Cessation. American Journal of Public Health, 103(7), e43e49.

http://doi.org/10.2105/AJPH.2012.301062