Tobacco-Free Colleges and Universities: A Wisconsin Guide

Transcription

1 Tobacco-Free Colleges and Universities: A Wisconsin Guide October 2012

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3 TABLE OF CONTENTS Introduction Section I. Tobacco and Trends 7 Other Tobacco and Nicotine Products 9 Health Effects of Tobacco Use 10 Young Adult Tobacco Use 11 Social Use of Tobacco 12 Marketing Tactics 13 Marketing to Disparate Populations 13 Tobacco on Campuses 15 Current State of Tobacco-Free College and University Policies 16 Tobacco-Free Campuses in Wisconsin 17 Section I. References Section I. Supplemental Resources Spark Survey Results YO Written Survey Summary YO Online Survey Summary WI OTP Survey Summary Tobacco and Trends Links Section II. Tobacco-Free Policy Adoption and Implementation 19 Campus-Specific Policy Solutions for Tobacco-Related Problems 19 Administrative Policies and College Campuses 19 Wisconsin s Statewide Smoke-Free Air Law 20 Other County or City Policies % Tobacco-Free Campus Policy 22 Phases of a Policy Initiative 22 Phase 1: Environmental Campus Scan 23 Phase 2: Tobacco-Free Policy Adoption 24 Phase 3: Tobacco-Free Policy Implementation 26 Cessation 29 Spark Sample Tobacco-Free Campus Policy 31 Section II. References 3

4 Section II. Supplemental Resources Spark Sample Tobacco-Free Campus Policy Spark Sample Survey Three Phases of a Tobacco-Free Campus Policy Spark Activity Matrix Spark Sample Petition Spark Sample Student Organization Introduction Letter Example Letter of Support from Community Spark Sample Implementation Plan Spark Sample Post-Implementation Letter to Neighbors Policy Adoption and Implementation Links Section III. Marketing and Communication Section III. Supplemental Resources Spark Message Map Spark Sample Letter to the Editor Spark Sample News Release Spark Tobacco-Free FAQ s Spark Sample Fliers Facebook Setup Spark Earned Media Guidance Example Tobacco-Free Signage Marketing and Communication Links Section IV. Spark Tools Section IV. Supplemental Resources Spark One-Pager Spark Other Tobacco Products (OTP) PowerPoint Presentation 2013 Spark Mini-Grant Application Materials In back pocket Spark Advocacy Guide Tobacco-Free Campus Video Card Spark Info Sheet Section V. Resources and Links Section V. Supplemental Resources Cessation Resources Spark Resource Links 4

5 Introduction Younger adult smokers have been the critical factor in the growth and decline of every major brand and company over the last 50 years. February 29, 1984, RJR Report, Young Adult Smokers: Strategies and Opportunities. The quote from the tobacco industry above demonstrates that it understands the importance of young adults to the industry s future growth and profits. Through its studies, the industry found that transition towards addiction isn t over when one is 18 it can continue up to the age of 25 (Hammond, 2005). Almost no one starts smoking after age 25. Nearly 9 out of 10 smokers started smoking by age 18, and 99% started by age 26. Progression from occasional to daily smoking almost always occurs by age 26 (Office of the Surgeon General, Preventing Tobacco Use among Youth and Young Adults, 2012). The findings from the Wisconsin Department of Health Services 2011 Behavioral Risk Factor Surveillance System show that 22.9% of year olds in Wisconsin reported themselves as smokers. Dual use, the use of smokeless tobacco products among current smokers, and a practice marketed heavily by the tobacco industry, is also an increasing trend. Making tobacco use a difficult choice on post-secondary campuses is one way we can work to reduce the harm and destruction caused by the tobacco industry. Tobacco-free policies can improve campus environments and aid students in making healthy choices that will positively impact them throughout their lifetimes. Spark, a Wisconsin-wide, state supported program, offers year olds an opportunity to educate peers, community leaders, and decision makers that tobacco is a threat to the health of all individuals. Spark s mission is to ignite change and reduce the deadly impact of tobacco by advocating for tobacco-free campuses and policy change surrounding tobacco issues. Spark helps college campuses pass tobacco-free policies and educates campus communities that tobacco in all its forms is a threat. More information about Spark can be found at sparkwi.org. As of October 2012, Spark has collaborated with campuses around Wisconsin to protect the health of almost 100,000 students, staff and faculty. The movement on campuses across the state and country to adopt tobacco-free policies is just that a movement! These campuses include public, private, and vocational schools. This guide, adapted with permission from the California Youth Advocacy Network (CYAN) College Advocacy Guide: Campaign Organizing on Campus (Vagadori, 2007) and the American Lung Association of the Upper Midwest s Guides to Tobacco-Free Colleges and Universities in Minnesota, Illinois and Iowa, is intended to educate and assist campuses who are on the path to becoming part of this movement by adopting a tobacco-free policy. Spark stands ready to partner with campuses by sharing the tools and resources and providing lessons learned, modeling policy language, and offering compliance and enforcement tips. 5

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7 Section I. Tobacco and Trends Tobacco-free policies are rooted in research-based evidence that indicates tobacco is harmful. According to the United States Centers for Disease Control and Prevention (CDC), tobacco use is the single most preventable cause of disease, disability, and death in the United States. For the purpose of this guide, Spark s definition of tobacco includes any lighted or unlighted cigarettes, cigars, cigarillos, pipes, hookahs, and any other smoking product. This also includes smokeless, spit or spitless, dissolvable, or inhaled tobacco products, including but not limited to dip, chew, snuff, snus, or tobacco in any form (orbs, sticks, pellet, etc.). Spark s recommended policy also prohibits nicotine products that are not approved as smoking cessation products by the Food and Drug Administration (FDA) such as e-cigarettes. Other Tobacco and Nicotine Products For years, generations have understood the harm that cigarettes and smoking can cause. However, cigarettes are not the only form of tobacco that people use. Other inhaled and smokeless tobacco products are becoming increasingly popular, as tobacco companies create new forms of smokeless tobacco designed to circumvent successful smoke-free laws. Smokeless Tobacco Products The two traditional types of smokeless tobacco in the United States are chewing tobacco and snuff. Chewing tobacco comes in a variety of forms, including loose leaf, plugs, or twists (rolls). Snuff is finely ground tobacco that can be dry, moist, or packaged in sachets. Smokeless tobacco products are now also available in new forms. Snus, a form of moist snuff, is widely available in Wisconsin. Dissolvable tobacco products such as lozenges, orbs, sticks, and strips are being test marketed nationally. These novel smokeless products are Photo credit: available in a range of flavors, which research suggests makes them more attractive to young people. These products may be more appealing to young people and women than traditional smokeless tobacco products because they do not require spitting and can be used discreetly. In addition, the packaging and appearance of these products, some of which look like breath mints, may also lead users to believe that they are harmless and may even disguise the fact that they contain tobacco (CDC Congressional Testimony, 2010). 7

8 Little Cigars One reason youth cigar smoking rates are high is because cigars are being marketed in a range of youth-attracting flavors, such as candy, fruit, and chocolate (Lewis & Wackowski, 2006). For example, Swisher Sweets products, including cigarillos and blunts, come in flavors such as chocolate and strawberry, and Phillies Sugarillo Cigarillos have been advertised with the tagline, when sweet isn t enough. These products are inexpensive and flavored, appealing to youth. National survey data show that Phillies and Swisher Sweets are among the most popular cigar brands among youth ages (Substance Abuse and Mental Health Services Administration, 2011). The most recent Surgeon General s report, Preventing Tobacco Use among Youth and Young Adults, highlights the need to address flavored cigars, particularly because cigar manufacturers have manipulated flavored cigarettes, reformatting them as flavored cigars to circumvent the ban on flavored cigarettes in the Family Smoking Prevention and Tobacco Control Act (Office of the Surgeon General, Preventing Tobacco Use among Youth and Young Adults, 2012). The inaccurate belief that cigars are much less harmful than cigarettes is also part of the problem (Campaign for Tobacco Free Kids, The Rise of Cigars and Cigar-Smoking Harms, 2012). Interviews with college students, for example, found that some smoked little cigars because they believed they were less addictive and less harmful than cigarettes (Jolly, 2008). Hookahs Hookahs sometimes called water pipes are used to smoke specially made tobacco that is available in a variety of flavors (e.g., apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon). Hookah smoking is typically practiced in groups, with the same mouthpiece passed from person to person. Water pipe smoking delivers the addictive drug nicotine and is at least as toxic as cigarette smoke. Due to the mode of smoking including frequency and depth of inhalation, and length of the smoking session hookah smokers may actually absorb higher concentrations of the same toxins found in cigarette smoke. Hookah smoking is most common in the Unites States among young adults ages Estimates of hookah use among college students over the past month and lifetime range from 9.5% to 20.4% and 41% to 48%, respectively. Hookah smoking may serve as a bridge to other forms of tobacco use and, like little cigars, is falsely perceived as less harmful than cigarette smoking (American Lung Association, A Growing Threat to Public Health, 2012). Electronic Cigarettes Electronic cigarettes, or e-cigarettes, come in a variety of shapes and flavors. Some look like cigarettes, pipes, or cigars, while others are disguised as pens or other harmless items. Whatever their shape, they all incorporate a batteryoperated heating element, a replaceable cartridge that contains nicotine and other chemicals, and an atomizer that converts the chemicals into an inhalable vapor. Photo credit: A Guide to Tobacco-Free Colleges and Universities in Minnesota 8

9 The dose of nicotine delivered with each puff may vary substantially by brand and model. One FDA analysis recorded nicotine doses ranging between 26.8 and 43.2 micrograms per puff. It also detected nicotine in products labeled as nicotine-free. Electronic cigarettes also deliver an array of other chemicals, including diethylene glycol (a highly toxic substance found in industrial solvents and anti-freeze), various nitrosamines (powerful carcinogens found in tobacco), and at least four other chemicals suspected of being harmful to humans. In addition, by simulating the cigarette smoking experience, electronic cigarettes might reactivate the habit in ex-smokers. They could also be a gateway into tobacco abuse for young people who are not yet hooked (Simon, 2011). Despite their growing popularity, electronic cigarettes have not been proven to be a safe alternative to smoking nor an FDAapproved method to stop smoking. Dual Use Traditionally, cigarette smokers and smokeless tobacco users were fairly distinct groups. However, in recent years there appears to be a trend developing toward dual use of these products. Patterns of smokeless tobacco use across several national surveys indicate that a large proportion of smokeless tobacco users are also smoking cigarettes. This pattern of dual use is more common among adolescents and young adults than among older Americans (CDC Congressional Testimony, 2010). An analysis of data from CDC s Behavioral Risk Factor Surveillance System from 10 states found that 26% of adult male smokers used another tobacco product in addition to cigarettes, particularly smokeless tobacco. The proportion of adult smokers using other tobacco products was twice as high among 18 to 29 year olds as among those 45 years and older (CDC Congressional Testimony, 2010). Health Effects of Tobacco Use Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke and another 8.6 million live with a serious illness caused by smoking. Despite these risks, approximately 46.6 million U.S. adults smoke cigarettes (CDC, Tobacco: Targeting the Nation s Leading KillerAt A Glance, 2011). In Wisconsin, smoking causes more than 7,200 deaths annually. Smokeless tobacco, cigars, and pipes also have deadly consequences, including lung, larynx, esophageal, and oral cancers. Smokeless tobacco can cause cancer, oral health problems, and nicotine addiction (CDC, Smokeless Tobacco Facts, 2011). Hookah smokers are at risk for the same kinds of diseases as those caused by cigarette smoking, including oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function, and decreased fertility (CDC, Smoking and Tobacco Use, 2011). In Wisconsin, smoking causes more than 7,200 deaths annually and costs nearly $2.02 billion in direct healthcare costs. 830,300 Wisconsinites still smoke and smoking-related 9

10 disease and death impact not only the smokers but their families and loved ones as well (Campaign for Tobacco Free Kids, 2012). The harmful effects of smoking do not end with the smoker. An estimated 88 million nonsmoking Americans are exposed to secondhand smoke. Even brief exposure can be dangerous because nonsmokers inhale the same poisons in cigarette smoke as smokers. Secondhand smoke exposure causes serious disease and even death including heart disease and lung cancer in nonsmoking adults and sudden infant death syndrome (SIDS), acute respiratory and ear infections, and more frequent and severe asthma attacks in children. Each year, an estimated 3,000 nonsmoking Americans die of lung cancer and more than 46,000 die of heart disease due to exposure to secondhand smoke, (CDC, Tobacco: Targeting the Nation s Leading Killer At a Glance, 2012). Young Adult Tobacco Use The historical norm of people starting to smoke before the age of 18 is slowly changing. Among individuals who started using tobacco before 18, regular or daily smoking was not established until the ages of 20 or 21. Internal tobacco industry documents support this conclusion but argue that the transition from an experimental to confirmed smoker can occur up to the age of 25 (Green, 2007). An internal memo from R. J. Reynolds Tobacco Company researcher Diane Burrows dated February 29, 1984, states, Younger adult smokers have been the critical factor in the growth and decline of every major brand and company over the last 50 years. If young adults turn away from smoking, the industry will decline, just as a population which does not give birth will eventually decline. Young adults ages 18 to 25 have the highest rate of current use of a tobacco product. Smoking patterns continue to change and evolve during the transition from adolescence to adulthood and the tobacco industry knows this. An industry document states, The ten years following the teenage years is the period during which average daily consumption per smoker increases to the average adult level. The overall success for tobacco prevention in the future depends in part on reaching young adults (Rode, 2011). For decades, the tobacco industry has heavily and successfully targeted the young adult population in its marketing. The industry s increased focus on 18 to 24 year olds came quickly after the signing of a multi-state tobacco settlement in 1998, known as the Master Settlement Agreement (MSA). As a part of the MSA, the participating tobacco companies publicly agreed to change the way they marketed and advertised their products. Specifically, they agreed to no longer target youth under the age of 18 (Vagadori, 2007). This led to an increase in marketing to young adults. As a result of intense industry marketing, occasional and daily tobacco use among young adults increased in the 1990 s. A 2000 Harvard study found that between 1993 and 1997, cigarette smoking prevalence increased 28% among college students in the U.S. (Rigotti, 10

11 2000). A 2010 National Survey on Drug Use and Health conducted by the U.S. Department of Health and Human Services revealed that young adults ages 18 to 25 had the highest rate of current use of a tobacco product (40.8%) compared with youths ages 12 to 17 and adults ages 26 or older (10.7% and 27.2%, respectively). Young adults had the highest usage rates of each of the specific tobacco products as well. In 2010, the rates of past month use among young adults were 34.2% for cigarettes, 11.2% for cigars, 6.4% for smokeless tobacco, and 1.8% for pipe tobacco (Substance Abuse and Mental Health Services Administration, 2011). In Wisconsin, dual use has been documented as an issue of concern with the young adult population. A convenience-sample survey conducted at the University of Wisconsin- Whitewater shows students who are using tobacco products are not just using cigarettes but many other tobacco products as well (University of Wisconsin Whitewater, 2011). Social Use of Tobacco Over the last few years, researchers have found young adults are more likely to be occasional users of tobacco than any other segment of the population. The college years have been identified as a time of increased risk for smoking initiation and transition into regular tobacco use. College is a time of introduction into a world full of different social experiences that may include tobacco use and drinking. These years also present situations that are outside the daily structure and routines of young adults, including stress, boredom, and socialization. These unstructured situations provide college students with opportunities to experiment with tobacco or increase current use of tobacco products (Green, 2007). One particular population of interest to researchers is occasional smokers. Identifying Items distributed to women at Camel No. 9 promotional parties include wristbands, berry lip balm, and jeweled lighters. Photo credit: why these young people smoke, when they smoke, where they smoke, and who they smoke with is a priority. One common finding among researchers is that nondaily tobacco users do not consider themselves to be smokers (Levinson, 2007). This finding is an alarming misperception. Many young people believe it is socially acceptable to use tobacco and there is no harm associated with it (Murphy-Hoefner, 2004). Young adult smokers, both daily and nondaily smokers, consider themselves to be in control of their use, and feel they can quit using tobacco at any time (Moran, 2004). Unknowingly, young adults who use tobacco, even occasionally, are more likely to develop long-term addiction (Levinson, 2007). 11

12 The social environment is an important factor in cigarette smoking. Social context has been shown to be an important factor in the initiation of smoking, as well as becoming an established smoker. Tobacco industry researchers place great emphasis on how social environments can encourage increased consumption of cigarettes because social activities are of great importance to young adults. Therefore, the tobacco companies target social environments attended by young adults. Marketing Tactics Make no mistake about it: tobacco companies are investing millions of dollars researching how best to appeal to young adults. On campus, that may include product marketing (e.g., Marlboro) and company marketing (e.g., Philip Morris). Product marketing may occur at campus-sponsored events such as fraternity and athletic events that are not sanctioned by the National Collegiate Athletic Association (NCAA). Company marketing may occur at career fairs, as well as department/school events. Tobacco companies host local events in community and private venues to promote their products through the free distribution of tobacco products, coupons, and other giveaways such as shot glasses, T-shirts, and other promotional items. In many cases, the companies will forge relationships with bar owners and offer financial stipends to ensure their ability to sponsor events at their establishments. In addition, tobacco companies often hire local people to attend these sponsored bar nights, community events, and student parties to distribute free products and promotional items. Bar and club promotions provide the tobacco industry an age-restricted environment to advertise their products. Alcohol use at bars may reduce inhibitions making tobacco use more likely. Students who are current smokers, former smokers, never smokers, or social smokers are more likely to use tobacco while consuming alchohol (Gilipin, 2005). Attendance at tobacco industry sponsored events is associated with a higher smoking prevalence among college students. Promotional events may encourage the initiation or the progression of tobacco use among college students who are not smoking regularly when they enter college (Sepe, 2002). Tobacco companies have created young adult friendly websites that offer opportunities to customize cigarette packs, enter contests, listen to free music from independent artists, and learn where and when future bar, nightclub, and music events will be held. The companies also use the websites to collect personal information about individuals who visit their sites for future marketing efforts. 12

13 Tobacco companies also have a strong presence on social networking sites such as Facebook and Twitter. In these forums they can interact with updates, photos, links, and applications. The companies have access to all the information the individuals interacting with their pages have on their profiles. Marketing to Disparate Populations Certain tobacco products are advertised and promoted disproportionately in communities of color. African American communities in particular are bombarded with cigarette advertising. For example, expenditures for magazine advertising of mentholated cigarettes, popular with African Americans, increased from 13% of total advertising expenditures in 1998 to 49% in 2005 (Connoly, 2007). Cigarette brands such as Rio, Dorado, and American Spirit are marketed toward Hispanics, American Indians, and Alaska Natives (Office of the Surgeon General, Tobacco Use among U.S. Racial/Ethnic Minority Groups, 1998). Similar to the strategy used for racial and ethnic populations, the tobacco industry couples advertising efforts to the LGBT community with donations to events and organizations, especially HIV/AIDS-related charities, which helps create goodwill toward their companies and foster brand loyalty(lgbt Tobacco Treatment Fact Sheet, 2009). Photo credit: Tobacco on Campuses Tobacco may be found in many different forms on college campuses. It can be seen as a lit tobacco product, wandering secondhand smoke, cigarette litter, or a tobacco company sign at a sporting event. Tobacco may also be sold in the campus bookstore or distributed at a fraternity event. Whatever the form, tobacco affects campuses in a number of different, but comparably dangerous ways. 13

14 In recent years, tobacco companies have increased their presence on campus through partnerships and financial support of colleges and universities. Colleges may welcome these partnerships as increasing fees and budget cuts persist. Since tobacco products are legal, campus administrations may view them as an unlimited source of financial support, not recognizing the conflict in accepting their support. Tobacco companies also rely on these partnerships with colleges and universities to improve public credibility and promote their products to a captive audience. After years of litigation and the increased presence of a powerful tobacco control movement, the tobacco industry must improve its public image and continue to recruit new tobacco users in order to make profits and appease their stakeholders. College campuses are opportune places for the industry to accomplish these goals. When developing tobacco-free campus policies, it is important to consider all the places the tobacco industry tries to infiltrate a college campus. A comprehensive 100% tobacco-free policy should address tobacco use and sponsorship in the following areas. Tobacco may be found in many different forms on college campuses. Indoors - Wisconsin state law prohibits smoking in workplaces and public buildings; however, the law does not apply to smokeless tobacco products. If no policy exists, use of smokeless tobacco products may still be allowed in campus buildings. Residential Halls - Wisconsin s smoke-free indoor air law applies to all campus-owned, residential housing. This includes smoking products, but not smokeless tobacco use. Offcampus or non-university student apartment owners and managers may create their own tobacco- and smoke-free policies. Outdoors - Unless a campus has a restrictive outdoor smoke-free policy, tobacco use is generally allowed anywhere outdoors with a few, specific exceptions. State law prohibits outdoor smoking within 25 feet of all residential halls under University of Wisconsin control. Smoking is also prohibited in sports arenas and bus shelters. Chapters 17 and 18 of the UW-Board of Regents Administrative Code state that no person may smoke in any residence hall or other university-owned or university-leased housing, or in any location that is 25 feet or less from such resident hall or housing. Campus administration of both public and private institutions may specify additional rules regarding other outdoor areas. Retail Sale - Wisconsin state statutes require obtaining a tobacco retail license from the local municipality in order to sell tobacco products. Campus Publications - Tobacco companies sometimes advertise for events they are hosting or sponsoring. Policies prohibiting advertising by the tobacco industry should address advertisements by the tobacco industry and other tobacco retailers such as tobacco shops and hookah establishments. Clubs and Organizations - Tobacco companies may attempt to sponsor student clubs and organizations by providing financial support, as well as product samples. 14

15 Athletics - Campus athletic teams and clubs not considered part of the NCAA sometimes allow tobacco industry advertising and marketing at sporting events. NCAA athletes and coaches are prohibited from using tobacco during practice and competition and Wisconsin s smoke-free air law prohibits smoking in athletic arenas and stadiums. Club teams need to establish guidelines governing tobacco use during their events. Performing Arts - Tobacco companies sometimes support national performing arts groups and events, such as art exhibits and dance troupes. While these groups are not directly affiliated with college campuses, many of their events are held on college campuses. Smoking is not permitted in the theater or gallery, even as a part of the production. Career Fairs - Tobacco companies often attend campus career and job fairs throughout the academic year to recruit entry-level employees. Company representatives also host private information and interview sessions on campus. Departments/Schools - The tobacco industry sometimes offers gifts or grants to departments or schools on campus. These can range in size from one or two thousand dollars to millions of dollars. Research grants, contracts, or fellowships may be offered to university faculty to conduct tobacco-related research. In return, the tobacco industry attempts to establish a relationship with the campus. Portfolios - Colleges sometimes invest in tobacco companies through their endowments and foundations. Most educational institutions own some tobacco stock. The evolving relationship between colleges and tobacco companies represents a troubling trend for college campuses. This trend, coupled with an increase in tobacco use among young adults and an increasing concern over secondhand smoke exposure, makes college campuses ideal locations to fight tobacco use and the tobacco industry. A 100% tobacco free policy is the best defense to ensure the health and wellbeing of the entire campus community. Current State of Tobacco-Free College and University Policies The American College Health Association (ACHA) has adopted a NO TOBACCO USE policy and encourages colleges and universities to be diligent in their efforts to achieve a 100% indoor and outdoor campus-wide tobacco-free environment. In September 2012, the U.S. Department of Health and Human Services together with tobacco policy experts and educational leaders, announced the national Tobacco-Free College Campus Initiative. More information about this initiative can be found at Currently over 300 colleges and universities have passed policies that prohibit the use of all forms of tobacco everywhere on campus (i.e., no designated smoking areas) (American Lung Association, Colleges and Universities with 100% Tobacco-Free Campus Policies, 2012). Wisconsin continues to build momentum toward establishing tobacco-free policies at colleges and universities across the state. As of October 2012, 16 institutions of higher education in Wisconsin, encompassing over 57 campuses, have adopted tobacco-free policies, with many more in some stage of discussion and/or policy development. 15

16 Tobacco-Free Campuses in Wisconsin Alverno College Bellin College of Nursing Carroll University Chippewa Valley Technical College (9 locations) Gateway Technical College (8 locations) Madison College (9 locations) Marian University (7 locations) Medical College of Wisconsin Moraine Park Technical College (3 locations) Nicolet College (3 locations) Western Technical College (6 locations) University of Wisconsin-Baraboo/Sauk County University of Wisconsin Schools of Medicine & Public Health, Nursing and Pharmacy University of Wisconsin-Stout Waukesha County Technical College (3 locations) Wisconsin Indianhead Technical College- Superior b9a440d609a30341e&msa=0 16

17 Section I References American Lung Association. (Updated 2012, June). Colleges and Universities with 100% tobacco-free campus policies. Retrieved October 12, 2012, from American Lung Association: American Lung Association. A growing threat to public health. Retrieved September 11, 2012, from American Lung Association: Campaign for Tobacco Free Kids. (2012). The rise of cigars and cigar-smoking harms: Campaign for Tobacco Free Kids. (2012). The toll of tobacco in Wisconsin: CDC Congressional Testimony. (2010, June 1). Retrieved December 22, 2011, from Centers for Disease Control and Prevention: CDC Smoking and tobacco use: hookahs. (2011, August 22). Retrieved December 22, 2011, from Centers for Disease Control and Prevention: CDC Smoking & tobacco use: smokeless tobacco facts. Retrieved October 16, 2012, from Centers for Disease Control and Prevention: htm CDC Tobacco use: Targeting the nation s leading killer at a glance Retrieved October 16, 2012, from Centers for Disease Control and Prevention: Connoly, G. (2007). Testimony before the Senate HELP Committee. Gilipin, E. W. (2005). How effective are tobacco industry bar and club marketing efforts in reaching young adults? Tobacco Control, 14, Green, M. P. (2007). A closer look at somking among young adults: Where tobacco control should focus its attention. American Journal of Public Health, 97, Hammond, D. (2005). Smoking behavior among young adults: Beyond youth prevention. Tobacco Control, 14, Jolly, D. H. (2008). Exploring the use of little cigars by students at a historically black university. Preventing Chronic Disease, 5 (3),

18 Levinson, A. H. (2007). Smoking, but not smokers: Identity among college students who smoke cigarettes. Nicotine & Tobacco Reasearch, 9, Lewis, M., & Wackowski, O. (2006). Dealing with an innovative industry: A look at flavored cigarettes promoted by mainstream brands. American Journal of Public Health, 96 (2), LGBT Tobacco Treatment Fact Sheet. (2009). Retrieved December 11, 2009, from National LGBT Tobacco Control Network: Moran S, W. H. (2004). Social smoking among US college students. Pediatrics, 114 (4), Murphy-Hoefner, R. A. (2004). Perceptions about cigarette smoking and risks among college students. Nicotine & Tobacco Research, 6, S371-S374. Office of the Surgeon General. (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Retrieved October 12, 2012, from the Office of the Surgeon General: Office of the Surgeon General. (2012). Tobacco use among U.S. racial/ethnic minority groups Retrieved October 25, 2012, from the Office of the Surgeon General: Rigotti, N. L. (2000). US College students' use of tobacco products: Results of a national survey. Journal of American Medical Association, 284, Rode, P. (2011). Tobacco use among college and non-college young adults: A work in progress. St. Paul, MN: Minnesota Department of Health. Sepe, E. L. (2002). Smooth moves: Bar and nightclub tobacco promotions that target young adults. American Journal of Public Health, 92, Simon, H. (2011, September 22). Electronic cigarettes: help or hazard? Retrieved January 9, 2012, from Harvard Health Blog: Substance Abuse and Mental Health Services Administration. (2011). Results from the 2010 national survey on drug use and health: Summary of national indings. Rockville, MD: Substance Abuse and Mental Health Services Administration. University of Wisconsin Whitewater. (2011). Tobacco-Free Campus Interest Survey. Retrieved October 12, 2012 from web site: Vagadori, K. H. (2007). College Advocacy Guide: campaign organizing on campus. California Youth Advocacy Network. Sacramento, CA. 18

19 II. Tobacco-Free Policy Adoption and Implementation Campus-Specific Policy Solutions for Tobacco-Related Problems Past policy efforts have focused on two objectives: 1) reducing tobacco use and 2) decreasing secondhand smoke exposure on campus. These objectives resulted in campus advocacy efforts concentrated specifically on smoke-free policy initiatives. Since then, campus advocates have begun to recognize other tobacco-related problems on campus. This recognition has sparked an increase in overall tobacco prevention and 100% tobacco-free policy initiatives. Comprehensive tobacco-free policies discourage all tobacco use and prevent tobacco companies from influencing college communities. Since no two college campuses are identical, policy initiatives must be specially developed to address each one s unique needs and priorities. Local colleges and universities are defined by their distinct governing processes, communities, environments, and locations. In addition, tobacco issues differ from campus to campus. Thus, it is important to understand the issues specific to a particular campus before moving forward. Administrative Policies and College Campuses Administrative polices are the most common types of rules that guide the behaviors and activities on college campuses. The state legislature has granted the governing bodies of public institutions the authority to set policies for their campuses. Private institutions can also adopt tobacco-related administrative policies per the guidance of their campus leadership and decision makers. There may be a number of different methods to adopt tobacco-related policies. For the most part, campus-wide policies are determined by the campus administration. However, some policies may be passed at a system level. Wisconsin s Statewide Smoke-Free Air Law Universities and colleges can create their own policies that build upon and strengthen existing laws, further protecting their students, faculty, staff, and guests. The Wisconsin Legislature enacted 2009 Wisconsin Act 12 (Wisconsin Legislative Council, 2009), which took effect on July 5, Information about the state law is available at 19

20 wibettersmokefree.com. The law states that smoking is prohibited in virtually all indoor public places and indoor places of employment, including: State Capitol and immediate vicinity Residence halls of colleges and universities Day care centers and outside of a day care center when children are present Educational facilities Correctional facilities (and on the grounds of juvenile correction facilities) State institutions (mental health, developmentally disabled persons) All restaurants and taverns All retail establishments All bowling centers All skating rinks Private clubs (any facility used by an organization that limits membership and is organized for recreational, social, political etc. purposes) Common areas of multi unit residential properties Hotels, motels, bed & breakfasts, and tourist rooming houses All municipal buildings A reasonable distance from smoke free places and entrances Sports Arenas of all kinds including Lambeau Field, Miller Park, gymnasiums, & swimming pools (whether or not they fit the definition of an enclosed space) Bus shelters, public transit Health and medical centers including hospitals, physician s offices, treatment centers Inpatient health care facilities (county home, nursing homes, hospice, veteran s home) Theaters All other enclosed places other than list above that are places of employment or public places Other County or City Policies Some colleges and universities in Wisconsin also may be impacted by local policies that further restrict tobacco-use. Campuses should be aware of these policies and any upcoming tobacco-free initiatives in the municipalities where their campuses are located, as they may provide opportunities for combining efforts such as message sharing, media campaigns, signage, etc. 100% Tobacco-Free Campus Policy A 100% tobacco-free campus policy is the Spark standard. Smoke-free or tobacco-free what s the difference? While smokefree and tobacco-free policies share many similarities, they also are significantly different. A smoke-free policy strictly addresses smoking; whereas a tobacco-free policy addresses all tobacco use (e.g., chew, snuff, snus, etc.). In Wisconsin, most campuses are following the national trend to enact 100% tobacco-free policies. 20

21 Comprehensive 100% tobacco-free policies are easier to communicate and enforce and have many advantages over other types of smoke- or tobacco-free policies including: Providing complete protection from secondhand smoke exposure while on campus Setting a clear boundary on where smoking and/or tobacco use is permitted or not permitted Reducing cigarette butt and other tobacco product litter on campus grounds Combatting the dual use tobacco trend among young adults The chart that follows lists outdoor smoking-related policies that institutions have used in the past and illustrates the challenges with each. Outdoor Policy and Exceptions Entryway or perimeter policy where smoking is prohibited within X-feet from entryways or buildings but allowed elsewhere Designated smoking areassmoking is prohibited on campus with the exception of designated smoking areas Smoke-free policy that prohibits smoking on campus with the exception of parking lots Smoking is prohibited on all campus property, including parking lots, but smokeless tobacco use is allowed Challenges Policy prohibits people from smoking near entryways only Policy does not safeguard secondhand smoke entering into windows and ventilation systems Difficult to enforce People are not aware of where they can and cannot smoke Difficult to encourage campus community to use designated areas during bad weather or if designated areas are located in a hard to reach parts of campus Allowing a designated smoking area sends a message that smoking is acceptable Difficult to enforce Policy difficult to comply with on larger campuses with extensive distances between campus buildings and parking lots Smoking only in parking lots may create safety concerns Campus buildings may border a parking lot thus increasing the likelihood that smoke from parking lots may enter building windows, doors, and ventilation systems Difficult to enforce Inconsistent policy implies other tobacco product use is not dangerous Not inclusive of tobacco products of all types Does not prioritize health messaging for all students, faculty, and staff Could lead to dual use of tobacco products Difficult to enforce 21

22 Phases of a Policy Initiative The most effective policies are well thought out, successfully implemented, and actively promoted. Spark has identified three phases in a tobacco-free policy initiative: 1) environmental campus scan, 2) tobacco-free policy adoption, and 3) tobacco-free policy implementation. Policy efforts focusing solely on adoption fail to ensure the effectiveness of a policy. Without successful implementation of a policy, it becomes just another policy few know about and may lead to low compliance. Policies have three phases: environmental campus scan, adoption, and implementation. Policy efforts focusing solely on adoption fail to ensure the effectiveness of a policy. Phase 1: Environmental Campus Scan Spark recommends the formation of a tobacco-free campus staff/student coalition to organize a campus assessment. Each campus needs to determine if it is ready to begin working toward a tobacco-free campus policy. The development of a tobacco-free campus initiative should begin with an assessment of the campus community and environment. Assessments are essential for understanding tobacco-related problems that exist on campus, possible solutions, and individuals and organizations that can support the efforts of the initiative and the processes for effecting change. Utilizing existing campus data makes it is possible to gain helpful information regarding tobacco use and attitudes toward tobacco use on campus and in the surrounding community. The percent of current and daily tobacco users among students, faculty, and staff and the percentage of students exposed to secondhand smoke on campus is critical information. Sources of data might include the College Student Health Survey, CORE Tobacco, Alcohol, and Other Drug Use Survey, and the National College Health Association Survey. The purpose of conducting assessments is not about the quantity of information collected but the quality of the information and the connections made along the way. The assessment phase should be considered a time to start building relationships with possible partners within the campus community as well as a time to gauge the campus environment and political climate. Throughout the process of collecting information, consider using a variety of methods to document problems and measure knowledge, attitudes, and beliefs. Some of the more commonly used methods of data collection include campus-based surveys, key informant interviews, and environmental scans. 22

23 Surveys Surveys can be used to collect information about who uses tobacco products, what types of products are used and how often, and where people use tobacco on campus. Surveys can also be initiated to collect data on people s beliefs and attitudes about tobacco use on campus, including student perception of tobacco use and campus support for tobaccorelated policies. Finally, surveys can be used to evaluate the campus community s knowledge of an existing campus tobacco policy (e.g., what percentage of the campus population knows where smoking is permitted on campus). These surveys can be easily and quickly completed and compiled using online surveying tools. Key Informant Interviews Key informant interviews are a useful way for collecting specific information from one or several individuals. A key informant interview is a conversation between two people with one person asking questions and the other providing responses. These interviews can take place over the phone or in person. On rare occasions, an interview can be conducted over ; however, may not be as effective, as it may be more time intensive for the interviewee and may result in the collection of inconclusive or unclear answers. Key informant interviews are also an effective way of learning who has worked on tobacco issues on a particular campus. These interviews can uncover what has been previously done on campus, roadblocks former advocates may have run into, and what advocacy efforts were successful on campus. Environmental Scans An environmental scan is a visual scan of your campus environment. Environmental scans can be done quickly and efficiently and are useful for collecting information on where tobacco is on campus (e.g., tobacco products in the bookstore, advertisements in the newspaper), where tobacco is used on campus (e.g., near entryways), and where tobacco products are disposed of on campus (e.g., cigarette litter in planter boxes). These scans can also be completed to learn more about the location of tobacco-free signage and disposal receptacles. The benefit of using an environmental scan is it can be done easily by one or more individuals. While doing an environmental scan, taking pictures can be useful to document findings. Once the assessments have been completed, the information should be efficiently organized to review the findings and identify the most pressing issues on campus as well as consider if any of the problems relate to one another. The information should then be compiled into a presentation to share with administration and other parties with influence to move the tobacco-free policy forward. Phase 2: Tobacco-Free Policy Adoption The development and adoption of a policy depends on the procedures and processes of the campus and its administration. The Spark sample policy can be used as a starting point in establishing 100% tobacco-free policy language. Once the policy language is determined the coalition begins working to pass the proposed policy. It is important to maintain 23

24 momentum of group members and campus networks in this stage. Reaching out to campus/community media sources is crucial in promoting the need for a tobacco-free campus and urging campus leaders to take action. The appointment of a policy workgroup is a good way to ensure representation from all of the various campus constituencies. Broad representation of campus constituents helps ensure objectivity and credibility with the larger campus community. The scope of the work for the workgroup may vary depending on the campus It is important that the workgroup have broad campus representation. processes and protocols. It is important that there be clear guidance and expectations. Campus entities to consider for the workgroup: Administration Campus/Community Health Services Community Business Leaders Community Neighbors/Members Commuter Students Contractors Faculty, Academic Staff, and Classified Staff Senate Faculty/Staff in various academic disciplines Maintenance/Grounds Crew Multicultural Groups Residence Hall Association Residence Life Safety/Security Officers Student Affairs Student Athletics Student Organizations (may include but are not limited to): Environmental/Green Organizations Peer Health Educators Political Clubs Pre-Med/Nursing Club Religious Organizations Service Clubs Social Justice Clubs Sororities and Fraternities Sports Teams Student Senate Visitor Affairs Phase 3: Tobacco-Free Policy Implementation The information shared for Phase 3 has been revised from Helpful Hints to Create a Smoke-Free/Tobacco-Free Campus Policy. (University of Minnesota, 2011) Implementation of a new smoke-free or tobacco-free policy is essential to ensuring the success of the policy. This phase carries out the newly passed tobaccofree campus policy. In this stage it is important to focus on education, promotion, and compliance with the new policy. Education - Implementation activities include educating the campus community on the policy, updating or adding applicable signage, and revising policy language in written campus publications and websites (including campus catalogs, course schedules, and employee and student manuals). A key to successful implementation is education. If the campus community is educated on the policy, they are much more likely to comply with it. 24

25 Timing - Determine the best date for policy implementation. The passage date of the policy may not be the best date to begin. It is important to plan a smooth transition that will allow time to fully educate campus and community members. Choosing an implementation date that integrates with the academic calendar may be a good option (e.g., implementing a new tobacco-free policy at the start of the fall semester). If the policy was passed in early fall, the winter/spring semester might be a good time to start. Signage - Clear and consistent signage throughout campus is crucial to communicating a new policy. The locations, size, number, and cost of signs should be considered. Possible slogans (e.g., Tobacco-Free WITC or Fresh Air Everywhere UW-Eau Claire), graphics, and copy for the signs should also be addressed. Sample signs can be found in the resource section of this guide. Communication and Campus Outreach - Increasing awareness of the policy through adequate advance communication and throughout the implementation stage will increase compliance. Consistent branding on signage and other components of the communication plan will aid in community recognition of the policy. Some places to communicate policy information may include: Campus employment advertisements Campus stationary Campus tour scripts Contracts for campus room rentals s to students, faculty, staff, parents, and vendors/ contractors Press releases to local media to inform larger community and campus neighbors Programs for athletics, music, and theater Season ticket holder information Staff/faculty newsletters Student newspapers Student welcome packets Photo credit: WITC Superior A dedicated webpage to explain the new policy may be helpful. In addition to celebrating the passage of the new policy, the website can highlight the results of assessments and explain the rationale for the new or updated policy. It also may contain the actual wording of the new policy, the implementation timeline, a means for the campus community to provide feedback, and enforcement/non-compliance details. Compliance and Enforcement - Depending on the success of the policy implementation, enforcement may not be necessary. However, some enforcement may be needed after the policy has been implemented. It is important to include those individuals and organizations involved with enforcement in the development of the policy to determine the most effective and realistic plan for compliance and enforcement. 25

26 Expecting 100% compliance of a tobacco-free policy is probably not realistic. In most cases, this policy is addressing a change in social norms, which can take time. Because each campus environment is unique, colleges and universities have approached compliance and enforcement in many different ways. The campuses that are most successful usually integrate a proactive approach encouraging compliance, and a reactive approach consisting of policy enforcement for offenders. Strategies used to address non-compliance might include determining if additional signage is needed or meeting with non-compliant students or staff to review the policy. For repeat offenders, disciplinary action may be considered in accordance with student conduct guidelines or employee workplace policies. If campus police or security are involved in enforcing other policy infractions, it may be helpful to work with them in establishing a protocol that will be both effective and convenient for enforcing the tobacco-free policy. Students can be involved in reminding campus and community members about the tobacco-free policy as well. In the first days and weeks of a new tobacco-free policy, violations will likely be more frequent because it may take time for people to become educated and familiar with the restrictions of the new policy. With time and consistent enforcement, the campus community will become more compliant with the policy out of habit so enforcement will become less of an issue. Cessation The new tobacco-free policy may motivate some tobacco users to quit. Cessation services should be available to provide a means for both assisting tobacco users in overcoming their addiction and for advertising and promoting the new policy. An assessment should be made of current cessation services offered on campus and in the nearby community along with the services that students, staff, and faculty would like to have available and the findings considered in determining what gaps and opportunities exist. The most effective quit rates are shown when tobacco users access a combination of behavior modification and counseling along with nicotine replacement therapy (NRT) and/or other FDA approved medication. Cessation resources the campus might consider publicizing or offering should include: Ready to Quit? Cessation is a key component of successful tobacco-free campus policy implementation. process. Cessation Training: Identify individual(s) willing to participate in the American Lung Association s Freedom from Smoking (FFS) training or attend the Mayo Clinic Nicotine Dependence Center for training. Work with an existing or newly trained cessation counselor and administration to schedule dedicated time for individual and group counseling for students, staff, and faculty on campus. 26

27 Cessation Counseling Services: Integrate cessation services into student health services. Promote the Wisconsin Tobacco Quit Line (800-QUIT-NOW). Promote the American Lung Association s Lung Helpline (800- LUNG-USA). Become familiar with online cessation resources such as FFS Online. The most effective quit rates are shown when tobacco users access a combination of behavior modification and counseling along with nicotine replacement therapy and/or other FDA approved medication. Nicotine Replacement Therapy (NRT) and Quit Medication: Consult with staff at the university health services, local public health agencies, hospitals, or clinics for FDA approved cessation medication (some medications require a prescription from a health care provider). Insurance Coverage: Work with appropriate governing bodies to cover cessation services (i.e., counseling and medication) in all health insurance plans offered to students, staff, and faculty. In conjunction with the new policy, it is important to include cessation resources on informational brochures, posters, new student and employee handbooks, s, ads in campus publications, and on the school website. 27

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29 Spark is available to assist with all phases of campus tobacco-free policy development and implementation. The following is Spark s recommendation for 100% tobacco-free policy language. SPARK SAMPLE TOBACCO-FREE CAMPUS POLICY 1.0 INTRODUCTION The XYZ college/university acknowledges and supports the findings of the Surgeon General that tobacco use in any form, active and passive, is a significant health hazard. The XYZ college/university further recognizes that tobacco smoke has been classified as a Class-A carcinogen, a known cancer-causing agent. The American College Health Association has adopted a NO TOBACCO USE policy and encourages colleges and universities to be diligent in their efforts to achieve a 100% indoor and outdoor campus-wide tobacco-free environment (Position Statement on Tobacco on College and University Campuses, Nov. 2011). In light of these health risks and recommendations, and in support of a safe and healthy learning and working environment, the XYZ college will implement the following 100% tobacco-free campus policy on (INSERT DATE). 2.0 DEFINITIONS For the purposes of this policy, tobacco is defined to include any lighted or unlighted product containing tobacco, including cigarettes (clove, bidis, kreteks), cigars, cigarillos, pipes, hookah products, and any other smoking product. This also includes smokeless, spit or spitless, dissolvable, or inhaled tobacco products, including but not limited to: dip, chew, snuff or snus, in any form (orbs, sticks, pellet, etc.). Nicotine products not approved by the Food and Drug Administration (FDA) as a smoking cessation product, such as e-cigarettes, are also prohibited. 3.0 EXCEPTIONS Nicotine replacement products approved by the FDA (patches, gum, etc.) are allowed on campus to support those in the process of quitting. This policy does not apply to the practice of cultural activities by American Indians that are in accordance with the American Indian Religious Freedom Act, 42 USC, sections 1996 and 1996a. All ceremonial use exceptions must be approved in advance by the Facilities Services Department. 29

30 4.0 STATEMENT OF POLICY 4.1 Smoking or use of other tobacco products is prohibited on all campus grounds (including inside personal vehicles), college-owned or leased properties, and collegeowned, leased, or rented vehicles. This includes but is not limited to all college sidewalks, parking lots, landscaped areas, and recreational areas; and at lectures, conferences, meetings, and social and cultural events held on college property or grounds. Smoking or use of other tobacco products is also prohibited in the interior of all buildings, college residences, and dormitories. 4.2 This policy applies to all faculty, staff, students, clients, contractors, and visitors before, during, and after campus hours. 4.3 The XYZ college/university will not sell, market, or promote tobacco products. 4.4 All XYZ college/university staff and students are responsible for compliance and for advising visitors of the policy. 4.5 Violations will be handled like other work rule or policy violations. 30

31 Section II References American College Health Association.(2011, November) ACHA Guidelines, Position Statement on Tobacco on College and University Campuses. Retrieved from American College Health Association Web site: University of Minnesota. (2011) Healthy Campus Tobacco-Free, Helpful Hints to Create a Smoke-Free/Tobacco-Free Campus Policy. Retrieved from University of Minnesota Web site: Wisconsin Legislative Council. (2009, August 12). Wisconsin Legislative Council Information Memorandum. Retrieved April 18, 2012, from State Smoking Ban-Questions and Answers: Wisconsin's Statewide Smoke-free Air Law. (2010, May 10). Retrieved April 18, 2012, from tobwis: 31