The Tobacco-Free College Campus Initiative Making the Case for Your Campus Going Tobacco-Free Clifford E. Douglas, J.D. Director, University of Michigan Tobacco Research Network Lecturer, University of Michigan School of Public Health October 17, 2013 SC Tobacco-Free College and University Summit
Topics The tobacco epidemic: more work to do HHS leadership & TFCCI Acceleration of campus policies nationwide HBCUs A Regional Priority Why many campuses now go tobacco-free Effectiveness of campus policies Environmental benefits Economic benefits
AIDS Alcohol Car crashes Fires Heroin Homicide Cocaine Suicide
Each day, 1,200 Americans die from smoking Each smoker who dies is replaced by 2 young smokers 90% of all smokers start before age 18 99% of all smokers start before age 26
Acetone (solvent and paint stripper) Ammonia (poisonous gas and toilet bowl cleaner) Arsenic (potent ant poison) Benzene (poisonous toxin) Butane (flammable chemical in lighter fluid) Cadmium (carcinogenic chemical in batteries; lung & intestinal irritant) Carbon monoxide (poisonous gas in auto exhaust) Formaldehyde (dead frogs love it) Hydrogen cyanide (deadly ingredient in rat poison) Methanol (jet engine and rocket fuel) Polonium-210 (radioactive element and spy-killer) Toluene (poisonous industrial solvent)
One day s inhalations: 10 per cigarette x 20 cigarettes per day = 200 One year s inhalations = 200 inhalations x 365 days = 73,000 50 years of smoke (by the average smoker s mid-60s, if still alive) = 3.65 million inhalations on 365,000 cigarettes There is no safe level of tobacco use or exposure to secondhand smoke
24.8% of full-time college students aged 18-22 years old were current smokers in 2010 The number of smokers who initiated smoking after age 18 increased from 600,000 in 2002 to 1 million in 2010 Progression from occasional to daily smoking almost always occurs by age 26 Tobacco companies have carefully studied the attitudes and behaviors of young people, particularly as they go through life transitions, such as attending college.
College Students Projected Toll Based on current rates, it is predicted that more than 1 million current college students will die prematurely from tobacco use If young people don t start using tobacco by age 26, they almost certainly will never start. - Surgeon General Regina Benjamin
Historic New Commitment of the U.S. Department of Health and Human Services
Vision: Widespread expansion of tobacco-free policies to institutions of higher learning across the U.S. Goals: 1. Foster a collaborative, cooperative effort among academic institutions and partners in the public health community 2. Expand awareness in academia and among the public of the need for and benefits of such policies 3. Facilitate information flow and access to technical assistance
Lead Partners U.S. Department of Health and Human Services American College Health Association University of Michigan Sponsors American Legacy Foundation Americans for Nonsmokers Rights Campaign for Tobacco-Free Kids National Center for Tobacco Policy Other Partners (a few examples) American Lung Association The BACCHUS Network California Youth Advocacy Network (CYAN) Center for Social Gerontology (Smoke-Free Environments Law Project) Montana State University Partnership for Prevention State University of New York Upstate Medical University Tobacco Control Legal Consortium University of Kentucky
A Key Pillar of HHS s Tobacco Control Strategic Action Plan: Lead by Example ( Walk the Talk ) In July 2011, HHS established a comprehensive tobacco-free campus policy covering all indoor and outdoor properties The announcement stated: Taking this action will protect the health and safety of all HHS employees, contractors and visitors and will serve as a role model for workplaces everywhere Educational and promotional efforts will be provided in support of the policy s implementation. We know that quitting tobacco can be difficult for even the most motivated people, and we want to help employees succeed.
Acceleration of Campus Policies Nationwide
As of July 2013 1,178 campuses in U.S. are 100% smoke-free with no exemptions, including residential housing facilities (where applicable) Of those, 793 about two thirds have a 100% tobacco-free policy Examples of large campuses that have gone tobacco-free: University of California (all 10 campuses) City University of New York (all 24 campuses) Arizona State University University of Oregon University of Oklahoma University of Kentucky Montana State University University of Florida ( Gators don t chew. They chomp! ) Emory University Ohio State University Source: Americans for Nonsmokers Rights Foundation, http://www.no-smoke.org/pdf/smokefreecollegesuniversities.pdf
2012 775 colleges and universities had implemented 100% smoke-free campus policies 2013 1,178 colleges and universities had implemented 100% smoke-free campus policies
1400 1200 1000 800 600 400 200 0 Oct- 05 100% Smoke-Free Campuses Now
Opportunity The U.S. Department of Education identifies 4,583 colleges, universities and other institutions of higher learning in the U.S.
HBCUs A Regional Priority
47,000 African Americans die each year from smoking-related diseases Adult African American smoking prevalence rates are comparable to Whites, but African Americans have higher lung cancer rates 72 percent of African Americans are exposed to secondhand smoke African Americans are more likely to die from the three leading causes of smoking-related death Coronary heart disease Stroke Lung Cancer African American men are at least 50 percent more likely to develop lung cancer than white men
Tobacco-free campus policies need to reach the Historically Black Colleges & Universities (HBCUs) Of the 106 institutions classified as HBCUs, 19 are currently known to have 100% smoke-free or tobacco-free policies Region IV is the home of 64 HBCUs, thus the high priority for this region (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee) South Carolina has 8 of the HBCUs
Why Do Many Campuses Go Tobacco-Free?
Tobacco that is not burned (combusted) Traditional smokeless products *Chew ( spitting tobacco, placed between cheek and gums) *Snuff (dry snuff sniffed through nose; moist snuff, or dip, placed between cheek and gums) Snus (finely ground tobacco administered in small packets) New generation of products Dissolvables (lozenges, orbs, sticks, strips) E-cigarettes (not called smokeless tobacco, but are similarly not combusted, and the federal court system has ruled that, under the law, they are to be treated as tobacco products subject to regulation by the Food and Drug Administration) *Currently dominate the U.S. smokeless tobacco market
Addictive Not a safe alternative to cigarette smoking Most smokeless tobacco products contain carcinogens (at least 28 have been identified, and nitrosamine levels are higher in smokeless tobacco than in cigarettes) Most smokeless tobacco products cause oral, esophageal, and pancreatic cancer Use of these products causes gum recession, gum disease, and tooth loss Use also associated with greater risk of fatal heart attacks and stroke
After years of steady progress, declines in youth tobacco use have slowed for cigarette smoking and stalled for use of smokeless tobacco. The latest research shows that concurrent use of multiple tobacco products is common among young people, and suggest that smokeless tobacco use is increasing among White males. - Surgeon General s Report, 2012 There are approximately 8 million smokeless tobacco users in the U.S.
Tobacco industry promotes dual use Ads promote use of smokeless tobacco products not to replace cigarettes but as a way for smokers to satisfy addiction wherever they cannot smoke There is a need to clearly position the [smokeless tobacco] product as a situational substitute for cigarettes rather than a replacement. - R.J. Reynolds spokesman, 2009
(September 2013) We think consumption of e-cigs could surpass consumption of conventional cigs within the next decade. E-Cig Vs. Conventional Cig Volume E-Cig Vs. Conventional Cig Operating Profit Pool 16.0 20.0 Equivalent Pack Volume (in billions) 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 2011 2012 2013E 2014E 2015E 2016E 2017E 2018E 2019E 2020E 2021E 2022E 2023E Operating Profit Pool (in $ billions) 18.0 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 2011 2012 2013E 2014E 2015E 2016E 2017E 2018E 2019E 2020E 2021E 2022E 2023E E-Cigarettes (in equivalent packs) Conventional Cigarettes (in packs) E-Cigarettes Conventional Cigarettes Importantly, growth of the combined profit pool could accelerate in the next decade. We estimate total conventional & e-cig total profits will generate a CAGR of 7.2% over the next decade. Source for all charts: Company reports and Wells Fargo Securities, LLC estimates 29
A Final Note about E-Cigarettes Health issue is not e-cigarette s level of harmfulness compared to conventional cigarettes, but rather the risk it poses for public health irrespective of whether it is as bad as ordinary tobacco use If treated differently, implies acceptance of addiction to unregulated nicotine delivery products, complicating university s health mission Permitting e-cigs encourages dual usage (cigarettes and e-cigs) in lieu of cessation in some individuals who might otherwise quit Creates potential confusion regarding rules and mixed health message
There is no safe tobacco product, and the Initiative encourages adoption of comprehensive tobaccofree policies. It is also recognized that each institution must make its own decisions when it comes to promoting health and preventing disease in its students, faculty, employees and visitors. Tobacco-free policies go further in promoting a culture of health and wellness while reducing exposure to the variety of non-smoked forms of tobacco that cause cancer, heart disease and other serious illnesses.
Effectiveness of Campus Policies
Study compared undergraduates smoking behaviors and attitudes at two Big Ten campuses with similar demographics Purdue University (no policy) and Indiana University (tobacco-free policy implemented in 2008) Indiana University smoking prevalence: 16.5% in 2007; 12.8% in 2009 (-3.7) Purdue University smoking prevalence: 9.5% in 2007; 10.1% in 2009 (+0.6) Indiana University consumption rate: 6.6 cigs/day in 2007; 5.9 cigs/day in 2009 (-0.7) Purdue University consumption rate: 5.2 cigs/day in 2007; 6.8 cigs/day in 2009 (+1.6) Study also showed significant favorable change in attitudes among Indiana University students regarding elimination of smoking in public places and on university property Source: Dong-Chul Seo et al., The Effect of a Smoke-free Campus Policy on College Students Smoking Behavior and Attitudes, Preventive Medicine 2011;53:347-352.
89% of faculty/staff and 83% of students supported policy 72% of faculty/staff and 65% students noticed decrease of smoking on campus Smoking by faculty & staff dropped from 6% to 4% 29% of smokers reduced consumption 40% of smokers attempted to stop in last 12 months 22% of smokers participated in MHealthy Tobacco Independence Program 13% of faculty/staff reported the policy influenced them to quit or attempt to quit smoking 16% of students reported the policy influenced them to quit or attempt to quit smoking Source: University of Michigan, MHealthy & Smoking Declines After U-M Campus Ban, May 9, 2013
The University of Michigan in Perspective
Environmental Benefits
Cigarette butts = single most commonly collected waste item found each year in park and beach clean-ups, and not biodegradable Cigarette butts = 25-50% of all collected litter from roads and streets 5.6 trillion butts dumped into the global environment annually
Cigarette butts contain all of the carcinogenic (cancer-causing) chemicals, pesticides and nicotine that make tobacco use the leading cause of preventable death
Cigarette butt waste is the last socially acceptable form of littering in what has become an increasingly health and environmentally conscious world. We [must] find solutions for eliminating this especially toxic form of trash. - Cheryl Healton et al., Butt Really? The Environmental Impact of Cigarettes, Tobacco Control, May 2011 A study by the University of North Carolina at Chapel Hill, concluded that 77% fewer cigarette butts were found on county college campuses that adopted 100% smoke-free campus-wide policies.
Economic Benefits
Economic Benefits of Strong Campus Policies Reduced employee health care costs Reduced absenteeism Increased employee productivity Cost savings in grounds and building maintenance The costs of cleaning up this extensive pollution are borne entirely by communities and institutions, not tobacco manufacturers or their customers Reduced fire damage
There is no higher priority in public health than ending the tobacco epidemic. Dr. Howard Koh, Assistant Secretary for Health
Please visit us at: TobaccoFreeCampus.org