Role of College Health Services in Campus and Community Tobacco Control

Edward P. Ehlinger, MD, MSPH

Megan Whittet, MPH

Boynton Health Service

May 6, 2005

101 Years Ago May 6, 1904 American Lung Association held its first

meeting in Atlantic City, NJ.

1904   American Tobacco Company merged with its holding company, Continental Tobacco Co.

Sigmund Freud born on May 6, 1856

"The voice of the intellect is a soft one,

but it does not rest till it has gained a

hearing."

“Knowledge is the intellectual

manipulation of carefully verified

observations.”

“From error to error one discovers the

entire truth.”

History of Tobacco Control Activities at Boynton Health Service

Tobacco Use Trends in 1999University of Minnesota

Over ½ of first year students were current users of tobacco!

Tobacco use was increasing among males and females

Over half of tobacco users in college began using after age 18

Tobacco SummitTobacco Use

Among College and University StudentsApril 27, 2001

Tobacco Companies Marketing to 18-24 Year Olds In 1999 tobacco-product trade

promotions rose to $3.54 billion --

43% of the industry's advertising

budget.

An effective way to drive sales while

complying with marketing restrictions

imposed by a 1998 master

settlement agreement with 46 states.

John Steinbeck awarded the Pulitzer Prize for The Grapes of Wrath, May 6, 1940 “I know this – a man got to

do what he got to do.”

“Ideas are like rabbits. You

get a couple and learn how

to handle them, and pretty

soon you have a dozen.”

Agenda to address tobacco use by students Adopt a comprehensive approach

Work in collaboration with others in the

tobacco control community

Don’t try to do it all – alone.

Take a long-term perspective

Agenda to address tobacco use by students Make tobacco use by 18-24 year olds a priority issue Nationally Minnesota On Campus

Lobby for policy changes – on and off campus Smoke-free residence halls Sales on campus Smoke-free entrance policy Sponsorship policy Smoke-free workplaces

Agenda to address tobacco use by students Increase educational efforts

In clinical encounters focus attention on tobacco use

Initiate cessation program and increase demand for cessation

Develop state-wide network of post-secondary institutions

Develop counter marketing campaign

Wednesday, November 14th 2001 Minnesota Daily

Monday, November 19th 2001Minnesota Daily

Minnesota DailyDecember 5, 2001

Rebellion from Paternalism of Public Health

Matt Brophy, Columnist

“There is no reason for this ban…. Committees, no matter how benevolent they might deem themselves, should not be allowed to treat us like children. And, no matter how unsavory tobacco sales are to the University …, this does not justify trampling on the rights of students.”

Our freedom goes up in paternalistic smoke (12/6/00)

Make tobacco use by 18-24 year olds a priority issueNational CDC

Best Practices for Cessation for Youth and Young

Adults

Data analysis

CORE Institute Reanalyzed data from Core Surveys

Harvard Alcohol Study Expanded tobacco-related articles

Make tobacco use by 18-24 year olds a priority issueMinnesota MPAAT

Made 18-24 year olds a priority for funding Healthy Campus: Tobacco Free

Blue Cross/Blue Shield of Minnesota Made 18-24 year olds a priority Funded Tobacco Summit Increased collaboration

American Cancer Society RESIST and Tick Tock Campaign

MN Dept. of Health Adult Tobacco Survey

Make tobacco use by 18-24 year olds a priority issueOn Campus Tobacco control made a priority by Boynton

Health Service Data collection

Education

Clinical preventive services

Policy development

Cessation programs

Healthy Campus: Tobacco Free

Data Collection

Collaborate with MDH, MPAAT, and BC/BS of MN

on Adult Tobacco Survey

Continued regular collection of U of MN data

Collect additional information on ETS

Survey special populations – nursing students

Survey Twin Cities area colleges/universities

Metro Area College Survey

18 Schools being surveyed

2 and 4 year schools surveyed

20,000 students surveyed

Each school will have adequate sample for

their own use

Pre-smoke free ordinance data

Clinical Preventive Services Tobacco use as a vital sign Education of providers and nursing staff

about tobacco use and their importance in cessation

Educational materials Insurance coverage NRT and buproprion Referral to cessation counselor

Lobby for policy changeson and off campus

Smoke-free residence halls

Sales of tobacco on campus

Smoke-free entrance policy

Sponsorship by tobacco companies

Smoke-free workplaces

Cessation Programs

Cessation counselor Quit and Win

Quit and Win

810 smokers (and 810 smoke-

free buddies) enrolled

642 were daily smokers

11% of eligible smokers enrolled

32% of daily smokers enrolled

360 used NRT

Over 50% remained smoke-free

for the month of the campaign

Two- Year Project Grant Funded by: The Minnesota Partnership for

Action Against Tobacco (MPAAT)

August 2003-July 2005http://www.healthycampusmn.umn.edu

Advisory CommitteeThe Advisory Committee was formed at the beginning of the project.

The first committee meeting took place in late October 2003. Members

included: Student Representative from Minnesota Student Association Student Representative MN State University Student Association Student Representative MN Association of Private College Students Administrator Representative from MN State Colleges and Universities Administrator Representative from MN Private College Council Community Agency Representative from American Cancer Society Community Agency Representative Minnesota Department of Health Boynton Health Service and Healthy Campus: Tobacco-Free project staff Healthy Campus: Tobacco-Free outside project evaluator

Healthy Campus Network Initial invitation to 59 post-secondary institutions to join

the Healthy Campus Network- Nov. 2003

Initial invite brought 28 schools on board, with 50

Individual members (13 of which were students).

Currently, 44 schools in the Network (42 from MN, 1

from WI, and 1 from SD).

95 Individual members with 26 students

4 Community Agency members

Post-secondary Institution Tobacco Control Survey

Where are Minnesota’s Colleges and Universities with their tobacco control efforts?

December 2003- February 2004

Acknowledgements

This project was funded by the Minnesota Partnership forAction Against Tobacco. These findings are solely theresponsibility of the authors and do not necessarilyrepresent the official views of the Minnesota Partnership forAction Against Tobacco.

Data Collection Administrators at post-secondary institutions in Minnesota

o Mailed questionnaire to 66 Health Services Staff or Student Affairs Officers

o Received 54 surveys (82% response rate)o Private Colleges & Universities, 12/54 (22.2%) o Public Community and Technical College (2-Year), 30/54 (55.6%)o Public Universities (4-year), 12/54 (22.2%)

Student Body Presidents at post-secondary institutions in Minnesota

o Mailed questionnaire to 68 Student Body Presidentso Received 29 surveys (43% response rate)o Private Colleges & Universities, 14/29 (48.3%) o Public Community and Technical College (2-Year), 8/29 (27.6%)o Public Universities (4-year), 7/29 (24.1%)

Key Themes From Administrators Almost all of the Institutions have indoor tobacco polices

in place. These high percentages suggest that institutions are further along with indoor policies than originally thought.

The majority of administrators feel it is the responsibility of their college or university to make tobacco control a priority for their campus.

Compliance with smoke-free policies on campus was rated on the high end by administrators. Which is more receptive than people may anticipate it to be. Average Rate=7.78

Key Themes From Administrators Many administrators feel it is important to get a variety of

individuals involved on campus, including students, and also recognize local and state agencies as resources.

Almost half, 46.3% are offering treatment programs to students however, only 24.1% to faculty and staff. Of those offering programs 46.8% advertise to students.

Administrators accurately see how students view tobacco issues for their campus.

Lack of outdoor policies as well as written policies as they pertain to other tobacco control efforts on campus.

Indoor Smoking Policies on Campus…

0

20

40

60

80

100

GeneralIndoor

Policies*

StudentApartmentBuildings

CommonAreas ofResident

Halls

StudentUnions

CampusAthletic

Facilities

CampusEating Areas

CampusOwned

Vehicles

Indoor Policies

Perc

ent*

*

Don't Know

No

Yes

*General Indoor Policies Include: Resident Hall’s Student Rooms, Academic or Classroom Buildings, Campus Libraries, Computer Labs, & Faculty and Administrative Offices

**Some of the policies were not applicable for all respondents, percents are based on

applicable responses only.

Outdoor Smoking Policies on Campus…

0

20

40

60

80

100

Distance FromResidential Areas

Distance FromAcademicBuildings

OutdoorRecreational

Areas

Other

Outdoor Policies

Per

cent

*

Don't KnowNo Yes

*Some of the policies were not applicable for all respondents, percents are based on applicable responses only.

Distance ranged from 5-90 feet

Institutional written policies on prohibiting…

0102030405060708090

100Per

cent

*

Job recruitmentfrom tobacco

industry

Tobacco Ads Sponsorship fromtobacco industry

Investment/ stockownership in

tobacco industry

Written Policies

YesNoDon't Know

*Some of the policies were not applicable for all respondents, percents are based on applicable responses only.

Sell Tobacco on Campus?

0102030405060708090

100

Written PolicyBanning

Tobacco Sales

Sell TobaccoOn Campus

Per

cent

Don't KnowNoYes

Administrators feel that tobacco control should be a priority on campus!

13

50

33.3

0

20

40

60

80

100

5 to 6 7 to 8 9 to 10

Rating*

Per

cent

*Rating based on a 1-10 scale (10 being the highest)

Average Rate= 7.98

Key Themes from Student Body Leaders Top tobacco issues on campus include: smoking in front of

building entrances, having a designated place to smoke on

campus, and proper disposal of cigarette butts.

Many of the student leaders feel that administrators are

interested in reducing student exposure to secondhand

smoke, while less feel that administrators are interested in

reducing tobacco use.

Students do not feel that it is the responsibility of their college

or university to make tobacco control a high priority on

campus.

Key Themes from Student Body Leaders Students do not rank tobacco as a top priority.

When ranked with other health issues tobacco falls

in the middle.

The majority of students do not feel like they have a

role in tobacco efforts on their campus. In addition,

many did not know how to get students involved.

Few students were aware of any treatment

programs available on their campus.

Health Issues Ranked By Student Leaders…

Alcohol UseMental Health

Sexual Health Nutrition

Tobacco Illegal Drug Use

Pregnancy Prevention Cancer

DiabetesHeart Disease

Least Important

Most Important

Strengths and Limitations… Strengths: Representative sample of post-secondary institutions in Minnesota for the

administrator survey, high response rate Provides a baseline on where Minnesota’s Colleges and Universities are at

with their tobacco policies and programs Qualitative survey results provide a summary on what student leaders think

about this health issue for their campus

Limitations: Not a representative sample of students or student body leaders, we cannot

generalize these findings to all students on college campuses Does not provide details on what the campus policies are, for example, we

don’t know if the policies have smoking restrictions or if they have smoke-free policies.

Healthy Campus: Tobacco-Free Events Three Regional Forums- April 2004

102 participants (27 MN Colleges/Universities and 1 WI school, 13 Community Agencies)

Tobacco Summit- November 2004 61 participants (43 Colleges/Universities and 18

Community Agency Representatives). Smoking Cessation Workshop- April 2005

41 participants (15 Colleges/Universities and 4 Community Agencies)

Healthy Campus: Tobacco-Free Newsletter Quarterly Newsletters Currently 4 Issues (plan to have 5 issues total) Content topics include:

Data or research article related to tobacco and 18-24 year old population

Community Programs or local issues Smoking Cessation or Smoking prevalence Announcements for upcoming Healthy Campus: Tobacco-Free

events

Website and Listserv

http://www.healthycampusmn.umn.edu E-mail Listserv for Network participants

Project Evaluation, Spring 2005 8 Initial network members have been interviewed by our outside

project evaluator during the Spring 2004, Fall 2004, and again

Spring 2005.

20 New network and non-network members are being interviewed

Spring 2005.

69 MN Post-secondary Administrators sent follow-up survey

Interview and assessment questions are on tobacco control efforts,

activities, assess project events, website, newsletters, listserv, etc.

Lessons Learned

A diverse advisory committee board can greatly increase

the success of the project. It is best to have them on

board as early as possible in the project

Student involvement and administrative buy in is

necessary for successful programming

Valuable to get feedback from participants prior to

implementing the project (i.e. pre-project assessment)

Lessons Learned Institutions are willing to make tobacco a priority for their

campus Some of the barriers to implementing tobacco policies,

prevention programs and treatment programs on campus include “readiness of the campus” (i.e. funding, time, staff, and enforcement)

Collaboration among institutions and among community agencies is important and valuable.

Many MN schools are interested in collaborating and networking on tobacco control efforts for their college campuses

Lessons Learned Follow-up is key to bringing more individuals on board in

the network and to keep participation in the network going

Many individuals are very interested in participating in regional events related to tobacco, however, time to spend at these events/meetings continues to be a valid barrier.

Individuals appreciate a wide variety of information, including both research and practice.

Thank YouMinnesota Partnership for Action Against Tobacco

(MPAAT)!For not only funding but

also supporting this project.

Agenda to address tobacco use by students

Adopt a comprehensive approach

Work in collaboration with others in the

tobacco control community

Don’t try to do it all – alone.

Take a long-term perspective

Agenda to address tobacco use by students Make tobacco use by 18-24 year olds a priority issue

Nationally Minnesota On Campus

Lobby for policy changes – on and off campus Smoke-free residence halls Sales on campus Smoke-free entrance policy Smoke-free workplaces

Increase educational efforts In clinical encounters focus attention on tobacco use Initiate cessation program and increase demand for

program Develop state-wide network of post-secondary institutions Develop counter marketing campaign

Collaborations Hennepin County Community Health

Department MN Department of Health Blue Cross/Blue Shield of MN American Cancer Society Resist/Tick Tock Counter marketing

Campaign Hennepin Medical Society

Counter Marketing

Tick Tock Counter Marketing

Smoke-Free Workplace Ordinances Collaboration with Hennepin Medical Society

(and numerous other organizations)

Data on 18-24 year olds helped support the

issue Workers

Social settings

54.8

3934.3

29.6

10.9

30.7

0

10

20

30

40

50

60

Perc

en

t

0 hours <30 min to 1hour

2+ hours

Level of Exposure

Exposure to Environmental Tobacco Smoke: 18-24 year old undergraduates

AverageWeekday

AverageWeekendday

Data Source:

2004-U of M Student Health Assessment Survey

Exposure to ETS18-24 year old nursing students

0

10

20

30

40

50

60

70

80

Campusevent

Res Hall Bar/Rest. house/apt. Parties Worksite Auto other NA

Tobacco usersNon-tobacco users

2004 Nursing Student Tobacco Use Survey

Smoke-Free Workplace Ordinances Collaboration with Hennepin Medical Society

(and numerous other organizations) Data on 18-24 year olds helped support the

issue Workers Social settings

Having the U of MN involved was helpful It was helpful to students to have someone

from college health be at the table

Impact of these Tobacco Control efforts

Henry David Thoreau, died on

May 6, 1862 (age 44)

“Men are born to succeed, not

fail.” “If you have built castles in the air,

your work need not be lost; that is

where they should be. Now put

the foundations under them.”

Current Tobacco Use18-24 year old undergraduates

41.8

26.3

35.1 36.2 35

27.428.5

0

5

10

15

20

25

30

35

40

45

1992 1994 1996 1998 2000 2003 2004

Perc

en

t

Data Source: 1992, 1994, 1996, 2000, 2003 –U of M Core Alcohol and Drug Survey, 1998, 2004-U of M Student Health Assessment Survey

** Data are weighted by gender

Current Tobacco Use: Male:Female18-24 year old undergraduates

3529.136.4

44.840.538

29.2

24.227.8

39.2

40

32.932.5

24.1

0

5

10

15

20

25

30

35

40

45

50

1992 1994 1996 1998 2000 2003 2004

MaleFemale

Tobacco Use by 1st Year StudentsCurrent Use

21.3

46.343.9

53.3

33.6

24.820.5

0

10

20

30

40

50

60

1992 1994 1996 1998 2000 2003 2004

Quit attempts: 18-24 year old

undergraduates(Among current tobacco users)

34.1 30.4

35.5

Data Source:

2004-U of M Student Health Assessment Survey

Do not consider themselves to be smokers

Attempted to quit within the past 12 months

Have made no quit attempts in past 12 months

30.527.2

15.9

7.35.3

2.6 2.6

8.7

0

5

10

15

20

25

30

35

Perc

en

t

1 2 3 4 5 6 7 8+

Number of Quit Attempts

Number of Quit Attempts by Smokers/Past 12 Months(based on smokers who attempted to quit at least once)

Data Source:

2004-U of M Student Health Assessment Survey

Conclusions Reducing tobacco use among college students is possible

Smokers are trying to quit We’ve got some tools

Second hand smoke in bars and restaurants is a significant problem for college students

A comprehensive approach to tobacco use among college students is effective.

Collaboration is essential for tobacco control. Involving college health services is helpful in overall tobacco

control efforts. More work needs to be done.

Sigmund Freud born May 6, 1856

“Thought is action

in rehearsal.”