Smoke-free policies in New Zealand public tertiary education institutions

University students' and staff attitudes toward the implementation of a "tobacco-free" policy: A view from Qatar

Objectives

Tobacco-free campus policies are needed to create environments conducive to prevention or quitting in the Eastern Mediterranean Region (EMR), where the use of various tobacco products is on the rise among university students. The objectives of this study were to assess overall support for a 100% tobacco-free campus policy and its predictors among different stakeholder groups at the largest national university in Qatar and to understand attitudes towards specific policy components.

Study design

A cross-sectional online survey of faculty and students.

Methods

We measured sociodemographic variables, tobacco use, and support for components of a 100% tobacco-free campus policy. A total score for support was calculated, and associations with selected predictors were assessed using multivariable linear regression.

Results

413 respondents participated in the survey. A majority of faculty/staff and students (76.6% and 75.5%, respectively) supported the implementation of a 100% tobacco-free campus policy, with a majority supporting extension of the policy beyond cigarettes. Support for other components of the policy varied. Among students, overall support was lower among males and tobacco users and higher among the married. Among faculty and staff, support was lower among Qatari nationals and tobacco users.

Conclusion

In the context of a growing tobacco crisis in the EMR, implementing and understanding the impact of tobacco-free campus policies is essential. This paper underscores the importance of addressing diverse stakeholder attitudes and providing empirical evidence to guide policy implementation and evaluation.

State of the literature discussing smoke-free policies globally: A narrative review

Despite the success of the Framework Convention on Tobacco Control (FCTC), most jurisdictions in the world do not have policies that create 100% smoke-free environments in indoor workplaces, indoor public places, public transport, or other public places. We conducted a narrative review of articles that discuss smoke-free policies and describe the state of the current literature. A search of peer-reviewed and gray literature, published between 1 January 2004 and 30 April 2022, was conducted using PubMed and EMBASE databases. We classified articles based on the location of the policy discussed (WHO region, World Bank income classification) and the environment that was being made smoke-free. Insights related to policy development and implementation, as well as compliance and enforcement, were also identified. The search identified 4469 unique citations; 134 articles met the criteria for inclusion and underwent data extraction by two independent coders. The sample included articles published in or about jurisdictions in each WHO region, in high- and low- and mediumincome countries, and articles that discussed policies regulating smoke-free indoor workplaces, indoor public places, public transport, outdoor/quasi-outdoor environments, and other (unspecified) public places. Some important insights from the literature related to smoke-free policy implementation included tobacco industry interference, the important role of civil society, and the need for effective communication, education, and leadership. Enforcement officials' awareness and training, stakeholders' attitudes and beliefs, and understanding social norms were identified as relevant determinants of effective smoke-free policies. There continue to be challenges for implementing smoke-free policies in jurisdictions throughout the globe, in high- and low- and middle-income countries. The literature includes insights to support 100% smoke-free policies in each environment that must be made smoke-free as per the FCTC.

Programme and policy perspectives towards a tobacco-free generation in India: findings from a qualitative study

OBJECTIVE

This study explored multistakeholder perspectives on existing adolescent-specific tobacco control policies and programmes, to advance India's transition towards a tobacco-free generation.

DESIGN

Qualitative semi-structured interviews.

SETTING

Interviews were conducted with officials involved in tobacco control at the national (India), state (Karnataka), district (Udupi) and village level. Interviews were audio recorded, transcribed verbatim and analysed thematically.

PARTICIPANTS

Thirty-eight individuals representing national (n=9), state (n=9), district (n=14) and village (n=6) levels, participated.

RESULTS

The study findings highlighted the need to strengthen and amend the existing Tobacco Control Law (2003) provisions, particularly in the vicinity of schools (Sections 6a and 6b). Increasing the minimum legal age to buy tobacco from 18 to 21 years, developing an 'application' for 'compliance and monitoring indicators' in Tobacco-Free Educational Institution guidelines were proposed. Policies to address smokeless tobacco use, stricter enforcement including regular monitoring of existing programmes, and robust evaluation of policies was underscored. Engaging adolescents to co-create interventions was advocated, along with integrating national tobacco control programmes into existing school and adolescent health programmes, using both an intersectoral and whole-societal approach to prevent tobacco use, were recommended. Finally, stakeholders mentioned that when drafting and implementing a comprehensive national tobacco control policy, there is a need to adopt a vision striving toward a tobacco-free generation.

CONCLUSION

Strengthening and developing tobacco control programmes and policies are warranted which are monitored and evaluated rigorously, and where adolescents should be involved, accordingly.

Using the Unified Theory of Acceptance and Use of Technology (UTAUT) and e-health literacy(e-HL) to investigate the tobacco control intentions and behaviors of non-smoking college students in China: a cross-sectional investigation

BACKGROUND

Non-smoking college students are starting to smoke in increasing numbers, which shows that their tobacco control situation seems not optimistic. The UTAUT and e-HL are commonly used models and theories to predict health behaviors, while there are few studies on tobacco control. This paper aims to study the influencing factors of tobacco control intention and behavior of non-smoking college students in China by combining the UTAUT and e-HL.

METHODS

Based on the stratified sampling method, 625 college students from 12 universities were selected. Data were collected using a self-made questionnaire designed based on the UTAUT and e-health literacy scales. Data were analyzed by SPSS 22 and AMOS 26, including descriptive statistics, one-way variance analysis and structural equation model analysis.

RESULTS

The results of one-way variance analysis showed that there were significant differences in the score of non-smoking college students' tobacco control intention or behavior by hometowns, monthly living expenses, and parents' smoking history. Performance expectancy, effort expectancy, social influence had direct positive effects on behavioral intention. Facilitating condition, behavioral intention had direct positive impacts on use behavior and e-HL had an indirect positive impact on use behavior.

CONCLUSIONS

The combination of the UTAUT and e-HL can be used as an appropriate framework to predict the influencing factors of non-smoking college students' intention and behavior of tobacco control. Improving performance expectancy, effort expectancy, and e-HL among non-smoking college students, creating positive social environments, and providing facilitating condition are key aspects of increasing their tobacco control intention and behavior. It is also beneficial to promote the implementation of smoke-free campus and smoke-free family projects.

National Sporting Organisation Policies: A health promotion opportunity?

The objective was to identify whether National Sporting Organisations (NSOs) have policy documentation on healthy behaviours (smokefree, sun-protection, healthy food/beverages, and alcohol) and, for organisations with such documentation, whether this is in-line with current scientific evidence of past best practice in cancer prevention.

METHODS

This cross-sectional policy analysis study was performed September - December 2018 in New Zealand. A content analysis was undertaken using NSO policy documents matched against a framework of key indicators for best practice within health behaviours of interest. Data analysis of the policy process was undertaken through key informant telephone interviews with NSO staff using semi-structured qualitative interviews.

RESULTS

Of 96 NSOs, nearly half (49%) mentioned smokefree at least once in one of their policy documents, and 47% had an alcohol policy, although in both instances the policies lacked comprehensiveness. Two NSOs had a reasonably comprehensive sun protection policy. Seventeen had at least one specific nutrition policy/guideline. The contents of the latter were primarily related to short-term athletic performance rather than non-communicable disease prevention, specifically promoting hydration during sports participation, and food and nutrition to support sporting performance. Two NSOs had policies relating to the promotion of health food/nutrition more widely. For some NSOs the lack of health-related policies was not a conscious choice but just not considered previously. Other NSOs reported they lacked resources or had other priorities.

CONCLUSIONS

Although this study clearly demonstrates that many NSOs lack adequate health-related policies, this is not necessarily a conscious choice, but the result of a lack of resources, other priorities, or just that they had not considered developing policies in these areas. A number expressed support for these types of policies although it was apparent that some, particularly smaller NSOs would require assistance in policy template development. It seems probable that the development of health-related policies will only occur if partner agencies become involved.

Why staff at European schools abstain from enforcing smoke-free policies on persistent violators

Secondary schools in European countries increasingly implement comprehensive smoke-free school policies (SFSPs) that prohibit most or even all adolescents from smoking during school hours. Consistent enforcement of SFSPs is essential for realizing optimum effectiveness. A main challenge represents adolescents who persistently violate the rules. We studied how staff in European countries respond to these persistent violators and why they may turn a blind eye. We used interview transcripts from 69 staff members at 22 schools in 6 European countries to identify cases in which staff turned a blind eye. We then applied thematic analysis for identifying the considerations as to why they turn a blind eye. Turning a blind eye on persistent violators happened among school staff in all six countries. Three considerations were identified. First, staff believe their primary role and duty is to support all adolescents to develop into well-functioning adults, and sometimes it is best to accept smoking. Second, staff expect that applying stricter disciplinary measures will not stop persistent violators and is more likely to create more severe problems. Third, staff do not feel supported by relevant actors in society (e.g. parents) in influencing adolescent smoking. We conclude that staff’s considerations stress the need to support school staff in enforcing the increasingly comprehensive rules on the most persistent smokers.

University Staff and Students' Attitudes towards a Completely Smoke-Free Campus: Shifting Social Norms and Organisational Culture for Health Promotion

A large university in Queensland, Australia with a diverse staff and student community introduced a campus wide smoke-free policy in 2016. The purpose of this enquiry was to understand attitudes about a new smoke-free policy, its potential impact and the shift in social norms and organizational culture to inform the next phase of implementation. An electronic survey was distributed to all staff and students approximately 12 weeks after the smoke-free policy was implemented. The survey consisted of multiple-choice questions about demographics, smoking behaviour, attitudes towards smoking and tobacco control, awareness of the smoke-free policy, and attitudes towards the effect of a completely smoke-free campus on quality of life, learning and enrolment. The survey was completed by 641 university staff and students. Respondents reported seeking out (80.4%) and socialising in smoke-free environments (86.6%) and supported smoke-free buildings (96.1%), indoor areas (91.6%), and outdoor areas (79%). The results revealed overwhelming support for a completely smoke-free campus (83%) and minority support for designated smoking areas (31%). Overall, respondents reflected positively towards a campus wide smoke-free policy. These findings suggest Queensland’s early adoption of tobacco control laws influenced the social environment, de-normalised smoking, changed behaviour, preference for smoke-free environments and shifted social norms. These findings provide convincing evidence for organisational change and suggest health promotion policy makers should progress the implementation of smoke-free policies nationally across the higher education sector.

Going smoke-free: University staff and students' qualitative views about smoking on campus during the implementation of a smoke-free policy

Background

Despite many Australian universities introducing smoke-free policies on campus, there is little information about staff and students understanding of smoking on campus in the context of the implementation of a smoke-free policy.

Objective

This research explores the qualitative views of university staff and students about smoking on campus during the implementation of a smoke-free policy.

Methods

In 2016, an electronic survey was distributed to all current staff and students of a large university in Queensland, Australia during the implementation of a smoke-free policy. The survey consisted of multiple-choice questions about demographics, tobacco use, attitudes towards smoking, awareness of and attitudes towards the policy, and intentions to quit smoking. The final question asked for a short, open-ended response: “Would you like to comment on the issue of smoking on QUT* campuses?” This question was extracted from the survey and analysed using inductive thematic analysis. This paper reports the findings from this question. *Queensland University of Technology.

Results

The survey was completed by 641 staff and students. There were 351 responses to the final question. Five inductive themes emerged about smoking on campus during the implementation of a smoke-free policy: 1) the watering down of the policy, if it is not enforced, 2) the creation of hot spots on campus boundaries affecting those who pass by, 3) concern, especially by those who don’t smoke, about the impact on smokers emotional health and welfare, 4) disagreement about the value of designated smoking areas and 5) suggestions about how to better implement the policy.

Conclusion

Overall, participants views about smoking on campus during the implementation of a smoke free policy suggest broad agreement but reflect concerns about enforcement, boundaries, non-smokers and designated areas. Consistent and systematic processes for implementation, maintenance and enforcement of policy goals, and cessation support, is needed to create a non-smoking culture on university campuses.

Development and evaluation of smoke-free or tobacco-free policies in university settings: a systematic scoping review

We conducted a systematic scoping review to map the available evidence on smoke-free or tobacco-free (SF/TF) university policies globally. We specifically looked at (i) how policies were developed and communicated and (ii) what indicators were used to evaluate their impact. We searched for peer-reviewed literature, published up to January 2020, across 10 multi-disciplinary databases. We followed a duplicate, independent data selection, and charting process. We inductively categorized the studies according to the research design and objective of 'process' and 'impact evaluation'. We identified 75 unique studies across 23 countries conducted between 1993 and 2019. Most studies were conducted in the United States (46/75, 61.3%), were based on quantitative research design and focused on impact evaluations; a third (n = 28) reported both process and impact evaluations (37.3%). Community engagement and multi-channel communication strategies were mostly used to disseminate SF/TF policies. The impact was determined by a wide range of indicators for knowledge, attitudes and behaviors related to policies. There is a mature, relevant body of literature describing the development and evaluation of SF/TF policies in universities. Future reviews could quantify the impact of the bans and may consider process indicators as moderating factors to explain the potential heterogeneity of results.

Why Secondary Schools Do Not Implement Far-Reaching Smoke-Free Policies: Exploring Deep Core, Policy Core, and Secondary Beliefs of School Staff in the Netherlands

Background

Secondary schools that implement smoke-free policies are confronted with students who start smoking outside their premises. One solution is to complement smoke-free policies with prohibitions for all students to leave the school area during school hours, technically making school hours a smoke-free period. However, there are strikingly few Dutch secondary schools that implement this approach. This study explores why staff members in the Netherlands decide not to implement smoke-free school hours for all students.

Method

We interviewed 13 staff members, with different functions, from four secondary schools. The analysis was informed by the Advocacy Coalition Framework (ACF) to delve into the values, rationales, and assumptions of staff with the aim to identify deep core, policy core, and secondary beliefs.

Results

We identified six beliefs. Two deep core beliefs are that schools should provide adolescents the freedom to learn how to responsibly use their personal autonomy and that schools should only interfere if adolescents endanger or bother others. Three policy core beliefs identified included the following: that smoking is not a pressing issue for schools to deal with; that schools should demarcate their jurisdiction to intervene in adolescents’ lives in time, space, and precise risk behavior; and that implementing smoke-free school hours would interfere with maintaining positive student-staff relationships. One secondary belief identified was that smoke-free school hours would be impossible to enforce consistently.

Conclusion

This paper was the first to demonstrate the many beliefs explaining why schools refrain from voluntary implementing far-reaching smoke-free policies.

Understanding school staff members' enforcement of school tobacco policies to achieve tobacco-free school: a realist review

BACKGROUND

School tobacco policies (STPs) that aim to achieve a tobacco-free environment require consistent enforcement by school staff. However, little is known about why staff choose whether or not to enforce STPs. Therefore, we investigated staff members' responses to STPs that determine enforcement. Furthermore, we examined how these responses depend on contextual factors at the individual, interpersonal, school, implementation, and national levels.

METHODS

We performed a realist review (RR), which synthesizes existing primary evidence into a programme theory demonstrating key causal pathways through Context-Mechanism-Outcome configurations (CMOs). These CMOs link contextual factors to outcomes (i.e. staff enforcement) by explaining the underlying generative mechanisms (i.e. staff members' cognitive, psychosocial, and behavioural responses). A systematic literature search for the period 2000-2016 was performed using Academic Search Premier, PsycInfo, and MEDLINE. Forty English-language articles were identified for the synthesis.

RESULTS

Our programme theory demonstrated three CMOs: when contextual factors make staff members experience STP enforcement as part of their professional role and duties, it may lead to staff members showing responsibility for STP enforcement (CMO1); when contextual factors make staff members feel their contribution is leading to positive outcomes, it may lead to staff members showing motivation to enforce STPs (CMO2), and when contextual factors make staff members feel that they are able to deal with students' responses, it may lead to staff members showing confidence in STP enforcement (CMO3). Moreover, the programme theory provided more precise insights into what contextual factors contribute to triggering the individual mechanisms and the consequent outcomes.

CONCLUSIONS

By applying a realist approach, we have been able to detect three CMOs explaining staff members' STP enforcement. The findings provide useful insights explaining how stakeholders can support staff members' STP enforcement and consequently improve the impact of STPs on adolescent smoking.

The contribution of smokefree outdoor areas in achieving New Zealand's Smokefree 2025 goal

ISSUES ADDRESSED

With the adoption of Smokefree 2025, further commitment from local government to extend smokefree outdoor area policies is becoming increasingly important in the presence of high public support. The aim of this study was to identify local government commitment in the Canterbury/West Coast (CWC) region to the New Zealand Smokefree 2025 goal through provision of smokefree outdoor areas.

METHODS

Document analysis of the different stages of council long-term plans (LTPs) was undertaken, including 239 draft LTP documents, 5926 public submissions on these documents and 13 final LTP documents. A comparison between the 2015 final document and the 2012 final document was undertaken. Following this, semi-structured telephone interviews were undertaken with council staff.

RESULTS

No council had referred to Smokefree 2025 or smokefree community spaces in any 2015 LTP draft document. Each of the CWC councils received a number of smokefree-related submissions, with the main theme being the extension of current Smokefree Outdoor Area Policy. The final LTP documents showed that 5 councils had included a brief statement about Smokefree 2025. Smokefree issues were mentioned more often in the 2012 LTP compared to the 2015 LTP.

CONCLUSIONS

This research highlights a need for more commitment by local government to achieving the Smokefree 2025 goal. So what? There are opportunities for health groups to work with councils to try and enhance their overall commitment to Smokefree 2025 and promote wellbeing.

Supportive of a smoke-free campus but opposed to a 100% tobacco-free campus: Identification of predictors among university students, faculty, and staff

Many universities are adopting campus tobacco policies, but little research has explored factors influencing the choice between the policy options of smoke-free versus 100% tobacco-free. Students, faculty, and staff at a U.S. state university participated in a web-based survey in 2013, approximately one year after adoption of a smoke-free policy. Respondents who expressed support for the policy were included in an analysis to examine their opinions regarding a 100% tobacco-free policy. The samples included 4138 students and 1582 faculty/staff. Bivariate analyses and multivariate logistic regression were used to identify predictors of opposition to a tobacco-free campus. Independent variables included strength of support for a smoke-free campus, past-month tobacco use (cigarettes, smokeless tobacco, e-cigarettes, non-cigarette combustible tobacco products), campus exposure to secondhand smoke, perceptions of tobacco-related behaviors and norms, and demographics. Of these supporters of a smoke-free campus, 14.3% of students and 10.2% of faculty/staff were opposed to a tobacco-free campus. In the multivariate analyses, in both samples, smokeless tobacco use predicted opposition while smoke-free policy support and female gender predicted support. In addition, among students, current or former cigarette smoking and non-cigarette combustible tobacco use predicted opposition; international student status and secondhand smoke exposure predicted support. Among faculty/staff, age over 55 predicted support. Future research should examine why current and former smokers might oppose policies restricting non-combustible tobacco products, even when they support smoke-free policies. In policy planning, campus administrators should communicate actual tobacco usage levels. International students who do not use tobacco may be a source of policy support.