The National Tobacco-Free College Campus Initiative Supporting the University System of Georgia’s

1. The National Tobacco-Free College Campus Initiative Supporting the University System of Georgia’s New Tobacco-Free Policy Clifford E. Douglas, J.D. Director, University of Michigan Tobacco Research Network Lecturer, University of Michigan School of Public Health Consulting Tobacco Control Policy Advisor, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services USG Tobacco- and Smoke-Free Campus Implementation Kick-Off Macon, Georgia (July 10, 2014)

2. The Health Consequences of Smoking:50 Years of Progress 1964 2014

3. Remarkable Public Health Achievement • In the last half century, lower smoking rates have saved about 8 million lives in the U.S. Average life expectancy has increased by about 10 years, almost one-third of which – about 3 years – is due to reductions in tobacco use Source: Theodore R. Holford, Rafael Meza, Kenneth E. Warner, Clare Meernik, et al., Tobacco Control and the Reduction in Smoking-Related Premature Deaths in the United States, 1964-2012, JAMA 2014;311:164-171.

6. But … the Tobacco Problem is Not “Solved” • Since 1964, cigarette smoking has killed more than 20 million Americans, including 2.5 million nonsmokersand more than 100,000 babies • Today 42 million adults and 3 million middle and high school students in the U.S. smoke cigarettes • Tobacco causes 480,000deaths per year • Tobacco costs the U.S. $132 billion in medical bills and $157 billion in lost productivity per year

7. Smoking Still Kills More Americansthan All of these Combined AIDS Alcohol Fires Car crashes Cocaine Heroin Suicide Homicide

8. Tobacco’s Tollin Georgia • Health Toll • Adult smoking rate: 20.4% (1,515,600) • High school students who smoke: 12.8% (71,600) • High school students (males) who use smokeless/spit tobacco: 15.7% • 10,300 adults die from smoking each year • 204,000 kids now under 18 are projected to die prematurely from smoking • Economic Toll • $3.18 billion in annual healthcare costs ($537 million covered by state’s Medicaid program) • $3.29 billion in annual productivity losses

9. College Students – Projected Toll • Based on current rates, it is projected that nationwide more than 1 million current college students will die from tobacco use “If young people don’t start using tobacco by age 26, they almost certainly will never start.” - Acting Surgeon General Boris Lushniak

10. TFCCI Promotes Healthier Campus Communities Across the U.S. Vision: Widespread expansion of tobacco-free policies to institutions of higher learning across the U.S. Goals: • Foster a collaborative and cooperative effort among academic institutions and partners in the public health community • Expand awareness in academia and among the public of the need for and benefits of such policies • Facilitate information flow and access to technical assistance U.S. Assistant Secretary for Health Howard Koh launching TFCCI with national leaders at the University of Michigan, September 12, 2012

11. TFCCI is about Collaboration • U.S. Department of Health and Human Services • American College Health Association • University of Michigan • Association of Schools and Programs of Public Health • American Legacy Foundation • Americans for Nonsmokers’ Rights • Campaign for Tobacco-Free Kids • National Center for Tobacco Policy Other key partners include colleges, universities, and public health organizations (e.g., American Cancer Society, American Lung Association)

12. TFCCI is about Communication

13. TFCCI/HHS Serves Your Region

14. TFCCI is about Communication Please LIKE! And FOLLOW @TFCCI!

15. TFCCI is about Leading by Example • “Many risk factors, including tobacco use, peak between 18-25 years of age. So college attendance can be a key turning point in whether or not a young adult becomes, or remains, addicted to tobacco… We are optimistic that by working together to encourage implementation of comprehensive tobacco-free policies at universities and colleges across the United States, we will accelerate the progress that has already been achieved.” • Acting U.S. Surgeon General Boris Lushniak, April 28, 2014

16. Campus Smoke- and Tobacco-Free Policies are Accelerating

17. Georgia is Part of a Highly Successful National Effort – Congratulations! • As of July 3, 2014: 1,372 campusesare 100% smoke-free indoors and outdoors, with no exemptions, including residential housing facilities (where applicable) • Of those, 938 (two-thirds!) have a 100% tobacco-free policy, and 176 now also prohibit the use of e-cigarettes anywhere on campus • Here are some of the large campuses that have adopted comprehensive, campus-wide tobacco-free policies: • Emory University • University of Kentucky • University of South Carolina • University of Oklahoma • Arizona State University • Montana State University • University of Oregon • University of California (all 10 campuses) • City University of New York (all 24 campuses) • University of Florida (“Gators don’t chew. They chomp!”) • Exciting new addition: The entire Georgia public higher ed system (31 colleges & universities!) In the first 22 months following the launch of TFCCI's campaign, 598 more college and university campuses went 100% smoke-free, a 77.3% increase! Source: Americans for Nonsmokers’ Rights Foundation, http://www.no-smoke.org/pdf/smokefreecollegesuniversities.pdf

18. This is What It Looks Like

19. Many Campuses Go Tobacco-Free * • Image from tobacco-free campus • PSA featuring Rah Sun Roberts, • former head drum major, Bethune- • Cookman University, Daytona • Beach, FL

20. Health Effects of Smokeless (Spit) Tobacco • Contain nicotine and are addictive • Not a safe alternative to cigarette smoking • Most smokeless tobacco products in the U.S. cause oral, esophageal, and pancreatic cancer • Use of these products causes gum recession, gum disease, and tooth loss • Increase risk of fatal heart attacks and stroke

21. Industry Promotes Dual Use of Cigarettes & Smokeless Tobacco • Ads promote use of smokeless tobacco products not to replace cigarettes but as a way for smokers to maintain 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

22. Major New Issue: E-Cigarettes

23. The FDA Cautions Consumers Against Becoming Guinea Pigs • The FDA considers electronic cigarettes a tobacco product, and not a way to quit smoking

24. Encourage Evasion of Smoke-Free Laws Discourage Quitting

25. Industry Says They “Do Not Market to Youth” Lorillard wrote to FDA Commissioner Margaret Hamburg on October 23, 2013: “Responsible e-cigarette manufacturers, including blu eCigs, do not market to youth. Lorillard understands the sensitivity associated with advertising and marketing campaigns and their potential influence on minors. For this reason, blu e-Cigs is actively and effectively ensuring that its advertising is directed at adult smokers.”

26. Recent Example of Not Marketing to Youth

27. E-cigarettes are derived from tobacco, contain nicotine, are inhaled, and emit fine particles that pollute the air • E-cigarette aerosol is a dense mixture of vapor and fine particles that smells and looks like tobacco smoke • If exempt from smoke-free policies, the appearance of many e-cigarette products, and the look and smell of e-cigarette aerosol, create confusion for campus enforcement purposes • E-cigarette marketing encourages dual use (cigarettes and e-cigarettes) instead of quitting or truly switching, and also targets kids • E-cigarettes threaten to “re-normalize” smoking Why Campus Policies are Including E-Cigarettes

28. Campus Policies Work

29. Indiana University (vs. Purdue University) Campus Policies are Effective • Study compared undergraduates’ smoking behaviors and attitudes at two Big Ten campuses with similar demographics … Indiana University (tobacco-free policy implemented in 2008) andPurdue University (no policy) • Indiana University smoking prevalence: 16.5% in 2007; 12.8% in 2009 (-3.7 percentage points) • Purdue University smoking prevalence: 9.5% in 2007; 10.1% in 2009 (+0.6 percentage points) • Indiana University consumption rate: 6.6 cigs/day in 2007; 5.9 cigs/day in 2009 (-0.7 cigs/day, or 10.6%) • Purdue University consumption rate: 5.2 cigs/day in 2007; 6.8 cigs/day in 2009 (+1.6 cigs/day, or 30.8%) • Study also showed a 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.

30. University of Michigan16 Months After Implementation Campus Policies are Effective • Smoking by faculty & staff dropped from 6% to 4% • 29% of smokers reduced consumption • 40% of smokers attempted to quit in last 12 months • 22% of smokers participated in university Tobacco Independence Program • 13% of faculty/staff who smoked reported the policy influenced them to quit or attempt to quit smoking • 89% of faculty/staff and 83% of students supported policy • 72% of faculty/staff and 65% of students noticed decrease of smoking on campus • 16% of students who smoked 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

31. To be Most Successful, Campus Policies Must be Nurtured • These policies are popular, widely accepted, and largely self-enforcing, but require sustained attention • Campus enforcement approaches vary … many apply “enforcement light” strategies • USG’s policy makes enforcement the responsibility of the president, but notes that the policy is also a shared community responsibility. (Violations will be handled under the Student Code of Conduct and campus human resource policies.)

32. The “3 Ts” of effective tobacco-free policy implementation Tell about the policy via good signage, branding, and integrated, consistent communication Treat tobacco users by providing free nicotine replacement therapies (NRT) and a menu of counseling/behavioral support Train staff and volunteers in firm yet compassionate scripting in handling violators Have a user-friendly process for reporting violations (www.uky.edu/Tobaccofree) The University of Kentucky’sInnovative Example Reference: Hahn, E.J. et al., (2012). The Three T’s of adopting tobacco-free policies on college campuses. Nursing Clinics of North America, 47(1), 109-117.

33. Environmental Benefits

34. 5.6 trillion cigarette butts dumped into the global environment annually Contain nicotine, pesticides, other chemicals Single most commonly collected waste item found each year in park and beach clean-ups 25-50% of all collected litter from roads and streets, and do not biodegrade And … 18.6 billion trees are destroyed every year for tobacco production Cigarette Litter = #1 Source of Waste

35. Campus Policies ReduceCigarette Butt Litter • Researchers at the University of North Carolina concluded that 100% smoke- or tobacco-free policies are associated with reduced cigarette butts near building entrances compared with campuses with limited or no restrictions • 77% fewer cigarette butts were found on college campuses with 100% smoke-free campus-wide policies Source: Lee JGL, Ranney LM, Goldstein AO. Tobacco Control (2013), Tob Control 2013 22: 107-112, originally published online December 1, 2011, doi: 10.1136/tobaccocontrol-2011-050152, http://tobaccocontrol.bmj.com/content/22/2/107.full.pdf+html.

36. Campus Policies ReduceCigarette Butt Litter “Box plots of average cigarette butts per day at building entrances, by policy strength. Note that the centre bold line represents the median rate, the box represents the 25th through 75th percentiles and the ‘whiskers’ show the range of rates.” (p. 110) Source: Lee JGL, Ranney LM, Goldstein AO. Tobacco Control (2013), Tob Control 2013 22: 107-112, originally published online December 1, 2011, doi: 10.1136/tobaccocontrol-2011-050152, http://tobaccocontrol.bmj.com/content/22/2/107.full.pdf+html.

37. Economic Benefits

38. 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 Economic Benefits of Strong Campus Policies

39. “There is no higher priority in public health than ending the tobacco epidemic.” Dr. Howard Koh, U.S. Assistant Secretary for Health