Role of College Health Services in Campus and Community Tobacco Control

1. 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

2. 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.

3. Sigmund Freudborn 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.”

4. History of Tobacco Control Activities at Boynton Health Service

5. Tobacco Use Trends in 1999University of Minnesota

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

7. Tobacco use was increasing among males and females

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

10. Tobacco Summit Tobacco Use Among College and University StudentsApril 27, 2001

11. 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.

15. 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.”

16. 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

17. 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

18. 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

19. Wednesday, November 14th 2001Minnesota Daily

20. Monday, November 19th 2001Minnesota Daily

21. Minnesota DailyDecember 5, 2001

22. Rebellion from Paternalism of Public Health Our freedom goes up in paternalistic smoke (12/6/00) “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.”

23. 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

24. 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

25. 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

26. 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

27. 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

29. 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

30. 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

31. Cessation Programs • Cessation counselor • Quit and Win

32. 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

33. Two- Year Project Grant Funded by: The Minnesota Partnership for Action Against Tobacco (MPAAT) August 2003-July 2005http://www.healthycampusmn.umn.edu

34. Advisory Committee The 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

35. 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

36. Post-secondary Institution Tobacco Control Survey December 2003- February 2004 Where are Minnesota’s Colleges and Universities with their tobacco control efforts?

37. Acknowledgements This project was funded by the Minnesota Partnership for Action Against Tobacco. These findings are solely the responsibility of the authors and do not necessarily represent the official views of the Minnesota Partnership for Action Against Tobacco.

38. Data Collection • Administrators at post-secondary institutions in Minnesota • Mailed questionnaire to 66 Health Services Staff or Student Affairs Officers • Received 54 surveys (82% response rate) • Private Colleges & Universities, 12/54 (22.2%) • Public Community and Technical College (2-Year), 30/54 (55.6%) • Public Universities (4-year), 12/54 (22.2%) • Student Body Presidents at post-secondary institutions in Minnesota • Mailed questionnaire to 68 Student Body Presidents • Received 29 surveys (43% response rate) • Private Colleges & Universities, 14/29 (48.3%) • Public Community and Technical College (2-Year), 8/29 (27.6%) • Public Universities (4-year), 7/29 (24.1%)

39. 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

40. 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.

41. Indoor Smoking Policies on Campus… *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.

42. Outdoor Smoking Policies on Campus… Distance ranged from 5-90 feet *Some of the policies were not applicable for all respondents, percents are based on applicable responses only.

43. Institutional written policies on prohibiting… *Some of the policies were not applicable for all respondents, percents are based on applicable responses only.

44. Sell Tobacco on Campus?

45. Administrators feel that tobacco control should be a priority on campus! Average Rate= 7.98 *Rating based on a 1-10 scale (10 being the highest)

46. 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.

47. 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.

48. Health Issues Ranked By Student Leaders… Most Important Least Important

49. 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.

50. 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)