Community Determinants of College based Tobacco-free Policies in the United States: A mixed- methods approach

Tobacco use among young adults between 18 and 24 years is higher than the national average (21.8% vs. 20.6% in 2009), about a third of whom attend colleges and universities. It is during this age period that they are exposed to peer pressure, risky behaviors and targeted by tobacco industry, and transitioning from social to permanent smoker. Thus, attainment of Healthy People 2020 goal of 12% national smoking rate requires a drastic decrease in smoking among college students. In this study, we used mixed-methods approach to analyze college based tobacco-free policies and delineate determinants of policies' strengths. Qualitatively, a CDC School Tobacco-Free Policy (STPI) Index was used to code the policies using Nvivo software. Additionally, using Bronfenbrenner's ecological systems model, we conducted multivariate regression analysis of policies by integrating school and community socioeconomic, political, geographic and cultural characteristics to ascertain the key determinants. In Tennessee, while there is wide variation in policies, two institutions, East Tennessee State University and Milligan College, “identified as having 100% tobacco-free campuses”, respectively scored 22 and 18 of 40 on STPI, primarily due to low compliance, weak enforcement and absence of reporting mechanisms. This study shall confer public health professionals an understanding of policy environment of educational institutions, assistance in tailoring their efforts towards policy change and developing programs for tobacco use prevention and cessation. Furthermore, the key determinants of policies shall provide guide for directing scarce resources to venues of high possibility for policy change, namely a “Shifting Venue Systems Approach.”