Assessment of campus smoke-/tobacco-free policies in the United States: A qualitative approach

Tobacco use among young adults between 18 and 24 years is higher than national average (21.8% vs. 20.6% in 2009). About a third of young adults attend college or university, where they are exposed to peer-pressure, risky behaviors, and tobacco industry promotions; transitioning from a social to permanent smoker. Thus, attainment of Healthy People 2020 goal of 12% national smoking rate requires drastic decrease in smoking among college students. In this study, we collected smoke-/tobacco-free policies from 639 higher educational institutions and analyzed them using Nvivo qualitative software. A grounded theory approach was used to thematically code the policies using a CDC's school-policy index; based on four key components -- tobacco-free environment, policy organization, enforcement, and prevention and treatment services. In Tennessee, we found that while 83% and 43% of policies address tobacco-free environment and enforcement, only 26% and 12% address policy organization and prevention and treatment services respectively. Additionally, we identified that around 95% of the policies adopted "smoking-designated areas" instead of full campuses coverage, and "general" enforcement instead of "specific". Analyzing campus smoke-/tobacco-free policies qualitatively helps policymakers and public health community to not only understand the campus tobacco-free environment but also identify weak areas and tailor their efforts and scarce resources to strengthen them. This study also identifies these higher educational institutions as new venues for high possibility of tobacco policy change, "Shifting Venue Systems Approach", and promotes them as a paradigm for remaining 1,693 educational institutions where smoke-/tobacco-free policies were non-existent.