Mixed-Methods Evaluation and Cost-Effectiveness Analysis of a Tobacco-Free Campus Initiative

Background: Current estimates indicate that there are now more than 1,180 smoke-free campuses nationwide.  Many universities have evaluated their policies, but most evaluations were initiated after the policy went into effect.  This study represents one of the few studies to have collected comprehensive data both pre- and post-implementation to allow for a more accurate assessment of policy impacts. 

Methods:  Data were collected across four campuses at a major U.S. university using a mixed methods approach. Phase I (Spring 2013; pre-implementation) involved tobacco-related litter counts, online surveys and key stakeholder interviews with staff and student groups, and a preliminary cost-effectiveness analysis. Phase II (Fall 2013; post-implementation) was the second wave of campus litter counts.  Phase III (Spring 2014) included all Phase I measures as well as focus groups with tobacco users and grounds crews.  Surveys were electronically distributed to a random sample of 20,000 students and all benefits-eligible staff (n=8,960). 

Results:  Phase I cost-effectiveness analyses indicated that the university and the surrounding county were well-positioned to realize a positive net benefit of the tobacco-free campus initiative.  Litter count comparisons from Phases I and II showed immediate decreases of 35-57% in tobacco-related litter.  However, Phase III interviews and focus groups indicated that these initial decreases may have tapered off due to limited enforcement and consequences for policy noncompliance.  Additional Phase III results are expected in May 2014.

Conclusions: The tobacco-free campus initiative appears to be a positive return on investment, although compliance rates and policy impacts might improve with strengthened enforcement strategies.