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

101 Years Ago May 6, 1904 American Lung Association held its first meeting in Atlantic City, NJ. May 6, American Tobacco Company merged with its holding company, Continental Tobacco Co.

Sigmund Freud born 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.”

History of Tobacco Control Activities at Boynton Health Service

Tobacco Use Trends in 1999 University of Minnesota

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

Tobacco use was increasing among males and females

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

Tobacco Summit Tobacco Use Among College and University Students A pril 27, 2001

Tobacco Companies Marketing to 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.

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.”

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

Agenda to address tobacco use by students Make tobacco use by 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

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

Wednesday, November 14th 2001 Minnesota Daily

Monday, November 19th 2001 Minnesota Daily

Minnesota Daily December 5, 2001

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

Make tobacco use by year olds a priority issue National 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

Make tobacco use by year olds a priority issue Minnesota MPAAT  Made year olds a priority for funding  Healthy Campus: Tobacco Free Blue Cross/Blue Shield of Minnesota  Made year olds a priority  Funded Tobacco Summit  Increased collaboration American Cancer Society  RESIST and Tick Tock Campaign MN Dept. of Health  Adult Tobacco Survey

Make tobacco use by year olds a priority issue On Campus Tobacco control made a priority by Boynton Health Service  Data collection  Education  Clinical preventive services  Policy development  Cessation programs Healthy Campus: Tobacco Free

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

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

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

Lobby for policy changes on and off campus Smoke-free residence halls Sales of tobacco on campus Smoke-free entrance policy Sponsorship by tobacco companies Smoke-free workplaces

Cessation Programs Cessation counselor 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

Two- Year Project Grant Funded by: The Minnesota Partnership for Action Against Tobacco (MPAAT) August 2003-July

Advisory Committee The Advisory Committee was formed at the beginning of the project. The first committee meeting took place in late October 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

Healthy Campus Network Initial invitation to 59 post-secondary institutions to join the Healthy Campus Network- Nov  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

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

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.

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

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

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.

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.

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

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

Sell Tobacco on Campus?

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

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.

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.

Health Issues Ranked By Student Leaders… Alcohol Use Mental Health Sexual Health Nutrition Tobacco Illegal Drug Use Pregnancy Prevention Cancer Diabetes Heart Disease Least Important Most Important

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.

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)

Healthy Campus: Tobacco-Free Newsletter Quarterly Newsletters Currently 4 Issues (plan to have 5 issues total) Content topics include:  Data or research article related to tobacco and year old population  Community Programs or local issues  Smoking Cessation or Smoking prevalence  Announcements for upcoming Healthy Campus: Tobacco-Free events

Website and Listserv Listserv for Network participants

Project Evaluation, Spring Initial network members have been interviewed by our outside project evaluator during the Spring 2004, Fall 2004, and again Spring New network and non-network members are being interviewed Spring MN Post-secondary Administrators sent follow-up survey Interview and assessment questions are on tobacco control efforts, activities, assess project events, website, newsletters, listserv, etc.

Lessons Learned A diverse advisory committee board can greatly increase the success of the project. It is best to have them on board as early as possible in the project Student involvement and administrative buy in is necessary for successful programming Valuable to get feedback from participants prior to implementing the project (i.e. pre-project assessment)

Lessons Learned Institutions are willing to make tobacco a priority for their campus Some of the barriers to implementing tobacco policies, prevention programs and treatment programs on campus include “readiness of the campus” (i.e. funding, time, staff, and enforcement) Collaboration among institutions and among community agencies is important and valuable. Many MN schools are interested in collaborating and networking on tobacco control efforts for their college campuses

Lessons Learned Follow-up is key to bringing more individuals on board in the network and to keep participation in the network going Many individuals are very interested in participating in regional events related to tobacco, however, time to spend at these events/meetings continues to be a valid barrier. Individuals appreciate a wide variety of information, including both research and practice.

Thank You Minnesota Partnership for Action Against Tobacco (MPAAT)! For not only funding but also supporting this project.

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

Agenda to address tobacco use by students Make tobacco use by 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  Smoke-free workplaces Increase educational efforts In clinical encounters focus attention on tobacco use Initiate cessation program and increase demand for program Develop state-wide network of post-secondary institutions Develop counter marketing campaign

Collaborations Hennepin County Community Health Department MN Department of Health Blue Cross/Blue Shield of MN American Cancer Society Resist/Tick Tock Counter marketing Campaign Hennepin Medical Society

Counter Marketing

Tick Tock Counter Marketing

Smoke-Free Workplace Ordinances Collaboration with Hennepin Medical Society (and numerous other organizations) Data on year olds helped support the issue  Workers  Social settings

Data Source: 2004-U of M Student Health Assessment Survey

Exposure to ETS year old nursing students 2004 Nursing Student Tobacco Use Survey

Smoke-Free Workplace Ordinances Collaboration with Hennepin Medical Society (and numerous other organizations) Data on year olds helped support the issue  Workers  Social settings Having the U of MN involved was helpful It was helpful to students to have someone from college health be at the table

Impact of these Tobacco Control efforts Henry David Thoreau, died on May 6, 1862 (age 44) “Men are born to succeed, not fail.” “If you have built castles in the air, your work need not be lost; that is where they should be. Now put the foundations under them.”

Current Tobacco Use year old undergraduates Percent Data Source: 1992, 1994, 1996, 2000, 2003 –U of M Core Alcohol and Drug Survey, 1998, 2004-U of M Student Health Assessment Survey ** Data are weighted by gender

Current Tobacco Use: Male:Female year old undergraduates

Tobacco Use by 1 st Year Students Current Use

Data Source: 2004-U of M Student Health Assessment Survey Do not consider themselves to be smokers Attempted to quit within the past 12 months Have made no quit attempts in past 12 months

Data Source: 2004-U of M Student Health Assessment Survey

Conclusions Reducing tobacco use among college students is possible  Smokers are trying to quit  We’ve got some tools Second hand smoke in bars and restaurants is a significant problem for college students A comprehensive approach to tobacco use among college students is effective. Collaboration is essential for tobacco control. Involving college health services is helpful in overall tobacco control efforts. More work needs to be done.

Sigmund Freud born May 6, 1856 “Thought is action in rehearsal.”