Going Tobacco-Free
on Campus
and Why it Matters
Clifford E. Douglas, J.D.
Director, University of Michigan Tobacco Research Network
Lecturer, University of Michigan School of Public Health
October 2, 2013
Center for Public Health Initiatives, University of Pennsylvania
Topics
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The tobacco epidemic: more work to do
College students & smoking
Environmental impact
Economic impact
U.S. Government leadership & TFCCI
Acceleration of campus policies nationwide
University of Michigan experience
Effectiveness of campus policies
Why many campuses now go tobacco-free
The Tobacco
Epidemic:
More Work to Do
AIDS
Car crashes
Heroin
Homicide
Alcohol
Fires
Cocaine
Suicide
 Each day, 1,200 Americans
die from smoking
 Each smoker who dies is
replaced by 2 young
smokers
 90% of all smokers start
before age 18
 99% of all smokers
start before age 26
Acetone (solvent and paint
stripper)
Ammonia (poisonous gas and
toilet bowl cleaner)
Arsenic (potent ant poison)
Benzene (poisonous toxin)
Butane (flammable chemical in
lighter fluid)
Cadmium (carcinogenic
chemical in batteries; lung &
intestinal irritant)
Carbon monoxide (poisonous
gas in auto exhaust)
Formaldehyde (dead frogs love it)
Hydrogen cyanide (deadly
ingredient in rat poison)
Methanol (jet engine and rocket fuel)
Polonium-210 (radioactive
element and spy-killer)
Toluene (poisonous industrial solvent)

One day’s inhalations: 10 per cigarette x 20 cigarettes
per day = 200

One year’s inhalations = 200 inhalations x 365 days =
73,000

50 years of smoke (by the average smoker’s mid-60s, if
still alive) = 3.65 million inhalations from 365,000
cigarettes
There is no safe level of tobacco use or exposure
to secondhand smoke

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24.8% of full-time college students aged 18-22 years old
were current smokers in 2010
The number of smokers who initiated smoking after age
18 increased from 600,000 in 2002 to 1 million in 2010
Progression from occasional to daily smoking almost
always occurs by age 26
Tobacco companies have carefully studied the attitudes and
behaviors of young people, particularly as they go through life
transitions, such as attending college.
College Students – Projected Toll
Based on current rates, it is predicted
that more than 1 million current college
students will die prematurely from
tobacco use
“If young people don’t start using tobacco by
age 26, they almost certainly will never start.”
- Surgeon General Regina Benjamin
Environmental
Impact
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Cigarette butts = single most commonly collected
waste item found each year in park and beach
clean-ups, and not biodegradable
Cigarette butts = 25-50% of all collected litter from
roads and streets
5.6 trillion butts dumped into the global
environment annually

Cigarette butts contain
all of the carcinogenic
(cancer-causing)
chemicals, pesticides
and nicotine that make
tobacco use the leading
cause of preventable
death
“Cigarette butt waste is the last socially
acceptable form of littering in what has
become an increasingly health and
environmentally conscious world. We
[must] find solutions for eliminating this
especially toxic form of trash.”
- Cheryl Healton et al., “Butt Really? The
Environmental Impact of Cigarettes,”
Tobacco Control, May 2011
A study by the University of North Carolina at
Chapel Hill, concluded that 77% fewer
cigarette butts were found on county college
campuses that adopted 100% smoke-free
campus-wide policies.
Economic
Impact
Economic Benefits of Strong
Campus Policies
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Reduced employee health care costs
Reduced absenteeism
Increased employee productivity
Cost savings in grounds and building
maintenance
 The costs of cleaning up this extensive pollution are
borne entirely by communities and institutions, not
tobacco manufacturers or their customers

Reduced fire damage
U.S. Government
Leadership
Vision:
A society free of tobaccorelated death and disease
First Charge:
www.hhs.gov/ash/initia
tives/tobacco/tobaccos
trategicplan2010.pdf
Base the new HHS strategic
action plan on the tobacco
control goals set forth in
Healthy People 2020
Healthy People 2020’s Tobacco
Prevention Objectives
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Reduce tobacco use by adults and adolescents
Reduce the initiation of tobacco use by
children, adolescents, and young adults
Increase successful cessation attempts by
tobacco users; and
Reduce the proportion of non-smokers exposed
to secondhand smoke
A Key Pillar of HHS’s Plan is to Lead
by Example (“Walk the Talk”)
• In July 2011, HHS established a comprehensive
tobacco-free campus policy covering all indoor
and outdoor properties
• The announcement stated: “Taking this action
will protect the health and safety of all HHS
employees, contractors and visitors and will
serve as a role model for workplaces
everywhere … Educational and promotional
efforts will be provided in support of the policy’s
implementation. We know that quitting tobacco
can be difficult for even the most motivated
people, and we want to help employees
succeed.”
Vision:
Widespread expansion of tobacco-free
policies to institutions of higher learning
across the U.S.
Goals:
1. Foster a collaborative, cooperative effort
among academic institutions and partners
in the public health community
2.
Expand awareness in academia and
among the public of the need for and
benefits of such policies
3.
Facilitate information flow and access to
technical assistance

Lead Partners
◦ U.S. Department of Health
and Human Services
◦ American College Health
Association
◦ University of Michigan

Sponsors
◦ American Legacy Foundation
◦ Americans for Nonsmokers’
Rights
◦ Campaign for Tobacco-Free
Kids
◦ National Center for Tobacco
Policy

Other Partners (a few examples)
◦ American Lung Association
◦ The BACCHUS Network
◦ California Youth Advocacy Network
(CYAN)
◦ Center for Social Gerontology
(Smoke-Free Environments Law
Project)
◦ Montana State University
◦ Partnership for Prevention
◦ State University of New York Upstate
Medical University
◦ Tobacco Control Legal Consortium
◦ University of Kentucky
Accelerating Campus
Policies Across the
Nation

As of July 2013
◦ 1,178 campuses in U.S. are 100% smoke-free with no exemptions,
including residential housing facilities (where applicable)
◦ Of those, 793 – about two thirds – have a 100% tobacco-free policy
◦ Examples of large campuses that have gone tobacco-free:
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University of California (all 10 campuses)
City University of New York (all 24 campuses)
Arizona State University
University of Oregon
University of Oklahoma
University of Kentucky
Montana State University
University of Florida (“Gators don’t chew. They chomp!”)
Emory University
Ohio State University
Source: Americans for Nonsmokers’ Rights Foundation,
http://www.no-smoke.org/pdf/smokefreecollegesuniversities.pdf
100% Smoke-Free Campuses
1400
1200
1000
800
600
400
200
0
Oct05
Now
Opportunity
The U.S. Department of Education identifies
4,583 colleges, universities and other
institutions of higher learning in the U.S.
Penn’s Opportunity
Would become the first Ivy League
school to adopt a comprehensive
campus policy
The
University of Michigan
Experience
•
Decision to go smoke-free on all three campuses (Ann Arbor,
Dearborn and Flint) was announced in April 2009, and, following
its development, was promoted for a year prior to
implementation
•
Strong community involvement: committees, public forums, etc.
•
Policy went into effect on July 1, 2011
•
If Michigan had adopted policy now, it probably would have gone
fully tobacco-free … the norm has shifted rapidly
Michigan Policy - Coverage
• Smoking prohibited on all university property
• No designated smoking shelters
• Smoking is allowed on thoroughfare sidewalks
and in private vehicles
Michigan Policy - Implementation
• Communications began more than
a year in advance of effective date
• Installation of new signage;
currently being updated and
expanded (ongoing process)
• E-mail blasts, social media
messages, posters, tent cards, bus
posters, campus newspaper
articles, sidewalk chalk, dedicated
website, video
• Advisory committee meets 3x a
year
www.smokefree.umich.edu
Michigan Policy - Enforcement
• Enforcement is through peer education and
multiple forms of communication, fostering
ongoing social norm change
• Respectful reminders to people who are
observed failing to adhere to the policy
• People who smoke where not permitted and
decline to stop when informed – particularly
repeat offenders – are subject to existing
disciplinary processes

University of Kentucky’s program enhanced compliance,
using the “3 T’s” approach
◦ Tell – conduct robust communications (repetition; and keep it fresh)
◦ Treat – provide evidence-based tobacco treatment services
◦ Train – supervisors, faculty, administrators & student leaders learn
how to approach violators, serving as ambassadors and respectfully
fostering a culture of compliance

At Kentucky, 4 part-time ambassadors and more than 50
student & staff volunteers
Promoting Cessation – Components *
Implement before campus policy goes into effect
Promote cessation as an opportunity, but not as an obligation
The message: Campus policy implementation = A Great Time to Quit
Three targeted populations: students, staff & faculty
Remove cost/access barriers to treatment
Implement ongoing systems of cessation, not just a one-time
program
• Integrate services into student, staff & faculty health services
• Use free national quitline, 1-800-QUIT NOW, to supplement, but not
substitute for, campus programs
• Expand insurance coverage to include counseling and all FDAapproved medications
•
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•
•
•
•
* With thanks to Michael C. Fiore, MD, MPH, MBA,
Professor of Medicine; Director, Center for Tobacco
Research & Intervention; University of Wisconsin
School of Medicine and Public Health
Effectiveness of
Campus Policies
•
•
•
89% of faculty/staff and 83% of students supported policy
72% of faculty/staff and 65% students noticed decrease of
smoking on campus
Smoking by faculty & staff dropped from 6% to 4%
• 29% of smokers reduced consumption
• 40% of smokers attempted to stop in last 12 months
• 22% of smokers participated in MHealthy Tobacco Independence
Program
•
•
13% of faculty/staff reported the policy influenced them to quit
or attempt to quit smoking
16% of students reported the policy influenced them to quit or
attempt to quit smoking
Source: University of Michigan, MHealthy & “Smoking Declines After U-M Campus Ban,”
May 9, 2013
• Study compared undergraduates’ smoking behaviors and
attitudes at two Big Ten campuses with similar demographics
… Purdue University (no policy) and Indiana University
(tobacco-free policy implemented in 2008)
• Indiana University smoking prevalence: 16.5% in 2007; 12.8%
in 2009 (-3.7)
• Purdue University smoking prevalence: 9.5% in 2007; 10.1% in
2009 (+0.6)
• Indiana University consumption rate: 6.6 cigs/day in 2007; 5.9
cigs/day in 2009 (-0.7)
• Purdue University consumption rate: 5.2 cigs/day in 2007; 6.8
cigs/day in 2009 (+1.6)
• Study also showed significant favorable change in attitudes
among Indiana University students regarding elimination of
smoking in public places and on university property
Source: Dong-Chul Seo et al., The Effect of a Smoke-free Campus Policy on College
Students’ Smoking Behavior and Attitudes, Preventive Medicine 2011;53:347-352.
Why Do Many
Campuses Go
Tobacco-Free?

Tobacco that is not burned (combusted)
◦ Traditional smokeless products
 *Chew (“spitting tobacco,” placed between cheek and gums)
 *Snuff (dry snuff sniffed through nose; moist snuff, or “dip,”
placed between cheek and gums)
 Snus (finely ground tobacco administered in small packets)
◦ New generation of products
 Dissolvables (lozenges, orbs, sticks, strips)
 E-cigarettes (not called “smokeless tobacco,” but are similarly not
combusted, and the federal court system has ruled that, under
the law, they are to be treated as “tobacco products” subject to
regulation by the Food and Drug Administration)
*Currently dominate the U.S. smokeless tobacco market
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Addictive
Not a safe alternative to cigarette smoking
Most smokeless tobacco products contain carcinogens
(at least 28 have been identified, and nitrosamine levels
are higher in smokeless tobacco than in cigarettes)
Most smokeless tobacco products cause oral,
esophageal, and pancreatic cancer
Use of these products causes gum recession, gum
disease, and tooth loss
Use also associated with greater risk of fatal heart
attacks and stroke
“After years of steady progress, declines in youth
tobacco use have slowed for cigarette smoking and
stalled for use of smokeless tobacco. The latest
research shows that concurrent use of multiple
tobacco products is common among young people,
and suggest that smokeless tobacco use is increasing
among White males.”
- Surgeon General’s Report, 2012
There are approximately 8 million
smokeless tobacco users in the U.S.

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Tobacco industry promotes dual use
Ads promote use of smokeless tobacco
products not to replace cigarettes but
as a way for smokers to satisfy
addiction wherever they cannot smoke
“There is a need to clearly
position the [smokeless tobacco]
product as a situational substitute
for cigarettes rather than a
replacement.”
- R.J. Reynolds spokesman, 2009
(September 2013)

We think consumption of e-cigs could surpass consumption of conventional
cigs within the next decade.
E-Cig Vs. Conventional Cig Volume
E-Cig Vs. Conventional Cig Operating Profit Pool
20.0
18.0
14.0
Operating Profit Pool (in $ billions)
Equivalent Pack Volume (in billions)
16.0
12.0
10.0
8.0
6.0
4.0
2.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
0.0
2011
2012
2013E 2014E 2015E 2016E 2017E 2018E 2019E 2020E 2021E 2022E 2023E
E-Cigarettes (in equivalent packs)
Conventional Cigarettes (in packs)
2011
2012
2013E 2014E 2015E 2016E 2017E 2018E 2019E 2020E 2021E 2022E 2023E
E-Cigarettes
Conventional Cigarettes
 Importantly, growth of the combined profit pool could accelerate in
the next decade.
 We estimate total conventional & e-cig total profits will generate a
CAGR of 7.2% over the next decade.
Source for all charts: Company reports and Wells Fargo Securities, LLC estimates
46
A Final Note about E-Cigarettes
• Health issue is not e-cigarette’s level of harmfulness compared to
conventional cigarettes, but rather the risk it poses for public
health irrespective of whether it is as bad as ordinary tobacco use
• If treated differently, implies acceptance of addiction to
unregulated nicotine delivery products, complicating university’s
health mission
• Permitting e-cigs encourages dual usage (cigarettes and e-cigs) in
lieu of cessation in some individuals who might otherwise quit
• Creates potential confusion regarding rules and mixed health
message

“There is no safe tobacco product, and the Initiative
encourages adoption of comprehensive tobaccofree policies. It is also recognized that each
institution must make its own decisions when it
comes to promoting health and preventing disease
in its students, faculty, employees and visitors.”

“Tobacco-free policies go further in promoting a
culture of health and wellness while reducing
exposure to the variety of non-smoked forms of
tobacco that cause cancer, heart disease and other
serious illnesses.”
“There is no higher priority in
public health than ending
the tobacco epidemic.”
– Dr. Howard Koh, U.S. Assistant Secretary
for Health
Please visit us at:
TobaccoFreeCampus.org