A Model for Effective Health Communication: Promoting 100% Tobacco-Free Policy in the Tennessee Higher Education System

Theoretical Background and research questions/hypothesis:  Tobacco use is the leading preventable cause of morbidity and mortality in the United States and imposes economic burden on both the federal, state, and local governments. The smoking prevalence rate in Tennessee (23.2%) is higher compared to the national average (18.1%), and is the 45^th worst in the country. Similarly, the average age-adjusted mortality rate is higher compared to the national average. Annually, about 9,700 deaths are attributed to smoking in the Tennessee.  In 2004, economic burden in terms of direct medical cost and lost productivity imposed on the state was estimated to be over $5 billion. Although Tennessee is the third largest tobacco-growing state in the country, it enacted and implemented the Non-Smokers Protection Act in 2007 to protect nonsmokers from secondhand smoke, deal with the problem of the high rate of tobacco use, and improve the health of residents.  The focus of tobacco control activities in the state, however, has generally been on populations other than those on university/college campuses where young adults between 18 and 24 years with high tobacco use rate reside, and are targeted by tobacco companies through marketing and promotional activities. To deal with the problem of tobacco use, higher education institutions in the state have developed varied forms of tobacco-free campus policies.

Methods:  In this study, we conduct a comparative analysis of tobacco-free policies of all the 50 higher education institutions in Tennessee using Nvivo 8, qualitative research software. Additionally, we present the results of our first internet survey of employees of one of the higher education institutions in Tennessee.

Results:   We found a very wide range of smoke-free university/college policies, from a 100% tobacco-free policy in which both smoke and smokeless tobacco products are prohibited to virtual absence of a smoke-free policy. The results of our internet survey with a response rate of 58% shows an overall high level of support for a tobacco-free policy that ban tobacco use (smoke and smokeless) in all of the institution’s premises/property except in private cars. However, a slight rate of noncompliance still exists.

Conclusions:  Our study suggests that to reduce the high rate of tobacco use on higher education institutions in the state and to bring down the generally high tobacco prevalence rate in the state, there is the need for standardized policy in the higher education system.

Implications for research and/or practice:  Given the overwhelmingly high rate of support for tobacco-free policy in our initial survey, 100% tobacco-free campus should be the model for higher education institutions in the state. Further data from other higher education institutions will be collected to determine how to promote this policy throughout the state.