Abstract
Background. Colleges across the country are adopting tobacco-free policies to prevent and decrease tobacco use among college-aged young adults. Aims. This study examines differences between nontobacco, single-product, and polytobacco users’ perceptions of the importance of enforcing tobacco-free policies, support for various enforcement strategies, and success of policy enforcement on campuses. Method. A Kruskal-Wallis test was conducted to examine group differences on the importance of enforcing polices, support for enforcement strategies, and success of policy enforcement among 10,351 students attending 10 Texas colleges. Results. Findings show significant group differences on all dependent variables. Post hoc tests indicated that nontobacco users reported the most favorable responses, followed by single-product users, then polytobacco users. Discussion. Despite group differences, findings show all students feel it is important to enforce tobacco policies and support enforcement strategies but believe current campus enforcement efforts are only moderately successful. Conclusions. Findings may prompt administrators to adopt policy enforcement strategies to curb tobacco use on campuses.
College-aged young adults, age 18 to 24, have the highest prevalence (22%) of polytobacco use or the concurrent use of multiple tobacco products (Osibogun et al., 2018). Polytobacco use is concerning because it exposes users to greater nicotine levels and increases risk for sustained use and dependence and for reduced quitting (Butler et al., 2015). Polytobacco use is also associated with other risky behaviors such as marijuana use and binge drinking in college-aged populations (Yu et al., 2017).
Addressing tobacco use in college-aged young adults is vital because roughly 99% of smokers first try smoking before the age of 26, and progression from occasional to daily smoking typically occurs by age 26 (Centers for Disease Control and Prevention, 2012). One strategy for preventing and decreasing tobacco use in this population is adopting tobacco-free policies on college campuses. Approximately 67% of students who graduated high school in 2017 were enrolled in colleges or universities in the fall; thus, efforts to address tobacco use in this age-group should target college students (U.S. Department of Labor, 2018).
A large number of colleges are implementing tobacco-free policies in an effort to reduce tobacco use on campus. As of January 2020, the American Nonsmokers’ Rights Foundation (2020) reported that 2,487 college campuses were 100% smoke-free. Adoption of tobacco policies on college campuses reduces tobacco use, decreases prosmoking attitudes, and increases the number of students seeking treatment and cessation resources to quit using tobacco; however, adopting these policies alone is not sufficient for substantial change among college students (Fallin et al., 2015).
Although colleges have made great strides in implementing tobacco-free policies, enforcement of these policies remains a challenge. Roditis et al. (2015) found that many tobacco polices on campuses do not have well-defined statements regarding policy enforcement. Without a clearly defined enforcement strategy, tobacco-free policies have minimal effect (Fennell, 2012). Intervention efforts to improve tobacco policy compliance are emerging, yet research is sparse on effective enforcement strategies on college campuses (Fallin-Bennett et al., 2017). Even less is known about the support of enforcement efforts among college students. College administrators are more amenable to policy changes if there is strong student demand and support for changes (Braverman et al., 2015). Understanding students’ perceptions of enforcement strategies may facilitate college administrators’ enforcement efforts on college campuses.
Studies report significant differences in the support of tobacco-free policies by smoker status, with nonsmokers reporting greater support of these policies than smokers (Braverman et al., 2015; Loukas et al., 2006). It is feasible, then, that support for enforcement of tobacco policies may differ among broader categories of tobacco user groups. Research increasingly indicates that polytobacco users are a distinct group that vary from single-product users in their perceptions about tobacco use (Butler et al., 2015). Polytobacco users also have more favorable attitudes and lower harm perceptions regarding tobacco use and therefore may be less supportive of tobacco policies than single-product users and nontobacco users (Butler et al., 2015). The overall purpose of this study is to examine the perception of enforcement strategies of tobacco policies on college campuses by tobacco user group. Specifically, we examined differences between nontobacco, single-product, and polytobacco users on their perceptions of the importance of enforcing policies, support for types of enforcement efforts, and success of enforcement strategies on Texas college campuses.
Method
Participants
Participants were a convenience sample of 10,351 college students, aged 18 to 29, attending 10 colleges in Texas. Their mean age was 21.2 (SD = 2.68); 63.9% were female; and 32.6% non-Hispanic White, 28.6% Hispanic, 14.1% Asian, 12.3% indicated a race/ethnicity of “Other,” 6.1% were multiracial, 5.0% Black/African American, 0.3% were American Indian, and 0.2% were Native Hawaiian/Other Pacific Islander. In addition to the 10,351 participants, 6,666 students were removed from the sample because they attended a college with no tobacco policy, did not finish the majority of the survey, or were not 18 to 29 years old.
All 10 colleges were public institutions, and all but one were 4-year colleges. Seven of the schools had comprehensive tobacco policies, and three had partial tobacco policies, as determined by the Texas College Tobacco Policy Database (www.txcollegetobaccopolicy.org). Schools with comprehensive policies received a rating of 100%, illustrating that they prohibit tobacco use in all campus buildings including residence halls, on all campus property or designated outdoor areas including parking lots, and prohibit the use of electronic nicotine delivery systems and smokeless tobacco; partial tobacco policies were schools with a rating less than 100%.
The institutional review board from the university leading the study approved administration of the survey. Students were recruited to participate in an online survey through email addresses provided by each school. A total of 205,768 unique email invitations were distributed; 17,017 students participated in the survey, yielding an overall response rate of 8.3%.
Procedures
Prospective participants received an email invitation to participate in the study in February 2017. Students who did not participate in the survey were sent up to two reminders, and the survey was available for completion until March 2017. Participants completing the survey were entered into a prize drawing for one of fifty $20 gift certificates. The survey was a 60-item online anonymous questionnaire assessing students’ knowledge, attitudes, and behaviors related to traditional and alternative tobacco products.
Measures
Tobacco Use Groups
Respondents were categorized into three groups: nontobacco user, single-product user, and polytobacco user. These groups were determined based on students’ responses to the following questions: “During the past 30 days, how many days did you use the following?” Responses for each product, “Traditional Cigarettes”; “Cigars, cigarillos, or little cigars”; “Hookah”; “Smokeless (i.e., chewing tobacco, snus, snuff, or dip)”; “ENDS (i.e., e-cigarettes, vape pens, or e-hookah),” were “0 days,” “1 or 2 days,” “3 to 5 days,” “6 to 9 days,” “10 to 19 days,” “20 to 29 days,” and “All 30 days” (Starr et al., 2005). The nontobacco user group comprised students indicating “0 days” on all product types. Of the total sample, 8,295 (80.1%) identified as nontobacco users. The single-product user group included participants who responded using only one product at least 1 day during the past 30 days, and the polytobacco user group responded using two or more products at least 1 day during the past 30 days. There were 1,181 (11.4%) single-product users and 875 (8.5%) polytobacco users in the total sample.
Dependent Variables
One item assessed the importance of enforcing tobacco policies by asking, “How important is it to you that your school enforces the tobacco policy on your campus?” Responses ranged from 1 (not at all important) to 5 (extremely important).
Three items assessed support for types of enforcement strategies by asking, “To what extent would you support citations, an online reporting tool and peer enforcers on your campus?” Responses ranged from 1 (strongly oppose) to 5 (strongly support).
One item assessed the success of enforcement strategies of tobacco policies by asking, “How successful has enforcement of the tobacco policy been on your campus?” Responses ranged from 1 (not successful at all) to 5 (extremely successful).
Data Analysis
Analyses were conducted to examine the difference between the three tobacco user groups’ perceptions of the importance of enforcing tobacco policies, support for types of enforcement efforts, and the success of enforcement strategies on college campuses. All five outcome variables were nonnormally distributed. As a result, a nonparametric test was deemed the most appropriate for this sample. A Kruskal-Wallis test was conducted with tobacco user group as the independent variable and the importance of enforcement, support for citations, support for online reporting tool, support for peer enforcers, and the success of enforcement efforts of tobacco policies as the dependent variables. We then calculated effect sizes for each dependent variable to examine the proportion of outcome variation between the tobacco user groups. Post hoc Dunn pairwise comparisons were performed to examine differences between each tobacco user group for each dependent variable. Finally, we stratified the data by strength of campus tobacco policy and conducted the Kruskal-Wallis test to determine if differences across the three tobacco user groups varied across students attending schools with a comprehensive policy versus those attending schools with a partial policy.
Results
Examination of differences in perceptions of enforcement strategies of tobacco policies on college campuses indicated significant differences among the three tobacco user groups on each of the five dependent variables as shown in Table 1. The proportion of variability in each of the first four ranked dependent variables ranged from .08 to .12, indicating moderate to strong relationships. In contrast, the proportion of variability in the success of enforcement strategies accounted for by tobacco user group was trivial. Results from Dunn post hoc pairwise comparisons indicated very strong significant differences at the α = .0167 level (Bonferroni adjustment for three pairwise comparisons, α = .05/3) between each tobacco product user group on each dependent variable, and as expected the nontobacco user reported the most favorable responses, followed by single-product user, then polyproduct users. Finally, analyses stratified by campus policy strength indicated that observed differences were consistent across students attending schools with a comprehensive policy and those attending schools with a partial policy.
Descriptive Statistics of the Dependent Variables for the Overall Sample and by Tobacco User Group.
Note. Pairwise comparisons for each group on all dependent variables are statistically significant at the .0167 level (0.05/3), such that nontobacco users report higher means for importance, support, and success than single-product users as well as polytobacco users, and single-product users report higher means than polytobacco users.
Sample sizes vary slightly because of missing data for the dependent variable; all were ≤1%.
Significant at the p < .001 level.
Discussion
Limitations
This study extends current research by describing the differences in support of enforcing tobacco policies on college campuses among tobacco user groups; however, a limitation of this study is that the results are not generalizable to a broader population. There was a low response rate (8.3%) and included only students from colleges in Texas. Future research should include schools and students from various regions throughout the country.
Strengths
Strengths of this study include a large and ethnically diverse sample of students, as well as a large and diverse sample of schools. Accounting for the variability of policy strength across schools in examining student perceptions of policy enforcement strategies on college campuses is also a strength of this study.
Implications
College administrators are more amenable to policy changes if there is strong student demand and support for changes (Braverman et al., 2015). Findings from this study indicate that college students feel it is important to enforce tobacco policies on campus, that students are supportive of various enforcement strategies, and that the majority of students in this sample find current enforcement efforts are only moderately successful. These outcomes, along with previous research, may facilitate college administrators’ plans for tobacco policy enforcement in order to curb tobacco use on college campuses.
As expected, and consistent with research on support of tobacco-free policies, there were group differences in students’ perceptions of enforcement strategies by tobacco user groups (Braverman et al., 2015; Loukas et al., 2006). Polytobacco users report it being only slightly important for schools to enforce tobacco policies, single-product users indicate it being moderately important, and nontobacco users report it being very important for schools to enforce tobacco policies. Polytobacco users are also the least supportive of all enforcement strategies (citations, online reporting tool, and peer enforcer), followed by single-product users, while nontobacco users are the most supportive. Finally, all three tobacco user groups report current enforcement efforts on their campuses as being only slightly to moderately successful.
A preponderance of students in our sample perceive current enforcement endeavors on college campuses as being only moderately successful. Given this outcome, along with previous research, college administrators should implement tobacco policy enforcement strategies on college campuses that include both social and formal enforcement approaches in an effort to curb tobacco use (Fallin-Bennett et al., 2017). In addition, findings indicate that polytobacco users are a distinct group of tobacco users, and extend existing research by showing that polytobacco users are less supportive of campus tobacco policies than single-product users, perhaps because they have more favorable perceptions regarding tobacco use (Butler et al., 2015). Understanding differences between polytobacco and single-product users is important to develop tailored intervention plans as well as customized messaging for these distinct groups. Tailored messages that target polytobacco users are particularly important to increase support for enforcement strategies of tobacco policies on college campuses to reduce tobacco use.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
