C Y. A Toolkit for Colleges and Universities

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1 MPPR OM CO REEH AC HEEN GA NG NSSIIV ATTIIN VEE C REEA CR RE EE EP O--FFR CO PO OLLIIC CC AC BA TTO CY OB Y A Toolkit for Colleges and Universities

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3 Introduction Texans Standing Tall, in line with the American College Health Association (ACHA), acknowledges and supports the findings of the U.S. Surgeon General that tobacco use in any form, active or passive, is a significant health hazard. The 2013 National Survey on Drug Use and Health conducted by the U.S. Department of Health and Human Services revealed that young adults aged 18 to 25 had the highest rate of current use of tobacco products (37%) compared to all other age groups. In Texas, 34% of college students reported they used tobacco in the past year and 22% reported they used tobacco in the past month, according to the 2013 Texas Survey of Substance Use Among College Students. Tobacco is the leading cause of preventable death and disease in Texas. According to the Campaign for Tobacco-Free Kids, 28,000 smokers die from tobacco-related diseases each year in Texas, and an estimated 498,000 kids under age 18 who are alive now in Texas will eventually die prematurely due to smoking. Non-smokers are harmed by tobacco as well because secondhand smoke increases the risk of cancers and other tobacco-related diseases. According to the Centers for Disease Control and Prevention, since 1964, 2,500,000 nonsmokers in the U.S. have died from health problems caused by exposure to secondhand smoke. Tobacco use and secondhand smoke is also a huge cost burden to the state. The Campaign for Tobacco-Free Kids indicates that, in Texas, the annual health care costs directly caused by smoking is $8.85 billion and the estimated productivity losses due to smoking are $8.22 billion a year. Colleges and universities can improve the health of students and campus communities while also saving money on tobacco-related costs by implementing a comprehensive tobacco-free campus policy.... in Texas the annual health care costs directly caused by smoking is $8.85 billion and the estimated productivity losses due to smoking are $8.22 billion a year. Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

4 Benefits of a Comprehensive Tobacco-Free Policy College and university campuses can take part in reducing the impact tobacco use has on Texans each year by implementing a strong tobacco-free campus policy or strengthening an existing policy. While it has become relatively common for colleges and universities to have policies requiring that all buildings, including residential housing, be smoke-free and/or tobacco-free indoors, many colleges and universities have not updated their policies to include outdoor use. Comprehensive tobacco-free policies protect the health of the campus community and environment. College campuses endure institutional costs associated with campus tobacco use, and new or updated policies can help protect campus facilities and the bottom-line as well as protect student and employee health. Improve Student and Employee Health Creating a tobacco-free environment protects individuals from secondhand smoke and secondhand aerosol from electronic cigarettes. Current tobacco users may be encouraged to seek cessation services or reduce use when a comprehensive tobacco-free policy is implemented. Save Money Reduce staff time spent on maintenance of campus facilities as well as loss of productivity and sick leave. Valuable staff time is saved when time is no longer spent emptying ashtrays and picking up cigarette butts and other tobacco waste. Avoid Legal Liability According to the Americans with Disabilities Act (ADA), colleges are required to maintain accessible campuses and provide reasonable accommodation for students and employees with medical conditions, including conditions such as asthma that are triggered by secondhand smoke. Enhance Overall Campus Environment Comprehensive tobacco-free policies can encourage current users to quit, prevent initiation of tobacco use by non-users, and protect the campus buildings and environment from tobacco litter and smoke residue. Ultimately, this can generate social, economic, and environmental benefits for the college that will impact its bottom line. Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

5 Smoke-Free vs. Comprehensive Tobacco-Free An increasing number of colleges and universities are adopting comprehensive tobacco-free policies. As of January 1, 2015, the American Nonsmokers Rights Foundation (ANRF) documented that, in the United States, there are now at least 1, % smoke free campuses. Of these, 1,014 are 100% tobacco-free, and 587 prohibit the use of e-cigarettes anywhere on campus. While smoke-free policies and comprehensive tobacco-free policies share many similarities, they also have a number of differences. Texans Standing Tall reviewed definitions from a variety of reputable sources, including ANRF and the Tobacco-Free College Campus Initiative, to create working definitions of policy types as indicated below. A smoke-free policy is one that limits or eliminates the use of smoke-producing tobacco, such as cigarettes, cigars, cigarillos, mini-cigars, and hookahs. It may include innovations in smoke or tobacco products that emit a smoke-like substance such as electronic cigarettes or other electronic nicotine delivery devices. A tobacco-free policy limits or eliminates any tobacco product, including but not limited to any lighted or unlighted cigarette, cigar, pipe, bidi, hookah, and all forms of smokeless tobacco and any electronic nicotine delivery device, such as electronic cigarettes. A comprehensive tobacco-free policy eliminates the use of any tobacco product, including, but not limited to, cigarettes, cigars, cigarillos, mini cigars, hookahs, spit tobacco, snus, and other smokeless products. It also includes innovations in smoke or tobacco products and electronic nicotine delivery devices, such as electronic cigarettes. A comprehensive tobacco-free policy may also address campus tobacco sales, marketing, sponsorship, and investments. Electronic cigarettes are also know as: e-cigarettes/e-cigs Electronic Nicotine Delivery Systems or ENDS e-cigars e-hookah hookah pens vape pens E-Hookahs Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

6 Framework for Campaign Development Step #1: Campus Assessment & Investigation Campus assessments provide clarity on tobacco-related problems that exist on campus, possible solutions to the problem, and the options for creating change. The quantity of information collected is less important than the quality of the information and connections made along the way. Campaign development should begin with a thorough assessment and investigation of the campus community, environment, and political climate. Once you have identified the tobacco-related problems on your campus, collect data around the main issue or main concern. Data collection methods include: Review of existing campus documents in order to fully understand the existing policies and procedures in place at the college or university. Examples of documents include student handbooks, employee handbooks, health service records, and other written policies. Campus-based surveys provide information about the students and the campus community that can underscore the need for a comprehensive tobacco-free policy. Campus-based surveys often show tobacco use rates and other relevant student behaviors. Examples include: National College Health Assessment CORE Alcohol and Drug Survey Texas Department of State Health Services Texas Survey of Substance Use Among College Students Surveys can also be developed and conducted to assess campus opinions and beliefs related to tobacco use and specifically to a tobacco-free policy. Individuals or organizations to survey may include: Campus Health/Wellness Center employees Campus faculty and staff Maintenance personnel Student organizations, including public health clubs, peer educators, and pre-med/ pre-nursing groups Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

7 Key informant interviews are in-depth interviews with people who can share important information about the campus community related to your issue. Key informants may include: Personnel from health services Residence Life staff Student Affairs staff Student Government Campus faculty and staff Maintenance personnel Human Resources personnel Department Chairs Environmental scans are visual observations of the campus environment. Conduct an environmental scan by walking through the campus and noting what you see. Be sure to note areas where smoking occurs or smokers congregate, cigarette butt litter, ashtrays, any tobacco marketing, tobacco-free signage or lack thereof, etc. Taking pictures to document findings is useful to demonstrate the problem to others. Areas to include in an environmental scan include: Building entrances Parking lots Designated tobacco-use areas (if applicable) Areas surrounding residence halls or dorms Classrooms and student common areas, especially if indoor e-cigarette use is a concern Athletic fields or stadiums Cafeterias/eating areas Step #2: Build a Diverse Campus Coalition Campaign development and policy change require a team effort and a wide variety of skills, ideas, and resources. Developing a diverse campus coalition means including a variety of campus stakeholders and groups who have the ability and interest to address the tobacco use problems identified in the campus assessment phase. To build your coalition, initially you may want to recruit individuals or groups who have knowledge that is directly related to the tobacco use problem. For example, if your assessment shows that tobacco use is a problem outside of a residence hall, you will want to recruit students and RAs who live in that residence hall. You should also outreach to organizations that do not necessarily have tobacco-specific knowledge, but can offer information on engaging the campus administration. Coalition members may include: Faculty Administrators Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

8 Students Residence Life personnel Student Affairs personnel Campus police and safety department personnel Campus nurse or campus health personnel Greek Life students or staff Student health organizations Athletics department Student Government Once you have formed your coalition, it s time to Find Your Champion! Who can be your champion for campus policy change? Your champion is someone who will speak on behalf of your cause and has influence with campus decision makers. This person will be your team s vocal advocate and the main force behind the push for policy change. He/she will jumpstart the work toward a comprehensive tobacco-free policy, draw attention to issues unveiled by the campus assessment, and keep your coalition motivated to achieve its goal. Your champion should be part of the campus community and willing to speak out on behalf of the coalition. Your policy champion may be a student, faculty member, student organization, administrator, donor/financial supporter, or alumni. Step #3: Develop an Action Plan Your coalition will need to develop an action plan to guide their efforts to achieve policy change. With your champion and coalition, review the findings from the campus assessment to identify key problems on your campus. If your campus already has a tobacco policy, revisit the policy and outline additional issues on which your coalition would like to focus. Determine which problems or issues are of greatest concern on your campus. Examples include: Secondhand smoke (campus wide, near designated smoking places, near building entrances, etc.) Cigarette litter High smoking rates among students Waste from smokeless tobacco Concerns about e-cigarette use in classrooms Your action plan should include specific goals and objectives related to how to create a comprehensive tobacco-free policy that addresses your campus s priority issues. It is helpful to use SMART goals when building your plan. A SMART goal is specific, measureable, attainable, relevant, and time-bound. Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

9 Part of your plan should include researching answers to potential questions or concerns that administrators and others in the campus community may have. Be sure to address the following: A. Policy implementation How is the policy going to be implemented? The plan for implementing the policy should include: 1) an educational campaign to inform the campus community about the policy changes; and 2) steps to create a tobacco-free environment, such as updating student handbooks, removing designating smoking areas, installing new signage, etc. B. Cessation services Are cessation services going to be provided? If so, how? Planning for cessation services includes determining how the campus will provide cessation resources and services to both students and employees. These services may be provided through the state or local health department, campus student health services, American Cancer Society s Quitline, or other local resources. C. Policy enforcement How is the policy going to be enforced? The plan must address mechanisms for policy enforcement including how reported violations and penalties will be reviewed and enforced. It should also include definitions of violations and associated penalties. D. Evaluation How will we know if the policy is working? The plan should include ways to evaluate ongoing compliance with the policy and to determine any needed refinements over time. As the coalition creates their action plan, remember to explore legal and budgetary considerations along with existing campus procedures related to adoption of new policies. Develop a timeline and assign action plan activities to coalition members. Step #4: Mobilize and Build Capacity Develop materials to share with other individuals or groups with influence who can help move the policy forward. Include the primary issues and concerns along with research and the campus assessment findings in the materials. Materials may include: Summary of assessment findings One-pager showing main concerns and policy solution Presentation Website or social media page with relevant information Ultimately, you are mobilizing members of the campus community to be vocal supporters for your effort. This mobilized group will demonstrate to administrators that there is campus support for the policy change. Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

10 Step #5: Policy Workgroup Policy creation and adoption varies greatly depending on your campus s procedures for policy development. The best way to start drafting your policy is to create a policy workgroup. A policy workgroup is a subset of your coalition members that will be involved with policy development and implementation. The policy workgroup includes representatives from student, faculty, staff, and campus organizations as well as other key players, such as local community-based organizations and campus administrators. Bringing together key stakeholders in your campus community ensures a higher likelihood of policy compliance when the policy is implemented. A policy workgroup can provide a joint recommendation to campus decision makers on behalf of the campus community. However, the policy workgroup will need the support of the administration in order for the policy to be implemented. Once a policy workgroup has been formed, draft an outline of your policy goals. Your policy goals should address the issues you previously identified. When developing your policy goals and language: Review your campus assessment. Review policies, processes, and model language that have been used by other college/ university campuses. Incorporate preemptive language in your policy. Policy language that addresses problems that do not yet exist can be a benefit to the campus in the future. When your policy goals have been developed, begin writing a draft policy with your policy workgroup using policies from other campuses as guides. For examples of comprehensive tobacco-free campus policies in Texas, visit Texans Standing Tall s Database of Texas Institutions of Higher Education and their Tobacco Policies at www. txtobaccofreecolleges.org. Step #6: Present to Campus Administration Once your policy workgroup has completed a draft policy, you will need to obtain feedback and gain support from campus administration. Present your draft policy to the designated administrative group along with any data or related information that supports your policy. Informational meetings with a key decision maker/s may be necessary prior to scheduling a formal presentation of your draft policy this is where one-page fact sheet can be particularly helpful. At this point, work with administration as needed to answer questions related to the policy. A formal presentation is often the best way to present your concerns and policy solution to campus administration because it provides opportunity for discussion and Q&A. If a formal presentation is not an option, the information can also be delivered through a scheduled meeting, formal letter, an , or a one-on-one conversation. Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

11 If the college president and other key administrators have provided support: Request the key administrators to assign responsibility and authority for coordinating the development and implementation of the tobacco-free policy to an appropriate senior level member of the administration. Depending on your campus, your policy workgroup may be asked to continue supporting the administration in policy development. If the college president and other key administrators have not provided support: Your coalition and/or policy workgroup should evaluate and determine what issues led to the administrators decision. Once you have identified the reason for opposition, re-group and mobilize supporters to re-approach administration at another time with additional information. When your policy is adopted, celebrate your success! Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

12 Post-Policy Adoption After your campus adopts the tobacco-free policy, use this momentum to continue working with your coalition in order to ensure successful implementation, enforcement, and evaluation of the policy. Step #1: Policy Implementation Develop a communication plan and campaign to disseminate the new policy to the campus community as well as the larger community. Share details about the policy on the campus website, in a letter to students and parents from the President, on flyers/bulletins around campus, through earned media coverage on local news, through social media posts, etc. Create a tobacco-free environment by removing designated smoking areas, providing clear tobacco-free signage, etc. Integrate policy information into new student and new employee orientations as well as student and employee handbooks. Use the campus website, newspaper, radio, , intranet, campus video screens, short-term signage, etc. to reinforce the message. Step #2: Cessation Services Promote cessation resources and services. These services can be through the state or local health department, campus student health services, or other local area resources. Certain insurance companies may offer coverage for tobacco cessation medication, nicotine-replacement therapy, and cessation counseling as well. Existing campus services could begin to help students and employees determine what cessation services are covered in their health insurance. Below you will find a few options for cessation services: American Cancer Society Quitline. The American Cancer Society Quitline provides free and confidential counseling services. This service is funded by the Texas Department of State Health Services (DSHS) and offers both telephone and web-based counseling in certain communities. Visit com for more information. Campus Health Services. Tobacco cessation support and resources may be available through your campus s health and/or counseling facilities. DSHS Tobacco Prevention and Control Program. The Texas Department of State Health Services Tobacco Prevention and Control Program provides prevention and cessation services through local coalitions and regional coordinators. Visit for more information. Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

13 Employee Benefits Programs. Some employers offer tobacco cessation services and/or incentives to their employees as part of their health benefits packages. Contact your campus s benefits provider for additional information to provide to campus employees. Step #3: Policy Enforcement A policy is only effective if it is fully implemented and enforced. Write guidelines on procedures and practices for enforcement and clearly define violations and penalties. Provide training to those who will be responsible for monitoring the campus for policy compliance and addressing violations. Keep in mind that the first and best method for policy enforcement is the policy itself including provisions for educating the campus community about the new policy, including posting highly visible signage. Step #4: Evaluation After the policy has been fully implemented, evaluate outcomes from the policy and policy compliance. Document successful changes that have occurred on campus as a result of the policy as well as any issues that need increased enforcement. For example, individuals may no longer be smoking near building entrances but you may notice increased cigarette butt litter in other locations. Repeat a campus assessment of students and employees in order to document progress related to tobacco use and tobacco-related concerns. Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

14 Other Resources Developing, implementing, and enforcing a comprehensive tobacco-free policy on campus takes time and commitment. Texans Standing Tall s toolkit is designed to serve as a basic framework, illustrating the steps needed to achieve your tobacco-free campus policy goals. Below are several other more detailed policy toolkits from organizations nationwide that campuses might find useful in creating or updating their campus policy. Resources for Comprehensive Tobacco-Free Campus Policy Development: Creating a Tobacco-Free Campus: A Policy Guide (Public Health- Seattle & King County) Making Your College Campus Tobacco-Free: A Guide for College Leaders (TobaccoFree Oregon) Georgia Tobacco-Free Colleges & Universities Tool Kit (Georgia Department of Public Health) Helpful Hints to Create a Smoke-Free/Tobacco-Free Campus Policy (Healthy Campus Tobacco-Free) Tobacco-Free College Campuses in New York State (New York State Colleges Tobacco Free Initiative) Tobacco-Free Campus Policy: Implementation Guide (Peers Against Tobacco) For additional information and guidance in creating a tobacco-free environment on your campus: Contact Texans Standing Tall at tst@texansstandingtall.org. Visit our Database of Texas Institutions of Higher Education and Their Tobacco Policies at txtobaccofreecolleges.org to review and compare other campus tobacco-free policies. Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated

15 About the Policy Database Texans Standing Tall created the Database of Texas Institutions of Higher Education and Their Tobacco Policies to assist campuses, community members, and concerned stakeholders in quickly identifying the tobacco-free campus policies of Texas institutions of higher education (IHEs). For this database, Texans Standing Tall (TST) examined the policies of more than 160 Texas IHEs and classified whether each campus is: 100% smoke-free 100% smokeless tobacco-free 100% e-cigarette-free This database recognizes campuses in Texas that have dedicated time and resources to become 100% smoke-free, smokeless tobacco-free, and e-cigarette-free and is meant to encourage action among institutions that do not have a comprehensive tobacco-free policy. The database is meant to serve as a tool for campuses, community members, coalitions, and concerned stakeholders to better understand existing campus policies and to support implementation of comprehensive tobacco-free policies on more campuses. What is a comprehensive tobacco-free policy as indicated in the database? Texans Standing Tall used Americans for Nonsmokers Rights Foundation s best practices to establish the definition of a comprehensive tobacco-free policy. To qualify as a comprehensive tobacco-free campus, a college must prohibit smoking as well as smokeless tobacco and e-cigarette use on all of its campuses and controlled properties at all times. The policy must prohibit the use of any tobacco product on campus property, including but not limited to cigarettes, cigars, cigarillos, mini cigars, hookahs, spit tobacco, and snus. It also includes prohibiting innovations in smoke or tobacco products, such as electronic cigarettes. Creating a Comprehensive Tobacco-Free Policy: A Toolkit for Colleges and Universities 2014, updated