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10/3/2013
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The Nuts and Bolts of
Implementing and Evaluating
a Tobacco-free Campus
Using the 3Ts Model
Ellen J. Hahn, PhD, RN, FAAN Professor and Director Kentucky Center for Smoke-free Policy University of Kentucky College of Nursing Co-Chair, Tobacco-free Campus Task Force
November 19, 2009
Getting the right people to the table
3 T’s Model for implementing and evaluating tobacco-free campus policies
Using effective methods to evaluate the policy
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UK Administrative Regulation 6:5
• The use of all tobacco products
is prohibited in all owned,
operated, leased, occupied, or
controlled University buildings
and structures, grounds, parking
structures, enclosed bridges and
walkways, sidewalks, streets,
parking lots, and vehicles, as
well as personal vehicles in
these areas.
These Tobacco Products are
NOT Allowed on UK Property
• Snus
• Water Pipes
• Pipes
• Hookahs
• And any other non-
combustible tobacco product
• Cigarettes
• E-cigarettes*
• Cigars
• Snuff
• Chew
*The FDA considers electronic
cigarettes a tobacco product,
not a way to quit smoking.
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Why E-Cigarettes are Prohibited
E-cigs are derived from tobacco and an inhaled product that emits fine particles into the air. For this reason, they should be covered under smoke-free policies.
‘Vaping’ creates a dense mix of vapor and fine particles that smells and looks like tobacco smoke. If exempt from smoke-free policies, the ‘smoky look and smell’ creates confusion with enforcement.
E-cigs may pollute the air less than conventional cigarettes but they still pollute the air.
• Get administrative support ▫ Lead on public health matters; don’t poll
• Planned, deliberate planning, implementation, and evaluation approach
• Take time to create buy-in ▫ 9-12 months planning phase prior to
implementation
• Get the right people around the table • Sustain a tobacco-free infrastructure beyond
implementation
Making it Happen
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• Faculty Senate • Staff Senate • Student Government • Auxillary Services • Athletics • University Health Services • University Architect • Student Affairs • Public Affairs • Office of Legal Counsel • Real Property Office • UK HealthCare • External Affairs • Enrollment Management • Dean’s Council
• College of Agriculture • Dining Services • Testing & Counseling • University Neighborhood
Advisory Council • Human Resources • Physical Plant Division • Bluegrass Community
Technical College • Graduate Student Congress • Research • Resident Student Association • Residence Life • Hilary J. Boone Center • UK Libraries
Get the Right People to the Table
• Facilities/Boundaries/Signage
• Communications/Marketing
• Tobacco Treatment/Addiction Management
• Compliance
• Good Neighbor
Committees
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The 3 Ts of Tobacco-free
Policy Implementation
•TELL about the policy via good signage, branding, and integrated, consistent communication
•Treat tobacco users by providing free NRT and a menu of counseling/behavioral support
•Train staff and volunteers in firm yet compassionate scripting in handling violators
Hahn, E.J., Fallin, A., Darville, A., Kercsmar, S.E., McCann, M., Record, R. (2012). The Three T’s of adopting tobacco-free policies on college campuses. Nursing Clinics of North America, 47(1), 109-117.
Tell: Put Signage Where People See It!
Brand the policy with the goal in mind: …Welcome
to our Tobacco-free Campus: A
healthy place to live,
work, and learn
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NRT instead of tobacco!
• The policy covers the University-controlled streets and sidewalks.
• For those sidewalks adjacent to streets not controlled by the University, we ask that you respect the pedestrians and our efforts to provide a healthier environment by refraining from tobacco use on those sidewalks.
Sidewalks & Streets
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• Tell: More About the Tobacco-free Policy, Help to Quit, and Reporting Violators: www.uky.edu/Tobaccofree
• Follow us on Twitter & Facebook @UKTakeAction
Tell: All Dorm Residents Get
this Card at Check-In
Front Back
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Tell: Targeted Messaging for Visitors
on our Medical Campus
Front of the Card Back of the Card
Tell: Build Tobacco-free into Health & Wellness Activities
• Partner with others on campus to sponsor wellness activities. Be sure to include the Tobacco-free Policy Campaign ‘brand.’
• Host fitness walks/runs on your tobacco-free campus (e.g., Lung Cancer Walk)
• Leverage unpaid media about the policy before, during, and after these events.
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Tell: Building Tobacco-free Into the Green/Sustainability Movement
• Cigarette butt pick up by student environmental groups
• Display during Sustainability Expo
Treat: Access to Evidence-based
Treatment and Symptom Management
• www.uky.edu/TobaccoFree
• Menu of treatment options
• NRT (12 weeks) for employees, sponsored dependents, and students; behavioral component required
• Discounted NRT available for purchase at corner stores for symptom management
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Help to Manage Cravings Promotes
Compliance and Quitting
• Free nicotine replacement products (gum and patches) for employees, sponsored dependents, and students who participate in behavioral support.
• To help manage cravings, low-cost nicotine replacement products are available for purchase at convenient on-campus locations.
Train: Creating a
Culture of Compliance
• Compliance is achieved through communicating a universal, consistent message via scripting and policy and tobacco treatment education.
• Use a firm, polite, and compassionate approach!
• Electronic reporting: [email protected]
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Compliance is Everyone’s Business.
• Tobacco-free Take Action! is a team of employees and students who are committed to improving compliance with our tobacco-free policy.
Ickes, M.J., Hahn, E.J., McCann, M., & Kercsmar, S. (2013). Tobacco-free Take Action! Increasing policy adherence on a college campus. World Medical and Health Policy, 5(1), 47-56.
Become a Tobacco-free Ambassador!
• You will be prepared and empowered to politely approach and advise violators about the policy using kind, yet firm scripts.
• You will learn proper ways of reporting violators.
• As an Ambassador, you will be the agent of change for a healthy environment.
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HELPFUL TIPS WHEN APPROACHING
TOBACCO USERS ON CAMPUS
• Always be very friendly and polite. Stay positive and introduce yourself.
• Remind them to throw away their cigarette
butt and not just throw it on the ground. • Remember you have nothing to lose by
approaching someone violating the tobacco-free policy. The majority of those approached comply and respond in a positive manner.
Universal Scripting
“Hello, my name is ______ (your name) and I am a(n) ______ (position) at UK. Our campus is completely tobacco-free so I need to ask you to please put out your cigarette. Thank you for respecting our policy!”
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Ambassadors
Enforcement
• Frame as creating a ‘culture of compliance’ via constant messaging, scripted reminders.
• Integrate into existing corrective action procedures
• Partner closely with tobacco treatment resources to help violators comply.
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Report violators of the tobacco-free policy to: [email protected]
OR
submit via the online form on our website www.uky.edu/TobaccoFree
Corrective Action • Students – report to the Dean of Students
▫ Subject to corrective action according to Student Code of Conduct
• Employees – report to supervisor, Human Resources Employee Relations, Faculty Affairs ▫ Subject to corrective action according to HR Policies &
Procedures
• Campus Visitors – may be asked to leave
campus
See www.uky.edu/Tobaccofree for more information
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12.6
*69.8
0
10
20
30
40
50
60
70
80
Covered by Policy Not covered by policy
Avera
ge #
of
cig
are
tte b
utt
s
*p = < 0.001
Figure 1. Average Number of Butts by Whether or
Not Location Covered by Policy
n=72 n=216
Evaluating the Policy
Fallin, A., Murrey, M., Johnson, A.O., Riker, C.A., Rayens, M.K., & Hahn, E.J. (2012). Measuring compliance with tobacco-free campus policy. Journal of American College Health, 60:7, 496-504.
Figure 1. Request for
Tobacco Treatment
and NRT Coupons
Redeemed Pre- and
Post Tobacco-free
Policy
4-fold increase in quit attempts. An average of 3 enrolled in cessation programs per month before to 11 after the policy.
4-fold increase in treatment utilization. An average of 10 NRT coupons redeemed per month before to 41 after the policy.
Only 1.4-fold increase in cost per 2-week NRT coupon. An average of $491.86 per month before to $696.55 per month after the policy.
Lower cost per NRT coupon negotiated by UK Pharmacy after policy took effect. $47.60 per coupon before to $17.15 after the policy.
Note. Pre-policy, 11/08-11/09. Post-policy, 10/09-09/11
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TFTA! How Effective Is It?
Cigarette Butts Reduced by 51% Overall
Location # Butts Pre – Day 1 2 3
# Butts Pre – Total
# Butts Post – Day 1 2 3
# Butts Post - Total
Percent Change
Hotspot A 284 23 14 321 121 14 23 158 -51%
Hotspot B 1800 196 255 2251 765 97 40 902 -60%
Hotspot C 285 48 33 366 250 26 10 286 -22%
Hotspot
D 746 168 59 973 739 118 37 894 -8%
Hotspot E 996 364 129 1489 226 126 70 422 -72%
TOTAL
5400
2662
-51%
Most People Positive When Approached
• From April 16 to May 18, 2012
▫ 467 Violators Observed
▫ 388 Approached (83%)
▫ 93% Positive Response
Evaluating Compliance Interventions
• Large scale awareness campaign ▫ Distributed 5,900 message cards
▫ Four high-traffic locations for three days
▫ All individuals passing offered a card
Fallin, A., Johnson, A.O., Riker, C.A., Cohen, E., Rayens, M.K., & Hahn, E.J. (2013). An intervention
to increase compliance with a tobacco-free university policy. American Journal of Health Promotion,
27(3):162-9. .
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Take Home Messages • Be patient and persistent. Tobacco-free policy
implementation involves culture change. Change takes time!
• Brand your policy with the goal in mind. The goal is to provide a healthy environment!
• Look for ways to build tobacco-free into existing activities and systems!
• Compliance is Everyone’s Business. Create Buy-In through a Broad-based Task Force and Report Line.
Tobacco-free Campus Policy
Changes the Culture of
Expectations
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Contact Us!
• UK Tobacco-free Campus Initiative • Co-Chairs: Ellen Hahn: [email protected] and Anthany
Beatty: [email protected]
• Policy website: www.uky.edu/Tobaccofree ▫ Follow us @UKTakeAction
▫ Like us at Tobacco-free Take Action
• Kentucky Center for Smoke-free Policy – www.kcsp.uky.edu
– Find us on Twitter and Facebook @kysmokefree
