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Table 1 Study characteristics and main study findings

From: College anti-smoking policies and student smoking behavior: a review of the literature

Study Purpose Study Design Methods Policy type Subjects College type Region Findings
Borders et al. [31] To determine the association between university tobacco control policies and students’
smoking behavior
Cross-sectional Self-report Prohibit on - campus sales and distribution of tobacco products
Restrict smoking to 20 ft from building entrances
Prohibit smoking in residence halls
Clearly identify non-smoking areas
Provide preventive education
Provide smoking cessation classes
N = 13,041
M age NP, majority 18–22 years old; 61% F; 74% W, 11.7% H, 2.6 B, 11.4% O
4 year South Having preventive education program on campus was
associated with lower odds of smoking.
Presence of smoking cessation programs and designated smoking areas were associated with higher odds of smoking.
Policies governing the sales and distribution of cigarettes were not associated with smoking.
Braverman et al. [33] To determine the extent of outdoor tobacco smoke exposure and identify correlates of policy support a year after smoke-free policy was enactment Cross-sectional Self-report Smoke-free campus N = 3,994
M age NP, majority 18–25 years old; 45.5% F, 53.5% M, 77.5% W, 0.5% B, 9.2% A, 0.5% AI/AN, 0.4% NH/PI, 6.5% MI, 5.6% O
4 year Northwest Enactment of policy led to smoking activity shifting to the campus periphery.
Limited exposure to smoke near building entrances since the policy was enacted, but the majority of staff (55%) and students (77%) reported increased exposure near campus boundaries
Butler et al. [40] To determine the associations between community and campus smoke-free policies and attitudes and behaviors of undergraduate alcohol drinkers, including motivation to quit smoking Cross-sectional Self-report Smoke-free campus and smoke-free bars close to campus N = 337
M age = 20.3 (SD = 1.6); 68% F;
92% W, 8% O
4 year South 26% of the sample were current smokers
9% of the smokers reported that the smoke-free policy increased their motivation to quit
3% reported that the policy reduced their motivation to quit 88% reported that the policy had no effect on their motivation to quit smoking
82% reported that the policy had no effect on the number of cigarettes smoked daily
Fallin et al. [34] To validate the Tobacco-Free Compliance Assessment Tool designed to assess compliance with tobacco-free campus policy Cross-sectional Cigarette butts and smokers were counted in hot spots Tobacco-free campus NA 4 year Southeast More cigarette butts were counted in areas not covered by the tobacco-free policy in the health care campus
No relationship found between location covered by the policy and the number of cigarette butts on the main campus
Fallin et al. [16] To assess the association between tobacco-free college policies and students’ tobacco smoking behavior and attitudes Cross-sectional Self-report Smoke-free indoors only (campus)
Designated outdoor smoking areas (campus)
Smoke-free campus
Tobacco-free campus
N = 1309
M age NP, majority 18–24 years old; 61% F; 14% W, 4.5% B, 21% A, 39% H, 9% 0
4 year West Recent smoking was highest among students on campuses with designated outdoor smoking, compared to campuses with other policies (e.g., tobacco free, smoke-free)
Stronger policies were associated with reduced self-reported exposure to secondhand smoke
Students on tobacco-free campuses were less likely to report intentions to smoke in the next 6 months compared with students in colleges with less comprehensive policies
Hahn et al. [16] To assess the outcomes and costs associated with implementing a tobacco-free policy using 3 T approach (Tell, Treat, and Train) Cross-sectional Counting smokers using cessation services
Tobacco-free campus with smoking cessation service Demographics for treatment seeking individuals NP
N = 36 for survey; M age NP; 61% F; Ethnicity NP
4 year Southeast 335 smokers received treatment after policy took effect over 2-year period compared with 33 smokers in the year preceding policy enactment
Average number of Nicotine Replacement Therapy coupons redeemed per month after policy took effect was 41 compared with 10 before policy enactment
Survey results indicated higher confidence in remaining smoke-free while on campus among current smokers who received treatment
Harris et al. [32] To test the effects of a tobacco-free campus policy enforcement package Longitudinal Observers recorded smokers’ compliance before and after intervention Restrict smoking to 25 ft from building entrances N = 709
M age = 22.0 (SD NP); 53% F, 82% W
4 year Northwest The intervention had a significant effect on compliance: 33% compliance at baseline increased to 74% during the intervention week and to 54% at follow-up
Lechner et al. [36] To assess the effectiveness of a campus-wide anti-tobacco intervention Longitudinal Self-report Tobacco-free campus with smoking cessation service N = 4947
M age = 20.5 (SD = 1.8) at baseline; 52.5% F, 82.8% W, 4.1% B, 2.3% A, 6% AI, 2.3% O
4 year Midwest Intervention was not effective in reducing general smoking prevalence but significantly reduced proportions of high-frequency smokers and low-frequency smokers
Intervention had significant effects on reduced exposure to secondhand tobacco smoke
Intervention had significant effects on reducing pro-smoking attitudes such as positive weight-loss expectancy
Lee et al. [35] To examine differences in cigarette smoked on campus premises by campus policy strength Cross-sectional Cigarette butts were counted Tobacco-free campus
Designated smoking area
NA 2 year Southeast 100% tobacco-free college campuses had significantly fewer cigarette butts on premises than campuses with no outdoor restrictions
Butts on campuses with partial policies were not significantly different from campuses with 100% tobacco-free policies
Lochbihler et al. [41] To determine social
rewards associated with using designated smoking
areas on college campuses
Cross-sectional Self-report Designated smoking area Sample 1:
N = 188
M age = 29 (SD = 8.4); 62.7% F; Ethnicity NP
Sample 2:
N = 94
M age = 29 (SD = 9.6); 60.6% F; Ethnicity NP
4 year Midwestern Social interaction while smoking on campus (as compared with smoking alone) significantly increased the perceived reward of smoking, looking forward to spending time in the campus smoking areas, and how many times the campus smoking areas were visited
Although designated smoking areas may protect nonsmoking students from the dangers of secondhand smoke, these areas may increase the rewards associated with nicotine for the smokers who use them
Seo, Macy, Torabi, and Middlestadt [37] To assess change in students’ attitudes and behaviors due to policy implementation Longitudinal Self-report Smoke-free campus N = 3266
M age = 20.0 (SD NP); 58% F; 86% W, 4% B, 6% A, 0.4% NH/PI, 0.2% AI/AN, 2.2% M
4 year Midwest Compared with the control condition, students exposed to smoke-free campus policy showed significant reduction in smoking behavior.
  1. M Mean, SD Standard Deviation, W White, B Black/African American, H Hispanic, A Asian, AI/AN American Indian/Alaskan Native, NH/PI Native Hawaiian/Pacific Islander, M Mixed ethnicity, O Other ethnicity, F Female, T Transgender, NA Not applicable, NP Not Provided