The Battle for Students' Hearts -- and Lungs
Thursday, March 17, at 2 p.m., U.S. Eastern time
Despite years of warnings about the dangers of cigarette smoking, an increasing number of college students are taking up the habit. Tobacco companies, prohibited by law from marketing to children, have poured money into promotions aimed at "entry-level" smokers -- those age 18 to 24. Free cigarettes and lighters are routinely available at college hangouts and cigarette makers often sponsor contests for lavish prizes like flat-screen televisions.
Meanwhile, college health centers already have their hands full dealing with drinking-related problems, mental health issues, and sexually transmitted diseases. Why should they have to tackle this problem as well? Aren't students, as some cigarette makers argue, adults who can make informed decisions about smoking on their own? Are there really any effective ways to convince students to stop using a product that is considered more addictive than heroin?
» The Battle for Hearts and Lungs (3/18/2005)
Linda C. Hancock is the assistant director of health promotion at Virginia Commonwealth University. Last fall, she helped 200 students quit smoking.
Elizabeth F. Farrell (Moderator):
Happy St. Patrick's Day and thanks for joining us for our chat on college smoking. My name is Elizabeth Farrell, and I am the reporter who wrote our story on college smoking. I'd like to welcome our moderator, Linda Hancock, a health educator with about two decades' experience working on smoking issues. Linda will be answering most of your questions, but we also welcome comments as well -- so if any participants have programs that work extremely well (or poorly) please feel free to offer up your ideas on success stories and failures. We look forward to your thoughts.
Linda C. Hancock:
Welcome to the online chat about tobacco issues on campus.
I am both honored and humbled to be the so-called "expert".
Before we begin, I feel compelled to offer a few disclaimers. First, my only real qualification for being an "expert" is that I have spent 20 years working "in the trenches" with college students at Virginia Commonwealth University. We are a large urban university with 27,000 students. I work both in the Student Health Services and in the Office of Health Promotion.
Three days a week I work as a nurse practitioner. I love smokers... my job is to keep them on the planet longer. I have learned many things from smokers over the years. As a result I have become our clinic's local "smoking cessation guru". (Although, I really must brag that the entire staff here does a fabulous job with cessation service.)
In addition, I have a PhD in Education and so two days a week I provide health promotion on all the "S's" (sex, substance abuse, smoking, stress, and spirituality). In my spare time I direct a few grants related to alcohol and tobacco issues. Our staff considers it important to freely share what we have found helpful with other universities. If you are interested in our prevention posters and media please see www.smokefreeVCU.org and www.yourstrategy.org.
You may email me directly at quit@vcu.edu for the contents of our "quit kits" or for documents such as "How to use the smoking cessation pill" and a "Clinical Assessment form for Tobacco Cessation".
Much that I have learned has come from colleagues. Since 1998 I have been the chair the Virginia College Alliance for Tobacco Use Reduction. This fabulous statewide group started with 5 colleges and has expanded to a membership of 18. This group helps re-energize me and also freely shares ideas and resources.
Now for the CAVEATS!
I am NOT a policy expert. I struggle with policy issues at the local level but there are far wiser people than I about policy. If you have questions I suggest you talk to Michael McNeil mpmcneil@temple or Abigail Halerin abigail@u.washington.edu for starters.
Finally, I do not spell well... but I mean well.
So if something looks funny, just assume it is a typo.
Trust me, I would seem much more intelligent if we were chatting.
Having said all that... now let's have some fun and learn something from each other.
Question from Patricia Schwarz:
Alcohol and tobacco are both lethally addictive drugs. Science is suggesting more and more that all forms of addiction involve the same set of neurochemical events. If the brain only knows one kind of addiction, then why can't there just be one single policy to cover all drug abuse on campus, whether it be alcohol, tobacco or marijuana?
Linda C. Hancock:
Interesting question.
It brings to mind this old quote:
"Every complex problem has a simple solution...
and it's usually wrong."
I would have to disagree that science is making things more simple. It appears to me that the more we know about neuropharmacology, genetics, and drugs...the more complex we find the addiction process is.
I think that in the long run we would delay any beneficial policies if we tried to get consensus about multiple drugs in one policy. It would be too much like trying to make policies about apples and oranges. You can't handle these fruit in the same way and expect good eating results. Likewise you can't handle rules about different drugs and humans in the same way and expect good behavioral results.
Question from Michael McNeil, Temple U.:
Liz: Can you post a link to the article?
Linda C. Hancock:
The Battle for Hearts and Lungs
Question from Brian McMillan, Capella University:
Is it really the institutions responsibility or role to intervene in this issue or should it simply make a position statement then remain neutral?
Linda C. Hancock:
I think that the American's with Disabilities Act makes it impossible for institutions to remain neutral about secondhand smoke. We can't just make a position statement and then take no action to comply.
Asthma has taken on epidemic proportions in the American youth. Asthmatics must be assured that they can access all aspects of campus life and not have their asthma flare.
Colleges have the responsibility to make sure that all students can attend class free from fear of secondhand smoke exposure both in and around buildings. Schools who fail to protect the rights of asthmatics will be open to law suits.
Question from Judy Lyle, Murray State University - Murray KY:
There is a tremendous amount of tobacco money on our campus in the form of scholarships and research grants. What suggestions do you have for combating this influence?
Linda C. Hancock:
I have never seen a published response to your question (that doesn't mean it doesn't exit... but I haven't seen it). The answer to this question would however be a sort of practical and ethical tool to help new researchers determine whether or not to take industry money.
I suggest that we bring this issue to the attention of the Tobacco Intervention and Prevention Task force for the American College Health Association. This group has just updated their "Position Statement on Tobacco on College and University Campuses." This group might be able to develop a different document... sort of an overview of the "pro's" and "con's" of taking industry money. You can't mandate what research funds schools and individuals do or do not take, but you can help them look at the long and short term ramifications. It would probably be most helpful to interview some veteran tobacco and nicotine researchers to see what implications they think this funding has for individuals, institutions and for science in general.
Moderator:
---Hello- This is Elizabeth Farrell and I would like to add some perspective to this as well. In the course of researching this story, I came across tons of examples of tobacco financing on campuses not only for research grants but in the form of scholarships. Philip Morris, for example, regularly gives to the Thurgood Marshall Scholarship fund, and many others.
But at the same time, I couldn't find a lot of compelling evidence that tobacco money on campuses actually influences the policies at the student health center. It's more that the tobacco money influences the type of research projects undertaken by a certain department.
And in response to this, there has been considerable backlash from the American Cancer Society and the Legacy Foundation - both have instituted policies that forbid universities and/or academic departments within a university that take money from tobacco companies from receiving grant money from their organizations. So this problem is being addressed on some level. James Enstrom at UCLA might be a good person to talk to about this, as he has commented extensively on this issue in the past.
Question from Reena:
Considering most college students know about the risks, have seen the anti-tobacco ads, have heard everything bad there is to hear about smoking and they're not smoking around non-smokers to affect them, is it really necessary to try so hard to convince students to give up cigarettes? Isn't it their choice to continue or quit? Maybe it's selfish of them to put themselves at risk but if they know the risks and continue to smoke, shouldn't they be allowed to without others trying to control their behavior?
Linda C. Hancock:
That would be true except for one thing... life isn't fair.
I always tell my students that each of them are charming "genetic snowflakes." A person can choose to try a substance but they can't choose how their body metabolizes that substance. 1 in 4 people is missing the genetic ability to make an enzyme that breaks down nicotine. If they try and smoke, they turn green and puke. They aren't so morally upright. They just got a lucky genetic roll of the dice. (Oh, and it is a fact that 48% of all cigarettes are sold to someone with a history of anxiety/depression/ADHD. Tobacco companies know that people with risk for those illnesses are most likely to become users for life.)
Tobacco use occurs in young people who have been sold a bill of goods that smoking is glamorous and something they can change in the future. Until our culture stops making money off of youth who get addicted, I will do all I can to help. As Leo from West Wing said, "Addiction isn't a smart, dumb thing." It is a brain level biological change. Yes, they deserve help. And yes, we should try to stop addiction of people who haven't started.
Question from Donald K. Beman, Erie Community College:
Why not simply accept the fact that our students (as was the case with my children, who are now adults!) will, for the most part, do what we do and not what we say? Therefore, shouldn't we simply set an example?
Linda C. Hancock:
Please see the response that I posted to the previous question as it lays the ground work for this response.
Our education of young people has been inadequate to date. The majority of students will tell you that "everyone smokes" (which is NOT true, while students estimate that 60%-70% of their peers smoke, the reality is that only about 30% of students had a cigarette in the past month). So students who start smoking are just trying to "be normal" and do what they see. In addition the vast majority are unaware of how their own genetics put them at risk for addiction.
For example, my mother was a charming genetic snowflake that bicycled across country when other women were afraid to go to the store in pants. She was a risk taker.. we need risk takers. They are our pioneers and creatives. Not surprisingly, my mom became a 3 pack a day smoker.
My children have never seen me smoke. Yet I know that my children are at high risk for addiction if they even try nictine.
So, no we can't just set a good example.
It's a start, but it's not enough when dealing with such a powerfully addictive and damaging substance.
Question from Shelley Fisher Fishkin, Stanford University:
Most anti-smoking arguments presented to high school and college students focus on the long-term negative health effects--something that may seem fairly abstract and remote to 18-24-year-olds. But there is another argument that may be more compelling for them. Surgeons grill patients on their smoking history during the preoperative interview because that history can affect the kinds of operations they can perform with ease. Young people who may not be able to imagine themselves decades down the road can easily imagine themselves getting into a car accident and needing surgery. I've found that letting them know that smoking may interfere with their getting the surgery they might need after a car accident seems to impress them more than the potential longterm effects. Why don't surgeons and college health centers create visual displays and other informative guides that specify the ways in which smoking can hamper young people's getting optimal medical care in an emergency? If such materials already exist, I'm glad to know that. I haven't encountered any myself. I have found that repeating to young people information that I gleaned from a surgeon during the preoperative interview can be a powerful deterrent to smoking
Linda C. Hancock:
Sounds like a creative approach to me.
It does bring the subject closer to motivating students in the present. It probably works better with keeping non-smokers as non-smokers than in helping addicted smokers to quit.
Over the years, the smokers that I have seen be most successful at quitting were those who could identify what positive thing they wanted more than their tobacco.
I usually have them make a symbol of "what they want more". I have one young man who wants to be a Marine. He can't run and smoke. He is carrying around a keychain with a Marine Corps emblem. He is now a non-smoker.
Question from Terry Wilson, Unviversity of Missouri-Columbia:
How do you get 200 students a semester to quit smoking? Do you offer individual counseling? Is their a model you use such as motivational interviewing? How do you track students for smoking status? Do you do anything similar to the Great American Smokeout on your campus? Thanks
Linda C. Hancock:
At VCU we tried doing the "group" thing. But we would get about 5-6 people per semester and about 3 would end up quitting.
We have moved instead to a format where our entire clinical and front desk staff is trained. More smokers use clinic services than non-smokers and we get them at "reachable" moments. We advertise with fliers in our waiting room and out on campus.
A grant from the health department allows us to offer FREE Quit Kits to students. Quit kits are really incentivizing for both the staff and the students. It provides a fun and positive way for the staff to open the discussion about tobacco AND it lets the students know we care. Service learning students put the kits together.
Quit kits have fun stuff like gum, mints, straws, a silly putty egg (with a poem inside that says things like... keep you hands busy, don't get in a tizzy...etc.) Kits also have educational info (the Why I smoke test, How to make a solid decision, and a GREAT educational sheet on the smoking cessation pill). This speeds the clinical session and allows for a brief motivational intervention on the spot since everything is prepackaged ahead of time and easy for the clinicians to use. We have designed a FORM that speeds cessation assessment and improves our ability to write for prescription meds like bupropion (the smoking cessation pill). I can send you all of those documents if you email me. quit@vcu.edu Feel free to edit and adapt them for use on your campus.
The quit kit has a "recipient card" that allows us to follow students over time. Student contact info is entered into an Access data base. Studies done in the past suggest that about 1/2 of those who respond to our email surveys are smokefree and the other half have decreased their smoking by 10 cigs/day. I can send you those studies as well. On average we give out about 150-200 kits per semester.
We don't do smoke out since we do it everyday.
Question from Chris Donaghey, Indiana University - South Bend:
I'm a nursing student at IUSB in the process of completing my community health clinical rotation. My question is multi-tiered: First, what do you believe is the main impetus for young people to start smoking? I am in the age group in question (being 21 years old) and I see it as nearly entirely influenced by peer pressure. The focus in that question is on you and not the majority opinion, of course. Also, in a related manner, do you believe that there would ever be a case in which multimedia shock tactics (i.e. TheTruth.com) would be effective in curtailing the incidences of youth smoking? Thank you.
Linda C. Hancock:
I would suggest you read the book called "The tipping Point" by M. Gladwell. He has a chapter on smoking. He makes the point that smokers don't smoke because smoking is cool... smokers smoke because they are cool.
I agree. Some smokers start because they are risk taking cool people and this is a forbidden cool looking fruit. Others start because they feel inadequate (and who can't identify with that?)
I think that the TRUTH campaign from florida has proved that you can make other behaviors... like getting infront of peoples faces and demanding the truth... more cool than smoking. I would suggest you check out the website www.bigtobaccsucks.org if you are interested in some other ways to get young peoples attention about real issues. Keep up the good work. Nursing rocks.
Question from Aviva Meyer, NH Department of Health and Human Services:
It sounds as if your University Health Services prioritize tobacco cessation. However, many seem to feel that it is the lesser of many evils, compared to alcohol and eating disorders. What can be done to change that attitude?
Linda C. Hancock:
Just don't give up. It is the singe health behavior that impacts all other health behaviors the most.
Question from Colleen Whiteside, Ozarks Technical Community College:
Does the student health insurance cover the cost of Zyban at VCU? Do students need to meet with a physician to obtain the prescription? What are your success rates for students using Zyban?
Linda C. Hancock:
At VCU we use the generic 100 mg bupropion which does require a prescription. You can by it from our pharmacy for $15/month supply (anyone get it at Costco for about $27/month supply and Walmart for about $36/month)
I usually don't prescribe the Wellbutrin SR or the Zyban because my patients can't afford it and most of their insurance companies don't cover it. It also tends to give people more "zoomy" side effects.
Instead my students pay cash for the generic. Perfectly legal and less side effects on the lower dose.
While there are no magic drugs... bupropion is amazing. It helps many people who thought they could never quit. Many of our referrals for smoking cessation come from friends of people who used this medication succesfully.I think all smoking cessation programs should have access to this form of treatment.
I used to think it was my great behavioral counseling that helped people... Not! It's the drug.
Question from Owen Moran, Concordia University:
I have been working on helping people quit smoking for the last 5 years and I find that my strategey/approach has changed as I have learned more about nicotine addiction and the ways that people overcome it. I assume that you may have had a similar situtation in that what you do has changed over the years. I am interested in hearing what strategies you have found to be ineffective so that as I continue to refine my approach I can avoid some of these.
Linda C. Hancock:
Go positive.
Find out what sings to their heart.
Only use the negatives if you find it specifically relates to their individual health status.
Like them. Keep the door open at all time. Laugh more.
Hang in there. You sound like a good counselor to me and one I'd want to see again.
I have a bumper sticker in my office that says...
"Remember, smoking doesn't kill people.
People who are quitting smoking kill people."
It's my job to make quitting easier and to have fun with them as they meet their challenges.
Comment from Colleen Whiteside, Ozarks Technical Community College:
The numbers speak for themselves that at many colleges across the country, there are many more students exiting as smokers than entering. It is absolutely a person's choice whether or not they want to smoke, however colleges are currently serving as a place where students are learning to smoke and encouraged to do so. It is the responsibility of the college to prepare students to be a positive and marketable addition to the workforce, not to be teaching students to pick up an addictive habit.
Comment from Karen Caldwell, Buncombe County HealthCenter -North Carolina:
I would like to respond to Question earlier from Reena. I work in tobacco use prevention and control in my county. As a health educator, I would like to see more people quitting tobacco use, simply for their health, and for the health of thoses exposed to their second-hand smoke. As a tax payer, I want to see them stop, as well. My county spends about $9 million per year on smoking-related medicaid costs. Did you know that smoking attributable Medicaid costs in 2002 in the US averaged $1.31/pack of cigarettes sold? It is costing non-smokers too.
Comment from Michael McNeil, Temple U.:
As a comment on the last question - prioritizing tobacco cessation can help reduce long term expenses in college health. Given that more smokers access services and more often, by reducing smoking behavior, you can cut down on visits (and associated expenses) for simple things - like URI.
Question from Reina Sims, The Ohio Tobacco Use Prevention and Control Foundation:
Hello Linda. We have a college tobacco use pilot study going on at 4 camuses in Ohio (Ashland University, Kent State University, Central State University and The College of Wooster). One of which would like to intergrate tobacco control into college courses to promote student participation. Have you been able to integrate tobacco control into any college courses? If so, how? Thank you.
Linda C. Hancock:
I think you should definitely go for the classroom infusion.
Every fall we go into our freshmen orientation classes (about 50 classes with 20-30 students in each) and do something called a "snowball survey".
This survey looks at misperceptions and actual behavior. The goal is to denormalize unheatlhy and overestimated behaviors like tobacco use. We then also advertise cessation services on campus. (Email me for a copy of an article on how to do this.)
When I do curriclum infusion about tobacco it is almost always done in a broader health framework.
Tobacco affects so many things that it is easier to put it into a bigger picture and adapt it to a million classes.
I'd be happy to chat with you about it in detail. Call me sometime 804 828-7815.
Question from Michael McNeil, Temple U.:
The recent listserv discussion of Hookahs sparks new concerns about making smoking "sexy, social and fun" - any suggestions for countering this idea?
Linda C. Hancock:
Well, my worst fear is we will inadvertantly advertise for hookah places.
We walk a fine line between educating and advertising. I guess I would see how many people are really involved and step in when I felt that what I was doing would be positive and not inadvertantly just serve to advertise what I'm trying to stop (wow... a run on sentance).
Question from Candy Flores, Fresno State:
Are you guys collaborating with CYAN?
Linda C. Hancock:
CYAN has been nice enough to send me a copy of their "College Advocacy Guide" and I have gotten email info from them before. But that's about the extent of our collaboration. I think I sent them a copy of my "Tobacco Use Reduction Guide for Colleges and Universities".
MODERATOR NOTE:
For those of you who aren't familiar with CYAN, it is the California Youth Advocacy Network, and they are an amazing resource for all things tobacco related. Their organization also provides a very interesting perspective because they live in a state that has probably done more to stigmatize smoking than others, yet still has problems with youth smoking levels. I would highly recommend their web site to all health professionals:
http://www.cyanonline.org
And don't forget Ms. Hancock's website: http://www.smokefreevcu.org
Question from Kevin Koett:
As you know, many students do not get excited about being "told" what is good or not good for them. Particularly with smokeless tobacco as opposed to cigarettes (i.e., "I am only harming myself and not others with secondhand smoke). Have you have particular success with any form of ad campaign to help students "get on board" with your programs?
Linda C. Hancock:
I agree with you completely.
No one wants to be told what to do.
Students do however care greatly about injustice.
Tobacco is just another form of slavery that unjustly taps into people who have a genetic risk for or a predisposing condition setting them up for addiction.
As I mentioned before, I usually take a broader approach.
I challenge my students with a "framework" for understanding addiction. It is based on PRI's Lifestyle Risk Reduction Model. I do a talk called "Tylenol, Twinkies and the Tobacco Puzzle." At the end of the talk students figure out the answer to the question, "What's the most devastating drug?"
The answer is of course... "The one you like the best." If you don't like nicotine, or alcohol or cocaine.. then they will never be a problem in your life.
All the founders of Alcoholics Anonymous died of lung cancer. Because the one molecule they really like the best was nicotine.
Question from Alissa Eischens, Loyola University Chicago:
I have a practical question. Is offering smoking cessation groups for students a viable or effective option? I understand that it can be difficult to get students to come in. Any strategies or ideas on how to make this work?
Linda C. Hancock:
I think it is a viable option. It just hasn't worked for us. There is man named Marcus Gardner in South Carolina who has people coming out of his ears in the smoking cessation groups at the University of South Carolina. I haven't talked to him in a few years but if you email me... I'll forward your email to him and you two could chat.
Comment from Ferd Schlapper, Boise State University:
Following up on your response to Aviva Meyer, there are many studies and a lot of useful data that highlight the link between tobacco use and mental health problems/depression, high-risk drinking/drug use/sexual practices AND lower academic performance. Please see: www.ttac.org/college/facts/negative-effects.html For those school that don't see tobacco cessation as an important programmatic priority (given limited resources), it will really cast a new light on the subject for you!
Comment from Colleen Whiteside, Ozarks Technical Community College:
This is in response to Reina's question. Here at OTC we have been completely tobacco-free (the entire campus) since August 2003. A part of the success of the policy has been due to classroom integration. Students learn about the policy and take a survey about their tobacco-use during orientation. We have conducted focus groups on the policy in communication classes to give students the chance to learn about a focus group while collecting data. Teachers have created assignments based on the policy and even structured classroom debates. The idea is to show students that we respect and solicit their opinions while giving them a constructive outlet to do so.
Comment from Sharon Lawler,Brock University:
Linda:
Hi! Just wanted to share with you and others, a special campaign we have just finished on two university campuses here in Ontario. As you know many of our campuses have the Leave The Pack Behind program, which is government funded and operates through Student Health Services. One of our student teams decided that they wanted to do a "Smoke Free Campus Day". So we tried this on two campuses with some differences in programming. McMaster campus started the day with a free pancake breakfast for anyone. The students had all their information out and asked everyone to sign a pledge to support the day and wear a special button. This was all done in the student centre. They had a musician play & sing Elton John songs and that went over very well! Speakers at noon included the university president and Heather Crowe, a waitress & non smoker, dying of lung cancer which she contracted from secondhand smoke in her work place. At Brock University the next day, we did something similar. We had "Morning Break" coffee, muffins and breads etc at two busy locations, so smokers could join us instead of going out for a smoke. During the two weeks before the big day, we put small packages of nicorettes at strategic locations for anyone so they could be prepared not to smoke for the one day. Again we had speakers at noon, many display tables including Leave The Pack Behind students, the Environment, Health & Saftey staff, public health and major agencies from the community. Both days went very well with lots of interest from everyone on campus. We distributed almost 600 packages with 3 nicorettes and about 4000 Smoke Free Campus buttons (at Brock). The goal of these days was to support clean air policies on the campuses. The whole event starts with getting permission from the university proesident so right away we had the support of administration. A new policy is underway here which will inlcude no sale of tobacco porducts on campus, no tobacco sponsered events, smoking only in outdoor designated areas and no smoking within 5 metres of any entrances. This is how we are tackling policy development on our campuses. I expect that others will try this campaign next year after we have evaluated both of these pilots. For more information on these days please check out our web site at: LeaveThePackBehind.org. There will soon be pictures on the MmcMaster & Brock campus sites.
Question from miranda, University of Missouri:
There has been much more focus on alcohol related issues in colleges the past year. I would like to be able to hook in drinking decrease with decreasing tobacco intake. Any suggestions or good research that states if you decrease tobacco use, drinking decreases as well ( the administration would love to see something like this!)
Linda C. Hancock:
Yeah, wouldn't we all. I think the state of california might have your answer. They have decreased tobacco sales... but I don't know what happened to their alcohol sales. I'm not sure the two are linked in a direct proportion. Nice try.
Question from Liz Carson, Pennsylvania College of Technology:
Could you please expand on the point you made earlier about smoking being the single greatest influence on other health behaviors? I would like to be able to repeat this argument, but I'm not exactly sure how smoking affects other "health behaviors."
Linda C. Hancock:
If you look at a problem list on a medical record... then ask the health care provider what behavior most impacts those problems... the answer is always get rid of the tobacco.
It makes everything worse... heart disease, diabetes, ulcers, cataracts!
The single easiest way to reduce morbitity and mortality in anyone individual is to get them to stop smoking.
Question from Lori Pierce, DePaul University:
Are non-drinkers less likely to smoke? Do students who curtail their drinking have an easier time quitting or cutting back on their smoking.
Linda C. Hancock:
Yes. Yes.
Risk taking students are more likely to both drink and smoke.
The reason why tobacco addiction relapse rates higher than heroin is because... if you do heroin, you do it a few times a day. Not linked to too much. If you smoke a pack of cigs/day it is linked to 200 things. Coffee cup, telephone, steering wheel. AND the biggest link and synergistic buzz is ALCOHOL. 90% of people relapse when they are drinking.
so yes, non-drinkers have it a little easier.
Question from Alison Beaver, University of Virginia:
Hi Linda!
It feels like there is a small group of us (students, faculty & staff) who are trying to make our campus "smokefree". We have been "close" SO many times...(long story...). Recently, students were up in arms about the "smoking hypocrisy" at UVA--our dining services selling tobacco products AT THE SAME TIME we are receiving grant monies for tobacco cessation efforts, education, prevention & policy change. We were happy to have this "controversy"; HOWEVER, the Student Council voted to KEEP tobacco products available on campus for two main reasons:
1)Freedom of choice ("even though I don't want to smoke, I don't want to tell others what to do/not to do")
2)Safety ("walking off campus to get tobacco products is a safety issue, when they are available right here in the DORM").
I know it's absurd...how can we help students see the "other side" without them feeling like we are pushing our agenda on them? (Administration is "taking away" their rights, since it's legal to smoke).
Linda C. Hancock:
Isn't it ironic that it is framed as a "freedom" of choice issue, when addiction isn't freedom at all.
If students are so addicted that they have to walk off campus in the dark or the cold... it just proves that they aren't free.
I think you could use more info from www.bigtobaccosucks.org and look at the social justice ramifications more with your very intelligent population.
You aren't pushing your issue. You are just looking at the bigger picture and all the ramifications.
Question from Colleen Whiteside, Ozarks Technical Community College:
I'm sure your behavioral counseling is a big part of it! How many months does a typical student need to take the bupropion? Is "quit" determined by the stages of change model (maintenance after 6 months) or do you use a different guide? How do you determine if a student is a good candidate for the pill? Thanks!
Linda C. Hancock:
The company says you stay on it for 3 months (recently they increased that recommendation to 6 months). We usually make it up based on what they are doing in their life. I don't like to yank people off the med at finals or if they are in a stressful life period.
Students can use bupropion if they do NOT have
a seizure disorder
an eating disorder
or are
on other medications like MAO inhibitors or St. Johns wort
Be careful if they are on other psych drugs and ask about past psychiatric issues.
Be careful if they are drinkers. A hangover is seizure prone state. So you could have one or two drinks on the med but you don't want it to be 4 or 5. I'll send you our screening form if you email me quit@vcu.edu
Question from Dallas Sammons,Morehead State University:
We are going tobacco-free in the fall 2005 in our residence halls. Do you have any suggestions? We have looked at a lot of the VCU stuff and like your campaign materials.
Linda C. Hancock:
Wow! Congratulations.
BACCHUS has done some good work with colorado colleges. They positively reinforce people for following the rules. For example, they give prizes to people who obey the 25 foot rules instead of disobey them.
I think you will be pleasantly suprised at how happy almost everyone will be. From what other campuses have told me... the transition is usually smooth sailing with a lot of happy campers.
Question from Jeff Jordan Rescue Productions:
The rise in young adult smoking has some correlation to the rise in tobacco industry spending on young adult marketing. These young adults are not dumb, and they haven't been tricked, they are simply responding to well developed experiential marketing at clubs and bars. Isn't that enough of a clue to tell us what to do? Where are our creative marketing approaches to promote being smokefree? Making posters that say only 30% of young adults smoke isn't going to change perspectives. The tobacco industry doesn't make ads that say most people do smoke. They are achieving success through their marketing. What approaches are we taking to develop real marketing strategies that go beyond posters?
Linda C. Hancock:
Great points. I agree with your comments... the problem is the budget! Have you calculated out how much the tobacco industy has to spend per person in advertising and then what we have to spend? Do it and that's your answer.
You get what you pay for... AND we aren't paying much to make this world smokefree.
Question from Devin Lammy, University of Missouri-Columbia:
Your program is so extensive and looks like it needs substantial funds to back it up, though I'm sure that it took awhile to get to where you are now. We're having a tough time getting the money that we need to run a large program like yours. Where did you look to get financial support, and do you have any suggestions for us? Thank you!
Linda C. Hancock:
Well, we aren't rolling in dough. Schools in the VA College Alliance for Tobacco Use Reduction get about $1,000-$5,000 to do work on their campus.
I think a little bit of grant money can go a long way.
Try to get something, not matter how little because it moves this issue way up the priority list.
It allows you to do posters and to build quit kits and to start the conversation on campus about policy change.
Try your local health department. The American Cancer Society has grants for colleges as well. They also have a group called Colleges Against Cancer.
Question from Julie Knost, MACTUPP:
I work for a local public health department that does receive some funding for tobacco prevention and control (focused in the 4th-8th grades). We are just starting to look at working with our local colleges and universities (15 total) to work on tobacco prevention efforts. I am wondering if you have any ideas and/or strategies that we could use that require little to no funding?
Linda C. Hancock:
Yes, you should have normative data. Launch a social norms campaign at the middle school level... go to www.smokefreeVCU.org and adapt either our "True facts of Modern Life" campaign or the optical illusion campaign.
Then at the college level... do the same thing but also advertise the cessation services on the same poster. WE have updated the illusion campaign to do both.
That's almost free... just do it on cheap black and white paper.
Question from Candy Flores, California State University -Fresno:
Hi Linda? I'm very intersted about the surveys. How do you guys do your surveys? Do you have to go and speak to a certain person, or do you go directly to the instructor and ask for permission to do the surveys?
Linda C. Hancock:
I'm assuming you are referring to the snowball survey. We did go through our IRB... but the surveys are all optional and anonymous. We give students a pen. Everyone writes in the same color ink. No identifying marks on the paper. They we have a huge snowball fight and look at the results.
It is a great visual of the truth.
I say things like "Stand if the person who took your survey marked...."
The instructors know that we will be doing an "optional and anonymous survey". They have never had a problem with this activity because it is so interactive and informative.
Question from Chris Donaghey, Indiana University - South Bend:
Do you believe that the approach of utilizing a health fair at campuses is an effective one? In my experiences with them, you are able to make differences, but the booths are blown off frequently. They seem to be perceived as more of a buzzkill than a positive vessel for health alteration.
Linda C. Hancock:
I generally do not do health fairs.
They take a ton of organizational time, which I don't have.
I generally go more for cheap media (posters, tabletents) and for classroom infusion activities. Colleges are full of captive audiences. You just have to figure out how to get connected with professors and have something of value to offer for that specific class curriculum.
Comment from Melissa Murphy, College Tobacco Prevention Resource:
Many of the questions covered in today's chat are explored on TTAC's College Tobacco Prevention Resource (CTPR)website. CTPR provides practical information, ideas, and guidance to college leaders involved with planning, implementing, and evaluating effective campus tobacco policies and programs. In addition to case studies that you might find helpful, the site contains facts about college tobacco use, strategies for comprehensive college tobacco prevention, recommended steps for taking action on campus, glossary and links, and frequently asked questions.
If you'd like to learn more about what CTPR has to offer, check out the site using the following link: http://www.ttac.org/college/.
Additionally, the case study examples can be accessed using the following link: http://www.ttac.org/college/campus/index.html.
Question from Mary Strohm, Northern Illinois University:
The 2003 Monitoring the Future Study shows that college student smoking rates have been declining for the past 5 years. Any thoughts on what's contributing to this decline and whether or not the trend might continue? Also, in dealing with a large campus population (20,000+ students) where approximately 25% smoke, any thoughts on how to best reach large numbers for tobacco prevention and cessation?
Linda C. Hancock:
1. We look better at College because our society is doing a better job with younger students.
Joe Camel moved overseas to addict third world children in 1997. Combine his absence and no tobacco billboards with increased prevention efforts like the TRUTH campaign and you have improvement. The sad part is that students in the 18-24 year old group are not doing as well as their younger counter parts. Partially from increased point of purchase and event marketing strategies. We need to combat those strategies to keep our college students safer. Media and movies continue to glorify smoking.
2. When your campus is large you have to do media (posters, table tents) and electronic things like screen savers, list serves, email distribution lists) and then keep doing it until you feel like you could scream. It never ends. You have to be the EB (Energizer Bunny). Even brief visits in large classrooms can offer a big return on your effort.
Question from Jeani Donnay Nurse Practitioner, St. cloud State University, Minnesota:
Hello, Thank you for this opportunity to network about a very important and challanging issue in college health. Question? How do you market your amoking cessation resources to "get them in the door of the health service for assistance? We will be screening all students when they come in for visits and I have had Nicotine Dependency training specifically, but I need help knowing how do you reach the students to know about your services? Thanks (I just finishing seeing my last patient of the morning so wil be right back!!) Jeani
Linda C. Hancock:
We market cessation services many ways... because not every student pays attention to anyone type of message.
We do cheap black and white fliers on campus.
Anytime I do any program (even one on STI's) I advertise our cessation services.
I send out listserv announcements each semester to student groups.
We put signs in the clinic waiting room.
I wish I had more time to target market to high risk groups such as: Greeks, Art Students, Sexual Minority students, etc.
You just need to let them know thay you like them, respect them and have services... and they will come.
Linda C. Hancock:
Time flies.
I can't thank you enough for all the questions and comments. I would like to thank The Chronicle for addressing this very important issue and for providing this opportunity for idea exchange.
Feel free to contact me if I can be of help in the future. I always gain as much as I give. Thanks for your insights.
Elizabeth F. Farrell (Moderator):
Thank you all for joining us, and a special thank you to Ms. Hancock for volunteering her time today to offer so much insight for this chat. Today's forum has certainly been very lively and extensive. If any participants have colleagues who are interested in seeing the transcript of today's chat, or if you just want to reference it yourself, you can come back to the same page to view the transcript. Good luck with your efforts on campuses nationwide.
Copyright © 2008 by The Chronicle of Higher Education