Running head: BANNING TOBACCO ON COLLEGE CAMPUSES 1

Banning Tobacco-Related Products on California

College Campuses

Brandon L. Ignatowski

May 05, 2017

HSCI 660D Midterm Exam

BANNING TOBACCO ON COLLEGE CAMPUSES 2

Introduction

Tobacco-related use is one of the leading factors to disability and premature death, and

approximately five to six million people die from tobacco-related use every year. Most of these

deaths are attributed to tobacco use itself, but close to half a million are related to secondhand

exposure.3 California State University, San Bernardino (CSUSB) serves many populations on

campus and in the surrounding community. CSUSB serves the veteran community through the

Veterans Success Center (VSC) by providing support for academics and counseling services.

CSUSB also serves the surrounding high-schools since many graduates transfer to this campus.

Both groups struggle with health behavior choices, which include the use of tobacco-related

products. The bill proposal (AB1594) focuses on the health policy to ban tobacco-related

products throughout the California State University and California Community Colleges to

improve the health of CSUSB and the community it serves. In order for this policy to be

successful, there are many social determinants and implications that must be addressed before

solutions can be implemented.

Policy Implications & Social Determinants of Health

Education/Health Literacy

As a Public Health Consultant hired by the CSUSB Student Health Center, it is important

to address the health policy implications of this proposal by looking at the social determinants of

health (SDOH) that determine poor health outcomes and allow individuals to continue or start

using tobacco-related products. Educating the CSUSB campus can lead to the spread of this

information into the surrounding community it serves. In order to implement and uphold this

health policy, it is important that everyone understands the importance of what it is attempting to
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accomplish. Research shows that the more education an individual has, the healthier that

individual will be. Literacy is one of the most important products of education, and it includes

many parts like health knowledge, understanding ones health, and knowing how to use health

services.5 These things lead one to health literacy, which includes reading, understanding, and

acting on health care information that is received. Improving the health literacy of the CSUSB

campus on the effects of tobacco-related use and secondhand smoke can improve the chances of

this policy being upheld. Not only will improving the health literacy of the CSUSB and San

Bernardino community members lead to improved health, but it may also lead to better education

for them. This can allow them to enjoy greater amounts of self-reported health and decreased

morbidity and mortality.5

Individuals are more likely to smoke if they have little to no education, no matter their

sex, or where they live in the country.3 In order to ensure this policy is upheld by the CSUSB

campus, the staff and students must understand why this policy exists, which can be

accomplished by educating them. A majority of the CSUSB campus may understand the negative

health effects of using tobacco-related products, but some individuals may not have the same, if

any, level of understanding. Research shows that education is one of the most important

determinants of tobacco use no matter where that person is from.3 Also, the less education

individuals have the greater the chances they will perform certain health behaviors like

smoking.2 Research also shows that education plays a key role in the health behavior choices

made by individuals, so in order to make this health policy effective it is important that CSUSB

students and employees are educated about it. In order to educate CSUSB on the importance of

this policy, the money individuals are fined for violating it should be used to open smoking

cessation programs for each college on campus. These programs can be tailored to the amount of
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knowledge each college may or may not know about the subject. Capstone classes can also

implement a section on tobacco cessation and the health effects of tobacco use into their

curriculum to ensure that all students are exposed to this information. Access to several types of

education can have a profound impact on this health policy. For instance, educating students on

how to combat stress is important because many people do so by using tobacco-related products.

Stress negatively impacts the health of individuals across the lifespan, and this makes it

important to learn how to deal with stress in a positive manner.2 Policies should be made that

make meditation classes and various forms of stress management available for students and

faculty to learn how to cope with stress.

Built Environment

Another SDOH that must be addressed to improve the chances of success regarding this

health policy includes the built environment people live and grow up in. Risk for smoking

initiation does not end at adolescence, so the public health community must use tobacco control

initiatives throughout young adulthood. As many as 37% of young adults begin smoking when

they enter a new environment like college to form their own identity, and many assume smoking

makes them look more mature. In addition, 25% of smokers increase their habit upon entering

college.7 Implementing a session on tobacco-cessation through the Student Orientation,

Advising, and Registration (SOAR) program may be an effective way to inform students on

positive health behaviors at the beginning of their college careers. If an environment makes

tobacco-related products more accessible it is more likely that individuals are going to smoke.

Making CSUSB tobacco-free will eliminate the number of people that are exposed to these

products, which will make it more difficult for individuals to be tempted by their environment.8
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Social Norms

Changing social norms is important when it comes to reaching CSUSB and the

community it serves. The attitudes people have about smoking and tobacco-related products can

influence their health behaviors. Peer influence is a particularly important part of the early stages

of tobacco-related use. Whether peers include students, professors, staff, veterans, or those from

local high-schools, they all play an important part on those around them.1 Therefore, it is

important to change the social norms and attitudes regarding tobacco-related products by

prohibiting its use at CSUSB. Social norms can be changed regarding the use of tobacco-related

products by creating an atmosphere on campus that limits student exposure. This can lead to

changing social norms and expose current smokers to cessation classes.1 If social norms change

in a positive manner, it can create a more positive social support system from their peers.

Communities Served

Veteran Community

CSUSB impacts various communities through outreach programs, and one of them is the

veteran community. CSUSB serves the veteran community through the VSC where they receive

services that assist them in transitioning from the military to college life. It is known that

veterans struggle from tobacco use in greater numbers than the general population, so this health

policy can help them stop smoking while on campus.4 They can affect their own community in a

positive manner by quitting smoking and encouraging other veterans to quit. Smoking makes

them more susceptible to chronic disease and higher death rates, but this health policy can create

an avenue to a healthier lifestyle and ultimately lower these rates. Veterans that utilize Veterans

Affairs (VA) services for smoking cessation have shown a decrease in tobacco use, so this health
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policy can help this community that CSUSB serves because it plans to implement smoking

cessation classes by using the money gained from violations. Although, research shows that

using nicotine replacement therapy (e.g. nicotine gum, patches, lozenges, etc.) must be used in

concert with cessation therapy.4 CSUSB should take a que from this research and provide these

materials in cessation classes from the Student Health Center.

Surrounding High-Schools

Another community that CSUSB serves is the surrounding high-schools, and this health

policy can improve these students tobacco and health behavior knowledge and social norms

before they begin initiation or increase their use of tobacco-related products. Health educators

should go into the community and speak to the surrounding high-schools about the dangers of

smoking in order to prevent them from initiation. This may go a long way because it can improve

the chances of stopping them before they develop a habit. Implementing a tobacco-free campus

policy can have far reaching effects throughout surrounding campus communities. A good

portion of CSUSB undergraduates recently exited high-school, so creating a campus that

prohibits tobacco usage can bring awareness to their friends and family members that have yet to

graduate. This can help create the mindset within these high-school students that smoking is not

an option for them once they enter the CSUSB campus. Any thoughts they may have had that

smoking will help them appear more mature will be limited due to this policy.8

Conclusion

This health policy insinuates that many people will be affected by the health behavior

choices they can make while on the CSUSB campus. In order to make this transition effective

and withstanding, certain aspects must be addressed through the governing bodies of CSUSB.
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There must be campus-wide educational programs that address this policy, and there must be

programs that inform and educate the campus on how to stop using tobacco-related products.

Education is a vital element to promoting health.6 SOAR can address this before students start

their first quarter, or staff and students can be educated through capstone classes or online

interactive lessons. However this policy is handled, it is important to realize that CSUSB serves

other communities that are surrounding or attached to the campus. As a Public Health

Consultant, it is important to keep in mind that staff and students live in and are attached to other

communities that do not follow the same tobacco-free rules. They are affected by various SDOH

that should be addressed in order to implement a new policy, and they should be taught why this

policy exists in the first place. In addition, the veteran and high-school communities that are

connected to CSUSB can be affected by this health policy, so instilling healthier behaviors at

CSUSB can enable this behavior to spread outside this campus community and hopefully change

social norms.
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References

1. Centers for Disease Control and Prevention (1994). Preventing tobacco use among young

people: A report of the Surgeon General (Executive Summary). MMWR, 43(4).

2. Heiman, H., & Artiga, S. (2015). Beyond health care: The role of social determinants in

promoting health and health equity. The Kaiser Commission on Medicaid and the

Uninsured, Issue Brief, 1-8.

3. Hosseinpoor, A., Parker, L., dEspaignet, E., & Chatterji, S. (2011). Social determinants of

smoking in low- and middle- income countries: Results from the world health survey.

PLoS ONE, 6(5), 1-7.

4. Kelly, M., Sido, H., Rosenheck, R. (2016). Rates and correlates of tobacco cessation service

use nationally in the Veterans Health Administration. Psychological Services, 13(2), 183-

192.

5. Low, M., Low, B., Baumler, E., & Huynh, P. (2005). Can education policy be health policy?

Implications of research on the social determinants of health. Journal of Health Politics,

Policy and Law, 30(6), 1131-1162.

6. Nutbeam, D. (2006). Health literacy as a public health goal: A challenge for contemporary

health education and communication strategies into the 21st century. Health Promotion

International, 15(3), 259-267.

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7. Tercyak, K., Rodriguez, D., & Audrain-McGovern, J. (2007). High school seniors smoking

initiation and progression 1 year after graduation. American Journal of Public Health, 97

(8), 1397-1398.

8. Xu, X., Leung, D., Li, B., Wang, P., & Zhao, Y. (2015). Smoking-related knowledge, attitude,

social pressure, and environmental constraints among new undergraduates in Chongqing,

China. International Journal of Environmental Research and Public Health, 12, 895-909.