University of New Hampshire - Model Comprehensive Policies

Public university located in Durham, NH
Enrollment: 12,800(10,800 undergraduates)
Fraternity/sorority membership: 9% of students (10 sororities, 5 fraternities)
Gender breakdown: Male: 42%, Female: 57%
Racial breakdown: Caucasian: 89%, African-American: 1%, Asian: 2%, Hispanic: 1%, International: 1%, Unknown: 6%

Summary:
Policy/Program Description. In 2002, the University of New Hampshire (UNH) issued a comprehensive tobacco policy statement. The policies included a ban on smoking in and within 20 feet of all campus buildings, a ban on tobacco advertising in UNH publications and on campus property, a ban on all campus tobacco sales, and increased availability to smoking cessation services. Background. Several tobacco policies, including smoke-free residence halls (effective 2000), were already in place at UNH when national policy recommendations, public health concerns, state restrictions on tobacco use, and increasing complaints and concern from campus constituents spurred the President to call for a committee to draft the comprehensive tobacco policy statement. Strategy for Action. The committee considered expert opinion, input from public forums, Student Senate, and Faculty Senate as well as the policies of other colleges and workplaces when drafting the policy statement. The statement underwent 17 revisions in 18 months and was signed by the President on July 1, 2002. Outcomes. There has been minimal resistance to the policy and few compliance problems. Reduction of exposure to second-hand smoke at building entrances has been praised and requests for cessation information has increased. Future Plans. UNH continues to fine tune services, with special attention on improving the efficacy of cessation programs. A social norms marketing campaign that focuses on tobacco will continue. Behavior changes will be tracked through health surveys.

Lessons Learned

Background:
Implementation of the University of New Hampshire’s (UNH) comprehensive tobacco policy statement tied new smoke-free initiatives together with related regulations enacted over the years. Smoke-free initiatives began in the 1980s, when cigarette vending machines were removed from campus and sales of tobacco products in the Student Union building was prohibited. Decision-making surrounding policy at UNH is fairly decentralized, with policy changes driven by the needs and initiative of various stakeholders on campus.

Several events prompted the move toward a single comprehensive policy statement on tobacco:

• The release of the American College Health Association (ACHA) tobacco policy recommendations
• An announcement by the U.S. Public Health Service (USPHS) of its goal to lower the prevalence of adult smokers to less than 12% by the year 2010
• Increasingly restrictive tobacco policies throughout New Hampshire
• Requests to address tobacco issues more formally on campus from various campus constituents, such as Residential Life and the Health Management and Policy department
• The move to smoke-free residence halls in 2000 after Residential Life’s Community Development survey found that 82% of students wished to live in a smoke-free dorm

The combination of concern, complaints, and interest from campus constituents and outside pressures created a synergy that called for a more formal examination of UNH’s tobacco policies. UNH President Joanne Leitzel (retired June 2002) called for the formation of a committee representing various stakeholders on campus to draft a new, comprehensive tobacco policy statement for UNH. The committee was comprised of faculty and representatives from Health Services and the Office of Environmental Health and Safety.

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Strategy for Action:
Committee Action. The committee wanted to produce a policy statement that would enunciate UNH’s position on tobacco issues as an institution of higher education and be more than a set of rules and regulations. The goal was to promote an environment that supported health and safety and linked people to services.

The committee considered several sources of information and input as they drafted the policy statement:

• Opinions from committee members with tobacco expertise, most notably, Marc Hiller, a professor in the Department of Health Management and Policy who was a key architect and advocate of the policy statement
• Information about what other campuses were doing about tobacco, as well as what workplaces were doing to restrict exposure to second-hand smoke
• The public health literature on the risks of tobacco use
• Public forums about the policy statement which gave students, faculty, and other community members the opportunity to offer input on potential tobacco policies

Once input was gathered, a policy statement was written that included:

• A ban on smoking in or within 20 feet of any campus buildings, and in several outdoor locations such as courtyards and campus stadium
• Student tobacco cessation services including hypnosis, counseling, affordable acupuncture, and low-cost Nicotine Replacement Therapy (NRT), supported in part by the American Lung Association of New Hampshire
• Bans on campus tobacco sales, sampling, and marketing and advertising
• Education about tobacco policies, rights, and responsibilities at all new employee and student orientation programs

Issues of Concern. A draft of the policy statement was presented to the Student Senate and the Faculty Senate. President Leitzel ultimately had the power to implement the policy statement, but gaining support from these stakeholders was critical for buy-in and future compliance.

In response to concerns about the “individual freedoms” of smokers, the committee conducted a significant amount of tobacco public health education. They also revised the policy so that it would not appear confrontational to smokers. For example, one revision included the statement that “whenever the needs of smokers and nonsmokers conflict, smoke-free air shall always have priority.”

Enforcement was another major issue. With such comprehensive policies, who would be in charge of enforcement, and how would it be carried out? Would peer enforcement work? Eventually, it was decided that the Environmental Health and Safety Office would field all complaints about tobacco policy violations. Due to continued debate on the enforcement issue, protocol beyond directing complaints to the Environmental Health and Safety Office has not been determined.

Approving and Implementing Policy. The policy draft took 18 months to process, and underwent 17 revisions as debate and education continued. No extra funding supported this process. After all campus stakeholders had the opportunity to offer input, the President signed the final policy statement in May 2002.

Advertising the policy changes began immediately. The policy took full effect at the start of the academic year in September 2002. The University distributed signs citing the new restrictions to all campus departments to be posted in and around their respective buildings. Buildings and Grounds moved all outdoor ashtrays at least 20 feet away from buildings. Campus documents, including admission applications, were updated with the new policy.

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Outcomes:
Health Services notes an increased interest in smoking information and cessation since the policy was enacted. There has been little resistance or protest to the policies, and the Environmental Health and Safety Office has received few complaints of violations. There has also been praise that people no longer have to walk through “clouds of smoke” at building entrances since tobacco use is now banned within 20 feet of buildings. A survey on smoking behaviors administered every other year will track changes in student tobacco use.

The American Cancer Society and the Center for Disease Control and Prevention’s Office of Smoking and Health presented President Leitzel with a plaque and a letter of appreciation for her efforts in advancing UNH toward becoming a smoke-free university.

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Future Plans:
UNH continues to work on improving access to cessation services for students, faculty, and staff, focusing especially on those geared to students. Last year, UNH designed a social norms marketing campaign that focused on tobacco issues. The normative message that seven out of ten UNH students don’t use tobacco will continue to be disseminated on campus in the future, with the goal of correcting misperceptions about student tobacco use. In addition, UNH will continue to track any behavioral change since the implementation of the policy statement through behavioral health surveys focused on tobacco use.

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Lessons Learned:

• Know your campus culture. Paying attention to the decentralized structure at UNH resulted in committee formation that included a variety of key stakeholders.
• Engage in conversation with the campus community throughout the process. Taking the time to gather input from students, faculty, and the public was worthwhile because it led to better buy-in and compliance.
• Offer cessation services. When changing the environment, be sure to offer help to those who are already addicted to nicotine.

To learn more about UNH’s smoke-free policies, visit:
http://www.unh.edu/hr/pdfs/smoking-policy.pdf

Contact
Kathleen Grace-Bishop
Associate Director
Health Services
kgbishop@cisunix.unh.edu

Marc D. Hiller DrPH
Associate Professor
Health Management and Policy
marc.hiller@unh.edu

This case study was written in September 2003.

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