CESSATION PROGRAMS ON COLLEGE CAMPUSES
(CAMPUS TOBACCO CESSATION SERVICES)

Tobacco cessation programs are critical on college campuses. College is a time when many young adults either establish or abandon tobacco use.

• College Students and Quitting
• Cessation Programs for College Students
• “Stages of Change” Model for Smoking Cessation
• Unique Challenges

• References

College Students and Quitting:

• Most college students want to quit smoking. A nationwide survey of college students found that two-thirds of current college cigarette smokers had tried to quit (DeBernardo, 1999).
• Many college students have difficulty quitting. One national survey found that 82.0% of ever-daily smokers had tried to quit, and that 75.0% of those students were still current smokers (Everett, 1999). Similary, data from a recent college smoking behavior study suggested that 87% of baseline daily smokers and almost 50% of occassional smokers continued to smoke over a 4-year period (Wetter, 2004).
• Many college students see themselves as “social smokers” not susceptible to nicotine addiction. They often view smoking as something they can easily drop when they finish school. It is quite common for students to set graduation, attainment of a post-college job, marriage, or parenthood as a time when they will stop smoking, unaware of the likelihood that they will become addicted to nicotine over time (Wechsler, 2001).
• Some college smokers do not connect their smoking behaviors with health consequences. Although they knew the long-term health risks, 25.0% of community college students surveyed did not believe their smoking habits affected their health in any way, and 50.0% thought quitting would bring them little or no health benefit (Allen, 2003).
• Social smokers complicate the challenge of enrolling college students in cessation programs. Because they do not view themselves as smokers, they are extremely unlikely to seek out smoking cessation services.
  

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Cessation Programs for College Students:

• A national survey of U.S. public universities reported that 70.0% have some type of smoking cessation program offered through student health insurance, but few offer the comprehensive services of counseling, nicotine replacement therapy (NRT), and education (Halperin, 2003).
• Only 20-30% of college health plans include coverage for NRT and/or bupropoin (e.g Zyban, Wellbutrin) (Halperin, 2003, Wechsler, 2001). Despite the Surgeon General's guidelines that pharmacotherapies should almost always be used with those trying to quit smoking, more than 70% of colleges do not offer NRT and/or buproprion (OSG, 2001).
• Cessation programs for non-cigarette tobacco use are even less common on college campuses. Although there has been little research about cessation programs for smokeless tobacco (Chakravorty, 1997), the American Cancer Society (ACS) emphasizes the importance of oral substitutes and pharmacotherapies for smokeless tobacco cessation (ACS, 2002).
• Cessation programs are in low demand by students. Eighty-eight percent of schools surveyed from a national sample said they had no waiting list for cessation programs, and 6.0% of schools had discontinued smoking cessation due to lack of demand (Wechsler, 2001). More research is needed on the low demand for campus tobacco cessation services.
  

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The “Stages of Change” Model for Smoking Cessation:

• Many campus cessation programs are guided by the Stages of Change Model, derived from the field of health behavior. This model recognizes that cessation is a long-term process that involves five basic steps or stages. The five stages of change are:
  1. Pre-contemplation: The smoker is not considering cessation and may not acknowledge that smoking is a problem behavior.
  2. Contemplation: The smoker has not yet made the decision to quit but is thinking about cessation and processes information about the health effects of smoking and ways to quit.
  3. Preparation/Ready for Action: The smoker has developed a plan and strategies to help them stop smoking.
  4. Action: The smoker has been smoke-free for up to six months.
  5. Maintenance: Long term abstinence from smoking is being established, as the ex-smoker has not smoked in over six months.
  *Relapse can occur during action or maintenance, in which case the smoker may recycle back to any of the previous stages. (Prochaska, 1992, and MA TCP, 1994).
• For more information on the Stages of Change, please visit the following site: http://www.uri.edu/research/cprc/transtheoretical.htm
• Although campus smoking cessation programs have not yielded very favorable results, college students are a critical population for such interventions in part because their smoking habits are not yet well-established (Black, 1991).
  

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Unique Challenges in Designing Campus Cessation Programs:

• Traditional smoking cessation programs designed to help adults quit smoking have had mixed results among college students. Some alternative approaches should be considered when designing cessation programs for college students.
• Due to the “social smoker” phenomenon, programs may need to focus on keeping “some day” smokers from becoming nicotine-dependent, regular smokers (Wechsler, 2001).
• Because of its widespread and frequent use among college students, the internet should be explored as a potential cessation intervention mechanism (Wechsler, 2001).
• Physician intervention has been significantly associated with cessation success. However, only a quarter of college freshmen reported being asked about tobacco use by their physician (Foote, 1996).
• Convenience, flexibility, and affordability are important to college students. Students reported that they would be more likely to attend a cessation program on a weekday, if friends participated, if they were sent reminders, if it cost under $25.00, and if it was no more than three miles from where they live (Black, 1993).
• One-stop services are much more effective for students. The fewer referrals to other services on or off campus, the more likely it is that college students will adhere to a smoking cessation program or plan (Mooney, 2001).
• Among college athletes who use smokeless tobacco, an intervention that includes an examination by a dental professional to point out damage to the mouth, advice to quit, and counseling increase the likelihood of success (Walsh, 1999).
  

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