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Smoking-Free Policies and Smoking Behaviors among Historically Black Colleges and Universities Students in the United States
✉Corresponding author email: emartin@hrsa.gov
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Received: ,
Accepted: ,
This article was originally published by Global Health and Education Projects, Inc. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Background:
There is limited research on the impact of smoke-free policies on students' attitudes and smoking behaviors at Historically Black Colleges and Universities (HBCUs) in the United States. This study examined African American students' attitudes toward differential smoke-free campus policies and their smoking behavior at two HBCUs in the Mid-Atlantic region.
Methods:
In this original study, 202 African American undergraduate and graduate students enrolled at two urban HBCUs participated and completed the online and in-person surveys conducted between October and December 2019. Descriptive statistics (Chi-square x2 and t-statistics) and multivariable logistic regression were used to examine differences in smoking attitudes and behaviors prompted by smoking-free policies.
Results:
One of the two surveyed HBCUs supported a comprehensive smoke-free policy (CSFP), which prohibits any tobacco use, including smoking, anywhere on campus at any time. The other HBCU followed a regular smoke-free policy (RSFP), which limits smoking to certain designated areas. The majority of students at the two schools reported that the smoke-free policy had not affected their smoking behavior. The multivariable analysis did not indicate a statistically significant association between students' attitudes toward smoke-free policies and their smoking behavior. Furthermore, the difference in smoking prevalence between the two schools was not statistically significant by policy type.
Conclusions and Implications for Translation:
Smoke-free polices have the potential to educate students about the risk of smoking and improve their attitudes about it. Implementing and enforcing a comprehensive or regular smoke-free policy is an essential step toward providing a healthy learning environment for students. Understanding the context-specific factors that contribute to smoking behaviors among African American students would provide additional important insights to policymakers in developing more effective programs for students at HBCUs.
Keywords
Comprehensive or Regular Smoke-Free Policy
Health Equity
Health Disparities
Historically Black Colleges and Universities (HBCU)
Tobacco Control
Student
1. Introduction
Tobacco use is one of the most preventable leading causes of illness and death. Cigarette smoke has over 60 well-established carcinogens, and, although smoking is decreasing, it is responsible for approximately 30% of all cancer deaths in developed countries.1 In fact, smoking is known to kill more Americans than alcohol, car crashes, AIDS-related causes, fires, heroin, cocaine, homicide, and suicide combined.2 Sadly, tobacco use and addiction mostly start during young adulthood. In 2016, the US Centers for Disease Control and Prevention (CDC) projected that approximately 5.6 million Americans aged 18 years and older would die prematurely from smoking-related illnesses.3
In the United States (US), many lives are severely affected by smoking-related illnesses at a cost of approximately $300 billion each year, including nearly $170 billion for direct medical care for adults. Tobacco use is also responsible for more than $156 billion in lost productivity, with $5.7 billion attributed to second-hand smoke exposure.3,4 Studies have shown that early exposure to tobacco use can lead to devastating long-term health outcomes related to brain development deficits and nicotine addiction.5 Comprehensive and long-term initiatives are needed to prevent and reduce the use of all tobacco products among US youths. Ending tobacco use is still the best way to decrease most of the related chronic illnesses that persist around smoking.6-8 Each year, approximately 45,000 African Americans die from smoking-related diseases. The Truth Initiative has declared the disproportionate health impact of smoking on African Americans a social justice issue.9 Despite the fact that African Americans usually smoke fewer cigarettes and start smoking cigarettes at later ages, they are more likely to die from smoking-related diseases than Whites.10-13
Tobacco prevention and control strategies, including increasing tobacco product prices, adopting comprehensive smoke-free laws, and implementing national public education media campaigns, likely have contributed to the reduction in use of certain tobacco products, including cigarettes, among youths in recent years.14 However, the lack of decline in use of cigarettes and cigars from 2014 to 2015 is concerning, as more than 80% of adult smokers begin smoking by age 18.15 Powe et al. projected that over 1.5 million teenaged African Americans would become regular cigarette smokers, and over a third of them would die of a smoking-related disease.16 Tobacco use among college students adversely affects their well-being and threatens their future ability to support their families. In addition to shortening lifespans, smoking can also decrease quality of life, and one out of three smokers will die an average of 12 to 15 years sooner than healthy life expectancy.17 Cigarette smoking is a significant health problem within the African American community.18,19 Despite significant progress in reducing tobacco use and eliminating racial and ethnic health disparities over the past decades, inequities persist.20 These racial disparities are widening for low- socioeconomic status populations such as African Americans and Hispanic/Latino students attending higher educational institutions in the US.19,21 Rigotti et al. recommended that further research include determining the prevalence of smoke-free college policies (SFPs), identifying factors that facilitate and impede policy adoption, and evaluating the impacts of specific SFPs on smoking prevalence.22 Borders et al.23 conducted a study on how one tobacco-free policy affected students' decisions to use tobacco, and Burns et al.24 and Cho and DeVaney25 surveyed attitudes of staff and students regarding adopting, implementing, and enforcing a tobacco-free campus policy. Given limited research in this area, this study examined African American students' attitudes toward differential smoke-free campus policies and their smoking behavior at two Historically Black Colleges and Universities (HBCUs) in the Mid-Atlantic region of the United States.
2. Methods
The study was a quantitative, cross-sectional design. A non-random survey of 35 items that included questions about attitudes toward smoke- free policies on campus, smoking behaviors, and demographics was administered between October 2019 and December 2019 to students of the two HBCUs. Participants described their attitudes by indicating their level of agreement with a statement on a five-point Likert scale: strongly agree, agree, neither agree nor disagree, disagree and strongly disagree. The survey used items from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) to collect information on students' smoking history and behaviors, and their knowledge of and attitude towards the smoke-free policies in their institution.27 Data were captured online using the SurveyMonkey tool. The SurveyMonkey questionnaire was available in hard-copy and electronically via a QR code. Initially, the researcher received a total of 250 survey submissions: 135 from the CSFP school and 115 from the RSFP school. However, after data cleaning, six respondents were excluded because their consent forms could not be validated, and 42 respondents were excluded because they did not respond to any of the survey items. Thus, the final sample included 202 male and female African American undergraduate and graduate students and a small number of non-African Americans enrolled at the two HBCUs. Data analysis consisted of descriptive statistics to summarize the survey responses and multivariable logistic regression to analyze differences in smoking attitudes and behaviors by smoking-free policies.
3. Results
3.1. Sociodemographic Characteristics
Table 1 summarizes the surveyed students' responses to demographic and baseline characteristics of respondents. Chi-square (χ2) with column percentages are used to summarize categorical variables. More than half of the respondents identified as female (n=132, 65.7%), and 34.3% (n=69) of the respondents identified as male. This sample is representative of the female majority attending both of the surveyed schools (63% at the RSFP school, 53% at the CSFP school) (College Tuition Compare, 2017-2018). The average age of the 202 surveyed students was 23 years (SD=6.7). Respondents' ages ranged from 18 to 61 years. The distribution of respondents by race and ethnicity shows that a majority of the respondents identified as African American or Black (n=181, 89.6%). The sample results reflect the African American or Black majority attending the surveyed schools (83% at the RSFP school, 75% at the CSFP school) (College Tuition Compare, 2017-2018). Other respondents reported their race/ethnicity as Asian (n=5, 2.5%), White or Caucasian (n=4, 2.0%), Hispanic (n=4, 2.0%), and other (n=8, 4.0%). The number of respondents per grade level included 46 freshmen, 31 sophomores, 46 juniors, 46 seniors, and 33 graduate students. The majority of respondents resided off-campus (n=134, 66.3%) as opposed to on-campus (n=68, 33.7%). More than three-quarters of respondents reported being single (n=154, 76.2%), while 32 (15.8%) reported being in a relationship, 12 (5.9%) reported being married, and 4 (2%) indicated otherwise. Approximately 71% of the respondents were the first person in their family to attend college. Roughly one-third of respondents reported an average family income between $50,000 and $100,000 (n=70, 35.2%), while 60 (30.1%) reported an average family income between $25,000 and $50,000. There were 37 (18.6%) respondents who reported an average family income under $25,000, and 32 (16.1%) with an average family income of $l00,000 or more.
| Variable | RSFP n (Column %) | CSFP n (Column %) | Total n (%) | P-value |
|---|---|---|---|---|
| Gender | ||||
| Male | 27 (32.1) | 42 (35.9) | 69 (34.3) | |
| Female | 57 (67.9) | 75 (64.1) | 132 (65.7) | 0.580 |
| Age | ||||
| Mean (SD) | 21 (3.4) | 24 (8.0) | 23 (6.7) | p<0.00I |
| Race/Ethnicity | ||||
| African American or Black | 78 (92.9) | 103 (87.3) | 181 (89.6) | |
| Asian | 1 (1.2) | 4 (3.4) | 5 (2.5) | |
| White or Caucasian | 0 (0.0) | 4 (3.4) | 4 (2.0) | |
| Hispanic | 3 (3.6) | 1 (0.9) | 4.(2.0) | |
| Other | 2 (2.4) | 6 (5.1) | 8 (4.0) | 0.192 |
| Grade Level | ||||
| Freshman | 30 (35.7) | 16 (13.6) | 46 (22.8) | |
| Sophomore | 13 (15.5) | 18 (15.3) | 31 (15.3) | |
| Junior | 22 (26.2) | 24 (20.3) | 46 (22.8) | |
| Senior | 16 (19.0) | 30 (25.4) | 46 (22.8) | |
| Graduate | 3 (3.6) | 30 (25.4) | 33 (16.3) | p<0.00I |
| Residency | ||||
| Off campus | 39 (46.4) | 29 (24.6) | 68 (33.7) | |
| On campus | 45 (53.6) | 89 (75.4) | 134 (66.3) | p<0.00I |
| Marital Status | ||||
| Single | 68 (81.0) | 86 (72.9) | 154 (76.2) | |
| Married | 2 (2.4) | 10 (8.5) | 12 (5.9) | |
| In a relationship | 13 (15.5) | 19 (16.1) | 32 (15.8) | |
| Other (e.g., separated or divorced) | 1 (1.2) | 3 (2.5) | 4 (2.0) | 0.267 |
| First-Generation College Attendance | ||||
| No | 22 (27.2) | 36 (30.8) | 58 (29.3) | |
| Yes | 59 (72.8) | 81 (69.2) | 140 (70.7) | 0.337 |
| Family Income | ||||
| Under $25,000 | 16 (19.0) | 21 (18.3) | 37 (18.6) | |
| 25,000-$50,000 | 26 (31.0) | 34 (29.6) | 60 (30.1) | |
| 50,000-$I00,000 | 29 (34.5) | 41 (35.6) | 70 (35.2) | |
| 100,000 or more | 13 (15.5) | 19 (16.5) | 32 (16.1) | 0.687 |
Chi-square tests with n and percentages for categorical variables, and independent sample t-test with mean and standard deviation for continuous variables were used.
Table 2 shows the five survey questions that asked about how much respondents agreed or disagreed with statements about knowledge of their school's smoke-free policy and one question that asked if the smoke-free policy allowed smoking for indoor public or common areas at their school (differences by smoking-free policies were significant; p<0.001). For the question, “Smoking is prohibited outside of buildings within 25 feet.....” more students in the CSFP school strongly agreed (or agreed) with this statement 33.1% (or 36.4%) compared to students in RSFP school 28.9% (or 24.1%). This difference was significant (p=0.014). Overall, the majority of the students either strongly agreed (31.3%: n=63) or agreed (31.3%: n=63) with this statement. For the question “According to the policy smoking of any kind of tobacco products on campus is banned,” there was a significant difference in the responses of CSFP students and RSFP students (p=0.002). More CSFP students strongly agreed/agreed 41.0% (or 41.0%) compared to RSFP students 22.6% (or 41.7%). The results of the descriptive analysis for research questions to determine students' attitudes toward the smoke-free policies (RSFP and CSFP) at their school showed that a majority of the HBCU students surveyed had positive feelings toward their schools' smoke-free policy, and agreed that a smoke-free policy is beneficial in reducing students' exposure to second-hand smoke.
| Variable | RSFP n (%) | CSFP n (%) | Total n (%) | P-value |
|---|---|---|---|---|
| Smoking is prohibited outside of buildings within 25 feet of any building entrance, air intake duct, or window | ||||
| Strongly agree | 24 (28.9) | 39 (33.1) | 63 (31.3) | |
| Agree | 20 (24.1) | 43 (36.4) | 63 (31.3) | |
| Neither agree nor disagree | 15 (18.1) | 23 (19.5) | 38 (18.9) | |
| Disagree | 16 (19.3) | 11 (9.3) | 27 (13.4) | |
| Strongly disagree | 8 (9.6) | 2 (1.7) | 10 (5.0) | p=0.014 |
| According to the policy, smoking of marijuana on campus is banned | ||||
| Strongly agree | 22 (26.2) | 47 (40.2) | 69 (34.3) | |
| Agree | 35 (41.7) | 41 (35.0) | 76 (37.8) | |
| Neither agree nor disagree | 14 (16.7) | 20 (17.1) | 34 (16.9) | |
| Disagree | 11 (13.1) | 9 (7.7) | 20 (10.0) | |
| Strongly disagree | 2 (2.4) | 0.(0.0) | 2 (1.0) | 0.108 |
| According to the policy, smoking of any kind of tobacco products on campus is banned | ||||
| Strongly agree | 19 (22.6) | 48 (41.0) | 67 (33.3) | |
| Agree | 29 (34.5) | 48 (41.0) | 77 (38.3) | |
| Neither agree nor disagree | 20 (23.8) | 12 (10.3) | 32 (15.9) | |
| Disagree | 12 (14.3) | 8 (6.8) | 20 (10.0) | |
| Strongly disagree | 4 (4.8) | 1 (0.9) | 5 (2.5) | p=0.002 |
| Smokers are less likely to get lung cancer than non-smokers | ||||
| Strongly agree | 7 (8.4) | 10 (8.7) | 17 (8.6) | |
| Agree | 18 (21.7) | 13 (11.3) | 31 (15.7) | |
| Neither agree nor disagree | 11 (13.3) | 12 (10.4) | 23 (11.6) | |
| Disagree | 23 (27.7) | 33 (28.7) | 56 (28.3) | |
| Strongly disagree | 24 (28.9) | 47 (40.9) | 71 (35.9) | 0.232 |
| Which of these best describes the smoke-free policy at your school for indoor public or common areas, such as lobbies, rest rooms, and lunchroom? | ||||
| Not allowed in any public areas | 25 (30.5) | 87 (75.7) | 112 (56.9) | |
| Allowed in some public areas | 30 (36.6) | 10 (8.7) | 40 (20.3) | |
| Allowed in all public areas | 1 (1.2) | 3 (2.6) | 4 (2.0) | |
| Not applicable | 26 (31.7) | 15 (13.0) | 41 (20.8) | p<0.001 |
| Within the past 12 months, the school offered stop smoking program or other help to students who want to quit smoking | ||||
| Strongly agree | 4 (4.9) | 6 (5.2) | 10 (5.1) | |
| Agree | 14 (17.1) | 14 (12.2) | 28 (14.2) | |
| Neither agree nor disagree | 46 (56.1) | 61 (53.0) | 107 (54.3) | |
| Disagree | 11 (13.4) | 23 (20.0) | 34 (17.3) | |
| Strongly disagree | 7 (8.5) | 11 (9.6) | 18 (9.1) | 0.706 |
*Association is significant at the .05 level (2-tailed). Chi-square tests with n and percentages for categorical variables were used.
To determine students' reported tobacco use behaviors, summaries of the respondent's history, and initiation of smoking by school are shown in Table 3. To address this question, Chi-square statistics with numbers and percentages for categorical variables were calculated. Most respondents indicated they currently smoked no tobacco products at all. Questions about the respondent's history and initiation of smoking by school reported one significant association regarding quit attempts. More RSFP students responded that in the last 12 months they had more quit attempts compared to CSFP students.
| Variable | RSFP n (Column %) | CSFP n (Column %) | Total n (%) | P-value |
|---|---|---|---|---|
| How old were you when you first started smoking cigarettes regularly? | ||||
| Under 18 | 7 (8.3) | 3 (2.5) | 10 (4.9) | |
| 18-24 | 7 (8.3) | 6 (5.1) | 13 (6.4) | |
| 25-34 | 1 (1.2) | 2 (1.7) | 3 (1.5) | |
| Other | 61 (72.6) | 94 (79.7) | 155 (76.7) | 0.243 |
| If you said that you never smoked regularly, how old were you the first time you smoked part or all of a cigarette? | ||||
| Other | 58 (69.1) | 90 (76.3) | 148 (73.3) | |
| Under 18 | 8 (9.5) | 10 (8.5) | 18 (8.9) | |
| 18-24 | 7 (8.3) | 3 (2.5) | 10 (4.9) | |
| 25-34 | 1 (1.2) | 2 (1.7) | 3 (1.5) | |
| Missing | 10 (11.9) | 13 (11.0) | 23 (11.4) | 0.426 |
| Has the smoke-free policy impacted your smoking? | ||||
| Yes | 6 (7.8) | 13 (11.1) | 19 (9.8) | |
| No | 71 (92.2) | 104 (88.9) | 175 (90.2) | 0.447 |
| How has the school’s smoke-free policy affected your smoking? | ||||
| I have reduced the amount i smoke | 7 (21.9) | 4 (7.8) | 11 (13.3) | |
| I have tried to quit | 2 (6.3) | 0 (0.0) | 2 (2.4) | |
| I go off campus to smoke | 6 (18.8) | 11 (21.6) | 17 (20.5) | |
| I have increased the amount i smoke | 3 (9.4) | 3 (5.9) | 6 (7.2) | |
| I quit but started again | 1 (3.1) | 0 (0.0) | 1 (1.2) | |
| Other | 13 (40.6) | 33 (64.7) | 46 (55.4) | 0.071 |
| Has the enforcement of the smoke-free policy impacted your smoking? | ||||
| Yes | 10 (12.2) | 14 (12.1) | 24 (12.1) | |
| No | 72 (87.8) | 102 (87.9) | 174 (87.9) | 0.979 |
| Do you currently smoke any tobacco products? | ||||
| Everyday | 1 (1.2) | 2 (1.7) | 3 (1.5) | |
| Somedays | 13 (15.5) | 15 (12.8) | 28 (13.9) | |
| Not at all | 70 (83.3) | 100 (85.5) | 170 (84.6) | 0.834 |
| Have you smoked at least 100 cigarettes in your lifetime? | ||||
| Yes | 5 (6.3) | 4 (3.5) | 9 (4.6) | |
| No | 75 (93.8) | 112 (96.6) | 187 (95.4) | 0.357 |
| If you answered everyday or some-days to currently smoking any tobacco products, what do you smoke? | ||||
| Cigarettes | 5 (7.1) | 3 (3.3) | 8 (4.9) | |
| E-cigarettes | 0 (0.0) | 1 (1.1) | 1 (0.6) | |
| Shisha/hookah | 2 (2.9) | 4 (4.4) | 6 (3.7) | |
| I don’t smoke | 46 (65.7) | 64 (69.5) | 110 67.9) | |
| Other | 17 (24.3) | 20 (21.7) | 37 (22.8) | 0.660 |
| On average, how many cigarettes do you smoke each day? | ||||
| Other | 14 (25.0) | 14 (16.1) | 28 (19.6) | |
| None at all | 42 (75.0) | 73 (83.9) | 115 (80.4) | 0.190 |
| Do you usually smoke menthol or non-menthol cigarettes? | ||||
| Menthol | 4 (6.4) | 4 (4.7) | 8 (5.4) | |
| Non-menthol | 6 (9.5) | 3 (3.5) | 9 (6.1) | |
| No usual type | 53 (84.1) | 78 (91.8) | 131 (88.5) | 0.278 |
| Around this time 12 months ago, were you smoking cigarettes every day, some days, or not at all? | ||||
| Everyday | 5 (6.1) | 1 (0.9) | 6 (3.1) | |
| Somedays | 6 (7.3) | 7(6.3) | 13 (6.7) | |
| Not at all | 71 (86.6) | 104 (92.9) | 175 (90.2) | 0.109 |
| During the past 12 months, have you tried to quit smoking? | ||||
| Yes | 15 (22.7) | 10 (10.3) | 25 (15.3) | |
| No | 51 (77.3) | 87 (89.7) | 138 (84.7) | p=0.031 |
| Did you use any of the following? | ||||
| A telephone help line or quit line | 2 (2.9) | 1 (1.0) | 3 (1.8) | |
| Internet or web-based program or tool | 5 (7.3) | 4 (4.2) | 9 (5.5) | |
| Internet or web-based program or tool | 62 (89.9) | 91 (94.8) | 153 (92.7) | 0.457 |
| Are you planning to quit within the next 30 days? | ||||
| Yes | 11 (18.6) | 9 (10.5) | 20 (13.8) | |
| No | 48 (81.4) | 77 (89.5) | 125 (86.2) | 0.161 |
*Association is significant at the .05 level (2-tailed). Chi-square tests with n and percentages for categorical variables were used.
Teens demonstrate a higher frequency of addiction to smoking, despite smoking less than adults.27 Thus, it is important to explore the smoking behaviors of students to gain a better understanding of how the habit can be mediated or prevented altogether. When asked about their smoking behaviors, a majority of the 202 HBCU students who were surveyed responded that they were not currently smoking, had not smoked at least 100 cigarettes in their lifetime, and had never smoked regularly. These responses reflect how smoking is not a widespread phenomenon at HBCUs, nor is the activity likely encouraged in these schools.28 As shown in Table 3, a very small number of respondents (n=18, 8.9%) indicated they were under 18 years old when they first started smoking cigarettes regularly.
Respondents' reported smoking behavior, including smoking cessation, are also shown in Table 3. Quit attempts showed one significant difference at (p=0.031), in the responses of CSFP students versus RSFP students. More RSFP (n=15, 22.7%) students responded that in the last 12 months they had more quit attempts compared to (n=10, 10.3%) CSFP students. An overwhelming number (n=131,88.5%) of the responding students indicated they did not regularly smoke either menthol or non-menthol cigarettes. A majority (n=175, 90.2 %) of the 202 students responded that they did not smoke cigarettes “at all” this time 12 months ago. Most respondents (n=153, 92.7%) of the 202 students indicated they had reviewed information about smoking on the internet or web-based program.
Bivariate and multivariable logistic regression models were conducted to compare the smoking behavior of students at the CSFP school with those at the RSFP school. The results of the regression analysis indicated no association between students' attitudes toward their HBCUs' smoke-free policies and students' reported smoking behavior. The results also indicated that there was no significant difference in the smoking behaviors between the two schools with different smoke-free policies. The difference in smoking prevalence and odds between the two schools by policy type was not statistically significant (data not shown).
The overall smoking prevalence for students at the CSFP and RSFP is similar to the prevalence in Maryland and the US population (data not shown). A small number of respondents (n=31, 15.4%) reported smoking. A majority of the CFSP respondents (n=100, 85.5%) and RSFP respondents (n=70, 83.3%) indicated that they were not smoking at the time of the survey, while 17 (14.5%) CSFP students and 14 (16.7%) RSFP students said that they were smoking.
4. Discussion
The purpose of this study was to investigate the association of smoke-free policies on HBCU students' attitudes and smoking behaviors. We hypothesized that there would be a significant association between students' attitudes toward smoke-free policies and students' reported smoking behavior. Students were recruited at two HBCU campuses in the Mid-Atlantic region to participate and fill out a self- administered survey. Our study found that there was not a statistically significant difference between the smoking behavior of HBCU students at the school with a comprehensive smoke-free policy (CSFP) and students at the school with a regular smoke-free policy (RSFP). This study contributes to the existing literature on tobacco prevention and control and empowers students, parents, and college communities to create healthier environments on college campuses.29
4.1. Limitations
A limitation of this study is the degree to which a non-random sample of students can support the identification of statistically significant associations. These concerns were paramount in conducting the study due to the financial and time-specific resources of the principal investigator. Of the four HBCUs located in the Mid-Atlantic region, only two urban campuses are represented here. This limits the number and diversity of participants and excludes data collected in a non-urban settings and from the larger pool of HBCUs in the US (Table 4). Under-representation of students from varied demographic backgrounds, such as students of different ethnicities and nationalities, can lead to bias. The survey results are also subject to non-random biases.
| Region | State | HBCU | Students enrolled |
|---|---|---|---|
| California | California | Charles R. Drew University of Medicine and Science | 656 |
| Mid-Atlantic | Delaware | Delaware State University | 4,872 |
| Mid-Atlantic | Maryland | Bowie State University | 5,561 |
| Mid-Atlantic | Maryland | Coppin State University | 2,724 |
| Mid-Atlantic | Maryland | Morgan State University | 7,747 |
| Mid-Atlantic | Maryland | University of Maryland Eastern Shore | 2,334 |
| Mid-Atlantic | Pennsylvania | Cheyney University of Pennsylvania | 755 |
| Mid-Atlantic | Pennsylvania | Lincoln University of Pennsylvania | 2,361 |
| Mid-Atlantic | Virginia | Hampton University | 4,619 |
| Mid-Atlantic | Virginia | Norfolk State University | 5,616 |
| Mid-Atlantic | Virginia | Saint Paul College | 556 |
| Mid-Atlantic | Virginia | Virginia State University | 5,414 |
| Mid-Atlantic | Virginia | Virginia Union University | 1,678 |
| Mid-Atlantic | Virginia | Virginia University of Lynchburg | 597 |
| Mid-Atlantic | Washington D.C | Howard University | 10,002 |
| Mid-Atlantic | Washington D.C | Howard University College of law | 473 |
| Mid-Atlantic | Washington D.C | Howard University College of Medicine | 120 |
| Mid-Atlantic | Washington D.C | University of the District of Columbia | 5,667 |
| Midwest | Missouri | Harris- Stowe State University | 1,390 |
| Midwest | Missouri | Lincoln University of Missouri | 3,156 |
| Midwest | Ohio | Central State University | 2,033 |
| Midwest | Ohio | Wilberforce University | 500 |
| South | Alabama | A&M University | 6,001 |
| South | Alabama | Alabama State University | 5,475 |
| South | Alabama | Bishop State Community College | 3,982 |
| South | Alabama | Concordia College- Selma | 546 |
| South | Alabama | Gadsden State Community College | 7,031 |
| South | Alabama | H Councill Trenholm State Technical College | 1,758 |
| South | Alabama | JF Drake State Technical College | 1,384 |
| South | Alabama | Lawson State Community College- Birmingham Campus | 5,460 |
| South | Alabama | Miles College | 1,500 |
| South | Alabama | Oakwood University | 1,711 |
| South | Alabama | Selma University | 547 |
| South | Alabama | Shelton State Community College | 5,307 |
| South | Alabama | Stillman College | 615 |
| South | Alabama | Talladega College | 350 |
| South | Alabama | Tuskegee College | 3,117 |
| South | Arkansas | Arkansas Baptist College | 990 |
| South | Arkansas | Philander Smith College | 996 |
| South | Arkansas | Shorter College | 569 |
| South | Arkansas | University of Arkansas at Pine Bluff | 2,382 |
| South | Kentucky | Kentucky State University | 1,926 |
| South | Kentucky | Simmons College of Kentucky | 216 |
| South | Louisiana | Dillard University | 1,301 |
| South | Louisiana | Grambling State University | 4,863 |
| South | Louisiana | Southern University and A & M College | 6,489 |
| South | Louisiana | Southern University at New Orleans | 3,165 |
| South | Louisiana | Southern University at Shreveport | 2,834 |
| South | Louisiana | Southern University of Louisiana | 6,489 |
| South | Louisiana | Xavier University of Louisiana | 3,231 |
| South | Mississippi | Alcorn State University | 3,523 |
| South | Mississippi | Coahoma Community College | 2,999 |
| South | Mississippi | Hinds Community College | 12,811 |
| South | Mississippi | Jackson State University | 9,811 |
| South | Mississippi | Mississippi Valley State University | 21,622 |
| South | Mississippi | Rust College | 1,064 |
| South | Mississippi | Tougaloo College | 809 |
| South | Tennessee | American Baptist College | 5,319 |
| South | Tennessee | Fisk University | 853 |
| South | Tennessee | Knoxville College | 28,894 |
| South | Tennessee | Lane College | 2,200 |
| South | Tennessee | Lemoyne-Owen College | 987 |
| South | Tennessee | Meharry Medical College | 835 |
| South | Tennessee | Tennessee State University | 9,027 |
| South | West Virginia | Bluefield State College | 2,063 |
| South | West Virginia | West Virginia State University | 3,879 |
| Southeast | Florida | Bethune-Cookman University | 3,773 |
| Southeast | Florida | Edward Waters College | 769 |
| Southeast | Florida | Florida A&M University College of Law | 529 |
| Southeast | Florida | Florida Agricultural and Mechanical University | 9,614 |
| Southeast | Florida | Florida memorial University | 1,339 |
| Southeast | Georgia | Albany State University | 6,122 |
| Southeast | Georgia | Clark Atlanta university | 3,920 |
| Southeast | Georgia | Fort valley State University | 2,624 |
| Southeast | Georgia | Interdenominational Theological Center | 265 |
| Southeast | Georgia | Morehouse College | 2,167 |
| Southeast | Georgia | Morehouse School of medicine | 329 |
| Southeast | Georgia | Morris Brown College | 240 |
| Southeast | Georgia | Paine College | 370 |
| Southeast | Georgia | Savannah State University | 10,517 |
| Southeast | Georgia | Spelman College | 2,120 |
| Southeast | North Carolina | Barber-Scotia College | 120 |
| Southeast | North Carolina | Bennett College for Women | 780 |
| Southeast | North Carolina | Elizabeth City State University | 2,002 |
| Southeast | North Carolina | Fayetteville State University | 6,020 |
| Southeast | North Carolina | Johnson C Smith University | 1,620 |
| Southeast | North Carolina | Livingstone College | 1,156 |
| Southeast | North Carolina | North Carolina A & T State University | 12,754 |
| Southeast | North Carolina | North Carolina Central University | 8,096 |
| Southeast | North Carolina | North Carolina Central University School of Law | 364 |
| Southeast | North Carolina | Saint Augustine’s College | 1,508 |
| Southeast | North Carolina | Shaw University | 1,660 |
| Southeast | North Carolina | Winston-Salem State University | 5,190 |
| Southwest | Oklahoma | Langston University | 2,219 |
| Southwest | Texas | Huston-Tillotson University | 1,160 |
| Southwest | Texas | Jarvis Christian College | 905 |
| Southwest | Texas | Paul Quinn College | 424 |
| Southwest | Texas | Prairie View A & M University | 8,940 |
| Southwest | Texas | Southwestern Christian College | 224 |
| Southwest | Texas | St. Philips College | 11,198 |
| Southwest | Texas | Texas College | 972 |
| Southwest | Texas | Texas Southern University | 10,514 |
| Southwest | Texas | Texas Southern University- Thurgood Marshall School of law | 573 |
| Southwest | Texas | Wiley College | 1,400 |
| Virgin Islands | Virgin Islands | University of the Virgin Islands | 2,138 |
| Virgin Islands | Virgin Islands | University of the Virgin Islands-Kingshill | 1,850 |
5. Conclusions and Implications for Translation
The findings of the present study show that students generally had positive perceptions of their schools' smoke-free policies. However, only a few respondents reported that these smoke-free policies had an impact on their smoking behaviors. Most respondents were non-smokers or had smoked at least once in the 12 months preceding the survey. The results of the regression analysis showed although students' attitudes toward smoke-free policies were not significantly associated across all of the policy variables, there were at least two instances where the students' attitudes toward the smoke-free policies were significantly associated with students' reported smoking behaviors. It is critical to understand the impact of smoke-free policies at institutions of higher education and how they positively influence the tobacco smoking decisions of young adults. Racial/ethnic minority populations are at high risk for using tobacco and tend to bear an unequal share of the human and economic cost of tobacco use. Racial/ethnic health disparities have persisted for African Americans and other racial/ethnic students attending higher education institutions in the United States. The changing social surroundings in which college students find themselves contribute to self-exploration and smoking behaviors can become involved in this process.
Compliance with Ethical Standards
Financial Disclosure:
None to report.
Conflicts of interest:
None.
Disclaimer:
The views expressed are the authors’and not necessarily those of their institutions.
Ethical approval:
Permission was received from each school’s Institutional Review Board (IRB) for human subjects research approval to collect data from the surveyed students. Students were required to read and sign informed consents that described the purpose of the study, the voluntary nature of their participation, and the protections for confidentiality and privacy.
Acknowledgments:
None.
Funding Support:
None.
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