Tobacco on campus: industry marketing and tobacco control policy among post-secondary institutions in Canada
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《烟草控制杂志》
1 Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
2 Direction régionale de santé publique de la Capitale nationale, Beauport, Québec, Canada
3 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
4 Faculté de Medécine, Université du Laval, Laval, Québec, Canada
5 Physicians for a Smoke-free Canada, Ottawa, Ontario, Canada
ABSTRACT
Objective: Post-secondary institutions provide a unique opportunity to implement and evaluate leading edge tobacco policies, while influencing a key group of young adults. To date, however, we know little about the tobacco control environment at post-secondary institutions outside the USA.
Design: Telephone surveys were conducted with campus informants from 35 post-secondary institutions in Canada to evaluate tobacco control policies and the presence of tobacco marketing on campus.
Main outcome measures: Tobacco marketing on campus, tobacco control policies, and attitudes towards tobacco control.
Results: The findings indicate that tobacco marketing is prevalent among post-secondary institutions in Canada. Every university and half of all colleges surveyed had participated in some form of tobacco marketing in the past year. Among universities, 80% had run a tobacco advertisement in their paper and 18% had hosted a tobacco sponsored nightclub event. Tobacco control policies varied considerably between institutions. Although several campuses had introduced leading edge policies, such as campus wide outdoor smoking restrictions and tobacco sales bans, there is a general lack of awareness of tobacco issues among campus decision makers and fundamental public health measures, such as indoor smoke-free policies, have yet to be introduced in many cases.
Conclusions: Post-secondary institutions in Canada remain tobacco friendly environments. Without increased direction and support from the public health community, post-secondary institutions will continue to lag behind, rather than lead current policy standards.
Keywords: tobacco use; campus policy; marketing; attitudes; post-secondary
Approximately 31% of Canadians aged 19–24 years smoke, the highest smoking rate among all age groups.1 Young adulthood represents a critical period when the transition from experimental to established smoking occurs, along with important increases in consumption.2,3 In contrast to older smokers, young adults are considerably more elastic in their smoking behaviour and remain susceptible to starting smoking.4
Post-secondary students are somewhat less likely to smoke than other young adults. In Canada, 22% of students smoke compared to 32% of their peers. However, because almost half of young adults attend university or college, post-secondary institutions account for more smokers than any other occupational setting in Canada.5,6 Together, university and college students comprise 30% of all young adult smokers and 7% of all smokers in Canada.5 Not only is tobacco use common among post-secondary students, but it appears to be declining at a slower rate than among other groups.7 Indeed, recent data suggest that fewer students may be quitting and a greater proportion may be starting smoking at university and college than is generally acknowledged.8,9,10
Post-secondary students also represent an important segment of the 18–24 year old demographic that is vital to tobacco companies. This demographic represents a narrow window of opportunity during which time tobacco marketing seeks to promote brand loyalty, increase daily consumption, and establish smoking as a habitual, long term behaviour among experimental and occasional smokers.11,12 As the youngest legal targets of tobacco marketing, young adults also serve as an important link to youth.
Post-secondary campuses are in many ways ideally suited to tobacco marketing. First, most institutions have their own media outlets, as well as their own bars and pubs. These campus venues serve as the social and entertainment centre for many students, particularly the majority of first and second year university students who live on campus. Second, campus marketing is relatively inexpensive.13 Student and administrative groups that operate media and entertainment outlets are typically in need of revenue and receptive to marketing opportunities. Third, campus marketing is sufficiently decentralised that it is difficult to monitor and likely to avoid public scrutiny. Further, promotional and sponsorship campaigns on campus are more subtle than traditional advertising and may be more acceptable to campus groups who are reluctant to be associated with overt tobacco marketing. This type of "below-the-line" advertising is particularly effective with advertising savvy young adults and is less likely to produce reactance among students.14 Ultimately, campus environments provide tobacco companies with a direct, focused means of targeting a key segment of young adults.15
The available evidence suggests that tobacco companies have been successful in integrating tobacco marketing within campus environments. In particular, tobacco companies have successfully established links with academia.16 For example, in Canada, 39% of universities were found to have received donations from the tobacco industry between 1996 to 1999, and 26 university related appointments were found to be held by tobacco industry officers between 1996 and 2001.17 These types of funding arrangements provide the industry with credible associations to academia that help to maintain the "legitimacy" of the industry and its products.16 Observational evidence also suggests that tobacco companies in Canada have run more direct marketing campaigns in campus newspapers, as well as promotional events in campus bars and nightclubs. To date, however, we have little idea of the scope of tobacco marketing on campus or the extent to which students might be exposed to these initiatives.
If post-secondary students and campuses appeal to tobacco companies, so too should they appeal to the tobacco control community. Campus environments provide a unique opportunity to introduce and evaluate tobacco control policies among an influential group of young adults. Although tobacco control policies appear to be gaining prominence in US colleges and universities,18,19 the potential for tobacco control on campus has yet to be realised. For example, as of 2000, only half of US colleges restricted smoking in all campus buildings and student residences, while more than two thirds accepted tobacco advertising in their newspapers.19 Outside of the USA there are few data on the state of tobacco control among post-secondary institutions. In Canada, what little regional data exists suggests wide variability in tobacco control policies between institutions.20
For their part, post-secondary students have widely endorsed more stringent campus tobacco control policies, including comprehensive smoking restrictions and curbs on tobacco marketing on campus.10,21 Yet, despite this support and a growing number of resources,22–24 it would appear that university and college administrators continue to underestimate the importance of and support for tobacco control policies among their students.25
The current study sought to: (1) assess the prevalence of tobacco marketing at post-secondary institutions in Canada; (2) assess the state of tobacco control policies at universities and colleges; and (3) examine attitudes to tobacco control and perceived importance of tobacco issues among campus decision makers.
METHODS
Procedure
A total of 36 post-secondary institutions (23 universities and 13 colleges) were selected to participate in the study. Universities and colleges were selected from each of Canada’s 10 provinces and two of the three territories to ensure geographical representation. The largest institution or college in each region was selected; additional universities were drawn from the most populated provinces in both urban and rural areas, where possible. Participating universities had an average enrolment of 23 177 students per school for a total of 509 880 students, or approximately 51% of university students in Canada. Participating colleges had an average of 6730 students per school for a total enrolment of 80 763 students, or approximately 24% of college students in Canada.26 Note that, in Canada, universities are registered degree granting institutions, while colleges offer diplomas, typically for vocationally oriented programmes. Universities are generally much larger than colleges, both in terms of student enrolment and infrastructure. Universities are also "public" institutions, whereas colleges can be either public or private.
A telephone survey was conducted with campus informants from each institution. The following six campus informants were identified at each institution: student union executive (president or vice-president), retail store manager, campus newspaper editor, campus bar manager, health services contact, and university or college administrator. Calls were made until contact was established with the campus informant or a suitable replacement could be surveyed. Each informant was asked to complete a five minute survey of tobacco control policies and industry marketing on campus (see below). Telephone surveys were conducted between March 2004 and April 2004, in both French and English. In cases where informants reported a campus policy, written copies of the policy were requested. In order to verify the accuracy of informants’ reports of industry marketing, a sub-sample of five universities was selected for an environmental scan. Research assistants completed a scan of campus newspapers in the previous 12 months, bars and pubs, and retail outlets to detect incidences of tobacco marketing. Any discrepancies between these observations and survey responses were recorded.
Measures
The telephone survey was developed from validated sources, including the tobacco component of the Harvard College Alcohol Survey27 and a recent survey on tobacco policy conducted in south western Ontario.10 Respondents were asked to report on the following tobacco control policies: restrictions on point-of-purchase marketing; tobacco sales; tobacco advertisements in the student newspaper; hosting tobacco sponsored events; accepting tobacco funding in the form of donations or grants; and smoke-free restrictions (student housing, bars/restaurants, designated outdoor areas, and campus wide). Policies were identified through campus informants, as well as an electronic search of the institution’s website. Campus informants were also asked whether they had been approached or participated in the following types of tobacco marketing in the past 12 months: tobacco advertisements in campus newspapers; retail promotions, including cigarette shelf or countertop displays; signs or posters in bars; and nightclub, concert, or any other events associated with tobacco companies. Finally, student executives from each institution were asked whether they recalled discussing tobacco issues or policies at meetings, and to report their perceived importance of tobacco issues on campus ("Relative to other issues on campus, how important is the issue of tobacco use").
Statistical analysis
All analyses were conducted using SPSS (version 12.0). Given the organisational differences between colleges and universities described above, the results for these institutions are reported separately.
RESULTS
One university selected to participate in the study was excluded because of missing data from numerous campus informants. Complete data were ascertained from 98% of the campus informants at the remaining 35 universities.
General
Of the 22 universities surveyed, all had been approached to participate in tobacco marketing and all had received money for some form of tobacco marketing in the past 12 months (fig 1). Among colleges, six (46%) had been approached to participate in tobacco marketing, all of whom had received funding in the past 12 months.
Promotional events
Every university surveyed had a bar or pub on campus. Among universities, eight campus bar managers (37%) reported that a general policy regarding promotional events existed, although only one bar manager reported guidelines restricting tobacco related promotions. Nineteen universities (86%) had been approached about hosting tobacco sponsored events or promotions in the campus bar, and four (18%) had actually hosted an event in the past 12 months, such as the Benson & Hedges Gold Club Series. Only two universities had a written policy prohibiting tobacco sponsored events on campus.
Three colleges (23%) had bars or pubs on campus. One college reported general policies on promotions, though none specific to tobacco. All three of the colleges with bars had been approached to host a tobacco sponsored event and one had done so in the past 12 months.
Campus newspaper advertisements
All but one university (95%) and six colleges (46%) published a campus newspaper. Only 11% of university newspapers reported a policy against accepting tobacco advertisements, while 17% of college newspapers had such a policy. Approximately 80% (16 of 20) of universities had run at least one tobacco advertisement in the last 12 months, while 50% (three of six) of college newspapers had done so. Of the papers that ran tobacco advertisements, the vast majority ran numerous, full page colour ads (fig 1). Only two institutions had written policies prohibiting tobacco advertisements in campus newspapers.
Point-of-purchase promotions
Twenty of 22 universities had retail outlets. Of universities with retail outlets, 55% (11/20) had point-of-purchase (POP) promotions, including "power walls" of cigarettes at retail outlets. Six of the 11 schools without POP promotions reported an explicit policy prohibiting tobacco retail promotion. Of the nine colleges with retail outlets, 33% (3/9) reported POP promotions. The remaining six colleges with retail outlets reported policies against POP promotions. Figure 2 depicts the overall prevalence of tobacco marketing at universities and colleges.
Tobacco sales
Twenty one universities (95%) had retail outlets on campus. Of these, 76% (16/21) sold tobacco products: 57% (11/21) of universities sold tobacco in campus stores, while 19% (5/21) sold tobacco only in campus bars. Among colleges, nine (70%) had campus retail outlets. Of these, 56% (5/9) sold tobacco products: 44% colleges (4/9) sold tobacco in campus stores, while 12% (1/9) sold tobacco products only in campus bars.
Smoke-free restrictions
Twenty one universities and eight colleges offered on-campus student housing. As fig 3 illustrates, 81% (17/21) of universities and 75% (6/8) colleges with student housing reported smoke-free policies in student residences. Only 41% (9/22) prohibited smoking in campus bars. Of the three colleges with campus bars, two prohibited smoking (66%). Seven universities (32%) and eight colleges (57%) reported smoke-free areas in designated outdoor locations, such as entrance ways to buildings. Two universities had comprehensive smoke-free restrictions that prohibited smoking anywhere on campus, including all outdoor areas.
Tobacco company donations and investments
Policies on accepting financial donations existed in 39% (7/18) of responding universities, and only 8% of colleges (1/13). However, only 11% (2/18) of the responding universities and 8% of colleges (1/13) had rules or policies specifically related to donations from tobacco companies. Six universities (32%) and two colleges (15%) had general policies or ethical rules concerning how they invested their holdings or pension funds. No universities had policies or rules against investing in tobacco companies and only two (15%) of the colleges had such restrictions.
Attitudes towards and support for tobacco control
When asked to report the most important student health issues that need to be addressed, the majority of college and university student executives reported mental health (including stress and anxiety), eating/nutrition, sexual health, and active lifestyles. Approximately 16% mentioned smoking among important student health issues.
The majority (62%) of university student executives at universities recalled discussing tobacco issues or policies at meetings, while only 36% of student executives at colleges reported discussing tobacco issues or policies at meetings. In addition, student executives at 32% of universities reported that, relative to other campus issues, the issue of tobacco use was "not very important", 45% reported tobacco use was "somewhat important", while 23% reported that tobacco was a "very important" campus issue. Among colleges, slightly more than half (57%) reported that tobacco issues were "not very important", while the remaining 43% reported that tobacco issues were "very important". In terms of perceived student support, university student executives at 10% of universities perceived "no" student support for strong campus tobacco policies, 62% perceived only "a little" support, while 20% perceived "a lot" of support for strong tobacco policies on campus. Approximately 10% reported that they "did not know". Among college student executives 29% perceived "no" student support for stronger tobacco policies, 36% perceived "a little" support", while 29% perceived "a lot" of student support for strong tobacco policies on campus.
DISCUSSION
The findings indicate extensive tobacco marketing on post-secondary campuses in Canada. Every university and half of colleges surveyed reported receiving money for some form of tobacco marketing in the past year. Among universities, 80% had run tobacco advertisements in the campus newspaper and over half had received money to display tobacco products or other retail promotions in the past year. In addition, approximately one fifth of universities had hosted a tobacco sponsored event in the past year. Tobacco marketing was less prevalent, although still significant, among colleges. In general, colleges were considerably less likely to have campus bars and media outlets and provided fewer opportunities for tobacco marketing. Note, however, that every college that had been approached to participate in marketing had done so. This suggests that, although colleges may lack the venues or the opportunities, they are no less receptive to tobacco marketing than universities. Overall, these findings suggest that tobacco marketing is prevalent among post-secondary institutions in Canada.
The findings indicate considerable variability in campus tobacco control policies. While some institutions reported leading edge policies such as tobacco sales bans and comprehensive smoke-free restrictions, other institutions reported a virtual absence of tobacco control policy. Even in cases when tobacco marketing did not occur, explicit policies or prohibitions were rare. Although campus informants reported a number of "unwritten" policies that may reflect common practice and social norms on campus, these unofficial rules are difficult to validate and are apt to change with the annual turnover in student executives or to be reversed at a later date. To ensure that restrictions are adequately enforced, post-secondary institutions must make campus tobacco policies explicit. In addition, despite growing calls from the public health community for restrictions on tobacco company donations and institutional investments in the tobacco industry,28,29 the findings indicate little activity or apparent support for these policies among post-secondary administrators.
The extent of smoke-free restrictions was generally weaker than might be expected for post-secondary institutions. Not all campuses had restrictions in student residences, and only half of universities and colleges restricted smoking in campus bars and pubs—a critical environment for student tobacco use and exposure to secondhand smoke. In general, smoke-free restrictions appear to follow municipal or provincial restrictions: few campuses had introduced smoke-free bylaws in campus bars and restaurants unless required to do so. The notable exceptions to this trend are Dalhousie and Lakehead Universities, which have introduced benchmark smoke-free policies covering the entire campus area, including outdoor areas.
Student executives demonstrated only a modest awareness of tobacco issues and support for tobacco control policies. Even among schools with progressive policies, few student union executives and administrators reported that tobacco control is a priority and many failed to recognise marketing initiatives such as POP promotions as forms of tobacco marketing. These perceptions among campus decision makers are in notable contrast with support for stronger tobacco policies among students, reported elsewhere.10,21
Limitations
The main limitation of this research concerns the reliability of campus informants. Despite our efforts to survey all relevant contacts, several campus informants had difficulty recalling individual forms of marketing. Indeed, in three cases, newspaper editors reported that the campus paper had not published tobacco advertisements, when a scan of the paper indicated otherwise. As a result, the current findings may provide an underestimate of the actual level of tobacco marketing at post-secondary institutions. A second limitation concerns the representativeness of the findings. Institutions were not selected at random, but rather through purposeful sampling to ensure geographical coverage. While the current findings should not be generalised to all post-secondary institutions, the data derives from a sufficiently broad range of colleges and universities to be generally reflective of post-secondary institutions in Canada.
What this paper adds
Post-secondary environments represent a unique opportunity for tobacco control: approximately one third of young adult smokers attend university or college, and campus environments represent an important venue for tobacco marketing. To date, however, there is little research on the prevalence of tobacco marketing on campuses or the current state of tobacco control policies.
The current findings indicate that tobacco marketing is prevalent among Canadian universities and colleges. Although several institutions have introduced leading edge policies, there is a lack of awareness of tobacco issues among campus decision makers, and fundamental public health measures such as comprehensive smoke-free policies have yet to be introduced in most cases. Overall, Canadian campuses remain tobacco friendly environments.
Conclusions and implications
Overall, post-secondary campuses in Canada remain tobacco friendly environments: tobacco marketing is prevalent, there is a lack of awareness of tobacco issues among campus decision makers, and fundamental public health measures such as comprehensive smoke-free policies have yet to be introduced in many cases. There are, however, grounds for optimism. Campus advocacy has increased in recent years, along with resources for, and support among, students for more effective tobacco control measures.22 Campus advocates have also achieved several striking successes in recent years, including smoke-free restrictions in outdoor areas and tobacco sales bans. These policies serve as policy benchmarks not only for post-secondary institutions, but for all jurisdictions.
If the tobacco industry has made university and college students a priority, so too must the public health community. Indeed, relative to other initiatives, campus tobacco policies represent a cost effective investment for the public health community. Campus tobacco policies are already supported by the overwhelming majority of constituents, they are unlikely to be actively opposed by the industry, nor are they likely to change once introduced. Yet, without direction from the tobacco control community, campus policies will continue to lag behind, rather than lead current standards in tobacco control policy.
ACKNOWLEDGEMENTS
This research was supported by Physicians for a Smoke-Free Canada, with funding from Health Canada’s Tobacco Control Program. We would like to thank the members of the Tobacco on Campus Workgroup for their contributions to this study, including Eric Breton, Mary-Jean Costello, Tara Elton, Larissa Hausmanis, Dan Johnson, Erin Martin, Roman Pabayo, Marion Schnebellen, and Heather Travis. We would also like to thank Joanna Cohen, Fernand Turcotte, Geoffrey T Fong, Sharon Lawler, and Tim Dewhirst for their feedback on an earlier draft.
FOOTNOTES
Competing interests: none
REFERENCES
Health Canada. Summary of Results for Wave 1 (February to June) of 2003. Canadian Tobacco Use Monitoring Survey (CTUMS) 2004.
US Department of Health and Human Services. Cigarette smoking among adults-United States, 1965–1996. MMWR Morb Mortal Wkly Rep 1998;47:837–48.
Ling PM, Glantz SA. Why and how the tobacco industry sells cigarettes to young adults: evidence from industry documents. Am J Public Health 2002;92:908–16.
Lantz PM. Smoking on the rise among young adults: implications for research and policy. Tobacco Control 2003;12 (suppl I) :i60–70.
Hammond D. Young adults and smoking behaviour: initiation and progression to established smoking. Tobacco Control (in press).
Adlaf EM, Gliksman L, Demers A, et al. Cigarette use among canadian undergraduates. Can J Public Health 2003;94:22–4.
Wechsler H. Rigotti NA, Gledhill-Hoyt J, et al. Increased levels of cigarette use among college students: a cause for national concern. JAMA 1998;280:1673–8.
Choi WS, Harris KJ, Okuyemi K, et al. Predictors of smoking initiation among college-bound high school students. Ann Behav Med 2003;26:69–74.
Wetter DW, Kenford SL, Welsch SK, et al. Prevalence and predictors of transitions in smoking behavior among college students. Health Psychol 2004;23:168–77.
Hammond D, Costello MJ, Fong GT. Tobacco industry marketing and policy support among university students: findings from the campus tobacco survey. Toronto, Ontario: Presented at the Ontario Tobacco Control conference, May, 2004.
Katz SK, Lavack AM. Tobacco related bar promotions: insights from tobacco industry documents. Tobacco Control 2002;11 (suppl I) :i92–101.
Burrows D. Strategic Research Report: Young Adult Smokers – Strategies and Opportunities, RJ Reynolds Marketing Research. 29 February 1984.
Ramage R. Big plans on campus. Marketing 2004;109:17–19.
Sepe E, Glantz SA. Bar and club promotions in the alternative press: targeting young adults. Am J Public Health 2002;92:75–8.
Morrison DA. Marketing to the campus crowd. Chicago: Dearborn Trade, 2004.
Cohen JE. Universities and tobacco money. BMJ 2001;323:1–2.
Cohen JE, Ashley MJ, Ferrence R, et al. Institutional addiction to tobacco. Tobacco Control 1999;8:70–4.
Wechsler H, Kelley K, Seibring M, et al. College smoking policies and smoking cessation programs: results of a survey of college health center directors. J Am Coll Health 2001;49:205–12.
Halperin AC, Rigotti NA. US Public universities’ compliance with recommended tobacco control policies. J Am Coll Health 2003;51:181–8.
Action on Smoking and Health (ASH) Alberta. Survey of post-secondary tobacco control policies: in Alberta. Building Capacity for Smoke-Free Environments in Alberta. November 2003.
Rigotti NA, Regan S, Moran SE, et al. Students’ opinion of tobacco control policies recommended for US colleges: a national survey. Tobacco Control 2003;12:251–6.
Tobacco Technical Assistance Consortium (TTAC) College Tobacco Prevention Resource website. (Accessed July 2004).
American Cancer Society (Smoke-Free New-England). Sample for a Tobacco Free-Campus. %20Policy%20For%20a%20Tobacco-Free%20Campus.pdf (Accessed July 2004).
American College Health Association (ACHA) Guidelines. Position statement on tobacco on college and university campuses. June 2000.
Halperin A, Ehlinger E, Majchrzak N. Reducing tobacco use among college students by changing campus policies and practices. New Orleans, Louisiana: presented at the National Conference on Tobacco or Health, November, 2001.
Enhanced Student Information System (E S I S). Statistics Canada, 2002. Ottawa, Canada.
Wechsler H, Lee JE, Rigotti NA. Cigarette use by college students in smoke-free housing: results of a national study. Am J Prev Med 2001;20:202–7.
Cohen JE. Universities and tobacco money: some universities are accomplices in the tobacco epidemic. BMJ 2001;323:1–2.
Anon. Tobacco industry funding to universities: a joint protocol of Cancer Research. Universities UK. June 2004.(D Hammond, I Tremblay, M )
2 Direction régionale de santé publique de la Capitale nationale, Beauport, Québec, Canada
3 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
4 Faculté de Medécine, Université du Laval, Laval, Québec, Canada
5 Physicians for a Smoke-free Canada, Ottawa, Ontario, Canada
ABSTRACT
Objective: Post-secondary institutions provide a unique opportunity to implement and evaluate leading edge tobacco policies, while influencing a key group of young adults. To date, however, we know little about the tobacco control environment at post-secondary institutions outside the USA.
Design: Telephone surveys were conducted with campus informants from 35 post-secondary institutions in Canada to evaluate tobacco control policies and the presence of tobacco marketing on campus.
Main outcome measures: Tobacco marketing on campus, tobacco control policies, and attitudes towards tobacco control.
Results: The findings indicate that tobacco marketing is prevalent among post-secondary institutions in Canada. Every university and half of all colleges surveyed had participated in some form of tobacco marketing in the past year. Among universities, 80% had run a tobacco advertisement in their paper and 18% had hosted a tobacco sponsored nightclub event. Tobacco control policies varied considerably between institutions. Although several campuses had introduced leading edge policies, such as campus wide outdoor smoking restrictions and tobacco sales bans, there is a general lack of awareness of tobacco issues among campus decision makers and fundamental public health measures, such as indoor smoke-free policies, have yet to be introduced in many cases.
Conclusions: Post-secondary institutions in Canada remain tobacco friendly environments. Without increased direction and support from the public health community, post-secondary institutions will continue to lag behind, rather than lead current policy standards.
Keywords: tobacco use; campus policy; marketing; attitudes; post-secondary
Approximately 31% of Canadians aged 19–24 years smoke, the highest smoking rate among all age groups.1 Young adulthood represents a critical period when the transition from experimental to established smoking occurs, along with important increases in consumption.2,3 In contrast to older smokers, young adults are considerably more elastic in their smoking behaviour and remain susceptible to starting smoking.4
Post-secondary students are somewhat less likely to smoke than other young adults. In Canada, 22% of students smoke compared to 32% of their peers. However, because almost half of young adults attend university or college, post-secondary institutions account for more smokers than any other occupational setting in Canada.5,6 Together, university and college students comprise 30% of all young adult smokers and 7% of all smokers in Canada.5 Not only is tobacco use common among post-secondary students, but it appears to be declining at a slower rate than among other groups.7 Indeed, recent data suggest that fewer students may be quitting and a greater proportion may be starting smoking at university and college than is generally acknowledged.8,9,10
Post-secondary students also represent an important segment of the 18–24 year old demographic that is vital to tobacco companies. This demographic represents a narrow window of opportunity during which time tobacco marketing seeks to promote brand loyalty, increase daily consumption, and establish smoking as a habitual, long term behaviour among experimental and occasional smokers.11,12 As the youngest legal targets of tobacco marketing, young adults also serve as an important link to youth.
Post-secondary campuses are in many ways ideally suited to tobacco marketing. First, most institutions have their own media outlets, as well as their own bars and pubs. These campus venues serve as the social and entertainment centre for many students, particularly the majority of first and second year university students who live on campus. Second, campus marketing is relatively inexpensive.13 Student and administrative groups that operate media and entertainment outlets are typically in need of revenue and receptive to marketing opportunities. Third, campus marketing is sufficiently decentralised that it is difficult to monitor and likely to avoid public scrutiny. Further, promotional and sponsorship campaigns on campus are more subtle than traditional advertising and may be more acceptable to campus groups who are reluctant to be associated with overt tobacco marketing. This type of "below-the-line" advertising is particularly effective with advertising savvy young adults and is less likely to produce reactance among students.14 Ultimately, campus environments provide tobacco companies with a direct, focused means of targeting a key segment of young adults.15
The available evidence suggests that tobacco companies have been successful in integrating tobacco marketing within campus environments. In particular, tobacco companies have successfully established links with academia.16 For example, in Canada, 39% of universities were found to have received donations from the tobacco industry between 1996 to 1999, and 26 university related appointments were found to be held by tobacco industry officers between 1996 and 2001.17 These types of funding arrangements provide the industry with credible associations to academia that help to maintain the "legitimacy" of the industry and its products.16 Observational evidence also suggests that tobacco companies in Canada have run more direct marketing campaigns in campus newspapers, as well as promotional events in campus bars and nightclubs. To date, however, we have little idea of the scope of tobacco marketing on campus or the extent to which students might be exposed to these initiatives.
If post-secondary students and campuses appeal to tobacco companies, so too should they appeal to the tobacco control community. Campus environments provide a unique opportunity to introduce and evaluate tobacco control policies among an influential group of young adults. Although tobacco control policies appear to be gaining prominence in US colleges and universities,18,19 the potential for tobacco control on campus has yet to be realised. For example, as of 2000, only half of US colleges restricted smoking in all campus buildings and student residences, while more than two thirds accepted tobacco advertising in their newspapers.19 Outside of the USA there are few data on the state of tobacco control among post-secondary institutions. In Canada, what little regional data exists suggests wide variability in tobacco control policies between institutions.20
For their part, post-secondary students have widely endorsed more stringent campus tobacco control policies, including comprehensive smoking restrictions and curbs on tobacco marketing on campus.10,21 Yet, despite this support and a growing number of resources,22–24 it would appear that university and college administrators continue to underestimate the importance of and support for tobacco control policies among their students.25
The current study sought to: (1) assess the prevalence of tobacco marketing at post-secondary institutions in Canada; (2) assess the state of tobacco control policies at universities and colleges; and (3) examine attitudes to tobacco control and perceived importance of tobacco issues among campus decision makers.
METHODS
Procedure
A total of 36 post-secondary institutions (23 universities and 13 colleges) were selected to participate in the study. Universities and colleges were selected from each of Canada’s 10 provinces and two of the three territories to ensure geographical representation. The largest institution or college in each region was selected; additional universities were drawn from the most populated provinces in both urban and rural areas, where possible. Participating universities had an average enrolment of 23 177 students per school for a total of 509 880 students, or approximately 51% of university students in Canada. Participating colleges had an average of 6730 students per school for a total enrolment of 80 763 students, or approximately 24% of college students in Canada.26 Note that, in Canada, universities are registered degree granting institutions, while colleges offer diplomas, typically for vocationally oriented programmes. Universities are generally much larger than colleges, both in terms of student enrolment and infrastructure. Universities are also "public" institutions, whereas colleges can be either public or private.
A telephone survey was conducted with campus informants from each institution. The following six campus informants were identified at each institution: student union executive (president or vice-president), retail store manager, campus newspaper editor, campus bar manager, health services contact, and university or college administrator. Calls were made until contact was established with the campus informant or a suitable replacement could be surveyed. Each informant was asked to complete a five minute survey of tobacco control policies and industry marketing on campus (see below). Telephone surveys were conducted between March 2004 and April 2004, in both French and English. In cases where informants reported a campus policy, written copies of the policy were requested. In order to verify the accuracy of informants’ reports of industry marketing, a sub-sample of five universities was selected for an environmental scan. Research assistants completed a scan of campus newspapers in the previous 12 months, bars and pubs, and retail outlets to detect incidences of tobacco marketing. Any discrepancies between these observations and survey responses were recorded.
Measures
The telephone survey was developed from validated sources, including the tobacco component of the Harvard College Alcohol Survey27 and a recent survey on tobacco policy conducted in south western Ontario.10 Respondents were asked to report on the following tobacco control policies: restrictions on point-of-purchase marketing; tobacco sales; tobacco advertisements in the student newspaper; hosting tobacco sponsored events; accepting tobacco funding in the form of donations or grants; and smoke-free restrictions (student housing, bars/restaurants, designated outdoor areas, and campus wide). Policies were identified through campus informants, as well as an electronic search of the institution’s website. Campus informants were also asked whether they had been approached or participated in the following types of tobacco marketing in the past 12 months: tobacco advertisements in campus newspapers; retail promotions, including cigarette shelf or countertop displays; signs or posters in bars; and nightclub, concert, or any other events associated with tobacco companies. Finally, student executives from each institution were asked whether they recalled discussing tobacco issues or policies at meetings, and to report their perceived importance of tobacco issues on campus ("Relative to other issues on campus, how important is the issue of tobacco use").
Statistical analysis
All analyses were conducted using SPSS (version 12.0). Given the organisational differences between colleges and universities described above, the results for these institutions are reported separately.
RESULTS
One university selected to participate in the study was excluded because of missing data from numerous campus informants. Complete data were ascertained from 98% of the campus informants at the remaining 35 universities.
General
Of the 22 universities surveyed, all had been approached to participate in tobacco marketing and all had received money for some form of tobacco marketing in the past 12 months (fig 1). Among colleges, six (46%) had been approached to participate in tobacco marketing, all of whom had received funding in the past 12 months.
Promotional events
Every university surveyed had a bar or pub on campus. Among universities, eight campus bar managers (37%) reported that a general policy regarding promotional events existed, although only one bar manager reported guidelines restricting tobacco related promotions. Nineteen universities (86%) had been approached about hosting tobacco sponsored events or promotions in the campus bar, and four (18%) had actually hosted an event in the past 12 months, such as the Benson & Hedges Gold Club Series. Only two universities had a written policy prohibiting tobacco sponsored events on campus.
Three colleges (23%) had bars or pubs on campus. One college reported general policies on promotions, though none specific to tobacco. All three of the colleges with bars had been approached to host a tobacco sponsored event and one had done so in the past 12 months.
Campus newspaper advertisements
All but one university (95%) and six colleges (46%) published a campus newspaper. Only 11% of university newspapers reported a policy against accepting tobacco advertisements, while 17% of college newspapers had such a policy. Approximately 80% (16 of 20) of universities had run at least one tobacco advertisement in the last 12 months, while 50% (three of six) of college newspapers had done so. Of the papers that ran tobacco advertisements, the vast majority ran numerous, full page colour ads (fig 1). Only two institutions had written policies prohibiting tobacco advertisements in campus newspapers.
Point-of-purchase promotions
Twenty of 22 universities had retail outlets. Of universities with retail outlets, 55% (11/20) had point-of-purchase (POP) promotions, including "power walls" of cigarettes at retail outlets. Six of the 11 schools without POP promotions reported an explicit policy prohibiting tobacco retail promotion. Of the nine colleges with retail outlets, 33% (3/9) reported POP promotions. The remaining six colleges with retail outlets reported policies against POP promotions. Figure 2 depicts the overall prevalence of tobacco marketing at universities and colleges.
Tobacco sales
Twenty one universities (95%) had retail outlets on campus. Of these, 76% (16/21) sold tobacco products: 57% (11/21) of universities sold tobacco in campus stores, while 19% (5/21) sold tobacco only in campus bars. Among colleges, nine (70%) had campus retail outlets. Of these, 56% (5/9) sold tobacco products: 44% colleges (4/9) sold tobacco in campus stores, while 12% (1/9) sold tobacco products only in campus bars.
Smoke-free restrictions
Twenty one universities and eight colleges offered on-campus student housing. As fig 3 illustrates, 81% (17/21) of universities and 75% (6/8) colleges with student housing reported smoke-free policies in student residences. Only 41% (9/22) prohibited smoking in campus bars. Of the three colleges with campus bars, two prohibited smoking (66%). Seven universities (32%) and eight colleges (57%) reported smoke-free areas in designated outdoor locations, such as entrance ways to buildings. Two universities had comprehensive smoke-free restrictions that prohibited smoking anywhere on campus, including all outdoor areas.
Tobacco company donations and investments
Policies on accepting financial donations existed in 39% (7/18) of responding universities, and only 8% of colleges (1/13). However, only 11% (2/18) of the responding universities and 8% of colleges (1/13) had rules or policies specifically related to donations from tobacco companies. Six universities (32%) and two colleges (15%) had general policies or ethical rules concerning how they invested their holdings or pension funds. No universities had policies or rules against investing in tobacco companies and only two (15%) of the colleges had such restrictions.
Attitudes towards and support for tobacco control
When asked to report the most important student health issues that need to be addressed, the majority of college and university student executives reported mental health (including stress and anxiety), eating/nutrition, sexual health, and active lifestyles. Approximately 16% mentioned smoking among important student health issues.
The majority (62%) of university student executives at universities recalled discussing tobacco issues or policies at meetings, while only 36% of student executives at colleges reported discussing tobacco issues or policies at meetings. In addition, student executives at 32% of universities reported that, relative to other campus issues, the issue of tobacco use was "not very important", 45% reported tobacco use was "somewhat important", while 23% reported that tobacco was a "very important" campus issue. Among colleges, slightly more than half (57%) reported that tobacco issues were "not very important", while the remaining 43% reported that tobacco issues were "very important". In terms of perceived student support, university student executives at 10% of universities perceived "no" student support for strong campus tobacco policies, 62% perceived only "a little" support, while 20% perceived "a lot" of support for strong tobacco policies on campus. Approximately 10% reported that they "did not know". Among college student executives 29% perceived "no" student support for stronger tobacco policies, 36% perceived "a little" support", while 29% perceived "a lot" of student support for strong tobacco policies on campus.
DISCUSSION
The findings indicate extensive tobacco marketing on post-secondary campuses in Canada. Every university and half of colleges surveyed reported receiving money for some form of tobacco marketing in the past year. Among universities, 80% had run tobacco advertisements in the campus newspaper and over half had received money to display tobacco products or other retail promotions in the past year. In addition, approximately one fifth of universities had hosted a tobacco sponsored event in the past year. Tobacco marketing was less prevalent, although still significant, among colleges. In general, colleges were considerably less likely to have campus bars and media outlets and provided fewer opportunities for tobacco marketing. Note, however, that every college that had been approached to participate in marketing had done so. This suggests that, although colleges may lack the venues or the opportunities, they are no less receptive to tobacco marketing than universities. Overall, these findings suggest that tobacco marketing is prevalent among post-secondary institutions in Canada.
The findings indicate considerable variability in campus tobacco control policies. While some institutions reported leading edge policies such as tobacco sales bans and comprehensive smoke-free restrictions, other institutions reported a virtual absence of tobacco control policy. Even in cases when tobacco marketing did not occur, explicit policies or prohibitions were rare. Although campus informants reported a number of "unwritten" policies that may reflect common practice and social norms on campus, these unofficial rules are difficult to validate and are apt to change with the annual turnover in student executives or to be reversed at a later date. To ensure that restrictions are adequately enforced, post-secondary institutions must make campus tobacco policies explicit. In addition, despite growing calls from the public health community for restrictions on tobacco company donations and institutional investments in the tobacco industry,28,29 the findings indicate little activity or apparent support for these policies among post-secondary administrators.
The extent of smoke-free restrictions was generally weaker than might be expected for post-secondary institutions. Not all campuses had restrictions in student residences, and only half of universities and colleges restricted smoking in campus bars and pubs—a critical environment for student tobacco use and exposure to secondhand smoke. In general, smoke-free restrictions appear to follow municipal or provincial restrictions: few campuses had introduced smoke-free bylaws in campus bars and restaurants unless required to do so. The notable exceptions to this trend are Dalhousie and Lakehead Universities, which have introduced benchmark smoke-free policies covering the entire campus area, including outdoor areas.
Student executives demonstrated only a modest awareness of tobacco issues and support for tobacco control policies. Even among schools with progressive policies, few student union executives and administrators reported that tobacco control is a priority and many failed to recognise marketing initiatives such as POP promotions as forms of tobacco marketing. These perceptions among campus decision makers are in notable contrast with support for stronger tobacco policies among students, reported elsewhere.10,21
Limitations
The main limitation of this research concerns the reliability of campus informants. Despite our efforts to survey all relevant contacts, several campus informants had difficulty recalling individual forms of marketing. Indeed, in three cases, newspaper editors reported that the campus paper had not published tobacco advertisements, when a scan of the paper indicated otherwise. As a result, the current findings may provide an underestimate of the actual level of tobacco marketing at post-secondary institutions. A second limitation concerns the representativeness of the findings. Institutions were not selected at random, but rather through purposeful sampling to ensure geographical coverage. While the current findings should not be generalised to all post-secondary institutions, the data derives from a sufficiently broad range of colleges and universities to be generally reflective of post-secondary institutions in Canada.
What this paper adds
Post-secondary environments represent a unique opportunity for tobacco control: approximately one third of young adult smokers attend university or college, and campus environments represent an important venue for tobacco marketing. To date, however, there is little research on the prevalence of tobacco marketing on campuses or the current state of tobacco control policies.
The current findings indicate that tobacco marketing is prevalent among Canadian universities and colleges. Although several institutions have introduced leading edge policies, there is a lack of awareness of tobacco issues among campus decision makers, and fundamental public health measures such as comprehensive smoke-free policies have yet to be introduced in most cases. Overall, Canadian campuses remain tobacco friendly environments.
Conclusions and implications
Overall, post-secondary campuses in Canada remain tobacco friendly environments: tobacco marketing is prevalent, there is a lack of awareness of tobacco issues among campus decision makers, and fundamental public health measures such as comprehensive smoke-free policies have yet to be introduced in many cases. There are, however, grounds for optimism. Campus advocacy has increased in recent years, along with resources for, and support among, students for more effective tobacco control measures.22 Campus advocates have also achieved several striking successes in recent years, including smoke-free restrictions in outdoor areas and tobacco sales bans. These policies serve as policy benchmarks not only for post-secondary institutions, but for all jurisdictions.
If the tobacco industry has made university and college students a priority, so too must the public health community. Indeed, relative to other initiatives, campus tobacco policies represent a cost effective investment for the public health community. Campus tobacco policies are already supported by the overwhelming majority of constituents, they are unlikely to be actively opposed by the industry, nor are they likely to change once introduced. Yet, without direction from the tobacco control community, campus policies will continue to lag behind, rather than lead current standards in tobacco control policy.
ACKNOWLEDGEMENTS
This research was supported by Physicians for a Smoke-Free Canada, with funding from Health Canada’s Tobacco Control Program. We would like to thank the members of the Tobacco on Campus Workgroup for their contributions to this study, including Eric Breton, Mary-Jean Costello, Tara Elton, Larissa Hausmanis, Dan Johnson, Erin Martin, Roman Pabayo, Marion Schnebellen, and Heather Travis. We would also like to thank Joanna Cohen, Fernand Turcotte, Geoffrey T Fong, Sharon Lawler, and Tim Dewhirst for their feedback on an earlier draft.
FOOTNOTES
Competing interests: none
REFERENCES
Health Canada. Summary of Results for Wave 1 (February to June) of 2003. Canadian Tobacco Use Monitoring Survey (CTUMS) 2004.
US Department of Health and Human Services. Cigarette smoking among adults-United States, 1965–1996. MMWR Morb Mortal Wkly Rep 1998;47:837–48.
Ling PM, Glantz SA. Why and how the tobacco industry sells cigarettes to young adults: evidence from industry documents. Am J Public Health 2002;92:908–16.
Lantz PM. Smoking on the rise among young adults: implications for research and policy. Tobacco Control 2003;12 (suppl I) :i60–70.
Hammond D. Young adults and smoking behaviour: initiation and progression to established smoking. Tobacco Control (in press).
Adlaf EM, Gliksman L, Demers A, et al. Cigarette use among canadian undergraduates. Can J Public Health 2003;94:22–4.
Wechsler H. Rigotti NA, Gledhill-Hoyt J, et al. Increased levels of cigarette use among college students: a cause for national concern. JAMA 1998;280:1673–8.
Choi WS, Harris KJ, Okuyemi K, et al. Predictors of smoking initiation among college-bound high school students. Ann Behav Med 2003;26:69–74.
Wetter DW, Kenford SL, Welsch SK, et al. Prevalence and predictors of transitions in smoking behavior among college students. Health Psychol 2004;23:168–77.
Hammond D, Costello MJ, Fong GT. Tobacco industry marketing and policy support among university students: findings from the campus tobacco survey. Toronto, Ontario: Presented at the Ontario Tobacco Control conference, May, 2004.
Katz SK, Lavack AM. Tobacco related bar promotions: insights from tobacco industry documents. Tobacco Control 2002;11 (suppl I) :i92–101.
Burrows D. Strategic Research Report: Young Adult Smokers – Strategies and Opportunities, RJ Reynolds Marketing Research. 29 February 1984.
Ramage R. Big plans on campus. Marketing 2004;109:17–19.
Sepe E, Glantz SA. Bar and club promotions in the alternative press: targeting young adults. Am J Public Health 2002;92:75–8.
Morrison DA. Marketing to the campus crowd. Chicago: Dearborn Trade, 2004.
Cohen JE. Universities and tobacco money. BMJ 2001;323:1–2.
Cohen JE, Ashley MJ, Ferrence R, et al. Institutional addiction to tobacco. Tobacco Control 1999;8:70–4.
Wechsler H, Kelley K, Seibring M, et al. College smoking policies and smoking cessation programs: results of a survey of college health center directors. J Am Coll Health 2001;49:205–12.
Halperin AC, Rigotti NA. US Public universities’ compliance with recommended tobacco control policies. J Am Coll Health 2003;51:181–8.
Action on Smoking and Health (ASH) Alberta. Survey of post-secondary tobacco control policies: in Alberta. Building Capacity for Smoke-Free Environments in Alberta. November 2003.
Rigotti NA, Regan S, Moran SE, et al. Students’ opinion of tobacco control policies recommended for US colleges: a national survey. Tobacco Control 2003;12:251–6.
Tobacco Technical Assistance Consortium (TTAC) College Tobacco Prevention Resource website. (Accessed July 2004).
American Cancer Society (Smoke-Free New-England). Sample for a Tobacco Free-Campus. %20Policy%20For%20a%20Tobacco-Free%20Campus.pdf (Accessed July 2004).
American College Health Association (ACHA) Guidelines. Position statement on tobacco on college and university campuses. June 2000.
Halperin A, Ehlinger E, Majchrzak N. Reducing tobacco use among college students by changing campus policies and practices. New Orleans, Louisiana: presented at the National Conference on Tobacco or Health, November, 2001.
Enhanced Student Information System (E S I S). Statistics Canada, 2002. Ottawa, Canada.
Wechsler H, Lee JE, Rigotti NA. Cigarette use by college students in smoke-free housing: results of a national study. Am J Prev Med 2001;20:202–7.
Cohen JE. Universities and tobacco money: some universities are accomplices in the tobacco epidemic. BMJ 2001;323:1–2.
Anon. Tobacco industry funding to universities: a joint protocol of Cancer Research. Universities UK. June 2004.(D Hammond, I Tremblay, M )