Clifford E. Douglas, J.D. Director, University of Michigan Tobacco Research Network Lecturer, University of Michigan School of Public Health Consulting Tobacco Control Policy Advisor to the Assistant Secretary for Health, U.S. Department of Health and Human Services May 29, 2013 The Tobacco-Free College Campus Initiative Making the Case for Your Campus Going Tobacco-Free ACHA 2013 Annual Meeting – Boston

 The tobacco epidemic  Commitment of the U.S. Department of Health and Human Services  Acceleration of campus policies nationwide  Why go tobacco-free?  Effectiveness of campus policies  Economic costs and benefits Topics

The Tobacco Epidemic

AIDS Car crashes Heroin Homicide Alcohol Fires Cocaine Suicide

 90% of all smokers start before age 18  99% of all smokers start before age 26

Cigarettes and other tobacco products are highly addictive More than 7,000 chemicals & chemical compounds in tobacco smoke Young adults under age 30 who started smoking as teens or in early twenties can develop … Early cardiovascular disease Smaller lungs that don’t function normally Wheezing that leads to asthma DNA damage that can cause cancer almost anywhere in the body Lifelong smokers get sicker and die an average of 13 years younger than non-smokers

Acetone (solvent and paint stripper) Ammonia (poisonous gas and toilet bowl cleaner) Arsenic (potent ant poison) Benzene (poisonous toxin) Butane (flammable chemical in lighter fluid) Cadmium (carcinogenic chemical in batteries; lung & intestinal irritant) Carbon monoxide (poisonous gas in auto exhaust) Formaldehyde (dead frogs love it) Hydrogen cyanide (deadly ingredient in rat poison) Methanol (jet engine and rocket fuel) Polonium-210 (radioactive element and spy-killer) Toluene (poisonous industrial solvent)

 One day’s inhalations: 10 per cigarette x 20 cigarettes per day = 200  One year’s inhalations = 200 inhalations x 365 days = 73,000  50 years of smoke (by the average smoker’s mid-60s, if still alive) = 3.65 million inhalations on 365,000 cigarettes There is no safe level of tobacco use or exposure to secondhand smoke

 24.8% of full-time college students aged years old were current smokers in 2010 (almost 1/3 aged 18-26)  The number of smokers who initiated smoking after age 18 increased from 600,000 in 2002 to 1 million in 2010  Progression from occasional to daily smoking almost always occurs by age 26 Tobacco companies have carefully studied the attitudes and behaviors of young people, particularly as they go through life transitions, such as attending college.

“After years of steady progress, declines in youth tobacco use have slowed for cigarette smoking and stalled for use of smokeless tobacco. The latest research shows that concurrent use of multiple tobacco products is common among young people, and suggest that smokeless tobacco use is increasing among White males.” - Surgeon General’s Report, 2012 There are approximately 8 million smokeless tobacco users in the U.S.

“If young people don’t start using tobacco by age 26, they almost certainly will never start.” - Surgeon General Regina Benjamin If We Don’t Accelerate Our Progress Based on current rates, more than 1 million current college students are projected to die prematurely from tobacco use

Historic New Commitment of the U.S. Department of Health and Human Services

Vision: A society free of tobacco- related death and disease First Charge: Base the new HHS strategic action plan on the tobacco control goals set forth in Healthy People tives/tobacco/tobaccos trategicplan2010.pdf

*With due respect to previous founding fathers

 Reduce tobacco use by adults and adolescents  Reduce the initiation of tobacco use by children, adolescents, and young adults  Increase successful cessation attempts by tobacco users; and  Reduce the proportion of non-smokers exposed to secondhand smoke Healthy People 2020’s Tobacco Prevention Objectives

A Key Pillar of HHS’s Plan is Leading by Example (“Walking the Talk”) In July 2011, HHS established a comprehensive tobacco-free campus policy covering all indoor and outdoor properties The announcement stated: “Taking this action will protect the health and safety of all HHS employees, contractors and visitors and will serve as a role model for workplaces everywhere … Educational and promotional efforts will be provided in support of the policy’s implementation. We know that quitting tobacco can be difficult for even the most motivated people, and we want to help employees succeed.”

Vision: Widespread expansion of tobacco-free policies to institutions of higher learning across the U.S. Goals: 1. Foster a collaborative, cooperative effort among academic institutions and partners in the public health community 2. Expand awareness in academia and among the public of the need for and benefits of such policies 3. Facilitate information flow and access to technical assistance

 Lead Partners ◦ U.S. Department of Health and Human Services ◦ American College Health Association ◦ University of Michigan  Sponsors ◦ American Legacy Foundation ◦ Americans for Nonsmokers’ Rights ◦ Campaign for Tobacco-Free Kids ◦ National Center for Tobacco Policy  Other Partners ◦ American Lung Association ◦ The BACCHUS Network ◦ California Youth Advocacy Network (CYAN) ◦ Center for Social Gerontology (Smoke-Free Environments Law Project) ◦ Global Advisors on Smokefree Policy (GASP) ◦ Montana State University ◦ Partnership for Prevention ◦ State University of New York Upstate Medical University ◦ Tobacco Control Legal Consortium

Acceleration of Campus Policies Nationwide

 As of April 2013 ◦ 1,159 campuses in U.S. are 100% smoke-free with no exemptions, including residential housing facilities (where applicable) ◦ Of those, 783 – almost 68% – have a 100% tobacco-free policy ◦ Examples of large campuses that already are or are becoming tobacco-free:  University of California (all 10 campuses)  City University of New York (all 24 campuses)  University of Arizona  University of Oregon  University of Oklahoma  University of Kentucky  Montana State University  University of Florida (“Gators don’t chew. They chomp!”)  Emory University  Ohio State University (pending) Source: Americans for Nonsmokers’ Rights Foundation,

There are 4,583 colleges, universities and other institutions of higher learning in the U.S., according to the U.S. Department of Education Opportunity

Why Go Tobacco-Free?

 “There is no safe tobacco product, and the Initiative encourages adoption of comprehensive tobacco-free policies. It is also recognized that each institution must make its own decisions when it comes to promoting health and preventing disease in its students, faculty, employees and visitors.”  “Tobacco-free policies go further in promoting a culture of health and wellness while reducing exposure to the variety of non-smoked forms of tobacco that cause cancer, heart disease and other serious illnesses. ”

 Tobacco that is not burned (combusted) ◦ Traditional smokeless products  *Chew (“spitting tobacco,” placed between cheek and gums)  *Snuff (dry snuff sniffed through nose; moist snuff, or “dip,” placed between cheek and gums)  Snus (finely ground tobacco placed in small packets) ◦ New generation of products  Dissolvables (lozenges, orbs, sticks, strips)  E-cigarette (not called “smokeless tobacco,” but is similarly not combusted and has been ruled a “tobacco product” subject to FDA regulation) *Currently dominate the U.S. smokeless tobacco market

 Addictive  Not a safe alternative to cigarette smoking  Most smokeless tobacco products contain carcinogens (at least 28 identified, and nitrosamine levels are higher in smokeless tobacco than in cigarettes)  Most smokeless tobacco products cause oral, esophageal, and pancreatic cancer  Use of these products causes precancerous lesions of the mouth (leukoplakia), as well as gum recession, gum disease, and tooth decay  Use also associated with greater risk of fatal heart attacks and stroke

◦ An individual, non-smoking smokeless tobacco user experiences lower overall disease and mortality risks than a smoker, but … the health effects depend on the properties of the specific product (they vary considerably) and how the product is used ◦ In 2010, almost 60 percent of young adults who used smokeless tobacco in the past month also smoked cigarettes during the same period ◦ Many smokers who begin using smokeless tobacco products neither successfully quit tobacco use nor transition to exclusive use of smokeless tobacco ◦ Many users remain stuck in a pattern of dual use of smoked and non-smoked tobacco products, instead of turning to FDA- approved nicotine replacement therapy (NRT) options ◦ This behavior effectively increases the user’s health risks

 Tobacco industry promotes dual use  Ads promote use of smokeless tobacco products not to replace cigarettes but as a way for smokers to satisfy addiction wherever they cannot smoke “There is a need to clearly position the [smokeless tobacco] product as a situational substitute for cigarettes rather than a replacement.” - R.J. Reynolds spokesman, 2009

Effectiveness of Campus Policies

Study compared two Big Ten campuses with similar demographics … Purdue University (no policy) and Indiana University (tobacco-free policy implemented in 2008) Indiana University smoking rate: 16.5% in 2007; 12.8% in 2009 (-3.7) Purdue University smoking rate: 9.5% in 2007; 10.1% in 2009 (+0.6) Indiana University consumption rate: 6.6 cigs/day in 2007; 5.9 cigs/day in 2009 (-0.7) Purdue University consumption rate: 5.2 cigs/day in 2007; 6.8 cigs/day in 2009 (+1.6) Study showed significant favorable change in attitudes among Indiana University students regarding elimination of smoking in public places and university property Source: Dong-Chul Seo et al., The Effect of a Smoke-free Campus Policy on College Students’ Smoking Behavior and Attitudes, Preventive Medicine 2011;53:

89% of faculty/staff and 83% of students supported policy 72% of faculty/staff and 65% students noticed decrease of smoking on campus Smoking by faculty and staff dropped from 6% to 4% Among continued smokers, 29% reduced consumption 13% of faculty/staff reported policy influenced them to quit or attempt to quit smoking 16% of students reported policy influenced them to quit or attempt to quit smoking Source: University of Michigan, “Smoking Declines After U-M Campus Ban, May 9, 2013

Economic Costs and Benefits

 Reduced employee health care costs  Reduced absenteeism  Increased employee productivity  Cost savings in grounds and building maintenance  Reduced risk of fires Economic Benefits of Tobacco- Free Campus Policies

Please Visit TFCCI’s Website: TobaccoFreeCampus.org