Evaluating a tobacco-free university policy: A repeated crosssectional survey of faculty and staff in Lebanon

Abstract

INTRODUCTION A growing body of research has evaluated the effect of university tobacco-free policies on faculty and staff, however, none of these studies has been carried out in the Eastern Mediterranean Region. This study evaluates changes in faculty and staff attitudes, perceptions and smoking behavior, at 1 year post adoption of a tobacco-free policy in a medium-sized university in Lebanon and the region. METHODS Two cross-sectional surveys were conducted in 2017 and 2018: baseline and at 1 year post policy implementation. A random sample of 625 and 624 participants took part in the 2017 and 2018 studies, respectively. RESULTS Faculty and staff had a positive attitude towards the policy at the two time points. The belief that there should be exceptions to the policy significantly decreased from 79% to 59% (p=0.002) among all smokers, particularly those with lower educational attainment (81% to 57%, p=0.007). Perception of compliance among peer smokers increased from 73% to 87% (p=0.009). The proportion of smokers did not significantly change at 1 year post policy implementation, however, 44% of smokers with lower educational attainment, compared to only 7% of those with higher educational attainment (p<0.001), reported a decrease in their smoking behavior outside campus. CONCLUSIONS The policy had a positive effect on the attitude, behavior and perception of policy benefits among smokers with lower educational attainment, who constitute the majority of smokers. Findings from this study inform and support future efforts to develop university and workplace tobacco-free policies.

Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis

“…1 ). 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ,…”

“… 54 , 105 , 118 Thirty-six reports assessed public support for policies that were already implemented ( Appendix IV ), among which five were introduced at the national level: smoke-free cars with children or pregnant women in Italy 82 ; a smoke-free prison policy in Scotland 37 , 114 ; and a smoke-free public housing act in the USA. 88 , 121 In the remaining thirty-one studies support for local smoke-free policies was assessed regarding university or college campuses, 31 , 35 , 38 , 41 , 52 , 76 , 84 , 97 , 109 , 127 school grounds, 40 , 113 hospital grounds, 40 , 59 , 80 , 117 , 122 playgrounds, 45 , 113 parks and beaches, 28 , 54 , 73 , 94 , 107 , 111 , 118 multi-unit housing, 44 , 46 , 70 and outdoor gathering places such as streets. 28 , 32 , 98 …”

“… 31 Six studies found that public support significantly increased following the introduction of smoke-free policies, 31 , 45 , 59 , 76 , 122 , 127 and six studies reported no significant change in support. 52 , 70 , 101 , 114 , 117 , 118 Increasing public support following implementation was found for smoke-free public transportation stops and children’s playgrounds, 45 a smoke-free policy on grounds and parking places of an Australian health service, 59 university campuses, 31 , 76 , 127 and hospital campuses. 122 Two studies showed a decrease in support directly after implementation of a policy, which subsequently increased at follow-up.…”

“… 31 , 45 , 59 , 76 , 122 , 127 Among the remaining studies support was often already high, indicating a plateau in support. 52 , 70 , 76 , 114 An additional worry could be that support is theoretical and might change when it regards actual implementation. However, our study showed no differences in support between implemented policies and hypothetical scenarios.…”

University students’ and staff attitudes toward the implementation of a “tobacco-free” policy: A view from Qatar

“…However, these regulations appear to exist on only a small number of campuses in Middle Eastern countries. The American University of Beirut (AUB) in Lebanon became the first Lebanese university to implement a full tobacco-free policy in 2018 ( Farran et al, 2021 ), and following government guidelines King Saud University, one of Saudi Arabia's major institutions of higher education, also established a smoke-free campus policy ( Almutairi, 2014 ).…”