Smoke-Free Campus Policy

1. Smoke-Free Campus Policy North Dakota State University

2. Overview – How did we get to this point? • Tobacco History • Timeline (10 million killed per year by 2025) • Suits, Laws, and Agreements (Master’s Settlement Agreement - Tobacco companies admit to harm and deception) • Evidence-based Sciences (Health and Death Effects) • Driving Forces of Smoke-free Policies • Driving Force: Government • Driving Force: Health Organizations • Driving Force: Colleges and Universities • Driving Force: Businesses • More Evidence-based Science (Economic Effects in the U.S.) • NDSU’s Draft Smoke-free Policy • Purpose • Definition • Recommendations on Implementation and Responsibilities • Recommendations on Compliance and Enforcement • Resources

3. Tobacco History

4. Tobacco History: Timeline (10 million killed per year by 2025) • Important milestones of tobacco [For more detail on tobacco history see: Proctor, R. N. (2001). TIMELINE: Tobacco and the global lung cancer epidemic. Nature Reviews Cancer, 1(1), 82.] • Notable events: • 1854 – Friedrich Tiedman in Germany reports tobacco-induced cancer of the tongue • 1939 – First case-control epidemiological study to demonstrate a tobacco and lung cancer link • 1997 – WHO estimates that tobacco will kill 10 million people per year by 2025 • 1998 – US Tobacco companies finally admit to smoking poses a human health risk

5. Tobacco History: Suits, Laws, and Agreements (1) • Notable events: • 1998 – Master’s Settlement Agreement: 46 states and tobacco companies reach $206 billion settlement • 1999 – Broin v. Philip Morris Co: Flight attendants sue for exposure to second-hand smoke. Tobacco companies settle. • 1999 – Individual Suits: Several plaintiffs in Oregon, California, and Florida obtain large verdicts against cigarette manufacturers for tobacco related illnesses. • 1999 – Federal government lawsuit: Dept. of Justice files civil action against tobacco companies for Medicare cost reimbursement. • 2000 – Engle v. R.J. Reynolds: All Florida smokers addicted to cigarettes an suffering from certain conditions are allowed to file claims. • 2005 – United States v. Philip Morris: The U.S. Dept. of Justice sought to force cigarette manufacturers to disgorge $280 billion in proceeds from their past unlawful activity. Instead of imposing billions of dollars in fines, the court ordered the tobacco companies to stop using deceptive terms such as “light”. (adapted from Gostin, L. (2008). Public Health Law: Power, Duty, Restraint (2 ed.)

6. Tobacco History: Suits, Laws, and Agreements (2) • North Dakota’s Master’s Settlement Agreement • In April 2008, North Dakota received the first of ten annual strategic contribution fund payments. The 2008 payment was about $14 million, and each additional payment is projected to be near this amount, with the final payment in 2017.

7. Tobacco History: Evidence-based Science (Health and Death Effects) • Tobacco is the world’s single most avoidable cause of death, resulting in 438,000 premature deaths in the U.S. between 1997 and 2001.1 • This mortality is greater than that caused by AIDS, automobile crashes, alcohol, homicides, illegal drugs, suicides and fires combined. 2 • In North Dakota, 877 adults die prematurely annually due to the effects of smoke. Moreover, tobacco is the leading preventable cause of death and disability in North Dakota. 3

8. Driving Forces of a Smoke-free Policies

9. Driving Forces of a Smoke-free Policy Evidence-based Science (EBS)

10. Driving Force: Government • State and Federal Tobacco Laws5 • Public Health Cigarette Smoking Act (1969): Bans cigarette advertising on television and radio and requires a stronger health warning on cigarette packages: “Warning: The Surgeon General Has Determined that Cigarette Smoking is Dangerous to Your Health.” • Clean Indoor Air Act (1975): Prohibits smoking in public transportation (including “ticketing, boarding, and waiting areas in public transportation terminals”), places of employment, and public places. • Tighter regulations has led to the Family Smoking Prevention and Tobacco Control Act (2009): Gives the U.S. Food and Drug Administration (FDA) comprehensive authority to regulate the manufacturing, marketing, and sale of tobacco products.  • Health & Human Services - HealthyPeople 20104 • Tobacco control, decreasing tobacco-related illness, reducing health disparities are specific goals.

11. Driving Force: Health Organizations • American Cancer Society • The ACS standards for tobacco-free campuses were chosen because they were the first national standards published and for their efforts to define a comprehensive approach to campus tobacco policies.6 • American Lung Association • All college and university campuses should completely prohibit tobacco use, including all indoor and outdoor facilities, private offices, residence halls and dormitories. Tobacco use in outdoor areas should be prohibited to reduce the social acceptability of tobacco use and encourage quitting. This should include building entrances, stadiums, other public spaces and buses, vans or other campus vehicles. 7 • American Non-smokers Rights Foundation • “There are now at least 365 100% smoke-free campuses with no exemptions. There are now at least 76 100% smoke-free campuses with minor exemptions for remote outdoor areas. ” 8

12. Driving Force: Universities and Colleges (1) • American College of Health Associations - HealthyCampus 2010 • Strategic Planning for Aligning College Health with National Health Objectives • “ACHA has adopted a no tobacco use policy and encourages colleges and universities to be diligent in their efforts to achieve a campus-wide tobacco-free environment.”9 • ACHA Guidelines: Standards of Practice for Health Promotion in Higher Education http://www.mcg.edu/tobaccofree/index.html

13. Driving Force: Universities and Colleges (2) • On November 15, 2007, the Medical College of Georgia, MCG Health Inc., and MCG Physician Practice became tobacco free. • “The use of tobacco products of any kind will be prohibited on all MCG properties, including academic, research and clinical buildings, parking lots and green spaces on the main campus and at satellite facilities… The new policy will apply to employees, students, patients and visitors.”

14. Driving Force: Businesses • Healthy workplace and employees are goals of employers and insurers. • Decreasing tobacco use and hence tobacco related-illness are cost-effective and benefit individual and population health. • Improve health and economic outcomes • Absenteeism: Smokers are more likely to miss work than non-smokers • Productivity: Smokers are less productive than non-smokers • Healthcare cost: Smokers healthcare cost are more than non-smokers • Cleveland Clinic Smoking Policy (effective 9/1/2007) • Will not hire tobacco users • The policy involves a physical examination of applicants for cotinine, a nicotine metabolite • If they test positive, it precludes an employment offer. However, they can reapply after 90 days. They have an option to a free cessation program.

15. Driving Force: More Evidence-based Science (Economic Effects in the U.S.) • $96.7 billion: Total annual public and private health care expenditures caused by smoking 10 • $4.98 billion: Annual health care expenditures solely from secondhand smoke exposure11 • $97 billion: Productivity losses caused by smoking each year10 • $2.6 billion: Annual expenditures through Social Security Survivors Insurance for the more than 300,000 kids who have lost at least one parent from a smoking-caused death12 • $70.7 billion ($630 per household): Taxpayers yearly fed/state tax burden from smoking-caused government spending13

16. NDSU’s Draft Smoke-free Policy

17. NDSU’s Draft Smoke-free Policy: History • NDSU student’s voted favorable on a Smoke-free Policy • The key stakeholders of this policy are the NDSU and Fargo-Moorhead communities, and the State of North Dakota. This proposal builds on the partial smoking ban (NDSU Policy 153) that was voted on with “unanimous consent” by University Senate on July 1, 2008 (North_Dakota_State_University, 2008). • In addition, the students have voted on a “total smoking ban” policy during the past 2008-2009 school year, and a majority vote of 63.1% favored a “total smoking ban” (2,400 in support of a ban and 1,400 not in favor of a ban) (North_Dakota_State_University, 2009).

18. NDSU’s Draft Smoke-free Policy: History • NDSU staff voted favorable on a Smoke-free Policy • Official Staff Senate meeting • NDSU faculty voted favorable on a Smoke-free Policy • Faculty Straw Poll • Final vote at the University Senate Meeting December 14

19. NDSU’s Draft Smoke-free Policy: Purpose North Dakota State University Smoke-Free Campus Policy provides a healthy working and learning environment. Research findings show that tobacco use, including smoking and breathing secondhand smoke causes cancer, heart disease and respiratory disorders. In addition to causing direct health hazards, tobacco use contributes to institutional costs in other ways, including fire damage, cleaning and maintenance, employee absenteeism, health care, and medical insurance. The purpose of this policy is to reduce harm from tobacco and secondhand smoke, empower faculty, staff, and students to be tobacco-free, reduce health insurance and health-care costs, and promote a tobacco-free future.

20. NDSU’s Draft Smoke-free Policy: Definition • Definition: “For the purpose of this policy, “smoking” is defined as having in one’s possession a lighted tobacco product.” [A draft of policy 153 was created on September 17, 2009. http://www.ndsu.edu/fileadmin/staffsenate/policy_153.pdf] • North Dakota State University shall be a Smoke-free campus. Smoking is prohibited within university buildings, parking structures, walkways, arenas, in university or state fleet vehicles, and on university owned property. This policy applies to all administration, faculty, staff, students, contractors, vendors, and visitors at all NDSU sites.

21. Recommendations on Implementation and Responsibilities • The policy will be communicated to the NDSU and Fargo-Moorhead community. Education regarding the University’s smoke-free policy will be included in the formal orientation for all incoming students and employees (e.g., Baseline Safety by the Safety Office). Sufficient signage will be posted to inform members of the campus community and its visitors, including contractors and vendors , of the policy. Effective implementation of this policy will depend upon courtesy, respect, and cooperation of all NDSU employees and students. • It is the responsibility of all members of the campus community, including, visitors, to observe this policy. • All administrators, deans, directors, department chairs, and supervisors will communicate the policy to everyone within their respective areas of responsibility. • The President’s Office is responsible for determining policy applicability and will answer policy related questions. • It is the responsibility of the North Dakota State University Student Health Services and the Wallman Wellness Center to provide information regarding tobacco prevention and cessation

22. Recommendations on Compliance and Enforcement • Compliance with this policy is the shared responsibility and the right of all NDSU staff, students, and faculty members. • Complaints or disputes should be brought to the attention of the University employee who has immediate responsibility for the workplace, event, or residence, or to her/his supervisor. If satisfactory resolution is not reached, a representative of the President’s Office or University Police and Safety Office shall be consulted. • The Division of Student Affairs shall enforce this policy to students. The Office of Residential Life will work with the President’s Office to enforce and implement sanctions in dorms, sororities, fraternities and other student residences. A violation of this policy shall be dealt with in a manner consistent with violations of other NDSU policies. In situations where the policy violation escalates into inappropriate behavior, NDSU University Police shall be called to intervene. • All administrators, deans, directors, department chairs, and supervisors shall enforce this policy to their respective students and employees (i.e., faculty and staff). A violation of this policy shall be dealt with in a manner consistent with violations of other NDSU policies. In situations where the policy violation escalates into inappropriate behavior, NDSU University Police shall be called to intervene.

23. NDSU’s Draft Smoke-free Policy: Resources • NDSU encourages students and staff who use tobacco products to quit and improve their health. Therefore, NDSU will provide free, accessible tobacco treatment on campus—and will publicize its availability. A list of these programs is provided at the end of this policy. • Resources for Student Treatment and Cessation: • NDSU Student Health Services http://wellness.ndsu.nodak.edu/, 18th Street and Centennial Boulevard Fargo, ND 58105, (701)231-7331 • Resources for Faculty and Staff: • Blue Cross Blue Shield of North Dakota (Health Insurance), https://www.bcbsnd.com/pharmacy/tobacco/ • NDSU Worksite Wellness or NDPERS, http://www.healthynd.org/Tools.html • Fargo Cass Public Health, http://www.cityoffargo.com/CityInfo/Departments/Health/, 401 3rd Ave N, Fargo, ND 58102-4811, (701) 241-1360 • Innovis Health, http://www.innovishealth.com/ • MeritCare, http://www.meritcare.com/

24. References • Centers_for_Disease_Control_and_Prevention. (2005). Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses: Morbidity and Mortality Weekly Report (Report): Centers_for_Disease_Control_and_Prevention. • Hahn EJ, R. M., Chaloupka FJ, Okoli CT, Yang J. (2002). Projected Smoking Related Deaths Among U.S. Youth: A 2000 Update. Retrieved June 16, 2009, from http://repositories.cdlib.org/context/tc/article/1063/type/pdf/viewcontent/ • Centers_for_Disease_Control_and_Prevention. (2008). Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) Report (Report): Centers_for_Disease_Control_and_Prevention. • Health_and_Human_Services. (2000). Healthy People 2010: What Are Its Goals? Retrieved June 24, 2009, from http://www.healthypeople.gov/About/goals.htm • Freiberg, M., & Cork, K. (2009). Tracking Tobacco Laws: A Minnesota Digest (Report). St. Paul: Tobacco Law Center at William Mitchell College of Law. • American_Cancer_Society. (2001). Advocating for A Tobacco-Free Campus: A manual for college and university students (Report). New England Division: American Cancer Society. • American_Lung_Association. (2008). Big Tobacco on Campus: Ending the Addiction (Report): American Lung Association. • American_Non-smokers_Rights_Foundation. (2009). U.S. Colleges and Universities with Smokefree Air Policies (Report): American Non-smokers Rights Foundation. • American_Colleges_of_Health_Associations. (2005). ACHA Guidelines: Position Statement on Tobacco on College and University Campuses (Report): American Colleges of Health Associations. • Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and Mortality Weekly Report. 2008;57(45):1226–1228 • Campaign for Tobacco Free-Kids (CTFK). (2006). Toll of Tobacco in the USA. Research and facts, Factsheets, Tobacco’s toll – USA. [Online]. Available: http://tobaccofreekids.org/research/factsheets/pdf/0072.pdf • Leistikow, B., et al., "Estimates of Smoking-Attributable Deaths at Ages 15-54, Motherless or Fatherless Youths, and Resulting Social Security Costs in the United States in 1994," Preventive Medicine 30(5): 353-360, May 2000 • CDC, "Medical Care Expenditures Attributable to Smoking -- United States, 1993," MMWR 43(26): 1-4, July 8, 1994