Introduction

In 2016, approximately 3 million (14.9%) Australians aged 14 years and over were current daily, less often than weekly or weekly smokers. Of these, 2.4 million (12.2%) smoked tobacco daily [1]. The negative health impacts of smoking tobacco are well-documented [2]. In 2016, tobacco smoking was the leading risk factor contributing to disease in Australia, accounting for 9.0% of the total burden [1]. In 2015, the most recent reporting year, tobacco smoking led to the death of nearly 21, 000 Australians [3]. The related social costs in 2015–2016 are estimated to be $136.9 billion, significantly higher than the $31.5 billion reported in 2004–5 [4]. Similar significant negative impacts associated with smoking are seen internationally [5]. Using a variety of strategies, including smoke-free legislation and policies, bans on advertising, plain packaging, price increases, restriction on sales to minors and public education, Australia has been successful in reducing smoking prevalence [1]. Legislation and policies for smoke-free environments are now commonplace in Australia, and internationally [6]. Since the late-1980s, all Australian states and territories have progressively implemented smoke-free legislation, banning smoking in workplaces and many public spaces such as sporting venues, shopping centres, restaurants, and building entryways [2]. Many organisations, including several Australian universities, have implemented comparable policies. A similar trend towards the implementation of smoke-free legislation and policies has been observed internationally. In 2012, Hyland et al. [7] estimated approximately 11% of the world’s population live in countries with smoke-free legislation and / or policies.

Arguments against smoke-free policies suggest they are not widely supported, are difficult to implement and result in negative impacts such as lost revenue, displacement of smoking from public spaces into the home, and increased stigmatisation of smokers [7]. However, there is a significant body of literature which demonstrates smoke-free legislation and policies result in smoking-related health improvements. International research has demonstrated smoke-free legislation and policies result in significant reductions in smoking rates [8–10]. A meta-analysis published in 2015 suggests smoke-free policies on university campuses specifically result in reductions in smoking rates of 14.7% after 1 year, and 8.3% after 3 years [11]. Smoke-free legislation and policies result in reduced rates of exposure to second-hand tobacco smoke [12]. Research indicates smoke-free policies are generally well-supported, by both staff and students, in university contexts both in Australia and internationally [11, 13].

In 2016, when this study was undertaken, twenty-two Australian universities had introduced smoke-free policies and two had published research reporting the outcomes of these policies [14–16]. This research has been quantitative in nature except for one study [14], which explored reasons for non-compliance. While this study provides valuable feedback for effective policy evaluation, it fails to gain insights from smokers who do comply with new regulations. Staff and students’ views about smoking on campus during the implementation of a smoke-free policy will contribute to a better understanding of compliance and non-compliance and provide evidence-based guidance for policy implementation. This research fills this gap in current knowledge by exploring staff and students’ views about smoking on campus during the implementation of a new smoke-free policy.

Materials and methods

At the time this study was undertaken in 2016, approximately 5% of universities in the United Kingdom, 25% in the United States [11] and 32% in New Zealand [17] had implemented smoke-free policies. Twenty two out of forty Australian universities had adopted smoke-free policies. Western Australia and Australian Capital Territory had successfully implemented smoke-free policies at all universities. In Victoria, seven out of eight universities have smoke-free policies. New South Wales and South Australia had implemented smoke-free policies at four out of six and two out of four universities respectively. Tasmania and Northern Territory had yet to adopt smoke-free policies at their universities. The remaining eighteen universities still allowed smoking in designated areas or have other unspecified restrictions in place.

At the time, all Queensland universities and other tertiary institutions had smoking policies in place but only two Queensland universities were totally smoke-free. These policies replicate applicable prohibitions outlined in The Tobacco and Other Smoking Products Act 1998 (the Tobacco Act), such as prohibiting smoking in buildings or enclosed spaces, outdoor eating and drinking areas and near building entrances. Recent amendments to the Tobacco Act could see Queensland universities adopt stringent restrictions regarding smoking prohibitions. The Act suggests public universities in Queensland could act as a government precinct to prescribe regulations where smoking is prohibited in all buildings and grounds.

This research was carried out during the initial stages of the implementation of a smoke-free policy at a large tertiary institution in Queensland, Australia which has nearly 49 000 student enrolments and more than 12 500 staff [18]. The university implemented a smoke-free policy on 01 July 2016. The policy prohibits smoking by all people in all areas of all university campuses, including grounds, buildings and vehicles. This includes the use of cigarettes and all other tobacco-related products (e.g. herbal cigarettes, loose smoking blends, cigarette-making machines, cigarette paper and filters, and electronic cigarettes) [19]. The policy encourages staff, students and visitors to the university to remind others the university is a smoke-free environment including those who they see smoking [20]. The policy specifies ‘disciplinary action’ may be taken in cases of repeated breach of the policy in accordance with relevant Codes of Conduct [19]. The policy directs smokers to areas outside the campus boundaries where smoking is permitted, and to sources of support should they wish to quit smoking [20].

Results

The survey was completed by 641 staff and students. Of these participants, 42.9% (n = 275) were staff and 57.1% (n = 166) were students. Most participants were female (74.5%, n = 458). There were 351 responses to the final question. Of these participants, 46.8% (n = 164) were staff and 53.2% (n = 187) were students. Most participants were female (71.5%, n = 251). The percentage difference between survey responses and responses to the final survey question across gender and primary role was 3–4%.

The second section of the survey, Tobacco use and second-hand smoke exposure asked respondents about their smoking status. Smoking status can be defined as non-smoker, ex-smoker, regular smoker and occasional smoker [15]. The results of respondents smoking status are presented here to provide context for the findings from the final open-ended survey question. Most participants report they ‘never smoked cigarettes at all, or never smoked them regularly’ (74.1%, n = 260). Approximately one-sixth (15.1%, n = 53) of survey participants report they ‘do not smoke now but used to smoke regularly (≥1 cigarette per day)’. Approximately one-fifteenth (6.8%, n = 24) report they ‘currently smoke cigarettes (>1 cigarette per day)’, and 3.1% (n = 11) report they ‘occasionally smoke cigarettes (on average, <1 cigarette per day)’. Less than 1% (n = 3) did not respond to the question about smoking status.

The following five themes emerged from analysing the answers provided to the final, open ended question, “Would you like to comment on the issue of smoking on [the university] campuses?”: (1) a lack of enforcement, (2) smokers on the boundary, (3) the effects of policy of personal experience, (4) the need for designated smoking areas and (5) suggestions for improving the policy.

Discussion

This research provides a unique understanding about staff and students views about smoking during the implementation of a smoke-free policy in an Australian university context. The findings from this research show there is some agreement for the need to introduce a smoke-free policy at the university. This may be a contextual finding due to Queensland’s early adoption of tobacco legalisation. However, the findings of this paper highlight some of the negative aspects of implementing a smoke-free policy such as ineffectiveness. This can be due to enforcement strategies, specifically the lack of enforcement by university staff. This finding is consistent with findings in similar studies involving smoke-free policies on university campuses [17, 22, 23]. Preceding research about smoke-free policies in Australian universities suggests staff do not perceive policy enforcement to be part of their role and are reticent to approach policy violators [16].

Enforcement is critical for the effective implementation of a smoke-free policy. When smoke-free policies are poorly enforced on university campuses, people are more likely to deliberately ignore them [24]. One study from the United States describes a shift towards a more formal approach to enforcing smoke-free policies on university campuses including punitive enforcement strategies such as mandatory participation in prevention classes after policy violation or monetary fines for repeat offenders [25]. However, the extent to which this would be effective and accepted in the Australian context remains unclear. Training opportunities about policy enforcement for staff, leading to a consistent approach to enforcement, have been shown to be effective in other Australian settings such as psychiatric inpatient units [26]. Furthermore, ongoing education and increasing permanent signage may promote increased self-enforcement of the policy [17].

Similar consistent findings to emerge from this research include smokers congregating on campus boundaries, leading to the problem of increased exposure to second-hand smoke for people entering or leaving the campus, and concerns regarding personal safety as many people go to secluded areas to smoke [13, 17]. Procter-Scherdtel and Collins [23] discuss the need to better manage community relations as people who smoke are displaced from university campuses surrounded by residential and shopping precincts. Another significant finding to emerge from this research is the concern regarding the effectiveness of “blanket ban” policies on university campuses. This is consistent with research conducted at other Australian universities which found this policy approach is not widely accepted [13, 14]. However, exposure to second-hand smoke is still a serious aspect to consider when evaluating the overall health of a campus community.

Another downside of implementing a smoke free policy is the impingement of personal freedoms, and the consequences. This research revealed concerns about the effects of a smoke-free policy on personal experience, and smokers’ rights to smoke where they choose. Similar findings are reported in another qualitative study exploring the effects of a smoke-free policy introduced at another large Australian university [14]. This is a finding supported by international literature [27] but challenged by another study which found most people believe the right to breathe clean air should take precedence over the right to smoke and people should only be exposed to harm if they understand the risks and choose to accept them [28].

Lastly, the victimisation of people who smoke by smoke-free policies was another key idea which emerged in this research. Authors Stuber, Galea and Link [29] agree smoke-free policies drive the social unacceptability of tobacco and, subsequently, the stigmatisation of people who smoke. These authors found smoker-related stigma may encourage people to quit or discourage initial uptake. However, the deterrent effects of stigma are not experienced equally across different socioeconomic and racial/ethnic groups, highlighting the need to better understand the stigma processes associated with the smoking epidemic [29]. Ultimately, the role of stigmatisation in the epidemic should be addressed by the tobacco control community to determine whether to promote or discourage this form of deterrence.

Conclusion

Smoke-free policies have impacted smoking prevalence and exposure to second-hand smoke, but policy implementation may not result in a smoke-free environment. An in-depth exploration of people’s views about smoking on campus during the implementation of smoke-free policies contributes to understanding why, how and under what circumstances smoke-free policies succeed. Our qualitative findings reveal five salient ideas reflecting views about smoking on campus during the implementation of a smoke-free policy; 1) the watering down of the policy, if it is not enforced, 2) the creation of hot spots on campus boundaries affecting those who pass by, 3) concern, especially by those who don’t smoke, about the impact on smokers emotional health and welfare, 4) disagreement about the value of designated smoking areas and 5) suggestions about how to better implement the policy. However, successful ecological approaches to tobacco control rely on consistent and systematic processes for implementation, maintenance and enforcement. Clear and frequent communication, education, regular and ongoing surveillance, permanent signage, positive reinforcement and tobacco cessation support services are essential during this transition period to assist in establishing a culture of compliance for a smoke-free environment.