Passive exposure and perceptions of smoke-free policies in hospital and university campuses among nursing students: A cross-sectional multicenter study

INTRODUCTION Outdoor smoke-free regulations reduce exposure to secondhand smoke (SHS) and help to denormalize tobacco use. As future key agents in health promotion, nursing students’ attitudes should agree with tobacco-control policies. The objectives of this study were: 1) assess nursing students’ exposure to SHS in nursing schools, 2) explore their perceptions of compliance with the existing smoke-free regulations in acute-care hospitals; and 3) describe their support for indoor and outdoor smoking bans on hospital and university campuses. METHODS This was a cross-sectional multicenter study conducted in 2015–2016 in all 15 university nursing schools in Catalonia, Spain. A questionnaire gathered information on SHS exposure, awareness of the smoke-free regulation in acutecare hospitals, and support for smoke-free policies in indoor and outdoor areas of hospitals and university campuses. Participants were nursing students attending classes on the day of the survey. We performed descriptive analyses and calculated adjusted prevalence ratios (APR) and 95% confidence interval (CI). RESULTS Of 4381 respondents, 99.1% had seen people smoking in outdoor areas of their university campus, and 75.2% had been exposed to SHS on the campus (6.0% indoors and 69.2% outdoors). Nearly 60% were aware of the smoking regulation in place in acute-care hospitals. There was widespread support for smoke-free indoor hospital regulation (98.7%), but less support (64.8%) for outdoor regulations. Approximately 33% supported the regulation to make outdoor healthcare campuses smoke-free, which was higher among third-year students compared to first-year students (APR=1.41; 95% CI: 1.24–1.62), among never smokers (41.4%; APR=2.84; 95% CI: 2.21–3.64) compared to smokers, and among those who were aware of the regulation (38.4%; 95% CI: 1.37–1.75). CONCLUSIONS Exposure to SHS on university campuses is high. Nursing students express low support for strengthening outdoor smoking bans on hospital and university campuses. Interventions aiming to increase their support should be implemented.

[1]  A. Hammerich,et al.  Tobacco is a threat to the environment and human health. , 2022, Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit.

[2]  E. Fernández,et al.  Knowledge, Attitudes, and Training in Tobacco Dependence and Cessation Treatment Among Nursing Students in Catalonia (ECTEC Study): Cross-Sectional Study , 2021, International Journal of Mental Health and Addiction.

[3]  M. Willemsen,et al.  Does support for smoke-free outdoor spaces increase after implementation?: A case study of a Dutch research center’s smoke-free campus transition , 2020, Tobacco prevention & cessation.

[4]  U. Mons,et al.  Global progress in tobacco control: the question of policy compliance , 2020, Global health action.

[5]  I. Ahluwalia,et al.  Revisiting the association between worldwide implementation of the MPOWER package and smoking prevalence, 2008–2017 , 2020, Tobacco Control.

[6]  E. Fernández,et al.  Patient perceptions of tobacco control after smoke-free hospital grounds legislation: Multi-center cross-sectional study. , 2019, International journal of nursing studies.

[7]  E. Fernández,et al.  Burden of disease attributable to second-hand smoke exposure: A systematic review. , 2019, Preventive medicine.

[8]  H. Koh,et al.  Smoke-free and tobacco-free colleges and universities in the United States , 2019, Tobacco Control.

[9]  E. Fernández,et al.  Prevalence and determinants of tobacco, e-cigarettes, and cannabis use among nursing students: A multicenter cross-sectional study. , 2019, Nurse education today.

[10]  C. Sreeramareddy,et al.  Prevalence of tobacco use and perceptions of student health professionals about cessation training: results from Global Health Professions Students Survey , 2018, BMJ Open.

[11]  P. Déchelotte,et al.  Changes and specificities in health behaviors among healthcare students over an 8-year period , 2018, PloS one.

[12]  J. Martínez-Sánchez,et al.  Attitudes of students of a health sciences university towards the extension of smoke-free policies at the university campuses of Barcelona (Spain). , 2017, Gaceta sanitaria.

[13]  Pallav Pokhrel,et al.  College anti-smoking policies and student smoking behavior: a review of the literature , 2017, Tobacco induced diseases.

[14]  C. García-Vivar,et al.  Intervention study for smoking cessation in Spanish college students: pragmatic randomized controlled trial. , 2015, Addiction.

[15]  S. Glantz,et al.  Association of campus tobacco policies with secondhand smoke exposure, intention to smoke on campus, and attitudes about outdoor smoking restrictions. , 2015, American journal of public health.

[16]  E. Fernández,et al.  Secondhand smoke in outdoor settings: smokers’ consumption, non-smokers’ perceptions, and attitudes towards smoke-free legislation in Spain , 2015, BMJ Open.

[17]  J. Townsend,et al.  A Systematic Review and Meta-analysis of the Acceptability and Effectiveness of University Smoke-Free Policies , 2015, Journal of American college health : J of ACH.

[18]  B. Jeong,et al.  Tolerance for and potential indicators of second-hand smoke exposure among nonsmokers: a comparison of self-reported and cotinine verified second-hand smoke exposure based on nationally representative data. , 2014, Preventive medicine.

[19]  E. Fernández,et al.  Assessment of the smoke-free outdoor regulation in the WHO European Region. , 2014, Preventive medicine.

[20]  S. Mache,et al.  Smoking behaviour and attitudes among German nursing students. , 2013, Nurse education in practice.

[21]  E. Fernández,et al.  Protection from secondhand smoke in countries belonging to the WHO European Region: an assessment of legislation , 2013, Tobacco Control.

[22]  Adam O Goldstein,et al.  Cigarette butts near building entrances: what is the impact of smoke-free college campus policies? , 2011, Tobacco Control.

[23]  C. Husten.  How should we define light or intermittent smoking? Does it matter? , 2009, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[24]  L. Sarna,et al.  Menopausal Status, Moderate-Intensity Walking, and Symptoms in Midlife Women , 2005, Research and Theory for Nursing Practice.

[25]  L. Sarna,et al.  ISNCC Tobacco Position Statement. , 2016, Cancer nursing.

[26]  Jeanette Lancaster,et al.  Public health nursing : population-centered health care in the community , 2008 .

[27]  M. Pena.  El proyecto de Ley reguladora de la venta, el suministro, el consumo y la publicidad de los productos del tabaco , 2004 .