Authors: Yang J, Mackey TK
Journal: SSM - Qualitative Research in Health
Year Published: 2022
Type: Original Research
Abstract:
Smoke- and tobacco-free university polices have been expanding throughout the United States. In spite of the benefits of such policies, policy compliance remains a challenge. A better understanding of campus community enforcement approaches is needed to inform future policy implementation to bring about greater adherence to university smoke- and tobacco-free policies. To this end, thirteen focus groups with 76 participants from two universities in Southern California with tobacco-free policies were held from October 2019 through October 2020 to discuss attitudes toward and experiences with the campus smoking policy, campus tobacco use behavior, and policy enforcement. Focus groups discussions were recorded, transcribed, and analyzed using a general inductive analysis approach. A wide array of campus stakeholders were involved in enforcement actions, including formal entities such as police and parking enforcement, as well as the general campus community such as students and employees. However, the majority of participants in the study had never had an enforcement experience and those who did only did so on rare occasion. Enforcement experiences were often perceived as aggressive, which elicited a desire for a similarly aggressive response on the part of the person smoking or vaping. The enforcement of e-cigarettes is particularly challenging because of the speed and discretion with which they can be used compared to combustible tobacco and perceived favorable norms toward e-cigarettes. Universities should consider using proactive, consistent, and tailored actions to reinforce changing social norms for greater policy compliance.
Citation: Yang J, Mackey TK. Enforcement experiences on tobacco-free universities in California. SSM - Qualitative Research in Health. 2 (2022) 100047

Authors: Cuomo RE, Purushothaman VL, Li J, Bardier C, Nali M, Shah N, Obradovich N, Yang J, Mackey TK
Journal: Frontiers in Public Health
Year Published: 2021
Type: Original Research
Abstract:
Introduction
College-aged youth are active on social media yet smoking-related social media engagement in these populations has not been thoroughly investigated. We sought to conduct an exploratory infoveillance study focused on geolocated data to characterize smoking-related tweets originating from California 4-year colleges on Twitter.

Methods
Tweets from 2015 to 2019 with geospatial coordinates in CA college campuses containing smoking-related keywords were collected from the Twitter API stream and manually annotated for discussions about smoking product type, sentiment, and behavior.

Results
Out of all tweets detected with smoking-related behavior, 46.7% related to tobacco use, 50.0% to marijuana, and 7.3% to vaping. Of these tweets, 46.1% reported first-person use or second-hand observation of smoking behavior. Out of 962 tweets with user sentiment, the majority (67.6%) were positive, ranging from 55.0% for California State University, Long Beach to 95.8% for California State University, Los Angeles.

Discussion
We detected reporting of first- and second-hand smoking behavior on CA college campuses representing possible violation of campus smoking bans. The majority of tweets expressed positive sentiment about smoking behaviors, though there was appreciable variability between college campuses. This suggests that anti-smoking outreach should be tailored to the unique student populations of these college communities.

Conclusion
Among tweets about smoking from California colleges, high levels of positive sentiment suggest that the campus climate may be less receptive to anti-smoking messages or adherence to campus smoking bans. Further research should investigate the degree to which this varies by campuses over time and following implementation of bans including validating using other sources of data.
Citation: Cuomo RE, Purushothaman VL, Li J, Bardier C, Nali M, Shah N, Obradovich N, Yang J, Mackey TK. Characterizing Self-reported Tobacco, Vaping, and Marijuana-related Tweets Geolocated for California College Campuses. Front in Pub Health. 2021;9:628812

Authors: JS Yang, A Sou, A Faruqui, TK Mackey
Journal: Preventive Medicine Reports
Year Published: 2021
Type: Original Research
Abstract: The 2019 outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) increased awareness of potential health risks associated with vaping among the general public. Little is known, however, about how unfolding information regarding EVALI affected knowledge, attitudes, and behaviors among e-cigarette users, particularly among young adults. This study describes attitudinal and behavioral responses to EVALI among young adult e-cigarette users. In October and November 2019, seven focus groups were held with college going young adult tobacco users from two four-year public universities in California. Focus groups included questions regarding knowledge of and reaction to EVALI news, and how the news affected product use. Text from current e-cigarette users was extracted to develop individual phenomenological textural-structural descriptions of e-cigarette use for 38 individuals which were used to create a composite experience of e-cigarette use in light of EVALI. Experiences indicated that e-cigarette users were aware of information regarding EVALI and received information from numerous sources. Information was filtered for legitimacy of EVALI claims and causes of EVALI. Risk rationalizations were developed to assess potential harm of continued e-cigarette use and provided reasoning for behavioral responses to EVALI. The emerging harm associated with EVALI prompted e-cigarette users to engage in a cognitive process resulting in employment of a range of rationalities to justify continued use. These results suggest how environmental, cognitive, and behavioral factors may interact as young adults negotiate e-cigarette-related harms.
Citation: Yang, J. S., Sou, A., Faruqui, A., & Mackey, T. K. (2021). A qualitative examination of e-cigarette use among California young adults during the EVALI outbreak. Preventive Medicine Reports, 24, 101506.

Authors: Yang J, Mackey TK
Abstract:
Smoke- and tobacco-free university polices have been expanding throughout the United States. In spite of the benefits of such policies, policy compliance remains a challenge. A better understanding of campus community enforcement approaches is needed to inform future policy implementation to bring about greater adherence to university smoke- and tobacco-free policies. To this end, thirteen focus groups with 76 participants from two universities in Southern California with tobacco-free policies were held from October 2019 through October 2020 to discuss attitudes toward and experiences with the campus smoking policy, campus tobacco use behavior, and policy enforcement. Focus groups discussions were recorded, transcribed, and analyzed using a general inductive analysis approach. A wide array of campus stakeholders were involved in enforcement actions, including formal entities such as police and parking enforcement, as well as the general campus community such as students and employees. However, the majority of participants in the study had never had an enforcement experience and those who did only did so on rare occasion. Enforcement experiences were often perceived as aggressive, which elicited a desire for a similarly aggressive response on the part of the person smoking or vaping. The enforcement of e-cigarettes is particularly challenging because of the speed and discretion with which they can be used compared to combustible tobacco and perceived favorable norms toward e-cigarettes. Universities should consider using proactive, consistent, and tailored actions to reinforce changing social norms for greater policy compliance.

Authors: Yang JS, Wenzel C
Summary:
- From Fall 2019 to Fall 2020, seventy-six students and employees who self-reported the use of tobacco products at two tobacco-free four-year public universities participated in discussions regarding knowledge, attitudes, and behaviors related to campus tobacco-free policies.
- Non-compliance with university tobacco-free policies was a result of the interplay of three factors: the desire to smoke or vape, lack of policy enforcement, and an individual smoker’s interpersonal efforts to reduce the risk of others’ secondhand smoke or aerosol exposure.
- Policy enforcement was carried out by a variety of campus stakeholders but was done so inconsistently and perceived as aggressive by participants.
- Ongoing and consistent efforts tailored to various campus constituents are needed for greater compliance with university tobacco-free policies. This includes mass communication campaigns, patrolling by institutional entities, cessation services, and programs to address the underlying motivators of smoking and vaping.

Authors: JS Yang, A Faruqui, A Sou, TK Mackey
Abstract:
Objective
Though university smoke- and tobacco-free campus policies have been proliferating across the United States, compliance and enforcement remain challenges. This study examined perceptions and behaviors of employee and student tobacco users on tobacco-free campuses. Study Design. Cross-sectional qualitative study design.

Methods
Students (n=56) and employees (n=20) from two tobacco-free 4-year public universities in Southern California who self-report using tobacco products on campus participated in focus groups to discuss attitudes toward campus tobacco policies and on-campus smoking. Focus group were transcribed and analyzed after structured coding and subcoding.

Results
Participants were generally aware that smoking and vaping were not allowed on campus though few could correctly identify their campus as tobacco-free. Attitudes toward the policy varied by subgroup and by campus with students and employees at different universities expressing varying levels of support. Non-compliance was a unique interaction of individual, institutional, and interpersonal factors including a desire to smoke or vape to reduce stress, lack of formal enforcement or penalty for violating the policy, and efforts to smoke or vape in ways that reduce harm to others as a way of rationalizing non-compliance.

Conclusions
Attitudes toward university tobacco-free policies are campus and constituency specific, with common individual, institutional, and interpersonal factors among constituencies and campuses. Interventions to increase compliance should address individual, institutional, and interpersonal influences on non-compliance through efforts tailored to specific campus constituencies based on their particular knowledge and attitudes.