Kathleen A. Fagan, DNSc, RN, BC, APN, C
Columbia University School of Nursing
Cigarette smoking is the single, major preventable cause of premature death in the United State. More than 430,000 Americans die annually from complications related to cigarette smoking. Environmental Tobacco Smoke (ETS) is a mixture of side stream smoking and exhaled mainstream smoke that pollutes the air in locations where tobacco smoking is taking place. As early as 1986, the Surgeon General’s Report concluded that involuntary smoking is a cause of disease in non-smokers and lead to the classification of ETS as a Class A human carcinogen. In June, 2002, the American College Health Association (ACHA) included in their smoking cessation position paper to prohibit smoking within 20 feet of any entrance to college buildings.
The purpose of this project was to change the institutional smoking policy that permitted smoking at all entrances to college buildings. Two secondary purposes were to provide a smoke free environment for all those who were subject to ETS on campus and to increase smokers’ awareness of the health benefits of smoking cessation.
Three separate surveys were distributed to three (3) separate populations on campus; namely, students attending the Women’s College; students attending the Adult and Graduate Education Program; and members of the faculty, staff and administration. The Women’s College surveys were distributed in November 2000; the surveys to the other groups were distributed one year later in November 2001. The findings indicated that passive smoking was not acceptable to the majority of responders. Representatives of the college administration, faculty, staff and students formed an Environmental Tobacco Committee. The goal of this committee was to follow the Rosswurm and Larrabee’s Model for Change to Evidence-Based Practice (1999) in order to change the institutional smoking policy.
The monthly Committee meetings were instrumental in addressing needs, resistance, sanctions, economics and maintenance of change. The theoretical framework provided the guidelines and strategies for success. Two (2) years after the initiation of the change project, a new institutional Environmental Smoking Policy prohibiting smoking within 25 feet of all college buildings and walking pathways was launched on the Great American Smoke out, November 2002. This change initiative is an ongoing effort. The Environmental Tobacco Committee continue to meet in order to address resistance to change, to obtain feedback from the college community, to disseminate the findings and to assist other institutions in this valuable endeavor.
Implications for College/University Healthcare Providers:
This change project has been instrumental in demonstrating the utility of the Rosswurm and Larrabee Model for Change. This proactive initiative can be instrumental in decreasing the risks and incidence of smoking related illnesses related to smoking and ETS. It is an opportunity for college/healthcare providers to develop leadership roles in changing health policy through vested interest partnerships, community collaboration and ongoing research in college/university health levels.
Rosswurm, M.A. & Larrabee, J.H. (1999). A model for change to evidence-based practice. Image: Journal of Nursing Scholarship. 31(4), 317-322