Vanishing Act: Smoke-Free UM
In April, President Mary Sue Coleman announced that the University of Michigan will go smoke-free in 2011. Now come the tough decisions.
When it comes to bad-for-you behavior, smoking is at the top of everyone’s list. It kills with deadly efficiency, stealing years of life expectancy from its victims. According to the United States Centers for Disease Control and Prevention, about one of every five deaths in the U.S. is caused, directly or indirectly, by smoking.
So when President Mary Sue Coleman announced last April that the University of Michigan’s Ann Arbor, Flint, and Dearborn campuses will go smoke-free on July 1, 2011, it seemed like a good idea. University officials say a smoke-free environment will improve the health of UM’s faculty, staff and students. They point out that more than 300 other colleges and universities, including four Big Ten schools, already have adopted smoke-free campus policies.
But while the intentions may be good, the devil is in the details: Exactly where is the borderline between university property and public property owned by the City of Ann Arbor? Will campus police issue tickets for smoking in parking structures? How far should a university that treasures individual rights go to stop people who want to smoke on campus?
Like most colleges and universities, UM has been gradually tightening the noose on smoking for years. In 1987, UM officials banned smoking in university buildings and vehicles, although it was still allowed in residence halls set aside for smokers. UM’s Residence Hall Association prohibited smoking in public areas of all residence halls in 1994, and extended the ban to all residence hall rooms in 2003. In 1999, the UM Health System implemented a smoke-free environment on its grounds, going beyond the university ban of smoking inside buildings. On other parts of the campus, current university policy requires smokers to go outside and stay “a reasonable distance from entrances” to buildings, dormitories, and apartments.
To work out all the messy details of how the UM will transition to a smoke-free campus, Coleman created a Smoke-Free University Steering Committee and asked Robert Winfield, UM’s chief health officer, and Kenneth Warner, dean of the School of Public Health, to serve as co-chairs.
Along with a diverse group of nearly 120 faculty, students, staff, and community members—including smokers, non-smokers, and former smokers—appointed to five subcommittees, Winfield and Warner will spend the next year listening to comments at informational meetings and developing a plan to implement the new smoke-free policy. The steering committee will present its plan to Coleman, who will make the final decision on the specific policy to become effective on July 1, 2011.
“This is a pro-health policy,” emphasizes Warner. “It’s consistent with President Coleman’s priority of establishing a healthy university community.”
The steering committee’s first meeting was in July, but they knew from the outset that the task would not be easy. One thorny issue is how to avoid shifting the problem to private businesses surrounding the campus.
“If we make all university property smoke-free and the weather is inclement and people come out of Hill Auditorium at intermission to smoke, how do we protect the Bell Tower Hotel from having 20 smokers clustered under its canopy?” ponders Winfield. “What if people just cross State Street to smoke in store entrances? There’s already a cigarette butt problem on the streets. How do we prevent that from becoming worse?”
“What do we do about public events like football tailgates?” asks Warner. “A lot of people want to smoke there. What about people smoking cigars on the golf courses? These are big issues, and I don’t now know how we’re going to resolve them.”
North Campus has its own set of issues, because all the grounds, streets and sidewalks are believed to be university property. Many of the graduate students who live in North Campus apartments and work in North Campus buildings come from countries where smoking is much more common than in the U.S. “In some of these communities, up to 50 percent of males may smoke,” says Winfield. “Will these students be able to smoke on the curbs of university roads? I don’t know. That’s the work of the committees.”
How many smokers are there at UM? No one knows exactly. Based on self-reported data from 22,000 UM employees who applied for life insurance in 2007, Winfield estimates about 14 percent of UM faculty and staff members are smokers. He says about 16 percent of UM students surveyed in 2006 said they smoked at least one cigarette per month.
About 20 percent of U.S. adults are smokers, according to Warner, but the percentage varies widely among different socioeconomic groups. “Smoking prevalence among college graduates is under 10 percent, but in some blue-collar populations, it’s in excess of 30 percent,” he says.
Studies show that when a business adopts a smoke-free workplace policy, more employees stop smoking. In 1999, when the UM Health System instituted a smoke-free environment on the Medical Campus, it provided a network of support services—including counseling, nicotine gum, and patches—to help employees quit.
According to Linda Thomas, director of the Health System’s Tobacco Consultation Services, the number of UMHS employees identifying themselves as smokers has fallen from 17 percent to between 11 percent and 12 percent since the services were implemented. Group and individual counseling programs are available to help employees quit smoking. About 31 percent of employees who complete the group program and 35 percent of those completing the individual program were still non-smokers 12 months later, Thomas says.
Winfield says the university will provide similar cessation services at no cost to employees and students who want to stop smoking. There will also be co-pay reductions for faculty and staff on most prescription nicotine-cessation drugs, and a full subsidy for up to six months of certain over-the-counter patches and gums.
“Discontinuing smoking will require a long-term commitment, because nicotine is a powerful addictive drug,” Winfield says. According to Warner, the mean number of attempts to quit before a smoker succeeds is about 10. That means some people quit on the first try and others never succeed.
“Most smokers want to quit, and I have a great deal of sympathy for them,” says Warner—a former smoker who tried four times to quit before giving cigarettes up for good in the mid-1970s. “Anything we can do to discourage young people from starting to smoke is a positive step.”
Winfield admits the switch to a smoke-free campus won’t be easy, but believes it can be done. “I’m optimistic that we have set aside enough time to do this thoughtfully and in a manner that conveys respect for smokers,” he says.
Winfield says university officials have set a few ground rules going in: Because it’s a university policy—not a state law or city ordinance—there is no plan to issue tickets or fines for smoking on campus. Also, there will be no drug testing of existing, new, or prospective employees to determine if someone is a smoker. He adds that university attorneys are investigating other possible legal issues related to the new smoke-free policy.
In the meantime, if you have an opinion about these issues or ideas on how to create a smoke-free campus, the committee wants to know about them. Watch for an informational meeting near you or send an e-mail to firstname.lastname@example.org. For more information, visit www.hr.umich.edu/smokefree/.
By Sally Pobojewski
- More than 1,000 U.S. teens become regular smokers every day.
- Each year, 444,000 smoking-related deaths occur in the U.S., among them an estimated 50,000 deaths from exposure to secondhand smoke.
- Tobacco smoke contains some 5,000 chemical compounds, including formaldehyde, arsenic, hydrogen cyanide, radioactive polonium-210, ammonia, naph-thalene, and carbon monoxide.
- Approximately one-third of U.S. deaths during middle age (40 to 65) are smoking-related.
- For every smoking-related death in the U.S., an additional 20 people are ill from smoking-related causes; nearly nine million Americans are currently ill as a result of smoking.
- The U.S. spends over $100 billion per year in smoking-induced health care costs.
- The toxicants emitted in cigarette smoke include some of the most important found in indoor air. Tests show that when restaurants and bars go smoke-free, exposure to these toxicants declines by as much as 95 percent.
We've Come a Long Way, Baby!
"As the University of Michigan embarks on its smoke-free initiative, let us reflect on how far we have come since the publication of the first United States Surgeon General’s report on smoking and health in 1964. While UM’s initiative is progressive, it is not pioneering. Other American campuses have already implemented far-reaching smoke-free policies. Yet such an effort would have been virtually unimaginable at the time that Dean Warner quit smoking in the mid-1970s. Public health efforts to combat the leading cause of premature death have undergone a revolution.
"As portrayed in the popular television drama Mad Men, back in the Sixties smoking was permitted essentially everywhere. It was typical for women to smoke during pregnancy, and children (along with everyone else) were regularly exposed to toxic secondhand smoke. Indeed, we’ve come a long way, baby!
"Advances in tobacco control—or, as one of my students once recommended calling it, “tobacco death prevention” —have been made in spite of ceaseless counterattacks by an influential corporate lobby with annual U.S. revenues of over $40 billion. In the face of a type of opposition that doesn’t complicate most other public health efforts, the public health community deserves tremendous credit for having more than halved the U.S. smoking rate since 1964.
"The tobacco death-prevention campaign achieved some notable gains before 1990, such as enactment of the national airline smoking ban and the launching of the movement to eliminate smoking in worksites and public places. The modern revolution did not get under way until 1994, however, when the public learned for the first time that the tobacco industry had for decades been secretly manipulating nicotine to cause and enhance addiction in tobacco users, including young children, across the globe. This disclosure, first made in investigative media reports, spawned historic congressional hearings, the emergence of industry whistleblowers, a cascade of legal actions by state attorneys general and the U.S. attorney general, the forced disclosure of millions of incriminating tobacco company documents, and a groundbreaking investigation by the Food and Drug Administration.
"The actual and potential benefits for public health are extraordinary. Following years of intense battle in Congress, on June 22, 2009, President Obama signed into law the Family Smoking Prevention and Tobacco Control Act, giving the FDA comprehensive authority to regulate the manufacturing, marketing, and sale of tobacco products. The new law represents the most sweeping action taken to date to stem the tobacco epidemic. Before enactment of the new law, tobacco products were essentially exempt from regulation under the nation’s federal health and safety laws. The FDA had regulated food, drugs, and cosmetics, but not the single most harmful consumer product found on store shelves.
"We are fortunate that UM’s smoke-free initiative proceeds in an environment that strongly supports programs to protect innocent non-smokers against exposure to toxic secondhand smoke and reduce the public health toll wrought by tobacco use. The initiative will ultimately foster a healthier community by protecting non-smokers, helping smokers quit, reducing health care costs and, finally, by setting a good example."
Clifford E. Douglas (at right in picture below) is director of the UM's Tobacco Research Network and
an adjunct lecturer in the UM SPH Department of Health Management and Policy. He was
responsible for the investigative news exposé on ABC News in 1994 that informed the
public for the first time that the tobacco industry was manipulating nicotine to cause
and enhance addiction in millions of consumers. The exposé ultimately prompted the
FDA to seek to regulate tobacco.