Tobacco-Free Campuses on the Rise: Q&A with Dr. Howard Koh, HHS

Aug 26, 2013, 11:05 AM

Howard Koh, MD, MPH, the U.S. Assistant Secretary for Health Howard Koh, MD, MPH, the U.S. Assistant Secretary for Health

Many students staring or returning to college this fall may find something missing—exposure to tobacco products.

Last September the U.S. Department of Health and Human Services (HHS), together with several key partners, launched the National Tobacco-Free College Campus Initiative to promote and support the adoption and implementation of tobacco-free policies at universities, colleges, and other institutions of higher learning across the U.S. Initiative partners include the American College Health Association and the University of Michigan. Initiative staff members work closely with academic leaders, public health advocates, students, researchers, and others to help speed up the elimination of tobacco use on college campuses. “This is a lofty goal, but an attainable one, as we are witnessing exponential growth in the adoption of these policies by academic institutions in all regions of the country,” says Howard Koh, MD, MPH, the U.S. Assistant Secretary for Health who helped launch the initiative last year at the University of Michigan, which included an internationally webcast symposium at the University of Michigan School of Public Health.

The initiative includes a website created to serve as a clearinghouse of key information to assist educational communities in establishing tobacco-free environments. The University of Michigan’s comprehensive smoke-free policy went into effect in 2011.

Smoke-free and tobacco-free policies are not the same, according to HHS. Smoke-free policies refer to any lighted or heated tobacco or plant product intended for inhalation—including cigars, cigarettes and pipes. Tobacco-free policies cover these and all other forms of tobacco (although e-cigarettes are still exempt on some campuses due to the still-evolving nature of the regulations). HHS officials point out that although some campuses are smoke-free while others are tobacco-free, the ultimate goal is for all campuses to eventually be 100 percent tobacco-free.

With the start of the fall college imminent or already underway at most universities, NewPublicHealth spoke with Dr.Koh about the success of the Tobacco-Free College Campus Initiative so far, and what’s ahead in tobacco control efforts for young adults by the Department of Health and Human Services.

NewPublicHealth: What success has the initiative seen since it was launched last year?

Dr. Koh: We’re very proud that the Tobacco-Free College Campus Initiative has accelerated rapidly. When we formally announced this in September of 2012, there were 774 colleges and universities that were tobacco or smoke-free and as of right now, the number has risen to 1,159—that’s an increase of more than one-third in less than a year. We are gratified by the positive response from colleges and universities and leaders from across the country who want to make their environments healthier.

NPH: What are the short-term and long-term goals for the initiative?

Dr. Koh: The ultimate goal is to have all colleges and universities in the U.S. choose to become 100 percent tobacco-free and we’re making steady progress towards that goal because we fully understand that prevention efforts must focus not just on children, but also young adults. The number of smokers who are starting to smoke after age 18 has increased. That number was a million in 2010 when it used to be 600,000 in 2002. We have figures that show that one out of four full-time college students were current smokers in 2010, which is higher than the national prevalence of 19 percent. These numbers underscore why college is a critical age to influence health habits of young adults.

NPH: What is it that’s so appealing about tobacco for young adults, high school students and college students, that despite all the warnings and all the education?

Dr. Koh: The tobacco industry knows that appealing to young people is a way to attract new and lifelong customers, and that is why we need to change the social norms when it comes to smoking. For decades, tobacco use has tragically led to dependence, disability and death. It’s time to reclaim the tobacco-free social norm that promotes wellness and health and that’s what this initiative is all about.

NPH: What impact do tobacco-free policies have on students ever starting to use tobacco?  

Dr. Koh: We stress that these are decisions made by colleges and universities after discussions and deliberations with the entire college and university community. So when the decisions go forward, they’re usually upheld because so many have been involved in that decision making process. The campuses have generally followed a very inclusive open process and it brings all the issues forward in a transparent manner. And when you bring these issues to the public, we have found that most participants voice the theme that they want to make the campus healthier and to protect the health of students, faculty, employees and visitors. And the science shows that such policies have decreased tobacco consumption and addiction, encouraged cessation and obviously improve air quality, not to mention reducing harm to nonsmokers. So overall, it creates a new social norm of wellness and health, which is something we want to encourage and recognize.

NPH: Have you found that the tobacco initiative has also increased and broadened the general conversation about health and prevention on some campuses?

Dr. Koh: Absolutely. We worked together with the American College Health Association in preparation for their annual meeting in Boston several months ago which had close to 2,500 in attendance. The theme of the conference was how to keep the entire academic community as healthy as possible, how to promote public health whether it’s tobacco or other related issues or threats to health such as obesity or lack of exercise. Other themes included promoting better mental health and creating respectful environments to decrease issues such as sexual assault and alcohol abuse. These are all themes aimed at keeping young people as healthy as possible.

NPH: What arguments have been persuasive to help campuses take that next step toward tobacco-free campuses?

Dr. Koh: This, as I’ve mentioned, is where the social norm theme is so important. We’re in an era now where people understand that the healthiest environment is one that is smoke-free and tobacco-free not just indoors, but also outdoors. And such policies improve the health of the entire academic community. So there’s an increasing movement to make the tobacco theme more comprehensive than ever before and have it apply both to the outdoor environment and the indoor environment and we’re very proud of the success that we’re seeing around the country in that regard.

NPH: Has engaging foreign students, who may get fewer anti-smoking messages at home, been important for creating tobacco-free campuses?

Dr. Koh: Yes. When we talked to the academic leaders, we found that relating to international students is very important and comes up during the open discussions and conversations. And from a public health point of view, we can say that this is a contribution on our parts to global health. If international students who come here for their education and also learn that the new social norm in American educational settings is a tobacco-free environment, these students, when they go home, can send that message back to their own societies and do their part in making the world healthier. That’s a very positive outcome from an initiative like this.

NPH: What additional efforts are ahead at HHS that might be affective for helping smokers stop smoking or never starting in the first place?

Dr. Koh: Several years ago the Department of Health and Human Services put out its first ever tobacco control strategic action plan called Ending the Tobacco Epidemic and our department is absolutely committed to end the epidemic as one of our highest public health goals. And last year the department launched a unified website called and this is a way of coordinating and unifying all of our resources online into one site and it has been extremely well received.

Other initiatives include a website run by the National Cancer Institute targeted specifically to teen smokers called Smoke-Free Teen as well as a smoke-free text message cessation service targeted to young people. The CDC has had, for several years now, stop smoking ads on TV. And starting later this year the Food and Drug Administration will be launching its first public health campaign focused on preventing tobacco initiation and promoting tobacco use cessation among the nation’s youth and young adults by educating them on the dangers of regulated tobacco products. We’re very excited about that.

And through the Affordable Care Act, we’ve had a great emphasis on prevention in public health with coverage of tobacco cessation services and counseling through new health plans.

NPH: What have you heard from students about the campus tobacco initiative?

Dr. Koh: It has been tremendous to meet students who care so deeply about this issue, and I’ve met many students who are our future public health leaders who’ve been very involved in this. It has been especially gratifying to meet students who were or are smokers who feel that this is an important initiative as well. When you get the support of students who are current smokers and understand that this is a positive step forward for public health that also adds to the richness of the conversation.

This commentary originally appeared on the RWJF New Public Health blog.