Smoking Issue in Queensland - Case Study Example

1.0.0 Introduction

Smoking is responsible for roughly 3,700 deaths and 36,000 hospitalizations in Queensland annually. For every 10 deaths that result from smoking, a non-smoker dies due to second-hand smoke (SHS) exposure.1 Currently, 17.9% of people between the age of 18 and 24 smoke daily in Queensland; 4.5% higher than the national average of 13.4%.1

There is no safe level of exposure2,3,4; the Cancer Council advised that exposure of as little as 30 minutes could affect the cardiovascular system of a non-smoker.1 Chronic exposure to SHS might cause a myriad of issues depending on exposure and susceptibility of the exposed; including respiratory disease, lung cancer, coronary heart disease, while also having the capacity to exacerbate the symptoms of allergies, asthma, and chronic obstructive pulmonary disease.3,5,6 Furthermore, Heffernan and O’Neil7 stated that exposure to tobacco smoke have been associated with a range of cognitive and working memory impairments; in addition, they observed that SHS could also potentially impact prospective (day-day) memory.

The current laws regarding smoking only restrict any form of smoking on educational grounds up to a secondary level.1 Lee, Ranny and Goldstein8 found no significant difference between college campuses with partial smoking restriction policies and no policies; only smoke-free environments (campuses) were found to be effective at being healthful.4,8 In addition, surveys from Deakin University and University of Melbourne found students were in widespread support of smoke-free campuses; the University of Melbourne survey also found that 75% of smokers wanted to quit smoking.1

Therefore, The Needs Assessment Project is set out to assess tobacco related issues and the specific needs in the light of creating a tobacco-free campus in the University of Queensland. The target population is the University students and the staff members (faculty and employees). In the exploration of the aforementioned areas, culture, attitudes and policies pertinent to tobacco use with the University will be of significance in creating a tobacco-free campus.

2.0.0 Aim

The aim of this Needs Assessment is to identify if there is a gap between current tobacco related policy and desired policies with regards to smoking on campus. In addition, this Needs Assessment will provide insight into tobacco related behaviours, its usage, and the challenges facing the creation of a smoking-free campus.

3.0.0 Methodology

3.1.0 Expert Needs

3.1.1 Databases

Published databases will be searched for expert data regarding the subject matter. The databases to be sought include PubMed, EMBASE, and PsycINFO. The string to guide on choice of the database are “(smoke/tobacco/smoking) and (prohibited/prohibiting/no smoking/ban/smoke-free/tobacco-free and (campus/university/campus wide)”. This same string will be used for the background search for unpublished information. For this category of literature review, base-search.net and google.com will be used as per the up to date requirement of October 2007. Data sorting criterion will be the setting on the study type and the outcome of the study that is a measure of any policies or contributions towards a tobacco-free university. A thorough analysis of the student attitudes towards smoke-free policies will be conducted. The random effect methods will be used to calculate the mean support accorded by students to the smoke-free policies.9 Smoking regulation policies such as designated smoking areas, indoor smoking ban, and the entire smoke-free zones will also be assessed.10

3.1.2 Government agencies/organisations

Investigation on the impediments to create a tobacco-free campus will be carried out in Queensland Universities. Alongside, the policy making process and stakeholders involvement in the process will be examined through consulting government agencies/organisations relevant to the subject topic, i.e. the Queensland Health, the Heart Foundation, and the Cancer Council Queensland.1 The stakeholders will also be allowed to submit their views on the question. Digital data assembly in the form of emails from health organisations, government agencies, and university unions will also be performed. To seal on this, a public hearing forum involving all Queensland University Representatives will be held in December 2017.

3.2.0 Felt Needs (Qualitative)

3.2.1 Focus group

As a follow up for the information gathered, focus groups will be used for direct feedback on the beliefs, perceptions, and tobacco related behaviours. Interaction with focus group will also help to identify the types of incentives that motivate compliance with tobacco-free policies. The participants of the focus groups will be invited through emails sent to UQ staff and students. The feedback from the email addresses will be highly confidential, as the emails will be anonymously received. Only staff and students attending the main campuses (UQ St Lucia, UQ Herston, UQ Gatton) will be called to attend the focus group sessions. For the staff members, focus group time will be during normal working hours and during departmental meetings; while for the students, the time and location must be convenient.

The dedicated support of existing tobacco-free advocate groups will be sought to help the team cover approximately 20 focus groups each with a varying number of participants. The Needs Assessment committee aims at having 6 people in each focus group with anticipation that there may be unforeseen barriers that may bar attendance. The time allotted to the session is one and a half hours headed by a facilitator, a support person, and a secretary to take notes. Debriefing form and needs assessment questions will be prepared by the Needs Assessment committee. Any phrases and memorable quotes from the audience will be recorded for reference. Those taking notes must seek clarity of responses where necessary; they must record the responses accurately, keep the information confidential, and ensure an enabling environment for participation.

3.3.0 Expressed Needs (Quantitative)

3.3.1 Clinical records

The university clinic will be the source of firsthand information about the current state of tobacco use in the University. Using the clinical records, the committee will extract information on general tobacco use, tobacco related conditions, cessation needs of the tobacco users, and the prevalence within the University. The committee will note the number of people using the provision of tobacco cessation services; for instance, self-help groups, individual services, and nicotine replacement therapy.10 The compilation and interpretation of these legions of data will give insight on the prevalent population in the university and the efforts in place to promote the tobacco-free policies and services.

3.3.2 Tobacco using assessments

An environmental scan of UQ campuses will help the Needs Assessment committee to locate where tobacco is present in the campus, where it is used, and the disposal spots. A follow up on the environmental scan is a campus-wide clean up. The volunteers for this activity will be solicited through classroom announcements in the public health department. Latex gloves, paper bags, hand sanitisers and trash pickers will be provided to safeguard the health concerns of the volunteers. For proper coverage, in terms of collection of cigarette butts, the volunteers will disperse into 25 groups to collect in the identified ten locations. Optimum collection is expected in one hour after which each volunteer will indicate number of cigarette butts in each bag. These numbers will be computed to determine the total number of collected cigarette butts from each of the ten locations. A list of locations on campus with greater cigarette butt accumulation will be made.11,12

3.4.0 Comparative needs

3.4.1. Between UQ and other university campuses

The data collected from the Queensland Universities will be analysed to make comprehensive comparison in the key areas pertaining tobacco-free polices. The Need Assessment team, the UQ university staff, the Queensland University of Technology staff, the Griffith University staff, and Central Queensland University staff will pool together their efforts to compare the results.

The university administrators will present the total enrolment of internal students. From this total number of internal students, a 1% representation is to be involved in the comparison. This representation will be selected systematically using a random cross-sectional survey to ensure that all the internal student population is equally represented in the collection of data by filling a questionnaire that has been previously validated.13,14,15 The questionnaire will be sent to the students’ emails and will be received with anonymity. The questionnaire includes quantitative questions regarding the use of tobacco and the established attitudes about tobacco smoking. It is also structured to allow for explanations or comments about tobacco use and perceptions of the possibility of having a tobacco-free campus. The age prevalence, and the state of health of the individuals will show a correlation with their smoking habit. In addition, their gender, aboriginality, and origin (international) will be of great insight.13 The smokers, as found from the WHO criteria, will instrumentally help to predict their behaviour if they stopped smoking in the UQ Campus.16 They will also give their perspective on support options that would help them recover from tobacco use.

Analysis of qualitative data for conclusive remarks will be executed using the Wordle software that will measure the overall reiteration of the opinions from the participants. Quantitative data will be analysed using the SPSS software to determine the frequencies of the variables. The statistical test compares means of variables, while the relation between variables will be established through logistic regression. The 95% confidence intervals and odd rations for the statistical analysis will be reported.

4.0.0 Potential Barriers – specific to the data quality

4.1.0 Logistics

Several trained research personal will be required to undertake the assessment, conduct the focused groups, and liaison with other universities. Therefore, without a full-time, well-funded, and trained research team, the quality of the data collected might vary.

The logistics involved with gathering sufficient volunteers to pick up cigarette butts across all three campuses might be difficult. Given the size of the campuses, a significant under-representation of the distribution of cigarette butts is possible. Furthermore, the number of butts collected will also be dependent on the number of smokers present that day, patrols of the cleaners, and week of the semester.

4.2.0 Practicalities and feasibly

For practicality purposes, focus groups will be used to represent the student population; however, the results might not accurately represent the 51,070 enrolled students and 6,703 staff or the distribution of smokers and non-smokers.17 Similarly, the participants of the surveys were selected on similar practical and feasible reasons.

Given that information will be conducted and collected across different universities in Queensland, the feasibility of the data collection methods and communication must be effective and achievable to reduce discrepancies in the data.

4.3.0 Potential Bias

The potential impact that social desirability bias (SDB) could have on the focus groups and surveys could significantly alter the findings, especially with negatively associated health behaviours.18 SDB is the tendency to underreport socially undesirable behaviours and attitudes comprising of two main methods; impressions management (to conform please an audience) and self-deception (maintain a positive self-concept).18

5.0.0 Stakeholders

Students and staff (smokers and non-smokers), neighbouring community, student and staff unions, campus and faculty managers, participants and institution heads will be the primary stakeholders.1

A small sample of primary stakeholders will be engaged early on as part of the initial consultations and conceptualisation process. The rest will be involved during the planning, data collection, and implementation stages to help secure funding, support, and resources required to achieve successful implementation. Primary means of communication is via email; communication will be ongoing with regular updates on findings, progress, and key decisions outcomes.

The research team will be the secondary stakeholders; they will be engaged throughout the process. They will first be engaged prior to starting the process: during the formation of the research team until the end when the policy advocating process is complete.

The other key stakeholders are the Queensland Department of Health, non-government organizations (Cancer council and Heart Foundation), and alumni. These stakeholders will be approached once the research proposal, goals, and objectives have been established to seek funding and resources to carry out and evaluate the objectives. Primary means of communication will be via email; information will be initially presented to these larger organizations through face-to-face meetings. These stakeholders and other similar organizations will be approached again at the end during policy implementation; seeking resources for implementation/transition, enforcement as well as resources to help smokers quit.

6.0.0 Ethical considerations

Prior to carrying out the Needs Assessment, researchers will need to ensure they adhere and agree to the Australian code of for the Responsible Conduct of research throughout the process, which guides researchers in responsible, fundamental ethical considerations, and responsibilities that must be upheld.19 This code covers a wide array of critical ethical considerations including ensuring autonomy, training and research responsibilities, and management of data (including confidentiality).19 Subsequently, they need to present their research proposal and any conflicts of interest to an independent and qualified ethics committee before carrying out the Assessment.19

Other considerations would include having to take into consideration measures to accommodate participants if they are disabled (e.g. deaf, injured) and ensuring easy access to focus groups sites. In addition, counselling services and other quitting services (Quitline) need to be readily available to smokers on site that might need support with the transition process.1

The impact of a successful smoke-free transition could potentially have negative implications on the behaviour of current smokers. The ban could encourage ‘covert’ behaviours to avoid detection, which could also compromise fire safety if they do not properly extinguish their cigarettes.1 Furthermore, the ban could force students to leave the safety of the campus to smoke, especially at night; this behaviour could also challenge relationships with neighbouring communities, as it increases their exposure to SHS.1