More than 2,000 college campuses in the U.S. are 100 percent smoke-free. Only four are in Virginia. The list doesn't include Virginia Commonwealth University, but a team of health and policy experts wants to change that.
Nearly a decade ago, the VCU Medical Center adopted a comprehensive smoke-free policy. The Monroe Park campus did not follow suit. Under the current regulations, students, faculty, staff and visitors are permitted to smoke in designated outdoor smoking areas and more than 25 feet outside of school buildings.
A recent grant-funded initiative has led a team of university officials and VCU Massey Cancer Center experts to draft a new policy called Smoke and Tobacco-Free Campus.
"It's really about trying to make a difference in the communities that we serve," says Bernard Fuemmeler, associate director of cancer prevention and control at the Massey Cancer Center. "We serve the public good, and we wanted to align our mission at the cancer center in a local way."
If approved, the new plan will prohibit the use of all tobacco products at the university "except in very specific and limited circumstances." Those circumstances include "authorized theatrical smoking or vaping," approved research and within designated smoking areas outdoors. A public-comment period ended a couple weeks ago, and the assistant vice president of safety and risk management at the university, Tom Briggs, says if the university council and the cabinet of the president approve the policy, it will go into effect in July.
But if establishing smoke-friendly spaces within a policy that's called smoke- and tobacco-free sounds contradictory, convoluted and confusing, that's because it is. Those behind the effort were careful to avoid using the phrase "100 percent tobacco-free" because controversial legal interpretations of a 2006 executive order signed by then-Gov. Tim Kaine say that public universities must include designated smoking areas, regardless of their campus-specific policies.
Executive Order 41, which prohibits smoking in state offices and vehicles, says "smoking shall be banned in any other building operated by executive branch agencies and institutions, including institutions of higher education." The two explicit exemptions are smoking in correctional facilities and in mental health facilities, in accordance with guidelines set by the directors of those departments.
The commissioner of health and secretary of administration later released guidelines based on the order. They require that smokers on state property be at least 25 feet away from an entrance or exit of any facility. According to Jayne Flowers, director of the Tobacco Control Program at the Virginia Department of Health, the sentence that's sparked debate between lawyers and university officials for years reads: "Health care facilities may prohibit smoking outdoors beyond the 25-foot limit."
"By saying health care facilities may, it didn't mean others may not," Flowers says.
She goes on to explain that since the publication of the guidelines, some lawyers have interpreted the rule to mean that agencies not explicitly named do not have the authority to limit smoking outside 25 feet.
"Not every attorney is going to say that, but enough have to create confusion," Flowers says, noting that many risk-averse lawyers have a tendency to err on the side of extreme caution. "We [at the Department of Health] have always contended that that is a misinterpretation of the intent of the policy."
The university isn't the only school grappling with this debate. Representatives from more than two dozen Virginia colleges and universities convened on VCU's medical campus last week for the inaugural Virginia Tobacco-Free Higher Education Summit to discuss ongoing initiatives to prohibit tobacco use on their campuses.
Guest speaker Cynthia Burwell, director of excellence in minority health disparities at Norfolk State University, laid out her school's years-long effort. In 2015, Norfolk State received a grant from the CVS Health and Truth Initiative, which is intended to increase the number of 100-percent smoke- and tobacco-free community colleges and historically black colleges and universities. Turnovers in administration scotched the process, which she said knocked the wind out of her sails. And as she and her team move forward with another attempt, they're still at the mercy of Executive Order 41.
"I know what it reads," she said of the document. "And this time around, I actually met with the person who is in charge of moving policies forward on our campus. And he distinctly said that it's going to be the interpretation of our legal department with that statement as to whether or not we get this policy to go through."
Among the speakers at the daylong event was Liz Williams, project manager at the American Nonsmokers' Rights Foundation. She presented a collection of statistics about smoke- and tobacco-free campuses across the country, plus a list of suggested practices when establishing new policies. Including designated outdoor smoking areas, for example, is something the organization strongly opposes.
Williams noted that no-tobacco-free policy is one-size-fits all. She encouraged university officials to tailor their approach to their student bodies.
"Some people don't want the annoyance of walking through secondhand smoke. Some people want a cleaner campus environment, some students really buy into the environmental component," she said. "It's also a social justice issue. Tie it into whatever your campus culture is."
Other speakers included assistant professor of psychology Caroline Cobb, who shared statistics about smoking habits of college students, and the assistant director of student wellness at Virginia Tech, Jon Fritsch, who discussed cessation programs and services available to students who want to quit smoking.
At VCU, a four-session cessation class called Breathe Free and one-on-one counseling with quit coaches will be available starting in the fall. Students, faculty and staff can also acquire quit kits from the Wellness Resource Center, which include nicotine gum, transdermal patches and educational information. Off-campus resources listed at tobaccofree.vcu.edu include help lines like Quit Now Virginia and apps like QuitNet and QuitPal.
The biggest news to come out of last week's summit was the announcement that a new executive order, which would require all state universities to be 100 percent tobacco-free, without designated smoking areas, is winding through state government. Virginia State Health Commissioner Norman Oliver, who also spoke at the summit, has approved the draft and passed it up the line. If Gov. Ralph Northam approves, it won't be the first tobacco measure he signs.
Earlier this year, Northam signed a law to raise the tobacco-purchase age to 21, and another banning tobacco products at public schools. Gina Roberts, from the Department of Health, who was one of the final speakers at the summit, pointed to these new measures as proof that eliminating tobacco use entirely from college campuses is the logical next step.
"The time is so right for this. High schoolers are ending their high school career in tobacco-free campuses, and now they're coming onto the college stage, where I know a lot of your mission statements, I know, say a lot about the health and well-being of your students," she said. "And with Tobacco 21 passing, most of your college students cannot purchase tobacco, so they surely shouldn't be able to use it on your campus. It's time."