This study provides insights into the contemporary smoking behaviours and attitudes towards smoke and comprehensive tobacco-free policy options, among 780 staff and students attending a large UK University. Overall, smoking prevalence was 14.0% (95% CI 11.6–16.6%) and over two-thirds of respondents (68.5%; 95% CI: 65.2–71.8%) expressed support for a smoke-free campus and just under half (47.3%; 95% CI: 43.8–50.9%) support a ban for e-cigarettes/vaping device use on campus. Smoking status was an independent predictor of support for tobacco control, with the lowest level of support for a smoke-free campus among daily and intermittent smokers. Our novel findings provide valuable baseline information regarding patterns of smoking within a university campus environment, which may inform development and enable future evaluation of a revised voluntary campus-based tobacco control policy option in the context of a UK higher education institution.
Prevalence of current tobacco smoking (14.0%) was marginally lower than the UK adult population (15.1%),  but broadly consistent with smoking rates observed in postsecondary educational settings in the United States and New Zealand [24, 25]. The proportion of current smokers reporting an intention to quit was lower than the national average (49.5% vs 60.8%)  potentially reflecting the demographic characteristics of our study population. Further differences were observed in e-cigarette usage patterns, with current usage reported by (8.3%) which is lower than the proportion of UK adult population who have tried an e-cigarette (19.4%), but higher than the proportion of current users in a national context (5.5%) .
Support for a campus-wide smoke-free policy was consistently high among both staff and students, with 86% of respondents expressing concern about SHS exposure and two-thirds (66.3%) supportive of an aspiration for a smoke-free campus. Attitudes towards inclusion of e-cigarettes or vaping devices within a smoke-free policy were less consistent; potentially due to mixed public awareness of the health impacts associated with vapour from these sources, or their role in supporting a smoke-free environment. Our findings are notably consistent with those of a meta-analysis of 19 studies performed by Lupton and colleagues, which found 58.9% of students and 68.4% of staff to be supportive of smoke-free campus policies . Similar levels of support were observed within a cross-sectional survey at Curtin University, Western Australia, where 84.1% of respondents were concerned about the harms of SHS exposure and 65.7% supportive of a smoke-free campus policy option, with comparable differences by smoking status .
The majority of participants reported that a smoke-free campus policy would have a positive impact upon the health of staff and students, suggesting awareness of the links between smoking and tobacco usage and associated health harms. Although we did not seek specific views on the impact of a revised policy upon quality of life measures, given attitudes towards a smoke-free campus were broadly positive, such an association suggests potential to achieve wider improvements in staff and student wellbeing. Raising awareness of relevant health messages and reinforcement of the harms of SHS exposure are likely to improve acceptance and policy compliance, as previously observed in bar and restaurant settings .
Understanding the factors associated with support among population sub-groups may be beneficial for leveraging relevant support and promotion of positive attitudes towards change. Consistent with other investigators,  we observed a gradient across categories of smoking status, with the lowest level of policy endorsement among daily, compared to intermittent and former smokers, and highest among never smokers. These attitudes may be magnified by concern around stigma, reflected in the high proportion of smokers (90.4%), who considered a smoke-free policy to be discriminative . Poland and colleagues (2012)  described the importance of characterisation of discrete types of smokers to inform targeted mitigation measures, identifying that ‘easygoing’ smokers were supportive of smoking restrictions if implemented sensitively and supported with appropriate messages.
In accordance with best practice in health promotion theory,  a comprehensive range of strategies including support for current smokers is most likely to achieve optimal outcomes. This assumption is further supported by existing evidence for workplace smoking restrictions as motivators for behaviour change; underpinned by the relatively high proportion of survey participants within the contemplative phase of health behaviour change  (intention to quit or quit attempt), suggesting policy implementation is likely to be most effective if integrated with smoking cessation provision.
This study had a number of strengths and limitations. Although the overall survey response rate was relatively low, the large study population comprises a diverse cohort of university staff and students. Males were slightly underrepresented comprising only 39.8% of participants, as were EU (10.3%) and international students (9.5%); however, this response pattern is similar to other campus smoking studies . We did not assess income or composite measures of socio-economic status, which are potential confounding factors; however, information was available for age, sex, ethnic group and staff status. The element of selective non-response bias may have resulted in more positive attitudes towards tobacco control policies than among the total university population; however, with the sample size of 780, our findings provide the most comprehensive information available concerning contemporary smoking behaviours and attitudes in a UK tertiary educational setting.
Use of a self-administered questionnaire provides only a subjective assessment of smoking status, and could be influenced by social acceptability bias; however, we did not collect identifiable information and participants were able to exclude their responses from research purposes. Our survey did not include questions regarding symptoms of smoke related illness or awareness of the harms of SHS or Thirdhand Smoke (THS) exposure, which may be better explored through future qualitative research. We administrated the questionnaire at a single time point, yet plan to conduct a repeat cross-sectional survey at a future date to explore changes in prevalence, attitudes and levels of support over time .
Implications for policy and research
The WHO FCTC suggests that national bodies and organisations should protect the population from hazards of SHS ‘wherever the evidence shows that hazard exists’, including quasi-outdoor and outdoor places . Despite gaining popularity worldwide, there remains limited research regarding attitudes towards and effectiveness of smoke- and tobacco-free campus policies. However, it is widely recognised that achieving effective adoption of smoke-free legislation in any setting requires population support and a high degree of compliance.
Potential challenges in local policy implementation include enforcement difficulties, smoking displacement, self-perceived workplace stress, negative community relations and safety concerns ; however, relevant mitigation measures may include phased smoke-free zones or designated shelter provision. These processes will require robust future implementation research, to develop the evidence base concerning policy implementation and organisational change processes, to inform widespread adoption of smoke-free and comprehensive tobacco-free policies across UK higher education institutions.