Using the theory of planned behavior to understand student intent to use tobacco in California universities
Keywords:Theory of planned behavior, Tobacco control, Tobacco policies, Tobacco-free universities, College students, Policy intervention
Background: Most tobacco use, including addiction, starts between 18-26 years of age. To prevent this, the University of California (UC) and California State University (CSU) have implemented system-wide tobacco-free policies in recent years. The objective of this study was to investigate the association of the theory of planned behavior (TPB) constructs: attitude, subjective norms (SN), and perceived behavioral control (PBC) with intention to use tobacco among students in tobacco-free universities in California. Additional objectives were to understand whether these primary TPB constructs were influenced by various policy enforcement levels (i.e., communication and signage), and the availability of smoking cessation programs on campus.
Methods: In this cross-sectional study conducted during March-May 2018, a survey was administered among students within select UC and CSU campuses. Students were recruited by cold-calling and emailing faculty to request assistance in disseminating an electronic survey to their students.
Results: There was a total of 167 survey respondents (mean age=18-24 years). Results indicated that attitude (β=0.12, p<0.025), SN (β=0.18, p<0.001), and PBC (β=0.33, p<0.001) were significantly and positively associated with student intention. Results showed no significant differences between different enforcement levels and TPB constructs but did show significant positive differences in student attitude between campuses that offer smoking cessation programs and campuses that do not (t=2.55, f=6.50, p<0.001).
Conclusions: Findings indicate tobacco-free policies positively influence shifts in student attitude and intention to use tobacco on California university campuses. Administrators are encouraged to tailor enforcement messages to increase compliance.
Centers for Disease Control. (2020). Health Effects. Retrieved on January 29, 2022. Available at: https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm. Accessed on 30 January, 2020.
California Department of Public Health. (2019). California Tobacco Facts and Figures
Policy on Systemwide Smoke and Tobacco Free 2016. California State University (2017). Available at: https://www.cdph.ca.gov/Programs/CCDPHP/ DCDIC/CTCB/CDPH%20Document%20Library/ResearchandEvaluation/FactsandFigures/CATobaccoFactsandFigures2019.pdf. Accessed on 29 January, 2022.
Environment Executive Order 1108. Retrieved on May 13, 2018. Available at: https://www.calstate. edu/eo/EO-1108.html. Accessed on 10 January, 2020.
Fallin A, Glanz SA. Tobacco-Control Policies in Tobacco-Growing States: Where Tobacco Was King. Milbank Quarterly. 2015;93(2):319-58.
Lovato CY, Sabiston CM, Hadd V, Nykiforuk CI, Campbell HS. The influence of school smoking policies and student perceptions of enforcement on school smoking prevalence and location of smoking. Health Educ Res. 2007;22(6):782-93.
UC Smoke and Tobacco Free Policy. University of California Office of the President. Available at: https://www.ucop.edu/safety-and-loss-prevention/environmental/program-resources/uc-smoke-free/uc-smoke-tobacco-free.html. Accessed on 13 May, 2018.
California State University Enforces System-Wide Smoking Ban on Every Campus in California. California State University, 2017. Available at: https://thelumberjack.org/2017/09/05/california-state-university-enforces-system-wide-smoking-ban-on-every-campus-in-california/. Accessed on 20 September, 2018.
Ajzen I. Constructing a TPB Questionnaire: Conceptual and Methodological Considerations. 2002. Available at: http://www.uni-bielefeld.de/ikg/zick/ajzen%20construction%20a%20tpb%20questionnaire.pdf. Accessed on 20 May, 2018.
Chase K, Reicks M, Smith C, Henry H, Reimer K. Use of the think-aloud method to identify factors influencing purchase of bread and cereals by low-income African American women and implications for whole-grain education. J Am Dietetic Asso. 2003;103(4):501-4.
Armitage C, Conner M. Efficacy of the theory of planned behavior: a meta-analytic review. Br J Soc Psycho. 2001;38:35-54.
Topa G, Moriana JA. Theory of planned behavior and smoking: meta-analysis and SEM model. Substance Abuse Rehabil. 2010;1:23-33.
Lenk K, Rode P, Fabian L, Bernat D, Klein E, Forster J. Cigarette use among young adults: Comparisons between two-year college students, four-year college students, and those not in college. J Am Coll Health. 2014;60(4):303-8.
Macy JT, Middlestadt SE, Seo DC, Kolbe LJ, Jay SJ. Applying the theory of planned behavior to explore the relation between smoke-free air laws and quitting intentions. Health Education Behavior. 2011;39(1):27-34.
Leonard JA, Pokorny SB, Schoeny ME. Evaluating the effects of enforcement and fines on youth smoking. Critical Public Health. 2010;13(1):33-45.
Karimy M, Zareban I, Araban M, Montazeri A. An extended theory of planned behavior (TPB) used to predict smoking behavior among a sample of Iranian medical students. Int J High Risk Behav Addict. 2015;4(3):e24715.