Objective: To assess occupational tobacco use and the impact of a tobacco-free policy in the Central Appalachia, an environment characterized by high tobacco use and production. Methods: This study was an Internet-based survey conducted on 2,318 university employees. Descriptive, chi-square, and logistic regression statistics were performed. Unadjusted and adjusted odds ratios (AOR) with respective 95 % confidence intervals (CI) were reported. Results: The survey response rate was 50.8 %; of the respondents, 9.0 % were current smokers. Smoking prevalence among faculty, administrators/professionals, and clerical/support staff was 6.1, 8.1, and 13.1 %, respectively. While those respondents aged 30-39 years showed a significantly increased likelihood of being a current smoker (AOR 5.64, 95 % CI 1.31-9.26), knowledge that secondhand smoke is harmful (AOR 0.22, 95 % CI 0.07-0.70) and support for tobacco-free policy (AOR 0.11, 95 % CI 0.04-0.27) decreased the likelihood. Conclusion: Low tobacco use among faculty and administrators confirmed the relationship between tobacco use and socio-economic status, even in a tobacco-producing environment. Disaggregation of tobacco use data assists the public health community in the efficient allocation of efforts and resources for cessation programs to reduce tobacco use in such environments.

Objective: To assess occupational tobacco use and the impact of a tobacco-free policy in the Central Appalachia, an environment characterized by high tobacco use and production. Methods: This study was an Internet-based survey conducted on 2,318 university employees. Descriptive, chi-square, and logistic regression statistics were performed. Unadjusted and adjusted odds ratios (AOR) with respective 95 % confidence intervals (CI) were reported. Results: The survey response rate was 50.8 %; of the respondents, 9.0 % were current smokers. Smoking prevalence among faculty, administrators/professionals, and clerical/support staff was 6.1, 8.1, and 13.1 %, respectively. While those respondents aged 30-39 years showed a significantly increased likelihood of being a current smoker (AOR 5.64, 95 % CI 1.31-9.26), knowledge that secondhand smoke is harmful (AOR 0.22, 95 % CI 0.07-0.70) and support for tobacco-free policy (AOR 0.11, 95 % CI 0.04-0.27) decreased the likelihood. Conclusion: Low tobacco use among faculty and administrators confirmed the relationship between tobacco use and socio-economic status, even in a tobacco-producing environment. Disaggregation of tobacco use data assists the public health community in the efficient allocation of efforts and resources for cessation programs to reduce tobacco use in such environments.

In 1994, Tennessee, the third largest tobacco-producing state in the U.S., preempted tobacco regulation. However, in 2005, higher educational institutions were exempted from this preemption and the 2007 Non-Smoker Protection Act required educational facilities to create smoke-free environment. To this date, while all higher educational institutions have some sort of smoke-free policy, East Tennessee State University is the only public institution with a tobacco-free policy. We investigated attitudes and behaviors of the university personnel, the most stable segment of the population, toward the policy and compliance with it using an internet-based survey. All employees (2,318) were invited to participate in a survey; 58% responded. Bivariate analyses found 79% of the respondents favored the policy. Multiple variable logistic regression analyses found support for the policy was higher among females [OR = 3.14; 95% CI (1.68, 5.86)], administrators/professionals [OR = 3.47; 95% CI (1.78, 6.74)], faculty [OR = 2.69; 95% CI (1.31, 5.53)] and those affiliated with the College of Medicine [OR = 4.14; 95% CI (1.45, 7.85)]. While only 67 employees (5.6% of sample) reported they have not complied with the policy, around 80.8% reported observing someone engaged in non-compliance. The high level of support for the policy suggests it should be promoted throughout the higher education system and nationwide. At the same time, in preemptive states, higher educational institutions should be targeted as venues for strong tobacco-free policies. The gap in compliance, however, implies in tobacco-friendly environments, a tobacco-free campus policy with no reporting and enforcement mechanisms could lead to high levels of non-compliance.