College Writing II Synthesis Essay Assignment Summer Semester 2017 Directions: For this assignment you will be writing a synthesis essay. A synthesis is a combination of two or more summaries and sources. In a synthesis essay you will have three paragraphs, an introduction, a synthesis and a conclusion. In the introduction you will give background information about your topic. You will also include a thesis statement at the end of the introduction paragraph. The thesis statement should describe the goal of your synthesis. (informative or argumentative) The second paragraph is the synthesis. You will combine two summaries of two different articles on the same topic. You will follow all summary guidelines for these two paragraphs. The synthesis will most likely either argue or inform the reader about the topic. The conclusion paragraph should summarize the points of your essay and restate the general ideas. For this essay you will read two research articles on a similar topic to the previous critical review essay as you can use this research in your inquiry paper. You will summarize both articles in two paragraphs and combine the paragraphs for your synthesis. In the synthesis you must include the main ideas of the articles and the author, title, and general idea in the first sentences. This essay will be three pages long and the first draft and peer review are due June 15. You must turn them in hardcopy in class so you can do a peer review. Running head: THESIS DRAFT 1 THESIS DRAFT 3Thesis Draft Katelyn B. Rhodes D40375299 DeVry University Point-of-Care Testing (PoCT) has dramatically taken over the field of clinical laboratory testing since it’s introduction approximately 45 years ago. The technologies utilized in PoCT have been refined to deliver accurate and expedient test results and will become even more sensitive and accurate in order to dominate the field of clinical laboratory testing. Furthermore, there will be a dramatic increase in the volume of clinical testing performed outside of the laboratory. New and emerging PoCT technologies utilize sophisticated molecular techniques such as polymerase chain reaction to aid in the treatment of major health problems worldwide, such as sexually transmitted infections (John & Price, 2014). Historic Timeline In the early-to-mid 1990’s, bench top analyzers entered the clinical laboratory scene. These analyzers were much smaller than the conventional analyzers being used, and utilized touch-screen PCs for ease of use. For this reason, they were able to be used closer to the patient’s bedside or outside of the laboratory environment. However, at this point in time, laboratory testing results were stored within the device and would have to then be sent to the main central laboratory for analysis. Technology in the mid-to-late 1990’s permitted analyzers to be much smaller so that they may be easily carried to the patient’s location. Computers also became more ...

1. College Writing II Synthesis Essay Assignment Summer
Semester 2017
Directions:
For this assignment you will be writing a synthesis essay. A
synthesis is a combination of two or more summaries and
sources. In a synthesis essay you will have three paragraphs, an
introduction, a synthesis and a conclusion.
In the introduction you will give background information about
your topic. You will also include a thesis statement at the end
of the introduction paragraph. The thesis statement should
describe the goal of your synthesis. (informative or
argumentative)
The second paragraph is the synthesis. You will combine two
summaries of two different articles on the same topic. You will
follow all summary guidelines for these two paragraphs. The
synthesis will most likely either argue or inform the reader
about the topic.
The conclusion paragraph should summarize the points of your
essay and restate the general ideas.
For this essay you will read two research articles on a similar
topic to the previous critical review essay as you can use this
research in your inquiry paper. You will summarize both
articles in two paragraphs and combine the paragraphs for your
synthesis. In the synthesis you must include the main ideas of
the articles and the author, title, and general idea in the first
sentences.
This essay will be three pages long and the first draft and peer

2. review are due June 15. You must turn them in hardcopy in
class so you can do a peer review.
Running head: THESIS DRAFT 1
THESIS DRAFT 3Thesis Draft
Katelyn B. Rhodes
D40375299
DeVry University
Point-of-Care Testing (PoCT) has dramatically taken over the
field of clinical laboratory testing since it’s introduction
approximately 45 years ago. The technologies utilized in PoCT
have been refined to deliver accurate and expedient test results
and will become even more sensitive and accurate in order to
dominate the field of clinical laboratory testing. Furthermore,
there will be a dramatic increase in the volume of clinical
testing performed outside of the laboratory. New and emerging
PoCT technologies utilize sophisticated molecular techniques
such as polymerase chain reaction to aid in the treatment of
major health problems worldwide, such as sexually transmitted
infections (John & Price, 2014).

3. Historic Timeline
In the early-to-mid 1990’s, bench top analyzers entered the
clinical laboratory scene. These analyzers were much smaller
than the conventional analyzers being used, and utilized touch-
screen PCs for ease of use. For this reason, they were able to be
used closer to the patient’s bedside or outside of the laboratory
environment. However, at this point in time, laboratory testing
results were stored within the device and would have to then be
sent to the main central laboratory for analysis.
Technology in the mid-to-late 1990’s permitted analyzers to be
much smaller so that they may be easily carried to the patient’s
location. Computers also became more portable and laptops
were used to collect test data for the instrument (Valorz, n.d.).
Since the late 1990’s, point-of-care testing technology has
grown even more portable and has a greater ease-of-use. The
testing instruments are still hand-held, but now do not require
the addition of a separate computing system to collect results.
Patient medical records are now predominantly electronic and
laboratories use sophisticated laboratory information system
(LIS) software to record, manage, and store data. Test
information for a given patient can now go directly from the
testing device to their electronic file (Henricks, 2012).
As time goes on, it is expected that point-of-care testing devices
will utilize more sophisticated testing methods to expand the
range of tests available. Furthermore, the mobility and
expanding test menu will make it possible to bring the clinical
diagnostic laboratory to those in developing countries.
Cultural
Global changes in the economic and social environments
are creating a strong need for changes in health care delivery
worldwide. Point-of-care testing has the potential to make
clinical diagnostic testing more accessible to a large population,
including those in developing countries. The laboratory
infrastructure in developing countries has been neglected, so
patients are not able to get critical services and care.

4. Furthermore, in the United States there is a high demand for
healthcare to be more economical. Point-of-care testing has the
potential to fulfill the need of economical benefit by using less
reagents, permitting more tests to be performed in a given
duration of time, and allowing for earlier diagnosis for patients.
The analyzers are also portable, use smaller sample volumes,
and have fewer requirements for use. However, there are still
many hurdles to overcome to make point-of-care testing the best
method for the patient (Huckle, 2008).
Political
In 2016, the Centers for Medicaid Services (CMS)
published a memo that established how educational
requirements for laboratory testing is to be interpreted. CMS
determined that nursing degrees are considered biological
science degrees and as such, nurses can perform non-waived,
high-complexity laboratory testing. Many point-of-care tests
are viewed by governing agencies as simple “recipes.”
However, in reality these tests still require critical thinking
skills, not just motor skills, and are best performed by trained
laboratorians. Allowing nurses to perform clinical diagnostic
testing is widely viewed as being detrimental to patients. As
such, there has been a great deal of effort to overturn this
interpretation of the educational requirements for point-of-care
testing (McDaniel, 2017).
Economic
In evaluating the economic benefits of point-of-care
testing, the faster turnaround times must also be considered.
There is an elevated cost per test for point-of-care testing, but
the overall gain in expedited patient flow counterbalances this,
especially in high-volume departments such as the emergency
room (Rooney & Ulf, 2014). In a fairly recent study, it was
determined that point-of-care testing would have limited
economical benefits unless care pathway processes change.
However, if the process of care is dramatically changed, point-
of-care testing could result in savings through the utilization of
resources, such as reduced emergency admissions, reduced

5. hospitalizations, reduced length of stay, and increased patients
who can receive home care (John & Price, 2013).
Point-of-care testing has the potential to make a positive
impact worldwide. However, with this relatively new
technology, numerous aspects of health care need to evolve as
well. Care pathway processes, management, the training of
testing personnel, quality control and proficiency testing must
be re-worked in order for point-of-care testing to be beneficial
to health care facilities and patients.
Ethical Considerations
Point of care testing has the potential to improve patient care
globally. It can decrease turn-around-times for common tests,
allowing for earlier diagnosis and bringing clinical laboratory
testing to those in developing countries.
Clinical laboratory scientists follow a deantological code that
binds them to their duties. For example, the Code of Ethics set
by the American Society of Clinical Laboratory Science
(ASCLS) includes a duty to the patient, duty to colleagues and
the profession, and a duty to society (Code of Ethics, n.d.). For
this reason, many laboratorians have rallied against the decision
by the Centers for Medicare and Medicaid Services (CMS) to
allow nurses to perform high-complexity laboratory testing.
Furthermore, this decision permits Advanced Practice
Registered Nurses (APRNs) to supervise laboratory testing.
Nurses and clinical laboratory scientists have vastly different
scopes of practice. While it is agreed upon that nurses are
highly valued, the education and training they obtain does not
delve into the depths of the scientific concepts that clinical
laboratory testing is based upon.
Support of this decision by the CMS goes against clinical
laboratory scientist’s duty to the patient as well as to the
profession, as it poses a serious risk to public health. It is
important to ensure that every patient receives the highest
quality of care and that the laboratory services are safe and
effective (McDaniel, 2016).
Clinical laboratory scientists also adhere to utilitarianism ethics

6. from time to time, as they must consider which testing method
would benefit the most people. Point-of-care testing often
supports this ethical principle in that the developed tests are
those commonly performed and would benefit patients by
having the ability to perform them outside of the laboratory.
Point-of-care testing also decreases turn-around times so that
results can be generated quicker. Additionally, there is a great
need to make health care more economical so that more people
may benefit from it worldwide. Point-or-care testing can
potentially aid in that effort, as they provide a shorter turn
around time that permits high-volume setting to conduct more
testing (John & Price, 2013).
Laboratorians follow a strict set of ethical standards to
ensure that they are fulfilling their duty to patients, colleagues,
society and the clinical laboratory science profession as a
whole. It is important to place the needs of the patient above
personal needs and to be accountable and take pride in the
quality and integrity of laboratory services provided.
Laboratorians also fulfill their duty to society by choosing
analytical methods that provide the greatest benefit to the
greatest number of patients.
Sources
Code of Ethics. (n.d.). Retrieved June 1, 2017, from
http://www.ascls.org/about-us/code-of-ethics
Henricks, W. H. (2012, October 09). LIS Basics: CP and AP LIS
Design and Operations. Retrieved May 18, 2017, from
http://www.pathinformatics.pitt.edu/sites/default/files/2012
Powerpoints/01HenricksTues.pdf
Huckle, D. (2008). Point-of-care Diagnostics: An Advancing
Sector With Nontechnical Issues. Retrieved May 26, 2017, from
http://www.medscape.com/viewarticle/584399_7
John, A. S., & Price, C. P. (2013, August). Economic Evidence
and Point-of-Care Testing. Retrieved May 26, 2017, from

7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799220/
McDaniel, G. (2016, July 31). CMS Says Nurses Can Perform
High Complexity Tests. Retrieved June 01, 2017, from
http://community.advanceweb.com/blogs/mt_2/archive/2016/07/
31/cms-says-nurses-can-perform-high-complexity-tests.aspx
Rooney, Kevin D., and Ulf Martin Schilling. "Point-of-care
testing in the overcrowded emergency department – can it make
a difference?" Critical Care. BioMed Central, 08 Dec. 2014.
Web. 27 May 2017.
Valorz, S. (n.d.). Point-of-Care Informatics: Past, Present and
Future. Retrieved May 18, 2017, from
https://view.officeapps.live.com/op/view.aspx?src=http%3A%2
F%2Fwww.pointof
care.net%2FBaltimore%2FOctober%25202004%2520Images%2
FPoint_of_Care_Informatics_Past_Present_and_Future_100804_
Final.ppt
Early to mid 1990's
Bench top analyzers
Touch screen PCs
Mid to late 1990's
Hand held devices
Late 1990's to now

8. Results sent to central lab for analysis
Laptops to collect device data
Electronic patient records
Results sent directly to LIS
PEER EVALUATION PRESENTATION ASSESSMENT FORM:
TO BE USED TO EVALUATE YOUR TEAMMATE’S COURSE
PAPER
DIRECTIONS:
1. Please use this form to evaluate your assigned peer’s final
research paper according to
the criteria below.
2. Specific information should be supplied for each item; that
is, do not simply answer Yes or No.
3. This form can be downloaded and expanded to allow space
for your report.

9. 4. This is a graded assignment.
1. Evaluate your assigned classmate’s paper according to the
following instructions:
FORMAT:
a. Were all required sections included?
b. Were they clearly distinguished from one another?
c. If not, were reasons given for not including some?
FOR EACH SECTION:
SOURCES:
d. Were in-text references used?
e. Were they properly formatted?
f. Were primary sources used?
g. Were they formatted properly?
h. Were sources from our textbook used?
i. Were they formatted properly?
j. Were the length requirements observed?
CONTENT:
k. Did the paper have a thesis and introduction?
l. Was it clear to you?
m. Did each section relate to the thesis? Evaluate by section.
n. If any of the sections did not apply to the paper, was a reason
given?
o. Was some form of quantitative reasoning used?
p. If so, did it apply to the thesis?
q. Conclusion: did it accurately summarize the author’s
argument?
r. Was a Works Cited page included?
s. Was it properly formatted?
WRITING SKILLS:
t. Evaluate the writing of the paper. The following includes all
elements of writing: spelling, grammar, punctuation, sentence
structure, and clarity of expression.

10. 1. Excellent: Virtually error free
2. Very good: Very few insignificant errors
3. Good: Some errors; somewhat distracting
4. Fair: Significant number of writing errors; distracting
5. Poor: Unacceptable level of writing errors
Title of Presentation
Student’s name
Feel free to adjust the color and scheme of this template. Color
and design are recommended in an appealing visual
presentation.
1
Introduction
Includes
The name of the student evaluated and the topic
Also should detail the purpose and flow of the presentation
Feel free to adjust the color and scheme of this template. Color
and design are recommended in an appealing visual
presentation.
2
Format of Paper
Evaluate the following three questions regarding the overall
format of the paper.
Were all required sections included?
Were they clearly distinguished from one another?

11. If not, were reasons given for not including some?
Feel free to adjust the color and scheme of this template. Color
and design are recommended in an appealing visual
presentation.
3
Historical Timeline and Predecessor Assessment Evaluation
Assess the following three components as detailed on the
Student Evaluation Form
Sources
Content
Writing Skills
Remember that graphics go a long way in a visual presentation.
Add them to play up the visual appeal of this slide but be sure
to cite them in proper APA format.
Add additional slides as needed for this section.
Feel free to adjust the color and scheme of this template. Color
and design are recommended in an appealing visual
presentation.
4
Analysis of Impact Evaluation
Assess the following three components as detailed on the
Student Evaluation Form
Sources
Content
Writing Skills
Remember that graphics go a long way in a visual presentation.
Add them to play up the visual appeal of this slide but be sure

12. to cite them in proper APA format.
Add additional slides as needed for this section.
Feel free to adjust the color and scheme of this template. Color
and design are recommended in an appealing visual
presentation.
5
Ethical Considerations Evaluation
Assess the following three components as detailed on the
Student Evaluation Form
Sources
Content
Writing Skills
Remember that graphics go a long way in a visual presentation.
Add them to play up the visual appeal of this slide but be sure
to cite them in proper APA format.
Add additional slides as needed for this section.
Feel free to adjust the color and scheme of this template. Color
and design are recommended in an appealing visual
presentation.
6
Concluding Remarks
Summarize the areas of the writer's strengths and weakness as
presented in your presentation and remember to always end on a
positive note!
Feel free to adjust the color and scheme of this template. Color
and design are recommended in an appealing visual
presentation.

13. 7
References
Reference all sources used in completing this assignment.
Remember that in-text citations are just as important in a
presentation as they are in papers.
The references listed here should be a list of what you have
posted on your previous slides, including any images that you
used, unless they are clipart.
Feel free to adjust the color and scheme of this template. Color
and design are recommended in an appealing visual
presentation.
8
Burns et al. BMC Res Notes (2016) 9:288
DOI 10.1186/s13104-016-2090-7
R E S E A R C H A R T I C L E
A cross sectional evaluation of a total
smoking ban at a large Australian university
Sharyn Burns*, Ellen Hart, Jonine Jancey, Jonathan Hallett,
Gemma Crawford and Linda Portsmouth
Abstract
Background: Total smoking bans have been found to contribute
positively to the health of non-smokers by reduc-
ing exposure to second-hand smoke, and to enhance the

14. likelihood of cessation among smokers.
Methods: Two cross-sectional electronic surveys of staff and
students at a large Australian university were conducted
prior (n = 969) and 1 year post (n = 670) the implementation of
a smoke free campus policy. Demographics, tobacco
use, intention to quit, attitudes towards smoking and smoking
restrictions and awareness of and attitudes towards
the campus smoking policy were measured.
Results: Exposure to second-hand smoke (SHS) reduced
significantly (p < 0.001) one year after policy implementa-
tion. Smoking prevalence was similar at both time periods (T1
9.3 %; T2 8.4 %) and over half of smokers indicated
they were planning to quit smoking in the future (T1 65.5 vs T2
62.3 %). There was a significant increase in positive
responses to the statement the campus should be totally smoke
free including all outdoor areas at T2 compared to T1
(T1 60.8 vs T2 71.4 %; p < 0.001), however respondents felt
there should be places on campus for smokers to smoke
(T1 53.6 vs T2 47 %; p < 0.05).
Conclusions: This study found a significant positive difference
in exposure SHS after implementation of the total
ban. Although prevalence of smoking in this study was low, the
proportion of respondents who were contemplating
smoking cessation suggests support for smokers would be
beneficial. Continued awareness raising, education and
enforcement is likely to enhance the long term outcomes of the
total ban.
© 2016 The Author(s). This article is distributed under the
terms of the Creative Commons Attribution 4.0 International
License
(http://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, and reproduction in any medium,

15. provided you give appropriate credit to the original author(s)
and the source, provide a link to the Creative Commons license,
and indicate if changes were made. The Creative Commons
Public Domain Dedication waiver (http://creativecommons.org/
publicdomain/zero/1.0/) applies to the data made available in
this article, unless otherwise stated.
Background
Australia has employed a coordinated, comprehensive
approach to tobacco control since the 1980s [1, 2] and as
a result has experienced a significant decline in the social
acceptability of tobacco use and smoking prevalence
[3]. Despite substantial progress in reducing smoking
prevalence and exposure to second-hand smoke (SHS),
tobacco smoking remains the largest contributor to and
one of the most preventable causes of ill-health in Aus-
tralia [4].
One strategy employed as part of a comprehensive
approach has been the introduction of smoke-free poli-
cies (prohibiting smoking in specific areas), which have
been found to contribute to reductions in smoking rates
and in turn SHS exposure and improved health outcomes
[5, 6]. Australia has a long history of smoke-free policy
with restrictions commencing in the 1970s [7] and by
2002 most enclosed public spaces were smoke-free in
almost all Australian states and territories [7]. By 2010,
smoking was banned in all non-hospitality workplaces,
restaurants and bars in all jurisdictions in Australia [5].
Some high income countries, including Australia have
extended smoke-free policies to outdoor spaces [5] con-
sistent with Western Australian legislation smoking
at this university was prohibited in all enclosed areas
and cafes [8], however in 2012 the ban was extended
to include all outdoor areas and university vehicles.

16. Although US studies have demonstrated favourable
changes in smoking behaviour [9] and exposure to SHS
[10] as a result of a total smoke free policy implementa-
tion, there is a paucity of data describing the evaluation
of total smoking bans in universities in Australia.
Open Access
BMC Research Notes
*Correspondence: [email protected]
Collaboration for Evidence, Research and Impact in Public
Health, School
of Public Health, Curtin University, GPO Box U1987, Perth,
WA 6845,
Australia
http://creativecommons.org/licenses/by/4.0/
http://creativecommons.org/publicdomain/zero/1.0/
http://creativecommons.org/publicdomain/zero/1.0/
http://crossmark.crossref.org/dialog/?doi=10.1186/s13104-016-
2090-7&domain=pdf
Page 2 of 9Burns et al. BMC Res Notes (2016) 9:288
Most Australians are aware of the harms of smok-
ing and SHS; reflected by negative normative attitudes
towards smoking [3]. These changes in attitudes over the
last few decades have coincided with the implementation
of smoke-free policies and declining prevalence of smok-
ing rates [3, 7]. Smoke-free policies have been associ-
ated with reduced respiratory symptoms, improved lung
function, and improved cardiovascular health for people
who would have previously been exposed to SHS [11]. A
study of the impact of tobacco bans in 15 Ontario munic-

17. ipalities found exposure to SHS decreased by 4.7 % and
2.3 % in public places and workplaces respectively over a
2 year period. The same study suggested these bans also
reduced exposure to SHS in private settings including
homes and cars [12].
While smoke-free policies assist in improving the
health of non-smokers they also appear to impact on the
health of smokers by reducing the amount of cigarettes
smoked per day and to support motivation for cessation
[5]. A US study found smoke-free laws (which included
bans in at least one location including workplaces, res-
taurants and bars) were associated with decreased cur-
rent and established smoking, but not with past year
initiation among young adults [13]. Others have found
total smoking bans to be more likely to promote quit
attempts compared to partial smoking bans [14]. A study
in California found smokers living in a city with a smok-
ing ban in outdoor spaces were more likely to reduce
smoking levels and to attempt to quit compared to those
living in other cities [15]. A qualitative study of smokers
at this university found some smokers felt the implemen-
tation of the total ban would provide good motivation for
them personally to quit [16].
Policy support is a key factor for successful implemen-
tation; Australians, including smokers, are generally sup-
portive of smoke-free policy [5, 17, 18]. Arguments used
by opponents of smoke-free areas (e.g. the difficulty of
enforcement and the risk that policies may be economi-
cally detrimental to specific industries, particularly the
hospitality industry) have been unfounded [5]. Although
only short term compliance has been measured, pol-
icy compliance is generally high in most countries, and
studies assessing the impact of smoke-free policy imple-
mentation have found no changes to hospitality revenue

18. [5]. Despite strong support for such policy in enclosed
areas, extensions to include outdoor spaces may be met
with greater resistance [5]. Support for smoking bans
at a range of community venues including zoos, parks
and community events has been found to be strong-
est for smaller outdoor venues. Women with children
were more supportive of total bans than other respond-
ents [19]. While overall support for total smoking bans
in universities has been positive, both smokers and
non-smokers have recognised the rights of smokers and
suggested campuses provide designated places for smok-
ers to smoke [10, 20].
A total smoking ban (including all buildings, grounds,
outdoor areas, student housing and university vehicles)
was implemented in a large university campus in West-
ern Australia. Prior to this ban, smoking was prohibited
in all buildings and undercover areas of the university.
The university presents particular challenges for the
implementation of a total ban due to the physical size of
the ground (119 hectares, which includes student hous-
ing in addition to extensive outdoor areas including gar-
dens, sports fields and natural bushland). In 2012 more
than 35,000 students were located at the Bentley campus.
Of the total student population approximately 80 % were
undergraduate students and 55 % were female. Across all
campuses the university employed 1378 academic and
1709 general staff (not including causal staff ) of whom
54 % were female. This paper reports on exposure to SHS,
attitudes towards smoking, and awareness of and atti-
tudes towards the policy according to smoking status at
baseline and one year following implementation.
Methods
Two cross-sectional electronic surveys of staff and stu-

19. dents were conducted, prior to the smoke free cam-
pus policy implementation (T1) and 1 year post policy
implementation (T2). For each survey a random sample
of students (n = 4500) and staff (n = 500) were invited
to participate via email. Participants at T1 and T2 were
matched to ensure samples were independent. Three par-
ticipants who completed the survey on both occasions
were excluded from the T2 analysis.
The use of a cross-sectional sample is often used in the
exploration of attitudes towards and health behaviour
compliance and policy implementation [21–24]. Surveys
were sent from the University Surveys Office to partici-
pants meeting the inclusion criteria: aged over 18 years;
staff working at the main campus or students enrolled
internally and attending the main campus. Students
were sent two and staff one follow-up reminder email.
Reminder emails were kept to a minimum to reduce bur-
den on staff and students and were limited due to project
resources.
Instrumentation
The survey instrument collected data on demograph-
ics, tobacco use, attitudes towards smoking and smoking
restrictions, awareness of and attitudes towards campus
smoking policy and intentions to quit. All questions were
developed based on previously validated instruments
[17]. To ensure the survey was appropriate for the target
audience it was tested for reliability using a test–retest
Page 3 of 9Burns et al. BMC Res Notes (2016) 9:288
(n = 32), and for content validity using an expert panel of
health promotion, research, and tobacco control profes-

20. sionals (n = 8). Items with low internal consistency were
removed or modified [17].
Demographics
Demographics included gender and primary role at
the university. Primary role asked respondents to iden-
tify their main role at the university from four options:
undergraduate student, postgraduate student, academic
staff or general/professional (administrative/technical)
staff [17].
Tobacco use and second‑hand smoke exposure
Similar to other university-based studies [25, 26] four
categories of smoking status were defined: non-smoker
(never smoked cigarettes or never smoked regularly); ex-
smoker (previously smoked regularly-at least one ciga-
rette a day); regular smoker (at least one cigarette a day);
or occasional smoker (less than one cigarette a day on
average). For the purpose of comparison with key inde-
pendent variables the regular and occasional smoker
variables were collapsed to form one variable (smoker).
SHS exposure was measured by self-reported exposure
to cigarette smoke on campus in the previous four weeks
[17, 25, 27].
Attitudes towards smoking and smoking restrictions
Questions on attitudes towards smoking were adapted
from previously validated questions [27]. Attitudes
towards a smoke-free campus were measured using ques-
tions adapted from a study of staff at Australian TAFEs
(technical and further education—tertiary institutions
offering a variety of vocational education and training)
[28]. Response options included agree, neutral, and disa-
gree [17].
Awareness and attitudes towards campus smoking policy

21. Respondents were asked if they were aware of a cam-
pus smoking policy that restricted smoking on campus
(response options: yes, no, don’t know/not sure) and sub-
sequently how they would describe the current campus
smoking policy. Attitudes towards the impact of a smoke-
free campus were measured by four items: staff quality of
life; student quality of life; student learning; and student
enrolment with three responses: negative, neither nega-
tive nor positive, and positive.
Data analysis
Data was analysed using SPSS for Windows version 20.0.
The dependent variable was tobacco use; independent
variables included exposure to SHS, attitudes towards
smoking, attitudes towards smoking bans, and awareness
of campus smoking policy. Demographics of the sample
were explored through descriptive statistics. Chi square
analysis was used to explore the impact of a smoke-free
campus for smokers, ex-smokers, and non-smokers. Due
to the cross sectional nature of the study z-tests were cal-
culated to explore any differences between the baseline
and post samples [9]. Differences were considered signifi-
cant at p < 0.001 and moderately significant at p < 0.05.
Results
Of the staff and students who were invited to participate,
969 respondents (62.6 % female) provided complete data
at T1 and 670 (64.6 % female) at T2. This represented a
response rate of 19.4 % at T1 and 13.4 % at T2.
There was no significant difference between gender,
length of smoking or plans to quit smoking at T1 and
T2. Use of tobacco was similar although there was a
moderately significant difference in respondents who
had previously smoked with T2 respondents being more

22. likely to categorise themselves as an ex-smoker (T1 11 vs
T2 14.7 %; p < 0.05) (see Table 1). Smoking prevalence
was similar at both time periods with 9.3 and 8.4 % of
respondents reporting to smoke at T1 and T2 respec-
tively. Over half of smokers indicated they were plan-
ning to quit smoking in the future (T1 65.5 vs T2 62.3 %).
There was a significant difference in primary role at the
University with more undergraduate students respond-
ing at baseline (61.8 %) compared to T2 (54.3 %) and a
greater proportion of general/professional staff respond-
ing at T2 compared to T1 (T1 13.6 vs T2 17.6 %). Demo-
graphics of respondents are described in Table 1.
Second‑hand smoke exposure
Although respondents reported some exposure to SHS at
both T1 (79.4 %) and T2 (58.1 %), levels of exposure fell
significantly between the two time periods (p < 0.001).
Approximately one-third of respondents (33.2 %)
reported no exposure to SHS while on campus during
the past four week period at T2 compared to 15.2 % at
T1 (p < 0.001). At T1 23.8 % of respondents reported to
have been exposed to SHS once or more daily and 34.8 %
at least once a week compared to 8.6 and 21.4 % respec-
tively at T2 (p < 0.001) (Table 2). At both time periods
most respondents agreed that second-hand smoke causes
harm (T1 84.1 vs T2 85.1 %) however smokers were less
likely to agree with this statement compared to the total
population (T1 46.7 vs T2 42.6 %).
Attitudes towards smoking
When all responses were considered, attitudes towards
smoking were generally negative with little change in atti-
tudes between T1 and T2 (see Table 2). Most respondents
agreed that they would prefer to socialise in a smoke-free

23. Page 4 of 9Burns et al. BMC Res Notes (2016) 9:288
environment (T1 83.8 vs T2 85.1 %) and they would prefer
to date a non-smoker (T1 84.8 vs T2 86.5 %). A greater
proportion of respondents suggested they would seek
out smoke-free environments at T2 compared to T1 (T1
67.4 vs T2 72.2 %; p < 0.05). For both time periods smok-
ers reported more positive attitudes towards smoking
compared to non-smokers and ex-smokers. Ex-smokers
were significantly more likely to agree that second-hand
smoke causes harm (T1: 80.4 vs T2: 82.8 %; p < 0.05) and
to agree that they would ask others around them not to
smoke at T2 compared to T1 (T1 26.2 vs T2 41.9 %;
p < 0.002).
Attitudes towards smoke‑free campus
There was strong agreement that the campus should
be smoke-free in all buildings at both time periods
(T1 91.3 vs T2 92.8 %). Although there was less agree-
ment that the campus should be totally smoke-free includ-
ing all outdoor areas there was a significant increase in
positive responses to this statement at T2 compared to
T1 (T1 60.8 vs T2 71.4 %; p < 0.001). This was true for
non-smokers (p = 0.017) and ex-smokers (p = 0.014)
however there was no statistical significance in responses
for smokers between the two time periods (p = 0.562)
(see Table 3). Respondents were significantly more
likely to agree that restrictions on where you can smoke
make it hard for smokers on campus at T2 compared to
T1 (T1 38.5 vs T2 56.6 %; p < 0.01). Agreement with the
statement at T2 was more likely for both non-smokers
(p < 0.001) and smokers (p < 0.05). Non-smokers were
less likely to agree that there should be some places on
campus where people can go to smoke at T2 compared to

24. T1 (T1 48.9 vs T2 42.3 %; p < 0.05), however there were
no significant differences in attitudes towards this state-
ment for ex-smokers or smokers between the two time
periods.
Awareness of campus smoking policy
Awareness of campus smoke free policy increased sig-
nificantly between T1 and T2 with 56 % of respondents
reporting they were aware that there was a smoke free
policy at T1 compared to 79.8 % at T2 (p < 0.001). How-
ever when this response was analysed by smoking sta-
tus; awareness of the policy increased for non-smokers,
ex-smokers and smokers, although changes were only
significant for non-smokers and ex-smokers (p < 0.001).
Awareness of specific aspects of the policy varied. At T1
58.7 % of respondents correctly identified that staff, stu-
dents and visitors were allowed to smoke in designated
areas of the campus but not inside the buildings. At T2,
65.9 % of respondents correctly identified that smoking
was now banned throughout the campus (Table 4).
Table 1 Demographics and smoking status at T1 and T2
* p < 0.05, ** p < 0.01
T1 T2 Significance (p) T1/T2
Gender
Male 362 (37.4) 237 (35.4) 0.412
Female 607 (62.6) 433 (64.6) 0.412
Total 969 670
Primary role

25. Undergraduate student 599 (61.8) 364 (54.3) 0.002**
Postgraduate student 141 (14.6) 108 (16.1) 0.384
General/Professional staff member 132 (13.6) 118 (17.6)
0.027*
Academic staff member 97 (10) 80 (11.9) 0.215
Total 969 670
Use of tobacco
Never smoked cigarettes at all, or never smoked them regularly
(non-smoker) 771 (79.6) 508 (76.2) 0.101
Do not smoke now but used to smoke them regularly (once or
more per day) (ex-smoker) 107 (11) 98 (14.7) 0.029*
Occasionally smoke (on average, less than one per day)
(smoker) 39 (4) 34 (5.1) 0.303
Currently smoke cigarettes (more than one per day) (smoker) 51
(5.3) 22 (3.3) 0.059
Prefer not to answer 1 (0.1) 5 (0.7) 0.033*
Total 969 667
Are you planning on quitting smoking?
Yes 59 (65.5) 38 (62.3) 0.682
No 31 (34.5) 23 (37.7) 0.001*

26. Total 90 61
Page 5 of 9Burns et al. BMC Res Notes (2016) 9:288
Discussion
Second‑hand smoke exposure
This study found significant reductions in all levels of
exposure to SHS over the two time periods. Despite these
promising results only one-third of respondents (33.2 %)
reported to have never been exposed to cigarette smoke
at T2 which indicates SHS exposure remains present and
unacceptably high. Smoke-free policies may drive smok-
ers to the periphery of campus and thereby still expose
students and staff to SHS during entry and exit to cam-
pus [10]. This is especially pertinent to this university
as the grounds are large (116 hectares) with poorly lit
perimeters making policy enforcement challenging [17].
The finding that a proportion of people continue to
smoke on campus despite the ban is supported by an
observational study at this university which was imple-
mented to measure compliance. Of the 50 smokers
observed, 37 agreed to participate in an intercept sur-
vey. Reasons for noncompliance with the policy included
defiance, necessity to smoke, inconvenience of travelling
off campus, unintentional noncompliance, and ease of
avoidance of detection, which may stem from inadequate
enforcement [29]. Enforcement is a key component to
supporting smoke-free policy and it is recommended
that it is implemented with initial warnings and educa-
tion, progressing to penalties if individuals continue not
to comply with the policy [30, 31].

27. Prevalence of tobacco smoking
Prevalence of tobacco smoking in this study was lower
than for the general adult population in Australia (daily
smoking 12.8 % in 2013) [32] however these findings are
consistent with other studies conducted at this univer-
sity [25]. The implementation of the smoke-free policy
Table 2 Agreement with tobacco smoking attitude statements
reported by University staff and students at T1 and T2
* p < 0.05, ** p < 0.01
Total sample
Baseline (n = 968)
Post (n = 636)
Non‑smokers N (%) Ex‑smokers N (%) Smokers N (%) Total #
of participants
who agree N (%)
Total
Baseline (T1) 771 107 90
Post (T2) 489 93 54
If someone smokes cigarettes around me they are causing me
harm because of second-hand smoke
Baseline 686 (89) 86 (80.4) 42 (46.7) 814 (84.1)
Post 441 (90.2) 77 (82.8) 23 (42.6) 541 (85.1)
Significance (T1/T2) 0.497 0.66 0.631 0.596
I prefer to socialise in a smoke-free environment

28. Baseline 695 (90.1) 86 (80.4) 30 (33.3) 811 (83.8)
Post 445 (91) 75 (80.6) 21 (38.9) 541 (85.1)
Significance (T1/T2) 0.610 0.960 0.502 0.490
I seek out smoke-free environments
Baseline 572 (74.2) 67 (62.6) 13 (14.4) 652 (67.4)
Post 388 (79.3) 60 (64.5) 11 (20.4) 459 (72.2)
Significance (T1/T2) 0.037* 0.779 0.358 0.041*
It disappoints me when a friend who normally doesn’t smoke,
smokes cigarettes while drinking
Baseline 547 (70.9) 46 (43) 13 (14.4) 606 (62.6)
Post 364 (74.4) 40 (43) 9 (16.7) 413 (64.9)
Significance (T1/T2) 0.177 1 0.719 0.342
I would rather date a non-smoker
Baseline 701 (90.9) 84 (78.5) 36 (40) 821 (84.8)
Post 458 (93.7) 74 (79.6) 18 (33.3) 550 (86.5)
Significance (T1/T2) 0.080 0.857 0.424 0.352
I ask others not to smoke around me
Baseline 354 (44.7) 28 (26.2) 2 (2.2) 375 (38.7)

29. Post 231 (47.2) 39 (41.9) 6 (11.1) 276 (43.4)
Significance
(T1/T2)
0.646 0.018* 0.024* 0.062
Page 6 of 9Burns et al. BMC Res Notes (2016) 9:288
had little impact on the prevalence of smoking over the
two time periods however this may be due to the low
baseline prevalence and the short time period that the
policy had been in place. Although studies have dem-
onstrated success in reducing prevalence through the
implementation of policy [9] it is also acknowledged
that policy is best combined with other strategies [1,
33]. Over 60 % of smokers in this study indicated they
were planning to quit smoking in the future. Consistent
with the Transtheoretical Model which helps to explain
different stages of change in the behaviour change pro-
cess, smokers in the contemplation and preparation
stages are ideal participants for quit smoking interven-
tions [34].
Attitudes to smoking
Attitudes towards tobacco smoking remained simi-
lar over the two time periods. Consistent with Austral-
ian data the majority of non-smokers reported negative
attitudes towards smoking [3]. The lack of change may
reflect the social norms associated with smoking in Aus-
tralia [35] and/or the predominately policy based nature
of the intervention as the policy implementation included
minimal awareness raising strategies and quit sessions for
staff.

30. Support for policy implementation has been identified
as critical to success [36]. Similar to this study, US college
studies have reported students to be generally support-
ive of smoke-free policy, especially smoke-free buildings
Table 3 Agreement with tobacco control attitude statements
reported by University staff and students at T1 and T2
* p < 0.05, ** p < 0.01
Total sample
Baseline (n = 968)
Post (n = 636)
Non‑smokers N (%) Ex‑smokers N (%) Smokers N (%) Total #
of participants
who agree N (%)
Total
Baseline (T1) 771 107 90
Post (T2) 489 93 54
Our campus should be smoke-free including all out door areas
Baseline 517 (67.1) 54 (50.5) 18 (20) 589 (60.8)
Post 378 (77.3) 63 (67.7) 13 (24.1) 454 (71.4)
Significance (T1/T2) 0.000** 0.014* 0.562 0.000**
The restrictions on where you can smoke makes it hard for
smokers on campus

31. Baseline 275 (35.7) 54 (50.5) 44 (48.9) 373 (38.5)
Post 262 (53.6) 58 (62.4) 40 (74.1) 360 (56.6)
Significance 0.000** 0.091 0.003** 0.000**
There should be some places on campus where people can go to
smoke
Baseline 377 (48.9) 72 (67.3) 70 (77.8) 519 (53.6)
Post 207 (42.3) 54 (58.1) 38 (70.4) 299 (47)
Significance (T1/T2) 0.023* 0.177 0.322 0.009**
There should be more help or support at university for people
who want to quit smoking
Baseline 470 (61) 59 (55.1) 43 (47.8) 572 (59.1)
Post 295 (60.3) 40 (43) 18 (33.3) 353 (55.5)
Significance (T1/T2) 0.826 0.087 0.891 0.156
Because of their professional role, university staff have a
responsibility to be non-smokers
Baseline 280 (36.3) 20 (18.7) 8 (8.9) 308 (31.8)
Post 191 (39.1) 22 (23.7) 8 (14.8) 221 (34.7)
Significance (T1/T2) 0.327 0.39 0.271 0.223
Our campus should be smoke free in all buildings
Baseline 724 (93.9) 97 (90.7) 63 (70) 884 (91.3)

32. Post 467 (95.5) 88 (94.6) 35 (64.8) 590 (92.8)
Significance (T1/T2) 0.226 0.289 0.516 0.298
Our campus should be completely smoke-free
Baseline 553 (71.7) 63 (58.9) 20 (22.2) 636 (65.7)
Post 345 (70.6) 57 (61.3) 10 (18.5) 412 (64.8)
Significance (T1/T2) 0.653 0.726 0.596 0.704
Page 7 of 9Burns et al. BMC Res Notes (2016) 9:288
[20, 37] and the reduction of SHS, however they were less
likely to agree that the campus should be totally smoke-
free [20]. Although the current study found around half
of all respondents felt there should be places people can
go to smoke on campus at both time periods this was
lower (T1 53.6 vs T2 47 %; p < 0.05) at T2. As in this
study, a US study found while smokers were more likely
to agree that there should be some places on campus to
smoke, non-smokers also felt smokers had the right to
smoke on campus [20]. While 92.8 % of respondents in
the current study felt the campus should be smoke-free
in all buildings at T2 only 64.8 % felt the campus should
be completely smoke-free. There was no significant dif-
ference in these responses over the two time periods.
Similarly, another US study reported that over 70 %
of college students and staff agreed that their campus
Table 4 Staff and students awareness of campus tobacco

33. smoking policy at T1 and T2
* p < 0.05, ** p < 0.01
Total Sample
Baseline (n = 968)
Post (n = 636)
Non‑smokers N (%) Ex‑smokers N (%) Smokers N (%) Total #
of participants
who agree with the
statement N (%)
Total
T1 771 107 90
T2 489 93 54
Awareness of policy
Yes
Baseline 405 (52.5) 72 (67.3) 65 (72.2) 542 (56)
Post 396 (78.7) 83 (86.5) 43 (78.2) 522 (79.8)
Significance (T1/T2) 0.000** 0.000** 0.322 0.000**
No
Baseline 189 (24.5) 12 (11.2) 19 (21.1) 220 (22.7)
Post 47 (9.3) 12 (12.5) 4 (7.3) 63 (9.6)
Significance (T1/T2) 0.000** 0.711 0.03* 0.000**

34. Don’t know/not sure
Baseline 177 (23) 23 (21.5) 6 (6.7) 206 (21.3)
Post 60 (11.9) 1 (1) 8 (14.5) 69 (10.6)
Significance (T1/T2) 0.000** 0.000** 0.11 0.000**
Describe the policy
No policy on tobacco smoking in place
Baseline 43 (5.6) 4 (3.7) 3 (3.3) 50 (5.2)
Post 22 (4.4) 3 (3.1) 6 (10.9) 31 (4.7)
Significance (T1/T2) 0.401 0.842 0.062 0.697
Staff, students, and visitors are allowed to smoke tobacco in
designated areas of campus buildings
Baseline 65 (8.4) 9 (8.4) 13 (14.4) 87 (9)
Post 25 (5) 4 (4.2) 2 (3.6) 31 (4.7)
Significance (T1/T2) 0.026* 0.238 0.041* 0.001**
Staff, students, and visitors are allowed to smoke tobacco in
designated areas of the campus grounds but not inside the
buildings
Baseline 447 (58) 65 (60.7) 56 (62.2) 568 (58.7)
Post 62 (12.3) 10 (10.4) 4 (7.3) 76 (11.6)

35. Significance (T1/T2) 0.000** 0.000** 0.000** 0.000**
Staff, students, and visitors are banned from smoking tobacco
throughout the campus; this includes all university buildings
grounds and vehicles
Baseline 61 (7.9) 11 (10.3) 5 (5.6) 77 (8)
Post 324 (64.4) 69 (71.9) 38 (69.1) 431 (65.9)
Significance (T1/T2) 0.000** 0.000** 0.000** 0.000**
Don’t know/not sure
Baseline 155 (20.1) 18 (16.8) 13 (14.4) 186 (19.2)
Post 70 (13.9) 10 (10.4) 5 (9.1) 85 (13)
Significance (T1/T2) 0.009** 0.219 0.363 0.001**
Page 8 of 9Burns et al. BMC Res Notes (2016) 9:288
should be totally smoke-free [10]. Consistent with other
studies [10] the current study found smokers to be least
supportive of smoke-free policy. Despite changing norms
towards smoking, and support generally being shown
for smoke-free policies by smokers, some studies still
find this group to be unsupportive of smoke-free policies
which may translate into non-compliance [17, 28].
While changes in policy awareness were positive
between the two time periods, over one-third of respond-
ents (34.1 %) were not aware of the specific restrictions
associated with the total ban on smoking on campus at

36. T2 supporting the need to continue to promote and
enforce the policy. Successful implementation of smoke-
free policy should include a comprehensive range of
strategies (for example, awareness raising, education,
quit sessions) and the policy needs to be consistently
enforced [5, 17]. Other studies assessing the implemen-
tation of smoke-free policy in large learning institutions
have found that enforcement can be difficult even when
there is a perception of high compliance among the pop-
ulation [28, 38]. Staff and students from a New Zealand
university suggest compliance should be enforced, poten-
tially by campus security [31]. Similarly, key stakeholders
and staff and student smokers from this university sug-
gested enforcement to be an important consideration for
the effectiveness of the policy, however given the exten-
sive grounds of this university this would be challenging
unless sufficient resources were provided [16, 17]. Cur-
rently the policy is enforced by Campus Security staff
who issue a warning or fine to repeat offenders.
A successful smoke-free policy can educate the com-
munity on the health benefits of not smoking, and
provide assistance for smoking cessation [17, 22, 39]
however policy implementation needs to also consider
the stigmatisation of smokers and in the case of this cam-
pus, smokers safety if they are to leave grounds to smoke
[16, 29]. A qualitative study conducted at this university
found smokers to feel stigmatised and marginalised [16].
While stigmatising smoking has been a strategy of smok-
ing control programs [10] there has been less focus on
the unintended consequences which may include guilt,
poor self-esteem and continued maintenance of smok-
ing [40]. It is recommended public health interventions
consider the negative psychological consequences of stig-
matization and include strategies that focus on positive
reinforcement and cessation support [40].

37. Universities provide a challenging yet important set-
ting for health promotion. For young university students
time at university represents an important transitional
period where health behaviours such as tobacco use may
become established [25]. While universities provide a
range of social experiences which have the potential to
influence smoking initiation and maintenance [25, 41]
they also provide an ideal setting to positively impact
health behaviours, including tobacco use [25].
Limitations
The cross sectional nature of this study precludes any causal
effects. The low proportion of smokers who participated
in this survey, while similar to other Australian university
and TAFE [25, 28] and New Zealand university [31] studies
may be due to selective non-reporting or under-reporting
[26]. The low response rate, while similar to other stud-
ies [28, 42] is a limitation, however this study had limited
resources for incentives and follow up. Although there are
slightly more female students (55 %) and staff (54 %) at the
university the overrepresentation of females (64.6 %) is also
a limitation of this study. A higher proportion of smokers
may have resulted in more positive attitudes towards smok-
ing and more negative views of related policy.
Conclusions
Despite minimal supporting strategies, the implementa-
tion of the total smoking ban on campus resulted in sig-
nificant reductions in exposure to second-hand smoke
on a daily and weekly basis. While smoking prevalence
did not change during the one year time period this was
low at T1 (9.3 %). The study found strong support for the
policy, however as expected smokers were least likely to
support the total ban. The findings demonstrate the ben-

38. efits of total smoking bans in large institutions but also
highlight the need for a range of coordinated strategies
which include awareness raising, education and enforce-
ment, with targeted intervention such as cessation sup-
port available for those who smoke.
Abbreviations
SHS: second-hand smoke; T1: data collection: time period 1;
T2: data collec-
tion: time period 1.
Authors’ contributions
SB, EH, JJ, JH, GC have made substantial contributions to the
conception
and design of the paper. SB and EH made substantial
contributions to the
data analysis. SB, JJ, JH, GC, LP were involved in planning and
implementing
the intervention. All authors reviewed the article for important
intellectual
content. All authors read and approved the final manuscript.
Acknowledgements
We would like to acknowledge Nicole Bowser who was the
project officer for
this study. We would also like to acknowledge the participants
of this study
who gave their time to complete the survey, the Curtin Office
for Strategy and
Planning for help administering the survey.
Competing interests
The authors declare that they have no completing interests.
Ethical approval
Curtin University Human Research Ethics Committee provided

39. approval for
this study (SPH-28/2011).
Informed consent
Participants provided consent at the time of the online survey
completion.
Page 9 of 9Burns et al. BMC Res Notes (2016) 9:288
Received: 24 April 2016 Accepted: 15 May 2016
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RESEARCH Open Access
An exploratory analysis of the impact of a
university campus smoking ban on staff and
student smoking habits in Japan
Hiroki Ohmi1*, Toshiyuki Okizaki1†, Martin Meadows2†,
Kazuyuki Terayama2† and Yoshikatsu Mochizuki3†
Abstract
Background: Smoking bans in public places have been shown to
have an impact on smoking habits, however the
potential influence of a university smoking ban on faculty and
staff smoking habits remains elusive.
Methods: This cross sectional study was implemented in Nayoro
City, Japan in 2011, among the faculty and
students of the Nayoro City University. Five years after the
declaration of a total ban on smoking on a university
campus, the smoking characteristics of all students, teachers
and office workers, and the policy’s impact on smokers
were investigated. The survey was conducted through an
anonymous, self-administered, multiple-choice
questionnaire. Information was gathered on the characteristics
and smoking characteristics of respondents, and the
smokers attitudes toward smoking.
Results: The recovery rate was 62.1%. Among respondents,
smoking prevalence was 17.9% in teachers and office

48. workers, and 4.0% in students. Among all smokers, 46.4% did
not abstain from smoking while at the university and
they indicated their smoking areas were “on the streets next to
the campus”: 16 and “outdoors on campus”: 3,
respectively. As for smokers, 29.6% of them reduced the
number of cigarettes smoked per day as a result of the
smoking ban. None of the ex-smokers replied that their
principal motivation for quitting smoking was the smoking
ban.
Conclusions: The ban on smoking served a motivator for
smokers to reduce in smoking, but not serve as an
effective motivator to quit smoking.
Keywords: University smoking policy, Total smoking ban,
Impact on smokers
Background
In Japan, a health promotion plan named “Healthy Japan
21” was published by the Ministry of Health and Welfare
in 2000 [1]. In the section dealing with anti-tobacco
measures, four aims were set. One of these aims was to
protect non-smokers from second-hand smoke in public
spaces. After release of the plan, several institutions en-
deavored to protect their users from second-hand
smoke, however they failed to take sufficient measures.
In order to give legal infrastructure to the plan, the
Health Promotion Law was implemented in 2003.
According to this law, it is the duty of institutional
managers to provide protection from passive smoking.
Article 25 of the law states that “persons in charge of
management at facilities used by large numbers of
people, such as schools, gymnasiums, hospitals, theaters,
viewing stands, assembly halls, exhibition halls, depart-
ment stores, offices, public facilities, and eating and

49. drinking places shall endeavor to take necessary mea-
sures to protect users of these facilities from being ex-
posed to second-hand smoke, (passive smoking refers to
being forced to inhale other people’s second hand smoke
in an indoor or equivalent environment)” [2].
A number of universities and colleges have declared a
smoke-free policy on campus, based on this law [3]. Re-
cent decreases in the prevalence of smoking among Jap-
anese adolescents may be due partly to such smoke-free
policies at school [4]. However, the impact of a school’s
* Correspondence: [email protected]
†Equal contributors
1Department of Nutritional Sciences, Faculty of Health and
Welfare Science,
Nayoro City University, W4-N8, Nayoro 096-8641, Hokkaido,
Japan
Full list of author information is available at the end of the
article
© 2013 Ohmi et al.; licensee BioMed Central Ltd. This is an
Open Access article distributed under the terms of the Creative
Commons Attribution License
(http://creativecommons.org/licenses/by/2.0), which permits
unrestricted use, distribution, and
reproduction in any medium, provided the original work is
properly cited.
Ohmi et al. Tobacco Induced Diseases 2013, 11:19
http://www.tobaccoinduceddiseases.com/content/11/1/19
mailto:[email protected]
http://creativecommons.org/licenses/by/2.0

50. smoke-free policy on the entire population of students,
teachers and office workers who habitually smoke has
not been conclusively identified.
In Nayoro City University, a smoking policy that in-
cludes a total ban on smoking both indoors and out-
doors on campus was declared in 2006. Five years after
introduction, the smoking characteristics of the entire
university population and the impact of the total smok-
ing ban on smokers were investigated in 2011.
Methods
Subjects
In May 2011, Nayoro City University was comprised of
101 teachers and office workers (male: 50, female: 51)
and 712 students (male: 118, female: 594), all of whom
participated in the survey. Students belonged to The
Faculty of Health and Welfare Science or Early Child-
hood Education.
Data collection
Data collection was done anonymously in May 2011 by
means of a self-administered, multiple-choice question-
naire. The questionnaire asked for information about
gender, status in the school (i.e. teacher, office worker or
student), and smoking characteristics (i.e. non-smoker,
ex-smoker, or smoker). Ex-smokers were asked about
their motivations for quitting smoking. The question-
naire also asked smokers about the number of cigarettes
smoked per day, years of smoking, items from the
Fagerström Test for Nicotine Dependence (FTND), their
smoking habits while at the university (i.e. abstinence or
not), smoking area while at the university, impact of the
smoking ban, the effect of a price increase on the num-
ber of cigarettes smoked per day, and their intention to

51. quit smoking.
The protocol of this study was approved by the Ethics
Committee of Nayoro City University.
Statistical analysis
Data were digitized then analyzed with descriptive sta-
tistics according to characteristics of subjects. With re-
spect to smokers, differences in years of smoking and
FTND between teachers/office workers, and students
were analyzed by Student’s t-test and Mann Whitney U-
test, respectively. In the same way, the relationship
between smoking habits of smokers while at the univer-
sity, and smoking characteristics and FTND were ana-
lyzed with the same tests. All P-values were based on a
two-tailed test and a significance level lower than 0.05
was defined as significant. Statistical analysis was
performed using the Dr. SPSS 2 for Windows 11.0.1 J
statistical package.
Table 1 Smoking prevalence of staff and students of the Nayaro
City University, Japan, 2011
Subject Respondent n (%)
Non-smoker Ex-smoker Smoker
Teachers & office workers
Male 50 25 13 (52.0) 7 (28.0) 5 (20.0)
Female 51 31 18 (58.1) 8 (25.8) 5 (16.1)
Subtotal 101 56 31 (55.4) 15 (26.8) 10 (17.9)
Students

52. Male 118 68 59 (86.8) 3 (4.4) 6 (8.8)
Female 594 381 362 (95.0) 7 (1.8) 12 (3.1)
Subtotal 712 449 421 (93.8) 10 (2.2) 18 (4.0)
Total 813 505 452 (89.5) 25 (5.0) 28 (5.5)
Table 2 Motivators for ex-smokers to quit smoking of staff and
students of the Nayaro City University, Japan, 2011
Most appropriate motivator Teachers & office workers Students
Subtotal
(%)Male Female Male Female
Ban on smoking 0 0 0 0 0 ( 0.0)
Price increase 2 1 1 1 5 (23.8)
Own health 2 2 1 4 9 (42.9)
Partner’s health 1 1 0 0 2 ( 9.5)
Child’s health 0 1 0 0 1 ( 4.8)
Partner’s comfort 0 0 0 2 2 ( 9.5)
Other 1 1 0 0 2 ( 9.5)
Ohmi et al. Tobacco Induced Diseases 2013, 11:19 Page 2 of 5
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Results

53. Smoking prevalence
Among 813 subjects, we obtained valid responses from 56
teachers and office workers (recovery rate: 55.4%) and 449
students (recovery rate: 63.1%) (Table 1). Among respon-
dents, the smoking prevalence was 17.9% among teachers
and office workers, and 4.0% among students.
Motivators for ex-smokers to quit smoking
Ex-smokers were asked to indicate the most appropriate
motivator THAT LEAD THEM TO QUIT SMOKING.
Among the listed motivators, none of the ex-smokers re-
plied that the most appropriate motivator for quitting
smoking was the ban on smoking (Table 2).
Smoking characteristics and habits of smokers
The smoking characteristics of smokers is shown in
Table 3. The number of years smoking among teachers
and office workers was greater than among students
(P=0.007: Student’s t-test). Statistically, there was no dif-
ference in FTND between teachers/office workers, and
students (Mann Whitney U-test). Among all smokers,
46.4% did not abstain from smoking while at the uni-
versity and they indicated their smoking areas were “on
the streets next to the campus”: 16 and “outdoors on
campus”: 3, respectively (Table 4). Number of cigarettes
smoked per day and FTND among non-abstinent
smokers were significantly greater than those among
the abstinent smokers (number of cigarette: P=0.001:
Student’s t-test and FTND:P=0.029: Mann Whitney U-
test, respectively, Table 5).
Impact of ban on smoking and intention to quit smoking
The impacts of the ban on smoking and the price in-
crease on the number of cigarettes smoked per day are
shown in Table 6. As for the smokers’ intention to quit

54. smoking, 48.1% replied “I do not want to quit smoking
now”, and another 48.1% replied “I want to quit smoking
in the near future”, while only one student replied, “I am
trying to quit smoking now” (Table 7).
Discussion
Main findings of this study
According to a previous survey on female students in the
Department of Nursing Science at Nayoro City University
(students in other departments were not included),
Table 3 Smoking characteristics of smokers of staff and
students of the Nayaro City University, Japan, 2011
n mean SD
Number of cigarettes smoked per day
Teachers & office workers male 5 15.4 5.3
female 4 12.5 6.5
Students male 6 10.7 4.8
female 12 11.8 6.6
Number of years of smoking n mean SD
Teachers & office workers male 5 22.2 10.1
female 4 11.5 10.5
Students male 6 4.7 3.8
female 12 4.0 1.6

55. P=0.007: Student’s t-test
FTND n median min max
Teachers & office workers male 5 5 3 8
female 4 1.5 0 3
Students male 6 2 1 5
female 12 2 0 6
P=ns, Mann Whitney U-test.
FTND Fagerström test for nicotine dependence.
Table 4 Smoking habits while at the university of staff
and students of the Nayaro City University, Japan, 2011
n (%) Smoking area (multiple
answers allowed)
n
Abstinent 15 (53.6)
Not abstinent 13 (46.4) On the streets next to the campus 16
Outdoors on campus 3
Indoors on campus 0
Table 5 Smoking habits while at the university and
smoking characteristics of staff and students of the
Nayaro City University, Japan, 2011
Number of cigarettes smoked per day n mean SD

56. Abstinent 13 8.9 3.4
Not abstinent 14 15.6 5.9
P=0.001: Student’s t-test
FTND n median min max
Abstinent 13 2 0 4
Not abstinent 14 3 1 8
P=0.029: Mann Whitney U-test
Table 6 Impact of ban on smoking and price increase on
number of cigarettes smoked per day of staff and
students of the Nayaro City University, Japan, 2011
n (%)
Ban on smoking Intend to decrease 8 (29.6)
No intent to decrease 19 (70.4)
Price increase Intend to decrease 5 (18.5)
No intent to decrease 22 (81.5)
Ohmi et al. Tobacco Induced Diseases 2013, 11:19 Page 3 of 5
http://www.tobaccoinduceddiseases.com/content/11/1/19
smoking prevalence was 12.3% in 2002 and 10.5% in 2003,
respectively [5]. In this 2011 survey, smoking prevalence

57. had decreased to 4.3% of students. A school policy
restricting smoking based on the Health Promotion Law
might be a contributory factor in discouraging the initi-
ation of smoking. As a result, the yearly admission of stu-
dents who do not later take up smoking may have had a
cumulative effect, leading to an overall decrease in the
prevalence of smoking [4].
As for smokers, 29.6% of them reduced the number of
cigarettes smoked per day as a result of the smoking
ban. More than half of smokers abstained from smoking
at the university. The ban on smoking was demon-
strated to have a certain effect in smoking reduction for
smokers.
By contrast, none of the ex-smokers also replied that
their principal motivation for quitting smoking was the
smoking ban. In the case of smokers, around 30% of
them reduced the number of cigarettes smoked per day
in consequence of the ban on smoking, however, almost
all of them were not willing to quit smoking. The ban
on smoking served a motivator for smokers to reduce in
smoking, but not serve as an effective motivator to quit
smoking.
The preventative effects of a reduction in smoking
on smokers’ own tobacco-related diseases differs across
studies [6-9]. Although it is still uncertain if a re-
duction in smoking has any preventative effect on
smokers’ tobacco-related diseases, several studies have
confirmed the health benefits of quitting smoking [10].
However, almost all the surveyed smokers were unwill-
ing to quit smoking right now in spite of current
school policy. For smokers, the ban on smoking did
not provide an effective motivator to quit smoking but
led to smoking on the streets off campus while at the

58. university. In this study, a heavy addiction was related
to non-abstinence while at the university, and smoking
on the street. The impact of a smoke-free policy on at-
titudes and quitting behaviors varies among studies
[11-15]. The reason might be that the principal aim of
the Health Promotion Law and school policy based on
that law is to protect non-smokers from second-hand
smoke, but not to encourage smokers to quit smoking.
Changing attitudes and behaviors among smokers
would be an unintended consequence of this legislation
and/or policy. In order to encourage addicted smokers
to quit smoking, other approaches that incorporate
effective educational and medical measures may be ne-
cessary. In Japan, smoking cessation therapy with nico-
tine gum/patches and varenicline has been covered by
health insurance under certain conditions since 2006
[16]. But almost all student smokers are excluded from
this insured treatment because of the short duration of
their smoking. Smoking cessation therapies for adoles-
cents and young adults with a short history of smoking
should be covered by health insurance in order to pre-
vent heavier addiction. In this study, smoking teachers
and office workers with a longer smoking history were
not any more willing to quit smoking than student
smokers.
Limitations of this study
This study was conducted in a small university with a
small sample size. Student subjects constituted a near
homogeneous age group. Smoking prevalence was inves-
tigated once in 2011 in a cross-sectional survey, but a
survey was not conducted in 2006 when the policy was
first declared. This study focused on smokers’ attitudes
and desires to quit, however non-smokers’ perceptions
were not investigated. Although the results may not be

59. generalizable, they do, however, provide some evidence
of the impact of a school, smoke-free policy based on
the Japanese Health Promotion Law on staff and stu-
dents who are habitual smokers.
Conclusions
Five years after the introduction of a university smoke-
free policy with a campus-wide smoking ban, the impact
of the ban on smokers was investigated. A total ban on
smoking served a motivator for smokers to reduce in
smoking, but not serve as an effective motivator to quit
smoking.
In order to encourage addicted smokers to quit smok-
ing, approaches other than a smoking ban that provide
effective educational and medical measures may be
crucial.
Competing interests
All the authors have no competing interest relevant to this
article.
Authors’ contributions
HO had primary responsibility for protocol development, data
collection,
outcome assessment, preliminary data analysis, and writing of
the
manuscript. TO participated in the data collection, analysis and
contributed
to the writing of the manuscript. MM, KT and YM supervised
the study,
Table 7 Intention to quit smoking of staff and students
of the Nayaro City University, Japan, 2011
n n (%)

60. Teachers & office
workers
Students Subtotal
I do not want to quit
smoking now.
8 5 13 (48.1)
I want to quit smoking
in near future.
2 11 13 (48.1)
I want to quit smoking
right now.
0 0 0 (0.0)
I am trying to quit smoking
now.
0 1 1 (3.8)
Ohmi et al. Tobacco Induced Diseases 2013, 11:19 Page 4 of 5
http://www.tobaccoinduceddiseases.com/content/11/1/19
performed the final data analysis, and contributed to the writing
of the
manuscript. All authors read and approved the final manuscript.
Author details

61. 1Department of Nutritional Sciences, Faculty of Health and
Welfare Science,
Nayoro City University, W4-N8, Nayoro 096-8641, Hokkaido,
Japan.
2Department of Liberal Arts Education, Faculty of Health and
Welfare
Science, Nayoro City University, W4-N8, Nayoro 096-8641,
Hokkaido, Japan.
3School of Nursing Science, Asahikawa Medical University,
E2-1-1-1,
Midorigaoka, Asahikawa 078-8510, Japan.
Received: 23 July 2012 Accepted: 12 September 2013
Published: 15 September 2013
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Cite this article as: Ohmi et al.: An exploratory analysis of the
impact of
a university campus smoking ban on staff and student smoking
habits
in Japan. Tobacco Induced Diseases 2013 11:19.
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allowed to download, reprint,
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AbstractBackgroundMethodsResultsConclusionsBackgroundMet
hodsSubjectsData collectionStatistical analysisResultsSmoking
prevalenceMotivators for ex-smokers to quit smokingSmoking
characteristics and habits of smokersImpact of ban on smoking
and intention to quit smokingDiscussionMain findings of this
studyLimitations of this studyConclusionsCompeting
interestsAuthors’ contributionsAuthor detailsReferences