Study Design
This study is based on two repeated cross-sectional surveys. The first was conducted prior to the implementation of the smoke-free policy (2017) while the second was done one year after (2018). A sample of 1722 staff and 960 faculty members was randomly selected in each round. Faculty and staff were sent invitations by emails and were asked to access a survey link if they considered participating. To ensure participation of lower grade staff (who rarely use their email accounts), hard copies of the questionnaire were also placed for 2 weeks in the administration office of almost all departments. Completed surveys were deposited in a locked box. Where needed, a research assistant from the Faculty of Health Sciences was available to assist staff, wishing to participate, in filling the questionnaire. The response rate was around 23% in both years (625 participated in 2017 and 624 in 2018). The research protocol was approved by the Institutional Review Board at AUB. Participation was voluntary and data were kept anonymous.
Measures
The online 55-question survey took 5–7 min to complete. The questionnaire asked about demographic information, faculty and staff attitude towards the smoking policy, perceived benefits, and smoking behavior. To ensure appropriateness and clarity of the survey, pre-testing was done on a small number (n = 20) of staff and faculty members before invitations were sent.
Demographics
Information on gender, age, marital status, and number of children were collected. Participants were asked to identify their primary role (staff or faculty) and their educational attainment (primary, intermediate, technical, secondary, bachelor’s, master’s, and doctoral degrees).
Smoking behavior
Information on the smoking status, history, and frequency were collected. The smoking status, initially divided into four categories (non-smokers, ex-smokers, occasional smokers and regular smokers) was grouped into two: smokers (current) and non-smokers (never smoked, former and occasional smoker). Participants, identifying themselves as smokers, were further asked if they considered themselves addicted, had concerns about the health effects of smoking, had intentions to quit, had made quit attempts, and considered participating in a cessation program. In addition, smokers had to report any changes (increase, decrease, remained the same) in smoking intensity post-policy implementation.
Attitude towards the smoking policy
Participants’ attitude towards the policy was assessed by the extent of support, and the extent to which they believed that the university tobacco-free policy had created a healthy environment, and promoted quit attempts. In addition, they were asked whether there should be exceptions to the policy. All these responses were initially reported on a 3-point Likert scale (large extent, some extent, not at all, not sure) then dichotomized into Yes or No (large extent and some extent were considered Yes, while not at all and not sure were considered as No).
Perception of compliance and benefits
In this section, participants had to determine whether they perceive their peers as compliant or not compliant with the policy. They were also asked to determine the extent to which they perceive the following as policy benefits: reduction in smoking frequency, increase in faculty and staff productivity, decrease in rate of faculty and staff sick days, and decrease in rate of student absences. Responses were first reported on a 4-point Likert scale (not a benefit, minor benefit, moderate benefit, major benefit and don’t know) then dichotomized into Yes or No (minor benefit, moderate benefit, and major benefit were considered Yes, while not a benefit and don’t know were considered as No).
Statistical analysis
Based on their educational attainment, smokers were stratified into participants with lower educational attainment (< bachelor degree (BD)) and higher educational attainment (> BD). χ² tests were computed to determine differences in attitude, perceived compliance, and perceived policy benefits pre- and one year post-policy implementation among smokers and non-smokers. The same analysis was repeated on smokers stratified by educational attainment. Significant differences were identified at a p value < 0.05. All the statistical analyses were performed using the statistical software R version 3.4.1.