On June 1, 2017, The University of Texas at Dallas enacted a comprehensive tobacco-free policy, prohibiting all forms of tobacco use on campus. It was a significant moment not just for the campus and its students, faculty, and staff, but for the entire University of Texas System, which became, at the same moment, the first entirely tobacco-free university system in the state and the largest single employer in Texas to prohibit tobacco use in the workplace.

Tobacco-free policies vary somewhat by campus, but every policy prohibits all forms of tobacco use on the grounds and in the buildings of every facility affiliated with the university. Every campus is also providing prevention and cessation services to students and staff.

“This was not inevitable,” says David Lakey, M.D., Chief Medical Officer and Associate Vice Chancellor for Population Health for UT System. “Just a year ago, 3 of our 14 institutions did not have comprehensive tobacco-free policies in place. Now they all do, and the work is continuing to improve not just the policies but the services offered as well, so that more people are quitting and fewer people are starting. It’s a remarkable accomplishment and testament to the hard work of a lot of people who care passionately about improving and protecting the health of their communities.”

The establishment of an entirely tobacco-free system was the product, in particular, of UT Eliminate Tobacco Use, an initiative launched in 2015 to coordinate and improve tobacco control efforts, and to create a tobacco free culture, across the 14 campuses of the UT System.

The initiative, led by The University of Texas MD Anderson Cancer Center and UT System, began in February of last year with a system-wide Eliminate Tobacco Use Summit. The Summit brought together representatives from all the campuses as well as tobacco control partners throughout the state. It helped establish a baseline of the status quo of tobacco policies, led to the formation of workgroups for policy, prevention and cessation services, as well as a task force at each institution and an executive steering committee. The first year’s goals was to assist the efforts in the adoption of comprehensive tobacco-free policies to UT Tyler, UT Permian Basin, and UT Dallas.

By November of 2016, with technical assistance from the initiative, both UT Tyler and UT Permian Basin had implemented tobacco-free policies. By April of 2017, when the second Eliminate Tobacco Use Summit was held, UT Dallas had announced that its policy would go into effect at the end of the semester. The second Summit was also attended by representatives from Texas A&M, Texas State University, Texas Christian University, Texas Tech University Health Science Center, and The University of California

“Our goal in creating this initiative was to promote the health and welfare of our students, faculty, staff, patients and communities,” says Ernest Hawk, M.D., vice president and head of the Division of Cancer Prevention and Population Sciences at MD Anderson. “It was also to lead by example. Tobacco use is the single leading cause of preventable death in Texas, associated with some 28,000 deaths a year. Our hope is that our efforts will ripple outward to improve the health of all Texans.”

Moving forward, the Eliminate Tobacco Use Initiative intends to focus primarily on closing the gap between policy and reality. There is a strong evidence base that tobacco prohibitions in the workplace do in fact lead to reductions in tobacco use, but the impact is likely to be greater when the policies are complemented with meaningful enforcement measures, to give the policies some teeth; good and easily accessible cessation services for those looking to quit; and programs like Peers Against Tobacco, which can help change the norms around tobacco use on campus.

The Eliminate Tobacco Use Initiative, in collaboration with UT Austin Center for Health Communication, will also be rolling out a new counter marketing campaign, with a single over-arching brand that will be customized for each UT campus. The campaign, which has a broken cigarette/check mark as its emblem, will focus on the idea of freedom, and on reframing quitting as an act of independence.

“We know from research on past campaigns that simply stating the health benefits of quitting neither encourages quitting nor discourages starting,” says Mike Mackert, Ph.D., Director of the Center for Health Communication, which is affiliated with both the Moody College of Communication and Dell Medical School. “Highlighting negative consequences can work but can also sometimes backfire. It can encourage more use, particularly among young people, by further associating smoking with rebellion. Our campaign identifies the negative consequences of smoking, as well as the benefits of quitting, but does so within a larger emotional frame that emphasizes independence. Rather than associating tobacco use with rebellion, it associates quitting, or not starting, with autonomy and freedom. Smokers are both free from their addiction and free to choose their experience of a reward and what ‘freedom’ personally means to them.”