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. 2025 Feb 26;25(1):316.
doi: 10.1186/s12913-025-12415-3.

The role of deans in implementing smoke-free campus policies: the case of medical schools in France

Diane Geindreau  1 , Anne Girault  2 , Karine Gallopel-Morvan  2
Affiliations

The role of deans in implementing smoke-free campus policies: the case of medical schools in France

Diane Geindreau et al. BMC Health Serv Res. .

Abstract

Background: Smoke-free campus (SFC) policies prohibit smoking and vaping on all university grounds and for all users. The literature on SFC shows that these policies reduce exposure to secondhand smoke and increase smoking cessation. Engagement from high-level leaders has been proven to be a key determinant in the SFC implementation process, but their attitudes toward SFC has rarely been investigated, and only in the USA. The aim of this research is to analyze deans' perceptions of SFC in medical schools in France, where smoking prevalence remains high despite broad awareness of the harms of tobacco.

Methods: We used semi-structured interviews to explore medical school deans' perceptions of SFC implementation in France. Between October 2022 and January 2024, we interviewed 31 deans and two associate-deans, representing 31 out of the 35 medical schools in mainland France. Interviews were transcribed and the results were thematically analyzed using Nvivo 14, mobilizing the "individuals domain" from the updated Consolidated Framework for Implementation Research.

Results: One school had a SFC policy, 6 were in the SFC implementation process, 23 had no SFC policy, and 1 had abandoned it. A majority of deans were unaware that a SFC goes beyond a smoking ban. However, 28 deans held a net-positive perception of SFC, arguing that it is a coherent multi-modal intervention and is effective in reducing smoking. However, SFC were also perceived as stigmatizing smokers and displacing the problem rather than solving it. Perceived barriers to SFC implementation were competing priorities, lack of funding, and opposition from smokers. Perceived facilitators of SFC implementation were access to existing resources, support from medical students, and natural legitimacy of medical schools. Deans felt they had a leadership role to play in initiating, promoting, and enforcing the SFC policy.

Conclusions: SFC are poorly developed in medical schools in France, mostly because medical school deans prioritize other issues over smoking prevention and are under-aware of the benefits of SFC policy. However, they hold a net-positive opinion on SFC policy and express a willingness to implement it. We provide a set of practical strategies to help remove the main barriers to SFC implementation.

Keywords: CFIR; High-level leaders; Implementation; Smoke-free campus.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Regarding ethical concerns, the French school of public health institutional review board (IRB) found this study exempt from the need for IRB review. Data collection and analysis were conducted in compliance with point 35 of the European General Data Protection Regulation (GDPR) https://www.cnil.fr/fr/reglement-europeen-protection-donnees and with article 64 of the French data privacy law. https://www.legifrance.gouv.fr/loda/article_lc/LEGIARTI000037823065 The study protocol strictly followed the principles of the Declaration of Helsinki [22] and the guidelines outlined by the French Data Protection Authority https://www.cnil.fr/fr/reglement-europeen-protection-donnees (CNIL in French). This research mobilizes social sciences with the aim of capturing and collecting medical-school deans’ perceptions. Consequently, French legislation on research involving human subjects, known as Jardé law, https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000025441587 does not apply, and so this research only required oral and written informed consent to data collection, data analysis and publication [23]. The interviews were voluntary and confidential. Informed consent was obtained from all participants who were provided with detailed information about the study prior to their participation before (oral consent) and after (written consent) the interview. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Perceptions of deans towards SFC before and after receiving a definition
See this image and copyright information in PMC

References

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