Cigarette smoking among adults may have dropped in recent decades—from 42 percent in 1965 to 17 percent in 2014, according to the American Cancer Society (ACS)—but tobacco use remains the leading cause of death and disease in the world. On campus, while few students smoke daily, around 20 percent report smoking socially.

As the nation commemorates the Great American Smokeout on Thursday, Nov. 17, Penn continues to support healthy decision-making among students, faculty, and staff, and promote numerous tobacco cessation and support networks.

Earlier this week, the University was recognized for its efforts to create a tobacco-free campus culture. The ACS and CVS Health announced that Penn is one of 20 colleges and universities to receive a $20,000 grant, part of the Tobacco-Free Generation Campus Initiative, a $3.6 million program intended to accelerate and expand the adoption and implementation of smoke- and tobacco-free campus policies.

“We are grateful to be among the recipients of the American Cancer Society/CVS Health tobacco grant as it recognizes and supports Penn’s commitment to a tobacco free campus,” says Penn President Amy Gutmann. “This generous grant will greatly aid the University’s ongoing efforts to effectively address this major public health epidemic.”

Specifically, the grant will examine whether removing smoking poles on campus affects cigarette butt litter, and fund communications materials aimed at students, faculty, and staff that announce Penn’s tobacco-free policy.

Underscoring these grant-funded efforts is Penn’s unique approach to addressing the tobacco epidemic. Guided by Frank Leone, director of the Comprehensive Smoking Treatment Program and associate professor of medicine at the Perelman School of Medicine, the University supports tobacco users in efforts to quit and encourages a shift in attitudes and beliefs about smoking, rather than penalizing or ostracizing tobacco-users.

“The argument that we made in the [ACS/CVS Health grant] application is, our school motto in Latin translates roughly to ‘laws without values are meaningless.’ We believe that an organization can make as many rules as they want; some people will follow those rules, other people will not follow the rules, some people will not know there are rules,” Leone says. “Rules by themselves don’t really effectively change behavior as much as you would like. Even if they do change behavior on campus, they don’t have the same downstream impact that we would like to see.

“We feel that this approach is really an expression of our values, primarily. It needs to be consistent with who we are as an organization,” Leone adds.

The grant was awarded to the Division of Human Resources (HR) and Campus Health and Student Health Service. Ultimately the tobacco-free campus initiative seeks to change hearts and minds about tobacco use, underscoring not only the importance of an individual’s health, but also other value systems that interface with tobacco use.

This model, which is a response to what the U.S. Office of the Surgeon General proposed in 2005 to address tobacco use, recognizes that every epidemic is about the interplay between biological, social, and cultural norms, and the environment.

“Every epidemic has elements in all three of those spheres and you can’t solve an epidemic by simply focusing on one sphere or another to the exclusion of the other two. You have to deal with how all three spheres interact with each other,” Leone explains. “That’s what the University of Pennsylvania is attempting to do by involving HR, by involving Student Health, by involving Public Safety, by involving Facilities and Real Estate Services, by involving the researchers, by involving the clinical staff.”

Jack Heuer, Penn’s vice president for Human Resources, says the grant recognizes the collaboration between offices that touch the lives of everyone on campus.

“The Penn policy is, we’re really committed to a healthy, safe work and learning environment,” Heuer says. “Every person working on this campus can be an example to the students who are studying and living on this campus. The removal of tobacco by the individuals working here is a very positive reinforcement message.

“This grant really supports practical ways that we can address the tobacco epidemic,” Heuer adds. “It gets us to the same point without, in some ways, pointing a finger or blaming anybody.”

The efforts to support behavior change can take time and require a deliberate, phased approach, says Max King, associate vice provost for health and academic services.

“What we want to do is rather than force people to change, we want to go through a process of change. If people are persuaded to change, behavior is gradual and not pre-scribed,” King says. “In order to do that, you need to have a phased approach so that gradually the campus embraces the notion of, ‘well, it’s always been this way.”

The need to reduce tobacco use on campus is still acute among students, says Ashlee Halbritter, director of Campus Health. Hookah use, while decreasing, is still an issue because many students don’t see that activity as tobacco use. She notes Campus Health is also seeing an uptick in electronic cigarette use, and many students continue to smoke socially.

“All of the data shows that tobacco use becomes a habit sometime before age 26, which is where most of our student population is—which is why this is just as an important issue among students as it is for faculty and staff, because if we want to prevent further tobacco use, we need to stop it now in students,” Halbritter says.

Trevor Glenn, a junior Biological Basis of Behavior major in the College of Arts & Sciences, serves on the Student Health Service board as an undergraduate representative, and says things like hookahs and vaping are considered socially acceptable.

“Many times when walking to class on Locust Walk or around campus I’ve seen people smoking or have noticed that the ground was peppered with cigarette butts. … There’s no active stigma against doing things like vapes or hookah,” Glenn says. “By implementing a tobacco-free campus policy, and by continuing to provide free smoking cessation services, Penn has taken a huge step to building a healthier and cleaner campus. It does make sense that people are more likely to adhere to a policy if it’s through a culture change rather than a mandate.”

Attempting to create a culture of compliance around this issue means that the community has to buy into it and act to keep Penn a tobacco-free campus, says Halbritter.

Leone agrees: “Tobacco use is a behavioral epidemic and as responsible members of a world community, people at the University of Pennsylvania have a responsibility to show some leadership in reevaluating, in assessing assumptions we make. [We’re] changing the conversation just a little. You place the emphasis not on self but on community. It’s a really simple idea but [it] runs so counter to how people think about this problem.”