Creating a Tobacco Cessation Environment: Training College Students How to Ask, Advise, and Refer

College campuses across the United States are establishing smoke-free and tobacco-free campuses. Many colleges in Arizona are moving in the same direction. Maricopa County Public Health Department (MCPHD) developed a comprehensive approach to support these efforts. In 2007, the County established a college youth tobacco prevention program called IGNITE. The purpose of the group is to educate college-aged students about the dangers of tobacco use, support tobacco-free initiatives, and provide cessation information. The main challenge in working with this group was identifying an effective strategy to support cessation efforts. Research indicates that the Ask, Advise, and Refer method is effective in healthcare provider settings and is considered an evidenced-based practice. The County adopted usage of this model and began training students. A focused effort to implement the program began in 2013 with the goal of full implementation occurring during the 2014-2015 school-year. Pre and post testing during the fall of 2013 revealed a 41% increase in the students comfort level with talking to tobacco users and a 56% increase in knowledge about how to make an ASHLine referral. College campuses made 37 referrals to the ASHLine in the fall of 2013. The lesson we are learning is that college-aged students can be effective at talking to tobacco users and conducting active referrals. We have identified a need to establish additional specific locations on campus where the 2A and R process can be set up and recommend moving toward this systems change over the next year.