Implementation, Maintenance, and Outcomes of an Electronic Referral to a Tobacco Quitline Across Five Health Systems.

INTRODUCTION: Electronic referral (e-referral) to quitlines helps connect tobacco-using patients to free, evidence-based cessation counseling. Little has been published about the real-world implementation of e-referrals across U.S. health systems, their maintenance over time, and the outcomes of e-referred patients. AIMS AND METHODS: Beginning in 2014, the University of California (UC)-wide project called UC Quits scaled up quitline e-referrals and related modifications to clinical workflows from one to five UC health systems. Implementation strategies were used to increase site readiness. Maintenance was supported through ongoing monitoring and quality improvement programs. Data on e-referred patients (n = 20 709) and quitline callers (n = 197 377) were collected from April 2014 to March 2021. Analyses of referral trends and cessation outcomes were conducted in 2021-2022. RESULTS: Of 20 709 patients referred, the quitline contacted 47.1%, 20.6% completed intake, 15.2% requested counseling, and 10.9% received it. In the 1.5-year implementation phase, 1813 patients were referred. In the 5.5-year maintenance phase, volume was sustained, with 3436 referrals annually on average. Among referred patients completing intake (n = 4264), 46.2% were nonwhite, 58.8% had Medicaid, 58.7% had a chronic disease, and 48.8% had a behavioral health condition. In a sample randomly selected for follow-up, e-referred patients were as likely as general quitline callers to attempt quitting (68.5% vs. 71.4%; p = .23), quit for 30 days (28.3% vs. 26.9%; p = .52), and quit for 6 months (13.6% vs. 13.9%; p = .88). CONCLUSIONS: With a whole-systems approach, quitline e-referrals can be established and sustained across inpatient and outpatient settings with diverse patient populations. Cessation outcomes were similar to those of general quitline callers. IMPLICATIONS: This study supports the broad implementation of tobacco quitline e-referrals in health care. To the best of our knowledge, no other paper has described the implementation of e-referrals across multiple U.S. health systems or how they were sustained over time. Modifying electronic health records systems and clinical workflows to enable and encourage e-referrals, if implemented and maintained appropriately, can be expected to improve patient care, make it easier for clinicians to support patients in quitting, increase the proportion of patients using evidence-based treatment, provide data to assess progress on quality goals, and help meet reporting requirements for tobacco screening and prevention.

Interpersonal Trauma in the Lives of Nurses and Perceptions of Nursing Work.

The purpose of this study was to explore associations between trauma experiences among nurses and nursing perceptions of risk for involuntary job loss and standing in society. This observational study used 2001 data from the Nurses' Health Study II (N = 53,323 female nurses). The outcome variables were nurses' perceptions of their risk for involuntary job loss and their social standing in the United States and within their own community. The exposure variables were childhood and adulthood interpersonal trauma. Nurses reported high levels of emotional (60% childhood; 44% adulthood), physical (45% childhood, 23% adulthood), and sexual trauma (15% childhood, 11% adulthood). Emotional trauma was associated with perception of higher risk for involuntary job loss, but also higher perception of nurse societal standing. Nurses experience high rates of interpersonal trauma, which may influence how they perceive their profession.

Impact of a web-based educational program on Japanese nurses tobacco cessation practice and attitudes in oncology settings.

PURPOSE: To evaluate the effects of a short web-based educational program on Japanese nurses' self-reported attitudes toward tobacco cessation and their use of interventions to help smokers to quit. DESIGN: Prospective, single-group design with a pre-educational survey, a short web-based educational program, and a follow-up survey at 3 months. METHODS: Clinical nurses were asked to view two prerecorded webcasts about helping smokers quit. They completed two online surveys, one at baseline and one at a 3-month follow-up. Generalized linear models were used to determine changes in nurses' self-reported routine practice after the study intervention. FINDINGS: A total of 1401 nurses responded to the baseline survey, 678 of whom completed the follow-up survey. Compared with baseline, nurses at follow-up were more likely to advise smokers to quit (odds ratio [OR] = 1.45, 95% confidence interval [CI: 1.15, 1.82]), assess patients' interest in quitting (OR = 1.46, 95% CI [1.01, 1.04]), and assist patients with smoking cessation (OR = 1.34, 95% CI [1.04, 1.72]). However, the proportion of nurses who consistently recommended resources for tobacco cessation did not significantly improve at follow-up. CONCLUSIONS: This study provides preliminary evidence that a web-based educational program can increase nurses' implementation of tobacco dependence interventions in cancer care practice. Sustaining these educational efforts could increase nurses' involvement in providing these interventions, encourage nurses to refer patients to cessation resources, and support nurses' attitudes towards their role in smoking cessation. CLINICAL RELEVANCE: Our short web-based educational program can increase nurses' use of tobacco-dependence interventions in cancer care practice. This role can be enhanced with additional information about existing cessation resources that nurses could use to refer patients for support post-discharge. Japanese nurses, when properly educated, are willing and significant contributors to promote tobacco use cessation for cancer patients. The contribution can be facilitated through nursing care protocol that integrate tobacco use cessation interventions within evidence-based cancer care approaches.

Transitions in hookah (Waterpipe) smoking by U.S. sexual minority adults between 2013 and 2015: the population assessment of tobacco and health study wave 1 and wave 2.

BACKGROUND: Tobacco smoking using a hookah (i.e., waterpipe) is a global epidemic. While evidence suggests that sexual minorities (SM) have higher odds of hookah use compared to heterosexuals, little is known about their hookah use patterns and transitions. We sought to examine transitions between hookah smoking and use of other tobacco and electronic (e-) products among SM adults aged 18 years of age and older versus their heterosexual counterparts. METHODS: We analyzed nationally representative data of ever and current hookah smokers from Wave 1 (2013-2014; ever use n = 1014 SM and n = 9462 heterosexuals; current use n = 144 SM and n = 910 heterosexuals) and Wave 2 (2014-2015; ever use n = 901 SM and n = 8049 heterosexuals; current use n = 117 SM and n = 602 heterosexuals) of the Population Assessment of Tobacco and Health Study. Comparisons between groups and gender subgroups within SM identity groups were determined with Rao-Scott chi-square tests and multivariable survey-weighted multinomial logistic regression models were estimated for transition patterns and initiation of electronic product use in Wave 2. RESULTS: Ever and current hookah smoking among SM adults (ever use Wave 1: 29% and Wave 2: 31%; current use Wave 1: 4% and Wave 2: 3%) was higher than heterosexuals (ever use Wave 1: 16% and Wave 2: 16%; current use Wave 1: 1% and Wave 2: 1%; both p < 0.0001). Among SM adults who reported hookah use at Wave 1, 46% quit hookah use at Wave 2; 39% continued hookah use and did not transition to other products while 36% of heterosexual adults quit hookah use at Wave 2 and 36% continued hookah use and did not transition to other products. Compared with heterosexuals, SM adults reported higher use of hookah plus e-products (Wave 2 usage increased by 65 and 83%, respectively). CONCLUSIONS: Compared to heterosexuals, in addition to higher rates of hookah smoking, higher percentages of SM adults transitioned to hookah plus e-product use between 2013 and 2015. Results have implications for stronger efforts to increase awareness of the harmful effects of hookah as well as vaping, specifically tailored among SM communities.

Building capacity in tobacco control by establishing the Eastern Europe Nurses' Center of Excellence for Tobacco Control.

INTRODUCTION: Properly educated nurses delivering evidence-based tobacco dependence treatment could contribute to improving health and reducing regional disparities in tobacco-related disease and death in Central and Eastern Europe. The aims of this study are to describe development of the Eastern European Nurses' Centre of Excellence for Tobacco Control (COE) and evaluate its online educational program on tobacco dependence treatment using the 5As framework. METHODS: The online education evaluation followed a prospective, single group, pre- and post-assessment of changes in nurses' self-reported tobacco cessation interventions. Leaders from five Eastern European countries (Hungary, Czech Republic, Romania, Slovakia, Slovenia) developed protocols for in-country tobacco control education. Nurses responded to a baseline survey, accessed an online nursing educational program, and completed a follow-up survey at 3 months, in the period December 2015 to June 2016. A total of 695 nurses from five countries answered questions on cessation interventions at baseline and of these 507 (73%) completed a follow-up survey at 3 months. RESULTS: At the follow-up at 3 months, the 507 nurses self-reported a significant increase in providing all 5A components, i.e. nurses were significantly (p<0.0001) more likely to always /usually advise a patient to quit, assess interest in quitting (p=0.002), assist with a quit plan, review barriers to quitting and recommend a smoke-free home post-discharge (all p<0.0001). They were also significantly more likely (p=0.01) to agree or strongly agree that nurses have an obligation to advise patients on the risks of smoking. There was a significant increase (p<0.0001) in nurses' estimate of the number of patients they provided a cessation intervention the previous week. Nurses who smoked were 60% more likely to assist and arrange compared to nurses who never smoked. CONCLUSIONS: Coordinating multi-country activities through a COE was successful in engaging a network of nurses to use an online educational program and participate in other tobacco control activities.

"Everyone Needs a Breath of Fresh Air": Workplace Impact on Nurses' Smoking Behaviors.

BACKGROUND: Europe continues to have among the highest worldwide prevalence of adult smoking (28%) and the highest among females (19%). Nurses' rates of smoking in the region are comparable or higher than the general female population. Nurses who smoke are less likely to intervene with patients who smoke; therefore, supporting nurses' efforts to quit is critical to promoting nurses' well-being and strengthening the profession's impact on prevention of tobacco-induced diseases. OBJECTIVE: The aim of this study was to explore nurses' perceptions of hospital workplace factors that influence nurses' smoking and quitting behaviors in Central and Eastern Europe. METHODS: Each country had a project director involved in the recruitment of participants and the translation of instruments. Using a moderator guide, focus groups (N = 9) about smoking and quitting were conducted in 5 countries (Czech Republic, Hungary, Romania, Slovakia, Slovenia) among 82 nurses who self-reported as current or former smokers. Recorded transcripts were translated and analyzed using content analysis methods. RESULTS: The majority of nurses were female (94%) and currently smoking (65%). Four major themes were identified that describe workplace factors influencing nurses' smoking behaviors and efforts to quit: (1) taking breaks, (2) effect of smoking on patient interactions, (3) perceived collegial support for quitting, and (4) impact of workplace policies. CONCLUSIONS: Workplace factors influence nurses smoking and quitting behaviors. IMPLICATIONS FOR PRACTICE: Changes in healthcare systems and policies are needed to support nurses' quit efforts. Additional education is needed to ensure that nurses understand issues related to smoking and interactions with patients.

Increased adoption of smoke-free policies on campuses with schools of nursing.

BACKGROUND: In 2015, the majority of U.S. American Association of Colleges of Nursing (AACN)-accredited schools of nursing resided on campuses without smoke-free policies. PURPOSE: To determine the presence of smoke-free policies at AACN-accredited after resolutions from AACN and the American Academy of Nursing, and the creation of online resources. METHODS: Smoke-free policies (2015-2017) were determined through listings on the ANRF College Campus Policy Database© and survey responses from nursing deans. RESULTS: Smoke-free policies for 689 schools of nursing increased from 36% in 2015 to 91% in 2017. There were no significant differences by nursing program types or geographic area. Twenty percent of deans reported using the resources, with over 1700-page views. CONCLUSION: Smoke-free policies increased after support from two national nursing organizations. Learning in a smoke-free environment should be an expectation for nursing students to protect their own health, and to support their future critical role in tobacco control.

High Carbon Monoxide Levels from Charcoal Combustion Mask Acute Endothelial Dysfunction Induced by Hookah (Waterpipe) Smoking in Young Adults.

BACKGROUND: Hookah smoking is marketed to youth as a harmless alternative to cigarettes. Although cigarette smoking acutely impairs endothelial function, the effect of smoking fruit-flavored hookah tobacco is unknown. Because charcoal traditionally is used to heat the hookah tobacco in the waterpipe, hookah smoke delivers tobacco toxicants and nicotine plus charcoal combustion products: not only carbon-rich nanoparticles, oxidants that may destroy nitric oxide and impair endothelial function, but also large amounts of carbon monoxide (CO), a putative vasodilator molecule. METHODS: To test the acute effect of hookah smoking on endothelial function, in young adult hookah smokers (n=30, age 26±1 years, mean±SE), we measured plasma nicotine, exhaled CO, and brachial artery flow-mediated dilation (FMD) before and after charcoal-heated hookah smoking. To remove the effect of charcoal combustion, the same measurements were performed when the same flavored hookah tobacco product was heated electrically (n=20). As a positive internal control, we studied age-matched cigarette smokers (n=15) who smoked 1 cigarette. To isolate the effect of the CO boost on FMD, hookah smokers (n=8) inhaled a 0.1% CO gas mixture to approximate their CO boost achieved with charcoal-heated hookah smoking. RESULTS: Nicotine levels increased similarly with all types of smoking, whereas exhaled CO increased 9- to 10-fold more after charcoal-heated hookah than after either electrically heated hookah or cigarette smoking. FMD did not decrease after smoking charcoal-heated hookah but instead increased by +43±7% ( P<0.001). In contrast, FMD decreased by -27±4% ( P<0.001) after smoking electrically heated hookah, comparable to the decrease after cigarette smoking. FMD increased markedly by 138±71% ( P<0.001) after breathing CO gas, 2.8 times more than the increase induced in the same subjects after smoking charcoal-heated hookah ( P<0.001), despite comparable increases in exhaled CO (24±1 versus 28±3 ppm, hookah versus CO). CONCLUSIONS: Smoking hookah tobacco, similar to cigarette tobacco, acutely impairs endothelial function. With traditional charcoal-heated hookah smoking, the acute endothelial dysfunction is masked by high levels of carbon monoxide, a potent vasodilator molecule generated by charcoal combustion. With respect to large-artery endothelial function, smoking hookah is not harmless. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT03616002 and NCT03067701.

Attitudes, barriers and facilitators to smoking cessation among Central and Eastern European nurses: A focus group study.

PURPOSE: Smoking among nurses is a barrier to providing smoking cessation interventions to patients. In Central and Eastern Europe-where tobacco use is the leading cause of preventable death and disease-there is limited knowledge about nurses' attitudes toward cessation interventions. Our aim was to describe the attitudes of nurses who are former and current smokers toward providing cessation interventions to patients as well as explore barriers and facilitators to their own quit efforts. METHODS: Nine focus groups with 81 nurses (94% females) in five Central and Eastern European countries. Content analysis was used to identify major themes. RESULTS: Nurses agreed that they should set a good example by not smoking; should be involved in helping patients stop smoking; and needed additional training in tobacco control. Five common themes were identified as barriers to quitting: smoking cues in the environment; presence of smokers in the environment; relapse postpartum; stress and nicotine addiction; and misperceptions about the dangers of smoking. Former smokers reported facilitators to quitting including: seeing the health consequences of smoking among their patients; personal and family health concerns; receiving support from family; and pregnancy. CONCLUSION: There is a need to build upon nurses' positive attitudes about engaging in smoking cessation interventions with patients to ensure that cessation interventions are standard nursing practice. Future studies should focus on programs that support nurses' quit efforts by addressing barriers to smoking cessation, which will improve their health and patient care.

Acute Effect of Hookah Smoking on Arterial Stiffness and Wave Reflections in Adults Aged 18 to 34 Years of Age.

Hookah (waterpipe) smoking is rapidly increasing in popularity worldwide. Despite being heavily advertised in the media as a healthier alternative to cigarettes, the toxicology of hookah smoke suggest otherwise. Cigarette smoking unequivocally causes an acute increase in arterial stiffness, but whether hookah does the same is unknown. In 48 young healthy habitual hookah but not cigarette smokers, we measured heart rate, peripheral and central blood pressure, carotid-femoral pulse wave velocity (measure of arterial stiffness), aortic augmentation index (measure of wave reflection), plasma nicotine, and exhaled carbon monoxide before and after ad lib hookah smoking. Hookah smoking increased heart rate by +16 ± 1 beats/min and mean brachial arterial pressure by +6 ± 1 mm Hg (both p <0.05, mean ± SE). Most importantly, it increased carotid-femoral pulse wave velocity and aortic augmentation index by +0.66 ± 0.09 m/s-1 and +8.76 ± 3.99%, respectively (p <0.05, mean ± SE), denoting increased acute arterial stiffness. These vascular effects were accompanied by increases in plasma nicotine concentration (+5.8 ± 1.2 ng/ml, p <0.05) and expired carbon monoxide (+25.44 ± 1.68 ppm, p <0.05). All these parameters were unchanged during time-control studies (n = 14). Thus, in contrast to effective media marketing of hookah as a safer alternative to cigarettes, the present study shows for the first time that in young adult hookah smokers, a single hookah smoking session causes an acute increase in arterial stiffness of comparable magnitude to what has been previously reported for cigarettes. Further research is warranted to determine whether habitual hookah smoking accelerates the age-dependent development of hypertension and its cardiovascular complications.

Impact of a webcast on nurses' delivery of tobacco dependence treatment.

AIMS AND OBJECTIVES: To evaluate an educational programme about nurses' role in tobacco dependence treatment, and its webcast component, on the long-term impact of increasing the frequency of nurses' self-reported changes in practice related to delivery of smoking cessation interventions. BACKGROUND: Healthcare professionals' knowledge about evidence-based tobacco dependence treatment using the 5As framework (Ask about tobacco use, Advise users to quit, Assess willingness to quit, Assist in making a quit plan and Arrange for follow-up, including referral to a quitline) is essential to increase smoking cessation rates in the United States. DESIGN: A 6-month pre-post design. METHODS: A convenience sample of nurses (N = 283) from Kentucky and Louisiana was provided access to the webcast and printed toolkit. Responses from those who completed an online survey at baseline, and at 3 or 6 months postimplementation of the educational programme were included in an analysis of changes in the consistent (always/usually) delivery of the 5As plus referral to the quitline. RESULTS: After 3 months, the intervention had a significant impact on increasing nurses' reports of consistently providing the 5As to patients who smoked, which was largely sustained at 6 months. Nurses who viewed the webcast were three times more likely to refer smokers to a quitline at 3 months; and four times more likely at 6 months than those who did not. CONCLUSIONS: An online educational programme, plus printed toolkit about tobacco dependence treatment increased nurses' delivery of smoking cessation interventions over time. This study provided preliminary evidence that including a webcast in a nurse-targeted educational programme could significantly increase the proportion of nurses who referred smokers to a quitline beyond the benefit of access to printed materials and web-based resources. RELEVANCE TO CLINICAL PRACTICE: Distance learning is a feasible mechanism for enhancing nurses' involvement in tobacco dependence treatment and promoting evidence-based clinical practice.

Nursing Practice, Research and Education in the West: The Best Is Yet to Come.

PURPOSE: This paper celebrates the 60th anniversary of the Western Institute of Nursing, the nursing organization representing 13 states in the Western United States, and envisions a preferred future for nursing practice, research, and education. BACKGROUND: Three landmark calls to action contribute to transforming nursing and healthcare: the Patient Protection and Affordable Care Act of 2010; the Institute of Medicine report Future of Nursing: Leading Change, Advancing Health; and the report Advancing Healthcare Transformation: A New Era for Academic Nursing. Challenges abound: U.S. healthcare remains expensive, with poorer outcomes than other developed countries; costs of higher education are high; our profession does not reflect the diversity of the population; and health disparities persist. Pressing health issues, such as increases in chronic disease and mental health conditions and substance abuse, coupled with aging of the population, pose new priorities for nursing and healthcare. DISCUSSION: Changes are needed in practice, research, and education. In practice, innovative, cocreated, evidence-based models of care can open new roles for registered nurses and advanced practice registered nurses who have knowledge, leadership, and team skills to improve quality and address system change. In research, data can provide a foundation for clinical practice and expand our knowledge base in symptom science, wellness, self-management, and end-of-life/palliative care, as well as behavioral health, to demonstrate the value of nursing care and reduce health disparities. In education, personalized, integrative, and technology-enabled teaching and learning can lead to creative and critical thinking/decision-making, ethical and culturally inclusive foundations for practice, ensure team and communication skills, quality and system improvements, and lifelong learning. CONCLUSION: The role of the Western Institute of Nursing is more relevant than ever as we collectively advance nursing, health, and healthcare through education, clinical practice, and research.

Lung Cancer and Tobacco: What Is New?

Lung cancer is the leading cause of cancer death worldwide. Tobacco use remains the single most important preventable cause of cancer and is responsible for 80% of all cases of lung cancer. Implementation of tobacco control measures, including preventing initiation and treating dependence, are pivotal to address the lung cancer epidemic. New evidence continues to emerge on the significant positive impact of incorporating tobacco dependence treatment within all lung cancer treatment protocols. Evidence and guidelines on how to implement these strategies exist and present an opportunity for nurses to make a difference in reducing suffering and preventing deaths from lung cancer.

Impact of Online Education on Nurses' Delivery of Smoking Cessation Interventions With Implications for Evidence-Based Practice.

BACKGROUND: Tobacco use is the leading cause of preventable disease and death in Europe and worldwide. Nurses, if properly educated, can contribute to decreasing the burden of tobacco use in the region by helping smokers quit smoking. AIMS: To assess: (a) the feasibility of an online program to educate nurses in Czech Republic and Poland on evidence-based smoking cessation interventions for patients and (b) self-reported changes in practices related to consistently (usually or always) providing smoking cessation interventions to smokers, before and 3 months after participation in the program. METHODS: A prospective single-group pre-post design. RESULTS: A total of 280 nurses from Czech Republic and 156 from Poland completed baseline and follow-up surveys. At 3 months, nurses were significantly more likely to provide smoking cessation interventions to patients who smoke and refer patients for cessation services (p < .01). Nurses significantly improved their views about the importance of nursing involvement in tobacco control. IMPLICATIONS FOR PRACTICE: Education about tobacco control can make a difference in clinical practice, but ongoing support is needed to maintain these changes. Health system changes can also facilitate the expectation that delivering evidence-based smoking cessation interventions should be routine nursing care. LINKING EVIDENCE TO ACTION: Educating nurses on cessation interventions and tobacco control is pivotal to decrease tobacco-related disparities, disease, and death. Online methods provide an accessible way to reach a large number of nurses.

Implementation of Tobacco Dependence Treatment Programs in Oncology Settings.

OBJECTIVES: To discuss strategies for implementing tobacco dependence treatment in cancer care and the role of oncology nurses. DATA SOURCES: Evidence-based clinical practice guidelines for tobacco dependence treatment, published literature and Web sites. CONCLUSION: There are many benefits of quitting smoking after a diagnosis of cancer. Implementation of tobacco dependence treatment can improve patient outcomes but requires system changes. The electronic health care record, access to telephone quit lines for smoking cessation, resources for providers, and changes in insurance coverage all facilitate the delivery of treatment. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can play an important role in championing tobacco dependence treatment in cancer care.

Research Priorities, Measures, and Recommendations for Assessment of Tobacco Use in Clinical Cancer Research.

There is strong evidence that cigarette smoking causes adverse outcomes in people with cancer. However, more research is needed regarding those effects and the effects of alternative tobacco products and of secondhand smoke, the effects of cessation (before diagnosis, during treatment, or during survivorship), the biologic mechanisms, and optimal strategies for tobacco dependence treatment in oncology. Fundamentally, tobacco is an important source of variation in clinical treatment trials. Nevertheless, tobacco use assessment has not been uniform in clinical trials. Progress has been impeded by a lack of consensus regarding tobacco use assessment suitable for cancer patients. The NCI-AACR Cancer Patient Tobacco Use Assessment Task Force identified priority research areas and developed recommendations for assessment items and timing of assessment in cancer research. A cognitive interview study was conducted with 30 cancer patients at the NIH Clinical Center to evaluate and improve the measurement items. The resulting Cancer Patient Tobacco Use Questionnaire (C-TUQ) includes "Core" items for minimal assessment of tobacco use at initial and follow-up time points, and an "Extension" set. Domains include the following: cigarette and other tobacco use status, intensity, and past use; use relative to cancer diagnosis and treatment; cessation approaches and history; and secondhand smoke exposure. The Task Force recommends that assessment occur at study entry and, at a minimum, at the end of protocol therapy in clinical trials. Broad adoption of the recommended measures and timing protocol, and pursuit of the recommended research priorities, will help us to achieve a clearer understanding of the significance of tobacco use and cessation for cancer patients.

Few U.S. schools of nursing on campuses with smoke-free policies: A Call for Action.

INTRODUCTION: Tobacco remains the leading cause of preventable death in the United States. Recognizing that smoke-free policies can significantly reduce tobacco-related morbidity and mortality by preventing exposure to second-hand smoke and increasing quit rates, members of the Tobacco Control Subgroup of the American Academy of Nursing's (AAN) Health Behavior Expert Panel launched a health policy initiative entitled the Smoke-Free Campus Policy for Schools of Nursing Campaign. Designed as a two-phased initiative, the Campaign is a Call to Action to increase smoke-free policies on campuses with Schools of Nursing across the United States by 2020. METHODS: Phase I of the AAN Campaign included a cross-sectional study using secondary data analysis to describe the presence of smoke-free policies on campuses of Schools of Nursing across the United States. A list of colleges and universities with smoke-free policies maintained by the Americans for Nonsmokers Rights Foundation in January 2015 was accessed to conduct the analysis. Schools of Nursing granting baccalaureate and graduate nursing degrees were included. Descriptive statistics were obtained for Schools of Nursing by region of the country and by highest level of nursing degree program of study at each institution. RESULTS: Smoke-free policies of 689 Schools of Nursing were examined. Of these, 442 (64%) did not have 100% smoke-free policies on their campuses. A greater percentage of nursing schools without a smoke-free policy were located in the Northeast (114, 79%) and West (70, 73%). Nearly half (57, 46%) of the Schools of Nursing with a PhD/DNS program had a smoke-free policy in place compared with all other degree program levels (BS/BSN: 69, 35%; MS/MSN: 83, 35%; DNP: 38, 30%). CONCLUSIONS: With only 247 (36%) of Schools of Nursing on campuses with comprehensive smoke-free policies, more must be performed to promote healthy learning and working environments for nursing students, staff, and faculty. As public health advocates, nursing leaders in Schools of Nursing have a moral and ethical imperative to advance tobacco control on college campuses to meet the American College Health Association goals for smoke-free/tobacco-free environments.