Background and challenges to implementation:
There are 20 million college and university students in the United States. More than 1 million of these young adults are projected to die from cigarette smoking. Progress has been made in protecting campus populations against tobacco. There are now 1,913 smoke-free college and university campuses, of which 1,611 are fully tobacco-free. Yet, there are 4,500 higher education institutions in the US, and many still lack comprehensive smoke- and/or tobacco-free policies due to inertia, competing needs and opposition from tobacco supporters and those expressing libertarian objections.

Intervention or response:
In response, the American Cancer Society launched the Tobacco-Free Generation Campus Initiative (TFGCI) in 2016, which targets students, faculty, staff and visitors at a variety of academic institutions - from small community colleges to large research universities - across the country. TFGCI provides financial support to colleges and universities to pursue campaigns to adopt and implement comprehensive tobacco-free policies and is supported by the CVS Health Foundation. Grantees also receive technical assistance and materials. TFGCI advises campus leaders and students on advocacy best practices, policy adoption, implementation and enforcement issues, cessation strategies and communications, and includes an evaluation component.

Results and lessons learnt:
Seven of the 20 institutions in Cohort 1 approved tobacco-free policies during the first year, a high level of success. Each institution confronted unique challenges, including opposition from skeptics - sometimes including the institution's leadership - but most effectively advanced knowledge and built support. Cohort 2 commences work in Fall 2017, and includes an additional 42 institutions. TFGCI will eventually support 125 institutions.

Conclusions and key recommendations:
Cohorts 1 and 2 cover 930,000 students, plus many faculty, staff and visitors. TFGCI has demonstrated that, with sufficient resources and application of best practices, these campaigns can succeed. Recommendations include the utilization of evidence-based resources, effective communication and education, and application of best practices in all campus policy campaigns.