Objective: To identify college presidents' support for tobacco-free campus policies (TFCP), perceived barriers and benefits to implementing such policies, and activities that might initiate policy adoption. Participants: Participants were 405 presidents (51% of 796 delivered surveys) from a national sample of eligible 4-year institutions in summer 2012. Methods: A 4-page, 24-item cross-sectional questionnaire was mailed to potential participants in 4 waves to maximize the response rate. Results: The vast majority of presidents support TFCP (84%) and believed they should play a key role in establishing TFCP (80%). A majority agreed advocacy by campus groups was necessary to establishing TFCP. Presidents with an existing policy were twice as likely to believe advocacy was necessary for policy establishment. Presidents most commonly selected creating policy drafts and designating a committee as important to initiating TFCP. Conclusion: Advocates would benefit from focusing on presidential involvement and solutions to personnel barriers in establishing TFCP.