The effects of a prison smoking ban on smoking behavior and withdrawal symptoms

Exploring the role of telehealth: A novel approach to group-based smoking cessation treatment for men incarcerated in a rural state prison

INTRODUCTION

Tobacco smoking remains an important public health issue in the United States (US), specifically among people who are incarcerated. There is little to no information about smoking behaviors of incarcerated people in rural areas and there is a lack of resources for smoking cessation interventions in rural settings. Telehealth might be efficient for delivering care to incarcerated people in rural areas. The purpose of this study was to determine the feasibility of delivering group-based smoking cessation treatment via telehealth to incarcerated male smokers in a rural prison.

METHODS

A 6-week group-based smoking cessation treatment program was conducted with 1-month follow up. Video conferencing was used from Weeks 2-5 to deliver treatment. A cross-sectional survey was administered collecting measures including criminal justice experience, smoking behaviors, withdrawal and triggers, mental health, physical health, and substance use. Baseline exhaled carbon monoxide (CO) levels were collected at Session 1, and a final CO level at Session 6 and 1-month follow-up.

RESULTS

Twenty (n = 20) incarcerated male smokers were recruited from a rural prison facility. The majority of the inmates were White (85%). Approximately, 80% of the inmates smoked about 20 or more cigarettes per day, and on average smoked for 28 years (SD = 9). Most inmates scored a moderate or high dependence score on the Fagerström Test for Nicotine Dependence.

CONCLUSION

Telehealth programs such as video conferencing smoking cessation treatment ought to be implemented to reduce tobacco-related disparities among incarcerated smokers housed in rural prisons.

An Evaluation of the Impact of a Multicomponent Stop Smoking Intervention in an Irish Prison

The disproportionately high prevalence of tobacco use among prisoners remains an important public health issue. While Ireland has well-established legislative bans on smoking in public places, these do not apply in prisons. This study evaluates a multi-component tobacco control intervention in a medium security prison for adult males in Ireland. A stop-smoking intervention, targeting staff and prisoners, was designed, implemented, and evaluated with a before-and-after study. Analysis was conducted using McNemar’s test for paired binary data, Wilcoxon signed rank test for ordinal data, and paired T-tests for continuous normal data. Pre-intervention, 44.3% (n = 58) of the study population were current smokers, consisting of 60.7% of prisoners (n = 51) and 15.9% of staff (n = 7). Post-intervention, 45.1% of prisoners (n = 23/51) and 100% of staff (n = 7/7) who identified as current smokers pre-intervention reported abstinence from smoking. Among non-smokers, the proportion reporting being exposed to someone else’s cigarette smoke while being a resident or working in the unit decreased from 69.4% (n = 50/72) pre-intervention to 27.8% (n = 20/72) post-intervention (p < 0.001). This multicomponent intervention resulted in high abstinence rates, had high acceptability among both staff and prisoners, and was associated with wider health benefits across the prison setting.

Réduire le tabagisme dans les prisons : éléments théoriques et méthodologiques nécessaires à la co-construction d’une intervention en contexte pénitentiaire

Révélateur des inégalités sociales de santé, le tabagisme en établissement pénitentiaire exige des interventions visant sa réduction d’être adaptées aux spécificités du milieu carcéral. Dans le cadre de la recherche interventionnelle TABAPRI, nous avons mobilisé une première étude sociologique afin d’apporter des connaissances sur cette problématique. Une enquête a été réalisée au sein de trois établissements pénitentiaires, précédant les phases de construction, d’implémentation et d’évaluation de l’intervention. Cet article décrit d’une part la démarche méthodologique et d’autre part, la contribution de la sociologie, tant dans ses apports conceptuels que méthodologiques, à la construction d’une intervention. Notre travail a notamment souligné l’importance d’aménager des espaces d’échange permettant aux professionnels et aux personnes détenues de construire ensemble les modalités d'intervention qui participent à la réduction du tabagisme en détention.

Incarceration exposure and electronic cigarette use during pregnancy: Findings from the pregnancy risk assessment monitoring system, 2016-2018

Smoking during pregnancy is a serious public health concern that poses risks for maternal and infant health. Considering the rise of electronic cigarette use in recent years, there is also growing concern about electronic cigarette use during pregnancy. Recent research has begun to explore correlates of electronic cigarette use among pregnant women. While research has revealed a strong connection between incarceration and smoking, scholars have yet to examine the connection between a woman's exposure to incarceration in the year prior to birth - either personally or vicariously through her husband or partner - and prenatal electronic cigarette use. The current study uses data from 74,554 recent mothers from the 2016-2018 Pregnancy Risk Assessment Monitoring System. Logistic regression and multinomial logistic regression models were used to assess the association between incarceration exposure and electronic cigarette use. The findings indicate a robust association between incarceration exposure and electronic cigarette use during pregnancy. Specifically, analyses demonstrate that incarceration-exposed women were approximately 2.7 times (AOR = 2.699, 95% CI = 1.939, 3.755) as likely to use electronic cigarettes after adjusting for a host of demographic, economic, health, and pregnancy related characteristics. Additional analyses reveal this association remains after accounting for conventional cigarette use during pregnancy. Considering the potential harmful health ramifications for electronic cigarette use during pregnancy, these findings suggest a need for interventions targeting electronic cigarette use among incarceration-exposed populations and point to electronic cigarette use among pregnant women in particular as an important area of focus for both criminal justice and public health practitioners.

Impact of incarceration on cardiovascular disease risk factors: a systematic review and meta-regression on weight and BMI change

OBJECTIVE

Cardiovascular disease is an underappreciated issue in prison medicine. Recent studies have revealed a higher prevalence of cardiovascular disease risk factors (CVDRFs) among individuals in prison, but the impact of incarceration on CVDRFs over time is not well understood. This review aimed to assess available literature and quantify the relationship between incarceration and trends in major CVDRFs in high-income countries.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-regression on weight change and obesity.

DATA SOURCES

Medline, Embase, PubMed, Cochrane Central Wiley and Web of Science.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Longitudinal studies reporting on the incidence of, or trends in any CVDRF among current or former people in prison over time, in high-income countries.

DATA EXTRACTION AND SYNTHESIS

Two authors independently screened articles for eligibility, extracted data and assessed quality using an adapted version of the Newcastle-Ottawa Scale. Trends in CVDRFs during and following incarceration were summarised and in those with sufficient data a meta-regression was performed.

RESULTS

Twenty-six articles were identified. CVDRFs assessed included obesity, hypertension, diabetes, dyslipidaemia, tobacco use, physical inactivity and unhealthy diet. A meta-regression on change in weight during incarceration found a mean increase of 5.3 kg (95% CI 0.5 to 10.1) and change in body mass index of 1.8 kg/m² (95% CI -0.9 to 4.6) at 2 years. Weight gain appeared most pronounced right after entering prison and then plateaued at 2 years. Concerning hypertension, the results were inconclusive, despite a trend towards rising blood pressure or prevalence of hypertension during incarceration, and an increased incidence of hypertension following incarceration. Results are contradictory or inconclusive for the other CVDRFs reviewed.

CONCLUSION

Possible explanations for the association between incarceration and weight include a sedentary lifestyle, unhealthy diet, forced smoking cessation, psychotropic medication use and high levels of stress. Incarceration may be an independent risk factor for cardiovascular disease.

Identifying significant contributors for smoking cessation among male prisoners in Australia: results from a randomised clinical trial

INTRODUCTION

In Australia, an estimated 90% of those entering prison are current tobacco smokers and three-quarters of current prisoners are tobacco smokers.

AIMS

To identify factors and their relative contributions to smoking cessation among male prisoners.

METHODS

A total of 425 male tobacco smokers with a median age of 32 years in Australian prisons. The primary outcome was continuous abstinence at 3, 6 and 12 months. We measured various sociodemographic characteristics, drug use, psychological distress and the mental and physical health status of the participants. Multivariate logistic regression models and population attributable risks (PAR%) were used to identify the significant factors and their contributions to smoking cessation rates.

RESULTS

The median age of participants was 32 years (IQR 25-41 years). High smoking cessation rates were collectively associated with not using drugs, lower psychological distress, good mental health scores and better physical health (PAR%: 93%, 98% and 88% at 3, 6 and 12 months).

CONCLUSION

Our study suggests that not using drugs and being in good mental/physical health are the important contributors to continuous abstinence among prisoners. Thus, effective smoking cessation programmes require a multicomponent approach that includes addressing drug problems and mental health functioning.

TRIAL REGISTRATION NUMBER

12606000229572.

How did the tobacco ban increase inmates' body weight during incarceration in Canadian federal penitentiaries? A cohort study

OBJECTIVE

This study aimed to determine how inmates' body weight changed during incarceration in Canadian federal penitentiaries, based on their history of tobacco use. Since tobacco was banned from all Canadian federal penitentiaries in 2008, little is known about the unintended health consequences of this ban, especially on inmates' body weight.

DESIGN

Cohort study.

SETTING

Participants were male and female inmates incarcerated for at least 6 months in Canadian federal penitentiaries. We collected data from 10 institutions in two Canadian regions (Ontario and Atlantic).

PARTICIPANTS

We collected data from 754 inmates who volunteered to participate in the study.

INTERVENTION

This study examined weight change in relation to a history of tobacco use. In 2016-2017, anthropometric data were collected and compared with recorded anthropometric data at the beginning of incarceration (mean follow-up of 5.0±8.3 years). Self-reported data on tobacco and substance use were collected. Weight change was compared between inmates with and without a history of tobacco use.

OUTCOMES

The main outcome measures were body weight change (kg), body mass index (BMI) change (kg/m²), annual weight change (kg/year), and BMI and waist circumference (cm) at the time of the interview.

RESULTS

During incarceration, ex-smokers gained more than twice the amount of weight compared with non-smokers (7.5 kg weight gain for smokers vs 3.7 kg weight gain for non-smokers). Once adjusted for covariates in a regression analysis, for inmates who gained the most weight (75th and 90th percentiles), non-smokers had, respectively, 1.64 and 2.3 lower BMI points than ex-smokers.

CONCLUSIONS

During incarceration in Canadian federal penitentiaries, inmates with a history of tobacco use gained significantly more weight than non-smokers. This put them at increased risk of developing obesity-related health problems. This information is important for the prison setting when planning related programmes and regulation.

Predictors of opinions on prison smoking bans: Analyses of survey data from Scottish staff and prisoners

INTRODUCTION

Policy-makers and practitioners need to understand characteristics associated with support for smoking restrictions to identify both potential allies and groups requiring particular support/targeted communication in the face of restrictions. Using data from prison staff and prisoners, we explored the structure and correlates of opinions relating to prison smoking bans.

METHODS

Questionnaires were completed by staff (online, N=1271; 27% return) and prisoners (paper-based, N=2512; 34%) in all 15 Scottish prisons in 2016–17. At that time, prisoners could smoke in their own cells and during outdoor recreation; staff smoking was prohibited anywhere on prison grounds. Staff and prisoner questionnaires included identical/very similar questions about opinions on smoking in prisons and prison smoking bans, own smoking behaviour, health and sociodemographic details. We also measured in every prison fine particulate matter (PM_2.5) as a proxy for secondhand smoke (SHS) levels.

RESULTS

Principal components analysis identified two factors: ‘Positive about bans’ (higher scores among staff) and ‘Bans will be difficult’ (higher scores among prisoners). In multivariable analyses, ‘Positive about bans’ was associated with: not smoking (both staff and prisoners), better general health, more respiratory symptoms and working in an operational role among staff; and no asthma, more sensory symptoms, higher educational level and status/release date among prisoners. ‘Bans will be difficult’ was associated with: fewer sensory symptoms and lower prison SHS levels among staff and being a smoker among prisoners. In smoker-only analyses, heavier smokers were less positive about bans and more likely to believe bans will be difficult.

CONCLUSIONS

Results suggest it is possible to be positive about prison smoking bans whilst also recognising and/or concerned about potential operational difficulties, and that these opinions are associated with several characteristics additional to smoker status. Support for future prison bans may be stronger if staff have access to objective SHS exposure measures.

Offenders' perceptions of the UK prison smoking ban

PURPOSE

Despite overall reductions in levels of smoking in the UK, rates of offender smoking remain high. In 2016, it was announced that prisons in England and Wales would gradually introduce a smoking ban. The purpose of this paper is to explore offenders' perceptions around the upcoming smoking ban.

DESIGN/METHODOLOGY/APPROACH

A total of eight focus groups were conducted in four prisons across the North of England. Both smoking and non-smoking offenders participated in the focus groups, and thematic analysis was used to explore the findings.

FINDINGS

Themes generated from the data were "freedom and rights", "the prison environment" and "guiding support". Participants discussed how the smoking ban was viewed as a punishment and restricted their freedom, with perceptions as to why the ban was being implemented centring around others trying to control them. Participants expressed concerns around the financial implications of the smoking ban on already stretched prison resources. Participants also recommended improving the nicotine replacement therapy on offer, and increasing the range of leisure activities within the prison to prepare for the smoking ban.

ORIGINALITY/VALUE

Overall, it was apparent that participants' awareness of the smoking ban was generally poor. It is recommended that offenders need to be made more aware of the smoking cessation support they will receive and given the opportunity to ask questions about the smoking ban. Increasing offenders' awareness of the ban may reduce stress associated with a perceived lack of choice around their smoking behaviours.

The smoking behaviors of incarcerated smokers

To determine smoking behaviors, quit attempts, and cessation preferences among incarcerated smokers, a cross-sectional survey was given to a sample of inmates from three state prison facilities in the United States. A majority of Black smokers (62%) identified as smokers, and 38% identified as ex-smokers, as compared to 46.4 percent of smokers (and 53.6% of ex-smokers) in the non-Black group. There were significant differences in the number of cigarettes smoked per day with non-Black smokers smoking one pack (M = 20.44, standard deviation = 15.86) than Black smokers (M = 14.49, standard deviation = 13.43; t = -2.50, p = 0.014). Smoking cessation interventions are needed to reduce smoking during incarceration.

Extending smoking abstinence after release from smoke-free prisons: protocol for a randomised controlled trial

BACKGROUND

A smoking ban was implemented across all prisons in Queensland, Australia, in May 2014, with the aim of improving the health of prisoners and prison staff. However, relapse to smoking after release from prison is common. Only one previous study, conducted in the United States, has used a randomised design to evaluate an intervention to assist individuals in remaining abstinent from smoking following release from a smoke-free prison.

METHODS

This paper describes the rationale for and design of a randomised controlled trial of an intervention to extend smoking abstinence in men after release from smoke-free prisons in the state of Queensland, Australia. Participants in the intervention group will receive a brief intervention involving four group sessions of motivational interviewing and cognitive behavioural therapy, initiated 4 weeks prior to release from prison. The comparison group will receive a pamphlet and brief verbal intervention at the time of baseline assessment. Assessment of self-reported, post-release smoking status will be conducted by parole officers at regular parole meetings with the primary outcome measured at 1 month post release.

DISCUSSION

The prevalence of smoking and related health harms among people who experience incarceration is extremely high. Effective interventions that result in long-term smoking cessation are needed to reduce existing health disparities in this vulnerable population.

TRIAL REGISTRATION

Current Controlled Trials ACTRN12616000314426.

Smoking cessation in smoke-free prisons: a grounded theory study

Purpose

Prisoners are vulnerable to tobacco addiction and have a smoking prevalence significantly higher than that of the general community. The context of this study was the implementation of a “smoke-free prisons” policy, which imposed forced smoking cessation onto the Queensland, Australian prison population. The study asked the question: “What are the psychosocial processes in which male prisoners engage during smoking cessation in a smoke-free environment?”

Design/methodology/approach

Qualitative interviews were conducted with 15 prisoners in South-east Queensland smoke-free correctional centres. Grounded theory methodology was applied to construct a theory of the processes of smoking cessation.

Findings

The constructed theory was named Engaging with Quitting. In this model, prisoners proceed through a cycle of evaluations, adjustments and reflections on their reality as related to the smoke-free prison. The study gives first-hand accounts of the prisoners’ use (and abuse) of nicotine replacement therapy. Three personality typologies emerged from the data: The Angry Smoker, the Shifting Opportunist and the Optimistic Quitter.

Research limitations/implications

This qualitative study makes no claim of generalisability and cannot be taken to represent all prisoners. Females, youths and culturally diverse prisoners were not represented in the sample.

Practical implications

Smoking cessation in prisons must be recognised as an ongoing process, rather than a discrete event. A coordinated approach between custodial and health authorities is required to minimise maladaptive coping strategies.

Originality/value

This study provides a descriptive account of the processes prisoners undertake during involuntary smoking cessation and has described the manner in which prisoners manufacture home-made tobacco from nicotine patches. The study has produced an original theory named Engaging with Quitting.

Changes in smoking-related symptoms during enforced abstinence of incarceration

BACKGROUND

Tobacco use among prisoners is much higher than among the general population. Little is known about changes in smoking-related symptoms during periods of incarceration. The objective of this study is to evaluate changes in smoking-related symptoms during incarceration.

METHODS

We recruited 262 inmates from a tobacco-free prison. At baseline, participants were asked about smoking-related symptoms prior to incarceration and then asked about recent symptoms.

RESULTS

All symptom scores on the American Thoracic Society Questionnaire (ATSQ) improved during incarceration. Higher ATSQ scores were associated with asthma, depressive symptoms, stress, higher addiction and more pack years of smoking. Greater improvement in symptoms was not associated with smoking status after release.

CONCLUSION

Forced tobacco abstinence leads to significant improvements in smoking-related symptoms. However, improvements in symptoms are not associated with smoking behavior changes. Addressing changes in symptoms during incarceration will require further evaluation in smoking cessation interventions for incarcerated populations.

Systematic review of health and behavioural outcomes of smoking cessation interventions in prisons

Objective

We conducted a systematic review to examine the impact of smoking cessation interventions, including smoking bans, on prisoners and prison staff.

Data sources

We systematically searched health and criminal justice databases for relevant studies. Search strings were used to combine terms related to smoking cessation interventions with terms related to incarceration. We used forward and backward snowballing to capture additional studies.

Study selection

Studies were included if: they were published between 1 January 1994 and 23 May 2016; the population was incarcerated adults and/or prison staff; they had a quantitative component; they were published in English; and they reported outcomes of a smoking cessation programme/ban with regard to reported change in smoking behaviour and/or behavioural outcomes.

Data extraction

Studies were reviewed for methodological rigour using the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies. Data were independently reviewed for methodological quality by 1 author and a research assistant.

Data synthesis

Cessation programmes, including free nicotine replacement therapy and/or behavioural counselling can significantly increase the likelihood of quitting in prison and increase abstinence postrelease. Indoor bans have little impact on prisoner smoking behaviour. Prisoners who experience a complete smoking ban typically resume smoking shortly after release from prison. Bans may result in adverse behavioural outcomes, but these are generally minimal and short-lived.

Conclusions

While there is limited evidence to inform tobacco control policies in custodial settings, outcomes of this review suggest that cessation programmes/bans can be an effective mechanism to interrupt prisoner smoking behaviour when properly enforced.

Impact of institutional smoking bans on reducing harms and secondhand smoke exposure

BACKGROUND

Smoking bans or restrictions can assist in eliminating nonsmokers' exposure to the dangers of secondhand smoke and can reduce tobacco consumption amongst smokers themselves. Evidence exists identifying the impact of tobacco control regulations and interventions implemented in general workplaces and at an individual level. However, it is important that we also review the evidence for smoking bans at a meso- or organisational level, to identify their impact on reducing the burden of exposure to tobacco smoke. Our review assesses evidence for meso- or organisational-level tobacco control bans or policies in a number of specialist settings, including public healthcare facilities, higher education and correctional facilities.

OBJECTIVES

To assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health-related outcomes.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE, EMBASE, and the reference lists of identified studies. We contacted authors to identify completed or ongoing studies eligible for inclusion in this review. We also checked websites of state agencies and organisations, such as trial registries. Date of latest searches was 22nd June 2015.

SELECTION CRITERIA

We considered studies that reported the effects of tobacco bans or policies, whether complete or partial, on reducing secondhand smoke exposure, tobacco consumption, smoking prevalence and other health outcomes, in public healthcare, higher educational and correctional facilities, from 2005 onwards.The minimum standard for inclusion was having a settings-level policy or ban implemented in the study, and a minimum of six months follow-up for measures of smoking behaviour. We included quasi-experimental studies (i.e. controlled before-and-after studies), interrupted time series as defined by the Cochrane Effective Practice and Organization of Care Group, and uncontrolled pre- and post-ban data.

DATA COLLECTION AND ANALYSIS

Two or more review authors independently assessed studies for inclusion in the review. Due to variation in the measurement of outcomes we did not conduct a meta-analysis for all of the studies included in this review, but carried out a Mantel-Haenszel fixed-effect meta-analysis, pooling 11 of the included studies. We evaluated all studies using a qualitative narrative synthesis.

MAIN RESULTS

We included 17 observational studies in this review. We found no randomized controlled trials. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before-and-after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before-and-after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group.The four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking-related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (risk ratio (RR) 0.71, 95% confidence interval ( CI) 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking-related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16).We judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational.

AUTHORS' CONCLUSIONS

We found evidence of an effect of settings-based smoking policies on reducing smoking rates in hospitals and universities. In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported. However, we rated the evidence base as low quality. We therefore need more robust studies assessing the evidence for smoking bans and policies in these important specialist settings.

A Qualitative Study of Smoking Behaviors among Newly Released Justice-Involved Men and Women in New York City

Long-term effects of cigarette smoking result in an estimated 443,000 deaths each year, including approximately 49,400 deaths due to exposure to secondhand smoke. Tobacco is a major risk factor for a variety of chronic health problems, including certain cancers and heart disease. In this article, authors present qualitative findings derived from individual interviews with men and women who were incarcerated in New York state and New York City. Participants were 60 racially and ethnically diverse men and women ages 21 through 60 (M = 46.42, SD = 6.88). Of the participants interviewed, 91.7 percent released from a smoke-free correctional facility resumed cigarette smoking and 8.3 percent remained abstinent. Daily consumption ranged from smoking four cigarettes to 60 cigarettes. The four themes that emerged from the study were (1) lifetime exposure to cigarette smoking influences smoking behavior; (2) cigarettes help relieve stress and are pleasurable; (3) there is a relationship between access, availability, and relapse; and (4) smoking cessation strategies are available. Negative influences from participants' families and peers, stressful housing situations, and mandated programs emerged from this study as key challenges to abstaining from smoking cigarettes. Involving family members and partners in smoking cessation interventions could influence newly released justice-involved men and women not to resume cigarette smoking and possibly maintain long-term abstinence.

Cigarette Smoking Among Inmates by Race/Ethnicity: Impact of Excluding African American Young Adult Men From National Prevalence Estimates

INTRODUCTION

Cigarette smoking prevalence is more than two times greater among incarcerated adults, a population usually excluded from national health surveys. African American young adult (18-25) men are less likely to smoke cigarettes than their white counterparts. However, they are two and a-half-times more likely to be incarcerated. This study estimated smoking prevalence with noninstitutionalized and incarcerated samples combined to determine if excluding incarcerated adults impacts smoking prevalence for certain populations.

METHODS

The Bureau of Justice Statistics last fielded the Survey of Inmates in State and Federal Correction Facilities in 2003-2004. We combined data from Survey of Inmates in State and Federal Correction Facilities (n = 17 910) and the 2003 and 2004 National Health Interview Survey (n = 61 470) to calculate combined cigarette smoking estimates by race/ethnicity, sex, and age.

RESULTS

Inmates represented the greatest proportion of smokers among African American men. Among African American young adult men, inmates represented 15.2% of all smokers in the combined population, compared to 2.0% among white young adult men. Cigarette smoking prevalence was 17.6% in the noninstitutionalized population of young adult African American men and 19.7% in the combined population. Among white young adult men, cigarette smoking prevalence was 29.8% in the noninstitutionalized population, and 30.2% in the combined population. There was little difference in estimates among women.

CONCLUSIONS

The exclusion of incarcerated African American young adult men may result in a small underestimation of cigarette smoking prevalence in this population. Increasing access to smoking cessation support among inmates may reduce smoking prevalence in disproportionately incarcerated segments of the US population.

IMPLICATIONS

The exclusion of incarcerated adults from national survey data should be considered when examining differences in cigarette smoking prevalence estimates between African American and white young adult men. Approximately one in six African American young adult men who smoke were incarcerated. Increasing access to smoking cessation support among inmates may reduce smoking prevalence among disproportionately incarcerated segments of the population.

Smoking cessation in male prisoners: a literature review

PURPOSE

The purpose of this paper is to review the available literature relating to smoking cessation (SC) for the male prisoner population.

DESIGN/METHODOLOGY/APPROACH

Databases PubMed, CINAHL and MEDLINE were searched for English language studies from 1990 to 2012. The authors identified 12 papers examining SC in male prisoners. Full-text articles were analysed for inclusion.

FINDINGS

A total of 12 studies were identified for inclusion. Four studies focused on forced abstinence (a smoking ban) while the remainder looked at various combinations of nicotine replacement, pharmacology and behavioural techniques. No robust studies were found that examined nursing approaches to SC for the prisoner population. The evidence shows a strong "pro-smoking" culture in prison and that many prisoners continue to smoke irrespective of an enforced ban. However, SC strategies can be successful if implemented systematically and supported by consistent policies.

RESEARCH LIMITATIONS/IMPLICATIONS

Female-only prisoner studies were excluded as females comprise just 7 per cent of the Australian prisoner population. The analysis does not differentiate between maximum- or minimum-security prisons, or length of prison sentence. Results cannot be generalised to other forms of detention such as police custody or immigration detention centres. Studies were not appraised for quality, as exclusion on that basis would render further exploration untenable. The analysis was presented in a narrative rather than meta-analytical format and may be subject to interpretation.

PRACTICAL IMPLICATIONS

This paper provides a foundation on which to build further research evidence into the smoking behaviour of prisoners. This information can be used to advocate for healthier public policy for a vulnerable and marginalised population.

ORIGINALITY/VALUE

To the authors' knowledge, this is the first literature review into SC interventions in prisons. The authors apply the findings of this literature review to the five strategies for health promotion to propose a population approach to smoking cessation in male prisoners. Recommendations specific to the correctional environment are outlined for consideration by correctional health professionals.

Smoking status and the presence of chronic obstructive pulmonary disease in prison

INTRODUCTION

Smoking, with a prevalence ranging from 42% to 91%, and secondhand smoke (SHS), with a high exposure level of 3 to 11 μg/m, are frequently seen in prisons.

OBJECTIVES

We aimed at investigating the prevalence of chronic obstructive pulmonary disease (COPD) among inmates and prison staff.

MATERIAL AND METHODS

This study included prisoners and prison staff in Bolvadin Closed and Open Prison in Turkey. All volunteers went through a standard spirometry and completed the Fagerstrom Test for nicotine dependence.

RESULTS

A total of 179 volunteers, 109 of whom were prisoners and 70 prison staff, were involved in the study. Average age was 35.6 ± 11.9 years. There were 123 smokers (68.7%), 26 ex-smokers (14.5%), and 30 nonsmokers (16.8%). Up to 89.4% of participants reported that they were exposed to SHS. Mean forced expiratory volume in 1 second (FEV1) value was found to be 3.68 ± 0.80 (93.9 ± 15.1%), forced vital capacity (FVC) value to be 3.87 ± 0.83 (83.1 ± 14.3%), and FEV1/FVC to be 98.4 ± 19.6. Eighteen inmates and 2 prison staff members had the diagnosis of COPD; 22 prisoners (20.2%) and 4 prison staff members (5.7%) had COPD. There were pulmonary symptoms in 49.2% of the volunteers; the symptoms were statistically higher in smokers when compared to non-smokers and ex-smokers (P = 0.000). There was a statistically significant relationship between exposure to SHS and presence of COPD (P = 0.043), and pulmonary symptoms (P = 0.008).

CONCLUSIONS

The frequency of smoking in this prison was considerably high (68.7%, compared against 22%-31% in non-incarcerated populations). The prevalence of COPD was also found high among inmates (20.2% vs 4.2%-23% in non-incarcerated populations). Therefore, pulmonary symptoms should be examined carefully when screening prisoners, including consideration for the use of lung spirometry and screening for tobacco use disorder.

Prevalence and factors associated with smoking tobacco among men recently released from prison in California: A cross-sectional study

BACKGROUND

Over 1.5 million people are incarcerated in state and federal correctional facilities in the United States. Formerly incarcerated men have significantly higher rates of mortality and morbidity than the general population, disparities that have been partially attributed to higher rates of tobacco smoking-related illnesses such as cardiovascular disease, pulmonary disease and cancer.

METHODS

We compared the prevalence of smoking tobacco in a sample of 172 men who were released from California state prisons to Oakland and San Francisco between 2009 and 2011 to sub-populations of respondents to the 2009 California Health Interview Survey (CHIS). Using logistic regression, we analyzed the association between lifetime history of incarceration and self-reported smoking status.

RESULTS

Seventy-four percent of men recently released from prison reported being current tobacco smokers. The prevalence of smoking in a demographically similar group of men in the CHIS was 24%. We found in bivariate analysis that each additional five years of history of incarceration was associated with 1.32 times greater odds of smoking (95% CI 1.02 to 1.71). Illicit substance use was associated with a 2.47 higher adjusted odds of smoking (95% CI 1.29 to 5.39). In the multivariate model adjusting for age, income, substance use and mental health, every five years of incarceration was associated with 1.23 greater odds of smoking (95% CI 0.94 to 1.63) which was not statistically significant.

CONCLUSIONS

Given the high prevalence of smoking tobacco among former prisoners and the underlying high tobacco-related mortality rates, these findings suggest that a history of incarceration may be an important determinant of smoking. Prison and parole systems may be important potential settings for smoking-cessation interventions.

Smoke-free policies in U.S. Prisons and jails: A review of the literature

INTRODUCTION

Despite progress in limiting exposure to secondhand smoke (SHS) in the United States, little is known about the impact of smoke-free polices in prisons and jails. SHS exposure in this setting may be great, as smoking prevalence among inmates is more than three times higher than among non-incarcerated adults. To inform the implementation of smoke-free policies, this article reviews the literature on the extent, nature, and impact of smoke-free policies in U.S. prisons and jails.

METHODS

We systematically searched PubMed, Embase, EconLit, and Social Services Abstracts databases. We examined studies published prior to January 2014 that described policies prohibiting smoking tobacco in adult U.S. correctional facilities.

RESULTS

Twenty-seven studies met inclusion criteria. Smoke-free policies in prisons were rare in the 1980s but, by 2007, 87% prohibited smoking indoors. Policies reduced SHS exposure and a small body of evidence suggests they are associated with health benefits. We did not identify any studies documenting economic outcomes. Non-compliance with policies was documented in a small number of prisons and jails, with 20%-76% of inmates reporting smoking in violation of a policy. Despite barriers, policies were implemented successfully when access to contraband tobacco was limited and penalties were enforced.

CONCLUSION

Smoke-free policies have become increasingly common in prisons and jails, but evidence suggests they are not consistently implemented. Future studies should examine the health and economic outcomes of smoke-free policies in prisons and jails. By implementing smoke-free policies, prisons and jails have an opportunity to improve the health of staff and inmates.

Assessment of effectiveness of smoking cessation intervention among male prisoners in India: A randomized controlled trial

Background:

Tobacco smoking is an integral part of prison life and an established part of the culture. Little attention has been paid to prevention of smoking in prison. Approximately 70–80% of prisoners have been identified as current smokers. Aim: To assess the effectiveness of smoking cessation intervention among male prisoners at Central Jail, Bangalore city.

Aim:

To assess the effectiveness of smoking cessation intervention among male prisoners at Central Jail, Bangalore city.

Materials and Methods:

A randomized controlled trial was planned among male prisoners in Central Jail, Bangalore city. There were 1600 convicted prisoners. A self-administered questionnaire was given to the prisoners to assess their smoking behavior by which prevalence of tobacco smoking was found. Exactly 1352 tobacco users were studied. Among them, there were 1252 smokers. Based on inclusion criteria and informed consent given by the prisoners, a sample of 600 was chosen for the study by systematic random sampling. Among the 600 prisoners, 300 were randomly selected for the study group and 300 for the control group.

Results:

Prevalence of tobacco smoking among the prisoners was 92.60%. In the present study, after smoking cessation intervention, 17% showed no change in smoking, 21.66% reduced smoking, 16% stopped smoking, and 45.33% relapsed (P < 0.0001) at the end of 6-month follow-up in the study group.

Conclusion:

Tobacco use was high among the prisoners. Tobacco reduction is possible in the prison even if the living conditions are not favorable. Relatively high rate of relapse in our study indicates that some policies should be adopted to improve smokers’ information on consequences of tobacco on health and motivational intervention should be added to prisoners.

Prison tobacco control policies and deaths from smoking in United States prisons: population based retrospective analysis

OBJECTIVE

To determine the mortality attributable to smoking and years of potential life lost from smoking among people in prison and whether bans on smoking in prison are associated with reductions in smoking related deaths.

DESIGN

Analysis of cross sectional survey data with the smoking attributable mortality, morbidity, and economic costs system; population based time series analysis.

SETTING

All state prisons in the United States.

MAIN OUTCOME MEASURES

Prevalence of smoking from cross sectional survey of inmates in state correctional facilities. Data on state prison tobacco policies from web based searches of state policies and legislation. Deaths and causes of death in US state prisons from the deaths in custody reporting program of the Bureau of Justice Statistics for 2001-11. Smoking attributable mortality and years of potential life lost was assessed from the smoking attributable mortality, morbidity, and economic costs system of the Centers for Disease Control and Prevention. Multivariate Poisson models quantified the association between bans and smoking related cancer, cardiovascular and pulmonary deaths.

RESULTS

The most common causes of deaths related to smoking among people in prison were lung cancer, ischemic heart disease, other heart disease, cerebrovascular disease, and chronic airways obstruction. The age adjusted smoking attributable mortality and years of potential life lost rates were 360 and 5149 per 100,000, respectively; these figures are higher than rates in the general US population (248 and 3501, respectively). The number of states with any smoking ban increased from 25 in 2001 to 48 by 2011. In prisons the mortality rate from smoking related causes was lower during years with a ban than during years without a ban (110.4/100,000 v 128.9/100,000). Prisons that implemented smoking bans had a 9% reduction (adjusted incidence rate ratio 0.91, 95% confidence interval 0.88 to 0.95) in smoking related deaths. Bans in place for longer than nine years were associated with reductions in cancer mortality (adjusted incidence rate ratio 0.81, 95% confidence interval 0.74 to 0.90).

CONCLUSIONS

Smoking contributes to substantial mortality in prison, and prison tobacco control policies are associated with reduced mortality. These findings suggest that smoking bans have health benefits for people in prison, despite the limits they impose on individual autonomy and the risks of relapse after release.

"They are not taking cigarettes from me . . . I'm going to smoke my cigarettes until the day I die. I don't care if I get cancer": smoking behaviors of men under community supervision in New York City

INTRODUCTION

Cigarette smoking declined from 42.4% in 1965 to 19.3% in 2010 among the general population, but it remains the leading cause of preventable death and illness in the United States, especially among high-risk populations, including those with criminal justice involvement.

METHODS

A mixed-methods approach was used to investigate the smoking behaviors of men under parole or probation. Phase I focused on qualitative data of 30 semi-structured interviews of men who were recently released from a state prison and/or jail. Phase II analyzed quantitative data resulting from a study that examined smoking characteristics and treatment approaches of 259 participants, 197 of whom were cigarette smokers.

RESULTS

The survey participants' age of tobacco initiation ranged from 7 to 45 years of age. Participants smoked between 1 and 40 cigarettes per day; the mean number of cigarettes smoked per day was 10.37. Men released from prison used cigarettes for more years on average than men released from jail (t[194] = -2.22, p < .05). A linear regression procedure revealed that the influence of friends and family significantly predicted smoking behavior (β = .25, p < .0001). The qualitative data revealed the following themes: unintended consequences of the prison smoking ban, smoking as anxiety management, smoking cigarettes as part of a daily routine, and barriers to quitting.

CONCLUSIONS

Given the rapid growth of individuals under community supervision, public health and policy makers are missing an opportunity to develop strategies that promote smoking cessation treatments, especially among men who are serving parole or probation and during the incarceration period itself.

Factors associated with smoking among adolescent males prior to incarceration and after release from jail: a longitudinal study

Background

The prevalence of cigarette smoking among incarcerated adult men and women is three-four times higher than in the general population, ranging from 70-80%. However, little is known about factors associated with smoking among incarcerated adolescents, especially upon their re-entry into communities after release from jail. The current study explores factors associated with smoking among adolescent males prior to incarceration and one year after their release from jail.

Methods

We conducted a secondary data analysis of the Returning Educated African-American and Latino Men to Enriched Neighborhoods (REAL MEN) study, which was designed to reduce HIV risk, substance use, and recidivism among 16–18 year old males leaving jail. We examined differences between smokers and non-smokers at the time of their incarceration (N = 552) and one year after their release from jail (N = 397) using t-tests and chi-square tests. Using logistic and linear regression we examined factors associated with current smoking status, frequency of smoking, and quantity of cigarettes smoked per day both prior to the young men’s incarceration and one year after their release from jail.

Results

Prior to incarceration, 62% of the young men reported smoking, and one-year after jail release, 69% reported smoking. Prior to incarceration, foster care history, not living with parents, not attending school, drug sales, number of sex partners, gang involvement, current drug charges, and number of prior arrests were positively associated with smoking indicators prior to incarceration. Having violent charges was inversely associated with smoking indicators prior to incarceration. One-year after release from jail, foster care history and number of prior arrests before the index incarceration were associated with smoking indicators.

Conclusions

Several problem behaviors may be associated with adolescent males’ smoking behaviors prior to incarceration. However, the young men’s histories of difficult life circumstances and engagement in illegal activity may have long-term consequences on smoking for these young men during their transition between jail and community. Findings suggest a need for comprehensive risk reduction interventions in settings in which disadvantaged young men are institutionalized, starting in childhood.

The unmet medical needs of correctional populations in the United States

The goal of this study was to document the health needs of members in the criminal justice system and the capacity of the system to meet those needs. Using data from the National Criminal Justice Treatment Practices survey, we estimated the number of adults under correctional control who need medical care and the capacity of the correctional system to provide needed care. A mailed survey of 431 adult correctional agencies and administrators was used to define the capacity and techniques of the correctional system to meet the medical needs of the offender population. Most offenders in jail and prison received tuberculosis screening, physical health services, and mental health screening and treatment. Screening for sexually transmitted diseases (STDs) and provision of detoxification or methadone maintenance were universally absent, regardless of criminal justice setting. Community corrections settings were lacking in most health care areas. Prisons and jails are constitutionally mandated to provide health care; however, community corrections agencies are not federally required to provide health services. While community correction settings have the lowest provision of health care services, prisons and jails also demonstrate a deficiency in most services, but particularly for STD screening, substance abuse detoxification, and opioid maintenance therapies.

A randomized controlled trial of a smoking cessation intervention conducted among prisoners

AIM

To evaluate the efficacy of nortriptyline (NOR) added to a multi-component smoking cessation intervention, which included cognitive-behavioural therapy (CBT) and provision of nicotine replacement therapy (NRT).

DESIGN

Randomized controlled trial (RCT) comparing two study groups with blinded follow-up at 3, 6 and 12 months. Both groups received a multi-component smoking cessation intervention comprising two half-hour individual sessions of CBT and NRT with either active NOR or placebo.

SETTING

Prisons in New South Wales (17) and Queensland (one), Australia.

PARTICIPANTS

A total of 425 male prisoners met inclusion criteria and were allocated to either treatment (n = 206) or control group (n = 219).

MEASUREMENTS

Primary end-points at 3, 6 and 12 months were continuous abstinence, point prevalence abstinence and reporting a 50% reduction in smoking. Smoking status was confirmed by expired carbon monoxide, using a cut-point of ≤10 parts per million.

FINDINGS

Participants' demographics and baseline tobacco use were similar in treatment and control groups. Based on an intention-to-treat analysis, continuous abstinence between the treatment and control groups was not significantly different at 3 months (23.8 versus 16.4%), 6 months (17.5 versus 12.3%) and 12 months (11.7 versus 11.9%).

CONCLUSION

Adding nortriptyline to a smoking cessation treatment package consisting of behavioural support and nicotine replacement therapy does not appear to improve long-term abstinence rates in male prisoners.

Smoking and other drug characteristics of aboriginal and non-aboriginal prisoners in australia

Introduction and Aim. Although tobacco and alcohol use have declined substantially in the Australian community, substance use among prisoners remains high. The aim was to compare the smoking, drug, and alcohol characteristics, sociodemographic profile, and general health of Aboriginal and non-Aboriginal male prisoners in a smoking cessation intervention. Design and Methods. This study was a descriptive cross-sectional analysis of data from 425 male prisoners who joined a quit smoking trial conducted at 18 correctional centres in NSW and Queensland using data collected by standardised self-report instruments. Results. Average age was 33 years with 15% from Aboriginal descent. Compared to non-Aboriginal prisoners, Aboriginal prisoners were significantly more likely to have left school with no qualifications, to have been institutionalised as a child, to be previously incarcerated, and commenced smoking at a younger age. The tobacco use profile of both groups was similar; most of them had a medium to high level of nicotine dependence, smoked roll your own tobacco, and were “serious” about quitting. Discussion and Conclusion. Despite differences in terms of sociodemographic characteristics and offending history, the smoking characteristics of Aboriginal and non- Aboriginal prisoners were similar. Incarceration offers an opportunity to encourage smoking cessation and reduction of drug use.

Implementation and impact of anti-smoking interventions in three prisons in the absence of appropriate legislation

OBJECTIVE

To assess the acceptability and impact of anti-smoking policies in three prisons in Switzerland.

METHODS

A before-after intervention study in A) an open prison for sentenced prisoners, B) a closed prison for sentenced prisoners, and C) a prison for pretrial detainees. Prisoners and staff were surveyed before (2009, n=417) and after (2010-2011, n=228) the interventions. Medical staff were trained to address tobacco dependence systematically in prisoners. In prison A, a partial smoking ban was extended. No additional protection against second-hand smoke was feasible in prisons B and C.

RESULTS

In prison A, more prisoners reported receiving medical help to quit smoking in 2011 (20%) than in 2009 (4%, p=0.012). In prison A, prisoners and staff reported less exposure to second-hand smoke in 2011 than in 2009: 31% of prisoners were exposed to smoke at workplaces in 2009 vs 8% in 2011 (p=0.001); in common rooms: 43% vs 8%, (p<0.001). No changes were observed in prisons B and C.

CONCLUSIONS

Reinforcement of non-smoking rules was possible in only one of the three prisons but had an impact on exposure to tobacco smoke and medical help to quit. Implementing anti-smoking policies in prisons is difficult in the absence of appropriate legislation.

Health effects of the Federal Bureau of Prisons tobacco ban

BACKGROUND

Tobacco smoking remains the leading cause of preventable death in America, claiming 450,000 lives annually. Chronic Obstructive Pulmonary Disease, caused by smoking in the vast majority of cases, became the third leading cause of death in the U.S. in 2008. The burden of asthma, often exacerbated by tobacco exposure, has widespread clinical and public health impact. Despite this considerable harm, we know relatively little about the natural history of lung disease and respiratory impairment in adults, especially after smoking cessation.

METHODS/DESIGN

Our paper describes the design and rationale for using the 2004 Federal Bureau of Prisons tobacco ban to obtain insights into the natural history of respiratory diseases in adult men and women of different races/ethnicities who are imprisoned in federal medical facilities. We have developed a longitudinal study of new prison arrivals, with data to be collected from each participant over the course of several years, through the use of standardized questionnaires, medical chart reviews, lung function tests, six-minute walk tests, and stored serum for the analysis of present and future biomarkers. Our endpoints include illness exacerbations, medication and health services utilization, lung function, serum biomarkers, and participants' experience with their health and nicotine addiction.

DISCUSSION

We believe the proposed longitudinal study will make a substantial contribution to the understanding and treatment of respiratory disease and tobacco addiction.

Perceptions and influences of a state prison smoking ban

Prison smoking bans are increasingly common. It is important to consider how those who are incarcerated respond to these bans and to the subsequent development of contraband tobacco markets. Since there are high rates of smoking in individuals who become incarcerated, along with high rates of chronic illnesses that are exacerbated by smoking, it is critical to examine whether there are health promoting changes in perceptions of and intentions toward smoking and other health behaviors that can be maintained on release to the community. Interviews with incarcerated men experiencing a prison smoking ban revealed their responses to being smoke-free, reactions to the presence of contraband smoking, and the influences of this experience on their intentions to smoke following release.

Prisoners and cigarettes or 'imprisoned in cigarettes'? What helps prisoners quit smoking?

Abstract

Background

The aim of the study was, despite the special characteristics of prisons, to identify the features which led prisoners who attended the Smoking Cessation Centre at the Kassavetia Detention Centre in Volos (region of Thessaly, in the central part of mainland Greece) to quit smoking.

Methods

Personal interviews with 204 male prisoners irrespective of smoking habitus over the period June 2008 to December 2010 were obtained. Information about medical history, history of tobacco use and addiction to narcotic use was obtained and imprisonment status was recorded. Pharmaceutical treatment (Varenicline) and counselling or only counselling were suggested as alternative strategies to them in order to help quit smoking. SPSS v15.0 software was employed, descriptive statistics were used, and a X² independence test and Student’s t-test were performed.

Results

Of the sample examined, 75.5% (154) were smokers. They were mainly Greeks (51.5%), single (53.4%) and had not gratuated from a high school (secondary education level) (70.6%). 59.75% begun smoking early ( ≤14 years of age ) and 64.9% were highly addicted according to Fagerstrom Tolerance Questionnaire. 74% (114) of all smokers at the prison attended the Smoking Cessation Centre. Of them, 30.7% were able to quit smoking at 3 months but 1 year later there were 20.2% ex-smokers. The key characteristics of those who were able to be ex-smokers were a change in smoking habits (decreased) compared to when free (p = .001), previous attempts to quit (while incarcerated and in general) (p = .001), average dependence levels (p < .001), started smoking after 21 years of age (p = .032), no history of addictive substance use (p = .029), being already prisoners for a longer period of time (p = .019), a limited number (3.9 ± 3.4) of prisoners per cell (p < .001) and in particular a limited number (2.8 ± 3.2) of smokers in the cell (p < .001).

Conclusions

Average dependence, a past free of addictive substance abuse and a better environment of daily living for certain prisoners (as far as the number of cellmates was concerned) had a catalytic impact on prisoners finally managed to quit smoking.

The use of tobacco as gambling currency by federal offenders in Canada before and after a tobacco ban

In 2008 tobacco was banned in federal correctional institutions in Canada. In this paper we compare the use of tobacco as currency for gambling in two studies that we conducted, one before and one after the tobacco ban. The data from two studies were compared. The questionnaires were administered to offenders in federal and provincial institutions in Ontario. Study 1 included 254 male offenders and study 2 included 395 male offenders. The focus in this paper is on one questionnaire about the type of wager made while incarcerated. It was found that the use of tobacco as a currency in gambling went from 28.6% of those offenders who gamble to 2.3% of those offenders who gamble. In addition, there was an overall decrease in the number of federal offenders who reported gambling while incarcerated. However, information gained from the questionnaire and from interviews with incarcerated offenders suggests that there has been a shift to money wagers and that gambling inside has become more serious since the tobacco ban. The results suggest that the ban on smoking has resulted in a change in the type of currency used for gambling inside correctional institutions in Ontario Canada.

Implementing an indoor smoking ban in prison: enforcement issues and effects on tobacco use, exposure to second-hand smoke and health of inmates

OBJECTIVES

To describe the issues encountered during the implementation of an indoor smoking ban in prison and its effects on self-reported tobacco use, perceived exposure to second-hand smoke (SHS) and perceived health status of inmates in Quebec's provincial correctional facilities.

METHODS

Quantitative data were obtained from 113 inmates in three provincial correctional facilities in the province of Quebec, Canada. Qualitative data were obtained from 52 inmates and 27 staff members. Participants were recruited through a self-selection process. Particular efforts were made to enrol proportions of men, women, smokers and non-smokers similar to those generally found among correctional populations.

RESULTS

Despite the indoor smoking ban, 93% of inmates who declared themselves smokers reported using tobacco products inside the correctional facilities and 48% did not report any reduction in their tobacco use. Only 46% of smokers declared having been caught smoking inside the facility, and more than half of them (58%) reported no disciplinary consequences to their smoking. A majority of inmates incarcerated before the implementation of the ban (66%) did not perceive a reduction of their exposure to SHS following the indoor ban. Enforcement issues were encountered during the implementation of the indoor ban, notably because of the amendment made to the original regulation (total smoking ban) and tolerance from smokers in the staff towards indoor smoking. They were also related to perceptions that banning indoor smoking is complex and poses management problems.

CONCLUSION

This study's findings emphasize the importance of considering organizational and environmental factors when planning the implementation of an indoor smoking ban in correctional facilities.

Tobacco use by male prisoners under an indoor smoking ban

INTRODUCTION

Most correctional facilities have implemented tobacco restrictions in an effort to reduce costs and improve prisoner health, but little has been done to evaluate the impact of these policy changes. Patterns of tobacco use among prisoners were explored to determine the impact of incarceration in a facility with an indoor smoking ban on tobacco use behaviors.

METHODS

Recently incarcerated male inmates (n = 200) were surveyed about their tobacco use prior to and during incarceration.

RESULTS

Tobacco use was prevalent prior to arrest (77.5%) and increased during incarceration (81.0%). Though the number of cigarette smokers increased during imprisonment, per-capita cigarette consumption declined by 7.1 cigarettes/day (p < .001). Despite widespread tobacco use, most participants recognized that smoking is a cause of lung cancer (96.0%) and heart disease (75.4%) and that it can be addicting (97.5%). Most tobacco users (70.0%) reported a desire to quit, with 63.0% saying they intended to try quitting in the next year.

CONCLUSIONS

Indoor smoking bans do not promote cessation in prisons but may reduce the amount of tobacco consumed. Though smoking is commonplace in prisons, most prisoners recognize the risks involved and wish to quit. This creates an ideal setting for intervention. Evidence-based cessation assistance should be made freely available to all incarcerated smokers.

Smoking and predictors of nicotine dependence in a homeless population

OBJECTIVE

To assess prevalence rates of tobacco use and dependence in a sample of homeless individuals and to investigate trends for demographic and clinical characteristics across different levels of nicotine dependence (nonsmokers vs. lowly dependent smokers vs. highly dependent smokers).

METHODS

A cross-sectional study of 489 homeless men and women in 3 Canadian cities. Each subject was assessed using structured clinical interviews and the Fagerström Test for Nicotine Dependence (FTND). Cochran-Armitage trend tests were applied to determine unadjusted trends in sociodemographic and clinical variables across levels of nicotine dependence. A generalized logit model was computed to adjust for potential confounding.

RESULTS

The mean age was 37.9 years; 39.2% of the participants were women. About 80.8% were current smokers; the mean FTND score was 5.0. Although no significant differences were found between nonsmokers and smokers with low nicotine dependence, smokers with high nicotine dependence were only half as likely as nonsmokers to be Aboriginal, were 2.39 times more likely to have ever been incarcerated, and 2.44 times more likely to have current drug dependence. There were significant trends for the use of cocaine, opioids, and alcohol, with nonsmokers having the lowest and highly dependent smokers having the highest rates of using these substances.

CONCLUSIONS

Available public health smoking cessation treatment opportunities should be made available within health care services for the homeless. There is also a need for developing and implementing tobacco dependence treatment programs, which are accessible and tailored to meet the needs of this specific population, accounting for polysubstance use and concurrent substance dependence and mental health disorders.

Impact of self-initiated pre-quit smoking reduction on cessation rates: results of a clinical trial of smoking cessation among female prisoners

OBJECTIVES

This study examined differences in cessation success based on smokers' self-initiated pre-quit reductions in cigarettes per day (cpd).

METHODS

The study utilized data from a nicotine replacement+behavioral therapy smoking cessation intervention conducted in a female prison facility with 179 participants who were wait-listed for 6 months prior to intervention. We compared two groups of smokers based on whether they self-selected to reduce smoking prior to their cessation attempt (n=77) or whether they increased smoking or did not reduce (n=102). General Estimating Equations (GEE) were used to model smoking cessation through 12-month follow-up.

RESULTS

Examination of pre-cessation cpd showed that those who reduced were heavier smokers at baseline, relative to those who did not reduce (p<0.001). By the week prior to the quit attempt (week 3) heavier smokers at baseline smoked significantly fewer cigarettes (p<0.001) and had lower CO levels (p<0.05) compared to baseline lighter smokers. GEE analyses showed that individuals who reduced prior to their quit attempt had significantly higher quit rates during early treatment but these gains were not sustained by follow-up points.

CONCLUSIONS

Participant-initiated pre-cessation smoking reduction may be initially helpful in preparing to quit smoking, or may serve as a marker for participant motivation to quit smoking, but these differences do not sustain over time. More intensive interventions are still needed for successful cessation.

Smoking in prisons: the need for effective and acceptable interventions

Tobacco-smoking prevalence has been decreasing in many high-income countries, but not in prison. We provide a summary of recent data on smoking in prison (United States, Australia, and Europe), and discuss examples of implemented policies for responding to environmental tobacco smoke (ETS), their health, humanitarian, and ethical aspects. We gathered data through a systematic literature review, and added the authors' ongoing experience in the implementation of smoking policies outside and inside prisons in Australia and Europe. Detainees' smoking prevalence varies between 64 per cent and 91.8 per cent, and can be more than three times as high as in the general population. Few data are available on the prevalence of smoking in women detainees and staff. Policies vary greatly. Bans may either be 'total' or 'partial' (smoking allowed in cells or designated places). A comprehensive policy strategy to reduce ETS needs a harm minimization philosophy, and should include environmental restrictions, information, and support to detainees and staff for smoking cessation, and health staff training in smoking cessation.

The impact of quitting smoking on weight among women prisoners participating in a smoking cessation intervention

OBJECTIVES

We examined the impact of smoking cessation on weight change in a population of women prisoners.

METHODS

Women prisoners (n = 360) enrolled in a smoking cessation intervention; 250 received a 10-week group intervention plus transdermal nicotine replacement.

RESULTS

Women who quit smoking had significant weight gain at 3- and 6-month follow-ups, with a net difference of 10 pounds between smokers and abstainers at 6 months. By the 12-month follow-up, weight gain decreased among abstainers.

CONCLUSIONS

We are the first, to our knowledge, to demonstrate weight gain associated with smoking cessation among women prisoners. Smoking cessation interventions that address postcessation weight gain as a preventative measure may be beneficial in improving health and reducing the high prevalence of smoking in prisoner populations.

The Impact of Implementing Smoking Bans Among Incarcerated Substance Users: A Qualitative Study

This article reports a study evaluating the effects of implementing smoking bans among drug-using prisoners in Taiwan. Seventy-seven new entrants were recruited in May 2008. Six focus groups were conducted in a prison-based treatment center, the only prison with a total smoking ban in Taiwan. All the subjects were male and their average age was 37 years. Three general reactions to the ban were identified across all focus groups: (a) unfair/hypocritical policy; (b) being forced to stop smoking; and (c) finding ways to smoke anyway. Future studies should compare the effects of total versus partial smoking bans among drug abusers in prison to better explore policy options.

Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption

BACKGROUND

Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and smoking behaviour of those populations they affect.

OBJECTIVES

To assess the extent to which legislation-based smoking bans or restrictions reduce exposure to SHS, help people who smoke to reduce tobacco consumption or lower smoking prevalence and affect the health of those in areas which have a ban or restriction in place.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL, Conference Paper Index, and reference lists and bibliographies of included studies. We also checked websites of various organisations. Date of most recent search; July 1st 2009.

SELECTION CRITERIA

We considered studies that reported legislative smoking bans and restrictions affecting populations. The minimum standard was having a ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. We included randomized controlled trials, quasi-experimental studies (i.e. non-randomized controlled studies), controlled before and after studies, interrupted-time series as defined by the Cochrane Effective Practice and Organization of Care Group, and uncontrolled pre- and post-ban data.

DATA COLLECTION AND ANALYSIS

Characteristics and content of the interventions, participants, outcomes and methods of the included studies were extracted by one author and checked by a second. Because of heterogeneity in the design and content of the studies, we did not attempt a meta-analysis. We evaluated the studies using qualitative narrative synthesis.

MAIN RESULTS

There were 50 studies included in this review. Thirty-one studies reported exposure to secondhand smoke (SHS) with 19 studies measuring it using biomarkers. There was consistent evidence that smoking bans reduced exposure to SHS in workplaces, restaurants, pubs and in public places. There was a greater reduction in exposure to SHS in hospitality workers compared to the general population. We failed to detect any difference in self-reported exposure to SHS in cars. There was no change in either the prevalence or duration of reported exposure to SHS in the home as a result of implementing legislative bans. Twenty-three studies reported measures of active smoking, often as a co-variable rather than an end-point in itself, with no consistent evidence of a reduction in smoking prevalence attributable to the ban. Total tobacco consumption was reduced in studies where prevalence declined. Twenty-five studies reported health indicators as an outcome. Self-reported respiratory and sensory symptoms were measured in 12 studies, with lung function measured in five of them. There was consistent evidence of a reduction in hospital admissions for cardiac events as well as an improvement in some health indicators after the ban.

AUTHORS' CONCLUSIONS

Introduction of a legislative smoking ban does lead to a reduction in exposure to passive smoking. Hospitality workers experienced a greater reduction in exposure to SHS after implementing the ban compared to the general population. There is limited evidence about the impact on active smoking but the trend is downwards. There is some evidence of an improvement in health outcomes. The strongest evidence is the reduction seen in admissions for acute coronary syndrome. There is an increase in support for and compliance with smoking bans after the legislation.

Prerelease intent predicts smoking behavior postrelease following a prison smoking ban

INTRODUCTION

More than 2 million persons are incarcerated in the United States. Most are young minority men, soon to reenter the community. The majority are also lifelong smokers with high rates of health-related problems. As prisons implement smoking bans, it is not known whether health behavior change that is mandated, rather than selected, can be maintained. The Wisconsin Department of Corrections smoking ban is a unique opportunity to investigate determinants of smoking behavior after release from prison.

METHODS

A convenience sample of 49 incarcerated men near release participated in two interviews (1-month prerelease, in prison, and 1-month postrelease via telephone). Descriptive analyses and multivariate modeling were conducted to determine associations with postrelease smoking.

RESULTS

Participants had a mean age of 36.7 years, 12.4 years of education, and a 2.3-year incarceration; 47% were Black and 41% White. They had smoked 14.5 years. Most (67%) believed that their health was improved after the smoking ban. Paired t tests revealed decreases in Positive and Negative Affect Scale negative affect (p = .001) and Patient Health Questionnaire-8 depression (p = .009) postrelease. Univariate analysis showed correlations of intent to smoke upon release with smoking relapse postrelease (p = .001), White race with smoking relapse postrelease (p = .045), and perceived better health since the prison smoking ban with nonsmoking on release (p = .01). There was a trend toward use of alcohol with smoking relapse on release (p = .061).

DISCUSSION

Prerelease smoking intention predicted postrelease behavior. Belief in improved health after the prison smoking ban correlated with nonsmoking on release. Targeted relapse prevention interventions are needed for people reentering the community.

Smoking characteristics of community corrections clients

INTRODUCTION

While smoking rates are 3-4 times higher among criminal justice populations than in the general population, no studies have previously examined smoking characteristics in a community corrections population.

METHODS

The current study involved descriptive analyses of self-reported survey data from 217 criminal justice supervisees reporting for urine drug screens during a 5-day period at a community corrections facility in the southeastern United States.

RESULTS

Most participants were current smokers (72.3%), males (65.9%), and Black (50.2%) who reported smoking three fourths of a pack of cigarettes per day and had been smoking for about 15 years. More than half of smokers reported that they would be interested in receiving cessation assistance if free help were available and of these, 60% were interested in pharmacotherapy. White smokers used more cigarettes per day, were more likely to have already tried medication to help them quit smoking, and were also more interested in pharmacotherapies and less interested in behavioral therapies compared with Black smokers. Female smokers did not differ from male smokers on key smoking characteristics, but male smokers were more likely to have tried or regularly used other tobacco products, such as cigars. Female smokers were significantly more likely to report interest in using a pharmacotherapy agent for future cessation, while male smokers reported more interest in nonpharmacotherapy approaches to quit smoking.

DISCUSSION

Results from this study highlight important differences among smoking groups and may indicate the need to test tailored smoking interventions.

Differential success rates in racial groups: results of a clinical trial of smoking cessation among female prisoners

INTRODUCTION

This study replicated prior observations of racial differences in smoking cessation in which Black smokers have demonstrated lower smoking cessation rates than White smokers.

METHODS

The study used data from a smoking cessation intervention and compared White and Black female prisoners (N = 233) on a 10-week intervention of group psychotherapy and nicotine replacement (patch). Generalized estimating equations were used to model smoking cessation across the 12-month follow-up.

RESULTS

Compared with an untreated control group, both Black and White smokers benefited from the cessation treatment. However, after controlling for potential confounds, White smokers had significantly higher overall smoking cessation rates across time compared with Black smokers (e.g., 30% vs. 24% abstinent at 6 weeks; 13% vs. 10% abstinent at 12 months). Smoking mentholated cigarettes was not associated with these differences in quit rates.

DISCUSSION

Understanding differential treatment responses can lead to the development of more tailored and efficacious smoking cessation interventions that may reduce the morbidity and mortality associated with smoking in prison populations.

Resumption of smoking after release from a tobacco-free correctional facility

Approximately 70% of incarcerated people smoke tobacco, and an estimated 12% of all smokers in the United States leave correctional facilities annually. Many facilities prohibit smoking, but no published study has measured the relapse to tobacco after release. In a study of 200 people with chronic health conditions reentering the community from jail, 165 (83%) were cigarette smokers. Of these, 129 were interviewed at 1 and/or 6 months after release. Self-reported sustained abstinence rates were 37.3% at the end of the first day, 17.7% for the first week, 13.7% for 1 month, and 3.1% for 6 months. These abstinence rates are lower than those reported after military basic training and medical hospitalization but similar to rates after inpatient psychiatric and addiction programs. More efforts and resources are needed to determine successful tobacco cessation interventions during incarceration and after release.