Smoking tobacco contributes to 11.5% of deaths worldwide and, in some countries, more hospitalizations than alcohol and drugs combined. Globally in 2015, 25% of men and 5% of women smoked. In the United States, a higher proportion of people in prison smoke than do community-dwelling individuals. To determine smoking prevalence in prisons worldwide, we systematically reviewed the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; we also examined whether prisons banned smoking or treated smokers. We searched databases for articles published between 2012 and 2016 and located 85 relevant articles with data representing 73.5% of all incarcerated persons from 50 countries. In 35 of 36 nations (97%) with published prevalence data, smoking for the incarcerated exceeded community rates 1.04- to 62.6-fold. Taking a conservative estimate of a 2-fold increase, we estimated that, globally, 14.5 million male and 26,000 female smokers pass through prisons annually. Prison authorities’ responses include permitting, prohibiting, or treating tobacco use. Bans may temporarily improve health and reduce in-prison health care costs but have negligible effect after prison release. Evidence-based interventions for smoking cessation effective outside prisons are effective inside; effects persist after release. Because smoking prevalence is heightened in prisons, offering evidence-based interventions to nearly 15 million smokers passing through yearly would improve global health.
Objectives: In 2013, the Northern Territory was the first Australian jurisdiction to introduce a smoke-free policy for all correctional facilities. We report on a process evaluation to identify what worked well, key challenges and unintended consequences. Methods:We interviewed 87 people, comprising remand, medium-security and low-security prisoners; visiting family members; and prison staff (including prison management and health workers). A realist evaluation approach was used.Results: A long lead-in time, collaborative planning and a comprehensive communication strategy were vital for generating support for the policy and ensuring a smooth transition, with no riots or major incidents. Many prisoners expressed a preference for cessation support options other than nicotine replacement therapy (NRT). An unintended consequence was misuse of NRT patches. Conclusions:A comprehensive approach to creating support among staff and prisoners is important for smooth implementation of policies for smokefree prisons. Planning should include assessment of prisoners' preferred form of cessation support and strategies to minimise NRT diversion.
Exposure to tobacco smoke is measured by a variety of invasive and noninvasive techniques. Our purpose was to examine how well some of these measures correlated when obtained simultaneously from the same subjects. On three occasions, six subjects were studied while they were smoking a single cigarette after 24 hr of abstinence. There were positive correlations between increases in heart rate and plasma nicotine concentrations and between percentage carboxyhemoglobin and exhaled carbon monoxide. Although residual cotinine was readily detected in samples of plasma before the subjects smoked, there was an increase in mean levels, with a peak approximately 1 hr after smoking. Urinary concentrations of nicotine, cotinine, and nicotine-1'-N-oxide and thiocyanate levels in plasma and saliva were essentially unchanged by smoking a single cigarette. Data on smoke generation and nicotine retention in cigarette butts correlated poorly with all other measures of smoke uptake.
A specific objective of this 6-week crossover study was to determine how 21 regular smokers of middle tar cigarettes changed their smoking behaviour and uptake of smoke constituents, when switching to either lower tar cigarettes capable of delivering amounts of nicotine similar to a conventional middle tar cigarette (maintained nicotine product), or to conventional low tar/low nicotine cigarettes. Subjects visited the laboratory every 2 weeks for detailed assessment of their smoking behaviour. Weekly per capita consumption was similar for all three cigarettes. They were smoked with variable intensities (low tar greater than maintained nicotine greater than middle tar), the tendency being for larger puff volumes, faster puffing and increased puff duration with the low tar cigarettes. The maintained nicotine cigarette was preferred to the middle tar cigarette, although acceptability ratings of the three cigarettes only differed marginally. The nicotine absorbed from the maintained nicotine and middle tar cigarettes was similar and significantly greater than the levels achieved from the low tar cigarettes. Intake of carbon monoxide into the mouth and absorption into the blood stream was lower for the maintained nicotine cigarette than for the middle tar cigarette, with the low tar cigarette occupying an intermediate position. Derived estimates of tar intake suggested reduced intake of tar into the respiratory tract (around 25%) from the maintained nicotine product relative to the middle tar product. The possible advantages of switching to maintained nicotine cigarettes is discussed.
Purpose This paper aims to determine whether a single session of a motivational interview (MI) reduces smoking relapse amongst people released from smoke-free prisons. Design/methodology/approach This study sought to recruit 824 ex-smokers from 2 smoke-free prisons in the Northern Territory, Australia. Participants were randomised to receive either one session (45–60 min) face-to-face MI intervention 4–6 weeks prior to release or usual care (UC) without smoking advice. The primary outcome was continuous smoking abstinence verified by exhaled carbon monoxide test (<5 ppm) at three months post-release. Secondary outcomes included seven-day point-prevalence, time to the first cigarette and the daily number of cigarettes smoked after release. Findings From April 2017 to March 2018, a total of 557 participants were randomised to receive the MI (n = 266) or UC (n = 291), with 75% and 77% being followed up, respectively. There was no significant between-group difference in continuous abstinence (MI 8.6% vs UC 7.4%, risk ratio = 1.16, 95%CI 0.67∼2.03). Of all participants, 66.9% relapsed on the day of release and 90.2% relapsed within three months. On average, participants in the MI group smoked one less cigarette daily than those in the UC within the three months after release (p < 0.01). Research limitations/implications A single-session of MI is insufficient to reduce relapse after release from a smoke-free prison. However, prison release remains an appealing time window to build on the public health benefit of smoke-free prisons. Further research is needed to develop both pre- and post-release interventions that provide continuity of care for relapse prevention. Originality/value This study is the first Australian randomised controlled trial to evaluate a pre-release MI intervention on smoking relapse prevention amongst people released from smoke-free prisons.
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