Feasibility and Acceptability of a Smoking Cessation Program for Individuals Released From an Urban, Pretrial Jail

Abstract

IMPORTANCE Tobacco use prevalence among individuals involved in the criminal-legal system is 125% higher than that of the general population and leads to high levels of smoking-related morbidity and mortality.OBJECTIVE To examine the acceptability, feasibility, and preliminary clinical outcomes of a smoking cessation intervention for individuals who are incarcerated. DESIGN, SETTING, AND PARTICIPANTS This pilot randomized clinical trial was conducted fromJanuary 2019 to May 2020. Participants were recruited in a pretrial county jail in a large Midwestern US city and were followed up after release. Participants were incarcerated, smoked daily before incarceration, desired to stay quit or reduce cigarette smoking upon release, and expected to be released to the community within 90 days of enrollment. Data analysis was performed from June to October 2020. INTERVENTIONSParticipants randomized to the counseling plus nicotine replacement therapy (NRT) group received 1 hour of smoking cessation counseling in jail, a supply of nicotine lozenges upon release, and up to 4 telephone counseling sessions after release. Those randomized to brief health education (BHE) received 30 minutes of general health education in jail. MAIN OUTCOMES AND MEASURESThe primary clinical outcome was biologically verified 7-day point prevalence abstinence (PPA) at 3 weeks after release. Secondary clinical outcomes included 7-day PPA at 12 weeks, changes in number of cigarettes per day, and time to smoking lapse and relapse. RESULTS A total of 46 participants (42 men [91%]; mean [SD] age, 38.2 [9.1] years) were enrolled and remained eligible at release; 23 were randomized to the counseling plus NRT group and 23 were randomized to the BHE group. Recruitment, enrollment, and retention of participants was feasible and acceptable. There were no significant differences in smoking abstinence between groups as determined by 7-day PPA at 3 weeks (adjusted 7-day PPA, 11.9% for counseling plus NRT vs 10.6% for BHE; odds ratio, 1.13; 95% CI, 0.14-9.07) and at 12 weeks (adjusted 7-day PPA, 11.1% for counseling plus NRT vs 14.3% for BHE; odds ratio, 0.75; 95% CI, 0.09-6.11). Cigarettes per day for the counseling plus NRT group decreased more compared with the BHE group at both 3 weeks (difference [SE], −4.58 [1.58] cigarettes per day; 95% CI, −7.67 to −1.48 cigarettes per day; P = .007) and 12 weeks

Cardiovascular Disease Risk Factor Control Following Release from Carceral Facilities

“…A recent feasibility trial in an urban jail found that nicotine replacement therapy was feasible to initiate and maintain following release, though there were no differences in abstinence rates between the groups that received standard behavioral health education compared with nicotine replacement therapy and counseling. 41 Future work needs to be conducted on how best to improve the transition of healthcare in and out of jail, which are usually short stay facilities, to the community for CVD risk factors and may also require examining how incarceration (movement from the community to the jail) affects these outcomes.…”

Nine years of smoking data from incarcerated men: A call to action for tobacco dependence interventions

“…Recognizing the significant emotional stressors that can accompany re-entry into society from prison, Richmond et al conducted a randomized control trial of a behavioral intervention with or without nortriptyline for people who were incarcerated in New South Wales but found no difference in abstinence rates between the two groups at any time point post-release ( Richmond et al, 2013 ). Interventions have also begun during incarceration but continued after release ( Winkelman et al, 2021 ). Reviews of relevant literature have concluded that, beyond a small number of promising studies, this area has not received the attention it deserves and needs ( Puljevic & Segan, 2019 ).…”

Health Education Initiatives for People Who Have Experienced Prison: A Narrative Review

“…Of the total number of studies selected (n = 19), the majority were quantitative studies (12), others were qualitative (2), and the rest were classified with a mixed methodological approach, quantitative and qualitative (5). Regarding the health interventions described in the studies, most (11) were developed in the context of the transition from prison to the community [18][19][20][21][22][23][24][25][26][27][28], two (02) were initiated after people returned to social life [29,30], and six (06) began during incarceration and were continued after arrest [31][32][33][34][35][36].…”