Post-implementation perspectives on smokefree prison policy: a qualitative study with staff and people in custody

Abstract

Background A comprehensive smokefree prison policy (SFPP) was introduced in Scottish prisons from November 2018, reflecting concern about inequalities in occupational exposures to second-hand smoke (SHS) and tobacco-related harms among people in custody (PiC). We aimed to address a gap, whereby few studies have sought to understand SFPP from the perspectives of people living and working in prisons. Methods As part of a comprehensive evaluation, focus groups and interviews with staff (n = 99) and interviews with PiC (n = 23) were conducted 6–9 months post-implementation of SFPP in Scotland. Data were analysed using the framework approach. Results Our study found that new restrictions on smoking had been widely accepted by PiC, after a period of adjustment which was less troublesome than participants had anticipated. Benefits of the SFPP for the safety and comfort of staff and PiC who were no longer exposed to SHS, and additionally for the health of PiC who were now smoking-abstinent, were widely acknowledged. Drawbacks of the SFPP, such as difficulties managing without tobacco and use of alternatives (e.g. e-cigarettes and changes in use of illegal drugs), were also reported. Contraband tobacco was not reported to be a major problem following prisons becoming smokefree. Conclusions The findings strengthen evidence that SFPPs can be implemented without causing major disruption and highlight the need for removal of tobacco to be underpinned by careful planning, partnership working and ensuring the availability of support for smokers. Experiences from Scotland may be of interest and some comfort, internationally for jurisdictions considering smoke-free rules in prisons.

Health in Prison: Does Penitentiary Medicine in Italy Still Exist?

“…The relationship may initially appear to mirror the normal characteristics of a free person-general practitioner relationship, but, in reality, it is subject to the self-serving use of medical, pharmacological, and welfare resources available to prisoners. The prison context inevitably obliges prisoners to adhere to internal rules and even procedures for which prison benefits may legitimately be requested [15].…”

Challenges associated with e-cigarette use by people in custody in Scottish prisons: a qualitative interview study with prison staff

“…[25][26][27] Findings from TIPs interviews exploring postimplementation perspectives on Scotland's smoke-free prison policy among a separate sample of staff and PiC also suggest that the smoke-free prison policy may have contributed to changes in the use of NPS, specifically through misuse of e-cigarettes. 9 Understandings of the general risks posed by e-cigarettes for illicit drug taking, including NPS, are developing: a 2018 systematic review 28 suggested several potential areas of risk. These include: that e-cigarettes might be viewed as a 'safer and innocuous method to experiment and try drugs'; levels of illicit drug use might increase due to the ease with which e-cigarettes can be used for drug delivery; the emergence of new patterns of drug use; and illicit drug use may be easier to conceal, leading to increased problems with detection by authorities and greater risks of 'unintended or malicious' exposures to bystanders (p107).…”

“…5 Complementary qualitative research suggests this broad support for e-cigarettes in Scottish prisons has been substantially influenced by perceptions that they are beneficial in helping PiC and staff to cope with the major operational change represented by the removal of tobacco. 9 Favourable perceptions of e-cigarettes in Scottish prisons also reflect broader evidence on their appeal and effectiveness for some current and ex-smokers (eg, those who feel unwilling or unable to quit nicotine) 10 11 and evidence on reduced harms to users and bystanders from vaping relative to smoking. 12 However, important issues and challenges in relation to permitting PiC to vape were also voiced by prison staff and some PiC in anticipation of their introduction, 1 13 as well as by commentators in other jurisdictions.…”

“…These include: rules around earnings and purchases that mean PiC are not always able to (formally) buy (enough of) the items they want or 'need'; operation of illicit prison economies in which any sought-after item can be traded or 'bought' using alternative currencies; and well established practices of PiC repurposing items, including for illicit purposes such as drug taking. 1 The benefits of e-cigarettes in prisons are well covered in our previous publications (including focus groups with prison staff before rules were changed to allow PiC to vape 7 13 ; interviews with PiC immediately after e-cigarettes were introduced 1 and again once new rules on e-cigarettes and smoking had bedded in 9 ; and repeat cross-sectional surveys of prison staff and PiC 5 ). This paper, therefore, focuses on the challenges of permitting the use of e-cigarettes in prisons identified by prison staff, based on novel interview data collected after vaping in prisons had become well established (8-11 months after sales of rechargeable e-cigarettes first began in Scottish prisons and 6-9 months after smoke-free rules were implemented).…”

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

“…For those prisoners who do not smoke, exposure to SHS also threatens to impede upon civil rights [4], while for prisoners who smoke, introducing a complete ban may further strip away the few remaining individual rights and privileges. Interventions to tackle tobacco use and second-hand smoke exposure can be challenging to implement, with concerns voiced that limiting access to tobacco products can lead to increased violence in prison setting, albeit evidence to validate this concern is mixed, and there are reports of reductions in violence following implementation [14][15][16].…”