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

Abstract

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 among 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 twenty-four percent. We found in bivariate analysis that each additional five years of history of incarceration were 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.

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

“…In a healthier sample with a much longer average incarceration time of 2.3 years, the 1-month abstinence rate (unknown if continuous) postrelease was 61% 39. Similarly, 74% of ex-prisoners in the third study resumed smoking postrelease, with time since release being a minimum of 3 months and a maximum 12 months 32. Only one study reported on cessation failure rate, with 76% of male prisoners continuing to smoke 1-month after the ban implementation 31.…”

“…Three studies evaluated an indoor smoking ban whereby smoking was limited to outdoor areas for prisoners and staff, with an aim to reduce SHS and improve air quality 39 45 46. Seven studies examined a complete prisoner smoking ban, prohibiting smoking within the facility grounds for prisoners (and in some cases staff) with a focus on cessation and/or reporting other behavioural impacts of smoking bans 24 31 32 39–42. In line with Valentine et al ’s recommendations,49 a meta-analysis was not conducted as the few studies available of high methodological quality were heterogeneous in focus and methods.…”

“…Two of these studies were randomised controlled trials (RCTs) of smoking cessation programmes,33 38 while the third was an RCT of a prerelease smoking abstinence programme in a prison with a complete smoking ban 44. With the exception of one cross-sectional survey,32 all other studies (n=15) were pre–post designs, with three of these involving different samples for pre and post measures 40 45 47. Five studies were of moderate methodological quality,24 30 34 37 39 and the remaining 12 studies (60% of all studies) were rated methodologically weak 8 32 35 36 40–43 45 46 48.…”

“…In another US study,39 prerelease smoking intent predicted postrelease smoking behaviour (p<0.001). Three US cohort studies examined smoking resumption following release from a smoke-free prison where no cessation or prerelease support was provided 32 39 42. While abstinence rates and follow-up time varied significantly, all observed significant reductions in smoking rates in the short term.…”

Incarceration History and Uncontrolled Blood Pressure in a Multi-Site Cohort

“…Moreover, as several other studies have shown that recent incarceration is associated with worse control of other chronic conditions, the benefits of screening are not limited to BP control. [37][38][39] That said, if the health effect of having a history of incarceration is mediated by stigma and provider behaviors, screening for incarceration history may have a detrimental effect. 30 There are several limitations to our study.…”