Successes and unintended consequences of the Northern Territory’s smoke-free prisons policy: results from a process evaluation

Abstract

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.

Constituents of “teabacco”: A forensic analysis of cigarettes made from diverted nicotine replacement therapy lozenges in smoke‐free prisons

“…One such example is the diverted use of nicotine replacement therapy (NRT), where prisoners are substituting traditional cigarettes by creating their own cigarettes out of NRT supplied by correctional authorities. This practice has been reported in smoke‐free prisons in Australia, New Zealand, and in the United Kingdom . The few published studies reporting diverted use of NRT in prison describe how prisoners first mix provided nicotine patches with tea leaves – earning this substance the nickname “teabacco” – then roll the mixture in paper (typically from standard‐issue prison Bibles or toilet paper tissue), and finally ignite the created cigarettes using batteries or electronic appliances.…”

“…This practice has been reported in smoke‐free prisons in Australia, New Zealand, and in the United Kingdom . The few published studies reporting diverted use of NRT in prison describe how prisoners first mix provided nicotine patches with tea leaves – earning this substance the nickname “teabacco” – then roll the mixture in paper (typically from standard‐issue prison Bibles or toilet paper tissue), and finally ignite the created cigarettes using batteries or electronic appliances. Two qualitative studies with Australian prisoners have described the use of teabacco made from nicotine patches, and one study has analyzed the chemical constituents of teabacco made from tea leaves and nicotine patches .…”

“…This forensic analysis found that smoking teabacco cigarettes made from nicotine patches released nicotine, as well as harmful toxins formaldehyde, acetaldehyde, acrolein, toluene, xylene, and heavy metals, providing clear evidence for the potential of this form of teabacco to result in short‐ and long‐term health harm. Participants in both qualitative studies also described fellow prisoners experiencing negative health effects as a result of smoking teabacco made from nicotine patches, including nose bleeds, seizures, and strokes …”

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

“…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.…”

“…This landmark ruling triggered a number of American prisons to become smoke-free or at least implement indoor smoking bans,15 strategies that have been shown to reduce exposure to SHS by improving air quality within prison grounds 16–21. Smoking bans in prison have since gained popularity in Canada,22 New Zealand23 and Australia 24…”