Abstract
SummaryBackgroundInternationally, smoking prevalence among people in prison custody (ie, people on remand awaiting trial, awaiting sentencing, or serving a custodial sentence) is high. In Scotland, all prisons implemented a comprehensive smoke-free policy in 2018 after a 16-month anticipatory period. In this study, we aimed to use data on medication dispensing to assess the impact of this policy on cessation support, health outcomes, and potential unintended consequences among people in prison custody.MethodsWe did an interrupted time-series analysis using dispensing data for 44 660 individuals incarcerated in 14 closed prisons in Scotland between March 30, 2014, and Nov 30, 2019. We estimated changes in dispensing rates associated with the policy announcement (July 17, 2017) and full implementation (Nov 30, 2018) using seasonal autoregressive integrated moving average models. Medication categories of primary interest were treatments for nicotine dependence (as an indicator of smoking cessation or abstinence attempts), acute smoking-associated illnesses, and mental health (antidepressants). We included antiepileptic medications as a negative control.FindingsA 44% step increase in dispensing of treatments for nicotine dependence was observed at implementation (2250 items per 1000 people in custody per fortnight, 95% CI 1875 to 2624) due primarily to a 42% increase in dispensing of nicotine replacement therapy (2109 items per 1000 people in custody per fortnight, 1701 to 2516). A 9% step decrease in dispensing for smoking-related illnesses was observed at implementation, largely accounted for by respiratory medications (−646 items per 1000 people in custody per fortnight, −1111 to −181). No changes associated with announcement or implementation were observed for mental health dispensing or antiepileptic medications (control).InterpretationSmoke-free prison policies might improve respiratory health among people in custody and encourage smoking abstinence or cessation without apparent short-term adverse effects on mental health dispensing.FundingNational Institute of Health Research Public Health Research programme, Scottish Government Chief Scientist Office, and UK Medical Research Council.
Highlights
In most countries worldwide, the prevalence of tobacco smoking among people in custody is high, in contrast to the decrease observed in the general population.[1]
In Scotland in 2017, 68% of people in prison custody were smokers compared with 18% of adults at liberty,[2,3] and levels of second-hand smoke in prisons were comparable to those within a typical smoking home.[4]
Added value of this study Using routine medication dispensing data for 44 660 people in custody in Scottish prisons during a 5·7-year period, we found that the implementation of a comprehensive smoke-free policy was associated with a substantial increase in indicators of smoking cessation or abstinence attempts and improvements in indicators of respiratory health, with no evidence of changes in dispensing for mental health
Summary
The prevalence of tobacco smoking among people in custody is high, in contrast to the decrease observed in the general population.[1]. Smoke-free policies in public places have resulted in substantial reductions in diseases associated with smoking and respiratory, irritant, and sensory symp toms.[5] national smoking bans vary in whether they encompass custodial settings. In the UK, prisons were partially exempt from the 2006–07 legislation on smoke-free enclosed public places; in Scotland people in custody were permitted to smoke in their cells and during outdoor recreation.[6]. Several jurisdictions worldwide have intro duced smoke-free prison policies,[7] little evidence is available on the health impacts of such policies, with regard to objective measures of health and health-care utilisation. A 2016 Cochrane review identified a need for more robust studies assessing the health impacts of smoking bans in institutional settings such as prisons, including both pre-ban and post-ban data and follow-up for longer than 6 months.[8]
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