Abstract
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. To examine the acceptability, feasibility, and preliminary clinical outcomes of a smoking cessation intervention for individuals who are incarcerated. This pilot randomized clinical trial was conducted from January 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. Participants 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. The 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. 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 (difference [SE], -3.26 [1.58] cigarettes per day; 95% CI, -5.20 to -0.20 cigarettes per day; P = .04) after release. Initiation of counseling plus NRT during incarceration and continuing after release is feasible and acceptable to participants and may be associated with reduced cigarette use after release. However, additional supports are needed to increase engagement in telephone counseling after release. A larger clinical trial is warranted to determine the effectiveness of counseling plus NRT. ClinicalTrials.gov Identifier: NCT03799315.
Highlights
There were no significant differences in smoking abstinence between groups as determined by 7-day point prevalence abstinence (PPA) at 3 weeks and at 12 weeks
Cigarettes per day for the counseling plus nicotine replacement therapy (NRT) group decreased more compared with the brief health education (BHE) group at both 3 weeks and 12 weeks after release
There was no difference in 7-day point prevalence abstinence at 3 weeks, but the reduction in cigarettes per day was significantly greater in the counseling plus NRT group compared with the control group. Meaning These findings suggest that counseling plus NRT is feasible, and preliminary results indicate a potential reduction in smoking after release from jail; larger clinical trials are needed to determine the effectiveness of smoking cessation interventions in county jails
Summary
Cigarette use in the US is concentrated among low-income populations and among individuals who are Black, Indigenous, or people of color. These populations are overrepresented in the US criminallegal system, where smoking rates are 125% higher compared with the general population and contribute to excess morbidity and mortality. an increasing body of research has focused on opioid use among people involved in the criminal-legal system, little attention has been paid to tobacco use and cardiovascular disease, the second leading cause of death among recently incarcerated people. Reducing tobacco use among a population with elevated levels of premature mortality and that frequently uses high-cost health care services could be associated with substantial improvements in health and reductions in health care costs.7Few clinical trials have examined smoking cessation treatment in correctional settings. In that study,8 93% of control and 75% of intervention participants relapsed by 3 weeks after release Another trial in an all-female prison that allowed smoking found that women who received nicotine replacement therapy (NRT) and group counseling while incarcerated showed significantly greater rates of abstinence than a waitlist control group (14% vs 3% abstinence during incarceration). These results suggest that individuals who are incarcerated have interest in initiating smoking cessation, forced abstinence alone does little to influence postrelease smoking, and counseling and/or NRT started during incarceration can reduce rates of smoking
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
