Smoke-free Prisons Research Articles

Recent evidence on rates and factors influencing smoking behaviours after release from smoke-free prisons: a scoping review.

Smoke-free prison policies have been introduced in some countries, in part to address very high levels of tobacco use in people in prison. However, relapse rates post-release remain high. This papers aims to improve understanding of post-release smoking and/or vaping behaviour is necessary to inform support for a priority population. The authors searched health, social science and criminal justice databases for studies about smoking/vaping behaviours among people released from smoke-free prisons. Studies were included if they reported primary data and were published between January 2017 and March 2024 in English; the population was adults/young people (16 yr+) imprisoned or formerly imprisoned, in prisons with comprehensive smoke-free policies; and at least one of the following was reported: pre-release intention to smoke, vape or remain abstinent post-release; smoking/vaping behaviour post-release and factors influencing smoking/vaping behaviour; attempts to quit again following post-release smoking/vaping relapse. Nine studies met our criteria. The evidence base is small and mainly from the USA or Australia. Evidence continues to suggest that most people resume smoking after leaving a smoke-free prison. No new interventions have been successful in reducing relapse rates. No studies report on vaping post-release, although two studies report on perceived factors affecting smoking relapse post-release from prisons allowing vaping. Given very high rates of relapse, there remains a significant need to better understand what approaches are feasible and acceptable for reducing return to smoking post-release. This review updates the limited evidence on smoking behaviours after leaving a smoke-free prison.

What works to promote staff health in prison settings: a systematic review

PurposeGiven epidemiological data highlighting poor health outcomes for prison staff and correctional workers, this systematic review aims to understand what health promotion interventions, delivered in prison settings, are effective for prison staff health.Design/methodology/approachA systematic review was undertaken, with search parameters encompassing papers published over a ten-year period (2013–2023). Health promotion programmes; well-being programmes; and occupational health interventions to support prison staff health as part of a targeted approach or as part of a whole-prison approach were included in the review.FindingsThe review identified 354 studies, of which 157 were duplicates and 187 did not meet the inclusion criteria. This left ten studies in the review from five countries. Reducing the impact of tobacco smoke was the commonly cited intervention, with four studies focusing on smoke-free prison legislation, but other studies focused on stress reduction for staff and supporting holistic health. The papers were of poor methodological quality, with the exception of three included studies that had robust designs. Most studies showed limited or no impact of interventions to support prison staff health, the exception being policy interventions to reduce second-hand smoke exposure.Originality/valuePrison staff have poor health outcomes and yet limited attention has been paid to interventions to support their health. This review suggests a number of considerations for future policy and practice and direction for further research to improve prison staff health.

A Qualitative Study of the Implementation and Continued Delivery of Complete and Partial Smoke-Free Policies Across England's Prison Estate.

In the United Kingdom, smoking among prisoners is up to five times more prevalent than the national average. Between 2015 and 2018, HMPPS introduced a complete smoke-free policy in all closed prisons, and a partial policy permitting smoking only in smoking shelters in open prisons. This study aimed to explore the views of stakeholders regarding the implementation and continuation of smoke-free policies, including the management of nicotine addiction during imprisonment and after release. Individuals with key strategic and/or operational roles in delivering smoke-free prison policies across England were purposively sampled to complete a semi-structured interview. Twenty-eight interviews were analyzed thematically. The smoke-free implementation across the closed prison estate was viewed as a success, though there were reports of reduced availability of smoking cessation support since the roll out. Participants thought the majority of tobacco smokers living in closed prison environments were now using an electronic cigarette, typically as a temporary means to manage nicotine addiction until release. In open prisons the partial policy has been less successful; high rates of smoking resumption on moving from closed to open conditions were reported, with many participants arguing that the open estate should also go completely smoke free. It was envisaged that most prisoners would resume smoking on community release. The smoke-free policies provide a unique opportunity to promote lifelong cessation in this highly disadvantaged group. However more could be done to adopt a consistent smoke-free policy across all prisons, and to support prisoners in quitting smoking and nicotine use during and after imprisonment. Our results identify the urgent need for more work to explore rates and reasons for relapse to smoking on transfer to the open estate and after release. With the majority of smokers in the closed prison estate now using e-cigarettes to manage their nicotine addiction, one way to support long-term tobacco abstinence could be to place greater emphasis on this switching behavior as a way of reducing tobacco-related harm within this population.

Implementation of a national smoke-free prison policy: an economic evaluation within the Tobacco in Prisons (TIPs) study

ObjectiveTo determine the cost-effectiveness of a smoke-free prison policy in Scotland, through assessments of the trade-offs between costs (healthcare and non-healthcare-related expenditure) and outcomes (health and non-health-related non-monetary consequences) of...

Purchasing of tobacco-related and e-cigarette-related products within prisons before and after implementation of smoke-free prison policy: analysis of prisoner spend data across Scotland, UK

ObjectivesTo examine the effect of smoke-free prison policy implementation in November 2018 on purchasing patterns in the prison canteen (shop).DesignInterrupted time series.SettingAll 12 closed, publicly run prisons in Scotland, UK.ParticipantsPeople...

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

ObjectivesLittle is known about the perspectives of staff working in prisons where e-cigarettes are permitted. Scotland now permits people in custody (PiC), but not staff/visitors to use e-cigarettes, following implementation...

Process and impact of implementing a smoke-free policy in prisons in Scotland: TIPs mixed-methods study

BackgroundPrisons had partial exemption from the UK’s 2006/7 smoking bans in enclosed public spaces. They became one of the few workplaces with continuing exposure to second-hand smoke, given the high levels of smoking among people in custody. Despite the introduction of smoke-free prisons elsewhere, evaluations of such ‘bans’ have been very limited to date.ObjectiveThe objective was to provide evidence on the process and impact of implementing a smoke-free policy across a national prison service.DesignThe Tobacco in Prisons study was a three-phase, multimethod study exploring the periods before policy formulation (phase 1: pre announcement), during preparation for implementation (phase 2: preparatory) and after implementation (phase 3: post implementation).SettingThe study was set in Scotland’s prisons.ParticipantsParticipants were people in custody, prison staff and providers/users of prison smoking cessation services.InterventionComprehensive smoke-free prison rules were implemented across all of Scotland’s prisons in November 2018.Main outcome measuresThe main outcome measures were second-hand smoke levels, health outcomes and perspectives/experiences, including facilitators of successful transitions to smoke-free prisons.Data sourcesThe study utilised cross-sectional surveys of staff (total,n = 3522) and people in custody (total,n = 5956) in each phase; focus groups and/or one-to-one interviews with staff (n = 237 across 34 focus groups;n = 38 interviews), people in custody (n = 62 interviews), providers (n = 103 interviews) and users (n = 45 interviews) of prison smoking cessation services and stakeholders elsewhere (n = 19); measurements of second-hand smoke exposure (e.g. 369,208 minutes of static measures in residential areas at three time points); and routinely collected data (e.g. medications dispensed, inpatient/outpatient visits).ResultsMeasures of second-hand smoke were substantially (≈ 90%) reduced post implementation, compared with baseline, largely confirming the views of staff and people in custody that illicit smoking is not a major issue post ban. Several factors that contributed to the successful implementation of the smoke-free policy, now accepted as the ‘new normal’, were identified. E-cigarette use has become common, was recognised (by both staff and people in custody) to have facilitated the transition and raises new issues in prisons. The health economic analysis (lifetime model) demonstrated that costs were lower and the number of quality-adjusted life-years was larger for people in custody and staff in the ‘with smoke-free’ policy period than in the ‘without’ policy period, confirming cost-effectiveness against a £20,000 willingness-to-pay threshold.LimitationsThe ability to triangulate between different data sources mitigated limitations with constituent data sets.ConclusionsTo our knowledge, this is the first study internationally to analyse the views of prison staff and people in custody; objective measurements of second-hand smoke exposure and routine health and other outcomes before, during and after the implementation of a smoke-free prison policy; and to assess cost-effectiveness. The results are relevant to jurisdictions considering similar legislation, whether or not e-cigarettes are permitted. The study provides a model for partnership working and, as a multidimensional study of a national prison system, adds to a previously sparse evidence base internationally.Future workPriorities are to understand how to support people in custody in remaining smoke free after release from prison, and whether or not interventions can extend benefits to their families; to evaluate new guidance supporting people wishing to reduce or quit vaping; and to understand how prison vaping practices/cultures may strengthen or weaken long-term reductions in smoking.Study registrationThis study is registered as Research Registry 4802.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 10, No. 1. See the NIHR Journals Library website for further project information.

Evaluation of a national smoke-free prisons policy using medication dispensing: an interrupted time-series analysis

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.

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

BackgroundA 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.MethodsAs 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.ResultsOur 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.ConclusionsThe 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.

A randomised controlled trial of motivational interview for relapse prevention after release from smoke-free prisons in Australia.

This paper aims to determine whether a single session of a motivational interview (MI) reduces smoking relapse amongst people released from smoke-free prisons. This study sought to recruit 824 ex-smokers from 2 smoke-free prisons in the Northern Territory, Australia. Participants were randomised to receive either one session (45-60 min) face-to-face MI intervention 4-6 weeks prior to release or usual care (UC) without smoking advice. The primary outcome was continuous smoking abstinence verified by exhaled carbon monoxide test (<5 ppm) at three months post-release. Secondary outcomes included seven-day point-prevalence, time to the first cigarette and the daily number of cigarettes smoked after release. From April 2017 to March 2018, a total of 557 participants were randomised to receive the MI (n = 266) or UC (n = 291), with 75% and 77% being followed up, respectively. There was no significant between-group difference in continuous abstinence (MI 8.6% vs UC 7.4%, risk ratio = 1.16, 95%CI 0.67∼2.03). Of all participants, 66.9% relapsed on the day of release and 90.2% relapsed within three months. On average, participants in the MI group smoked one less cigarette daily than those in the UC within the three months after release (p < 0.01). A single-session of MI is insufficient to reduce relapse after release from a smoke-free prison. However, prison release remains an appealing time window to build on the public health benefit of smoke-free prisons. Further research is needed to develop both pre- and post-release interventions that provide continuity of care for relapse prevention. This study is the first Australian randomised controlled trial to evaluate a pre-release MI intervention on smoking relapse prevention amongst people released from smoke-free prisons.

29.A. Workshop: Implementation of smokefree prisons across a national prison estate: experience from Scotland

Abstract Objective To present findings from the multi-methods, 3-Phase Tobacco in Prisons (TIPs) study, a comprehensive evaluation of the development, preparation for, implementation and outcomes of smoke free policy across Scotland's prison. Prisons had partial exemption from UK policy banning smoking in enclosed public spaces, and became one of few workplaces with continued exposure to secondhand smoke (SHS). Prison smoking bans have been introduced elsewhere, but evidence of the process and impact of implementing smokefree prisons is sparse. By presenting papers using different methods (objective measurements of SHS; qualitative focus group/interview data, surveys with people in custody and staff; prisoner purchasing data and an economic analysis), the workshop will demonstrate the success of implementing smokefree prison policy and the factors contributing to this success and related outcomes. It will discuss some of the challenging issues and decisions which other jurisdictions may face when considering a smokefree policy. Format The format of the workshop will comprise oral presentations from members of the TIPs research team. This will begin with an overview of a) the rationale for and challenges of implementing smokefree policies in the prison context, and b) the methods used during the three phases of the TIPs study. There will then be presentations on: (i) SHS exposure pre-post ban; (ii) experiences and opinions of staff including the use of e-cigarettes in prisons; (iii) the impact of smokefree policy on prisoner spend in the 'canteen' (prison shop); the impact of smokefree prison policy on medications dispensing; (v) the economic impacts of the smoke-free prison policy. As a study of an entire national prison service. This evaluation of the development, planning, implementation and impact of smokefree policy demonstrates the importance of research evidence for policy implementation, providing new evidence for other jurisdictions contemplating bans on smoking in prisons. Key messages Smokefree prison policy can be successfully implemented with support, partnership working and good communication. Exposure to secondhand smoke in prisons rapidly declines.

Opinions and experiences of a national smokefree prison policy: evidence from the TIPs study

Abstract Background Removal of tobacco from prisons poses distinct challenges, as prisons are 'homes' and smoking rates are high. TIPs is unique in comprehensively studying a smoking ban using data collected before, during and after the ban. This paper presents opinions and experiences of people in custody (PiC) and staff in Scotland, and identifies implementation success factors and lessons that are highly relevant for other jurisdictions and areas of public health. Methods Surveys of staff and PiC (response rates) were conducted in Nov-Dec 2016 (27%, 34%), May-Jul 2018 (31%, 26%) and May-Jul 2019 (16%, 18%), with questions on smoking, smoking cessation/abstinence and smoking restrictions in the prison context. Topics were also explored qualitatively with staff/PiC at similar time points (34 focus groups, 99 interviews). Survey responses were analysed using descriptive statistics and logistic regression analyses. Qualitative data were thematically analysed to identify the diversity of views and experiences. Results Smokefree policy is widely accepted as the new 'norm', but support was higher among staff than PiC before, during and after implementation. Surveys and qualitative data suggest perceptions of some of the potential difficulties (e.g. 'hard to enforce') and negative consequences (e.g. 'cause a lot of trouble') of smokefree policy reduced post implementation. Participants identified several implementation success factors relating to: planning and communication, smoking abstinence/cessation products/services, and partnership working. Conclusions Smokefree prison polices can be successfully implemented, providing the removal of tobacco is well managed and support measures are available for smokers. Some factors shaping the successful introduction of smokefree prisons in Scotland are relevant to other areas of public health transformation e.g. setting clear objectives and timescales; collaboration and teamwork; and involving staff at all levels and end-users.

Economic impacts of implementing a national smoke-free prison policy

Abstract Background Worldwide, over 600,000 non-smokers are killed annually due to exposure to secondhand smoke (SHS); the UK societal cost of SHS is estimated at £700million per annum. Prior to recent smoke free policy in Scottish prisons smoking rates were very high (70-75%), well above population rates, subjecting people in custody (PiC) and prison staff to high levels of SHS. Eradicating SHS exposure in prisons could lead to improved health in previous smokers and non-smokers alike, and decrease demand on the National Health Service. However, to date, there is little evidence relating to the economic impact of smoking bans in prisons. Methods An economic evaluation estimating the short-term and lifetime impacts of smokefree prison policy in Scotland policy used data from the TIPs study (Jun 2016-Nov 2019) for prison staff and PiC. The analyses adopted a public health and personal perspective and key resources included: implementation costs, cessation support services, health service use and personal costs. For the short-term analyses data were sourced from TIPs staff and PiC surveys, and routine data from the Scottish Prison Service and NHS National Services Scotland. Outcomes included SHS exposure, staff sickness absence, violent incidents and quality adjusted life years (QALYs). The life-time analysis used a Markov model to estimate cost per QALY for both staff and PiC. Results SHS exposure measures show a median reduction of 91%. Costs and economic outcome results (mean cost pre- and post-ban, cost-consequences balance sheet and incremental cost per QALYs) are confidential until May 2020 due to their sensitivity and will be available to present at EUPHA 2020. Conclusions Previous economic evaluations have focussed on smoking bans in public places and raising the smoking age. This is the first economic analysis of a national prison smoking ban and analysis will be of interest to prison services in other jurisdictions which have yet to implement smokefree policy.

Smokefree policy and medication dispensing for people in prison: interrupted time series analysis

Abstract Background Previous evaluations of smokefree prison policies have suggested improvements in self-rated health and some smoking-related symptoms. No studies to date have investigated impacts on medication use as proxy measures of objective ill-health or as indicators of potential negative unintended consequences. These is limited evidence to date on these important outcomes. Methods We obtained from NHS National Services Scotland aggregate data on medication items dispensed in prisons, based on individual named patient medication records, and from the Scottish Prison Service data on the prison population, for the period Jan 2013-Nov 2019. Items of interest comprised those for smoking cessation (varenicline and buproprion); nicotine replacement; specific smoking-related health conditions (glyceryl trinitrate; inhaled bronchodilators and steroids; antibiotics; chloramphenicol eye drops; and proton pump inhibitors and H2 receptor antagonists), and potential unintended mental health consequences (anti-depressants). We also included a set of negative controls for which dispensing was not expected to be affected by the new smokefree policy (anticonvulsants, excluding pregabalin and gabapentin). Analyses were undertaken using AutoRegressive Integrated Moving Average (ARIMA) time series methods, with the dates of the policy's announcement and of implementation included as pre-specified breakpoints. Results The results of ARIMA modelling of medication dispensing are confidential until May 2020 due to their sensitivity and will be available to present at WCPH 2020. Conclusions The use of routinely available dispensing data as an indicator of objective health impacts and potential negative unintended consequences provides novel insights into the effectiveness of smokefree prison policies. Results will be of interest to international jurisdictions considering such policies and to those seeking to harness the potential of administrative data for natural experiments.

From Smoking-Permitted to Smokefree Prisons: A 3-Year Evaluation of the Changes in Occupational Exposure to Second-Hand Smoke Across a National Prison System.

ObjectivesPrisons in Scotland were one of the few workplaces exempt from the 2006 comprehensive smoking ban in indoor public places, excluding the prison workforce from the health benefits of smokefree workplaces. The November 2018 introduction of comprehensive restrictions on smoking in Scottish prisons aimed to protect prison staff and people in custody from the harmful impacts of second-hand smoke (SHS) exposure. This study presents SHS exposure data gathered after smokefree policy implementation and compares these with data gathered during and before policy development.MethodsDylos DC1700 monitors were used to measure concentrations of fine particulate matter (PM2.5) derived from SHS across Scotland’s 15 prisons. Six days of fixed-site monitoring (09.00 22 May 2019 to 09.00 28 May 2019) were conducted in residential halls in each prison 6 months post-smokefree policy implementation. Prison staff task-based measurements were conducted to assess concentrations of SHS in various locations (e.g. gyms and workshops) and during specific activities (e.g. cell searches, maintenance, and meal service). Utilizing the fixed-site monitoring data, typical daily PM2.5 exposure profiles were constructed for the prison service and time-weighted average (TWA) exposure concentrations were estimated for the typical shift patterns of residential staff pre- and post-smokefree policy implementation. Staff perceptions of changes to SHS exposure were assessed using online surveys.ResultsAnalysis of both fixed-site and mobile task-based PM2.5 measurements showed the smokefree policy implementation was successful in reducing SHS exposures across the Scottish prison estate. Measured PM2.5 in residential halls declined markedly; median fixed-site concentrations reduced by more than 91% compared with measures in 2016 before policy announcement. The changes in the TWA concentrations across shifts (over 90% decrease across all shifts) and task-based measurements (89% average decrease for high-exposure tasks) provide evidence that prison staff exposure to SHS has significantly reduced. Following smokefree policy implementation, the majority of staff reported no longer being exposed to SHS at work.ConclusionsTo our knowledge, this is the first comprehensive international study to objectively measure SHS levels before, during, and after implementation of a smokefree policy across a country’s prison system. The findings confirm that such a policy change can be successfully implemented to eliminate occupational exposures to SHS. The results are highly relevant for other jurisdictions considering changes to prison smoking legislation.

Perspectives on smokefree prison policy among people in custody in Scotland.

This paper aims to explore smokefree prison policy, from the perspective of people in custody in Scotland. In total, 77 people in custody in Scotland were interviewed in the period leading up to implementation of a nationwide prison smokefree policy. Data were thematically analysed to identify the diversity of views and experiences. Participants described a widespread awareness in prisons of plans to implement a smokefree policy from 30 November 2018. Opinions about smokefree prisons varied among participants based on perceptions of the fairness, and anticipated positive and negative consequences of removing tobacco from prisons. At the time of the interviews, people in custody were responding to the impending smokefree policy, either by proactively preparing for the smokefree rule change or by deploying avoidance strategies. Participants described opportunities and challenges for implementing smokefree policy in prisons across three main themes: the role of smoking in prison, prison smoking cessation services and motivations for quitting smoking among people in custody. This study exploring smokefree prisons from the perspectives of people in custody has several novel features which extend the evidence base. The findings highlight measures for jurisdictions to consider when planning to prohibit smoking in their prisons in the future. These include the need for evidence-based smoking cessation support in advance of smokefree policy, effective communication campaigns, consideration of broader structural determinants of health in prison and ongoing measures to reduce rates of return to smoking post release.

Smoke-free prison policy development, implementation, and impact across the entire national prison service in Scotland (TIPs study): a three-phase, mixed methods natural experimental evaluation

BackgroundPrisons had partial exemption from UK 2006–07 policies banning smoking in enclosed public spaces, becoming one of few workplaces with continued exposure to second-hand smoke (SHS). Although bans have been introduced elsewhere, evidence of the process and impact of implementing smoke-free prisons is sparse. We aimed to provide evidence on the process and impact of implementation of smoke-free policy across the national prison service in Scotland. MethodsThe Tobacco in Prisons study (TIPs) is a three-phase, mixed-methods study exploring the periods before policy formulation (phase 1; September 2016–July 2017), during preparation for implementation (phase 2; August 2017–November 2018), and after implementation (phase 3; December 2018–May 2020). Data on SHS, health, smoking, beliefs (eg, smoking or e-cigarettes, desirability, benefits, and challenges of smoke-free policy) were gathered across all 15 Scottish prisons through: (1) staff and prisoner surveys, staff focus groups (phases 1 and 3), and cessation provider interviews; (2) SHS measures (fine particulate matter, PM2·5, using Dylos DC1700 monitors) before, during (week commencing Nov 28, 2018), and 6 months after (week commencing May 27, 2019) implementation on Nov 30, 2018. In six case-study prisons, in-depth interviews were carried out with prisoners, staff, and smoking cessation providers. We also accessed routine data (eg, sickness absence, “canteen” purchases of tobacco and other products) to assess policy impacts. Ethics approval was granted by SPS Research Access and Ethics Committee and University of Glasgow. Participants provided written informed consent. FindingsPhase 1 data showed high prisoner smoking rates (1858 [74%] of 2505 responders), confirmed by SHS measures (128 431 min of PM2.5 data, median 31·7 μg/m3), and concerns about the challenges of smoke-free policy (eg, 1954 [81%] of 2407 prisoners and 737 [58%] of 1269 staff thought smoking bans caused “trouble”). Compared with 2016, air quality improved in all prisons in 2018 (114 303 min of PM2.5 data) with an overall median reduction on the first full working weekday after implementation (Dec 3, 2018) of –81% (IQR –76 to –91). SHS measures collected 6 months after implementation (126 777 min of PM2·5 data) showed sustained improvement (median 3·1 μg/m3, overall median reduction –91% (IQR –88 to –93%)). Reasons for success and continuing challenges of smoke-free prison policy will be discussed. InterpretationThis evaluation of the development, planning, implementation, and impact of smoke-free prison policy demonstrates the importance of research evidence during policy implementation and, as a study of an entire national prison service, provides new evidence for other jurisdictions contemplating bans on smoking in prisons. FundingNational Institute for Health Research.

Views of prison staff in Scotland on the potential benefits and risks of e-cigarettes in smoke-free prisons: a qualitative focus group study

ObjectiveElectronic cigarettes (e-cigarettes) were introduced into all Scottish prisons in February 2018, some months after prisons began preparing in 2017 for a smoking ban implemented in November 2018. In 2016/2017,...

Staying Quit After Release (SQuARe) trial protocol: a randomised controlled trial of a multicomponent intervention to maintain smoking abstinence after release from smoke-free prisons in Victoria, Australia

IntroductionSmoke-free policies have been introduced in prisons internationally. However, high rates of relapse to smoking after release from prison indicate that these policies typically result in short-term smoking cessation only....

Smoke-free prisons in England: indoor air quality before and after implementation of a comprehensive smoke-free policy

ObjectivesHigh levels of particulate pollution due to secondhand smoke (SHS) have previously been recorded in English prisons. As part of an evaluation to ascertain whether a new comprehensive smoke-free policy...