Tobacco use in prison settings: A need for policy implementation

Abstract

• Tobacco use is the most widely used psycho-active substances by prisoners, with prevalence rates ranging from 64 to over 90 percent, depending on the country and the setting.
• Tobacco use is completely entangled in prison life where it occupies various functions, for instance as ways of coping with boredom, deprivation, stress, as self-help for relieving anxiety and tension; as a source of pleasure or monetary value in an environment without currency.
• Few measures other than the implementation of bans have been taken so far to reduce exposure to second hand smoke (SHS) - pointing to the low priority attached to this factor in health promotion within prisons.
• Prisons have implemented either partial or total bans, but those regulations cannot be considered as proper tobacco control policies. They are only part of a more comprehensive approach that should include tobacco cessation support, training health staff, and alternative ways to reduce inactivity and/or cope with stress, and education.
• There is lack of evidence for best practice regarding smoking cessation within the prison population. More cessation programs need to be implemented to gain abetter understanding of what is comparable to the general population in the wider community community and to equilibrate health services in prisons according to the epidemiology of substance use and the offer addressing other substances’ use.
• Interventions targeting tobacco issues need to take into account the complexity of interrelated dynamics influencing its use among incarcerated people, in order to avoid perpetuation and aggravation of these specific health inequality factors.
• Staff’s smoking should systematically be addressed in tobacco control policies in prisons. This concern is part of a wider health promoting workplace approach.
• Based on the fact that broader public health should systematically include incarcerated people, national and state tobacco strategies/plans should include prisons.