A qualitative study of the implementation and continued delivery of complete and partial smoke-free policies across England’s prison estate

Jayes, Leah; Waddingham, Jessica; Britton, John; Murray, Rachael

Abstract

Introduction In the UK, 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 views of stakeholders regarding the implementation and continuation of the smoke-free policies, including management of nicotine addiction during imprisonment and after release. Methods 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 analysed thematically. Results 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. Conclusion 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. Implications 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 an e-cigarettes to manage their nicotine addiction, one way to support long term tobacco abstinence could be to place greater emphasis on this switching behaviour as a way of reducing tobacco-related harm within this population.

Citation

Jayes, L., Waddingham, J., Britton, J., & Murray, R. (2023). A qualitative study of the implementation and continued delivery of complete and partial smoke-free policies across England’s prison estate. Nicotine & Tobacco Research, https://doi.org/10.1093/ntr/ntac296

• Journal Article Type: Article
• Acceptance Date: Dec 28, 2022
• Online Publication Date: Jan 11, 2023
• Publication Date: Jan 11, 2023
• Deposit Date: Jan 19, 2023
• Publicly Available Date: Jan 19, 2023
• Journal: Nicotine & Tobacco Research
• Print ISSN: 1462-2203
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1093/ntr/ntac296
• Keywords: Public Health, Environmental and Occupational Health
• Public URL: https://nottingham-repository.worktribe.com/output/16226948
• Publisher URL: https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac296/6983864