BMJ  2003;327:29 (5 July), doi:10.1136/bmj.327.7405.29

Filler

Smoking cessation dilemmas in prison

Helping prisoners to stop smoking can be a real conundrum. A delicate balance has to be struck between the equality of health care that prisoners deserve and the intricacies of running a secure prison. This year I had the opportunity to view this phenomenon in one of Britain's maximum security jails.

The implementation of a workable smoking cessation programme was an uphill battle for the staff involved. Even the simplest of leaflets on giving up, kindly designed by the Health Education Board for Scotland, were unsuitable. Their suggestions to "eat more fruit" or "take a walk" in the park to beat off a craving isn't really feasible when your scenery extends only to a prison cell and your meals are what you get given, not what you request.

There were further obstacles, including the devious personalities that can be found in prisons. Nicotine replacement gum was banned because it could be used to block locks or form key impressions. Opaque patches were also disallowed for fear that they could be used to conceal small items. The influx of illicit drugs into prison excluded the use of inhalers as these could be modified for transporting other substances into the body.

There was a multitude of hurdles and unique aspects of the prison environment that had to be considered in the delivering of the smoking cessation programme. I hope that this account gives you some insight into the barriers that our colleagues in the prison health service have to contend with in the struggle to provide equality in health care for Britain's prisons.

University of Dundee

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Smoking cessation dilemmas in prison

John Boyington
bmj.com, 28 Jul 2003 [Full text]