Smoking ban in prisons would lead to more assaults on staff
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7527.1228-d (Published 24 November 2005) Cite this as: BMJ 2005;331:1228
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Increasing numbers of correctional facilities in the United States
have become smoke-free and made tobacco, matches, and lighters contraband.
Most experience so far has not shown the feared difficulties arising when
facilities become completely tobacco free. Most programs that have gone
through the process note that the issues around staff tobacco use at the
facility are more challenging than those around prisoners' use. A recent
report indicated that 77% of US facilities surveyed in 2003 disallow
tobacco use for prisoners, though 79% of these facilities allow staff to
use tobacco on the premises (1), and various programs have noted some
difficulty resulting from this. On the other hand, the transition process
is not minimal, and some programs have reported difficulties, including
amplification of discontent among prisoners and staff. During the
transition period, some programs have made nicotine replacement therapy
available, though reportedly this was utilized by a small fraction or the
populations. To our knowledge, no facilities that have instituted smoking
bans have reversed that decision. In other mental health and addictions
settings, a critical review of 22 studies in the literature found no major
effects in behavioral indicators of unrest or compliance (2).
At admission to a smoke free jail, our patients have repeatedly
reported very little difficulty with stopping tobacco use, and that during
those initial days and weeks, thoughts and energy are directed to far more
pressing concerns. Unfortunately stopping is different from quitting and
the overwhelming majority (about 97%) has returned to tobacco use by six
months following release (3). Given this, and whether or not a facility is
tobacco free, there is a need for effective tobacco cessation and relapse
prevention programs for people passing through the correctional system. An
tobacco educational curriculum has been created for corrections and has
been well accepted by prisoners and staff, though tobacco use outcomes
have not yet been assessed (4).
1. Chavez RS, Oto-Kent DS, Porter J, Brown K, Quirk L, Lewis S.
Tobacco Policy, Cessation, and Education in Correctional Facilities.
National Commission on Correctional Health Care and National Network on
Tobacco Prevention and Poverty, 2005
2. El-Guebaly N, Cathcart J, Currie S, Brown D, Gloster S. Public health
and therapeutic aspects of smoking bans in mental health and addiction
settings. Psychiatric Services 53:1617-1622, 2002
3. Tuthill RW, Lincoln T, Conklin TJ, Kennedy S, Hammett TM, Roberts CA.
“Does involuntary cigarette smoking abstinence among inmates during
correctional incarceration result in continued abstinence post release?”
(poster). 26th National Conference on Correctional Health Care, Nashville,
Tennessee, October 21, 2002.
4. The National Commission on Correctional Health Care and National
Network on Tobacco Prevention and Poverty. Tobacco Cessation for
Correctional Populations: A Health Education Manual, 2005. Available at:
www.ncchc.org/pubs/catalog.html#tobacco_cessation
Competing interests:
None declared
Competing interests: No competing interests
I don’t smoke. I drink at home. I hate returning from the pub reeking
of tobacco smoke. I do not support a partial ban on smoking in public
places. Like the Chief Medical Officer, I would go the whole hog and ban
the lot in enclosed public places.
Except in prisons. Banning smoking in prisons is unthinkable.
I agree with Phil Wheatley, director general of the Prison Service,
that “prisons are special and the circumstances are special”. However, if
a total ban were instituted, the doctors and prison staff would not bear
the main brunt of the assault. That would be borne by the prisoners
themselves.
Prisoners are troubled people: they are angry, frustrated, addicted
and often mentally ill. Violence against the self and other prisoners is
very common and a huge burden on doctors, nurses, prison officers and
their local hospitals. It can only get worse. Banning smoking in prisons
would be a disaster.
Competing interests:
None declared
Competing interests: No competing interests
As a past part time forensic medical examiner in Herefordshire I was
pleased to witness a sucessful banning of overnight smoking in Hereford
police station's custody suite twelve months ago. I wonder if any data
regarding aggresion could/has been extracted regarding pre and post bans
in other suites?
The health of the staff has to be considered and I feel this non
smoking period could be extended by the offering and provision of nicotine
replacement therapy, which would give an opportunity to provide health
education to a group of patients who generally do not make as much use of
health services.
Competing interests:
None declared
Competing interests: No competing interests
Smoke-free Young Offenders Institute
We read with interest the news report which predicted the negative
affects that would result from a smoking ban in prisons(1). Ashfield
Young Offenders Institute is a prison in South Gloucestershire which
accepts remand and sentenced young people between the ages of 15 and 18.
Ashfield introduced a smoke-free policy on 1st February 2005. Smoking is
not permitted within the prison by young offenders or staff and all
tobacco related products are banned. The transition was smoother than
expected.
Prison staff were trained by the South Gloucestershire Primary Care
Trust ‘NHS Stop Smoking Service’ to give smoking cessation advice to staff
and trainees. Some staff received support from their general practice. The
prison offered to pay for nicotine replacement patches. Staff are able to
use patches and nicotine lozenges in the prison.
Staff who continue to smoke have the opportunity to go outside the
prison during their breaks, however this option is not available to staff
who are working the night shift. The response from staff has been mixed.
Some staff welcomed the change, including some smokers because it has
provided an impetus to stop smoking.
The offenders threatened to cause disruption, but it did not
materialise. There was an increase in minor altercations between trainees
approximately a month after the policy was introduced, which may have been
related to a large number of trainees experiencing withdrawal from
nicotine. In contrast to 27 fires in the first 10 months of the previous
year(2), there has only been one minor fire in the prison since the
introduction of the smoke-free policy.
We recognise that there are some notable differences between juvenile
and adult prisons with regard to greater challenges in stopping smoking
and the length of detention. However, we would encourage other prisons to
provide some smoke-free environments for prisoners and staff.
1 O’Dowd A. Smoking ban in prisons would lead to more assaults on
staff BMJ 2005;331:1228
2 House of Commons.Hansard Written Answers for 7 Dec (pt 2). Prisons
(Fires) 7 Dec 2004 : Column 411W.
http://www.publications.parliament.uk/pa/cm200405/cmhansrd/cm041207/text...
Competing interests:
None declared
Competing interests: No competing interests