Intended for healthcare professionals


Tobacco use in prisons

BMJ 2014; 349 doi: (Published 05 August 2014) Cite this as: BMJ 2014;349:g4946
  1. Catherine Ritter, medical doctor
  1. 1Geneva, Switzerland
  1. info{at}

None is best, but complete bans are not the answer

Tobacco use in prisons is a long neglected public health problem. Until recently, a permissive attitude regarding its use prevailed. But this has changed over the past two decades. Either partial bans (where smoking is permissible in designated areas) or complete bans have been introduced in prisons in Europe, Australia, New Zealand, and the United States.

These changes have had a substantial impact on health, as shown by Binswanger and colleagues’ linked cross sectional survey of all state prisons in the US.1

Tobacco-free indoor bans introduced between 2001 and 2011 were associated with a fall in mortality attributable to smoking (cardiovascular and pulmonary deaths) in prisoners. Cancer mortality fell when bans exceeded nine years. Overall, the lowest crude smoking related mortality was seen in states with the most restrictive bans.

The few earlier studies in this area described the high prevalence of tobacco use among prisoners, the types of …

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