Smoking and mental health - NCSCT

Smoking and mental health
unemployment, long-term disengagement from health and other services, and
poor relationships with those who might help them. 44 Time in prison therefore
presents a significant opportunity for smoking prevention and other health
interventions among this otherwise hard-to-reach, disadvantaged and often
otherwise neglected group. 45
The motivation for prisoners to smoke is often linked to coping with the prison
environment. Many prisoners smoke to relieve boredom or stress attributed to
prison life, 26,47–49 but in practice smoking also arises from nicotine withdrawal,
or because of peer-group pressure or the association with illegal drug use.
Prisoners have reported feeling a stronger need to smoke while imprisoned, 3
while boredom, being confined to cells for long periods and stress have also been
cited as reasons for relapse by prisoners who have made quit attempts while in
prison. 50 As a male prisoner in an English category C prison remarked, tobacco is
‘everybody’s lifeline in here’. 21 Smoking habits also change in prison, both
positively and negatively. The limited access to tobacco, in combination with
other factors, may contribute to reductions in the amount of tobacco smoked
and/or the frequency of smoking. 35,36 However, the high prevalence of smoking
among other inmates can promote smoking, as, for example, in a US female
prison in which 14% of prisoners started smoking for the first time and more
than 50% increased their smoking after entering prison. 51
7.2.3 Smoke-free policy in prisons
Smoke-free policies are intended primarily to protect prisoners and staff from
passive smoke exposure, but, as in general society, also reduce the general
acceptability and normality of smoking and hence support smoking prevention.
Given the high prevalence of smoking among prisoners, passive smoke exposure
in prisons can be extremely high; indeed, one study estimated that more
prisoners in the USA die from exposure to second-hand smoke every year than
from the death penalty. 52 As a result many countries, including most European
Union member states, now impose restrictions on smoking in common areas in
prisons, whereas in many parts of the USA smoking in prison is completely
prohibited. 25,32 In New Zealand, all prisons became completely smoke free inside
their secure perimeter on 1 July 2011, after a 12-month lead-in period and with
free access to NRT for prisoners. Implementation is reported to have been
successful, with no incidents of related violence, reported improvements in
tensions between prisoners and staff, and with half of those who smoke stating
that they intend to remain non-smokers after release. 53
Smoke-free legislation was introduced in prisons in Scotland in 2005, and
broadly similar measures in England and Wales and Northern Ireland in 2007;
the Prison Service Instruction (PSI) 09/2007 for England requires all indoor
areas of prisons to be smoke free with the exception of cells occupied solely by
smokers aged 18 and over. 54 The Prison Officers Association has since called for
136 © Royal College of Physicians 2013