Tobacco Control in Prisons

The case for addressing smoking among offenders is well made and endorsed in the tobacco control policy document ‘A Smokefree Future’. High levels of smoking are identified among prisoners (80%) and offenders are predominantly from disadvantaged backgrounds, often experiencing additional factors contributing to health inequalities including high levels of mental health conditions, substance misuse and educational limitations.

Prisoners may be considered a ‘captive audience’ but are also very mobile. So, for example, there is strength in developing the role of health trainers in probation settings to include signposting to services such as stop smoking. In addition, working with staff in these settings can enhance wellbeing and contribute to a more positive environment for quitting. It is also recognised that cessation work with offenders will address inequality issues and have improved health outcomes for families and the wider communities in which they live. Work with this group will also impact on smoking behaviour in routine and manual and mental health PCT cessation target groups, given the extremely high prevalence of mental health issues among offenders and the marked likelihood of coming from disadvantaged communities.

There is evidence of quit success in prison settings. National monitoring shows an overall quit rate of 61% over the last year, although recording relatively small numbers compared to other settings. This is a higher rate than shown in other settings and is especially striking when considering the client group and environment. Stop smoking interventions in prisons are reported to be relatively widespread. In our mapping exercise in 2003, nearly 80% of prisons reported smoking cessation support for prisoners. It is, therefore, important to maximise opportunities to engage across the Criminal Justice System, with joined up working that addresses individual offenders, families and their wider community, staff and a range of relevant organisational targets in order to improve service reach and top smoking outcomes and wider tobacco control developments.

The project worked within the North West of England, which has 17 prisons representing a wide range of categories, three probation areas, 24 primary care trusts and varied local government areas and localities. It focused on organisational/systems perspectives across prisons, probation services, and police custody in relation to tobacco control and stop smoking support and treatment – and aimed to:

• Develop and share knowledge and learning in relation to smoking cessation in prisons and broadening this out to other organisations across the criminal justice system that also have the potential to contribute to quitting and to generic services.
• Target groups within the criminal justice system such as offenders, families and staff.
• Develop functioning systems for provision of support and care pathways, in prisons, on release, across the criminal justice system, and into the community, which will result in enhanced engagement and quit rates.
• Provide substantial learning for the Department of Health (DH) in terms of implementing effective reach and provision in these settings and identify replicable and achievable principles for delivery, pathways and monitoring.
• Make recommendations to contribute to a national plan and to the prisoner section of the Annual NHS Stop Smoking Services Service and Monitoring Guidance.
  The findings and recommendations will focus on ‘what works’, recognising complexities such as the constraints within systems for practitioners; challenges of working across organisational boundaries; and the needs of differing audiences, such as commissioners and providers.