Objective: To examine the role of tobacco use in prison and possible influences of the prison environment on smoking among inmates in the context of developing inmate smoking cessation programs.
Method: Qualitative study based on 7 focus groups with prisoners and ex-prisoners.
Settings: A maximum security prison in rural New South Wales (NSW), Australia, and a community justice restorative centre and accommodation service for ex-prisoners in Sydney, NSW, Australia.
Participants:40 participants (28 men and 12 women) comprising 9 prisoners (including 4 Indigenous inmates) and 31 ex-prisoners.
Results: Prisoners reported that tobacco serves as a de facto currency in correctional settings and can be exchanged for goods, pay debts and for gambling. Smoking helps manage the stressful situations such as transfers, court appearances and prison visits. Inmate smoking cessation programs need to address the enmeshment of tobacco in prison life, improve availability of pharmacotherapies (e.g. nicotine patches, bupropion) and the Quitline (a free telephone helpline providing information on stopping smoking), provide non-smoking cells and areas within prisons, encourage physical activity for inmates, and maintain monitoring of smoking cessation status post release.
Conclusions: Tobacco is integrally bound up in the prison ‘culture’. Our findings are relevant to inform prison health authorities concerned with improving the health of prisoners, and for support organisations attempting to facilitate smoking cessation both in prison and post-release. Smoking cessation programs in prisons should be tailored to the unique stresses of the prison environment. Programs needs to acknowledge the difficulties of quitting smoking in prison arising from the stresses posed by this setting.
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