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Editor,—Since 1974, periodic national smoking prevalence studies have been published for the general Australian population.1 However, similar studies on prison populations are non-existent. We report the results of a survey carried out during the year 2000 in 21 of 23 New South Wales (NSW) correctional facilities. These facilities contain about 93% of the state's total prison population.
We assessed smoking prevalence indirectly by auditing the weekly shopping lists presented by inmates in each facility for at least two consecutive weeks June to November 2000. We calculated the average number of inmates presenting shopping lists as well as the average number of inmates buying tobacco. These shopping lists are usually for non-food items, as food is provided for all inmates. Inmates found to have purchased at least one packet of tobacco were recorded as regular smokers. This methodology was pilot tested in two correctional facilities (by comparing with observed number of smokers) and was found to provide an objective and reliable estimate of smoking prevalence.
Of the 5959 inmates who submitted shopping lists during the study period, 4294 (72%) were found to have purchased at least one packet of tobacco. Smoking prevalence ranged from 48–97%, with facilities at both extremes housing male, minimum security inmates.
Smoking prevalence was significantly higher among females (n = 324/402, 81%) compared with males (n = 3980/5575, 71%) (p < 0.001, 95% confidence interval (CI) 5.85 to 14.15).
Studies in the general Australian population reveal a downward trend in smoking patterns, from 40% adults in 1980 to 22% in 1998.2 3 Hence, the prevalence of tobacco use in NSW correctional facilities is currently more than triple that of the general Australian population. Also the higher prevalence of smokers among female inmates contrasts with the smoking trends in the general Australian population, with male smoking prevalence significantly higher than that of women.1
About 77% of inmates in metropolitan jails smoke (n = 1881/2430), compared with 68% in non-metropolitan jails (n = 2413/3529)—a significant difference (p < 0.001, 95% CI 6.69 to 11.31). The smoking prevalence among inmates in the prison psychiatric hospital wards was 83% (n = 66/80), significantly higher than the average prevalence of smoker inmates in NSW correctional facilities (p < 0.05, 95% CI 1.76 to 19.48). Comparatively higher smoking prevalence for mentally ill individuals has been reported for the general US community.4 Smoking rates are known to be consistently high in prison populations. For example, a 1991 statewide survey of 72 county jails in Wisconsin revealed that between 71% and 93% of inmates smoked.5
People who are educationally, socially or economically disadvantaged are at increased risk of becoming involved with the legal system, either as perpetrators or victims of crime.6 Within the context of “diffusion of innovation” theories,7cohorts of prison inmates comprise socioeconomically marginal individuals, who are least likely to be affected by mainstream educational strategies for tobacco control. Unfortunately, prison settings were not specifically addressed in the current Australia National Tobacco Strategy.8 In most correctional facilities in Australia, there is the additional issue of indifference in social concern, and reluctance by correctional authorities to allocate resources and address tobacco use in prisons—an issue that is sometimes perceived as capable of disrupting the “peace” in correctional environments, through protests and riots by inmates.9 10
Preliminary results from an ongoing pilot project on smoking cessation in NSW jails indicate that most inmates who smoke have comparatively less knowledge about tobacco. In line with the diffusion theories, such inmates may be considered not intrinsically unreachable, but as “laggards” who would catch up. Such an approach helps tobacco control workers to avoid victim blaming and focus attention on ways of speeding up the diffusion process. This may be achieved through individual and group counselling sessions on tobacco cessation, wide distribution of prison based tobacco educational materials, and tobacco cessation programmes incorporating free nicotine replacement therapy. We advocate the introduction of national prison inmate smoking prevalence surveys, and greater attention to tobacco control in prisons.
We are grateful to the following individuals for participation in the auditing of inmates' shopping lists: Michael Levy, Raymond Naoum, Beverly Spiers, Jenny Douglas, Helen Packwood, Maureen Fisher, Margaret Jones, Craig Gater, Dennis Folpp, Caroline O'Connor, Cheryl McAlister, Jammuna Bond. Lisa Jackson assisted with statistical analysis.