In many countries, prisons are almost a by-word for smoking. It is embedded in prison systems, part of their subcultures and special vocabularies. In Britain, for example, tobacco is “snout” and those who illicitly trade in it are “barons”. The thought of being able to stub out smoking in prisons has normally been regarded as little more than a pipedream.

All credit, then, to the prison authorities in California, the largest and most diverse US state, which now allows no tobacco at all on state property. No employee, visitor or inmate is exempted. With 33 prisons and 170 000 prisoners, seven out of 10 of whom are smokers, this is an extraordinary achievement, especially in light of its description as the country’s most overcrowded and gang-ridden prison system. However, the effect of living and working under the ban will eventually have substantial health benefits, for the 95% of inmates who will eventually leave prison, and also for the 40 000 staff who look after them.

Despite state legislation covering indoor smoking since 1998, covert smoking had continued, and both staff and inmates complained and filed lawsuits based on harm from secondhand smoking. Spurred on by this, and by the health, fire and maintenance costs arguments that apply to any workplace, new state regulations were passed in July 2005 with bipartisan support, including that of California’s Republican governor.

Tanzania: selling single cigarettes The marketing of single cigarettes is a well-recognised strategy to increase sales among poor people and children, who may find it difficult to obtain the sums necessary to purchase a pack of 20 cigarettes. Yet it is a widely used practice, with Action on Smoking and Health, UK recently drawing attention to its use by BAT in Kenya. As the figure of an advertisement pictured last August shows, the practice is also being employed in Tanzania. Individual cigarettes (sigara mojo) are being advertised by the Tanzania Cigarette Company, a joint venture between RJ Reynolds, a subsidiary of Japan Tobacco International, and the Tanzanian government. The price of a single cigarette is only 40 Tanzanian shillings, equivalent to less than a third of one US cent. [Photo: Martin McKee]

It cannot be said that inmates had a choice about stopping smoking, nor that nicotine replacement therapy was there to help them—it is contraindicated for prisoners in California—but in a telephone evaluation survey covering prisons in 58 counties, virtually no problems were reported. On the contrary, a number of recurring, positive comments were relayed by prison health staff. Many prisoners expressed gratitude for the opportunity to stop smoking for good, and some even felt that their success in beating tobacco might empower them to take other, positive steps in their lives. A key factor in many success stories appeared to be the total absence of tobacco: prisoners said that neither seeing nor smelling it, far less handling the stuff, apparently made quitting easier. This is something most would-be exsmokers in the general community do not have on their side, and it reinforces the oft-repeated advice to temporarily avoid old haunts and the company of smokers for a while after stopping smoking.

As with many such success stories, showing that one tough nut can be cracked encourages public health officials to reach for another. Legislation to make all California’s state mental hospitals similarly tobacco-free is currently being pursued. (Further information: Stephen L Hansen, hansens2{at}pacbell.net)