Tobacco smoking is an integral part of prison life and an established part of the prison culture. Tobacco serves a range of functions in prison: as a surrogate currency, a means of social control, as a symbol of freedom in a group with few rights and privileges, a stress reliever and as a social lubricant.

Smoking bans in prison have gained favour in recent times, particularly in North America.^1–3 Fear of legal action by non-smoking prison staff and other inmates appears to be the main driver rather than public health concerns. Prisons are some of the few places in the Western world where smoking is still allowed in enclosed spaces. More recently, however, moves have been made to bring prisons in line with other public institutions through the use of partial or total smoking bans.

While tobacco control strategies have successfully reduced smoking in the general community to below 20% in Australia, the rate among prisoners remains unacceptably high. In 1996 the overall prevalence of smoking among New South Wales (NSW) prisoners was a staggering 88%⁴ (compared with 27% in the community⁵) and in 2001 the prevalence was 90%⁶ (compared with 20% in the community⁷). Similar rates are reported in overseas prisoner health studies. Smoking is one of the most pernicious public health problems affecting prisons and one that all too often is ignored community based tobacco control strategies.

Reasons for smoking rates remaining high in prisoner populations include high nicotine dependency, mental illness, a lack of smoking cessation programmes available to prisoners, a paucity of evidence regarding best practice for smoking cessation in this population segment, confusion over ownership of the problem between health departments and custodial authorities, and poor access by this group to smoking cessation programmes while in …