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Use of prescribed smoking cessation pharmacotherapy following release from prison: a prospective data linkage study
  1. Cheneal Puljević1,
  2. Dominique de Andrade1,2,
  3. Megan Carroll3,
  4. Matthew J Spittal3,
  5. Stuart A Kinner1,3,4,5,6
  1. 1 Griffith Criminology Institute, Griffith University, Brisbane, Australia
  2. 2 Centre for Youth Substance Abuse Research, School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Centre for Children’s Health Research, Queensland University of Technology, Brisbane, Australia
  3. 3 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
  4. 4 School of Public Health and Preventive Medicine, Monash University, Sydney, Australia
  5. 5 Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, Australia
  6. 6 Mater Research Institute-UQ, University of Queensland, Queensland, Australia
  1. Correspondence to Cheneal Puljević, Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD 4122, Australia; c.puljevic{at}


Background A significant proportion of people who cycle through prisons express a desire to quit smoking, yet smoking rates in this population are two to four times higher than in the general community. Smoking cessation pharmacotherapy (SCP) is an important component of evidence-based cessation support, yet no studies have examined use of this pharmacotherapy after release from prison.

Methods We linked data from a survey of 971 smokers who were within 8 weeks of release from prison in Queensland, Australia, with federal Pharmaceutical Benefits Scheme (PBS) records for the 2 years after release, to identify subsidised use of SCP (varenicline, bupropion and nicotine patches). We used Cox proportional hazards regression to identify independent predictors of SCP use.

Findings According to PBS data, 86 participants (8.9%) accessed SCP in the 2 years following release from prison. Participants who were aged 25 years or older (HR 2.51, 95% CI 1.19 to 5.31), employed before prison (HR 1.93, 95% CI 1.14 to 3.28), highly nicotine dependent at baseline (HR 2.21, 95% CI 1.23 to 3.97) and using non-psychotropic medications in prison (HR 2.29, 95% CI 1.24 to 4.22) were more likely to use subsidised SCP during follow-up.

Conclusion Despite a very high rate of tobacco use among people cycling through prisons and the very low cost of (subsidised) SCP in Australia, few ex-prisoners obtain pharmaceutical assistance with quitting smoking. Policy attention needs to focus on supporting former prisoners to access SCP, to reduce the high rate of tobacco-related morbidity and mortality in this profoundly marginalised population.

  • Cessation
  • Nicotine
  • Priority/special Populations
  • Primary Health Care

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  • Contributors CP, DA, SAK: conception and design of study. DA, MC, MJS: data analysis. CP: drafting the manuscript. DA, SAK, MC, MJS: editing the manuscript. CP, DA, MC, MJS, SAK: approval of the version of the manuscript to be published.

  • Funding The HIP-Aus study is funded by NHMRC Strategic Award APP409966 and Project Grant APP1002463. SK is supported by NHMRC Senior Research Fellowship APP1078168.

  • Competing interests None declared.

  • Ethics approval University of Queensland’s Behavioural and Social Sciences Ethical Review Committee, Queensland Health Human Research Ethics Committee, and the Australian Institute of Health and Welfare Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.