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Introduction
Several jurisdictions have introduced prison smoking bans, responding to concerns around the health of people in custody (hereafter ‘prisoner’ for brevity) and staff, legal challenges and maintenance costs.1 2 Fears of disorder following bans are often expressed in advance.3–5 Although generally unfounded,6 7 such fears may reduce the stakeholder support that is vital for successful implementation.8 A complete prisoner smoking ban (staff smoking was already banned) was introduced in all 15 Scottish prisons in November 2018, precipitating no significant incidents.9 It has been evaluated by the three-phase Tobacco In Prisons study (TIPs).3 4 10 TIPs Phase 1 occurred before the ban’s announcement; Phase 2 following the announcement, but before policy implementation (during which rechargeable e-cigarettes became available to prisoners); and Phase 3 following implementation.
This novel analysis uses TIPs data to examine prisoners’ and prison staff’s opinions about prison smoking bans over the course of implementation.
Methods
Prison staff surveys were administered online, with links and reminders circulated to staff contacts in all Scottish prisons for forwarding to all prison staff. Staff surveys were open from November to December 2016 (Phase 1), from May to July 2018 (Phase 2) and from May to July 2019 (Phase 3). Prisoner surveys were via paper questionnaires administered from November 2016 to April 2017 (Phase 1), from June to July 2018 (Phase 2) and from June to July 2019 (Phase 3). In all except three prisons in Phase 1, prison staff distributed and collected questionnaires (in sealed envelopes protecting confidentiality), generally during overnight lock-up. Staff and prisoner questionnaires included identical/very similar questions around opinions on smoking bans and e-cigarettes in prisons4 (table 1), smoking, health and socio-demographic characteristics.
Agreement with opinion items among prisoners and staff: before a Scottish prisons’ smoking ban was announced (Phase 1); following the announcement (Phase 2); and following implementation of the ban (Phase 3) - numbers and percentages and any between-phase differences with p value<0.01
We compared opinions of both prisoners and staff across Phases, collapsing categories if necessary so all were binary outcomes and testing for differences via logistic regression analyses, adjusting for socio-demographic variables associated with both Phase and opinions. Simple weights were derived to adjust for varying survey return rates between prisons; unweighted results are presented, since they were virtually identical to weighted data results.
Results
Table 1 shows the lowest return rates in Phase 3 (18.1% prisoners, 16.1% staff), compared with highest returns of 33.8% (prisoners, Phase 1) and 31.4% (staff, Phase 2).
Opinions shifted over time in both groups, although more clearly among staff, with differences between Phases 1 and 3 and, for several items, between Phases 1 and 2 and/or 2 and 3. Initial support for prison smoking bans was higher among staff;4 support increased in anticipation of/following the ban among both prisoners and staff. Importantly, both groups displayed large decreases in the proportions agreeing that prison smoking bans ‘cause a lot of trouble’ and ‘are hard to enforce’, particularly: between Phases 2 and 3; and among staff (among whom concerns that bans ‘cause a lot of trouble’ had increased between Phases 1 (pre-announcement) and 2 (lead-up to ban)). Staff support for prisoner e-cigarette use increased in anticipation of the ban, remaining stable following its implementation.
Conclusion
There were notable opinion changes in both groups in the study period. We acknowledge possible sample bias, but suggest policymakers should be encouraged by these findings from Scotland which suggest support for prison smoking bans increases among prison staff and prisoners, following largely trouble-free implementation of such bans.
Ethics statements
Acknowledgments
We are grateful to the staff and prisoners who completed the surveys, and staff at the Scottish Prison Service and at the two non-Scottish Prison Service-run prisons (HMP Addiewell and HMP Kilmarnock) who assisted with the study. We thank colleagues at the MRC/CSO Social and Public Health Sciences Unit’s Public Health Research Facility for help with data collection and management, recognise the contribution of our Tobacco In Prisons study co-investigators to the overall design of the study and particularly acknowledge members of the Scottish Prison Service Research Advisory Group and University of Glasgow College of Social Sciences Ethics Committee for their helpful input throughout this research.
Footnotes
Contributors HS and ED are Co-Investigators and KH is the Principal Investigator of the Tobacco In Prisons study and therefore all contributed to the overall study design; AB is Research Assistant to the study. All contributed to survey content and management, which was led by HS. HS conceived and conducted the analyses presented here and first-drafted the manuscript. All authors contributed to subsequent drafts and approved submission.
Funding This study was funded by Chief Scientist Office (http://dx.doi.org/10.13039/501100000589), grant number (SPHSU-12); Medical Research Council (http://dx.doi.org/10.13039/501100000265), grant number (MC_UU12017/12) and Public Health Research Programme (http://dx.doi.org/10.13039/501100001921), grant number (15/55/44).
Competing interests HS is a member of the ASH Scotland Board and its Policy and Development Committee and chairs the Scottish Tobacco-free Alliance Research Group.
Provenance and peer review Not commissioned; externally peer reviewed.