Dataset Information

Purchasing of tobacco-related and e-cigarette-related products within prisons before and after implementation of smoke-free prison policy: analysis of prisoner spend data across Scotland, UK.

ABSTRACT:

Objectives

To examine the effect of smoke-free prison policy implementation in November 2018 on purchasing patterns in the prison canteen (shop).

Design

Interrupted time series.

Setting

All 12 closed, publicly run prisons in Scotland, UK.

Participants

People in custody (PiC) between August 2018 and end of March 2019 (n=11 944).

Interventions

Implementation of smoke-free prisons policy.

Outcome measures

Total spent on all products, nicotine-related products, and food and beverage products per week.

Methods

Canteen data were provided for the period July 2018-September 2019 by the Scottish Prison Service. In a series of generalised linear mixed effects models, the amount spent before and after implementation of smoke-free prison policy was compared for all purchases in the time period, and for PiC identified as 'smokers' and 'non-smokers' from their pre-implementation tobacco purchasing patterns.

Results

The amount spent on nicotine-related products significantly decreased from pre-implementation to post implementation (incident rate ratio (IRR) 0.40; 99% CI 0.33 to 0.51, p<0.001). However, total canteen spend did not change over the study period (IRR 0.92; 99% CI 0.84 to 1.00). Post implementation about 25% of previous 'smokers' total canteen spend was on nicotine-related products. The amount spent by previous 'smokers' on food and beverages increased from £8.67 (99% CI 8.23 to 9.13) pre-implementation to £10.24 in the post implementation period (99% CI 9.58 to 10.90).

Conclusion

Although the amount of money previous 'smokers' in prison spent on nicotine-related products decreased after smoke-free policy, nicotine products still account for a large proportion of canteen spend among PiC in smoke-free prisons in Scotland. Results indicate that many PiC may continue to use nicotine in smoke-free prisons where e-cigarettes are permitted.

SUBMITTER: Best CS

PROVIDER: S-EPMC8867351 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Purchasing of tobacco-related and e-cigarette-related products within prisons before and after implementation of smoke-free prison policy: analysis of prisoner spend data across Scotland, UK.

Best Catherine Susan CS Brown Ashley A Hunt Kate K

BMJ open 20220222 2

<h4>Objectives</h4>To examine the effect of smoke-free prison policy implementation in November 2018 on purchasing patterns in the prison canteen (shop).<h4>Design</h4>Interrupted time series.<h4>Setting</h4>All 12 closed, publicly run prisons in Scotland, UK.<h4>Participants</h4>People in custody (PiC) between August 2018 and end of March 2019 (n=11 944).<h4>Interventions</h4>Implementation of smoke-free prisons policy.<h4>Outcome measures</h4>Total spent on all products, nicotine-related produ ...[more]

PMID: 35193923

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Project description:BackgroundInternationally, smoking prevalence among people in prison custody (ie, people on remand awaiting trial, awaiting sentencing, or serving a custodial sentence) is high. In Scotland, all prisons implemented a comprehensive smoke-free policy in 2018 after a 16-month anticipatory period. In this study, we aimed to use data on medication dispensing to assess the impact of this policy on cessation support, health outcomes, and potential unintended consequences among people in prison custody.MethodsWe did an interrupted time-series analysis using dispensing data for 44 660 individuals incarcerated in 14 closed prisons in Scotland between March 30, 2014, and Nov 30, 2019. We estimated changes in dispensing rates associated with the policy announcement (July 17, 2017) and full implementation (Nov 30, 2018) using seasonal autoregressive integrated moving average models. Medication categories of primary interest were treatments for nicotine dependence (as an indicator of smoking cessation or abstinence attempts), acute smoking-associated illnesses, and mental health (antidepressants). We included antiepileptic medications as a negative control.FindingsA 44% step increase in dispensing of treatments for nicotine dependence was observed at implementation (2250 items per 1000 people in custody per fortnight, 95% CI 1875 to 2624) due primarily to a 42% increase in dispensing of nicotine replacement therapy (2109 items per 1000 people in custody per fortnight, 1701 to 2516). A 9% step decrease in dispensing for smoking-related illnesses was observed at implementation, largely accounted for by respiratory medications (-646 items per 1000 people in custody per fortnight, -1111 to -181). No changes associated with announcement or implementation were observed for mental health dispensing or antiepileptic medications (control).InterpretationSmoke-free prison policies might improve respiratory health among people in custody and encourage smoking abstinence or cessation without apparent short-term adverse effects on mental health dispensing.FundingNational Institute of Health Research Public Health Research programme, Scottish Government Chief Scientist Office, and UK Medical Research Council.

Project description:ObjectivesLittle is known about the perspectives of staff working in prisons where e-cigarettes are permitted. Scotland now permits people in custody (PiC), but not staff/visitors to use e-cigarettes, following implementation of smoke-free prisons policy in 2018. Previous studies, conducted before and immediately after the introduction of e-cigarettes in Scottish prisons, have evidenced stakeholder support for their use by PiC. This study focuses on key challenges associated with e-cigarette use in prisons, using data collected from prison staff once e-cigarettes had been allowed in a smoke-free environment for 6-9 months.SettingFive prisons in Scotland.ParticipantsSixteen qualitative interviews were conducted with prison staff from five prisons varying by population (sex, age and sentence length). Data were managed and analysed using the framework approach.ResultsWhile these staff confirmed strong support for the smoke-free prison policy and reported some benefits of replacing tobacco with e-cigarettes, they also spoke of the challenges e-cigarettes pose. These included: workplace e-cigarette vapour exposures; perceptions that e-cigarettes provide a new, effective way for some PiC to take illegal drugs, particularly new psychoactive substances; organisational challenges relating to the value attached to e-cigarettes in prisons; and implications for long-term nicotine use and tobacco cessation. Staff anticipated difficulties in tightening restrictions on e-cigarette use by PiC given its scale and significance among this population.ConclusionsMaximising the benefits of e-cigarette use by PiC is likely to require multiple measures to support effective and safe use and e-cigarette reduction/cessation where desired. This includes monitoring any misuse of e-cigarettes, and provision of guidance and support on appropriate e-cigarette use and how to limit or quit use if desired. Findings are relevant to jurisdictions considering or planning changes in prison smoking or vaping policies.

Project description:IntroductionE-cigarettes were one measure introduced to help people in custody (PiC) to prepare for and cope with implementation of comprehensive smokefree policies in Scottish prisons. Our earlier study explored experiences of vaping when e-cigarettes were first introduced and most participants were dual tobacco and e-cigarette users. Here we present findings of a subsequent study of vaping among a different sample of PiC when use of tobacco was prohibited in prison, and smokefree policy had become the norm.MethodsTwenty-eight qualitative interviews were conducted with PiC who were current or former users of e-cigarettes in prison, 6-10 months after implementation of a smokefree policy. Data were managed and analyzed using the framework approach.ResultsPiC reported that vaping helped with mandated smoking abstinence. However, findings suggest that some PiC may be susceptible to heavy e-cigarette use potentially as a consequence of high nicotine dependence and situational factors such as e-cigarette product choice and availability in prisons; issues with nicotine delivery; prison regimes; and use of e-cigarettes for managing negative emotions. These factors may act as barriers to cutting down or stopping use of e-cigarettes by PiC who want to make changes due to dissatisfaction with vaping or lack of interest in continued use of nicotine, cost, and/or health concerns.ConclusionsE-cigarettes helped PiC to cope with smokefree rules, although concerns about e-cigarette efficacy, cost, and safety were raised. PiC may desire or benefit both from conventional smoking cessation programs and from interventions to support reduction, or cessation, of vaping.ImplicationsFindings highlight successes, challenges, and potential solutions in respect of use of e-cigarettes to cope with mandated smoking abstinence in populations with high smoking prevalence and heavy nicotine dependence. Experiences from prisons in Scotland may be of particular interest to health and/or justice services in other jurisdictions, with similar legislation on e-cigarettes to the United Kingdom, who are planning for institutional smokefree policies in their prisons or inpatient mental health settings in the future.

Project description:ObjectivesPrisons in Scotland were one of the few workplaces exempt from the 2006 comprehensive smoking ban in indoor public places, excluding the prison workforce from the health benefits of smokefree workplaces. The November 2018 introduction of comprehensive restrictions on smoking in Scottish prisons aimed to protect prison staff and people in custody from the harmful impacts of second-hand smoke (SHS) exposure. This study presents SHS exposure data gathered after smokefree policy implementation and compares these with data gathered during and before policy development.MethodsDylos DC1700 monitors were used to measure concentrations of fine particulate matter (PM2.5) derived from SHS across Scotland's 15 prisons. Six days of fixed-site monitoring (09.00 22 May 2019 to 09.00 28 May 2019) were conducted in residential halls in each prison 6 months post-smokefree policy implementation. Prison staff task-based measurements were conducted to assess concentrations of SHS in various locations (e.g. gyms and workshops) and during specific activities (e.g. cell searches, maintenance, and meal service). Utilizing the fixed-site monitoring data, typical daily PM2.5 exposure profiles were constructed for the prison service and time-weighted average (TWA) exposure concentrations were estimated for the typical shift patterns of residential staff pre- and post-smokefree policy implementation. Staff perceptions of changes to SHS exposure were assessed using online surveys.ResultsAnalysis of both fixed-site and mobile task-based PM2.5 measurements showed the smokefree policy implementation was successful in reducing SHS exposures across the Scottish prison estate. Measured PM2.5 in residential halls declined markedly; median fixed-site concentrations reduced by more than 91% compared with measures in 2016 before policy announcement. The changes in the TWA concentrations across shifts (over 90% decrease across all shifts) and task-based measurements (89% average decrease for high-exposure tasks) provide evidence that prison staff exposure to SHS has significantly reduced. Following smokefree policy implementation, the majority of staff reported no longer being exposed to SHS at work.ConclusionsTo our knowledge, this is the first comprehensive international study to objectively measure SHS levels before, during, and after implementation of a smokefree policy across a country's prison system. The findings confirm that such a policy change can be successfully implemented to eliminate occupational exposures to SHS. The results are highly relevant for other jurisdictions considering changes to prison smoking legislation.

Dataset Information

Purchasing of tobacco-related and e-cigarette-related products within prisons before and after implementation of smoke-free prison policy: analysis of prisoner spend data across Scotland, UK.

Objectives

Design

Setting

Participants

Interventions

Outcome measures

Methods

Results

Conclusion

Publications

Purchasing of tobacco-related and e-cigarette-related products within prisons before and after implementation of smoke-free prison policy: analysis of prisoner spend data across Scotland, UK.

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