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BMJ. Dec 17, 2005; 331(7530): 1473.
PMCID: PMC1315702

US experience of smoke-free prisons

Thomas Lincoln, physician,1 R Scott Chavez, vice president,2 and Elizabeth Langmore-Avila, substance abuse clinician3

Editor—O'Dowd reports that a smoking ban in prisons would lead to more assaults on staff.1 Increasing numbers of correctional facilities in the United States have become smoke-free and made tobacco, matches, and lighters contraband. Most experience so far has not shown the feared difficulties arising when facilities become completely tobacco-free. Most programmes note that the issues around staff tobacco use at the facility are more challenging than those around prisoners' use.

A recent report indicated that 77% of US facilities surveyed in 2003 disallow tobacco use for prisoners, although 79% of them allow staff to use tobacco on the premises2; various programmes have noted some difficulty resulting from this. The transition process is not minimal, and some programmes have reported difficulties, including amplification of discontent among prisoners and staff. During the transition period some programmes have made nicotine replacement therapy available, although this was used by a small fraction of the populations. To our knowledge, no facilities that have instituted smoking bans have reversed that decision. In other mental health and addictions settings a critical review of 22 published studies found no major effects in behavioural indicators of unrest or compliance.3

On admission to a smoke-free jail our patients have repeatedly reported very little difficulty with stopping tobacco use, and that during the initial days and weeks, thoughts and energy are directed to far more pressing concerns. Stopping is different from quitting, and about 97% have returned to tobacco use by six months after release (R W Tuthill et al, 26th national conference on correctional health care, Nashville, Tennessee, October 2002).

Effective tobacco cessation and relapse prevention programmes are needed for people passing through the correctional system. A tobacco educational curriculum has been created and has been well accepted by prisoners and staff, though tobacco use outcomes have not yet been assessed.4


Competing interests: None declared.


1. O'Dowd A. Smoking ban in prisons would lead to more assaults on staff. BMJ 2005;331: 1228. (26 November.) [PMC free article] [PubMed]
2. Chavez RS, Oto-Kent DS, Porter J, Brown K, Quirk L, Lewis S. Tobacco policy, cessation, and education in correctional facilities. Chicago, IL: National Commission on Correctional Health Care and National Network on Tobacco Prevention and Poverty, 2005.
3. El-Guebaly N, Cathcart J, Currie S, Brown D, Gloster S. Public health and therapeutic aspects of smoking bans in mental health and addiction settings. Psychiatr Serv 2002;53: 1617-22. [PubMed]
4. National Commission on Correctional Health Care and National Network on Tobacco Prevention and Poverty. Tobacco cessation for correctional populations: a health education manual. 2005. www.ncchc.org/pubs/catalog.html#tobacco_cessation (accessed 8 Dec 2005).

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