Smoking Bans in Prisons: Smoking Bans in Prisons: The Final FrontierThe Final Frontier

Karen L. Cropsey, Psy.D.

Assistant Professor

Virginia Commonwealth University

Incarceration in U.S.Incarceration in U.S.

Incarceration rates in US highest in world– 699 per 100,000

From 2000 to 2001 the total incarceration population increased 1.6%– 4% average increase between 1995 and 2000– Incarceration rates highest among minority men

aged 25-29

International Center for Prison Studies, 2002

Number of Persons Under Number of Persons Under Correctional SupervisionCorrectional Supervision

0

500000

1000000

1500000

2000000

2500000

3000000

3500000

4000000

4500000

1980 1985 1990 1995 2000

Probation

Jail

Prison

Parole

Bureau of Prisons, 2002

Two Views of IncarcerationTwo Views of Incarceration

Public Health– “Incarceration presents a remarkable

public health opportunity for screening, counseling and treating…”

Corrections– “Mission of prison is now solely

custody…”

Recent NCCHC ReportRecent NCCHC Report

“…prisons and jails offer a unique opportunity for improving disease control in the community by providing comprehensive health care and disease prevention for inmates. Prisons and jails make it possible to reach a population that is largely underserved and difficult to identify and treat in the general community.”

NCCHC, March, 2002

Medical ExpenseMedical Expense

Medical costs for inmates currently accounts for 11% of the DOC

budget and are expected to double in the next 10 years.

Lamb-Mechanick-Nelson, 2000

““Each pack of cigarettes sold Each pack of cigarettes sold in the U.S. costs the nation an in the U.S. costs the nation an

estimated $7.18 in medical estimated $7.18 in medical care costs and lost care costs and lost

productivity.”productivity.”

Centers for Disease Control

April, 2002

Prevalence of Smoking in Prevalence of Smoking in Correctional PopulationsCorrectional Populations

80% of inmates smoke cigarettes (NCCHC, 2001).– 75% smoke; 70% smoke > 20 cpd or more

(Conklin et al, 2000).– 69.8% smokers & 18.5% ex-smokers;

M = 23 cpd (Colsher et al., 1992).

– 86% smokers; 66% smoked 20 cpd or less; 10% smoked > 30 cpd (Martin, 1984).

Why are smoking prevalence Why are smoking prevalence rates so high?rates so high?

Tobacco is widely available at prisons.Strong association between tobacco use and

other substance abuse, and rates of substance abuse are high among prisoners.

High correlation of smoking and mental illness, and a growing percentage of prisoners have an Axis I mental illness.

Smoking Interventions in Smoking Interventions in Correctional PopulationsCorrectional Populations

Behavioral and pharmacological smoking interventions are effective.

Smoking cessation considered “gold standard” for preventioncost effective

Only one study in the literature has examined smoking cessation with a prison population (Edinger et al., 1978).

Study demonstrated the feasibility of a smoking cessation program in prison.

Overview of Smoking Ban and Overview of Smoking Ban and StudyStudy

Smoking ban – August 1, 1997Banned smoking in all state prison

buildings and outside enclosed areasEnforcement of ban No clinical interventions to inmates,

although patches could be purchasedRationale for study

MethodMethodThree assessment times

– 1 week prior to the ban– Four days after the ban– 1 month after the ban

490 participants at baseline– 314 (64.1%) smokers– 110 (22.4%) ex-smokers– 66 (13.5%) non-smokers

Sample CharacteristicsSample CharacteristicsAge

M = 32.85; SD = 9.13; Range (16-66)

Ethnicity

Cauc. (70%), A.A. (28.7%), Other (1.2%)

Marital

Single (57.2%), Mar. (18.5%), Div. (21.2%)

Length of Sentence

Median = 16; Range (1 – Life)

Smoker CharacteristicsSmoker Characteristics

Smoker (63.3%); Non (13.5%); Ex (22.4%)FTND: M = 5.6, 40% dependentAge of smoking initiation

– < 10 (13.6%) 10-15 (49.1%), – 16-20 (30.1%) > 20 (7.1%)

Cigarettes per day– < 10 (24.3%) 11-20 (38.2%)– 21-30 (23.4%) > 31 (14.2%)

Policy AgreementPolicy Agreement

1

1.5

2

2.5

3

3.5

4

Baseline 4 days 1 Month

Time

Pol

icy

Agr

eem

ent

Smoker

Ex-smoker

Non-smoker

SD

SA

SummarySummary

High prevalence of inmate smoking.Medical burden in prisons is highLow support for the smoking ban.Most continued to smoke despite ban. Need for research on smoking

cessation interventions with prisoners.