Why banning smoking in prisons is a good idea

A riot overnight at Melbourne’s Metropolitan Remand Centre has prompted some commentators to argue that Victoria’s prison smoking ban, which started today, should be overturned. Prisoners rely on smoking to cope with stress and boredom, they argue, so a ban will only increase tension and violence.

It’s fair to say Victoria’s ban on smoking in prisons has had some teething issues, but there’s strong evidence to suggest the move is doing the right thing by inmates, staff and the health system.

Shifting the culture

Smoking has long been embedded in prison culture. Cigarettes have helped prisoners manage their stress and boredom in the absence of other more meaningful supports. They often provide a means of interaction.

Cigarettes have also been embedded into the token economy within prisons and have sometimes been relied on as a prized good to “manage” the milieu.

Rates of smoking within Australian prisons are five times higher than the general community. In 2012, 84% of prison entrants were current smokers, and 80% were smokers when leaving prison.

Prisoners have traditionally purchased cigarettes through the prison system and have been able to smoke in prison outdoor areas and also within their cells, depending on the various protocols.

Unfortunately, this leads to the perception that treating people’s addiction can be ignored. Passive smoking and its harms to non-smoking staff and prisoners are ignored. Smoking-related medical conditions are accepted and everyone just accepts that smoking is the way it always has been for these populations.

A large US study of 287 prisons and almost 15,000 prisoners between 2001 and 2011 found an association between prison smoking bans and a reduced risk of major smoking-related health conditions among prisoners, such as lung cancer, heart disease, stroke and emphysema.

A study from Ireland found that staff working in prisons without smoke-free policies were exposed to high levels of second-hand smoke. Almost half (44%) of non-smoking prison workers recorded carbon monoxide levels equivalent to those of a light to heavy smoker.

A Swiss study found that indoor air quality in prisons before and after smoke-free policies showed a significant decrease in nicotine concentrations in ambient air: the outdoor air within the general environment in which staff and prisoner routinely interact.

Smoke-free prisons

A growing number of Australian and overseas correctional facilities are going smoke-free. Along with Victoria’s new ban, Northern Territory and Queensland governments banned smoking in prisons in 2013 and 2014. South Australia, New South Wales and Tasmania are set to follow suit from later this year.

The research evidence and practical experience from New Zealand – which was the first country to ban smoking in prisons, in July 2011 – shows smoking bans can be very successful, provided the right policies and preparations are in place. These include:

• preparing and gaining buy-in from staff and prisoners well ahead
• supporting as many staff and prisoners early with smoking cessation tools, such as patches
• introducing other activities and supports for prisoners
• creating systems ready to manage and respond effectively to nicotine withdrawal
• thinking practically about how to manage enforcement
• considering transitioning prisoners’ needs and communicating about each point to ensure consistency of approaches
• including all staff, prisoners and visitors within prison premises, indoors and outdoors.

Many of the concerns expressed about contraband cigarettes, increased violence and fire risks are either unfounded or short-lived once the policy has been introduced and the various associated procedures have become routine.

Lessons from New Zealand

Tobacco control researcher Lucie Collinson and colleagues have identified three factors that contributed to the widespread acceptance of smoke-free prisons in New Zealand. First, they comprehensively prepared. Second, they ensured counselling and nicotine replacement therapy was available to prisoners and staff. Third, they enacted a comprehensive policy as opposed to a partial policy.

Partial smoke-free policy creates more problems and tensions because it creates the potential for inconsistency, fragmentation, inequity, and uncertainty. And this doesn’t help anyone; both prisoners and staff need to know where they stand.

Former smokers from New Zealand’s prisons say it was easier when everyone else was also subject to the policy; other say they “couldn’t have quit any other way” because the culture of smoking had been such a strong feature of the setting prior to the smoke-free policy.

The Victorian ban

Victoria’s Forensicare and Justice Health have researched how to introduce a policy that’s right for prisoners, staff and prisons. They have implemented supports to help prisoners transition to a smoke-free environment and have built nicotine withdrawal support into prison health services.

Importantly, they’ve understood the need to deal with any contraband, black market trade of tobacco and misuse of nicotine replacement patches in the initial period of the policy when this might occur as part of the smoke-free transition.

Sharon Lawn consulted to Forensicare as part of their preparation for smoke-free prisons.