1. Smoking Bans in Prisons: The Final Frontier Karen L. Cropsey, Psy.D. Assistant Professor Virginia Commonwealth University

2. 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

3. Number of Persons Under Correctional Supervision Bureau of Prisons, 2002

4. Two 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…”

5. Recent 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

6. Medical 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

7. “Each pack of cigarettes sold in the U.S. costs the nation an estimated $7.18 in medical care costs and lost productivity.” Centers for Disease Control April, 2002

8. Prevalence of Smoking in Correctional 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).

9. Why are smoking prevalence 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.

10. Smoking Interventions in Correctional Populations Behavioral and pharmacological smoking interventions are effective. Smoking cessation considered “gold standard” for prevention  cost 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.

11. Overview of Smoking Ban and Study Smoking ban – August 1, 1997 Banned smoking in all state prison buildings and outside enclosed areas Enforcement of ban No clinical interventions to inmates, although patches could be purchased Rationale for study

12. Method Three 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

13. Sample Characteristics Age 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)

14. Smoker Characteristics Smoker (63.3%); Non (13.5%); Ex (22.4%) FTND: M = 5.6, 40% dependent Age 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%)

15. Policy Agreement SD SA

16. Summary High prevalence of inmate smoking. Medical burden in prisons is high Low support for the smoking ban. Most continued to smoke despite ban. Need for research on smoking cessation interventions with prisoners.