Whether used as a relaxation, bartering, coping, weight control or other "tool," cigarettes have long been a staple of life in correctional facilities.

In a national survey published by the Journal of Drug Issues in 1993, correctional administrators of state prisons estimated that 62% of inmates and 43% of staff smoked. In contrast, the Centers for Disease Control and Prevention reports that about 25% of the entire US adult population smoked at that time; today the figure is closer to 23%.

Despite an increase in the number of facilities that have become "tobacco-free" in recent years, cigarettes and other tobacco products continue to have a strong presence in prisons in the form of contraband or in the possession of guards and other staff for personal use. However, given some of the common alternatives to tobacco—marijuana, heroin, cocaine and alcohol, to name a few—it is difficult for tobacco products to compete for prevention and cessation resources when other drugs are given more attention and perceived as being more dangerous.

This "lesser-of-two-evils" view of tobacco persists even though it is a known starter drug, often serving as the gateway to other drug use. By working to make tobacco control a priority issue among populations such as the incarcerated, the National Tobacco Prevention Network hopes to alter that perception and highlight the true dangers of tobacco to reduce its use and negative impact on the health and lives of those exposed to it.

As part of the Network’s tobacco control education efforts, NTPN and NCCHC (represented by vice president R. Scott Chavez) convened a discussion forum in April 2002 at the Clinical Updates in Correctional Health Care conference in Ft. Lauderdale, FL. The goal: to discuss tobacco use and assess the needs for education and prevention among inmates as well as prison personnel.

Forum participants consisted of correctional health care providers and administrators representing a variety of disciplines and serving incarcerated populations in Arizona, Connecticut, Florida, Georgia, Oregon, Michigan and Virginia. The group’s discussion focused on:

• Barriers and challenges to implementing tobacco-free policies in prisons and jails
• Existing tobacco education and prevention services and cessation programs in correctional facilities
• Proven methods to distribute informational and educational materials to inmates
• How maintenance of smoking cessation beyond incarceration can be encouraged

Key Issues
In discussing the participants’ experiences with and knowledge of tobacco use and control in correctional facilities, several important insights emerged:

• Tobacco use tends to be very high (estimated at 75% or more) among all inmates in the facilities represented, but lower (50% or less) for those who transfer in from smoke-free facilities or in areas with large populations whose religious beliefs discourage use.
• Tobacco use in the juvenile correctional facilities represented is estimated to be even higher (90% or more) than that in adult facilities.
• All facilities represented make allowances for traditional tobacco use in Native American religious ceremonies.
• Tobacco-free policies in correctional facilities tend to be initiated at the state level, not with the facility itself.
• Tobacco may be seen by inmates as one of the last forms of personal control and choice they have while incarcerated, so they try to hold on to this "privilege" as long as possible.
• Although some facilities had a transitional period prior to going tobacco-free (e.g., six months), most used a "cold turkey" approach and implemented that policy as they would any other policy or rule.

While it is definitely desirable from a health care and public policy perspective, converting to a tobacco-free facility brings many tangible benefits—but also challenges. Among the benefits:

• Reduction in tobacco-related health problems such as respiratory infections, hepatitis A (acquired by saliva when sharing cigarettes), diabetes and suicides using tobacco products
• Fewer fires in correctional facilities
• Decline in tobacco-related violence (e.g., inmates being set on fire by other inmates)
• Reduction in exposure to secondhand smoke and related lawsuits
• Drop in health care costs related to tobacco use

Tobacco-free policies often create many challenges, such as:

• Increased use of tobacco as contraband (replacing heroin as the number one contraband in some places)
• Insufficient staff to monitor inmates and guards; this relates to the added difficulty of recruiting and retaining staff given that many would-be candidates are smokers
• Perception that becoming tobacco-free is a form of punishment in facilities where it is often used and seen as a reward
• Reduction in revenues from tobacco sales and tobacco companies
• Increased weight gain among inmates

Enhancing Tobacco Control
Throughout the discussion, forum participants offered excellent suggestions and identified potential resources that would help enhance tobacco control efforts in correctional facilities. These included:

• Provide more education and materials on cessation for staff, inmates and families (e.g., health fairs, brochures throughout facilities, including in waiting rooms).
• Develop a short video to make information accessible to nonreaders.
• Provide access to toll-free quit lines for prisoners.
• Offer and promote cessation support and education postrelease.
• Advocate for tobacco control to become a higher profile public health issue like HIV and tuberculosis to increase legislation and funding that promote cessation.
• Solicit support from facility and government executives to push for tobacco-free facilities.
• Lay out the financial and nonfinancial costs of tobacco use on an annual, monthly and daily basis to users, children, families and others.
• Identify funding sources outside of the corrections budget to cover tobacco education and cessation costs.

Overall, the forum provided the Network with a much better understanding of how to support its membership in effectively educating and promoting cessation inside and outside of correctional facilities.

The Network is very appreciative to those who participated in the forum and to all who stopped by the NTPN booth during the conference and provided their input. We hope that more facilities and individuals will choose to become tobacco-free as they learn more about the benefits of doing so.

Get Involved!
NTPN is constantly searching for new organizations and individuals to join the fight against tobacco use, particularly among low-income populations. If you would like more information about tobacco control, joining NTPN or being added to NTPN’s mailing list, please contact us at (888) 442-2836 or (916) 556-3344. You can also reach us by e-mail at ntpn@healthedcouncil.org.