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Clinical guidelines

Supporting smoking cessationA guide for health professionals

People in prison

The prevalence of smoking in the prison population is far higher than among the general population, and tobacco use is accepted as the norm in prison life.204 There is a strong association between smoking tobacco and social disadvantage and those from low socioeconomic groups are over-represented in the prison system, for example, Indigenous people, drug users, the less educated and those suffering mental illness. Each of these factors predicts higher smoking rates.17

In correctional settings where long intervals may exists between opportunities to smoke, dependent smokers may experience repeated periods of withdrawal. This causes considerable distress and is a strong argument in favour of supported cessation as the optimum means to address nicotine addiction in this setting.

Motivation to quit smoking is high in the prison population. In New South Wales prisons where smoking rates were 80% in 2006, 52% of inmates had attempted to reduce or quit smoking and 58% had plans to quit.204 In some Australian states, smoking cessation groups and telephone support from Quitline have been provided in some prisons. A number of jurisdictions have implemented free or subsidised smoking cessation pharmacotherapy. In New Zealand, smokefree prisons have been successfully implemented, including freely available NRT for prisoners and staff who smoke.

Smoking cessation programs conducted in prisons should address prison-specific difficulties by including items such as a stressor pack to assist prisoners during transfer to other prisons and court appearances.43 Support programs should also discuss how to prevent relapse on release from prison.

Recommended smoking cessation treatment

  • Health professionals should take every opportunity to offer advice to quit.
  • Provide pharmacotherapy (NRT, bupropion, varenicline).
  • Provide proactive telephone counselling (Quitline 13 7848).
  • Follow-up closely.

References

  1. Scollo MM, Winstanley MH, editors. Tobacco in Australia: facts and issues. A comprehensive online resource. 3rd edn. Melbourne: Cancer Council Victoria, 2008. Available from www.tobaccoinaustralia.org.au [accessed 25 March 2011].
  2. Richmond R, Butler T, Belcher J, Wodak A, Wilhelm K, Baxter E. Promoting smoking cessation among prisoners: feasibility of a multi-component intervention. Aust NZ J Public Health 2006;30:474–8.
  3. Belcher J, Butler T, Richmond R, Wodak A, Wilhelm K. Smoking and its correlates in an Australian prisoner population. Drug Alcohol Rev 2006;25:343–8.
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