Offenders four times more likely to smoke than general population
Public Health England recently (15 March 2015) published guidance on how to help prisoners stop smoking. It’s easy to see why they felt this guidance was needed:
- Approximately four times as many prisoners smoke than in the general population, with similarly high levels of smoking found among those in police custody and probation.
- These extraordinarily high rates of smoking damage health, and, when compared with the general population, cause marked health inequalities for offenders.
- Given the high rates of smoking, exposure to second-hand smoke is extensive across the CJS and damaging to the health of smoking and non-smoking offenders, visitors and staff.
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Drop in smoking much slower amongst disadvantaged groups
A recent study that scored people in England according to the number of personal indicators of low socio-economic status (SES) found that 15% of those with no indicators of low SES smoked, compared with 61% of those with the most (6 to 7) indicators of low SES. Smokers from more deprived groups also have higher levels of cigarette consumption and are less likely to be successful when trying to quit.
Over the last 50 years, smoking has decreased significantly in the UK to the point where around 20% of the population currently smoke. However, smoking rates among offenders have remained at about 80%. In addition to the fact that higher smoking levels are associated with deprivation, tobacco is culturally integrated into offenders’ lifestyles, particularly in prison.
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How does prison life influence smoking?
The PHE report summarises our understanding of smoking in prison. On the one hand, limited access to tobacco can reduce how much and how often prisoners smoke as can the cost of tobacco for those surviving on a prison income.
Conversely, smoking is often seen as a coping strategy to manage the stress of imprisonment and helps to alleviate boredom. Not smoking in a culture where a large majority of people smoke can also be socially isolating. And, of course “Burn” remains one of the principal prison currencies.
Adult prisons were the only setting exempted from the national smoke-free policy which was introduced in England in 2007 although prisoners are only allowed to smoke in their own cells, and nowhere else in prison (although this restriction is frequently disregarded).
However, this was recently challenged on 4 March 2015 when the High Court found in favour of a prisoner who said second-hand smoke was damaging his health. Mr Justice Singh ruled that the Health Act should apply to prisons. It’s not yet clear (at least to me) whether the Justice Secretary intends to appeal this decision.
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The guidance
The PHE guidance recommends that a smoking cessation care pathway is established throughout the criminal justice system. This care pathway has multiple aims including:
- To help people reduce or stop smoking.
- To help people avoid problems with nicotine withdrawal.
- To reduce health inequalities.
- To give people control over an aspect of their lives which might increase confidence and self-respect.
- To improve the mental health of offenders.
- To potentially break the links between smoking and other substance abuse.
- To potentially reduce reoffending.
- To provide a smoke-free environment to protect people from the harms of passive smoking.
Public Health England basically recommends that the full range of pharmacotherapies and behavioural support that are available to the general public in the community should be available to prisoners inside. Interestingly, they also recommend that alternative recreational activities should be provided to help alleviate prisoners’ boredom, which is seen as one of the key reasons for smoking.
This last recommendation will clearly be a substantial challenge given the very severe cuts in prison expenditure which have already taken place over the course of the last Parliament and are likely to be extended further in the next.
