Title: Staying smokefree: Maximising the public health benefits of smokefree prisons (19/57 Continuing priority research topics of interest to PHR: Health Improvement interventions of offenders or ex-offenders)
Funder: Chief Scientist Office, Scotland

Abstract: People in custody (prisoners) are more likely to have poor health than other people. Part of the reason for this was high rates of smoking before a ‘smoking ban’ was put in place in prisons. The ban is meant to protect the health of staff and people in prisons. Help is available to make it easier for people in custody to manage without smoking or quit tobacco. This includes being able to buy e-cigarettes and get free help from prison stop smoking services._x000D_ _x000D_ In Scotland, in the Tobacco in Prisons study (TIPs for short), we did the biggest study of smoke-free prisons, to find out what people in custody and staff think about the smoking ban, and how it affects people’s health and their living or working conditions. Now we want to build on TIPs, to see what happens when people leave prison and to see what their families think about the ban. We also want to see if families of people in custody would like help and support to give up or cut down on smoking or to make their home smoke-free._x000D_ _x000D_ There are five parts to the new study:_x000D_ 1. We want to check what other researchers around the world have found out about how many people return to smoking after leaving prison. We also want to see what has been tried to help people who don’t want to smoke when they leave prison, or to help them protect other people in their home from tobacco smoke. _x000D_ 2. We want to talk to people in custody to hear how they are managing without tobacco and what they think they will do about smoking and vaping after they leave a smoke-free prison. We want to also want to talk to people after they leave prison or come back into prison._x000D_ 3. We want to give families of people in custody a chance to tell us if they think the smoke-free policy has had any effects on them, either good or bad ones. We also want to see if they would like any extra support or help to give up or cut down on smoking, either while their family member is still in prison or after they are released._x000D_ 4. If families want to take the chance to cut down or stop smoking when someone leaves prison, we want to see if family or household approaches could help them. We will ask families to tell us what they think about some help and support that has been tried for other families. If there are people in the family who don’t want to cut down or stop smoking, we will work with them to see if there is anything they can do to cut down on second-hand smoke in their home (smoke from other people’s cigarettes). Second-hand smoke can damage the health of children and adults in the home._x000D_ 5. We will use all this new information to estimate the possible benefits of smoke-free prisons. This means that we can use information about things like how many people start to smoke again after leaving prison to work out the difference this could make to people’s health in the future. _x000D_ _x000D_ If any of these different approaches seem to help people who want to stop or cut down on their smoking - for their health, for money reasons or for other reasons – we will make plans for a bigger study to see whether the health service or the prison service can provide this support in the long term._x000D_ _x000D_ We will work closely with key partners. This will include people in custody, their families, Families Outside, the prison service and the health service. That way we can make sure that anything we find has taken account of all of their opinions and experiences.

Lay abstract: Where allowed, most in prison smoke. Suitable interventions for ~15 million smokers in prisons each year could improve global health and reduce inequality. While designed to protect people living or working in prison from secondhand smoke, smokefree prison policy could deliver higher public health gain if people stay smokefree post-release and tobacco harms reduce in homes they return to._x000D_ _x000D_ Aim Understand a) if/how smokefree prison policy impacts families when a relative is in custody; b) how to reduce tobacco-related harms in people in or released from smokefree prisons and households they return to. _x000D_ _x000D_ OBJECTIVES:_x000D_ 1. work in partnership with prison/health services and policy-makers to understand opportunities and challenges in reducing tobacco-related harms among people (soon to be) released from smokefree prison and families (WP1);_x000D_ 2. scoping evidence on helping: people to be tobacco-free/reduce smoking after leaving prison; and people living in disadvantaged homes establish smokefree lifestyles/homes (WP2);_x000D_ 3. understand experiences, opportunities and challenges as people (prepare to) leave or return to smokefree prisons, to help reduce tobacco-related harms (WP3);_x000D_ 4. explore impacts of prison smokefree policy on families; and opportunities/challenges for reducing tobacco-related harms in those released from prison and their families (WP4); _x000D_ 5. adapt and feasibility test a household-targeted intervention to help people released from a smokefree prison, and their household, to cut down/quit smoking and/or cut secondhand smoke at home, to reduce tobacco-related harms in the community (WP5);_x000D_ 6. update cost-effectiveness models of smokefree prison policy; and investigate any spill-over effects on families or households (WP6);_x000D_ 7. feed findings into policy and practice (WP1)_x000D_ Methods_x000D_ We will conduct scoping reviews (WP2) to examine existing research, identify evidence gaps and synthesise information for other workpackages. Review 1 will synthesise findings on interventions aimed at changing smoking behaviours at home, to inform adaptation of a household-based intervention for people leaving custody. Review 2 will synthesise findings on (factors influencing) relapse to smoking after release. _x000D_ _x000D_ We will conduct in-depth interviews with a sample of people in custody at key transition points, and on long sentences; and staff providing support to people leaving or entering smokefree prisons (WP3). As prior research has focused on impacts of smokefree prison policy on those in custody and prison staff, we will interview people who have a family member in a smokefree prison to explore any negative or positive impacts on their life and health (WP4). _x000D_ With input from people in custody and households which include someone who has recently left prison, we will adapt and test the feasibility and acceptability of a household-based intervention, and assess research methods and outcomes which could be used in a later trial, if warranted (WP5)._x000D_ _x000D_ We will update the TIPs lifetime model of the cost-effectiveness of smokefree prison policy for PiC, with evidence on smoking relapse after release and e-cigarette use; and model impacts of smokefree policy on family members of people in or released from prison._x000D_ _x000D_ Impact/dissemination We build on partnerships with policy/service stakeholders to will ensure that relevant learning for the prison and health services is fed back, and disseminate to academics and the public.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;RESPIRATORY;STROKE