9A.5.1 Trends in the prevalence of smoking
Traditionally, the prevalence of smoking among people experiencing incarceration has been far higher than among the general population.1, 2 While smoking has decreased substantially over time in the Australian general community, the same is not true for people in custody, whose smoking rates, in facilities which allow smoking, remain high.3 In June 2020, there were about 41,000 adult prisoners in Australia; 92% of prison entrants at this time were men.4 In June 2018, about two in three (66%–69%) prison entrants aged 18–44 were daily smokers, compared with just one in seven (14%–16%) people in the general community5 Three in four (75%) of all Australian prison entrants reported being current smokers, and 85% reported having smoked at some stage in their life. Only 13% of prison entrants reported never having smoked, while 10% were ex-smokers.3 The average age of taking up smoking was 14, although several prisoners reported that they began smoking as young as three.3 Upon entry, female prison entrants (86%) were more likely than male prison entrants (74%) to report they were current smokers. Entrants aged 18–24 were most likely to report being current smokers (80%), with those aged 45 and over the least likely at 62%.3 Similar trends are observed internationally; a systematic review found that rates of smoking among people experiencing incarceration exceed community rates 1.04- to 62.6-fold.6
9A.5.2 Contribution of smoking to health outcomes and social inequality
Prisoners experience poorer physical and mental health than the general population. In 2018, almost one-third (29%) of Australian prison entrants reported a long-term health condition or disability that limited their daily activities and/or affected their participation in education or employment. A similar proportion (30%) reported having a chronic condition. Smoking-related illnesses such as asthma, cardiovascular disease, diabetes, and cancer were among the most common conditions. Almost one-quarter (22%) of entrants reported ever having been diagnosed with asthma, compared with 11% of the general population. A total of 40% of prison entrants reported ever having been told they have a mental health disorder, including alcohol and drug misuse.3 See Section 9A.3 for a detailed overview of the relationship between smoking and mental illness, as well as alcohol and substance use disorders, and Chapter 1, Section 1.10.6 for other drug use.
Epidemiological studies confirm that people who have been in prison experience higher rates of smoking-related illness, including various forms of cancer,7-10 hypertension,8 liver disease,7 asthma,8 and cardiovascular disease,11 further exacerbating their already increased levels of mortality and morbidity when compared to the general population.12-14 A study of over 85,000 people released from New South Wales prisons between 1988 and 2002 found a significantly higher rate of death from smoking-related cancers compared to the general community.9 Similarly, a study conducted in all state prisons in the US in 2014 found significantly higher age-adjusted smoking attributable mortality and potential life years lost as a result of tobacco smoking when compared to the non-incarcerated population.11
9A.5.3 Explanations for higher smoking prevalence
The primary reason for high rates of smoking among people experiencing incarceration is that smoking is common among groups over-represented in the prison population, including those of lower socioeconomic status, Aboriginal and Torres Strait Islander peoples, people with mental health disorders, people with substance use disorders, and people experiencing homelessness.3 For example, in 2019, Aboriginal and Torres Strait Islander prisoners accounted for just over a quarter (28%) of the total prisoner population (while only comprising 2.8% of the Australian population).15, 16 Tobacco use has historically been commonly accepted as part of prison life,2 serving a variety of purposes such as a form of currency,17, 18 a stress or boredom reliever,18-22 or a common ground for socialising. 23 Other reasons for these high smoking rates among prisoners include a lack of smoking cessation programs in prisons (as well as an overall lack of these programs in the community), a lack of evidence regarding best practice for smoking cessation in this population group, and confusion over ownership of the issue between health departments and custodial authorities.20
Prior to entering prison, many inmates had experienced lifetime exposure to cigarette smoking through their primary caregivers and friends.24 The average age at which Australian prison entrants had their first cigarette was 14,3 compared with 17 in the general population.25 A 2016 qualitative study in the US found many prisoners who smoked reported not having been taught by their family members about the dangers of smoking, rather it was more common that these family members themselves were smokers.24 One study found an association between heavy smoking among prisoners and past adverse childhood events such as alcoholism in the family, a psychiatric condition in the family, physical abuse, parental neglect and parental divorce.26 Factors within the prison environment that can increase prisoners’ likelihood of smoking include stress, boredom, lack of social support, high smoking rates among prisoners and staff, shared cells, relationship building between prisoners, and the use of tobacco as currency.27
9A.5.4 Interventions for reducing smoking
Despite very high smoking rates, and fewer than one in 10 (5%–10%) prison entrants having successfully quit smoking in the past, many detainees express an interest in quitting. In 2018, about two in five (41%) prison entrants who were current smokers wanted to quit. Of the 41% of prison entrants who wanted to quit smoking, almost half (47%) thought NRT would help, 25% thought counselling would help, 22% thought a quit program would help, and one-third (33%) said they did not want any help to quit. Upon exiting prison, dischargees, who were current smokers on entry, were asked what cessation assistance they had utilised while in prison. Eighteen per cent had utilised nicotine replacement therapy, 2% had utilised counselling or other, 6% had utilised a quit smoking program, and 27% had not wanted assistance to quit.3
Barriers to quitting in this population have included a strong smoking culture in prison; the role of tobacco as a de facto currency and common ground for socialising; high levels of nicotine dependence; mental illness; limited access to nicotine replacement therapy and cessation programs; boredom; and stressful events such as prison transfer, or family and legal stressors.17-19, 22, 23 Further problems include a lack of evidence for best practice for smoking cessation in this group, confusion over the ownership of the problem between the health department and custodial authorities, and poor access to smoking cessation programmes while outside the prison system.2, 18, 20, 28 In 2011, the National Preventative Health Strategy29 identified the prison population as a priority area for future interventions. Similarly, the 2012-2018 National Tobacco Strategy recognised prisons as an important setting for tobacco control efforts and stated that continued leadership is required to reduce the prevalence of smoking among prisoners, and to reduce exposure to second-hand smoke among prisoners and staff working in correctional settings.30
As of September 2021, all Australian territories and states (except Western Australia) have introduced or announced intentions to introduce complete smoking bans in prisons. International studies have found that these bans are effective at improving the health of people who live and work in prisons.12, 31-34 For example, a survey of all state prisons in the US found a 9% reduction in smoking-related deaths in prisons that had implemented a smoking ban, and prisons with bans in place for longer than nine years showed an 11% reduction in all smoking-related deaths, a 19% decrease in deaths from cancer, and a 34% reduction in deaths with pulmonary causes.12 Other studies have found that these bans result in improved air quality,35-39 reduced exposure to harmful second-hand smoke,40 and decreased in-prison dispensing of medication for smoking-related illnesses41
Prior to the implementation of bans in Australia, prisoners were provided with access to intensive cessation support,42 including free nicotine patches and access to Quitline, but this support was discontinued in most jurisdictions within a few months of the ban’s implementation. Access to nicotine replacement therapy remains limited in Australia’s smoke-free prisons, partly due to prisoners creating substitute cigarettes from nicotine patches 43 or lozenges. 44 In The health of Australia’s prisoners 2018 report, about one-third (30%) of dischargees from prisons that had banned smoking said they were current smokers, compared with more than half (56%) of dischargees from prisons which allowed smoking. However, there was only a two percentage point difference between prison dischargees’ intentions to smoke upon release from prisons that had banned smoking and prisons which allowed smoking (42% and 44% respectively).3
A 2018 systematic review investigating factors influencing smoking following release from smokefree prisons found a high and rapid rate of smoking relapse among dischargees.45 This was reflected in findings from a study showing that 72% of a sample of people released from Queensland prisons resumed smoking on the day of release, with 94% relapsing within two months of release.46 A 2016 qualitative study24 from the US found many transitional housing facilities were not smokefree properties, and dischargees from smokefree prisons would relapse due to cigarettes being readily available in these environments. Family members also play an important role in whether prison dischargees are able to remain smoke-free upon release. Seventy per cent of study participants said having family members who smoked influenced their own smoking behaviours during the re-entry process.24
Systematic reviews from 201647 and 20186 similarly found indoor bans on smoking in prisons to have little impact on prisoner smoking behaviour, with prisoners who had experienced a ban typically resuming smoking shortly after release. The 2018 systematic review also concluded that evidence-based interventions for smoking cessation found to be effective outside prisons are effective inside too, and that effects persist after release.6 These effective interventions included in-person delivery of motivational interviewing (to boost intention to remain abstinent post-release)45 and/or cognitive behavioural therapy.48, 49 Multi-component interventions using a combination of behavioural support and smoking-cessation pharmacotherapy have also been found to maximise chances of sustained cessation,45, 47 and there is limited evidence suggesting that refraining from risky drinking may assist in remaining quit post-release.50
Findings from a Queensland-based qualitative study suggest that interventions promoting continued smoking abstinence among people exiting smoke-free prisons should focus on targeting the perceived individual- and environmental-level barriers to maintained smoking abstinence, including pre-release intention to resume smoking, normalisation of smoking in home or social environments, resumption of smoking as a symbolic act of freedom and resistance from and to a restrictive environment, a perception that smoking provides stress relief, and the use of smoking to cope with cravings experienced on release for illicit substances.51 Despite the availability of smoking cessation pharmacotherapy (SCP) at a heavily subsidised rate in Australia, once released, only a small proportion of prison dischargees go on to use SCP, pointing to a missed opportunity in this vulnerable community.52 While maintaining support for dischargees post release is important for successful smoking abstinence, this support has typically fallen outside the scope of the implementation of smokefree prisons.52 Findings from a 2019 pilot study in Victoria Australia suggest more intensive support (provided before and after release) is required in order to reduce post-release relapse to smoking and to encourage those who do relapse to make further quit attempts.53 Finally, there is some limited evidence from the UK that the provision of e-cigarettes may assist to maintain smoking abstinence during incarceration.54, 55
Relevant news and research
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References
1. Awofeso N, Testaz R, Wyper S, and Morris S. Smoking prevalence in New South Wales correctional facilities, 2000. Tobacco Control, 2001; 10(1):84–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11347537
2. Belcher JM, Butler T, Richmond RL, Wodak AD, and Wilhelm K. Smoking and its correlates in an Australian prisoner population. Drug and Alcohol Review, 2006; 25(4):343–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16854660
3. Australian Institute of Health and Welfare. The health of Australia’s prisoners 2018. AIHW, Cat. no. PHE 246 Canberra 2019. Available from: https://www.aihw.gov.au/getmedia/2e92f007-453d-48a1-9c6b-4c9531cf0371/aihw-phe-246.pdf.aspx?inline=true
4. Australian Bureau of Statistics. Prisoners in Australia. Canberra: Australian Government, 2020. Available from: https://www.abs.gov.au/statistics/people/crime-and-justice/prisoners-australia/latest-release#prisoner-characteristics-australia
5. Australian Institute of Health and Welfare, The health of Australia's prisoners 2015. Cat. no. PHE 207. Canberra: AIHW; 2015. Available from: http://www.aihw.gov.au/publication-detail/?id=60129553527.
6. Spaulding AC, Eldridge GD, Chico CE, Morisseau N, Drobeniuc A, et al. Smoking in correctional settings worldwide: Prevalence, bans, and interventions. Epidemiologic Reviews, 2018; 40(1):82–95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29746635
7. Rosen DL, Schoenbach VJ, and Wohl DA. All-cause and cause-specific mortality among men released from state prison, 1980-2005. American Journal of Public Health, 2008; 98(12):2278–84. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18923131
8. Binswanger IA, Krueger PM, and Steiner JF. Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population. Journal of Epidemiology and Community Health, 2009; 63(11):912–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19648129
9. Kariminia A, Butler T, Corben S, Levy M, Grant L, et al. Extreme cause-specific mortality in a cohort of adult prisoners--1988 to 2002: a data-linkage study. Int J Epidemiol, 2007; 36(2):310–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17158524
10. Carbonnaux M, Fossard G, Amzallag E, Piegay C, Perot E, et al. Earlier onset and poor prognosis of lung cancer in imprisoned patients. Oncology, 2013; 85(6):370–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24335502
11. Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, et al. Release from prison--a high risk of death for former inmates. New England Journal of Medicine, 2007; 356(2):157–65. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17215533
12. Binswanger IA, Carson EA, Krueger PM, Mueller SR, Steiner JF, et al. Prison tobacco control policies and deaths from smoking in United States prisons: population based retrospective analysis. British Medical Journal, 2014; 349:g4542. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25097186
13. Richmond RL, Indig D, Butler TG, Wilhelm KA, Archer VA, et al. Smoking and other drug characteristics of Aboriginal and non-Aboriginal prisoners in Australia. J Addict, 2013; 2013:516342. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24940513
14. Fazel S and Baillargeon J. The health of prisoners. Lancet, 2011; 377(9769):956–65. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21093904
15. Australian Bureau of Statistics. 2071.0 - Census of population and housing: Reflecting Australia - stories from the census, 2016. ABS, 2017. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Aboriginal%20and%20Torres%20Strait%20Islander%20Population%20Data%20Summary~10
16. Australian Bureau of Statistics. 4517.0 - Prisoners in Australia, 2019. ABS, 2019. Available from: https://www.abs.gov.au/ausstats/abs@.nsf/mf/4517.0
17. Lankenau SE. Smoke 'Em If You Got 'Em: Cigarette Black Markets in U.S. Prisons and Jails. Prison J, 2001; 81(2):142–61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18064295
18. Richmond R, Butler T, Wilhelm K, Wodak A, Cunningham M, et al. Tobacco in prisons: a focus group study. Tobacco Control, 2009; 18(3):176–82. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19188210
19. Butler T and Milner L. The 2001 New South Wales Inmate Health Survey. Justice Health NSW, 2001. Available from: http://www.justicehealth.nsw.gov.au/publications/inmate-health-survey-2001.pdf
20. Butler T, Richmond R, Belcher J, Wilhelm K, and Wodak A. Should smoking be banned in prisons? Tobacco Control, 2007; 16(5):291–3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17897977
21. Richmond RL, Butler T, Belcher JM, Wodak A, Wilhelm KA, et al. Promoting smoking cessation among prisoners: feasibility of a multi-component intervention. Australian and New Zealand Journal of Public Health, 2006; 30(5):474–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17073232
22. Sieminska A, Jassem E, and Konopa K. Prisoners' attitudes towards cigarette smoking and smoking cessation: a questionnaire study in Poland. BMC Public Health, 2006; 6:181. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16827930
23. Cullen F. ‘Two's up and poncing fags’: young women's smoking practices, reciprocity and friendship. Gender and Education, 2010; 22(5):491–504. Available from: https://doi.org/10.1080/09540250903481595
24. Valera P, Bachman L, and Rucker AJ. A qualitative study of smoking behaviors among newly released justice-involved men and women in New York City. Health & Social Work, 2016; 41(2):121–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27263202
25. Australian Institute of Health and Welfare. Data tables: National Drug Strategy Household Survey 2019 - 2. Tobacco smoking chapter, Supplementary data tables. Canberra: AIHW, 2020. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/data
26. Papadodima SA, Sakelliadis EI, Sergentanis TN, Giotakos O, Sergentanis IN, et al. Smoking in prison: a hierarchical approach at the crossroad of personality and childhood events. European Journal of Public Health, 2010; 20(4):470–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20034931
27. Mackay A. Stubbing out smoking in prisons: Bans are an ineffective mechanism. Alternative Law Journal, 2014; 39(2):99–103. Available from: http://heinonline.org/HOL/LandingPage?handle=hein.journals/alterlj39&div=28&id=&page=
28. Baker A, Ivers R, Bowman J, Butler T, Kay-Lambkin F, et al. Where there's smoke, there's fire: high prevalence of smoking among some sub-populations and recommendations for intervention. Drug and Alcohol Review, 2006; 25:85–96. Available from: http://www.informaworld.com/smpp/content~content=a741424195~db=all~order=page
29. National Preventative Health Taskforce. Australia: the healthiest country by 2020. National Preventative Health Strategy, Canberra: Commonwealth of Australia 2009. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0022/424426/nphs-overview.pdf
30. Intergovernmental Committee on Drugs, National Tobacco Strategy 2012–2018. Commonwealth of Australia; 2012. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/national_ts_2012_2018.
31. Dickert J, Williams JM, Reeves R, Gara M, and DeBilio L. Decreased mortality rates of inmates with mental illness after a tobacco-free prison policy. Psychiatric Services, 2015; 66(9):975–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25975892
32. Clarke JG, Martin SA, Martin RA, Stein LA, van den Berg JJ, et al. Changes in smoking-related symptoms during enforced abstinence of incarceration. Journal of Health Care for the Poor and Underserved, 2015; 26(1):106–18. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25702731
33. Connell R. Tobacco-free prison policies and health outcomes among inmates, 2010, University of Kentucky. Available from: https://uknowledge.uky.edu/gradschool_diss/22/.
34. Heng CK, Badner VM, Clemens DL, Mercer LT, and Mercer DW. The relationship of cigarette smoking to postoperative complications from dental extractions among female inmates. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007; 104(6):757–62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17764988
35. Semple S, Dobson R, Sweeting H, Brown A, Hunt K, et al. The impact of implementation of a national smoke-free prisons policy on indoor air quality: results from the Tobacco in Prisons study. Tobacco Control, 2020; 29(2):234–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31064866
36. Hammond SK and Emmons KM. Inmate exposure to secondhand smoke in correctional facilities and the impact of smoking restrictions. J Expo Anal Environ Epidemiol, 2005; 15(3):205–11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15187988
37. Proescholdbell SK, Foley KL, Johnson J, and Malek SH. Indoor air quality in prisons before and after implementation of a smoking ban law. Tobacco Control, 2008; 17(2):123–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18285386
38. Ritter C, Huynh CK, Etter JF, and Elger BS. Exposure to tobacco smoke before and after a partial smoking ban in prison: indoor air quality measures. Tobacco Control, 2012; 21(5):488–91. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21836161
39. Thornley S, Dirks KN, Edwards R, Woodward A, and Marshall R. Indoor air pollution levels were halved as a result of a national tobacco ban in a New Zealand prison. Nicotine & Tobacco Research, 2013; 15(2):343–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22589420
40. Demou E, Dobson R, Sweeting H, Brown A, Sidwell S, et al. From smoking-permitted to smokefree prisons: A 3-year evaluation of the changes in occupational exposure to second-hand smoke across a national prison system. Ann Work Expo Health, 2020; 64(9):959–69. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32756912
41. Tweed EJ, Mackay DF, Boyd KA, Brown A, Byrne T, et al. Evaluation of a national smoke-free prisons policy using medication dispensing: an interrupted time-series analysis. Lancet Public Health, 2021; 6(11):e795–e804. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34537108
42. Quit Victoria. Correctional settings. 2015. Available from: https://www.quit.org.au/resources/policy-advocacy/policy/smokefree-environments/prisons/
43. Hefler M, Hopkins R, and Thomas DP. Successes and unintended consequences of the Northern Territory's smoke-free prisons policy: results from a process evaluation. Public Health Research and Practice, 2016; 26(2). Available from: https://www.ncbi.nlm.nih.gov/pubmed/27734062
44. Puljevic C, Coomber R, Kinner SA, de Andrade D, Mitchell C, et al. 'Teabacco': Smoking of nicotine-infused tea as an unintended consequence of prison smoking bans. Drug and Alcohol Review, 2018; 37(7):912–21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30051520
45. Puljevic C and Segan CJ. Systematic review of factors influencing smoking following release from smoke-free prisons. Nicotine & Tobacco Research, 2019; 21(8):1011–20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29733380
46. Puljevic C, de Andrade D, Coomber R, and Kinner SA. Relapse to smoking following release from smoke-free correctional facilities in Queensland, Australia. Drug and Alcohol Dependence, 2018; 187:127–33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29660697
47. de Andrade D and Kinner SA. Systematic review of health and behavioural outcomes of smoking cessation interventions in prisons. Tobacco Control, 2016; 26(5):495–501. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27798322
48. Clarke JG, Stein LA, Martin RA, Martin SA, Parker D, et al. Forced smoking abstinence: not enough for smoking cessation. JAMA Internal Medicine, 2013; 173(9):789–94. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23567902
49. Richmond R, Indig D, Butler T, Wilhelm K, Archer V, et al. A randomized controlled trial of a smoking cessation intervention conducted among prisoners. Addiction, 2013; 108(5):966–74. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23228222
50. Frank MR, Blumhagen R, Weitzenkamp D, Mueller SR, Beaty B, et al. Tobacco use among people who have been in prison: Relapse and factors associated with trying to quit. J Smok Cessat, 2017; 12(2):76–85. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29430256
51. Puljevic C, Coomber R, de Andrade D, and Kinner SA. Barriers and facilitators of maintained smoking abstinence following release from smoke-free prisons: A qualitative enquiry. Int J Drug Policy, 2019; 68:9–17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30974331
52. Puljevic C, de Andrade D, Carroll M, Spittal MJ, and Kinner SA. Use of prescribed smoking cessation pharmacotherapy following release from prison: a prospective data linkage study. Tobacco Control, 2018; 27(4):474–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28848000
53. Young JT, Puljevic C, Love AD, Janca EK, Segan CJ, et al. Staying Quit After Release (SQuARe) trial protocol: a randomised controlled trial of a multicomponent intervention to maintain smoking abstinence after release from smoke-free prisons in Victoria, Australia. BMJ Open, 2019; 9(6):e027307. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31167867
54. Brown A, Mitchell D, and Hunt K. Post-implementation perspectives on smokefree prison policy: a qualitative study with staff and people in custody. European Journal of Public Health, 2022; 32(1):112–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34448834
55. Brown A, O'Donnell R, Eadie D, Purves R, Sweeting H, et al. Initial views and experiences of vaping in prisons: A qualitative study with people in custody preparing for the imminent implementation of Scotland's prison smokefree policy. Nicotine & Tobacco Research, 2021; 23(3):543–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32447381