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 prevalence, in facilities which allow smoking, remain high.3 In June 2025, there were about 47,000 adults in Australian prisons; 92% of prison entrants at this time were men; Aboriginal and Torres Strait Islander people accounted for 37% of all people in Australian prisons, see Section 8.3.5 for prevalence of smoking among Aboriginal and Torres Strait Islander people in Australia’s prisons.4 Over half (51%–70%) of prison entrants aged 18–44 smoked daily,3 compared with fewer than one in eight (7%–11%) people in the general community.5 Almost three in four (71%) of all Australian prison entrants reported current smoking, and 86% reported having smoked at some stage in their life. Only 13% of prison entrants reported never having smoked, while 14% were quit. The average age of taking up smoking was 14, although several people in prisons reported that they began smoking as young as four. Upon entry, female prison entrants (75%) were more likely than male prison entrants (70%) to report current smoking. Entrants aged 35–44 were most likely to report current smoking (76%), with those aged 45 and over the least likely at 61%.3 Similar trends are observed internationally; a systematic review found that prevalence of smoking among people experiencing incarceration exceed community prevalence 1.04- to 62.6-fold.6
9A.5.2 Contribution of smoking to health outcomes and social inequality
People experiencing incarceration have poorer physical and mental health than the general population. In 2022, almost two in five (39%) 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 (42%) reported having a current chronic condition. Smoking-related illnesses such as asthma, cardiovascular disease, pulmonary disease, diabetes, and cancer were among the most common conditions. Just over half (51%) of prison entrants reported ever having been told they have a mental health disorder, including alcohol and drug abuse.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.
Epidemiological studies confirm that people who have been in prison experience higher levels 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 significantly higher numbers 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 a high prevalence 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 2022, Aboriginal and Torres Strait Islander people accounted for almost one-third (32%) of the total population of people in Australian prisons (while only comprising 3.8% 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 high smoking prevalence among people experiencing incarceration 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 in 2022,3 compared with 17 in the general population in 2022–23.25 A 2016 qualitative study in the US found many people experiencing incarceration 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 also smoked.24 One study found an association between heavy smoking among people experiencing incarceration 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 a persons likelihood of smoking include stress, boredom, lack of social support, high smoking prevalence among people experiencing incarceration and staff, shared cells, relationship building between people experiencing incarceration, and the use of tobacco as currency.27
9A.5.4 Interventions for reducing smoking
Despite very high smoking prevalence, many detainees express an interest in quitting, and about one in eight (14%) prison entrants having successfully quit smoking in the past. In 2022, almost half of (48%) prison entrants who currently smoked wanted to quit.3
In 2011, the National Preventative Health Strategy28 identified the prison population as a priority area for future interventions. The subsequent National Tobacco Strategies went on to recognise prisons as an important setting for tobacco control efforts and stated that continued leadership is required to reduce the prevalence of smoking among people experiencing incarceration, recent dischargees, prison staff and their families.29,30 The 2023–2030 National Tobacco Strategy, in particular, highlights that culturally appropriate cessation support should be provided for Aboriginal and Torres Islander people in prisons.30
Tobacco-free prison policies have been argued for by researchers as part of best practice for the prevention, management and treatment of tobacco use within carceral settings, and it is recommended that these tobacco-free policies be in conjunction with comprehensive tobacco-dependence treatment.31 Best practice recommendations state that comprehensive tobacco-free policies should be clear and succinct and written at a literacy level comprehensible by both justice-involved individuals and correctional personnel. Such policies should explicitly delineate the range of products prohibited (e.g. cigarettes, vaping products) and detail who must adhere to such policy (e.g. incarcerated individuals, correctional staff, visitors). The policy should unequivocally prohibit tobacco use in both enclosed and outdoor spaces, including staff-only spaces and facility vehicles. A comprehensive tobacco-free policy should also ban the sale of commercial tobacco products within custodial settings.31 As of February 2026, all Australian territories and states have introduced or have begun to introduce complete smoking bans in prisons—see Section 15.4.4.2 Prisons. International studies have found that smoking bans in prisons are effective at improving the health of people who live and work in prisons.12,32-36 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,37-41 reduced exposure to harmful second-hand smoke,42 and decreased in-prison dispensing of medication for smoking-related illnesses.36
In The health of people in Australia’s prisons 2022 report, about one-third (29%) of dischargees from prisons that had banned smoking said they currently smoked, compared with more than four in five (83%) of dischargees from prisons which allowed smoking. However, there was only a six percentage point difference between prison dischargees’ intentions to smoke upon release from prisons that had banned smoking and prisons which allowed smoking (48% and 54% respectively).3 And systematic reviews6,43-46 of smoking following release from smokefree prisons, have found a high and rapid rate of smoking relapse among dischargees. 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.47
People released from smokefree prisons encounter multiple and interacting barriers that undermine their ability to sustain smoking cessation. 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 A 2025 Scottish qualitative study48 found that maintaining smoking cessation after release from prison was undermined by a convergence of individual, social and structural factors. Participants described cognitively rationalising smoking despite acknowledging its harms. Relapse was further shaped by environmental conditions, including high tobacco retail density in disadvantaged areas and re-entry into social networks where smoking was normalised among family and friends. Structural barriers also played a role, with limitations in cessation services reducing access to sustained support. For many, remaining smokefree was deprioritised amid more immediate health, housing and social challenges, and relapse was intertwined with drug and alcohol use. 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 maintain 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.49 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.50 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.51-53 Further barriers to quitting in this population 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 programs while outside the prison system.2,18,20,54
Prior to the implementation of smoking bans in Australian prisons, people experiencing incarceration were provided with access to intensive cessation support,55 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 incidents of people creating substitute ‘cigarettes’ from nicotine patches56 or lozenges.57 However, researchers have argued that people experiencing incarceration ought to be provided with equal access to tobacco treatment, commensurate with what is offered in the community and in accordance with the standards for other substance use disorder treatment.31 Moreover, treatment should encompass routine assessment of tobacco use, medically supervised withdrawal, access to medication, and behavioural support during incarceration, with post release referral to continued treatment.31 This comprehensive approach to tobacco treatment, combined with comprehensive tobacco-free policy within prisons is argued for as best practice.31 Research has supported this, with a 2022 systematic review finding that smoking bans in combination with multi-component interventions that supported people in prisons and other facilities pre- and post-discharge were associated with higher cessation rates post-discharge.44
Further research on the effectiveness of cessation support for people experiencing incarceration has found multi-component interventions using a combination of behavioural support and smoking-cessation pharmacotherapy to maximise chances of sustained cessation.43,46 Limited evidence suggests that refraining from risky drinking may assist in remaining quit post-release.58 A 2018 systematic review 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)43 and/or cognitive behavioural therapy.59,60 However, a 2025 systematic review and meta-analysis61 evaluating the efficacy of psychological interventions in promoting smoking cessation among individuals who are currently incarcerated raised concern that research in this area is weak due to publication bias, a small number of high-quality studies and substantial heterogeneity limiting any generalisability.61
Despite limited access to cessation support in Australian prisons, people experiencing incarceration who want to quit are aware of available options and express interest in receiving support. In the 2022 report of The health of people in Australia's prisons, about two in five (41%) prison entrants who wanted to quit smoking thought nicotine replacement therapy (NRT) would help, 27% thought a quit program would help, 25% thought counselling would help, and one-third (36%) said they did not want any help to quit. Upon exiting prison, dischargees, who had smoked on entry, were asked what cessation assistance they had utilised while in prison. One in 10 had utilised NRT, 2% used another type of smoking cessation medication, 3% had discussions with a doctor or nurse, 2% had utilised another form of counselling/support and 4% had not wanted help to quit.3 A 2025 Queensland study also explored the preferences for smoking cessation support among people in smoke-free prisons who smoked daily prior to incarceration.62 Prior to prison, 32% of participants had used pharmacotherapy (NRT or medicines) for smoking cessation. While in prison, 26% reported using NRT and 3% reported accessing Quitline telephone counselling. After release from prison, despite most (76%) participants being aware that subsidised NRT was available, quitting ‘cold turkey’ was favoured over NRT as a cessation method after release (28% vs 24%). Peer support groups were the most preferred form of assistance during incarceration (42%) and after release (52%).62 Other research has shown that 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.50
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References
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