Understanding the perspectives of people in custody and prison staff through the process of a major policy change: the introduction of smokefree prisons in Scotland

Abstract

Background: Several jurisdictions have introduced smokefree policies in prisons, with or without permitting use of e-cigarettes, to address exposures to second-hand smoke (SHS) and tobacco-related harms among people in custody (PiC), but evidence on implementation and impacts is very limited to date. Aims: This thesis comprises five publications which qualitatively explore smokefree prison policy and use of e-cigarettes in prisons from the perspective of PiC and prison staff in Scotland. Methods: Publications 1 and 2 explore staff views on smokefree prison policies and e-cigarettes in prisons, using focus groups (n=19) conducted before any such policy was announced. Publication 3 explores smokefree prison policies using interviews (n=77 PiC) conducted with PiC as Scottish prisons prepared to go smokefree. Publication 4 explores perspectives of staff and PiC post-implementation of smokefree policies using focus groups (n=99 staff) and interviews (n=23 PiC). Publication 5 uses interviews (n=28 PiC) to explore e-cigarette use among PiC once smokefree rules were established. Results: Staff were more positive than PiC about smokefree policies before and after implementation, although views were varied and complex in both groups. Opinions were influenced by (I) beliefs about the fairness of smokefree prison rules; (II) perceptions of ease/difficulty of removing tobacco from prisons; and (III) evaluations of individual-level and organisational impacts. Both groups reported that e-cigarette use helped with mandated smoking abstinence in prisons. However, concerns were raised about safety, misuse, cost, and continued e-cigarette use. The transition to smokefree prisons was reported to be less troublesome than PiC and staff had anticipated and benefits from reduced SHS exposures and active smoking were acknowledged. In contrast, identified challenges centred on difficulties managing without tobacco and use of alternatives (e.g. e-cigarettes) among PiC. Conclusion: Findings suggest smokefree policies can be successfully implemented in prisons, providing they are underpinned by adequate planning, communication and support.