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      Challenges associated with e-cigarette use by people in custody in Scottish prisons: a qualitative interview study with prison staff

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          Abstract

          Objectives

          Little is known about the perspectives of staff working in prisons where e-cigarettes are permitted. Scotland now permits people in custody (PiC), but not staff/visitors to use e-cigarettes, following implementation of smoke-free prisons policy in 2018. Previous studies, conducted before and immediately after the introduction of e-cigarettes in Scottish prisons, have evidenced stakeholder support for their use by PiC. This study focuses on key challenges associated with e-cigarette use in prisons, using data collected from prison staff once e-cigarettes had been allowed in a smoke-free environment for 6–9 months.

          Setting

          Five prisons in Scotland.

          Participants

          Sixteen qualitative interviews were conducted with prison staff from five prisons varying by population (sex, age and sentence length). Data were managed and analysed using the framework approach.

          Results

          While these staff confirmed strong support for the smoke-free prison policy and reported some benefits of replacing tobacco with e-cigarettes, they also spoke of the challenges e-cigarettes pose. These included: workplace e-cigarette vapour exposures; perceptions that e-cigarettes provide a new, effective way for some PiC to take illegal drugs, particularly new psychoactive substances; organisational challenges relating to the value attached to e-cigarettes in prisons; and implications for long-term nicotine use and tobacco cessation. Staff anticipated difficulties in tightening restrictions on e-cigarette use by PiC given its scale and significance among this population.

          Conclusions

          Maximising the benefits of e-cigarette use by PiC is likely to require multiple measures to support effective and safe use and e-cigarette reduction/cessation where desired. This includes monitoring any misuse of e-cigarettes, and provision of guidance and support on appropriate e-cigarette use and how to limit or quit use if desired. Findings are relevant to jurisdictions considering or planning changes in prison smoking or vaping policies.

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          Most cited references31

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          Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends.

           To estimate how far changes in the prevalence of electronic cigarette (e-cigarette) use in England have been associated with changes in quit success, quit attempts, and use of licensed medication and behavioural support in quit attempts.
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            Electronic cigarettes for smoking cessation

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              Is Open Access

              E-cigarettes - An unintended illicit drug delivery system

              Since the introduction of electronic cigarettes (e-cigarettes) in 2003, the technology has advanced allowing for greater user modifications, with users now able to control voltage, battery power, and constituents of the e-cigarette liquid. E-cigarettes have been the subject of a growing body of research with most research justifiably focused on the chemical makeup and risk analysis of chemicals, metals, and particulates found in e-cigarette liquids and vapor. Little research to date has focused on assessing the risks associated with the drug delivery unit itself and its potential for use as an illicit drug delivery system. In light of this, a range of illicit drugs was researched focusing on pharmacodynamics, usual method of administration, the dosage required for toxicity, toxic effects, and evidence of existing use in e-cigarettes in both literature and online illicit drug forums. A systematic literature search found evidence of current use of e-cigarettes to vape almost all illicit drug types analyzed. This presents both a potential population health risk and a management issue for clinicians. It also raises the issue of policing illicit drugs due to potential altered characteristic smells and storage within e-cigarette fluids. E-cigarettes are a viable illicit drug delivery system with evidence both inside and outside of the formal medical literature detailing their potential use for drug delivery of a wide range of illicit and legal drugs.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2022
                18 February 2022
                : 12
                : 2
                : e051009
                Affiliations
                [1 ] departmentInstitute for Social Marketing and Health, Faculty of Health Sciences and Sport , University of Stirling , Stirling, UK
                [2 ] departmentUsher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine , University of Edinburgh , Edinburgh, UK
                [3 ] departmentMRC/CSO Social & Public Health Sciences Unit , University of Glasgow , Glasgow, UK
                Author notes
                [Correspondence to ] Dr Rachel O'Donnell; r.c.odonnell@ 123456stir.ac.uk

                RO’D and AB are joint first authors.

                Author information
                http://orcid.org/0000-0003-2713-1847
                http://orcid.org/0000-0002-2307-5916
                http://orcid.org/0000-0001-7411-4260
                http://orcid.org/0000-0001-8616-525X
                http://orcid.org/0000-0002-6527-0218
                http://orcid.org/0000-0002-3321-5732
                http://orcid.org/0000-0002-5873-3632
                Article
                bmjopen-2021-051009
                10.1136/bmjopen-2021-051009
                8860047
                35190418
                27b8da13-a9bf-4266-aac7-61db6690cda1
                © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 08 March 2021
                : 17 January 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000589, Chief Scientist Office;
                Award ID: SPHSU12
                Funded by: FundRef http://dx.doi.org/10.13039/501100000289, Cancer Research UK;
                Award ID: C45874/A27016
                Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Award ID: MC_UU_12017/12
                Categories
                Public Health
                1506
                1724
                Original research
                Custom metadata
                unlocked

                Medicine
                e-cigarette,vaping,staff,workplace,qualitative
                Medicine
                e-cigarette, vaping, staff, workplace, qualitative

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