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      Smoking and Smoking Cessation Among Criminal Justice–Involved Older Adults

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          Abstract

          Background:

          In jails and prisons worldwide, older adults are among the fastest growing demographic groups. Criminal justice–involved populations smoke tobacco at high rates. Older adults are also disproportionate smokers and have more difficulty quitting smoking than other age groups. Yet, little is known about tobacco use or knowledge and attitudes toward smoking cessation among the growing population of incarcerated older adults.

          Methods:

          A descriptive, cross-sectional survey study of 102 adults aged 55 years or older recently incarcerated in an urban jail using items from the Global Adult Tobacco Survey (GATS).

          Results:

          More than 70% of participants reported being current smokers despite strong knowledge (95%) of the connection between smoking and serious illness. More than half of current smokers reported a past failed quit attempt (62%) and/or said they would like to quit (60%).

          Conclusions:

          High rates of tobacco use in this population suggest that correctional institutions represent a critical site for the delivery of appropriate smoking cessation interventions to older adults, including integrated treatment approaches for those with co-occurring behavioral health diagnoses.

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          Most cited references39

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          50-year trends in smoking-related mortality in the United States.

          The disease risks from cigarette smoking increased in the United States over most of the 20th century, first among male smokers and later among female smokers. Whether these risks have continued to increase during the past 20 years is unclear. We measured temporal trends in mortality across three time periods (1959-1965, 1982-1988, and 2000-2010), comparing absolute and relative risks according to sex and self-reported smoking status in two historical cohort studies and in five pooled contemporary cohort studies, among participants who became 55 years of age or older during follow-up. For women who were current smokers, as compared with women who had never smoked, the relative risks of death from lung cancer were 2.73, 12.65, and 25.66 in the 1960s, 1980s, and contemporary cohorts, respectively; corresponding relative risks for male current smokers, as compared with men who had never smoked, were 12.22, 23.81, and 24.97. In the contemporary cohorts, male and female current smokers also had similar relative risks for death from chronic obstructive pulmonary disease (COPD) (25.61 for men and 22.35 for women), ischemic heart disease (2.50 for men and 2.86 for women), any type of stroke (1.92 for men and 2.10 for women), and all causes combined (2.80 for men and 2.76 for women). Mortality from COPD among male smokers continued to increase in the contemporary cohorts in nearly all the age groups represented in the study and within each stratum of duration and intensity of smoking. Among men 55 to 74 years of age and women 60 to 74 years of age, all-cause mortality was at least three times as high among current smokers as among those who had never smoked. Smoking cessation at any age dramatically reduced death rates. The risk of death from cigarette smoking continues to increase among women and the increased risks are now nearly identical for men and women, as compared with persons who have never smoked. Among men, the risks associated with smoking have plateaued at the high levels seen in the 1980s, except for a continuing, unexplained increase in mortality from COPD.
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            Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population.

            Despite growing inmate populations in the USA, inmates are excluded from most national health surveys and little is known about whether the prevalence of chronic disease differs between inmates and the non-institutionalised population. Nationally representative, cross-sectional data from the 2002 Survey of Inmates in Local Jails, 2004 Survey of Inmates in State and Federal Correctional Facilities and 2002-4 National Health Interview Survey Sample Adult Files on individuals aged 18-65 were used. Binary and multinomial logistic regression were used to compare the prevalence of self-reported chronic medical conditions among jail (n = 6582) and prison (n = 14,373) inmates and non-institutionalised (n = 76 597) adults after adjusting for age, sex, race, education, employment, the USA as birthplace, marital status and alcohol consumption. Prevalence and adjusted ORs with 95% CIs were calculated for nine important chronic conditions. Compared with the general population, jail and prison inmates had higher odds of hypertension (OR(jail) 1.19; 95% CI 1.08 to 1.31; OR(prison) 1.17; 95% CI 1.09 to 1.27), asthma (OR(jail) 1.41; 95% CI 1.28 to 1.56; OR(prison) 1.34; 95% CI 1.22 to 1.46), arthritis (OR(jail) 1.65; 95% CI 1.47 to 1.84; OR(prison) 1.66; 95% CI 1.54 to 1.80), cervical cancer (OR(jail) 4.16; 95% CI 3.13 to 5.53; OR(prison) 4.82; 95% CI 3.74 to 6.22), and hepatitis (OR(jail) 2.57; 95% CI 2.20 to 3.00; OR(prison) 4.23; 95% CI 3.71 to 4.82), but no increased odds of diabetes, angina or myocardial infarction, and lower odds of obesity. Jail and prison inmates had a higher burden of most chronic medical conditions than the general population even with adjustment for important sociodemographic differences and alcohol consumption.
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              The drug abuse screening test.

              The Drug Abuse Screening Test (DAST) was designed to provide a brief instrument for clinical screening and treatment evaluation research. The 28 self-report items tap various consequences that are combined in a total DAST score to yield a quantitative index of problems related to drug misuse. Measurement properties of the DAST were evaluated using a clinical sample of 256 drug/alcohol abuse clients. The internal consistency reliability estimate was substantial at .92, and a factor analysis of item intercorrelations suggested an unidimensional scale. With respect to response style biases, the DAST was only moderately correlated with social desirability and denial. Concurrent validity was examined by correlating the DAST with background variables, frequency of drug use during the past 12 months, and indices of psychopathology. Although these findings support the usefulness of the DAST for quantifying the extent of drug involvement within a help-seeking population, further validation work is needed in other populations and settings.
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                Author and article information

                Journal
                Tob Use Insights
                Tob Use Insights
                TUI
                sptui
                Tobacco Use Insights
                SAGE Publications (Sage UK: London, England )
                1179-173X
                12 March 2019
                2019
                : 12
                : 1179173X19833357
                Affiliations
                [1 ]Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
                [2 ]Epidemiology Division, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
                [3 ]Center for AIDS Prevention Studies and Prevention Research Center, University of California, San Francisco, San Francisco, CA, USA
                Author notes
                [*]Cyrus Ahalt, Division of Geriatrics, Department of Medicine, University of California, San Francisco, 3333 California Street, Suite 380, San Francisco, CA 94118, USA. Email: cyrus.ahalt@ 123456ucsf.edu
                Article
                10.1177_1179173X19833357
                10.1177/1179173X19833357
                6416677
                e40b0a29-8c36-44c0-a353-c0ce9460db8f
                © The Author(s) 2019

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 18 January 2019
                : 2 February 2019
                Funding
                Funded by: university of california, san francisco, FundRef https://doi.org/10.13039/100008069;
                Categories
                Original Research
                Custom metadata
                January-December 2019

                smoking,cessation,aging,older adults,jail
                smoking, cessation, aging, older adults, jail

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