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      Smoking, prisons and human rights Translated title: Tabaquismo, centros penitenciarios y derechos humanos

      editorial
      Revista Española de Sanidad Penitenciaria
      Sociedad Española de Sanidad Penitenciaria

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          Abstract

          The smoking pandemic is an international health problem that affects approximately 1.3 billion people according to the World Health Organisation (WHO). It is a pandemic that we ourselves have created, and it has led to devastating medical, social, economic and environmental consequences, while also placing obstacles in the path of sustainable development. Smoking is defined as a chronic, addictive and relapsing disease, which generates other chronic diseases, some of which are considered to be primary causes of mortality. Tobacco is a psychoactive substance that is addictive and conflictive, and which causes direct, cultural and structural violence. It is the cause of premature death for about 8 million people a year, 60,000 of whom are Spanish. Many of these victims live in mid and low income countries. 11.5% of global mortalities can be attributed to its effects 1 . The prevalence of smoking amongst prison inmates is about 70%, while prison staff are twice as likely to smoke as members of the general public, with the added aggravating effect of being passive smokers. More than 14.5 million people in prisons smoke every year around the world 2 . There are currently about 46,000 inmates in Spanish prisons, of whom 3,500 are women, with an average age of between 40 and 41 years, 75% of whom are Spanish. The prevalence of smoking in prisons is 74.4% amongst men and 67.4% amongst women, just under double the figures for the general public in Spain. Tobacco is by far the legal or illegal drug most commonly consumed by the inmate population 3 . Although prisons are punitive spaces, it should not be forgotten that their main objectives are re-education and social reintegration. They also fulfil an important role in public health through their work in health restoration, prevention and promotion, and by implementing healthy habits and reducing high-risk ones amongst inmates. It is a well known fact that “prison health is public health” 4 . Smoking cessation is not easy, but it is not impossible. It is a decision made by the smoker, in the exercise of their personal autonomy, and external help is usually required. Inmates do try to give up smoking, as do those outside prison, and although it is more difficult for them than it might be for the general public, interventions to help incarcerated smokers have achieved notable levels of success 5 . In addition, prohibitions against smoking in prisons have been shown to improve air quality by notably reducing second-hand smoke 6 , which minimises the effects for passive smokers and benefits both inmates and the personnel that care for and attend them. Likewise, the implementation of smoke-free prison policies has increased the dispensation of nicotine substitute therapies, which implies an increase in abstinence, a decrease in smoking cessation habits, and fewer prescriptions for medications to treat smoking related problems, such as respiratory and cardiovascular diseases 7 . This in turn implies that the prison population’s overall health has improved. The most evident benefit of smoke-free prisons in terms of the individual rights of inmates and the persons who care for them is in health protection. It is a right of these groups and public administrations are obliged to implement policies and measures that make this right a reality. But it is not the only one. Anti-smoking in prisons is linked to some other individual and fundamental rights. The right to life is evidently the first one; by improving inmates’ health one improves their life expectancy. Other rights connected to anti-smoking are the right to physical integrity and equality between persons. Tobacco has been and continues to be used as a means of exchange in prisons, and, as I mentioned above, possessing tobacco can be a cause for violence and inequalities between inmates. This state of affairs is such that the European Court of Human Rights (ECHR) has taken action over this issue for some years now, especially in cases where the protection of passive smokers is involved (cases: “Stoine Hristov vs. Bulgaria” of 16 January 2009 and “Elefteriaidis vs. Rumanía” of 25 January 2011). Public administrations are obliged to promote, shield and protect the exercise of individual human rights. The logical consequence of all the foregoing is that they should implement measures, and oversee and demand their compliance, with a view to reducing and even suppressing the use of tobacco in prisons. Ahmad Khalaf Specialist in Internal Medicine. Expert in Tobacco Control. President of the Azahar Association for the prevention of smoking and its diseases. Castellón.

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          Smoking in Correctional Settings Worldwide: Prevalence, Bans, and Interventions

          Abstract Smoking tobacco contributes to 11.5% of deaths worldwide and, in some countries, more hospitalizations than alcohol and drugs combined. Globally in 2015, 25% of men and 5% of women smoked. In the United States, a higher proportion of people in prison smoke than do community-dwelling individuals. To determine smoking prevalence in prisons worldwide, we systematically reviewed the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; we also examined whether prisons banned smoking or treated smokers. We searched databases for articles published between 2012 and 2016 and located 85 relevant articles with data representing 73.5% of all incarcerated persons from 50 countries. In 35 of 36 nations (97%) with published prevalence data, smoking for the incarcerated exceeded community rates 1.04- to 62.6-fold. Taking a conservative estimate of a 2-fold increase, we estimated that, globally, 14.5 million male and 26,000 female smokers pass through prisons annually. Prison authorities’ responses include permitting, prohibiting, or treating tobacco use. Bans may temporarily improve health and reduce in-prison health care costs but have negligible effect after prison release. Evidence-based interventions for smoking cessation effective outside prisons are effective inside; effects persist after release. Because smoking prevalence is heightened in prisons, offering evidence-based interventions to nearly 15 million smokers passing through yearly would improve global health.
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            The impact of implementation of a national smoke-free prisons policy on indoor air quality: results from the Tobacco in Prisons study

            Objective To determine secondhand smoke (SHS) concentrations in prisons during the week of implementation of a new, national prisons smoke-free policy. Design Repeated measurement of SHS concentrations immediately before and after implementation of smoke-free policies across all 15 prisons in Scotland, and comparison with previously gathered baseline data from 2016. Methods Fine particulate matter (PM2.5) measurements at a fixed location over a continuous 6-day period were undertaken at the same site in each prison as previously carried out in 2016. Outdoor air quality data from the nearest local authority measurement station were acquired to determine the contribution of outdoor air pollution to indoor prison measurement of PM2.5. Results Air quality improved in all prisons comparing 2016 data with the first full working day postimplementation (overall median reduction −81%, IQR −76% to −91%). Postimplementation indoor PM2.5 concentrations were broadly comparable with outdoor concentrations suggesting minimal smoking activity during the period of measurement. Conclusions This is the first evaluation of changes in SHS concentrations across all prisons within a country that has introduced nationwide prohibition of smoking in prisons. All prisons demonstrated immediate substantial reductions in PM2.5 following policy implementation. A smoke-free prisons policy reduces the exposure of prison staff and prisoners to SHS.
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              Evaluation of a national smoke-free prisons policy using medication dispensing: an interrupted time-series analysis

              Background Internationally, smoking prevalence among people in prison custody (ie, people on remand awaiting trial, awaiting sentencing, or serving a custodial sentence) is high. In Scotland, all prisons implemented a comprehensive smoke-free policy in 2018 after a 16-month anticipatory period. In this study, we aimed to use data on medication dispensing to assess the impact of this policy on cessation support, health outcomes, and potential unintended consequences among people in prison custody. Methods We did an interrupted time-series analysis using dispensing data for 44 660 individuals incarcerated in 14 closed prisons in Scotland between March 30, 2014, and Nov 30, 2019. We estimated changes in dispensing rates associated with the policy announcement (July 17, 2017) and full implementation (Nov 30, 2018) using seasonal autoregressive integrated moving average models. Medication categories of primary interest were treatments for nicotine dependence (as an indicator of smoking cessation or abstinence attempts), acute smoking-associated illnesses, and mental health (antidepressants). We included antiepileptic medications as a negative control. Findings A 44% step increase in dispensing of treatments for nicotine dependence was observed at implementation (2250 items per 1000 people in custody per fortnight, 95% CI 1875 to 2624) due primarily to a 42% increase in dispensing of nicotine replacement therapy (2109 items per 1000 people in custody per fortnight, 1701 to 2516). A 9% step decrease in dispensing for smoking-related illnesses was observed at implementation, largely accounted for by respiratory medications (−646 items per 1000 people in custody per fortnight, −1111 to −181). No changes associated with announcement or implementation were observed for mental health dispensing or antiepileptic medications (control). Interpretation Smoke-free prison policies might improve respiratory health among people in custody and encourage smoking abstinence or cessation without apparent short-term adverse effects on mental health dispensing. Funding National Institute of Health Research Public Health Research programme, Scottish Government Chief Scientist Office, and UK Medical Research Council.
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                Author and article information

                Contributors
                Role: Specialist in Internal MedicineRole: Expert in Tobacco ControlRole: President of the Azahar - Association for the prevention of smoking and its diseases
                Journal
                Rev Esp Sanid Penit
                Rev Esp Sanid Penit
                sanipe
                Revista Española de Sanidad Penitenciaria
                Sociedad Española de Sanidad Penitenciaria
                1575-0620
                2013-6463
                May-Aug 2023
                14 July 2023
                : 25
                : 2
                : 43-44
                Affiliations
                [1] originalSpecialist in Internal Medicine. Expert in Tobacco Control. President of the Azahar - Association for the prevention of smoking and its diseases orgnameAzahar - Association for the prevention of smoking and its diseases Morella, Spain
                Author notes
                [Correspondence ] Ahmad Khalaf. E-mail: azahar.asociacion@ 123456gmail.com
                Article
                10.18176/resp.00066
                10366707
                fd1f9e45-f1f0-4d3a-8020-58076b66edf0

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 20 February 2023
                : 22 February 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 7, Pages: 02
                Categories
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