Among all psychoactive substances, tobacco is the most widely used by people living in prisons. Studies conducted in the WHO European Region countries show that tobacco use prevalence rates can be as high as 90% among men and 85% among women. At the same time, smoking is the least addressed health risk in prisons compared to other types of substance abuse. A new factsheet published by WHO/Europe shines a light on the pressing need to tackle this public health issue.

Second-hand smoke exposure in prisons
While a remarkable decline in smoking rates has been observed in the general population where tobacco control policies are being implemented, no comparable changes have occurred in prison settings. In addition to the high prevalence of tobacco smoking, exposure to second-hand smoke (SHS) is common in prison settings, as people spend most of their time indoors or in compounds with poor ventilation systems.

Some efforts have been made across the Region to address an elevated probability of being exposed to SHS, with 25 countries reporting an availability of so-called smoke-free cells in prisons. While such isolated measures can bring an improvement in air quality, they remain insufficient, as they do not adequately protect from the harms of SHS. These include an increased risk of heart disease and lung cancer, by 20% to 30%, among non-smokers.

Opportunities to promote tobacco cessation
A comprehensive approach is needed to address tobacco use in prisons, including promoting cessation, preventing tobacco initiation, and protecting people living and working in prisons from SHS.

People living in prison often want to achieve something while they are there and can perceive smoking cessation as a big achievement. Many of them have their first opportunity to access cessation services and pharmacotherapy during incarceration. Therefore, it is crucial to support those wishing to quit, and tailor smoking cessation programmes in prisons to the unique stresses of the environment that people live in. Further consideration should be given for extra post-release support to avoid relapse.

There are many ways in which good health can be promoted in prisons, which would help address the extensive health inequalities experienced by this population group. A notable barrier to action is that many people in prison claim to smoke due to boredom. This could be alleviated by improving and increasing access to physical activities and various sports. Not only would this improve overall quality of life but would also act as an important appendage to traditional tobacco cessation initiatives.

Full implementation of the WHO Framework Convention on Tobacco Control, deeper collaboration with prison services, and a better integration of tobacco control measures in the priorities of custodial authorities are required for ensuring the health and well-being of those living in prison facilities and that they are not left behind in the battle against tobacco.