Prison nurse LOUISE CHA reports on the challenge of helping an estimated 80 per cent of prisoners quit when smoking was officially banned in prisons last winter.
As of July last year, prisons were deemed to become smoke free and intense efforts were made to support prisoners to stop smoking.
The reasons given for the smoking ban in prison were to improve the health of both prisoners and staff, through the elimination of second-hand smoke, and to make prisons a safer environment by minimising fire risk.
During 2006, the Ministry of Health identified that two-thirds of the prison population in New Zealand were smokers, and prevalence rates of smoking in prison were almost triple that of the general population. As a result, tobacco smoking was deemed to be one of the biggest health risk factors amongst prisoners.
The Spring Hill Corrections Facility near Meremere in the Waikato, where I practise, opened in 2007. It provides rehabilitation programmes and interventions with the aim of reducing re-offending. Spring Hill started as a 650-bed high-security male prison, but double-bunking legislation added 368 beds in 2010. The health centre has a team of 20 nurses on site, including one health centre manager and two team leaders.
Before the smoking cessation project was announced, an estimated 80 per cent of prisoners at Spring Hill were smokers. Prisoner smokers showed little interest in volunteering for the smokefree programme. There were a number of reasons contributing to this. Prisoners often had long periods confined within their cells (up to a maximum of 23 hours a day). Isolation times would be longer during weekends and holiday times. Opportunities for work were often limited; boredom while incarcerated was given as the main reason to smoke.
Life in prison is potentially stressful. Separation from family and close friends can cause great distress. Prisoners are mindful of being charged by corrections officers for inappropriate behaviours and attitudes. Dealing with difficult news from home or a setback in the release process can make their difficult situation worse. One prisoner reported he felt powerless to affect what was happening on the “outside”, such as family illness or financial problems. He said smoking offered him relief from these stresses.
The initial announcement of the total smoking ban in prison gave the prison nurses a year to prepare and ensure that everyone affected by the change was well informed. In Spring Hill, health services identified the smoking status of new prisoners on arrival through reception health screening. From May 2011, all resident prisoners were asked about their smoking status and willingness to participate in the smoking cessation programme. The prisoners were offered a one-to-one smoking cessation consultation and nicotine replacement therapy (NRT). NRT is usually provided for a 12-week period before being discontinued, as the craving for nicotine/tobacco is reduced. Some prisoners did, however, manage to stop smoking without any external assistance.
Since the smoking ban was implemented, NRT in the form of both patches and lozenges have been made available to prisoners. The resources supporting smoking cessation such as pamphlets and booklets and other literature were given out to the prisoners during this time.
From 1 September 2010, the Ministry of Health agreed to provide NRT to prison site staff free of charge. Regular scheduled clinics were held at the health centre in Spring Hill for staff who wanted to cease smoking.
The number of prisoners involved in the smoking cessation programme has dropped significantly since the smoking ban came into force. Currently, only 15 of the 933 prisoners are on NRT (1.5 per cent) compared to the 265 out of 798 prisoners (33 per cent) who had voluntarily participated in the programme in July 2011. The majority of prisoners were successful in their efforts to become smokefree.
I have noticed that the result has dramatically improved their overall medical wellbeing. Common ailments such as asthma and hypertension have reduced in prevalence amongst the prison population.
However, the process of implementing a smoking cessation programme within a correctional setting is a challenge for prison health staff. For example, the pamphlets or leaflets on quitting smoking, designed by the Quit Group or other health organisations, were unsuitable. Their suggestions to “eat more fruit”, or “take a walk” to manage cravings for tobacco were unrealistic when prisoners were heavily restricted in their everyday activities and choices.
Prisoners are immediately removed from the NRT programme once they are identified as misusing NRT. Misuse covers actions such as trading and/or hoarding NRT, being in possession of another prisoner’s NRT, incorrect or misuse of patches (wearing more than one patch at a time or consuming excessive quantities of lozenges).
If prisoners had not been offered NRT or support, and were unable to abstain from nicotine, they would have been forced to buy nicotine on the prison black market. Prisoners, visitors and others have all been implicated to some degree in smuggling tobacco on the black market.
The smoking cessation programme introduced into New Zealand prisons in July 2011 has been very successful. The prisoner smoking population has been markedly reduced, and through the use of NRT programmes the general health and wellbeing of prisoners and staff has been improved. Its success thus far can be seen as a positive step for other health providers to reflect upon.
Acknowledgement: I would like to acknowledge Anne Holtham (RN, Springhill Corrections Facility) for her support and guidance with the NRT programme for prisoners.
