For most non-smokers the idea of having to breathe in second-hand cigarette smoke at work is historical; smoke-filled offices or coming home from an evening out reeking of stale smoke remains but a memory. For some groups of workers it continues to be a very real issue with very real long-term risks to their health.
In 2006, Scotland was an early pioneer in introducing smoke-free laws which restricted smoking in enclosed public spaces, following New Zealand (2003), Ireland, Norway (2004) and Bhutan (2005). The public health benefits of such smoke-free laws are well documented, including reductions in hospital admissions from heart attacks and asthma and improved air quality in bars and restaurants. Since 2006, almost all workers in Scotland have been protected from the harmful effects of second hand smoke (SHS). But as smoke-free environments increasingly become the norm, people who still have to breathe SHS while at work can feel that their health is being neglected.
One large occupational group that has been required to work within smoking-permitted environments in the United Kingdom is prison staff. Almost three-quarters of prisoners are current smokers, levels not seen amongst men in the general population since around 1960. Not surprisingly, many prison staff report experiencing high levels of smoke in some areas, such as when they enter smokers’ cells and adjacent areas; and that their partners and families can smell tobacco smoke on them when they return home.
In 2013 the Scottish Government committed to reducing smoking rates to below 5% of the population by 2034. As part of this commitment to a ‘Tobacco-free generation’ they set out a broad aim of making the prison estate smoke-free. The Tobacco In Prisons Study (TIPs) was funded in 2016 by the UK National Institute for Health Research to examine the process of change towards smoke-free prisons. One of the first stages of TIPs included measuring just how often, and by how much, prison staff were exposed to SHS.
Almost three-quarters of prisoners are current smokers, levels not seen amongst men in the general population since around 1960.
Recently, in the largest global study of the exposure to SHS of prison staff conducted, we used multiple methods to quantify the concentrations of SHS in the air and to estimate how much SHS prison staff typically inhaled during their work shift. Gathering data involved working closely with the workforce at the Scottish Prison Service (SPS), with advice and input from a Research Advisory Group involving senior management, the trade unions, governmental policy makers, and NHS representatives. Co-operation, communication, and transparency were all key to ensuring that prison staff were involved with the study from an early stage and had confidence in our final results.
Using this collaborative approach, we measured levels of SHS in all fifteen prisons at a variety of locations and while prison staff performed particular tasks and duties. We used two measures of SHS: a chemical method that provided information on the concentration of nicotine in the air and a particle counting method that registers changes in fine particle levels each and every minute. Non-smoking prison staff volunteers provided samples of saliva at the start and end of their shift to help estimate how much nicotine they had inhaled while at work. Staff were also invited provide their own estimate about how often they are exposed to SHS at work through an online questionnaire.
Our analysis provided objective evidence that prison staff were exposed to SHS in all prisons in Scotland and that, on average, their exposure was similar to that of non-smokers who live with a smoker. Some tasks, such as entering prisoners’ cells, led to exposures that are as high as those measured in pubs and bars before smoke-free laws in 2006. Figure 1 shows the different levels of SHS in eight areas in one prison.
Within a very short amount of time of receiving the results the Scottish Prison Service moved to action, deciding that that all prisons in Scotland would become smoke-free by November 2018. The SPS’ Chief Executive described the results as a ‘wake-up call’ and both the Minister for Justice and the Minister for Health in Scotland publicly supported the announcement on the day the results were published in July 2017.
Scotland is not the first country to implement smoke-free prisons to prevent prison staff and non-smoking prisoners being exposed to SHS. In January 2016 all Welsh prisons became smoke-free, England has been phasing in smoke-free prisons since March 2016 and Australia, Canada, and some states in the USA have widespread restrictions on smoking within their prison estates.
Making prisons smoke-free, like other changes to smoke-free environments, will pose practical and logistical challenges but prison staff have a wealth of experience in dealing with addiction, complex problems and transforming lives, and many prisoners have indicated their wish to give up smoking. Finding the correct approach to supporting smoking prisoners to become smoke-free is essential for the success of the policy. The health benefits that can be achieved are considerable. In addition to protecting the prison workforce and prisoners from the known harms of SHS, there is also the potential to help prisoners return to their communities free from the health and financial burdens associated with smoking; the typical cost of smoking is around £1,600 per year. Helping ex-prisoners get back on their feet with an extra £30 of disposable income per week has to be a step in the right direction.
Quantifying prison workers’ exposure to second-hand smoke has helped bring forward action to protect their health. Other countries should examine these results and consider how acceptable it is to continue to expect workers to breathe harmful levels of second-hand smoke while earning their living.
Featured image credit: smoking me by Kenji Aryan. CC BY-SA 2.0 via Flickr.
Great article that shows why smoking issues in prisons can be tackled. However I feel that the real challenge is concerning the prison governors and staff attitude in implementing the programme. This article by Ismail and De Viggiani sheds some light on this problem: https://doi.org/10.1093/pubmed/fdx116. Though I believe a more in-depth qualitative study is desirable.
A really interesting debate, I fully agree that it is the staff attitudes that make a difference in challenging smoke free prisons…
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