1. Mortality attributed to smoking is greater in U.S. prisons than that in the general U.S. population.
2. States with prison smoking bans had lower mortality rates from smoking related causes than states without bans.
Evidence Rating Level: 2 (Good)
Study Rundown: The adverse health consequences of smoking tobacco are well known but effects on people in prison, a group at higher risk for poor health outcomes, has not been well investigated. The purpose of this study was to determine the effects of smoking and whether smoking bans reduced smoking related deaths in the prisoner population. This study looked at data from all U.S. state prisons from 2001 to 2011 and found the rates of mortality attributed to smoking and the years of potential life lost were higher than that in the general U.S. population. From 2001 to 2011, the number of states implementing a ban on smoking in prisons increased from 25 to 48 states. States with a ban had lower mortality rates than those without a ban, and states with bans on indoor as well as outdoor smoking had the lowest mortality rates.
The study’s strengths lie its complete sample and length analysis. This study was not able to factor effects of secondhand smoke in its calculations, an important factor in a population that lives in confined spaces with poor ventilation. Future studies will also need to investigate the rates of relapse after people are released from prison. Nonetheless this study is the first report on the effect of smoking bans in prison and has significant policy implications.
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In-Depth [retrospective cohort]: This study was a retrospective, population-based analysis of 14,499 individuals in a total of 287 U.S. state prisons from 2001 to 2011. The authors first analyzed cross sectional survey data from the Bureau of Justice Statistics and found that of people of all ages in state prisons, about 75% had ever smoked.16,024 deaths in this time period were attributable to 19 smoking related causes of death, and only 3.3% of these deaths were among women. The age adjusted rates of smoking attributable mortality and years of potential life lost were 360 and 5149 per 100,000, for women and men respectively, both of which were higher than that in the U.S. population (248 and 3501 per 100,000). Multivariate Poisson models found that mortality rates in states with a ban were lower than that in states with a ban (incidence rate ratio 0.86, 95% CI 0.83-0.89). In fact, states implementing a ban had a 9% reduction in smoking related deaths. Furthermore, bans that existed for more than nine years were associated with reductions in all smoking related deaths (incidence rate ratio 0.89, CI95%, 0.85-0.94), cancer deaths (0.81, CI95%, 0.74-0.90), and pulmonary deaths (0.66, CI95%, 0.54-0.80) compared to prisons without a ban.
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