Report on tobacco smoking in prison

The use of tobacco displays a great burden of disease, with 4.9 millions tobacco-attributed deaths worldwide each year. Tobacco is the single most important lifestyle risk factor for premature deaths.
Tobacco use is the second leading risk factor apart from high blood pressure, for premature deaths. 32% of European citizens are smokers, 21% were former smokers and 47% never smoked with significant variations throughout Europe. Tobacco and poverty are inextricably linked. In countries with a low gross national product (GNP) per capita, mostly in the Eastern part of the EU, smoking prevalence rates of over 50% compared with an average of 34% in wealthier countries can be observed. It is estimated that the overall daily adult smoking prevalence ranges around 26.8% whereas the respective prevalence among males is 40%. Data from several studies indicate a proportion of smokers among prisoners between 64-88%. Due to the fact that the majority of prisoners are male (approx. 95% of the European prison population) prevalence rates in prisons should be compared to the average of the male smoking population (which is 40%). This indicates that the prevalence of imprisoned men is one and a half to two times higher than in the general male population. No data are available about the percentage of female smoking prisoners.
To tackle the tobacco epidemic and the associated health problems the European Commission, the Member States and the World Health Organization have been running campaigns against tobacco for many years. The WHO “Framework Convention on Tobacco Control” (FCTC) entered into force in 2005 and has been signed by 168 and ratified by 152 Parties. Guidelines on smoke-free environments were adopted in 2007.
A coordinated effort towards “smoke-free Europe” is also one of the priorities of the European Commission’s public health, environment, employment and research policy. In its Environment and Health Action Plan (2004-2010), the Commission committed itself to "develop work on improving indoor air quality, in particular by encouraging the restriction of smoking in all workplaces by exploring both legal mechanisms and health promotion initiatives at both European and Member State level” (EC/DG Health and Consumer Protection 2007, 3). In 2007 the Commission published a Green Paper “Towards a Europe free from Tobacco smoke: policy options at EU level”.
The result of an inquiry on smoking bans in European prisons revealed that 22 (79%) out of 28 respondents (EU-Member States plus Switzerland and Monaco) have introduced smoking bans in all of their prisons. The European process of introduction of smoking bans in prisons started in 2006 in The Netherlands, Belgium, Finland, and Scotland.

Hardly any smoking prevention programme has been evaluated and integrated in a prison setting so far. Studies addressing the effectiveness of smoking and sales/possession bans in prisons in reducing the prevalence of smokers are few, methodologically weak, and do not provide a comprehensive overview about effects and side effects of a smoking ban in prisons. However, first results regarding smoking cessation and reduction of the smoking prevalence are encouraging.
From a public point of view both non-smokers and smokers should not be exposed to second- hand smoke. The research data doesn't give an answer to a question whether smokers should have the possibility to smoke in their cells and designated areas in the prisons.
The document suggests recommendations on tobacco control policies in prisons, on implementation of smoke-free environments, on smoking prevention and quitting support, as well as priority research.

Source: European Commission (DG Sanco now DG Santé or DG Health)

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Document author(s): 
Christina Hartwig, Heino Stöver, Caren Weilandt
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