Evaluation of a national smoke-free prisons policy using medication dispensing: an interrupted time-series analysis

Tweed, E. J. et al. (2021) Evaluation of a national smoke-free prisons policy using medication dispensing: an interrupted time-series analysis. Lancet Public Health, 6(11), e795-e804. (doi: 10.1016/S2468-2667(21)00163-8) (PMID:34537108) (PMCID:PMC8554387)

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Abstract

Background: Internationally, smoking prevalence among people in prison custody (ie, people on remand awaiting trial, awaiting sentencing, or serving a custodial sentence) is high. In Scotland, all prisons implemented a comprehensive smoke-free policy in 2018 after a 16-month anticipatory period. In this study, we aimed to use data on medication dispensing to assess the impact of this policy on cessation support, health outcomes, and potential unintended consequences among people in prison custody. Methods: We did an interrupted time-series analysis using dispensing data for 44 660 individuals incarcerated in 14 closed prisons in Scotland between March 30, 2014, and Nov 30, 2019. We estimated changes in dispensing rates associated with the policy announcement (July 17, 2017) and full implementation (Nov 30, 2018) using seasonal autoregressive integrated moving average models. Medication categories of primary interest were treatments for nicotine dependence (as an indicator of smoking cessation or abstinence attempts), acute smoking-associated illnesses, and mental health (antidepressants). We included antiepileptic medications as a negative control. Findings: A 44% step increase in dispensing of treatments for nicotine dependence was observed at implementation (2250 items per 1000 people in custody per fortnight, 95% CI 1875 to 2624) due primarily to a 42% increase in dispensing of nicotine replacement therapy (2109 items per 1000 people in custody per fortnight, 1701 to 2516). A 9% step decrease in dispensing for smoking-related illnesses was observed at implementation, largely accounted for by respiratory medications (−646 items per 1000 people in custody per fortnight, −1111 to −181). No changes associated with announcement or implementation were observed for mental health dispensing or antiepileptic medications (control). Interpretation: Smoke-free prison policies might improve respiratory health among people in custody and encourage smoking abstinence or cessation without apparent short-term adverse effects on mental health dispensing. Funding: National Institute of Health Research Public Health Research programme, Scottish Government Chief Scientist Office, and UK Medical Research Council.

Item Type:Articles
Additional Information:This study was funded by the NIHR Public Health Research programme (15/55/44), the Scottish Government Chief Scientist Office (CAF/17/11; SPHSU12, SPHSU13, SPHSU15, SPHSU17); and the UK Medical Research Council (MC_UU_12017/12, MC_UU_12017/13, MC_UU_12017/15, MC_UU_00022/2, and MRC_PC_13027).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Demou, Dr Evangelia and Mcmeekin, Mrs Nicola and Craig, Professor Peter and Pell, Professor Jill and Mackay, Professor Daniel and Boyd, Dr Kathleen and Leyland, Professor Alastair and Tweed, Dr Emily and Sweeting, Dr Helen
Authors: Tweed, E. J., Mackay, D. F., Boyd, K. A., Brown, A., Byrne, T., Conaglen, P., Craig, P., Demou, E., Graham, L., Leyland, A. H., Mcmeekin, N., Pell, J. P., Sweeting, H., and Hunt, K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:Lancet Public Health
Publisher:Elsevier
ISSN:2468-2667
ISSN (Online):2468-2667
Published Online:16 September 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Lancet Public Health 6(11): e795-e804
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
301147Morbidity and mortality among people experiencing severe and multiple disadvantage: a cohort study using cross-sectoral data linkageEmily TweedOffice of the Chief Scientific Adviser (CSO)CAF/17/11HW - MRC/CSO Social and Public Health Sciences Unit
Office of the Chief Scientific Adviser (CSO)SPHSU12
Office of the Chief Scientific Adviser (CSO)SPHSU13
Office of the Chief Scientific Adviser (CSO)SPHSU15
Office of the Chief Scientific Adviser (CSO)SPHSU17
727641SPHSU Core Renewal: Setting and Health Improvement Research ProgrammeKathryn HuntMedical Research Council (MRC)MC_UU_12017/12IHW - MRC/CSO SPHU
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
727671SPHSU Core Renewal: Informing Healthy Public Policy Research ProgrammePeter CraigMedical Research Council (MRC)MC_UU_12017/15IHW - MRC/CSO SPHU
Inequalities in healthMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit