Smoke-free prison policy development, implementation, and impact across the entire national prison service in Scotland (TIPs study): a three-phase, mixed methods natural experimental evaluation

Hunt, K. et al. (2019) Smoke-free prison policy development, implementation, and impact across the entire national prison service in Scotland (TIPs study): a three-phase, mixed methods natural experimental evaluation. Lancet, 394(S2), S15. (doi: 10.1016/S0140-6736(19)32812-0)

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Background: Prisons had partial exemption from UK 2006–07 policies banning smoking in enclosed public spaces, becoming one of few workplaces with continued exposure to second-hand smoke (SHS). Although bans have been introduced elsewhere, evidence of the process and impact of implementing smoke-free prisons is sparse. We aimed to provide evidence on the process and impact of implementation of smoke-free policy across the national prison service in Scotland. Methods: The Tobacco in Prisons study (TIPs) is a three-phase, mixed-methods study exploring the periods before policy formulation (phase 1; September 2016–July 2017), during preparation for implementation (phase 2; August 2017–November 2018), and after implementation (phase 3; December 2018–May 2020). Data on SHS, health, smoking, beliefs (eg, smoking or e-cigarettes, desirability, benefits, and challenges of smoke-free policy) were gathered across all 15 Scottish prisons through: (1) staff and prisoner surveys, staff focus groups (phases 1 and 3), and cessation provider interviews; (2) SHS measures (fine particulate matter, PM2·5, using Dylos DC1700 monitors) before, during (week commencing Nov 28, 2018), and 6 months after (week commencing May 27, 2019) implementation on Nov 30, 2018. In six case-study prisons, in-depth interviews were carried out with prisoners, staff, and smoking cessation providers. We also accessed routine data (eg, sickness absence, “canteen” purchases of tobacco and other products) to assess policy impacts. Ethics approval was granted by SPS Research Access and Ethics Committee and University of Glasgow. Participants provided written informed consent. Findings: Phase 1 data showed high prisoner smoking rates (1858 [74%] of 2505 responders), confirmed by SHS measures (128 431 min of PM2.5 data, median 31·7 μg/m3), and concerns about the challenges of smoke-free policy (eg, 1954 [81%] of 2407 prisoners and 737 [58%] of 1269 staff thought smoking bans caused “trouble”). Compared with 2016, air quality improved in all prisons in 2018 (114 303 min of PM2.5 data) with an overall median reduction on the first full working weekday after implementation (Dec 3, 2018) of –81% (IQR –76 to –91). SHS measures collected 6 months after implementation (126 777 min of PM2·5 data) showed sustained improvement (median 3·1 μg/m3, overall median reduction –91% (IQR –88 to –93%)). Reasons for success and continuing challenges of smoke-free prison policy will be discussed. Interpretation: This evaluation of the development, planning, implementation, and impact of smoke-free prison policy demonstrates the importance of research evidence during policy implementation and, as a study of an entire national prison service, provides new evidence for other jurisdictions contemplating bans on smoking in prisons.

Item Type:Articles
Additional Information:Meeting abstract from Public Health Science 2019, London UK, 29 Nov 2019.
Glasgow Author(s) Enlighten ID:Hunt, Professor Kathryn and Demou, Dr Evangelia and Mcmeekin, Mrs Nicola and Craig, Professor Peter and Pell, Professor Jill and Boyd, Dr Kathleen and Leyland, Professor Alastair and Tweed, Dr Emily and Sweeting, Dr Helen
Authors: Hunt, K., Brown, A., Bauld, L., Boyd, K., Conaglen, P., Craig, P., Demou, E., Dobson, R., Eadie, D., Leyland, A., Mcmeekin, N., Pell, J., Purves, R., Sweeting, H., Tweed, E., and Semple, S.
Subjects:R Medicine > RZ Other systems of medicine
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
Journal Name:Lancet
Publisher:Lancet Publishing Group
ISSN (Online):1474-547X
Published Online:28 November 2019
Copyright Holders:Copyright © 2019 Elsevier Ltd.
First Published:First published in Lancet 394(Supplement 2): S15
Publisher Policy:Reproduced in accordance with the publisher copyright policy
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
304677Evaluating graduated progress towards and impacts of the implementation of indoor smoke free prison facilities in Scotland (TIPS)Helen SweetingNational Institute for Health Research (NIHR)05571_NIHR 15/55/44_TIPSHW - MRC/CSO Social and Public Health Sciences Unit
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
Chief Scientist Office (CSO)SPHSU12
Chief Scientist Office (CSO)SPHSU13
Chief Scientist Office (CSO)SPHSU15