Breathing second-hand smoke at work – finally a thing of the past for prison staff in Scotland
Breathing smoke from other people’s cigarettes is a thing of the past for many of us, whether at work or out and about in other public places. Back in 2005 it was estimated that, across the UK, over 600 people per year died as a result of inhaling what we now call second-hand smoke (SHS) while at work. Since smoke-free laws were introduced in 2006/7 it has been illegal to smoke in enclosed public spaces including most workplaces. Compliance has been high and recent evidence in Scotland suggests that more than 80% of non-smoking adults don’t breathe SHS in any given day.
The 2006/7 legislation did provide exemption for a small number of indoor environments and these included the provision for prisoners to smoke in their cells. In countries where prisoners are allowed to smoke, typically around three-quarters of prisoners are smokers and, as a result, prison staff have been exposed to SHS as a daily part of their working life.
The Tobacco In Prisons study (TIPs) study was funded by NIHR in 2016 with the aim of examining the process of change towards smoke-free prisons. The team have worked closely with the Scottish Prison Service and unions to look at the issues surrounding all aspects of smoking in prisons. One of the first parts of our study was to look at the typical concentrations of SHS inside all 15 prisons in Scotland. That baseline study carried out in autumn 2016 used air quality monitors to measure a marker of cigarette smoke called PM2.5 (fine Particulate Matter less than 2.5 microns in size). The results varied by prisons but showed high peaks during certain tasks, such as entering cells. They also showed that there were notable background levels of SHS on prison landings and communal areas throughout much of the working day. These air measurements were confirmed by taking samples of saliva from prison officers at the start and end of their working day and measuring for a chemical called cotinine – a biomarker of how much nicotine they had inhaled at work. On average, the data showed that a typical prison officer was experiencing an exposure to SHS that was broadly similar to that experienced by someone who lived with someone who smoked within the home.
The results from that baseline study were described as a ‘wake-up call’ by the Chief Executive of the Scottish Prison Service in July 2017 and on the day that the results were published the Scottish Prison Service responded with a plan to create completely smoke-free prisons by November 2018. The prison service and the health service worked in partnership to prepare for this change. Careful planning, information and education, and a substantial increase in smoking cessation services were put into place in the lead up to the ban.
The TIPs research team worked with prison staff to plan and undertake a series of measurements during the week when the policy was implemented in November 2018, to capture data on changes in air quality before and immediately after the change. Reductions in PM2.5 concentrations were substantial and, importantly, were seen across all the prison estate. Taken overall, the average concentration of PM2.5 fell by 81% when the values measured on the first full working day after the ban came in were compared with the levels from the same prison in 2016. The scale of air quality improvement was very similar to that achieved in bars and workplaces when the original smoke-free law was successfully introduced in Scotland in 2006 (-86%). Figure 1 below shows a graph of minute-by-minute measurements made in one prison during the week when the policy came into force - demonstrating this substantial fall in PM2.5 concentrations. It is worth noting that while PM2.5 is a good marker of smoking there are other sources of this pollutant such as traffic pollution and fine dust; so the 81% reduction shouldn’t be seen as indicating that considerable smoking activity was continuing in prisons. Indeed, the average PM2.5 concentration in prisons reduced to a figure of about 5 μg/m3 (micrograms of fine particulate per cubic metre of air– almost identical to the concentration of fine particulate pollution in outdoor air in Scotland during this period.
The TIPs team will measure air quality again at the end of May 2019 to see if the changes have been sustained six months after the prisons’ smoking ban came into place. Our initial results from November 2018 show that well-planned changes to implement smoke-free prisons can bring big and immediate improvements to conditions - for both prison staff and prisoners - which are likely to lead to health benefits linked to no longer inhaling second-hand smoke, and to smoking cessation for those prisoners who previously smoked.
Smoke-free prisons now add another 4,000 workers to those who are protected from second-hand smoke at work in Scotland. There are now very few groups of workers who continue to have to inhaleSHS while carrying out their daily work and, with smoking prevalence among the population continuing to decline, we must hope that involuntary exposure to this known carcinogen will truly be a thing of the past.
Figure 1: Fine particulate matter concentration measurements from one prison from Wednesday 28 November to Tuesday, 4 December 2018. The red line marks the change to smoke-free.
More information on the TIPS study is available on the NIHR Journals Library website.
The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.