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Case study: The impact of smoke-free prisons in Scotland

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Second-hand smoke and ill-health

Smoking has been banned in most enclosed public spaces in Scotland since 2006. However, people in custody were still allowed to smoke in their cells, meaning prisons remained one of the few UK workplaces where staff continued to be exposed to second-hand smoke (SHS).

Prison rules changed in November 2018, when smoke-free policies were introduced in all prisons in Scotland, in part in response to evidence on SHS levels measured in the NIHR-funded Tobacco in Prisons Study. But what do we know about the impact of this major change on air quality in prisons, and why is it important?

SHS is linked to many illnesses, including cardiovascular disease, cancer, and chronic obstructive pulmonary disease. The World Health Organization estimates that the 1 billion individuals who smoke worldwide contribute to the 880?000 SHS-related deaths among non-smokers each year. 

Evaluating air quality

In the first study to evaluate changes in SHS concentrations across all prisons in a country that was planning to introduce a national smoke-free prison policy, NIHR-funded researchers set out to compare SHS concentrations in the air before and after the change came into force.

 The team, led by Professor Kate Hunt at the University of Stirling, used air quality monitors to rigorously measure SHS exposure over a six-day period in a residential area of each of the 15 prisons in Scotland in autumn 2016. At that time, the results showed that staff in Scottish prisons inhaled roughly the same amount of SHS as a non-smoker living in a household where someone smokes at home.

 The team compared the data collected in 2016 to SHS concentrations observed immediately before and after the introduction of the new restrictions in prisons in 2018, and again in 2019 – six months after the smoke-free policy was implemented - to report on the changes in air quality and inform practical policies to protect prison staff and people in custody.

Significant improvement in air quality

The data show that in the week after the introduction of the smoke-free policy in Scotland’s prisons, there was a reduction in the concentrations of SHS of over 80%. This significant and substantial effect on indoor PM2.5 concentrations (levels of fine particles found in the air), demonstrated just how dramatically air quality can improve in a short space of time following the implementation of a total smoke-free policy. Measures made in 2019 showed a lasting improvement, with PM2.5 concentrations reduced by around 90% in comparison with 2016.

Professor Kate Hunt, Professor of Behavioural Science and Health at the University of Stirling, and study Chief Investigator, said “As shown in ongoing analyses, the immediate and sustained improvement in air quality in prisons will benefit the health and wellbeing of people living and working in prisons. In detailed interviews and focus groups discussions, prison staff and people in custody expressed surprise at how quickly smoke-free prisons had been accepted as the ‘new normal’ and that the transition was largely trouble-free.

“People also recognised the challenges, particularly for some groups of those in custody. Views expressed about what can support such changes could be valuable in other countries which still allow smoking in prisons.

The study provides a good model for partnership-working, as we were able to share research findings on an ongoing basis so the prison service and NHS had independent data on measures of SHS, and on staff and prisoner views to inform their preparations for implementing this major policy change and sense-check their progress.

Impacts and health benefits

On July 17 2017 – when the Scottish Prison Service (SPS) announced changes to its tobacco control strategy with complete restrictions on smoking in all prisons in Scotland to take effect from November 30 2018 - it cited this research study as part of the reason to act.

The research also included extensive survey and detailed qualitative research with people in custody and prison staff, which helped to support the process of implementing a challenging policy change.

The research team continues to work in partnership with The Scottish Government, NHS Boards and the SPS to develop guidance in this area, such as the NHS Health Scotland report ‘Supporting individuals to cut down and quit vaping. Guidance for NHS Quit Your Way advisers based in prisons.’ They will publish data on health-related outcomes in 2021.

Debbie Sigerson, Organisational Lead for Tobacco in NHS Health Scotland said: “Smoking rates in prisons were much higher than they are outside. It was anticipated that creating a smoke free environment in prison would contribute to addressing this health inequality, and that the health of people who live and work there would be improved.

We are delighted that the results from this study show that one factor that impacts on that harm – exposure to second hand smoke – has significantly reduced. Everyone has a right to live in a smoke free Scotland and today’s results show that we are one step further along the way to getting there.

The study, ‘The impact of implementation of a national smoke-free prisons policy on indoor air quality: results from the Tobacco in Prisons Study’, also involved a multidisciplinary team of researchers including Dr Sean Semple, Associate Professor and Ashley Brown, Research Fellow at the ISMH, and Dr Helen Sweeting and Dr Evangelia Demou, Reader at the Institute of Health and Wellbeing at the University of Glasgow. The team worked with the SPS and NHS colleagues in the design of the study.

More reading

Read about the project on NIHR Funding and Awards
Read blog, by Dr Sean Semple and Kate Hunt: Breathing second-hand smoke at work – finally a thing of the past for prison staff in Scotland

Read more making a difference stories.