No smoker left behind: it’s time to tackle tobacco in Australian priority populations

In reply:

Our article stated that smoke-free policies can be feasibly introduced into prisons, and there is evidence that they reduce smoking in these facilities.1 Smoke-free prisons have become the norm in Australia due to a number of advantages (in addition to reducing prisoner smoking), such as reducing exposure to second-hand smoke for prison staff and prisoners, changing the smoking permissive culture within prisons, and assisting with relapse prevention for those interested in quitting by eliminating triggers and cues to smoke. The prison environment used to perpetuate smoking behaviours, with smokers increasing the amount they smoked following imprisonment.2 Some prisoners may be in correctional facilities for years, and thus smoke-free prisons give them a long term chance to free themselves of the physical addiction and the smoking norms.

Recognising the value of smoke-free prisons, as Puljević and Kinner do in their letter, does not preclude assisting ex-prisoners to sustain cessation once they leave the correctional facility. We agree with Puljević and Kinner that people leaving the prison system often return to smoking after release — partly due to inadequate smoking cessation support — and that support after release should be provided. The comprehensive approach to tobacco control includes population measures, such as smoke-free policies, together with evidence-based cessation support. We agree that further research is required to identify the most effective mechanism for helping ex-prisoners in sustaining their smoking cessation attempt, just as previous research identified core elements for cessation support inside prisons when smoking was still allowed.3

While the period after the release from prison is crucial for sustaining the abstinence achieved during imprisonment, we argue that broader efforts across priority populations over-represented in prisons are also required before people are incarcerated. Indigenous Australians, illicit drug users, people with mental health concerns, and low income groups experience incarceration and smoking rates higher than in the total Australian population. Providing smoking cessation support through community-based support services will reach these groups and will help support them to sustain abstinence. It is a public health prime concern to provide smoking cessation support to smokers in priority populations, both within institutional settings and in the community.4