Prison smoking bans in the United States: current policy, impact and obstacle

Smoking is the leading preventable risk factor of mortality in the United States. The threat of smoking is severer in prisons. Compared with the general US population, prisoners have a higher prevalence of smoking, as well as a higher smoking-related mortality. Nowadays, smoking bans have been enacted in 49 states’ federal correctional facilities, including 100% smoke-free and tobacco-free indoors and outdoors on all grounds (20 states), 100% smoke-free indoors and outdoors on all grounds (1 state), 100% smoke-free and tobacco-free indoors (16 states), and 100% smoke-free indoors (12 states). After implementation, a mortality reduction has been achieved, especially for cancers and respiratory diseases. In addition, a more comprehensive restriction (e.g., smoking and tobacco bans indoors and outdoors) and a longer implementation contribute to a higher reduction of mortality. However, some obstacles should not be ignored, such as the high relapse rate of smoking after release, existence of smoking in smoking-free prisons, nicotine dependence and nicotine withdrawal symptoms led by the bans, potentially high prevalence of mental illnesses among prisoners who also smoke, etc. Given the impact and obstacle of the current smoking bans, the author recommends that: (I) smoking bans should be kept enacting according to the mortality reduction after implementation; (II) more restrictive bans should be considered across the U.S. States, such as smoking-free insides and outsides on the ground; (III) further efforts should be made for reducing the high relapse rate of smoking after release; (IV) other implementations combining with smoking bans should be considered for smoking inmates with mental illnesses.