Short communicationSmoking among female prisoners: An ignored public health epidemic
Introduction
Compared to the general population, correctional populations are disproportionately affected by health problems, including substance abuse, infectious diseases, and medical and psychiatric problems Ditton, 1999, Hammett et al., 1999, Maruschak & Beck, 2001, Mumola, 1999. One area that has been particularly underresearched among correctional populations is cigarette smoking. Few studies document the prevalence of smoking in prison, although the National Commission on Correctional Health Care (NCCHC; n.d.) estimates that 80% of inmates smoke cigarettes. Several studies have found similar rates of smoking in prison populations Conklin et al., 2000, Colsher et al., 1992, Martin, 1984.
Given the high rates of smoking in correctional populations, it is not surprising that this population also has high rates of cardiovascular disease, cancer, and other smoking-related problems (NCCHC, n.d.). Although 88% of inmates are younger than 50, one in six reports a serious medical problem. The most common problems are smoking related, including heart problems, circulatory and respiratory problems, kidney and liver problems, and diabetes (Maruschak & Beck, 2001). Medical costs for inmates account for 11% of state correctional budgets and are expected to double in the next 10 years (Lamb-Mechanick & Nelson, 2000), with smoking-related disease making a substantial contribution to this rise in medical costs.
Despite these high rates of smoking in correctional facilities and the high personal and institutional costs for smoking-related illnesses, there is a dearth of information on institutional responses to smoking in correctional facilities in the United States. About 90% of state prisons restrict smoking to designated areas (Vaughn & del Carmen, 1993) and 10 states have banned smoking completely in their correctional facilities (Smuck, 2002). In terms of treatment interventions, only one behavioral study (Edinger, Nelson, Davidson, & Wallace, 1978) and no pharmacological studies have been reported with this population. The one behavioral study had serious methodological limitations, including attrition during treatment, small sample size, and no biological verification of treatment outcomes (Edinger et al., 1978). Interestingly, since this study in 1978, no other smoking cessation interventions in correctional systems have been reported in the literature despite an explosion in smoking-related interventions with other populations.
The purpose of the present study was to investigate smoking behavior and smoking-related disease and financial burden among incarcerated women prior to the development of a smoking cessation intervention for women at a state prison in Mississippi. Since little is known or understood about smoking in a prison environment, particularly among female inmates, this study was designed to give a baseline picture of smoking and receptivity to a smoking cessation intervention at the prison. It was expected that the majority of women would be current smokers or would use other tobacco products. In addition, it was expected that a subset of women would be interested in participating in a smoking cessation or reduction program.
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Participants
The 866 women surveyed were inmates at Central Mississippi Correctional Facility (CMCF), the only state correctional facility for women in Mississippi. See Table 1 for demographic information.
Procedure and measures
The entire female inmate population of CMCF was surveyed in October 1999. Because the Mississippi Department of Corrections (MDOC) conducted the survey for internal program development, IRB approval was not obtained prior to data collection. Participants did not sign a consent form; however, consistent
Tobacco users
Of the 866 women surveyed, 639 (73.9%) were current tobacco users; 66 (7.6%) were former users and 160 (18.5%) had never used tobacco. The mean duration of use was 165.1 months (S.D.=112.4; range 1 to 720 months) and 56.8% had used tobacco for more than 10 years (see Table 2). There were no differences in tobacco use based on education level; however, there were significant racial/ethnic differences (χ2=18.2, df=4, P<.001). White women were more likely to be current users than African American
Discussion
Consistent with estimates of smoking from the NCCHC (n.d.), 71.5% of female inmates at a state prison for women in Mississippi were current cigarette smokers—a rate three times higher than estimates of smoking prevalence among females over the age of 18 in the general population [U S Department of Health and Human ServiceUSDHHS USDHHS 2001]. The average amount smoked per day (14.6 cpd) was similar to estimates of smoking among women in the general population, which range from 16.1 to 11.0 cpd
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