OP66 Opinions and experiences of a national smokefree prison policy: evidence from the tobacco in prisons study

Background A national smokefree prison policy was implemented in Scotland from November 2018. The removal of tobacco from a prison system poses some distinct potential challenges, not least because prisons are ‘homes’ and rates of smoking in the prison population are very high. The Tobacco In Prisons study (TIPs) is internationally unique in comprehensively studying the introduction of restrictions on smoking in Scottish prisons, using data collected before, during and after the change to prison smoking policy. This paper presents opinions and experiences of prison smoking restrictions among people in custody (prisoners) and staff in Scotland, and identifies implementation success factors and lessons that are highly relevant for other jurisdictions and areas of public health. Methods Surveys of staff (online) and people in custody (paper-based) were conducted in November-December 2016 (return rates: 26.6% (staff); 33.8% (people in custody)); May-July 2018 (31.4%; 25.9%) May-July 2019 (16.1%; 18.1%). The surveys contained identical or similar questions on topics related to smoking, smoking cessation/abstinence and smoking restrictions in the prison context. Topics were also explored qualitatively with staff and people in custody at similar time points to the surveys via 34 focus groups and 99 interviews in total. Changes in survey responses over time were analysed using descriptive statistics and logistic regression analyses, adjusting for potentially confounding socio-demographic variables. Qualitative data were thematically analysed to identify the diversity of views and experiences. Results The new smokefree policy is widely accepted as the new ‘norm’ in Scottish prisons, although support was consistently higher among staff than people in custody before, during and after implementation. Both the surveys and qualitative work suggest that perceptions of some of the potential difficulties (‘hard to enforce’) and negative consequences (‘cause a lot of trouble’) of a smokefree prison policy reduced post implementation. Participants identified several implementation success factors relating to: planning and communication, smoking abstinence/cessation products/services, and partnership working. Conclusion Our study confirms that smokefree prison polices can be successfully implemented, despite widespread concerns, providing that the removal of tobacco is well managed and enhanced support measures are available for smokers. Some of the general factors shaping the successful introduction of smokefree prisons in Scotland are relevant to other areas of public health transformation e.g. setting clear objectives and timescales; collaboration and teamwork; and involving staff at all levels and end-users in change processes.