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The impact of implementation of a national smoke-free prisons policy on indoor air quality: results from the Tobacco in Prisons study.

ABSTRACT: OBJECTIVE:To determine secondhand smoke (SHS) concentrations in prisons during the week of implementation of a new, national prisons smoke-free policy. DESIGN:Repeated measurement of SHS concentrations immediately before and after implementation of smoke-free policies across all 15 prisons in Scotland, and comparison with previously gathered baseline data from 2016. METHODS:Fine particulate matter (PM2.5) measurements at a fixed location over a continuous 6-day period were undertaken at the same site in each prison as previously carried out in 2016. Outdoor air quality data from the nearest local authority measurement station were acquired to determine the contribution of outdoor air pollution to indoor prison measurement of PM2.5. RESULTS:Air quality improved in all prisons comparing 2016 data with the first full working day postimplementation (overall median reduction -81%, IQR -76% to -91%). Postimplementation indoor PM2.5 concentrations were broadly comparable with outdoor concentrations suggesting minimal smoking activity during the period of measurement. CONCLUSIONS:This is the first evaluation of changes in SHS concentrations across all prisons within a country that has introduced nationwide prohibition of smoking in prisons. All prisons demonstrated immediate substantial reductions in PM2.5 following policy implementation. A smoke-free prisons policy reduces the exposure of prison staff and prisoners to SHS.

SUBMITTER: Semple S

PROVIDER: S-EPMC7036294 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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The impact of implementation of a national smoke-free prisons policy on indoor air quality: results from the Tobacco in Prisons study.

Semple Sean S Dobson Ruaraidh R Sweeting Helen H Brown Ashley A Hunt Kate K

Tobacco control 20190507 2

<h4>Objective</h4>To determine secondhand smoke (SHS) concentrations in prisons during the week of implementation of a new, national prisons smoke-free policy.<h4>Design</h4>Repeated measurement of SHS concentrations immediately before and after implementation of smoke-free policies across all 15 prisons in Scotland, and comparison with previously gathered baseline data from 2016.<h4>Methods</h4>Fine particulate matter (PM<sub>2.5</sub>) measurements at a fixed location over a continuous 6-day p ...[more]

PMID: 31064866

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Project description:BackgroundInternationally, smoking prevalence among people in prison custody (ie, people on remand awaiting trial, awaiting sentencing, or serving a custodial sentence) is high. In Scotland, all prisons implemented a comprehensive smoke-free policy in 2018 after a 16-month anticipatory period. In this study, we aimed to use data on medication dispensing to assess the impact of this policy on cessation support, health outcomes, and potential unintended consequences among people in prison custody.MethodsWe did an interrupted time-series analysis using dispensing data for 44 660 individuals incarcerated in 14 closed prisons in Scotland between March 30, 2014, and Nov 30, 2019. We estimated changes in dispensing rates associated with the policy announcement (July 17, 2017) and full implementation (Nov 30, 2018) using seasonal autoregressive integrated moving average models. Medication categories of primary interest were treatments for nicotine dependence (as an indicator of smoking cessation or abstinence attempts), acute smoking-associated illnesses, and mental health (antidepressants). We included antiepileptic medications as a negative control.FindingsA 44% step increase in dispensing of treatments for nicotine dependence was observed at implementation (2250 items per 1000 people in custody per fortnight, 95% CI 1875 to 2624) due primarily to a 42% increase in dispensing of nicotine replacement therapy (2109 items per 1000 people in custody per fortnight, 1701 to 2516). A 9% step decrease in dispensing for smoking-related illnesses was observed at implementation, largely accounted for by respiratory medications (-646 items per 1000 people in custody per fortnight, -1111 to -181). No changes associated with announcement or implementation were observed for mental health dispensing or antiepileptic medications (control).InterpretationSmoke-free prison policies might improve respiratory health among people in custody and encourage smoking abstinence or cessation without apparent short-term adverse effects on mental health dispensing.FundingNational Institute of Health Research Public Health Research programme, Scottish Government Chief Scientist Office, and UK Medical Research Council.

Project description:BackgroundSmoke-free policies shown to reduce population exposure to secondhand smoke (SHS) are the norm in hospitals in many countries around the world. Armenia, a transition economy in the South Caucasus, has one of the highest male smoking rates in the European region. Although smoking in healthcare facilities has been banned since 2005, compliance with this ban has been poor due to lack of implementation and enforcement mechanisms and social acceptability of smoking. The study aimed to develop and test a model intervention to address the lack of compliance with the de jure smoking ban. The national oncology hospital was chosen as the intervention site.MethodsThis study used employee surveys and objective measurements of respirable particles (PM2.5) and air nicotine as markers of indoor air pollution before and after the intervention. The intervention developed in partnership with the hospital staff included an awareness campaign on SHS hazards, creation of no-smoking environment and building institutional capacity through training of nursing personnel on basics of tobacco control. The survey analysis included paired t-test and McNemar's test. The log-transformed air nicotine and PM2.5 data were analyzed using paired t-test.ResultsThe survey showed significant improvement in the perceived quality of indoor air, reduced worksite exposure to SHS and increased employees' awareness of the smoke-free policy. The number of employees reporting compliance with the hospital smoke-free policy increased from 36.0% to 71.9% (p < 0.001). The overall indoor PM2.5 concentration decreased from 222 ?g/m3 GM (95% CI = 216-229) to 112 ?g/m3 GM (95% CI = 99-127). The overall air nicotine level reduced from 0.59 ?g/ m3 GM (95% CI = 0.38-0.91) to 0.48 ?g/ m3 GM (95% CI = 0.25-0.93).ConclusionsThe three-faceted intervention developed and implemented in partnership with the hospital administration and staff was effective in reducing worksite SHS exposure in the hospital. This model can facilitate a tangible improvement in compliance with smoke-free policies as the first step toward a smoke-free hospital and serve as a model for similar settings in transition countries such Armenia that have failed to implement the adopted smoke-free policies.

Project description:Winter air pollution in Ulaanbaatar, Mongolia is among the worst in the world. The health impacts of policy decisions affecting air pollution exposures in Ulaanbaatar were modeled and evaluated under business as usual and two more-strict alternative emissions pathways through 2024. Previous studies have relied on either outdoor or indoor concentrations to assesses the health risks of air pollution, but the burden is really a function of total exposure. This study combined projections of indoor and outdoor concentrations of PM2.5 with population time-activity estimates to develop trajectories of total age-specific PM2.5 exposure for the Ulaanbaatar population. Indoor PM2.5 contributions from secondhand tobacco smoke (SHS) were estimated in order to fill out total exposures, and changes in population and background disease were modeled. The health impacts were derived using integrated exposure-response curves from the Global Burden of Disease Study.Annual average population-weighted PM2.5 exposures at baseline (2014) were estimated at 59 ?g/m3. These were dominated by exposures occurring indoors, influenced considerably by infiltrated outdoor pollution. Under current control policies, exposures increased slightly to 60 ?g/m3 by 2024; under moderate emissions reductions and under a switch to clean technologies, exposures were reduced from baseline levels by 45% and 80%, respectively. The moderate improvement pathway decreased per capita annual disability-adjusted life year (DALY) and death burdens by approximately 40%. A switch to clean fuels decreased per capita annual DALY and death burdens by about 85% by 2024 with the relative SHS contribution increasing substantially.This study demonstrates a way to combine estimated changes in total exposure, background disease and population levels, and exposure-response functions to project the health impacts of alternative policy pathways. The resulting burden analysis highlights the need for aggressive action, including the elimination of residential coal burning and the reduction of current smoking rates.

Dataset Information

The impact of implementation of a national smoke-free prisons policy on indoor air quality: results from the Tobacco in Prisons study.

Publications

The impact of implementation of a national smoke-free prisons policy on indoor air quality: results from the Tobacco in Prisons study.

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