The rate of incarceration in the United States has grown steadily since the mid-1970s to a point where 1% of American adults are currently being held in jails and prisons. Prisoners are sicker than the general population with a high prevalence of many negative health behaviors. Tobacco use is one such behavior, with past surveys finding that up to 85% of prisoners smoke. The Smoking and Tobacco in Ohio Prisons (STOP) Project was undertaken to examine the impact of incarceration on smoking behaviors and lay the groundwork for further research into tobacco use in prisons. A total of 200 recently-arrived male inmates, drawn from two Ohio prisons, were surveyed about their tobacco use.
Several measures of tobacco use were evaluated as part of the study. Self-reports were found to be a valid measure of tobacco use in the sample, based on biomarker confirmation (sensitivity = 98.5%, specificity = 88.9%). Carbon monoxide breath tests were less valid (sensitivity = 85.4%, specificity = 91.7%), especially among occasional smokers; however, as a non-invasive, inexpensive way of measuring short-term smoking they may still offer a useful measure in some research contexts. Using an enzyme immunoassay to measure salivary cotinine offers a less-expensive alternative to the gold standard liquid chromatography tandem mass spectrometry, however the current study found that economic savings are moderated by false-positive results (sensitivity = 94.2%, specificity = 100.0%).
The prevalence of current tobacco use was high prior to (77.5%) and during incarceration (82.0%). While entry into the prison was found to be associated with increases in the number of smokers, average cigarette consumption declined from 15.7/day to 8.6/day (p < 0.001). Smokeless tobacco use, including dual use of cigarettes and smokeless tobacco, increased following incarceration, especially among those sentenced from Appalachian counties. The tobacco use survey also exposed a gap between prison policy and prisoners' practice. A majority of smokers (51.2%) reported smoking indoors at least once since their arrival, and more than a third (34.1%) reported that they smoked inside on a daily basis. Despite widespread tobacco use among prisoners, a majority of users (70%) expressed a desire to quit smoking, indicating a high demand for effect cessation assistance.
Preliminary data were collected on participants' adverse childhood experiences (ACEs) using an audio computer-assisted self-interview system. Response rates for these questions, which covered sensitive topics including sexual abuse and household dysfunction, were high (>97%). Past studies in the general population have linked ACEs to smoking behavior. Non-significant trends in the current study suggest the existence of a similar relationship in incarcerated populations, however the limited sample size does not allow for the clear demonstration of an association.