Relapse to smoking following release from smoke-free correctional facilities in Queensland, Australia

Highlights • 94% of ex-smokers resumed smoking after release from smoke-free prisons. • 72% of these prior smokers resumed smoking on the day of release from prison. • Most were smoking less per day than before entering smoke-free prisons. • Tailored smoking cessation interventions are needed for those leaving prison. • Such interventions should include behavioral counselling and pharmacotherapy. Abstract Background: Smoke-free prison policies are increasingly common, but few studies have investigated relapse to smoking after release from prison. This study investigated return to tobacco smoking and correlates of smoking at reduced levels after release among adults recently released from smoke-free prisons in Queensland, Australia. Methods: A cross-sectional survey of 114 people at parole offices within two months of release from prison was used. The survey measured health, social, and criminological factors related to tobacco smoking. We used logistic regression to identify factors associated with reduced post-release smoking levels compared to pre-incarceration levels. Results: 94% of participants relapsed to smoking within two months of release; 72% relapsed on the day of release. 62% of participants smoked significantly less per day after compared with before incarceration. Living with a partner (Odds Ratio (OR) 2.77, 95%CI 1.02–7.52), expressing support for smoke-free prison policies (OR 2.44, 95%CI 1.12–5.32), intending to remain abstinent post-release (OR 4.29, 95%CI 1.88–9.82), and intending to quit in the future (OR 3.88, 95%CI 1.66–9.07) were associated with reduced smoking post-release. Use of illicit drugs post-release was negatively associated with reduced smoking post-release (OR 0.27, 95%CI 0.09–0.79). In multivariate analyses, pre-release intention to remain smoke-free was associated with reduced smoking post-release (AOR 2.69, 95%CI 1.01–7.14). Discussion: Relapse to smoking after release from smoke-free prisons is common, but many who relapse smoke