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Systematic Review of Factors Influencing Smoking Following Release from Smoke-free Prisons.

Introduction
Given the current proliferation of prison smoke-free policies internationally, and the multiple benefits of continued smoking abstinence for correctional populations, improved understanding of factors influencing post-release smoking abstinence is required to inform support strategies aimed at individuals exiting smoke-free prisons.


Methods
We systematically searched health, social science, and criminal justice databases for studies relating to smoking behaviours among people released from smoke-free prisons. Studies were included if: they were published between 1 January 2000 and 26 July 2017; they were published in English; the population was people who were incarcerated or formerly incarcerated in prisons with total smoke-free policies; and the reported outcomes included measures of: i) pre-release intention to smoke or remain abstinent from smoking following release, ii) smoking relapse or abstinence following release, or iii) quit attempts following post-release smoking relapse. Both authors independently screened returned citations to assess eligibility and reviewed studies for methodological quality using the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies.


Results
Fifteen of 121 publications were included. The evidence base in this area is small, almost exclusively US-based, and is mostly methodologically weak. Interventions delivered both pre- and post-release, that strengthen intention to quit, integrate with other substance use treatment, and facilitate social support for quitting may help maintain post-release smoking abstinence.


Conclusions
There is an urgent need for high-quality research to inform interventions to reduce high smoking relapse rates upon release from smoke-free prisons, to extend the multiple benefits of continued smoking abstinence into the community.


Implications
Interventions designed to help people remain abstinent from tobacco following release from smoke-free prisons are an important opportunity to improve the health, finances and well-being of this vulnerable population.