Economic evaluation of the smoking ban in Scottish prisons

A study of the various costs and benefits of implementing a smoke-free policy in prisons in Scotland indicates short- and long-term benefits for both prisoners and staff.

The prison population is one of the most frequent smokers, with its members coming primarily from very poor backgrounds. Estimated to be between two and eight times higher than that of the general population, smoking prevalence in Scottish prisons was 68% in 2017, four times higher than that of the region. However, smoking in prisons has a significant impact on the health of both prisoners and staff, due to the omnipresence of tobacco smoke.[1].

A first study of this kind in a prison environment

Following a smoking ban in Scottish prisons in November 2018, a study assessing the various costs and benefits of this policy was conducted by a team of researchers using data collected before and after the ban was implemented.[2]Three levels of analysis were determined: a cost-consequence analysis, which assesses a broad range of the consequences of this measure, a cost-effectiveness analysis, particularly in terms of air quality, and a cost-utility analysis, in terms of quality of life. While cost-effectiveness studies of such measures have been conducted in other settings, this one, conducted over twelve months, is the first of its kind in a closed prison environment.

Among the cost-consequence indicators, health criteria (assessed by the Euro-Qol-5D questionnaire) and other non-health criteria (number of attacks on staff or between inmates, number of fires, number of deaths in custody, number of incidents related to substance use) were taken into account. Beyond air quality measurements, the cost-effectiveness and cost-utility analyses took into account, for both staff working in detention and inmates, the cost of implementing the measures and the costs of the study itself. Long-term projections were also carried out.

Higher benefits for prison staff than for inmates

The results show a significant decrease in most medical costs (emergency or psychiatric hospitalizations, accidents, doctor visits, treatment of tobacco pathologies) and an increase in others (ambulance transport, nicotine treatments, medical visits). Exposure to tobacco smoke has fallen sharply. Staff are the first to benefit from this smoking ban policy. Inmates seem to have experienced this measure less well and the benefits they derive from it are more mixed in the short term; the gains in terms of health are offset by anxiety and depression scores, and savings on tobacco are partly used for e-cigarette equipment.

Over the life course, the benefits should nevertheless be greater for prisoners, provided that their smoking abstinence continues after release from prison; an indirect impact on the smoking behavior of those around prisoners is also expected, subject to confirmation. The overall lifetime savings (healthcare, tobacco purchases) for prisoners and staff are estimated at £200 million, based on a life expectancy of 70 years. While the costs of e-cigarettes were included, lifetime benefits were not included by the authors, as the consequences of long-term use of these devices are not yet known; moreover, the intensive consumption patterns of e-cigarettes by the prison population suggest greater long-term consequences than for other groups. Finally, the general costs and benefits for the prison administration (insurance, building maintenance, fire damage, etc.) were also not included.

Ultimately, it appears that the introduction of a smoking ban in prisons is generally beneficial in both the short and long term, with staff benefiting more than inmates in the short term. The study demonstrates the economic benefits of this type of measure and emphasizes that it is essential to consider a large number of parameters when evaluating it. The cost-utility ratio, which estimates the relevance and profitability of a measure, appears to be more reliable when supplemented by a cost-consequence ratio, which assesses the impact of this measure on the quality of life of the individuals concerned.

Keywords: Scotland, prisons, inmates, prison staff, cost-effectiveness, smoke-free policy.

©Generation Without Tobacco

MF

---

[1] Passive smoking in prison, Tobacco-Free Generation, published December 27, 2019, accessed March 8, 2022. [2] McMeekin N, Wu O, Boyd K, Brown A, Tweed E, Best C, Craig P, Leyland A, Demou A, Byrne T, Pell J, Semple S, Sweeting H, Graham L, Hunt K, Implementation of a national smoke-free prison policy: an economic evaluation within the Tobacco in Prisons (TIPs) study, Tob Control, Epub ahead of print: March 8, 2022, doi:10.1136/tobaccocontrol-2021-056991. National Committee Against Smoking |