Economic evaluation of the smoking ban in Scottish prisons

A study of the 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 heavily smoked, with people from very poor backgrounds. Estimated to be between two and eight times higher than the general population, smoking prevalence in Scottish prisons was 68% in 2017, four times higher than the regional rate. 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

On the occasion of a smoking ban in Scottish prisons in November 2018, a study assessing the different costs and benefits of this policy was conducted by a team of researchers using data collected before and after the implementation of this ban.[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 prisoners, number of fires, number of deaths in detention, number of incidents related to substance use) were taken into account. Beyond the air quality measurements, the cost-effectiveness and cost-utility analyses took into account, for both the staff working in detention and the prisoners, 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 some 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. Prisoners 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 the savings on tobacco are partly returned to electronic cigarette equipment.

Over the life course, the benefits should nevertheless be greater for prisoners, provided that their smoking abstinence continues after release; an indirect impact on the smoking behaviour of those around prisoners is also expected, subject to confirmation. The overall savings made over the life course (care, tobacco purchases) by prisoners and staff are estimated at £200 million, based on a life expectancy of 70 years. While the costs of e-cigarettes have been included, the lifetime benefits have not been 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.) have also not been 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 prisoners in the short term. The study shows the economic interest of this type of measure and highlights that it is essential to take into account a large number of parameters when evaluating it. The cost-utility ratio, which estimates the relevance and profitability of a measure, seems more reliable when it is supplemented by a cost-consequence ratio, which evaluates the impact of this measure on the quality of life of the people concerned.

Keywords: Scotland, prisons, prisoners, prison staff, cost-effectiveness, non-smoking policy.

©Tobacco Free Generation

M.F.

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[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 |