The results from these studies should inform policies to help minimise or eliminate the exposure of nonsmokers to tobacco smoke in exempt premises.
Prisons are seen as sensitive workplaces where every attempt to pacify inmates and protect workers is taken and as such require special attention when implementing a no-smoking policy. Tobacco use can be seen as an integral part of prison life and prison culture. It serves a range of functions including a means of social control, as a surrogate currency, as a symbol of freedom and in a group with few rights and privileges, a stress reliever and a social lubricant [4
]. Smoking prevalence is much higher among the prisoners than the general population. The General Health Care Study of the Irish Prison Population in 2000, estimated that 91% of men were current smokers and up to 100% of women were smokers. A letter published by O'Dowd [5
] in the British Medical Journal (BMJ) said that doctors, nurses, prison officers, and other staff would face a greater risk of assault if smoking were to be banned in such environments. Enforcing a complete blanket ban on smoking tobacco products in prisons could potentially create a bigger risk to staff and could result in potential riotous behaviour by prisoners, increase in injuries and assaults to staff, a view confirmed by the survey results presented here. The Irish Prison Smoking Policy states that there is such a value placed on cigarettes and tobacco products as a means of currency, that if they become contraband this would rival the existing drugs culture resulting in inmate discord causing an increase in the levels of assaults and violence amongst the prisoners themselves. Prisons have experienced riots when placing smoking bans into effect resulting in prisoners setting fires, destroying prison property, and persons being assaulted and injured. Such an incident occurred in Quebec (Canada) in February 2008, where a smoking ban enforced on 18 prisons was subsequently reversed following rioting by prisoners in these prisons.
The results of an inquiry on smoking bans in European prisons revealed that 22 (79%) out of 28 respondents (EU Member States plus Switzerland and Monaco) have introduced smoking bans in all of their prisons. The Irish Prison Officer Association (POA) health and safety coordinator Nigel Mallen claimed that the Government did not look hard enough to find ways of enforcing the ban in prisons. 3,150 members of the POA were prepared to challenge the constitutionality of the exemption of the ban in their workplaces. The working group appointed by the Director of Human Resources for the Irish Prison Service published a smoking policy in 2006 identifying prison recreational halls and circulation areas as the greatest risk of exposure to passive smoking for both staff and inmates. This working group also declared that limiting smoking to outside recreation yards and cellular accommodation may prove to be the most practical way to work towards a smoke-free prison environment. However, it was stated that this would still create major operational and management difficulties and therefore to minimise the impact, such restrictions would need to be implemented on a phased basis. Prison establishments or holding units for juveniles (persons under 18 years of age) must be entirely smoke-free environments, with smoking prohibited. Therefore, the policies adopted in such facilities should be applied to policies in all adult prisons.
Smoking bans in prisons must be implemented concurrently with cessation services appropriate for the client group which offer the prospect of long-term cessation. Better management of smoking in prisons should ensure that nonsmoker prisoners are not subjected to SHS in cells. In addition, nonsmoking prisoners need to be supported to prevent them starting smoking while in prison.
In England, two preventive programmes, the Acquitted programme and a nicotine replacement therapy programme were developed which offered prisoners group or one-to-one counselling and NRT with nicotine patches or Bupropion (Zyban), free of charge. An evaluation of the programmes between April 2004 and March 2005 in 16 prisons found the average quit rate for 4 weeks was 41%, validated by carbon monoxide monitoring. Results such as this highlight the huge potential in using smoking cessation programmes in prisons. However the results from this study show that prison officers are exposed to SHS in the workplace, and that 44% of nonsmoking prison officers have exhaled CO levels that would classify them as active smokers; these CO levels are slightly above those reported in Dublin bar staff before the smoking ban [6
]. These results show that there is scope for improvement and to reduce staff exposure to SHS. This could potentially be achieved by having designated outdoor smoking areas.
9.1. SHS Particulate Exposures
In a study of ultrafine airborne particulates in 12 Dublin pubs prior to the workplace smoking ban coming into force, concentrations on occasions reached 250,000 per cm3
with an overall average of approximately 85,000 per cm3
. Before the ban the typical concentrations in pubs were approximately 20,000 particles per cm3
with maximum values of around 80,000 per cm3
]. The results from this study in psychiatric hospitals above show the average ultrafine particle concentrations (130,000 per cm3
) almost twice as high as the levels in a Dublin pub before the ban and 6.5 times higher than a Dublin pub in the postban period. This shows beyond any doubt that excessive SHS levels prevail in some of the psychiatric hospitals, and that both staff and residence are at risk of excessive exposures, and clearly warrant some significant changes in practices to protect staff and nonsmoking residents.
In comparing the PM2.5
results in the psychiatric hospitals to the results of a study of PM2.5
levels in Dublin pubs [6
], psychiatric hospital levels (39.45μ
) are similar to the Dublin pubs before the introduction of the smoking ban (35.5μ
). However these PM2.5
levels in psychiatric hospitals (39.46μ
) are 8 times higher than the Dublin pub levels after the implementation of the ban (4.8μ
), showing that current levels in psychiatric hospitals are significantly greater that current levels in pubs. Again the results from the nursing homes (33μ
) are consistent with the levels observed in Dublin pubs prior to the smoking ban (35.5μ
For the purpose of putting these exposure levels in the nursing homes and psychiatric hospitals into context we compare them with levels measured by McLaughlin et al. [8
] and Hogg [10
] within 33 Irish dwellings during 2005-2006. The results found that dwellings with smokers present had an average ultrafine particle level of 42,700 particles per cm3
, while dwellings with only nonsmokers had an average ultrafine particle level of 16,500 particles per cm3
. Comparing these results to the levels in the psychiatric hospitals and nursing homes, the average particle concentration in an exempted psychiatric hospital (130,000 per cm3
) is more than 3 times the particle concentration found in selected Irish dwellings with smokers resident, and almost 8 times that of dwellings with only nonsmokers resident.
9.2. Nicotine Levels
Although we only present limited nicotine exposure data, there is clear evidence that nicotine levels in nursing home that allow smoking are significantly greater than in those where smoking is banned. Likewise the nicotine levels from the psychiatric hospitals and the nursing homes are extremely high and are consistent, if not higher than those from other published studies from pubs before smoking bans, [11