Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type






First Advisor

Dr. Ellen Hahn


This study was the first to examine the effect of tobacco policies in prisons on the health of inmates. Kentucky has two types of tobacco policies in its 16 state prisons: indoor smoke-free policies, where smoking is allowed outdoors and tobacco-free policies, in which no tobacco of any kind is allowed on the grounds of the prison. The smoking rate of inmates is three times higher than that of current smokers in the non-incarcerated population which results in high rates of tobacco-related health conditions such as heart disease and lung cancer.

A literature review discussed the evolution of tobacco policies in prisons , the motivations for strengthening policies in prisons and the unintended consequences. Health outcomes in the non-incarcerated population on the benefits to cardiovascular and respiratory health following passage of smoke-free laws in public places were reviewed. No studies have been found on the health outcomes of inmates with varying degrees of smoke-free or tobacco-free policies.

The first study was a time series analysis comparing the frequency of medication refills for asthma and/or COPD before and after a tobacco-free policy was implemented. Short-acting inhaler refills decreased in the first few months following the tobacco-free policy date but returned to baseline within 12 to 15 months. Rapid turnover of inmates, minimum security status of the prisons, and possible loosening of enforcement may have been related to the gradual increase in use.

The second study was a survival analysis on the time to an inmate’s first acute myocardial infarction (AMI) with tobacco policy status (tobacco-free or smoke-free) of the prison as the primary predictor variable. Controlling for the multiple movements over time, facilities, co-morbidities, past smoking history, age and race, there was a 2.87 hazard for AMI for time spent in a smoke-free (indoors) prison compared to a tobaccofree prison. This finding may be due to the fact that tobacco is considered contraband after prisons become tobacco-free and inmates risk disciplinary action by smuggling or using tobacco in the prison, thereby reducing secondhand smoke for non-smokers and probably reducing the consumption of current smokers.



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