Assessment of effectiveness of smoking cessation intervention among male prisoners in India: A randomized controlled trial

Abstract

Background:Tobacco smoking is an integral part of prison life and an established part of the culture. Little attention has been paid to prevention of smoking in prison. Approximately 70–80% of prisoners have been identified as current smokers. Aim: To assess the effectiveness of smoking cessation intervention among male prisoners at Central Jail, Bangalore city.Aim:To assess the effectiveness of smoking cessation intervention among male prisoners at Central Jail, Bangalore city.Materials and Methods:A randomized controlled trial was planned among male prisoners in Central Jail, Bangalore city. There were 1600 convicted prisoners. A self-administered questionnaire was given to the prisoners to assess their smoking behavior by which prevalence of tobacco smoking was found. Exactly 1352 tobacco users were studied. Among them, there were 1252 smokers. Based on inclusion criteria and informed consent given by the prisoners, a sample of 600 was chosen for the study by systematic random sampling. Among the 600 prisoners, 300 were randomly selected for the study group and 300 for the control group.Results:Prevalence of tobacco smoking among the prisoners was 92.60%. In the present study, after smoking cessation intervention, 17% showed no change in smoking, 21.66% reduced smoking, 16% stopped smoking, and 45.33% relapsed (P < 0.0001) at the end of 6-month follow-up in the study group.Conclusion:Tobacco use was high among the prisoners. Tobacco reduction is possible in the prison even if the living conditions are not favorable. Relatively high rate of relapse in our study indicates that some policies should be adopted to improve smokers’ information on consequences of tobacco on health and motivational intervention should be added to prisoners.

Systematic review of health and behavioural outcomes of smoking cessation interventions in prisons

“…These included five RCTs—three of which had strong methodological quality ratings,33 38 44 while two were rated as moderate quality 30 37. The lack of a control or comparison group contributed to the weak rating of the five remaining cohort studies 8 35 36 43 48.…”

“…The first of these studies37 was an RCT of MI with Indian male prisoners. An immediate, significant reduction was observed in the intervention group's daily smoking (p<0.001) and expired CO readings (p<0.001).…”

The efficacy of smoking cessation interventions in low‐ and middle‐income countries: a systematic review and meta‐analysis

“…The studies included a total of 13 141 participants from 11 countries. Seven studies (29%) were carried out in China [27,29,35,36,38,44,45], three (13%) each in India [39,42,46], Brazil [30,32,40] and Iran [22,26,33], two (8%) each in Malaysia [28,31] and South Africa [24,37] and one (4%) each in Pakistan [41], Syria [43], Thailand [23] and Turkey [34]. Four studies recruited participants from the community, one from a prison, and the remaining 19 recruited participants from medical clinics.…”

“…Three studies did not use a placebo control when evaluating pharmacological interventions [25,33,41]. Ten studies (42%) failed to indicate whether their outcome assessors were blinded to study condition [25,29,[32][33][34]36,[39][40][41]45], four studies (17%) reported that their assessors were not blinded to study condition [27,30,37,42] and the remaining 10 studies (42%) reported using blinded assessors [23,24,26,28,31,35,38,43,44,46]. Ten studies (42%) failed to indicate whether their outcome assessors were blinded to study condition [25,29,[32][33][34]36,[39][40][41]45], four studies (17%) reported that their assessors were not blinded to study condition [27,30,37,42] and the remaining 10 studies (42%) reported using blinded assessors [23,24,26,28,…”

“…In three studies, attrition rates were significantly different between study arms [25,30,35]. In six studies, attrition was not reported [26,[28][29][30]32,39]. Most often, study participants lost to follow-up were considered to be smokers (ITT), but five studies either did not specify [28,31] or did not report [30,36,42] ITT outcomes.…”