Dominique de Andrade

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

Objective We conducted a systematic review to examine the impact of smoking cessation interventions, including smoking bans, on prisoners and prison staff. Data sources We systematically searched health and criminal justice databases for relevant studies. Search strings were used to combine terms related to smoking cessation interventions with terms related to incarceration. We used forward and backward snowballing to capture additional studies. Study selection Studies were included if: they were published between 1 January 1994 and 23 May 2016; the population was incarcerated adults and/or prison staff; they had a quantitative component; they were published in English; and they reported outcomes of a smoking cessation programme/ban with regard to reported change in smoking behaviour and/or behavioural outcomes. Data extraction Studies were reviewed for methodological rigour using the Effective Public Health Practice Projects Quality Assessment Tool for Quantitative Studies. Data were independently reviewed for methodological quality by 1 author and a research assistant. Data synthesis Cessation programmes, including free nicotine replacement therapy and/or behavioural counselling can significantly increase the likelihood of quitting in prison and increase abstinence postrelease. Indoor bans have little impact on prisoner smoking behaviour. Prisoners who experience a complete smoking ban typically resume smoking shortly after release from prison. Bans may result in adverse behavioural outcomes, but these are generally minimal and short-lived. Conclusions While there is limited evidence to inform tobacco control policies in custodial settings, outcomes of this review suggest that cessation programmes/bans can be an effective mechanism to interrupt prisoner smoking behaviour when properly enforced.

Trouble in paradise: the crime and health outcomes of the Surfers Paradise licensed venue lockout

INTRODUCTION AND AIMS The lockout intervention has become embedded in Australian alcohol policy with little scientific evidence of its effectiveness in reducing violence and disorder. This paper reports an evaluation of the Queensland lockout pilot in Surfers Paradise. Patrons could not enter or re-enter licensed venues after 3 am, while patrons inside at this time could stay until close. DESIGN AND METHODS Using police and ambulance data, time series analyses examined the impact of tourism seasons and the lockout on rates of crime, violence, injury and intoxication. Additional analyses were also conducted to show spatial and temporal changes in crime over time. RESULTS Both police and ambulance data showed that the lockout introduction had no statistically significant impact on rates of crime, violence, head and neck injuries, and intoxication over the 2 years following lockout. Hot spot maps indicated limited spatial shift of crime within Surfers Paradise following the lockout introduction, with evidence of a temporary intensification of crime in already established hot spots. We found a moderate statistically significant change in the 24 h distribution of crime after the lockout implementation, suggesting temporal displacement of crime. DISCUSSION Results support the small existing body of evidence on lockouts that indicates they are largely ineffective in reducing crime and injuries in entertainment districts. CONCLUSION As multi-pronged strategies that include a lockout gain in popularity, further investigation should focus on identifying the key drivers of successful interventions such as the Newcastle strategy, to better refine these interventions for replication and evaluation elsewhere. [De Andrade D, Homel R, Townsley M. Trouble in paradise: The crime and health outcomes of the Surfers Paradise licensed venue lockout. Drug Alcohol Rev 2016;35:564-572].

Relapse to smoking following release from smoke-free correctional facilities in Queensland, Australia

BACKGROUND Smoke-free prison policies are increasingly common, but few studies have investigated relapse to smoking after release from prison. This study investigated return to tobacco smoking and correlates of smoking at reduced levels after release among adults recently released from smoke-free prisons in Queensland, Australia. METHODS A cross-sectional survey of 114 people at parole offices within two months of release from prison was used. The survey measured health, social, and criminological factors related to tobacco smoking. We used logistic regression to identify factors associated with reduced post-release smoking levels compared to pre-incarceration levels. RESULTS 94% of participants relapsed to smoking within two months of release; 72% relapsed on the day of release. 62% of participants smoked significantly less per day after compared with before incarceration. Living with a partner (Odds Ratio (OR) 2.77, 95%CI 1.02-7.52), expressing support for smoke-free prison policies (OR 2.44, 95%CI 1.12-5.32), intending to remain abstinent post-release (OR 4.29, 95%CI 1.88-9.82), and intending to quit in the future (OR 3.88, 95%CI 1.66-9.07) were associated with reduced smoking post-release. Use of illicit drugs post-release was negatively associated with reduced smoking post-release (OR 0.27, 95%CI 0.09-0.79). In multivariate analyses, pre-release intention to remain smoke-free was associated with reduced smoking post-release (AOR 2.69, 95%CI 1.01-7.14). DISCUSSION Relapse to smoking after release from smoke-free prisons is common, but many who relapse smoke less than before incarceration, suggesting that smoke-free prison policies may reduce post-release tobacco smoking. There is a need for tailored, evidence-based tobacco cessation interventions for people recently released from prison.

Use of prescribed smoking cessation pharmacotherapy following release from prison: a prospective data linkage study

Background A significant proportion of people who cycle through prisons express a desire to quit smoking, yet smoking rates in this population are two to four times higher than in the general community. Smoking cessation pharmacotherapy (SCP) is an important component of evidence-based cessation support, yet no studies have examined use of this pharmacotherapy after release from prison. Methods We linked data from a survey of 971 smokers who were within 8 weeks of release from prison in Queensland, Australia, with federal Pharmaceutical Benefits Scheme (PBS) records for the 2 years after release, to identify subsidised use of SCP (varenicline, bupropion and nicotine patches). We used Cox proportional hazards regression to identify independent predictors of SCP use. Findings According to PBS data, 86 participants (8.9%) accessed SCP in the 2 years following release from prison. Participants who were aged 25 years or older (HR 2.51, 95% CI 1.19 to 5.31), employed before prison (HR 1.93, 95% CI 1.14 to 3.28), highly nicotine dependent at baseline (HR 2.21, 95% CI 1.23 to 3.97) and using non-psychotropic medications in prison (HR 2.29, 95% CI 1.24 to 4.22) were more likely to use subsidised SCP during follow-up. Conclusion Despite a very high rate of tobacco use among people cycling through prisons and the very low cost of (subsidised) SCP in Australia, few ex-prisoners obtain pharmaceutical assistance with quitting smoking. Policy attention needs to focus on supporting former prisoners to access SCP, to reduce the high rate of tobacco-related morbidity and mortality in this profoundly marginalised population.

Substance use and recidivism outcomes for prison-based drug and alcohol interventions

We conducted a systematic review to examine the substance use and recidivism outcomes of prison-based substance use interventions. We searched public health, criminology, and psychology databases, and conducted forward and backward snowballing methods to identify additional studies. Studies were included if they were published between January 1, 2000 and June 30, 2017; were published in English; and reported substance use and/or recidivism outcomes of prison-based substance use interventions. Studies were reviewed for methodological rigor using the Effective Public Health Practice Projects Quality Assessment Tool for Quantitative Studies. Our search returned 49 studies: 6 were methodologically strong, 20 were moderate, and 23 were weak. Results suggest therapeutic communities are effective in reducing recidivism and, to a lesser extent substance use after release. There is also evidence to suggest that opioid maintenance treatment is effective in reducing the risk of drug use after release from prison for opioid users. Furthermore, care after release from prison appears to enhance treatment effects for both types of interventions. Results provide evidence that policymakers can use to make informed decisions on best-practice approaches when addressing prisoner substance dependence and improving long-term outcomes. This comprehensive review highlights the difficulties of conducting quality research in the prison setting and suggests innovative study design for future research.

Boozy Nights and Violent Fights Perceptions of Environmental Cues to Violence and Crime in Licensed Venues

This article examines perceptions of environmental cues to crime, violence, and injuries in barroom settings, and how they differ between bar fight participants and non-participants. Bouncer friendliness, patron sex composition, and room temperature were chosen as experimental variables based on three criteria: (a) emerged as a theme in bar user focus groups, (b) unclear effects in the literature, and (c) policy relevant and easy to modify. These experimental variables were manipulated in written vignettes set in a bar. A three-part online questionnaire recorded 681 male university students’ responses to questions on demographics, the experiment, drinking and clubbing habits, and the Snell Masculinity Scale. A 2 × 2 × 2 randomized independent groups factorial design with covariates was embedded in the questionnaire, measuring the effects of the experimental variables on bar users’ perceived fear of victimization, likelihood and frequency of crime, venue preference, and perceived severity of injuries after accounting for prior bar fight participation and masculinity. Participants generally rated perceived fear of victimization, likelihood and frequency of crime, and severity of injuries to be highest when the bouncer was unfriendly, the temperature was hot, and patrons were majority male. Only main effects were significant (p < .01). Masculinity scale responses were not related to participant perceptions. While fight participants (9.8% of the sample) and non-participants had similar perceptions of the risk associated with certain environmental cues, fight participants were significantly (a) less fearful of victimization in settings they perceived as dangerous and (b) more willing to drink in any hypothetical venue.

Lessons from Queensland's last-drinks legislation: the use of extended trading permits

INTRODUCTION AND AIMS The association between alcohol availability, alcohol consumption and, in turn, alcohol-related harms is well established. Policies to reduce alcohol-related harms focus on limiting accessibility through the regulation of the liquor industry, including trading hours. On 1 July 2016, the Queensland Government introduced legislation to reduce ordinary liquor trading hours, replacing 5 am closing times with 3 am cessation of liquor sales in designated entertainment precincts and 2 am cessation of sales across the rest of the state. However, the amendment was under-inclusive and did not apply to temporary extended trading permits, a provision of the Liquor Act 1992 allowing one-off variations in trading hours for special events. DESIGN AND METHODS We use 24 months of data (1 January 2015 to 31 December 2016) from the Office of Liquor Gaming and Regulation to explore patterns of extended trading permit use across Queensland, pre- and post- 1 July 2016. RESULTS We find that following the Amendment in 2016 there was also a distinct shift in the utilisation of temporary extended trading permits, with a 63% increase in approved permits between 2015 and 2016. Temporal clustering around key calendar events dissipated following 1 July 2016 with consistent concentration of permit utilisation over consecutive weeks. DISCUSSION AND CONCLUSIONS Using temporary extended trading permits venue owners avoided earlier closing times and continued to operate until 5 am. The findings provide lessons for future policy implementation by illustrating the capacity for under-inclusive legislation to result in the dilution of intended effects.

Alcohol-related harms and street service care in entertainment districts

Purpose Significant alcohol use increases the risk of injuries and violence in young people. The purpose of this paper is to examine factors associated with receiving street service care for alcohol intoxication, alcohol-related injury or violence among young people in a night-time economy (NTE). Design/methodology/approach Participants included 217 young adults, 135 of whom required street service care on a Friday or Saturday evening in an Australian entertainment district. The remaining 88 young adults were a matched control sample. Participants were surveyed and provided a breathalyser sample. A multinomial logistic regression was conducted to examine the relationship between blood alcohol content (BAC) level, subjective intoxication, gender, illicit drug use, age, preloading, total drinks consumed, and the receipt of care for intoxication, injury, or violence. Findings Of those who received care, 70.4 per cent received it for intoxication, 19.3 per cent for injury, and 10.3 per cent following a violent incident. Male gender and high BAC level were associated with receiving support following a violent incident. High-subjective intoxication and female gender were associated with receiving support for injury. Practical implications Results demonstrate the factors associated with receiving street service care for young people in the NTE experiencing non-emergent health needs. Further research is required to examine the impact of such a service on crime, injuries, and frontline service resources. Originality/value This is the first study to examine factors associated with receiving street service care for alcohol intoxication, injury, or violence in a NTE. Results inform policy and practice relating to the provision of street service care in the NTE for non-emergent health problems, and how this interrelates with other frontline services.