Circumstances Around Cigarette Use after Enforced Abstinence From Smoking in an American Prison

Objectives: Most adults return to smoking after enforced tobacco abstinence when incarcerated in US prisons. Little is known about the specific relapse triggers on reentry. This study examines situational, affective, and motivational antecedents of return to smoking immediately after release from a tobacco-free prison.

Methods: Assessments were administered before release and 1 and 7 days after release to 190 incarcerated adults who were smokers before incarceration. Those reporting smoking within 7 days after release were asked about circumstances surrounding their first cigarette.

Results: Two-thirds reported smoking in the 7 days after release (76% of those in the first day) with the first cigarette smoked 21 hours after release on average. Smoking occurred more quickly for women than men and for those who planned to smoke after release ( P values from 0.05 to 0.001). Forty-one percent of participants smoked while waiting for a ride or on the way home, 68% were given their first cigarette, 28% reported first smoking when reuniting with others, 42% first smoked with smokers, and 26% first smoked as celebration. The moods most reported before smoking were happy (60%) or excited (41.5%). Factors reported that could have prevented smoking were avoiding other smokers (27%), avoiding stress (16%), not drinking/using drugs (12%), and not having access to cigarettes (11%).

Conclusions: High rates of return to smoking occurred rapidly when around other smokers, using other substances, and in a positive mood. Interventions that focus specifically on these factors and can be immediately accessed upon release are required to help sustain people's desired abstinence.