Successes and unintended consequences of the Northern Territory's smoke-free prisons policy: Results from a process evaluation

Objectives: In 2013, the Northern Territory was the first Australian jurisdiction to introduce a smoke-free policy for all correctional facilities. We report on a process evaluation to identify what worked well, key challenges and unintended consequences.

Methods: We interviewed 87 people, comprising remand, medium-security and low-security prisoners; visiting family members; and prison staff (including prison management and health workers). A realist evaluation approach was used. 

Results: A long lead-in time, collaborative planning and a comprehensive communication strategy were vital for generating support for the policy and ensuring a smooth transition, with no riots or major incidents. Many prisoners expressed a preference for cessation support options other than nicotine replacement therapy (NRT). An unintended consequence was misuse of NRT patches.

Conclusions: A comprehensive approach to creating support among staff and prisoners is important for smooth implementation of policies for smokefree prisons. Planning should include assessment of prisoners' preferred form of cessation support and strategies to minimise NRT diversion.