Poster presented at TSRC 2022 by Cheryl K. Olson, M.P.H., Sc.D

Smoking in the U.S. is increasingly concentrated among vulnerable and marginalized groups.

One example is people in custody, who smoke at rates far exceeding those of the general population. Studies show that most incarcerated persons are multi-substance users driven to increase use under the stresses of prison/jail life. We conducted a qualitative/quantitative research program to understand the behaviors and perceptions of people in custody regarding smoking and reduced harm nicotine products, including a prison-safe ENDS product (eCig 4 Inmate).


Structured interviews with 30 recently incarcerated persons who had the option to legally purchase ENDS while in jail/prison, and a U.S. nationwide survey of 1,587 persons who did and did not vape during a recent incarceration.


Cigarettes are highly valued by persons in custody, and even used as currency. “Smoke-free” policies do not create smoke-free prisons; when cigarettes are banned, contraband cigarettes and prison-made combustibles (e.g., containing used chewing tobacco) are widely available. When ENDS devices were sold instead of cigarettes in prison/jail commissaries, ENDS were purchased by the vast majority of smokers (including those who had never vaped) and appeared to be satisfactory substitutes for cigarettes, potentially reducing harm and contraband. Many respondents expressed intent to switch completely to vaping or quit tobacco use now that they are “outside.”


Results are put into international context, including the successful transition of prisons in Scotland from smoking to vaping. A focus on vulnerable populations such as people in custody is an effective way to attract the attention of regulators, public health and health professionals to the urgent need for adult tobacco harm reduction.

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