title: Smoking in prison: a hierarchical approach at the crossroad of personality and childhood events.
abstract: BACKGROUND
  Smoking has long been considered part of prison culture and studies have shown a high prevalence of smoking within correctional facilities.
  
  
  METHODS
  A self-administered, anonymous questionnaire was administered to 173 male prisoners in the Chalkida prison, Greece. To assess current smoking habits, a hierarchical approach was adopted. The underlying conceptual framework included: (i) demographic parameters, (ii) adverse childhood history (physical abuse, parental neglect, parental divorce, alcoholism in the family, sexual abuse and psychiatric condition in the family), (iii) education, personality traits, such as impulsivity (Barrat Impulsivity Scale-11), aggression (Buss-Perry Aggression Questionnaire and Lifetime History of Aggression), and personal history of mental disease, (iv) prison-related features (duration of sentence, sentence already served and change in smoking habits during imprisonment).
  
  
  RESULTS
  Eighty percentage of the study sample reported current smoking; 43.4% disclosed deterioration in their smoking habits during imprisonment. The hierarchical approach pointed to: (i) adverse childhood events, i.e. alcoholism in the family [adjusted odds ratio (OR) = 6.29, 95% confidence interval (CI): 2.44-16.25], psychiatric condition in the family (adjusted OR = 4.10, 95% CI: 1.31-12.84), physical abuse (adjusted OR = 2.90, 95% CI: 1.30-6.46), parental neglect (adjusted OR = 2.66, 95% CI: 1.19-5.95), parental divorce (adjusted OR = 2.14, 95% CI: 1.00-4.56), and (ii) impulsivity (adjusted OR = 2.26, 95% CI: 1.12-4.58) as independent risk factors. In addition, deterioration of smoking habits during imprisonment exerted an effect of borderline significance (adjusted OR = 2.02, 95% CI: 0.97-4.24).
  
  
  CONCLUSIONS
  Heavy smoking in prison principally integrates two components: unfavourable childhood and current personality traits (impulsivity).
authors.affiliation: Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece. stpapd@gmail.com
authors.forename: Stavroula A
authors.initials: SA
authors.lastname: Papadodima
authors.forename: Emmanouil I
authors.initials: EI
authors.lastname: Sakelliadis
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Sergentanis
authors.forename: Orestis
authors.initials: O
authors.lastname: Giotakos
authors.forename: Ioannis N
authors.initials: IN
authors.lastname: Sergentanis
authors.forename: Chara A
authors.initials: CA
authors.lastname: Spiliopoulou
mesh_terms: D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology; D003430:Cross-Sectional Studies; D005195:Family Relations; D006115:Greece; D015438:Health Behavior; D006801:Humans; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010552:Personality Assessment; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D012309:Risk-Taking; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D012931:Social Environment; D011795:Surveys and Questionnaires