title: Forced smoking abstinence: not enough for smoking cessation.
abstract: OBJECTIVE
  Millions of Americans are forced to quit smoking as they enter tobacco-free prisons and jails, but most return to smoking within days of release. Interventions are needed to sustain tobacco abstinence after release from incarceration.
  
  
  OBJECTIVE
  To evaluate the extent to which the WISE intervention (Working Inside for Smoking Elimination), based on motivational interviewing (MI) and cognitive behavioral therapy (CBT), decreases relapse to smoking after release from a smoke-free prison.
  
  
  METHODS
  Participants were recruited approximately 8 weeks prior to their release from a smoke-free prison and randomized to 6 weekly sessions of either education videos (control) or the WISE intervention.
  
  
  METHODS
  A tobacco-free prison in the United States.
  
  
  METHODS
  A total of 262 inmates (35% female).
  
  
  METHODS
  Continued smoking abstinence was defined as 7-day point-prevalence abstinence validated by urine cotinine measurement.
  
  
  RESULTS
  At the 3-week follow-up, 25% of participants in the WISE intervention (31 of 122) and 7% of the control participants (9 of 125) continued to be tobacco abstinent (odds ratio [OR], 4.4; 95% CI, 2.0-9.7). In addition to the intervention, Hispanic ethnicity, a plan to remain abstinent, and being incarcerated for more than 6 months were all associated with increased likelihood of remaining abstinent. In the logistic regression analysis, participants randomized to the WISE intervention were 6.6 times more likely to remain tobacco abstinent at the 3-week follow up than those randomized to the control condition (95% CI, 2.5-17.0). Nonsmokers at the 3-week follow-up had an additional follow-up 3 months after release, and overall 12% of the participants in the WISE intervention (14 of 122) and 2% of the control participants (3 of 125) were tobacco free at 3 months, as confirmed by urine cotinine measurement (OR, 5.3; 95% CI, 1.4-23.8).
  
  
  CONCLUSIONS
  Forced tobacco abstinence alone during incarceration has little impact on postrelease smoking status. A behavioral intervention provided prior to release greatly improves cotinine-confirmed smoking cessation in the community.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01122589.
authors.affiliation: Brown University Center for Primary Care and Prevention, Pawtucket, Rhode Island, USA. Jennifer_Clarke@brown.edu
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Clarke
authors.forename: L A R
authors.initials: LA
authors.lastname: Stein
authors.forename: Rosemarie A
authors.initials: RA
authors.lastname: Martin
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Martin
authors.forename: Donna
authors.initials: D
authors.lastname: Parker
authors.forename: Cheryl E
authors.initials: CE
authors.lastname: Lopes
authors.forename: Arthur R
authors.initials: AR
authors.lastname: McGovern
authors.forename: Rachel
authors.initials: R
authors.lastname: Simon
authors.forename: Mary
authors.initials: M
authors.lastname: Roberts
authors.forename: Peter
authors.initials: P
authors.lastname: Friedman
authors.forename: Beth
authors.initials: B
authors.lastname: Bock
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000652:urine; D015928:Cognitive Behavioral Therapy; D003367:Cotinine / Q000652:urine*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D033182:Intention; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D015999:Multivariate Analysis; D016017:Odds Ratio; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons / Q000592:standards; D055502:Secondary Prevention; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology / Q000652:urine; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D003367:Cotinine