title: Decreased Mortality Rates of Inmates With Mental Illness After a Tobacco-Free Prison Policy.
abstract: OBJECTIVE
  Negative health consequences of smoking have prompted many correctional facilities to become tobacco free, including the New Jersey Department of Corrections, and this study examined the results of implementing tobacco-free policies.
  
  
  METHODS
  Mortality rates in the total population of inmates and in a subgroup with identified special mental health needs or mental illnesses (referred to in this article as persons with special needs) were measured from January 2005 through June 2014, a period during which tobacco use was significantly reduced and then eliminated.
  
  
  RESULTS
  The total mortality rate of all causes of death combined was three times higher for persons with special needs in 2005 compared with those without special needs. The total annual mortality rate decreased by 13%, from 232 to 203 per 100,000 population between 2005 and 2013. The mortality rate for persons identified as having special needs decreased by 48%, from an average of 676 per 100,000 population over the eight-year period before the ban to 353 per 100,000 in the 18 months after the ban. Reduced mortality among persons with special needs between 2005 and 2014 in half-year increments was correlated with the reduction and elimination of tobacco products (median bootstrapped Pearson r=.60, 95% confidence interval [CI] =.21 to .86). In strong contrast, however, the bootstrapped correlation between the mortality rate of persons not identified as having special needs and tobacco sales over the same period was not significant (median Pearson r=-.13, CI=-.50 to .28). No other major medical intervention occurred during these years.
  
  
  CONCLUSIONS
  This striking correlation of quick and substantial reduction of mortality among individuals with a mental illness in association with the reduction and subsequent ban of smoking suggests that smoking may play a major role in the reduced life span of persons with mental illness.
authors.affiliation: Dr. Dickert, Dr. Reeves, and Dr. DeBilio are with University Correctional Health Care, Rutgers University, Trenton, New Jersey. Dr. Williams and Dr. Gara are with the Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, where Dr. Dickert and Dr. Reeves are also affiliated. Dr. Gara is also with University Behavioral Health Care, Rutgers University, Piscataway, New Jersey. Send correspondence to Dr. Williams (e-mail: jill.williams@rutgers.edu ).
authors.forename: Jeff
authors.initials: J
authors.lastname: Dickert
authors.affiliation: Dr. Dickert, Dr. Reeves, and Dr. DeBilio are with University Correctional Health Care, Rutgers University, Trenton, New Jersey. Dr. Williams and Dr. Gara are with the Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, where Dr. Dickert and Dr. Reeves are also affiliated. Dr. Gara is also with University Behavioral Health Care, Rutgers University, Piscataway, New Jersey. Send correspondence to Dr. Williams (e-mail: jill.williams@rutgers.edu ).
authors.forename: Jill M
authors.initials: JM
authors.lastname: Williams
authors.affiliation: Dr. Dickert, Dr. Reeves, and Dr. DeBilio are with University Correctional Health Care, Rutgers University, Trenton, New Jersey. Dr. Williams and Dr. Gara are with the Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, where Dr. Dickert and Dr. Reeves are also affiliated. Dr. Gara is also with University Behavioral Health Care, Rutgers University, Piscataway, New Jersey. Send correspondence to Dr. Williams (e-mail: jill.williams@rutgers.edu ).
authors.forename: Rusty
authors.initials: R
authors.lastname: Reeves
authors.affiliation: Dr. Dickert, Dr. Reeves, and Dr. DeBilio are with University Correctional Health Care, Rutgers University, Trenton, New Jersey. Dr. Williams and Dr. Gara are with the Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, where Dr. Dickert and Dr. Reeves are also affiliated. Dr. Gara is also with University Behavioral Health Care, Rutgers University, Piscataway, New Jersey. Send correspondence to Dr. Williams (e-mail: jill.williams@rutgers.edu ).
authors.forename: Michael
authors.initials: M
authors.lastname: Gara
authors.affiliation: Dr. Dickert, Dr. Reeves, and Dr. DeBilio are with University Correctional Health Care, Rutgers University, Trenton, New Jersey. Dr. Williams and Dr. Gara are with the Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, where Dr. Dickert and Dr. Reeves are also affiliated. Dr. Gara is also with University Behavioral Health Care, Rutgers University, Piscataway, New Jersey. Send correspondence to Dr. Williams (e-mail: jill.williams@rutgers.edu ).
authors.forename: Lisa
authors.initials: L
authors.lastname: DeBilio
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000401:mortality*; D009515:New Jersey / Q000453:epidemiology; D011329:Prisoners / Q000706:statistics & numerical data*; D061845:Smoke-Free Policy; D012907:Smoking / Q000401:mortality*; D016540:Smoking Cessation / Q000706:statistics & numerical data*