title: Prevalence and factors associated with smoking tobacco among men recently released from prison in California: A cross-sectional study.
abstract: BACKGROUND
  Over 1.5 million people are incarcerated in state and federal correctional facilities in the United States. Formerly incarcerated men have significantly higher rates of mortality and morbidity than the general population, disparities that have been partially attributed to higher rates of tobacco smoking-related illnesses such as cardiovascular disease, pulmonary disease and cancer.
  
  
  METHODS
  We compared the prevalence of smoking tobacco in a sample of 172 men who were released from California state prisons to Oakland and San Francisco between 2009 and 2011 to sub-populations of respondents to the 2009 California Health Interview Survey (CHIS). Using logistic regression, we analyzed the association between lifetime history of incarceration and self-reported smoking status.
  
  
  RESULTS
  Seventy-four percent of men recently released from prison reported being current tobacco smokers. The prevalence of smoking in a demographically similar group of men in the CHIS was 24%. We found in bivariate analysis that each additional five years of history of incarceration was associated with 1.32 times greater odds of smoking (95% CI 1.02 to 1.71). Illicit substance use was associated with a 2.47 higher adjusted odds of smoking (95% CI 1.29 to 5.39). In the multivariate model adjusting for age, income, substance use and mental health, every five years of incarceration was associated with 1.23 greater odds of smoking (95% CI 0.94 to 1.63) which was not statistically significant.
  
  
  CONCLUSIONS
  Given the high prevalence of smoking tobacco among former prisoners and the underlying high tobacco-related mortality rates, these findings suggest that a history of incarceration may be an important determinant of smoking. Prison and parole systems may be important potential settings for smoking-cessation interventions.
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Howell
authors.affiliation: Philip R Lee Health Policy Institute, University of San Francisco, San Francisco, CA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Guydish
authors.affiliation: Behavioral and Urban Health Program, RTI International, San Francisco, CA, USA.
authors.forename: Alex H
authors.initials: AH
authors.lastname: Kral
authors.affiliation: Behavioral and Urban Health Program, RTI International, San Francisco, CA, USA. Electronic address: mcomfort@rti.org.
authors.forename: Megan
authors.initials: M
authors.lastname: Comfort
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D012307:Risk Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D055815:Young Adult
keywords: Prisoners/statistics & numerical data; Risk factors; Smoking/epidemiology; Smoking/prevention & control; Tobacco