To the Editor:
The article by Condon and colleagues1 concluded that “the excess burden of cancer in [Northern Territory] Indigenous Australians (higher incidence and lower survival) will persist until exposure to lifestyle risks is reduced, particularly the extraordinarily high prevalence of smoking”.
The NT has a population of 225 900, with 28.3% being Indigenous Australians.2 About 85% of the 1593 prisoners in the NT are Indigenous people, and nationally a staggering 83% of prisoners smoke tobacco: six times the rate of the general community.3
In July 2013, as part of a comprehensive healthy lifestyles strategy, the NT became the first Australian jurisdiction to introduce a total ban on smoking tobacco in all correctional facilities for inmates and staff.4 Four jurisdictions followed the NT lead by introducing complete bans — New South Wales, Victoria, Queensland and Tasmania — and three jurisdictions by banning smoking indoors — Western Australia, the Australian Capital Territory and South Australia. However, a United States study showed that “relapse to smoking is common upon release from [US prisons], approaching 90% within a few weeks”.5
In relation to smoking rates after release in Australia, the University of New South Wales started a randomised control trial that will investigate whether a brief health intervention called SNAP (smoking, nutrition, alcohol and physical inactivity), using a five-step model, will assist prisoners to extend tobacco cessation after release from prison, as well as reduce their risk factors for poor nutrition, alcohol misuse and physical inactivity (https://ndarc.med.unsw.edu.au/project/randomised-controlled-study-health-intervention-snap-northern-territory-prisons).
This trial has the potential to benefit prisoners, their communities, prison staff and Indigenous health clinics in remote areas by identifying the lessons learned from this initiative to ensure that the NT policy of banning smoking in correctional facilities is achieving its aims.
- 1. Condon JR, Zhang X, Dempsey K, et al. Trends in cancer incidence and survival for Indigenous and non-Indigenous people in the Northern Territory. Med J Aust 2016; 205: 454-458. <MJA full text>
- 2. Australian Bureau of Statistics. Northern Territory population growth (Cat. No. 1362.7). Canberra: ABS; 2011. http://www.abs.gov.au/ausstats/abs@.nsf/Products/1362.7∼Mar+2011∼Main+Features∼Population?OpenDocument (accessed Nov 2016).
- 3. Butler T, Stevens C. National Summit on Tobacco Smoking in Prisons: report on the summit. Perth: National Drug Research Institute; 2010. http://ndri.curtin.edu.au/local/docs/pdf/publications/R247.pdf (accessed May 2017).
- 4. Hefler M, Hopkins R, Thomas DP. Successes and unintended consequences of the Northern Territory’s smoke-free prisons policy: results from a process evaluation. Public Health Res Pract 2016; 26: e2621619.
- 5. Clarke JG, Martin RA, Stein L, et al. Working Inside for Smoking Elimination (Project WISE) study design and rationale to prevent return to smoking after release from a smoke free prison. BMC Public Health 2011; 11: 767.
Robyn Hopkins was the project manager of Smokefree NT prisons, and is working with the Menzies School of Health Research to review gaps in smoking pathways after prison release. Kate Dolan is the chief investigator on the SNAP randomised control trial.