Smoke-free New Zealand prisons: Changes in health perceptions of male prisoners following a smoking cessation programme: An evaluative study

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Authors
Muir, Stephanie
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Degree
Master of Nursing
Grantor
Eastern Institute of Technology
Date
2012
Supervisors
Marshall, Bob
Nicol, Nick
Type
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
Keyword
New Zealand
prisoners
male prisoners
Māori prisoners
smoking cessation
smoke-free environments
health
perceptions
interviews
ANZSRC Field of Research Code (2020)
Citation
Muir, S. H. (2012). Smoke-free New Zealand prisons: Changes in health perceptions of male prisoners following a smoking cessation programme; An evaluative study. (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Nursing). Eastern Institute of Technology (EIT), New Zealand.
Abstract
AIM To explore the changes in health perceptions of men in prison following a smoking cessation programme. DESIGN In depth semi-structured interviews and a quality of life questionnaire (SF-36) were carried out with 12 prisoners in November 2011. Thirty-eight prisoners also completed two separate lung age tests between May and October 2011. Prisoners involved included both Maori and non-Maori. SETTING One prison for males in the lower North Island of New Zealand. METHOD Prisoners were interviewed individually by one researcher, with a topic guide of health in prison after stopping smoking. Data were analysed thematically. The SF-36 results were calculated for aggregated and specific physical and mental health scores. All SF-36 results were normalised. The lung age test compared two units of the prison before and after the smoking cessation was introduced. Orem’s model of self-care deficit underpins this research and is used to formulate care plans for prisoners needing smoking cessation assistance. RESULTS Four main themes emerged from the interviews: the increase in exercise tolerance with improvements in general health; an ability to taste food again; an acknowledgement of stress; and the reasoning behind beginning smoking. Maori prisoners rated their health significantly higher than non-Maori in five of the eight parameters of the SF-36 questionnaire; they perceived themselves to have better physical functioning and general health, more vitality, but also more bodily pain and role limitations from emotional causes. Any limitations from physical causes were rated equally by both Maori and non-Maori. Non-Maori prisoners scored their social functioning and mental health as better than Maori prisoners. The mental health of these prisoners showed most (84%) did not enjoy the same mental health as men in the wider community. The lung age tests showed no meaningful differences between the two units, although 80% of the prisoners surveyed who completed all the tests, noted their lung ages had decreased and their physical health had improved. However, the lung ages of men older than 35 did not improve as quickly as men less than 35 years. Few prisoners had lung ages that were the same as their chronological age; most were noticeably higher. DISCUSSION The lung age tests were designed to be a visual prompt for prisoners to consider the damage smoking had done already to their health. It opened a dialogue for discussion around the smoking cessation programme. The prisoners who completed both the lung age tests expressed interest in the final results and many were pleased at the improvements. Although the quality of life survey within the prison was small, most Maori prisoners felt their overall health was better than in the community, especially their physical health. The SF-36 showed no improvement in the mental health of the Maori prisoners. Not all prisoners who were interviewed wanted to stop smoking; nevertheless they acknowledged the positive changes to their health. Only one man expressed a commitment to resume smoking on release. The ability to taste food again was appreciated by most, even when they stated they did not like prison food. The interviewed prisoners acknowledged smoking was used to combat the boredom of prison life and had become a habit they wanted to stop but did not know how to. All had started smoking at a young age to fit in with their peers. CONCLUSION While the smoking cessation was not voluntary, many prisoners have enjoyed the resulting improvement to their health. However, the literature indicates many return to smoking once released from prison. Assisting prisoners once they leave prison to remain smoke-free is a new challenge for health providers.
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