利用药物配给评估国家无烟监狱政策：一项中断时间序列分析。

Evaluation of a national smoke-free prisons policy using medication dispensing: an interrupted time-series analysis.

机构信息

Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.

Department of Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.

出版信息

Lancet Public Health. 2021 Nov;6(11):e795-e804. doi: 10.1016/S2468-2667(21)00163-8. Epub 2021 Sep 17.

DOI:10.1016/S2468-2667(21)00163-8

PMID:34537108

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8554387/

Abstract

BACKGROUND

Internationally, smoking prevalence among people in prison custody (ie, people on remand awaiting trial, awaiting sentencing, or serving a custodial sentence) is high. In Scotland, all prisons implemented a comprehensive smoke-free policy in 2018 after a 16-month anticipatory period. In this study, we aimed to use data on medication dispensing to assess the impact of this policy on cessation support, health outcomes, and potential unintended consequences among people in prison custody.

METHODS

We did an interrupted time-series analysis using dispensing data for 44 660 individuals incarcerated in 14 closed prisons in Scotland between March 30, 2014, and Nov 30, 2019. We estimated changes in dispensing rates associated with the policy announcement (July 17, 2017) and full implementation (Nov 30, 2018) using seasonal autoregressive integrated moving average models. Medication categories of primary interest were treatments for nicotine dependence (as an indicator of smoking cessation or abstinence attempts), acute smoking-associated illnesses, and mental health (antidepressants). We included antiepileptic medications as a negative control.

FINDINGS

A 44% step increase in dispensing of treatments for nicotine dependence was observed at implementation (2250 items per 1000 people in custody per fortnight, 95% CI 1875 to 2624) due primarily to a 42% increase in dispensing of nicotine replacement therapy (2109 items per 1000 people in custody per fortnight, 1701 to 2516). A 9% step decrease in dispensing for smoking-related illnesses was observed at implementation, largely accounted for by respiratory medications (-646 items per 1000 people in custody per fortnight, -1111 to -181). No changes associated with announcement or implementation were observed for mental health dispensing or antiepileptic medications (control).

INTERPRETATION

Smoke-free prison policies might improve respiratory health among people in custody and encourage smoking abstinence or cessation without apparent short-term adverse effects on mental health dispensing.

FUNDING

National Institute of Health Research Public Health Research programme, Scottish Government Chief Scientist Office, and UK Medical Research Council.

摘要

背景

在全球范围内，被监禁的人（即在押候审、等待判决或服刑的人）的吸烟率较高。2018 年，苏格兰所有监狱在经过 16 个月的预期期后实施了全面禁烟政策。在这项研究中，我们旨在利用药物配给数据评估该政策对被监禁者的戒烟支持、健康结果和潜在意外后果的影响。

方法

我们使用 2014 年 3 月 30 日至 2019 年 11 月 30 日期间在苏格兰 14 所封闭监狱中被监禁的 44660 个人的配药数据进行了中断时间序列分析。我们使用季节性自回归综合移动平均模型估计与政策公告（2017 年 7 月 17 日）和全面实施（2018 年 11 月 30 日）相关的配药率变化。主要关注的药物类别是尼古丁依赖治疗（作为戒烟或戒断尝试的指标）、急性与吸烟相关的疾病和心理健康（抗抑郁药）。我们将抗癫痫药物作为阴性对照。

结果

在实施时，观察到尼古丁依赖治疗的配药率增加了 44%（每 1000 名被监禁者每两周增加 2250 项，95%CI 1875 至 2624），主要是由于尼古丁替代疗法的配药增加了 42%（每 1000 名被监禁者每两周增加 2109 项，1701 至 2516）。在实施时，观察到与吸烟相关的疾病的配药减少了 9%，主要是由于呼吸系统药物（-646 项/每 1000 名被监禁者每两周，-1111 至-181）。对于心理健康配药或抗癫痫药物（对照），没有观察到与公告或实施相关的变化。