Effect of a tobacco free prison policy on air quality and risk for acute myocardial infarction

Background: The Kentucky Department of Corrections' (KY DOC) over-arching policy on tobacco is that all facilities are smoke-free (outdoor smoking is allowed). Five prisons have a tobacco-free campus (no tobacco use on the premises). Purpose: To examine the impact of a tobacco-free policy on air quality and cardiovascular health in Kentucky state prisons that have tobacco free campuses compared to prisons that allow smoking outdoors. Specific aims: Air quality study. 1. To determine if there is a difference in air quality as measured by particulate matter 2.5 (PM 2.5) between and within prisons with a tobacco free campus policy and prisons that allow outdoor smoking. Methods: Two prisons with a tobacco free campus and two prisons that allow outdoor smoking were selected for the study. Particulate matter 2.5 was measured for a two-hour period in four locations within each prison (two dormitories, the recreation area and the main lobby). Results: The mean smoke exposure in the tobacco free prisons was similar to the prisons that allowed outdoor smoking. However, the medium security dormitories had four times higher PM2.5 than the minimum security dormitories within the two prisons that allowed outdoor smoking only. Conclusions: Enforcement of a tobacco free policy in prisons varies within and among prisons resulting in high short term exposures to second hand smoke. Specific aim: AMI study 1. Examine the hazard ratio for acute myocardial infarctions (AMI) for inmates residing in a tobacco-free prison versus a prison that allows outdoor smoking. 2. Determine the risk for death from AMI or cardiac arrest based on length of time spent in a tobacco-free facility or a facility that allows outdoor smoking. Methods: Discharge diagnoses from hospitalizations for AMI and cardiac arrest were obtained from the health care management company which contracts with the KY DOC. This list of inmates was given to the DOC who provided all inmate movements over the last 10 years if available. The length of time the inmates were in a tobacco-free or outdoor smoking environment was calculated. Results: There was a 33% increased risk for having an AMI at a younger age for inmates who spent 100% of their incarceration in a facility that allows outdoor smoking. Survival analysis for death from cardiac arrest is pending further data from the DOC. Conclusions: Residing in a prison that allows outdoor smoking increases the risk for AMI which has policy and cost-saving implications for the states.