Background Smoking prevalence remains high among poor and marginalised groups, with very high rates reported among prison populations, contributing to ongoing inequalities. Smoking bans were introduced to tackle smoking in prisons, exposure to second hand smoke (SHS) and the subsequent health risks. While studies have confirmed health benefits of the smokefree prison policy, these are not necessarily carried forward into the lives of people following release. This scoping review aims to gather evidence on the prevalence of smoking and/or vaping after release from smokefree prisons and the factors influencing this behaviour post-release.

Methods This review followed PRISMA-ScR guidelines. We searched the Web of Science Citation Indices (Science Citation Index Expanded, Social Sciences Citation Index, and Arts and Humanities Citation Index), PsycINFO, Criminal Justice Abstracts (via EBSCOHost) and Medline. We included all types of studies (including protocols), published in English, since 2017. Our search strategy combined terms for prison, tobacco use, vaping/e-cigarettes, smokefree, release, relapse, prevention and cessation. Outcomes of interest were: 1) pre-release intentions to smoke/vape or remain abstinent following release; 2) prevalence post-release; 3) facilitators or barriers to staying smokefree or reducing tobacco consumption post-release.

Results In total, nine studies were included (n=7 Australia; n=4 USA; and n=1 New Zealand) from countries and/or states where prisons are smokefree.

Pre-release intentions to remain smokefree were reported in seven studies. These varied considerably and ranged from 33 to 60%. All studies reported on the prevalence of smoking after release from a smokefree prison. Results suggest a rate of relapse to smoking post-release of between 49.5–72% within 24hours, and most people relapsed to smoking within 3 months post-release.

Barriers to remaining smokefree post-release most often reported were substance abuse, excessive drinking, and normalised smoking among social networks. The use of smoking as a coping mechanism to deal with stressors around housing, employment and relationships post-release was also widely reported. In contrast, smoking cessation support pre- and post-release, assistance from social and other networks and engagement with healthy behaviours such as physical activity and meditation all facilitated abstinence from smoking.

Vaping/E-cigarette use was not mentioned in any study.

Conclusion While complete indoor/outdoor smokefree policies in prisons are increasing gradually around the world, relapse rates post-release remain significantly high thus limiting the long-term public health benefits. Our review highlights a significant need to develop effective interventions that equip those leaving prison with the skills, support and motivation to remain smokefree.