Background Tobacco consumption continues to be a driver of health inequalities. Prisons in Scotland, England and Wales became smokefree by late 2018. International evidence suggests comprehensive smokefree prison policies help protect against second-hand smoke exposures, but studies show most ‘smokers’ resume tobacco use following release, resulting in a missed opportunity for increasing long-term cessation in a highly disadvantaged group. No evidence is available globally on how permitted e-cigarette use in prison affects return to smoking rates. The current study aims to increase understanding of the barriers to maximising the benefits of smokefree prison policies.

Methods Qualitative interviews conducted in 2023/4 with people in prison (n=27), family members affected by imprisonment (n=9), and professionals supporting people in prison and/or families affected by imprisonment (n=7) have been transcribed and thematically analysed using the COM-B (‘capability’, ‘opportunity’, ‘motivation’ and ‘behaviour’) model of behaviour change to understand barriers to tobacco abstinence post-release.

Results Interview data from all stakeholders (people in prison, staff, and families affected by imprisonment) show substantial barriers to reducing tobacco-related harms among those leaving prison and the communities they return to, some of which have been exacerbated by the Covid-19 pandemic. Many people in prison continue to express a desire to cutdown/quit vaping while in prison and/or to be smokefree on release. Key barriers related to the interactions between people’s rationalisations for return to tobacco smoking behaviours (‘capability’), tobacco availability (post-release), prevailing social norms amongst the social networks people return to post-release, (gaps in) support services (‘opportunity’), and competing priorities and polysubstance use (‘motivation’). Our fieldwork and analysis have highlighted that addressing nicotine addiction among people in prison is a major challenge given competing health priorities, the decoupling of nicotine addiction from other health needs, overcrowding in prisons, and staffing and resource constraints.

Conclusion Smoking continues to be the leading cause of preventable illness and death globally, and is a significant driver of health inequalities for people who are/have been in prison. However, there are barriers to ensuring that the substantial health risk posed by smoking is more fully reflected in substance use strategy and service delivery during and following community transition. The current study aims to identify opportunities for supporting people leaving smokefree prisons who wish to reduce tobacco harms.