Identifying potential barriers and enablers to smoking abstinence after leaving a smokefree prison using the capabilities, opportunities, motivations -behaviour (COM-B) model: a qualitative interview study.

Background: Smokefree prison policies reduce smoking-related harms among those living and working in prisons. Helping people released from smokefree prisons to remain abstinent post-release could deliver considerable additional benefits given high rates of relapse and the substantial burden of smoking on health. However, understanding of post-release smoking behaviour and the best ways to support people leaving prison who want to stop smoking for good is limited. No previous studies have explored how access to vapes in smokefree prisons may help or hinder people to remain tobacco-free post-release. The current study aimed to explore potential enablers and barriers to long-term tobacco abstinence after being released from a smokefree prison.

Methods: Qualitative interviews conducted between 2022 and 2024 with people in prison (n = 27) and prison, health and third sector staff (n = 8) were transcribed and thematically analysed using the COM-B ('capability', 'opportunity', 'motivation' and 'behaviour') model of behaviour change to map facilitators and barriers to smoking abstinence post-release.

Results: People leaving prison face substantial barriers to staying tobacco-free. Interactions between people rationalising smoking in the face of recognised harms ('capability'), tobacco availability (post-release), pro-smoking norms, service limitations ('opportunity'), competing needs and priorities and drug and alcohol use ('motivation') were identified as barriers. In contrast, desires to quit smoking and other 'addictions' which have caused substantial damage in people's own and others' lives, access to 'smoking cessation' services in prisons and positive social influence were identified as facilitators. Access to vapes in prison was perceived to have the potential to help or to hinder post-release smoking abstinence based on individual preferences and experiences.

Conclusions: Reducing tobacco-related harms among people leaving prison and the communities they return to would help to reduce health inequalities and support other critical areas of public health and social justice work. Greater success requires overcoming considerable challenges, including those constraining prison and health services' abilities to support positive behaviour change. Improved collaboration across services and expanded use of appropriately supported peer mentors and digital health interventions, may be both helpful and feasible in the current climate for reducing tobacco-related harms in a priority group.