Going tobacco free in Australian prisons – increasing tattooing harm?

Viewpoint

Article Type: Viewpoint From: International Journal of Prisoner Health, Volume 11, Issue 4.

Carla Treloar, Eileen Baldry, Peter Higgs, Paul Dietze, Mark Stoove and Andrew Lloyd

Going tobacco free in Australian prisons – increasing tattooing harm?

Like many other parts of the world (Ritter et al., 2011; Djachenko et al., 2015), Australian prison authorities are moving to tackle high rates of tobacco smoking among inmates by introducing smoke free programs. Prisons in the Northern Territory have been tobacco free since July 2013, Queensland prisons have been smoke free since 2014, Victorian prisons anticipate being tobacco free from July 1, 2015 and the NSW Department of Corrections announced that all prisons in that state will be declared “tobacco-free” from August 2015. These are welcome moves to tackle the disproportionately high rates of smoking among inmates which can be as high as 70-90 percent (Gilles et al., 2008; Awofeso et al., 2001; Baker et al., 2006) and address the enormous individual and community health implications related to tobacco smoking. However, as in all policy implementation, there are likely to be unintended outcomes. The impact that removal of tobacco and associated implements may have on other aspects of inmates’ lives should also be examined (Richmond et al., 2009). Indeed, a recent paper has drawn attention to the unanticipated harms that may occur as a result of public health interventions and called for the examination and reporting of such harms to become a routine part of evaluating interventions (Allen-Scott et al., 2014).

One such unanticipated harm may be increased risk of blood-borne viruses, particularly hepatitis C. Although remaining illegal in prison, tattooing is regularly done and it is well-known that inmates manufacture equipment to apply tattoos within prison (Bonnycastle, 2011). A British study suggested that one in five prisoners with tattoos reported having had a tattoo done in prison (Strang et al., 2000). Among a sample of Victorian inmates, 41 percent of prisoners with tattoos reported acquiring a tattoo in prison, with 27 percent of these prisoners reporting that tattooing equipment had been shared and 42 percent reporting that tattoo ink had been shared (Hellard et al., 2007).

These rates of sharing were measured in settings in which the resources needed to manufacture tattooing equipment, including ink, were readily accessible. The crucial point here is that the manufacture of ink for prison tattooing often requires lighting implements (such as matches or cigarette lighters) which will become less readily available after tobacco bans in prisons.

Prior to tobacco bans, equipment and ink for tattoos could be made from items accessed within the prison, including the use of lighting implements to manufacture ink (e.g. the soot produced from burning rubber thongs/sandals is mixed with various substances to form ink). Given the current prevalence of tobacco smoking within prisons, access to lighting implements is common. Ink may be manufactured for each tattooing episode and then discarded as it can be easily manufactured again, when next required. When lighting implements become more difficult to access, it would follow that ink will become a more precious commodity and may be used by multiple people or stored between tattooing episodes. This could mean that ink used for one person (and contaminated with their blood) may be used to tattoo other people. This would increase the risk of transmission of viral infections (hepatitis C, hepatitis B and HIV) between inmates as a result of re-use of ink. The link between tattooing and risk of hepatitis C transmission has been well established, with prison tattoos generating additional concern because of high background hepatitis C prevalence and lack of sterile tattooing equipment (Jafari et al., 2010).

Various strategies could be used to reduce or eliminate such an unintended outcome. For example, consideration could be given to Australian prisons providing a tattoo program that would allow inmate access to a professional tattooist and sterile equipment. An evaluation of a pilot program in the Canadian setting found that “the initiative demonstrated potential to reduce harm, reduce exposure to health risk, and enhance the health and safety of staff members, inmates and the general public” (Kondro, 2007). Surveillance is required to understand the impact on blood borne virus transmission and other risks of the welcome intervention targeting tobacco smoking. We urge prison authorities to consider these risks and any potential harmful consequences and work to address them.

References

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