Outcomes of a Pilot Smoking Cessation Program After Release From Jail

This photograph depicts countless cigarette butts in a public ashtray. The photograph was taken in the city of Courbevoie, in the department of Hauts-de-Seine, France.
A study was undertaken to examine the acceptability, feasibility, and preliminary clinical outcomes of a smoking cessation intervention for individuals who are incarcerated.

Counseling during incarceration, with nicotine replacement therapy dispensed after release from jail, may decrease cigarette consumption. These findings from a pilot trial were published in JAMA Network Open.

The Jail-Based Use of Smoking Treatment (JUST) study (ClinicalTrials.gov Identifier: NCT03799315) was conducted at the Hennepin County Jail in Minnesota. Inmates (N=58) who smoked daily before incarceration were recruited between 2019 and 2020. Participants were randomly assigned in a 1:1 ratio to receive counseling plus nicotine replacement therapy or brief health education. This trial was assessed for feasibility, acceptability, and smoking outcomes at 1, 3, and 12 weeks after release from jail.

Counseling comprised a 1-hour in-person smoking cessation counseling session during incarceration and up to four 10- to 20-minute telephone sessions during the first 3 weeks after release. During the in-person session, participants sampled a 2-mg nicotine lozenge, and 3 packs of 81 lozenges were dispensed upon release.

The brief health education comprised a 30-minute general health education session focused on diet, exercise, tobacco use, and sexual health. Participants who were randomly assigned to this cohort were offered the nicotine lozenges at study conclusion.

Participants in the treatment and control participant cohorts had a mean age of 36.3 (SD, 8.8) and 40.0 (SD, 9.2) years, 91% and 91% were men, 30% and 26% were White, 35% and 22% were Black, and Fagerstrom Test for Nicotine Dependence scores were 5.87 (SD, 2.03) and 5.30 (SD, 1.55), respectively.

Among the intervention cohort, 60.8% completed at least 1 telephone counseling session during which time all reported using the nicotine lozenges. Reasons for missing sessions were unreliable access to a telephone (n=15), reincarceration (n=13), being at a drug rehabilitation clinic (n=8), and homelessness (n=5).

The average Client Satisfaction Questionnaire-8 score was 28.1 (SD, 2.5) among the intervention cohort. Participants reported that receiving the lozenges while still incarcerated would have helped with the stressful transition of release.

At 3 weeks, 7-day point prevalence abstinence was 11.9% for the intervention and 10.6% for the control participant cohorts. Individuals who received the nicotine replacement therapy smoked fewer cigarettes (difference, -3.26; 95% CI, -5.20 to -0.20 cigarettes per day; P =.04).

There was little evidence to suggest there were between-group differences for time to first cigarette or time to relapse.

This study was limited by the premature closing of enrollment due to the COVID-19 pandemic.

This pilot study demonstrated it was both feasible and acceptable, and had the potential to decrease the number of cigarettes smoked by individuals recently released from jail.


Winkelman TNA, Ford BR, Dunsiger S, et al. Feasibility and acceptability of a smoking cessation program for individuals released from an urban, pretrial jail: a pilot randomized clinical trial. JAMA Netw Open. 2021;4(7):e2115687. doi:10.1001/jamanetworkopen.2021.15687