Abstract
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). 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).