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Putting too much tobacco into the pipe will ultimately give off less flavor, and may even be difficult to light

Until recently, group health plans have largely been spared

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Smoking can be seen by prisoners as a way of helping to manage stressful situations such as prison transfers, court appearances and prison visits.[22] Missing friends and family and a lack of family support have been identified as further reasons why prisoners might feel the need to smoke.[23] Furthermore, boredom, prolonged periods locked in cells, bullying and stress have all been given as reasons for relapses by prisoners who attempted to quit smoking.[24] Cigarettes and tobacco are frequently used by prisoners as currency and reports indicate this may also apply to medicinal nicotine.[25] In some instances, prisoners have accessed smoking cessation programmes in order to obtain nicotine replacement therapy to sell to other prisoners, whilst they personally continue to smoke.[26] Nicotine patch exchange schemes have been introduced in some prisons in response to this problem, with some prisons insisting on the use of transparent patches to prevent the concealment of illicit substances.[27] Offenders often show other challenging issues in addition to smoking, including addiction to other substances and social and interpersonal difficulties that can affect motivation and the ability to quit smoking.[28] Learning difficulties and high levels of low educational attainment among prisoners can have an impact on an individuals ability to access services and to cope with complex health information materials, which often do not easily translate to the prison setting.[29] The transient nature of prisoners can provide additional challenges in terms of engaging and sustaining contact with stop smoking services and the continuation of support and counselling.[30] Therefore, stop smoking services should plan for the likelihood of transfers[31] by ensuring that medical records are transferred with prisoners, along with a short supply of pharmacotherapy until prescriptions can be renewed at the new location.[32] Linking community stop smoking services to prison programmes could also offer post-release support and thus reduce rates of relapse in a particularly stressful time of readjustment.[33] Mitigating stress and boredom should be included in stop smoking initiatives