If this intervention is efficacious, it can address the important issue of how to maintain smoking cessation after forced abstinence due to incarceration. Once released from a smoke free environment (incarceration, basic military training, substance abuse treatment or psychiatric facility) the vast majority of smokers immediately start smoking again [7, 32–34]. Hence, despite forced abstinence many smokers need interventions to decrease relapse post release. As described above, CBT has demonstrated efficacy/effectiveness; however, skills-based interventions may be less effective for persons unmotivated to implement them. The current literature does not address a combined approach to both a) enhance interest in maintaining cessation and b) learn and implement skills during forced abstinence while incarcerated. This study addresses this gap in the knowledge base. In addition, given the racial/ethnic diversity often found in these settings, it is important to study interventions that may be suitable to this diverse population.
This study is an initial investigation of the efficacy of combined MI/CBT for smoking abstinence after release. While prior studies used longer follow-ups, we chose an abbreviated follow-up because relapse to smoking is rapid after release and this is the first intervention study of its kind conducted in this setting. The short term outcomes of this study will reveal if MI/CBT has the potential to improve smoking cessation rates after release from prison and will provide information to adjust the intervention if needed. The design chosen for this study will allow us to explore potential mediators of the intervention's efficacy so that we may better understand the mechanism(s) by which this intervention may impact maintenance of smoking cessation.
Innovative treatments are needed that address enhancing interest in and skills for maintaining a smoke-free life-style after forced abstinence due to incarceration. This is a highly underserved population in great need. MI has been associated with good outcomes in racially/ethnically diverse samples, [35, 36] which is significant for prison settings that reflect high proportions of ethnic and racial minorities. A motivationally based intervention revealed that for smokers not motivated to quit, the intervention led to an odds ratio of quitting of 1.79 over controls and even higher (4.9) for ethnic minorities . Similarly, CBT also demonstrates good intervention effects for racial and ethnic minorities [8, 37, 38]. Although some meta-analyses have suggested that the effects of MI may not be robust for smoking,  others have argued against this [36, 40]. However, our use of MI is to enhance interest in change (i.e., maintaining cessation) and in engaging with additional treatment, and both uses have demonstrated efficacy [35, 41–43]. Therefore, MI+CBT may prove to be a more efficacious treatment for maintaining smoking abstinence after release from incarceration than either treatment alone. Importantly, this study will afford the opportunity for follow-up after release from incarceration, which is rarely or ever found in the literature with respect to smoking behaviors.
Incarcerated people have higher smoking prevalence than the general population and suffer disproportionately from the health effects of tobacco smoking due over-representation of ethnic and racial minorities, impoverished individuals, and those with mental health and drug addictions [17, 44–48]. The incarcerated setting provides a unique opportunity to intervene with this population prior to their release back into the community. Provision of an individually-tailored intervention to this particular population in this specific setting represents a highly innovative and extremely important effort to reach a vulnerable population of smokers.