Problem/Objective: Smoking prevalence among incarcerated individuals (and their guards) in many prison systems is about 400% of the national norm. Psychological stress, peer pressure, and inactivity all exacerbate prison smoking. Seeking ways to help prisoners resist and quit smoking, this study examined variables relating to health literacy and critical thinking. Tobacco control professionals working with many different special populations, not only corrections, will find this study of value.

Methods: About 400 state prisoners completed the National Youth Tobacco Survey. Their reading comprehension of cessation curricula and tobacco industry documents were tested. Prisoners also completed a health literacy test, and also a measure of critical and autonomous thinking. A smaller subsample of about 30 former prisoners provided intensive “think aloud” oral interview protocols. Appropriate data were subjected to qualitative as well as quantitative analyses.

Results: Prisoners easily comprehended cessation materials. They also understood the intent of tobacco industry documents. Prisoners were mostly already familiar with much of the information presented to them in informational, didactic formats. Reading comprehension per se did not predict smoking status nor intention to quit. In interviews prisoners displayed varying degrees of critical and autonomous thinking, and indeed measured resistance to persuasion did predict smoking status.

Conclusions: Incarcerated individuals do not need curricula teaching them what they mostly already know: smoking is lethal. Instead, prisoners need tobacco control curricula that help them cope with the psychological stress they are experiencing. They also need curricula that enhance their critical and autonomous thinking