Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 15 (12)

Inmates With Harmful Substance Use Increase Both Exercise and Nicotine Use Under Incarceration


Inmates With Harmful Substance Use Increase Both Exercise and Nicotine Use Under Incarceration

Ashley Elizabeth Muller et al. Int J Environ Res Public Health.


Exercise is increasingly understood as an important resource for people who engage in harmful substance use, including those in prison. Little is known about how inmates adopt various health behaviors during incarceration, without interventions. This cross-sectional study analyzed self-reports from 1464 inmates in Norwegian prisons in 2013⁻2014, compared them according to harmful substance use pre-incarceration, and explored changes in exercise and nicotine use during incarceration. Results were presented in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Inmates with harmful substance use reported higher rates of smoking, smokeless tobacco, and physical inactivity pre-incarceration than inmates without harmful use. However, inmates with harmful use also exhibited more behavioral changes: they adopted exercise, ceased smoking, and adopted smokeless tobacco at higher rates during incarceration than the non-harmful group, to the extent that inmates with harmful use exercised during incarceration more. Exercise is being taken up by a significant proportion of inmates, and may in particular be a replacement behavior for substance use. However, unhealthy behaviors also begin or are maintained. If prisons were used as an arena to facilitate healthy behaviors, the public health benefits to a marginalized group such as substance-using inmates could be substantial.

Keywords: cigarette; exercise; health behavior; smokeless tobacco; substance use.

Conflict of interest statement

The authors declare no conflict of interest.


Figure 1
Figure 1
Flow chart of participation in the Norwegian Offender Mental Health and Addiction (NorMA) study. AUDIT: Alcohol Use Disorders Identification Test. DUDIT: Drug Use Disorders Identification Test.
Figure 2
Figure 2
Exercise and nicotine use changes of inmates during incarceration. Within-group differences over time indicated by: * p < 0.05, ** p < 0.01, *** p < 0.001.
Figure 3
Figure 3
Changes in exercise frequency (sessions/week) of inmates during incarceration.

Similar articles

See all similar articles


    1. Caspersen C., Powell K., Christenson G. Physical Activity, Exercise, and Physical Fitness: Definitions and Distinctions for Health-Related Research. Public Health Rep. 1985;100:126–131. - PMC - PubMed
    1. World Health Organization . F10—F19: Mental and Behavioural Disorders Due to Psychoactive Substance Use. WHO; Geneva, Switzerland: 1992.
    1. Wang D., Wang Y., Wang Y., Li R., Zhou C. Impact of physical exercise on substance use disorders: A meta-analysis. PLoS ONE. 2014;9:e110728 doi: 10.1371/journal.pone.0110728. - DOI - PMC - PubMed
    1. Linke S.E., Ussher M. Exercise-based treatments for substance use disorders: Evidence, theory, and practicality. Am. J. Drug Alcohol Abus. 2015;41:7–15. doi: 10.3109/00952990.2014.976708. - DOI - PMC - PubMed
    1. Zschucke E., Heinz A., Strohle A. Exercise and physical activity in the therapy of substance use disorders. Sci. World J. 2012 doi: 10.1100/2012/901741. - DOI - PMC - PubMed