Circumstances around Cigarette Use after Enforced Abstinence from Smoking in an American Prison

Abstract

Objectives:

Most adults return to smoking following enforced tobacco abstinence when incarcerated in U.S. prisons. Little is known about the specific relapse triggers on re-entry. This study examines situational, affective, and motivational antecedents of return to smoking immediately following release from a tobacco-free prison.

Methods:

Assessments were administered pre-release and 1 and 7 days post-release to 190 incarcerated adults who were smokers prior to incarceration. Those reporting smoking within 7 days post-release were asked about circumstances surrounding their first cigarette.

Results:

Two-thirds reported smoking in the 7 days following release (76% of those in the first day) with the first cigarette smoked 21 hours post-release on average. Smoking occurred more quickly for women than men and for those who planned to smoke after release (ps from 0.05–0.001). Forty-one percent of participants smoked while waiting for a ride or on the way home, 68% were given their first cigarette, 28% reported first smoking when reuniting with others, 42% first smoked with smokers, and 26% first smoked as celebration. The moods most reported before smoking were happy (60%) or excited (41.5%). Factors reported that could have prevented smoking were avoiding other smokers (27%), avoiding stress (16%), not drinking/using drugs (12%), and not having access to cigarettes (11%).

Conclusions:

High rates of return to smoking occurred rapidly when around other smokers, using other substances, and in a positive mood. Interventions that focus specifically on these factors and can be immediately accessed upon release are required to help sustain people’s desired abstinence.

INTRODUCTION

Smoking remains the leading cause of preventable death in the U.S. An estimated 14% of U.S. adults in 2019 were smokers.¹ Between 50 and 83% of incarcerated adults were smokers before incarceration and one in eight smokers passed through the U.S. prison system annually.^2–4 Deaths from smoking-related illnesses among formerly incarcerated adults were about twice that of the general population.^5,6 In 2004 the U.S. Federal Bureau of Prisons instituted complete smoking and tobacco bans in prisons for both incarcerated persons and staff,⁷ but since 2018, several states began to allow cigarette use in prisons again so as to reduce the consequent contraband trade.⁸ Therefore, the number of states that prohibited smoking in prisons has been dynamic. In 2018, 20 states had banned smoking in correctional facilities.⁹

While these smoking bans result in prolonged tobacco abstinence during incarceration,^10–12 almost all people in these settings return to smoking post-release.^4,13 The prevalence of smoking among smokers 6 months post-release from U.S. prisons is 97%,⁴ higher than after military basic training or hospitalization,¹⁴ but similar to rates seen after release from inpatient psychiatric hospital and addiction treatment programs.^15–17

In the United States, smoking bans in health care facilities do not result in behavioral problems, unrest, or noncompliance while in the facility.^15,18 However, smoking bans appear to have little or no effect on long-term smoking cessation.^15,19 In the general population, withdrawal from nicotine and associated cravings play an important role in return to smoking,²⁰ but for most individuals released from prison, withdrawal symptoms have resolved for months to years.

The types of interpersonal and intrapersonal situations associated with return to use tend to be similar for smokers, dieters, alcohol dependent adults, and heroin users.^21–24 Negative affect and social pressure to use are the most prominent precipitants of return to use followed by positive emotional states and craving.^21,25 Constructs specifically related to increased risk of relapse for smokers in general are absence of an intention to quit,^26,27 decreased social support,^28,29 the presence of medical conditions,³⁰ poor ability to cope,^31,32 negative affect, alcohol consumption,^31,33,34 and being around other smokers.^35,36 Positive affective situations also precede return to smoking,^31,37–39 but negative affect, particularly anxiety, anger, and depression, is the most consistently cited emotion involved in return to smoking.^{22,31, 40} While evidence about sex differences in smoking relapse is mixed,⁴¹ it remains worth investigating. While one study investigated several predictors of smoking relapse after release from prison,²⁷ further research that describes the immediate antecedents of smoking among persons leaving correctional settings after a period of enforced tobacco abstinence is warranted.

Addressing tobacco use among this highly vulnerable population is especially important if we are to reduce existing health disparities in the U.S. associated with tobacco-related illnesses. Identifying how precipitants of return to smoking among individuals released from smoking-restricted correctional environments are similar or different from published precipitants for the general population may help target specific factors to be addressed. The goal of this study is to explore the situational, affective, and motivational antecedents of return to smoking among persons following release from incarceration in a tobacco-free facility, comparing these results to situational determinants found in the literature for smokers in general who were engaged in voluntary smoking cessation.

METHODS

Participants and Setting

Participants in this study were a subset of participants in a larger study,⁴² who were asked also to provide data 1- and 7-days post-release. Individuals were eligible if they were 18 years of age or older, had smoked ≥10 cigarettes per day prior to incarceration, were English-speaking, and were eligible for release in the following 8 weeks.

Procedures

Methods and results for the larger study are published elsewhere.^42,43 Project WISE (Working Inside for Smoking Elimination) was a randomized clinical trial of an intervention aimed at increasing smoking abstinence rates among individuals following release from a tobacco-free prison. Study procedures were approved by Memorial Hospital of Rhode Island’s Institutional Review Board, the Office for Human Research Protections, and the Medical Research Advisory Group at the Rhode Island Department of Corrections (DOC)before initiating recruitment, and a Certificate of Confidentiality was obtained from the U.S. Department of Health and Human Services.

The planning and research unit of DOC provided a weekly list of all individuals scheduled to be released within the next eight weeks. Potential participants were recruited by Research Assistants (RAs) in the housing units at DOC. Potential participants were informed that study participation was voluntary and did not affect privileges at the facility including probation or parole status. If eligible and willing to participate in the study, the informed consent process was completed. Incarcerated adults were interviewed by study staff in a private area. The informed consent process included an explanation of the study and that it was voluntary and would not affect facility privileges or legal status, with study staff reading the consent form to the individual and answering all questions before consent forms were signed.

After signing informed consent, participants completed a 60-minute Audio Computer-Assisted Self-Interview (A-CASI) questionnaire and listened to questions on headphones while reading questions on the computer screen. Participants entered responses using the computer keyboard and research study staff were available if the participant had questions or technical problems. Participants were contacted by telephone at 24 hours and 7 days after release to assess smoking status. All participants received an American Heart Association smoking cessation pamphlet, a list of community resources, and study contact information.

Measures

Measures at study enrollment (baseline) included demographics and smoking history. Tobacco use disorder was assessed using the Fagerström Test for Nicotine Dependence,⁴⁴ modified to ask about their smoking immediately prior to incarceration. Intention to remain tobacco-free was assessed using the Ladder of Change with wording modified to reflect remaining tobacco-free after release, rather than after actively quitting smoking.⁴² The 6-point scale was dichotomized: responses of “I plan to smoke when I get out of here and never plan to quit” to “I will probably smoke when I get out of here” were classified as “plans to smoke upon release.” Responses of “I probably won’t smoke when I get out of here” to “I have made plans to not smoke when I get out and I will never smoke again” were classified as “plans to not smoke upon release.”

Follow-up assessments were conducted by RAs 24 hours and 7 days after release, with questions about the first cigarette smoked since release at either 24 hours or 7 days depending on when the first cigarette was smoked. To obtain detailed antecedents of the first cigarette smoked, all participants were asked: “Have you smoked cigarettes since being released?” Participants who reported smoking were asked for details of the circumstances surrounding the first cigarette in an open-ended manner (about 5 min). Questions were: “Where were you when you smoked your first cigarette?”, “Who was with you?”, “What was the situation?”, “What were you doing?”, “How were you feeling?”, “How did you get the cigarette?” (with these response options: found it, someone gave it to me, bought it myself), “Were you using drugs or alcohol (before or after you smoked)?”, “What might have helped you not smoke?”, and “What has helped you to stay smoke free?” (asked of participants who did not smoke). When participants indicated more than one response, multiple responses were recorded and coded. To determine if other tobacco products were used, participants were asked “Have you used any other tobacco products (cigars, pipes, chews)?”.

Data Analysis

All responses requiring coding were double coded by two trained raters (one master’s level social worker and one Psy.D. candidate). Agreement for the raters ranged from 86 to 100%. In the event of discrepant coding between the two raters, the first author coded the response. Participants who had their first cigarette within 24 hours of release were coded as having “smoked on release day” and all others who smoked were coded as “smoked in first week, but not on release day.” Those who participated in the follow-up assessments at 24 hours versus 7 days after release were compared on baseline demographic and smoking variables. Analyses were primarily descriptive statistics and frequencies. Chi-square and t-tests were used to examine if intention to remain smoke-free, tobacco use disorder prior to incarceration, smoking while incarcerated, and sex were related to smoking variables in the 7 days post release.

RESULTS

Demographic and baseline characteristics

Of the 247 participants included in the larger study, 190 (76.9%) participants completed the follow-up post-release assessment and were included in this study. There were no significant differences between those who completed the post-release assessment and the remainder of the larger study sample as to age, sex, race, ethnicity, plans to smoke, cigarettes smoked per day prior to incarceration, or FTND prior to incarceration. However, those who were included in the study had a longer time since smoked regularly due to the length of their incarceration (M = 1.32 years, SD = 1.67) than those who were not included (M = 0.78, SD = 1.10), t(239) = 2.23, p = .03). Participants averaged 35.1 years of age (SD = 9.2) and 33.2% were women. About 58% identified as White, 21.3% as Hispanic, 21.8% as Black, 4.8% as Native American or Alaskan Native, 1.1% as Asian or Pacific Islander, and 5.3% as other races/ethnicities. At least a high school education was reported by 34%. The average time of incarceration was 1.20 (1.58) years. Participants smoked M = 21.8 (SD = 12.2) cigarettes per day prior to incarceration with M = 18.9 (SD = 10.0) total years smoking. FTND prior to incarceration was M = 5.2 (SD = 2.3), with 51.1% scoring 0–5 (low) and 48.9% scoring 6–10 (high). Fifty-two percent (n = 98) had plans to smoke after release and 48% (n = 92) planned not to smoke. Twenty-four percent (n = 24) of those who had plans to smoke after release did not smoke. Smoking during incarceration was reported by 15.8% of participants, with 10% smoking 1–20 cigarettes in total during incarceration, 3.7% smoking 21–100 cigarettes, and 2.1% smoking 100 or more cigarettes.

Smoking during the first seven days

Return to smoking was reported by 64.7% (n = 123) at 7 days post-release, by 49.5% (n = 94) in the first 24 hours. Among all who returned to smoking, 46.3% (n = 57) smoked within the first hour of release, 76.4% (n = 94) smoked in the first 24 hours, and 82.1% (n = 101) smoked within 48 hours of release. The mean time to first cigarette was 21 h and 29 min (SD = 41 h and 25 min); mode = 15 min; median = 2 h.

Table 1 presents the immediate antecedents of relapse after release. The most common social circumstances associated with the first cigarette were being with other smokers or reuniting with family, friends, or children, followed by celebrating and meeting with family and friends. Almost half smoked the first cigarette while waiting for a ride or on the way home from prison. A majority of those who returned to smoking were given their first post-release cigarette as opposed to buying it. The most common emotions reported were happy and excited, with negative emotions reported less frequently prior to smoking. Over one-third of participants reported using drugs or alcohol at the time of the first cigarette. Twelve participants used other tobacco sources. Half (n = 6) did not provide the type of product used, 16.7% (n = 2) reported using marijuana combined with tobacco, 16.7% (n = 2) reported smoking little cigars, and 16.7% (n = 2) reported smoking a single cigar. Four participants who reported use of other tobacco products also reported not smoking cigarettes.

Table 1.

Immediate antecedents of relapse after release from enforced tobacco abstinence among 123 formerly incarcerated persons.

Where were you?	%	Who were you with?	%
In car going home from prison	20.3	Family	31.7
Home	23.6	Friend	28.5
At prison waiting for a ride/bus	21.1	Alone	23.1
Family member’s house	8.1	Partner	22.0
Bar/party	8.1	Others at shelter or program	5.8
Shelter/transitional housing	5.7	other incarcerated persons	5
Friend’s house	4.9	Co-worker	<1
Treatment program	4.1
Other	4.9
What were you doing?		How were you feeling?
Hanging with other smokers	41.5	Happy	60.2
Reunited with family, friends, children	27.6	Excited	41.5
Celebrating	26.0	Nervous	26.0
Being with family/friends	26.0	Worried	12.2
Sad/got bad news	7.3	Upset	6.5
Party	6.5	Angry	3.3
Bar	4.9	Stressed	3.3
Around drugs/ETOH	15.4	Normal	2.5
Work	1.6	Sad	2.4
AA/NA meeting	1.6	Free	1.7
Went out for a meal	<1	Lonely	<1
Were you using drugs or alcohol?		How did you get the cigarette?
Yes	35.0	Someone gave it to me	68.3
Have you used any other tobacco products?		I bought it	29.3
Yes	6.8	I found it	2.4

Intention to remain smoke-free predicting smoking during the first week

Table 2 presents results by intention to remain smoke-free and by sex. Among those who smoked within 24 hours of release, about two-thirds had planned to smoke. Compared to those who planned to smoke, those who planned to not smoke: (1) had lower odds of smoking in the first hour of release; (2) had lower odds of smoking within 24 hours of release; (3) had lower odds of smoking in the first week of release; (4) were more likely to have found/been given their first cigarette than to have bought it. Among those who smoked, the time to first cigarette was about twice as long (t (1, 120) = 2.21, p = .03) for those who planned not to smoke (M = 32 h and 24 min, SD = 4 h and 17 min) compared to those who planned to smoke (M = 15 h and 25 min, SD = 37 h and 25 min).

Table 2.

Antecedents of relapse by plan to remain smoke-free and sex among 190 formerly incarcerated persons.

Variable	Plan to smoke N = 98	Plan to not smoke N = 91	OR [95%CI]	χ2 /p-value	Male N = 127	Female N = 63	OR [95%CI]	χ2/p-value
Smoked in first hour of release			.35[.18,.68]	10.09/.001*			4.21[2.18,8.15]	19.41/<.001*
No	59(60)	74(81)			102(80)	31(49)
Yes	39(40)	17(19)			25(20)	32(51)
Smoked on first day of release			.23[.12,.42]	23.87/<.001*			2.60[1.39,4.87]	9.18/.002*
No	33(34)	63(69)			74(58)	22(35)
Yes	65(66)	28(31)			53(42)	41(65)
Smoked in first week of release			.27[.14,.50]	17.49/<.001*			1.57[.82,3.02]	1.85/.174
No	21(21)	46(51)			49(39)	18(29)
Yes	77(79)	45(49)			78(61)	45(71)
Location of first cigarette			NA	6.15/.630			NA	26.19/.001*
In car going home from ACI	15(21)	8(18)			10(14)	14(31)
outside the prison waiting for a ride or at bus	20(26)	6(13)			10(14)	16(36)
At shelter/transitional housing	5(6)	2(4)			7(6)	0(0)
At home	15(20)	14(32)			20(27)	9(20)
Family member’s house	7(9)	3(7)			10(14)	0(0)
Friend’s house	4(5)	2(4)			4(5)	2(4)
At treatment program	2(2)	3(7)			5(6)	0(0)
Bar/Party	5(6)	5(11)			7(8)	3(7)
Other	4(5)	2(4)			5(6)	1(2)
Reported “nothing” would have helped them not smoke.			.31[.11,.88]	5.19/.023*			2.46[1.04,5.82]	4.35/.037*
No	54(71)	40(89)			64(83)	30(67)
Yes	22(29)	5(11)			13(17)	15(33)
Smoked on the way home after release			.54[.25,1.18]	2.43/.119			5.80[2.60,12.93]	19.91/<.001*
No	42(55)	31(69)			58(74)	15(33)
Yes	35(45)	14(31)			20(26)	30(67)
Other tobacco use			.82[.26,2.53]	.12/.724			1.59[.49,5.11]	.614/.433
No	79(92)	83(93)			117(94)	46(90)
Yes	7(8)	6(7)			8(6)	5(10)
How first cigarette was obtained			.38[.16,.93]	4.72/.030*			3.10[1.39,6.93]	7.89/.005*
Found/Given	49(64)	37(82)			62(80)	25(56)
Bought	28(36)	8(18)			16(20)	20(44)
Using drugs/EtOH			.38[.16,.93]	.114/.735			.89[.41,1.94]	.083/.774
No	49(64)	30(67)			50(64)	30(67)
Yes	28(36)	15(33)			28(36)	15(33)

Note. Data expressed n (%). One person did not indicate intentions so n = 189 for the data by plans to smoke.

Sex, FTND, and smoking while incarcerated predicting smoking during the first week

Compared to men, women: (1) had higher odds of smoking in the first hour of release; (2) had higher odds of smoking in the first day of release; (3) had higher odds of smoking on the way home from release; (4) were more likely to have bought their first cigarette than to have found/been given their first cigarette (Table 2). A higher proportion of women than men reported having had their first cigarette in their car ride home from prison or at the prison while waiting for a ride/bus. FTND prior to incarceration was not related to the time to first cigarette, r = −.16, p = .10, or return to smoking in the first seven days after release. Those who smoked during incarceration had rates of return to smoking in the first week after release similar to those who did not smoke during incarceration (60% and 64% respectively).

Perceived help for not smoking

Among the 128 who smoked there were 126 responses from 123 people to the question “What might have helped you not smoke?” (see Table 3). Almost one-quarter of participants reported there was nothing that might have helped them to not smoke. Not being around other smokers and avoiding stress were the most frequently endorsed ways to avoid smoking, followed by not drinking or using drugs and not having access to cigarettes.

Table 3.

Perceived support for smoking abstinence after release from enforced tobacco abstinence

What might have helped you not smoke?	n	N=123 %
Not being around other smokers	31	25
Nothing	28	23
Avoiding stress	18	15
Not drinking/using drugs	16	13
Not having access to cigarettes	14	11
More willpower	6	5
Medication/patch/acupuncture	4	3
Using marijuana	3	2
Not drinking coffee	2	2
Alternate activities	2	2
Not having money	1	<1
If first cigarette not tasted good	1	<1
More freedom to do what I want	1	<1
What has helped you stay smoke free?	n	N=67 %
No cravings to smoke	11	17
Spending time with family/non-smokers	7	11
Not having money	7	10
Alternative activities	5	8
Willpower	5	8
Health reasons & to stay healthy	5	7
Staying busy	4	6
Staying positive	4	6
What I learned from treatment program	4	6
Smell of smoking is gross	3	5
Being incarcerated	3	4
Avoiding smokers/cigarettes	3	4
Staying clean and sober	1	2
Smoke free housing	1	2
Using marijuana	1	1
Not wanting to revert to old behaviors	1	1
Faith	1	<1
Avoiding stress	1	<1

Among the 72 who did not smoke there were 150 responses from 67 people to the question “What has helped you stay smoke free?” (see Table 3). Most frequently reported were not having cravings to smoke, spending time with family, and not having money, followed by alternative activities, willpower, and thinking of health reasons to stay healthy. Examples of alternative activities included meditation, exercise, chewing gum, sex, playing video games, working out, and exercise.

DISCUSSION

This is the first detailed descriptive study of the immediate antecedents of the first cigarette smoked after a period of enforced abstinence while in prison, as opposed to correlating more general domains of health, history, intentions/beliefs, and substance use.⁴⁵ Of the 190 participants assessed, almost two thirds (64.7%) reported smoking in the first week after release, and about half of those within 24 hours. The findings reported here are similar to those of Lincoln et al.⁴ who found that among people released from prison with medical conditions, self-reported abstinence rates were 37% at the end of the first day and only 18% after the first week, as well as Puljevic et al.⁴⁵ who reported 72% relapse on the day of release and 94% relapse within two months of release. Overall abstinence rates in this study were 49.5% at the end of the first day and 35% after the first week. Moreover, almost half of the participants who returned to smoking smoked their first cigarette while waiting for a ride or on the way home from prison, and the majority of participants were given their first cigarette.

This rapid return to smoking suggests a need for interventions that are immediately accessible upon release from prison and that increase motivation to stay smoke free. Intervention delivery modalities for incarcerated adults that maximize accessibility and portability, such as mobile health (e.g., cell phone and other mobile devices) may be especially useful, low-cost, and scalable. Such interventions may be tailored to assist all incarcerated adults to resist the immediate urge to return to smoking post-release, and/or may be particularly effective if they target those individuals who had planned to remain smoke-free after release.

In contrast to precipitants of return to smoking for smokers in the general population engaged in voluntary smoking cessation,^24,46 negative affect did not appear to play a prominent role in return to smoking after release from enforced tobacco abstinence during incarceration. In contrast, feeling happy and excited, most likely due to being released from prison (one quarter said they were celebrating), were the feelings reported by more than half of those who smoked. While some newly released incarcerated individuals also reported feeling nervous and worried prior to their first cigarette, such negative moods were infrequently reported. Smoking cessation interventions typically place great emphasis on learning to cope with stress and negative moods to avoid relapse,⁴⁷ and less emphasis on positive moods as triggers for smoking. Results suggest that programs for this population may need to be modified to place additional emphasis on coping with positive moods without smoking, as well as placing special emphasis on handling the transition from a tobacco-free to a tobacco-available environment.

In addition, similar to previous research on smokers in the general population,^48,49 return to smoking in this study was associated with being in the presence of other smokers and with the use of other substances. The presence of other smokers seems both to be a trigger for smoking as well as a source of cigarettes themselves. Interventions that include the participant’s social environment (e.g., family, friends) may be particularly fruitful. Others in the social environment might be targeted broadly via public health messages, potentially adapted from UK’s Stoptober, which utilizes social support in part. Additionally, with permission it may be possible to include others during pre-release planning to discuss how best to support the client’s health during transition, and ways to celebrate release without tobacco or other substances. Future studies may wish to test utility of these approaches. Counseling might also include specific guidance on helping the participant to identify non-smokers who might drive them home after release or otherwise support their continued non-smoking efforts.

Despite being away from smoking during incarceration, 52% of participants apparently did not view themselves as non-smokers at the time of release as they intended to return to smoking. Differences between those who intended to return to smoking and those who did not, may highlight important intervention considerations. Those who planned to smoke had a shorter latency to the first cigarette, were less likely to be given their first cigarette, and were more likely to respond there was nothing that could have helped them not smoke, with no other differences in antecedent situations. People who do not want to resume smoking may benefit from training in refusal skills in preparation of being offered a cigarette. For those who intend to resume smoking after release, it may be efficacious to develop interventions to shift this group’s perception of incarceration as a period of time when they successfully quit smoking, rather than a period of time when they were prevented from smoking, with focus on increasing motivation to stay abstinent. Qualitative and ethnographic research⁵⁰ has demonstrated that smoker identity is multifaceted and more complex than just “smoker vs nonsmoker”. Interventions are needed that address the smoker’s self-perceived identity across multiple social contexts to assist them in adjusting their self-perception to include nonsmoking across diverse contexts.

Sex may be considered in tailoring treatment. For example, pre-release counseling for women might emphasize that the first hours during release are the most risky for returning to smoking. Counseling might focus on strategies to avoid places where cigarettes can be purchased, particularly during the first day post-release. Compared to men, women had higher odds of smoking within the first hour and the first day after release. Although both men and women had high rates of return to smoking, women appeared particularly vulnerable. Women were also more likely than men to have purchased their first cigarette rather than to have been given or found it. The act of purchasing a cigarette may require more time or planning, and therefore be amenable to different intervention as compared to being handed one.

There are some limitations to the present study. First, data were collected retrospectively, although only by a matter of days. Participants were asked to recall the circumstances surrounding their return to smoking, and recall may be imperfect, misrepresented, or shaped by subsequent experiences intervening between the event (first cigarette) and data collection (interview at 1 and 7 days). While the effect of recall bias was minimized by use of a 24-hour interview, results obtained by using ecological momentary assessment⁵¹ may be different, as measurements could be taken more frequently after release and would precede relapse.⁵² Second, data were collected approximately 10 years ago. Although smoking status in prisons has fluctuated during this time (see Introduction), findings remain informative given the dearth of data for this vulnerable population, and given that many corrections’ facilities maintain smoking bans. Third, this study was conducted in a smoke-free prison where tobacco products were banned from the campus for both incarcerated adults and staff. Settings where tobacco is less restricted may result in different post-release outcomes. In spite of these limitations, our findings provide evidence that may enable improved targeting of interventions, suggest such interventions may need to have particular impact within the first few hours of being released, and may need to include other significant individuals, such as family and friends.

CONCLUSIONS

This study provides additional insight into the circumstances surrounding return to smoking among individuals following release from a forced-abstinence environment. This study identified relatively high rates of resuming smoking when around other smokers and being given a cigarette, when using other substances, and when feeling happy or excited or celebrating. Behavioral interventions need to focus specifically on these factors to improve treatment effects for remaining smoke-free after release from prison. Interventions are also needed that can be immediately accessed upon release and which are cost-effective and scalable. Finally, interventions are needed to shift the motivations of the majority of people who planned to return to smoking after forced abstinence.