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Smoking Restrictions in Large-Hub Airports --- United States, 2002 and 2010

Secondhand smoke (SHS) exposure causes death and disease in both nonsmoking adults and children, including cancer, cardiovascular and respiratory diseases (1). SHS exposure causes an estimated 46,000 heart disease deaths and 3,400 lung cancer deaths among U.S. nonsmoking adults annually (1). Adopting policies that completely eliminate smoking in all indoor areas is the only effective way to eliminate involuntary SHS exposure (1). In 2009, an estimated 696 million aircraft passenger boardings occurred in the United States (2). A 2002 survey of airport smoking policies found that 42% of 31 large-hub U.S. airports had policies requiring all indoor areas to be smoke-free (3). To update that finding, CDC analyzed the smoking policies of airports categorized as large-hub in 2010. This report summarizes the results of that analysis, which found that, although 22 (76%) of the 29 large-hub airports surveyed were smoke-free indoors, seven airports permitted smoking in certain indoor locations, including three of the five busiest airports. Although a majority of airports reported having specifically designated smoking areas outdoors in 2010 (79%) and/or prohibiting smoking within a minimum distance of entryways (69%), no airport completely prohibited smoking on all airport property. Smoke-free policies at the state, local, or airport authority level are needed for all airports to protect air travelers and workers at airports from SHS.

Large-hub airports are defined by the Federal Aviation Administration as airports that accounted for ≥1% of total passenger boardings in the United States during the previous year. Combined, the 29 airports categorized as large-hub in 2010 accounted for approximately 70% of total passenger boardings in the United States in 2009 (2).

Smoking policies in airports can be established by state statute; county or city ordinance; or airport/transit authority rule, regulation, or policy. An airport was defined as smoke-free indoors when smoking by anyone was prohibited at all times, in all indoor areas of the airport. To determine the smoking policies in place at the 29 large-hub airports, information was collected during July--September 2010. CDC first reviewed and analyzed state and local laws from databases of current statutes and ordinances and airport authority rules and regulations available on Internet sites. Results were then compared with a list of airport smoking policies maintained by the Americans for Nonsmokers' Rights Foundation (4) and with other Internet resources, including policy information on airport websites. Finally, airport personnel were contacted to resolve any inconsistencies between CDC's findings and other reports and to collect additional information on smoking policies. These results were compared with information on smoking policies at the 31 airports categorized as large-hub in 2002 (3).*

The CDC analysis included identifying 1) whether smoking was allowed or prohibited in all indoor areas; 2) where smoking (if allowed) was permitted indoors, including the type and number of locations; 3) whether outdoor smoking areas were designated; 4) whether smoking was prohibited within a minimum distance of airport entrances; and 5) how smoking policies were communicated to aircraft passengers and airport workers and visitors (i.e., written policies, signage, or announcements on the public address system).

Twenty-two (76%) of the 29 large-hub airports were smoke-free indoors in 2010 (Table 1), compared with 13 (42%) of 31 large-hub airports in 2002 (Table 2). Among the seven large-hub airports that allowed smoking indoors in 2010, three were ranked among the top five in passenger boardings: Hartsfield-Jackson Atlanta International, Dallas/Fort Worth International, and Denver International.

None of the 29 large-hub airports completely prohibited smoking outdoors on airport property. A larger percentage (79%) of airports reported having specifically designated outdoor smoking areas in 2010 than in 2002 (68%). The percentage of airports with policies prohibiting smoking within a minimum distance of airport entrances (range: 10--30 feet) also was greater in 2010 (69%) than in 2002 (61%) (Table 2). In 2010, airports that permitted smoking indoors were less likely than those that did not to have designated outdoor smoking areas (71% versus 82%) or minimum distance requirements outdoors (29% versus 82%). A similar pattern was observed in 2002 (3).

All 29 large-hub airports reported posting signage to communicate their smoking policy; 72% of these airports also reported that announcements related to the smoking policy were made over the airport's public address system. Some large-hub airports reported that they had made such announcements previously but had discontinued them because the smoking policy was well-known.

Reported by

A Cordero, MPA, M Tynan, S Babb, MPH, G Promoff, MA, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

The findings in this report show increases from 2002 to 2010 in the percentages of large-hub airports that are smoke-free indoors, that have designated outdoor smoking areas, and that prohibit smoking within a minimum distance of airport entrances. However, seven large-hub airports allowed smoking indoors in 2010, including three of the five busiest airports. Together, these seven airports that allowed smoking indoors accounted for approximately 151 million (22%) of the 696 million total passenger boardings in the United States in 2009 (2). SHS exposure causes heart disease and lung cancer in nonsmoking adults and can have immediate adverse effects on the cardiovascular system (1). According to the 2006 report of the Surgeon General, the scientific evidence indicates that there is no risk-free level of SHS exposure (1). Brief exposures to secondhand smoke can cause blood platelets to become stickier, damage the lining of blood vessels, decrease coronary flow velocity reserves, and reduce heart rate variability, potentially increasing the risk for a heart attack (1,5). SHS contains chemicals that can quickly irritate and damage the lining of the airways. Even brief exposure can result in upper airway changes in healthy persons and can lead to more frequent and more severe asthma attacks in children who already have asthma (1).Smoke-free policies not only eliminate the risk from involuntary SHS exposure, but also change social norms and motivate smokers to quit (1).

Although smoking was prohibited on all airline flights to and from the United States in 2000, no federal policy requires airports to be smoke-free. Cigarette manufacturers have promoted separately enclosed and ventilated smoking areas to the management of airports and opposed efforts to make airports completely smoke-free (6,7). Enclosed and ventilated smoking rooms are not effective in eliminating SHS exposure (1), and air travelers or airport workers who pass by these rooms are at risk for exposure to SHS (8,9). A 2010 study found that, although ventilated smoking rooms in a medium-hub airport were operating properly, SHS leaked to surroundings areas where smoking was prohibited (9).

Air travelers and airport workers also are at risk for SHS exposure when entering or exiting an airport building. According to a study by the California Air Resources Board, nicotine concentrations adjacent to outdoor smoking areas at airports can be as high as those in some smokers' homes (10). Moreover, in some airports, the designated outdoor smoking areas are partially enclosed. Outdoor SHS levels might be particularly high in these partially enclosed areas or where smoking is allowed around airport entrances.

Most airports that are smoke-free indoors are located in states or cities that have laws in place prohibiting smoking in public places or places of employment with no exemptions for airports. The reported smoking policies of all 29 large-hub airports in this report appeared to be in compliance with state and local laws. For example, although state laws in Colorado and Utah§ prohibit smoking in workplaces and public places, they specifically exempt smoking rooms at airports.

The findings in this report are subject to at least three limitations. First, this study did not measure enforcement of or compliance with airport smoking policies. Second, the survey is based partially on self-report by airport personnel, rather than on firsthand observations by CDC researchers. However, self-reports were cross-checked with multiple information sources, and inconsistencies were reconciled. Finally, the findings from 2002 were based solely on self-report by airport personnel (3), which might yield less accurate findings than the multiple information sources used in this report.

To protect the health of air travelers and airport workers, greater efforts are needed to completely eliminate smoking inside airports through state or local laws or airport regulations and to remove exemptions from state and local laws that prohibit smoking in workplaces and public places, yet allow smoking within airports. In addition, further research on enforcement of and compliance with airport smoking policies is needed. Further research also is needed to measure levels of tobacco smoke constituents inside and outside of airport buildings.

Acknowledgments

This report is based, in part, on past contributions by the late Ron Davis, MD, former director, Office on Smoking and Health, and former president of the American Medical Association; and contributions by ES Pevzner, PhD National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC.

References

  1. US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2006. Available at http://www.surgeongeneral.gov/library/secondhandsmoke/report/fullreport.pdf. Accessed November 10, 2010.
  2. Federal Aviation Administration. Passenger boarding (enplanement) and all-cargo data for U.S. airports. Commercial service airports (primary and nonprimary). CY09 passenger boardings. October 2010. Available at http://www.faa.gov/airports/planning_capacity/passenger_allcargo_stats/passenger/media/cy09_cs_enplanements.xls. Accessed November 10, 2010.
  3. CDC. Survey of airport smoking policies---United States, 2002. MMWR 2004;53:1175--8.
  4. Americans for Nonsmokers' Rights Foundation. Smoking policies in the 30 busiest U.S. airports. October 1, 2010. Berkley, CA: American Nonsmokers' Rights Foundation; 2010. Available at http://www.no-smoke.org/pdf/smokingpoliciesbusiestairports.pdf. Accessed November 10, 2010.
  5. Institute of Medicine. Secondhand smoke exposure and cardiovascular effects: making sense of the evidence. Washington, DC: The National Academies Press; 2010.
  6. Legacy Tobacco Documents Library. Airport strategy plan, 1990. Available at http://legacy.library.ucsf.edu/tid/ajm30c00. Accessed November 10, 2010.
  7. Legacy Tobacco Documents Library. City of Atlanta and Philip Morris Incorporated: an agreement to accept funds for the construction of glass enclosed smoking areas at Hartsfield Atlanta International Airport, 1994. Available at http://legacy.library.ucsf.edu/tid/vru50b00. Accessed November 10, 2010.
  8. Pion M, Givel MS. Airport smoking rooms don't work. Tob Control 2004;13(Suppl 1):i37--40.
  9. Lee K, Hahn EJ, Robertson L, Whitten L, Jones LK, Zahn B. Air quality in and around airport enclosed smoking rooms. Nicotine Tob Res 2010;12:665--8.
  10. California Environmental Protection Agency, Air Resources Board. Environmental tobacco smoke: a toxic air contaminant. Fact sheet. October, 18, 2006. Available at http://www.arb.ca.gov/toxics/ets/factsheetets.pdf. Accessed November 10, 2010.

* Three airports that were categorized as large-hub in 2002 were categorized as medium-hub in 2010 (≥0.25% and <1% of all U.S. passenger boardings): Pittsburgh International, Lambert-St. Louis International, and Cincinnati/Northern Kentucky International. One airport, Chicago Midway International, was medium-hub in 2002 and large-hub in 2010.

Colo. Rev. Stat. Ann. § 25-14-205 (1)(f).

§ Utah Code Ann. § 26-38-3 (2)(c).


What is already known on this topic?

According to the 2006 Surgeon General's report, the scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke (SHS); the only effective way to eliminate involuntary exposure to SHS is to completely eliminate smoking in all indoor areas.

What is added by this report?

Although 76% of 29 large-hub airports were identified as smoke-free indoors in 2010, seven large-hub airports allowed smoking in designated indoor areas; these seven airports accounted for approximately 22% of the total passenger boardings in the United States in 2009. No airport reported completely prohibiting smoking on airport property, potentially leaving air travelers, airport visitors, and workers at airports at risk for SHS exposure when entering, exiting, or working outside of airports.

What are the implications for public health practice?

Policies making indoor areas within airports completely smoke-free are needed at the state, local, or airport authority level to better protect the health of air travelers, airport visitors, and airport workers; further study is needed to evaluate how to effectively eliminate outdoor exposure to SHS.


TABLE 1. Indoor smoke-free status of large-hub airports (N = 29), reported number of indoor smoking areas, and locations where smoking is permitted --- United States, 2010

Rank*

Airport

City, state

Smoke-free indoors

Reported no. of smoking areas

Locations where smoking is permitted

1

Hartsfield-Jackson Atlanta International

Atlanta, Georgia

No

12

Public smoking rooms; bars

2

Chicago O'Hare International

Chicago, Illinois

Yes

---

---

3

Los Angeles International

Los Angeles, California

Yes

---

---

4

Dallas/Fort Worth International

Fort Worth, Texas

No

2

Private airline clubs

5

Denver International

Denver, Colorado

No

4

Bars

6

John F. Kennedy International

New York, New York

Yes

---

---

7

McCarran International

Las Vegas, Nevada

No

1

Bar

8

George Bush Intercontinental/Houston

Houston, Texas

Yes

---

---

9

Phoenix Sky Harbor International

Phoenix, Arizona

Yes

---

---

10

San Francisco International

San Francisco, California

Yes

---

---

11

Charlotte/Douglas International

Charlotte, North Carolina

No

4

Nonpublic, leased tenant space

12

Newark Liberty International

Newark, New Jersey

Yes

---

---

13

Orlando International

Orlando, Florida

Yes

---

---

14

Miami International

Miami, Florida

Yes

---

---

15

Minneapolis-St Paul International

Minneapolis, Minnesota

Yes

---

---

16

Seattle-Tacoma International

Seattle, Washington

Yes

---

---

17

Detroit Metropolitan Wayne County

Detroit, Michigan

Yes

---

---

18

Philadelphia International

Philadelphia, Pennsylvania

Yes

---

---

19

General Edward Lawrence Logan International

Boston, Massachusetts

Yes

---

---

20

Washington Dulles International

Dulles, Virginia

No

4

Public smoking rooms

21

La Guardia

New York, New York

Yes

---

---

22

Baltimore/Washington Intl. Thurgood Marshall

Glen Burnie, Maryland

Yes

---

---

23

Fort Lauderdale/Hollywood International

Fort Lauderdale, Florida

Yes

---

---

24

Salt Lake City International

Salt Lake City, Utah

No

5

Public smoking rooms

25

Honolulu International

Honolulu, Hawaii

Yes

---

---

26

Ronald Reagan Washington National

Arlington, Virginia

Yes

---

---

27

San Diego International

San Diego, California

Yes

---

---

28

Tampa International

Tampa, Florida

Yes

---

---

29

Chicago Midway International

Chicago, Illinois

Yes

---

---

* Ranked by total number of passenger boardings in 2009 (range: 42.3 million--8.3 million), according to the Federal Aviation Administration.


TABLE 2. Number and percentage of large-hub airports, by restrictions on smoking indoors or outdoors --- United States, 2002 and 2010

Year

No. large-hub airports

Smoke-free indoors

Has designated outdoor smoking areas

Requires smokers to be a minimum distance* from entrances to airport buildings

No.

(%)

No.

(%)

No.

(%)

2002

31

13

(42)

21

(68)

19

(61)

2010

29

22

(76)

23

(79)

20

(69)

Source: (2002 data) CDC. Survey of airport smoking policies---United States, 2002. MMWR 2004;53:1175--8.

* Range: 10--30 feet.



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