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Smoke-Free Policies in the World’s 50 Busiest Airports — August 2017


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Michael A. Tynan1; Elizabeth Reimels, JD1; Jennifer Tucker, MPA1; Brian A. King, PhD1 (View author affiliations)

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Summary

What is already known about this topic?

There is no risk-free level of exposure to secondhand smoke. Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. An overwhelming majority of large-hub airports in the United States prohibit smoking indoors.

What is added by this report?

Among the 50 busiest airports worldwide, 23 airports (46%), including five of the 10 busiest airports, prohibit smoking in all indoor areas. While smoke-free airports among the 50 busiest are common in North America (14 of 18), few airports in Asia (4 of 22) have implemented smoke-free polices.

What are the implications for public health practice?

Broader implementation of smoke-free policies at the national, city, or airport authority levels can protect employees and travelers of all ages from secondhand smoke inside airports.

Exposure to secondhand smoke from burning tobacco products causes premature death and disease, including coronary heart disease, stroke, and lung cancer among nonsmoking adults and sudden infant death syndrome, acute respiratory infections, middle ear disease, exacerbated asthma, respiratory symptoms, and decreased lung function in children (1,2). The U.S. Surgeon General has concluded that there is no risk-free level of exposure to secondhand smoke (1). Previous CDC reports on airport smoke-free policies found that most large-hub airports in the United States prohibit smoking (3); however, the extent of smoke-free policies at airports globally has not been assessed. CDC assessed smoke-free policies at the world’s 50 busiest airports (airports with the highest number of passengers traveling through an airport in a year) as of August 2017; approximately 2.7 billion travelers pass through these 50 airports each year (4). Among these airports, 23 (46%) completely prohibit smoking indoors, including five of the 10 busiest airports. The remaining 27 airports continue to allow smoking in designated smoking areas. Designated or ventilated smoking areas can cause involuntary secondhand smoke exposure among nonsmoking travelers and airport employees. Smoke-free policies at the national, city, or airport authority levels can protect employees and travelers from secondhand smoke inside airports.

The 50 busiest airports were identified using data from the Airport International Council, which lists airports based on total passenger traffic for 2016 (4). The Airport International Council defines passenger traffic as the sum of enplaned passengers, deplaned passengers, and direct-transit passengers. To determine the extent of smoke-free policies at each of the 50 busiest airports worldwide, CDC reviewed and analyzed public information available on airport websites regarding availability of designated indoor smoking rooms at airports as of August 2017. Results were confirmed with information on smoke-free airports maintained by Americans for Nonsmokers’ Rights Foundation* and with other Internet resources, including information intended to assist smokers in finding places where smoking is permitted in airports. In a limited number of instances where airport websites contained unclear or ambiguous statements about policies, additional information was collected from other sources, including airport personnel and local public health personnel.

Airports were considered to have a smoke-free policy if they completely prohibit smoking in all indoor areas. Airports were considered to have no smoke-free policy if they allowed smoking in any indoor areas, including designated or ventilated indoor smoking areas. Designated smoking areas can include, but are not limited to, rooms designed for smoking tobacco; areas or rooms of restaurants or bars where smoking is allowed; and designated areas and rooms in airline clubs where smoking is allowed. Policy status was assessed overall and by global region.

Among the 50 busiest airports worldwide, 23 (46%) had a smoke-free policy (Table 1). Among the top 10 busiest airports, five had a smoke-free policy (Beijing Capital, Chicago’s O’Hare International, London’s Heathrow, Los Angeles International, and Shanghai Pudong International) and five allowed smoking in certain indoor areas (Atlanta Hartsfield Jackson International, Dubai International, Hong Kong International, Paris’s Charles de Gaulle, and Tokyo International).

Regional differences were observed in smoke-free policy status among the world’s 50 busiest airports (Table 2). Among those in North America, 14 of 18 had a smoke-free policy; in Europe, four of nine had a smoke-free policy, including airports in Madrid, Barcelona, and London (Heathrow and Gatwick airports); and in Asia, four of 22 had a smoke-free policy (all four are in China, including Beijing Capital International Airport, the world’s second busiest airport). The only airport among the 50 busiest in Oceania is Sydney International, which is smoke-free. None of the world’s 50 busiest airports is located in South America or Africa.

Discussion

As of August 2017, nearly half (46%) of the 50 busiest airports worldwide have a smoke-free policy. Smoke-free policies substantially improve indoor air quality and reduce secondhand smoke exposure among nonsmokers (1,2). The 2006 Surgeon General’s report concluded that eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke, and that separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposure of nonsmokers to secondhand smoke (1).

Although the airports in this analysis that do not have smoke-free policies only allow smoking indoors in designated or ventilated smoking areas, studies have documented that secondhand smoke can transfer from designated smoking areas into nonsmoking areas in airports, where nonsmoking travelers and employees can be exposed (57). In addition to subjecting nonsmoking travelers who pass through these areas to involuntary secondhand smoke exposure, designated or ventilated smoking areas can also result in involuntary exposure of airport employees who are required to enter these areas or work near them.

Since 2012, two of the five large-hub U.S. airports that allowed smoking in designated indoor areas have implemented, or are implementing, smoke-free policies. Salt Lake City International, a large-hub U.S. airport that is not among the world’s 50 busiest, closed its smoking rooms, and Denver International closed three of its four indoor smoking rooms, with the final smoking room scheduled to close by 2018.§

The findings in this report are subject to at least three limitations. First, information on smoke-free policies was based on information available on airport websites, which could be subject to bias or be outdated. However, these data were cross-checked with secondary information sources, and questions about unclear information were resolved by contacting local public health and airport personnel. Second, it was not possible to identify the types of smoking areas that were allowed in all airports (e.g., rooms used exclusively for smoking, smoking sections in restaurants and bars, rooms or areas in airline clubs, etc.), nor was it possible to ascertain passenger or employee movement through airports, which might or might not include use of or proximity to areas where smoking is permitted. In addition, because it was not possible to identify smoke-free policies in outdoor areas or areas near exits, this information was not reported. Finally, only the 50 busiest airports were included in this study; therefore, regions such as South America and Africa were not represented in the study because they did not include any of these busiest airports. However, many airports with lower passenger volume have implemented smoke-free policies (8).

Progress has been made in protecting nonsmoking passengers and employees from secondhand smoke in airports. A majority of airports are smoke-free in many countries worldwide, including Australia and New Zealand; European countries such as Denmark, Ireland, Norway, Spain, and the United Kingdom; South American countries such as Argentina, Brazil, Chile, Ecuador, and Uruguay; and North American countries such as Canada and the United States. Smoke-free policies at the national, city, or airport authority levels can protect employees and travelers from secondhand smoke inside airports.

Acknowledgment

Xiao Lin, National Tobacco Control Office, China CDC.

Conflict of Interest

No conflicts of interest were reported.


Corresponding author: Michael A. Tynan, mtynan@cdc.gov, 404-498-1202.

1Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, 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. https://www.surgeongeneral.gov/library/reports/secondhandsmoke/index.html
  2. US Department of Health and Human Services. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta: US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. https://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html
  3. CDC. Smoking restrictions in large-hub airports—United States, 2002 and 2010. MMWR Morb Mortal Wkly Rep 2010;59:1484–7. PubMed
  4. Port Authority of New York and New Jersey. Airport traffic report. Passenger traffic: top 50 worldwide airport comparisons, 2016, table 2.1.2. New York, NY: Port Authority of New York and New Jersey; 2016. http://www.panynj.gov/airports/pdf-traffic/ATR2016.pdf
  5. Pion M, Givel MS. Airport smoking rooms don’t work. Tob Control 2004;13(Suppl 1):i37–40. CrossRef PubMed
  6. Lee K, Hahn EJ, Robertson HE, Whitten L, Jones LK, Zahn B. Air quality in and around airport enclosed smoking rooms. Nicotine Tob Res 2010;12:665–8. CrossRef PubMed
  7. CDC. Indoor air quality at nine large-hub airports with and without designated smoking areas—United States, October–November 2012. MMWR Morb Mortal Wkly Rep 2012;61:948–51. PubMed
  8. Stillman FA, Soong A, Kleb C, Grant A, Navas-Acien A. A review of smoking policies in airports around the world. Tob Control 2015;24:528–31. CrossRef PubMed
Return to your place in the textTABLE 1. Indoor smoke-free policy status of 50 busiest airports — worldwide, August 2017
Rank* Airport Jurisdiction Country Has indoor smoke-free policy Region
1 Atlanta-Hartsfield Jackson International Atlanta United States No North America
2 Beijing Capital International Airport Beijing China Yes Asia
3 Dubai International Airport Dubai United Arab Emirates No Asia
4 Los Angeles International Airport Los Angeles United States Yes North America
5 Tokyo International Airports Tokyo Japan No Asia
6 O’Hare International Airport Chicago United States Yes North America
7 Heathrow Airport London United Kingdom Yes Europe
8 Hong Kong International Airport Hong Kong Hong Kong No Asia
9 Shanghai Pudong International Airport Shanghai China Yes Asia
10 Charles de Gaulle Airport Paris France No Europe
11 Dallas/Forth Worth International Airport Dallas/Fort Worth United States Yes North America
12 Amsterdam Airport Schiphol Amsterdam Netherlands No Europe
13 Frankfurt Airport Frankfurt Germany No Europe
14 Istanbul Ataturk Airport Istanbul Turkey No Asia
15 Guangzhou Baiyun International Airport Guangzhou China No Asia
16 John F. Kennedy International Airport New York City United States Yes North America
17 Singapore Changi Airport Changi Singapore No Asia
18 Denver International Airport Denver United States No North America
19 Seoul Incheon International Airport Incheon Republic of Korea No Asia
20 Suvarnabhumi/New Bangkok International Airport Bangkok Thailand No Asia
21 Indira Gandhi International Airport New Delhi India No Asia
22 Soekarno-Hatta International Airport Jakarta Indonesia No Asia
23 San Francisco International Airport San Francisco United States Yes North America
24 Kuala Lumpur International Airport Sepang District Malaysia No Asia
25 Madrid-Barajas Airport Madrid Spain Yes Europe
26 McCarran International Airport Las Vegas United States No North America
27 Chengdu Shuangliu International Airport Chengdu China No Asia
28 Seattle-Tacoma International Airport Seattle United States Yes North America
29 Chhatrapati Shivaji International Airport Mumbai India No Asia
30 Miami International Airport Miami United States Yes North America
31 Charlotte Douglas International Airport Charlotte United States Yes North America
32 Toronto Pearson International Airport Toronto Canada Yes North America
33 Barcelona-El Prat Airport Barcelona Spain Yes Europe
34 Phoenix Sky Harbor International Airport Phoenix United States Yes North America
35 Gatwick Airport London United Kingdom Yes Europe
36 Taiwan Taoyuan International Airport Taipei Taiwan No Asia
37 Munich Airport Munich Germany No Europe
38 Sydney International Airport Sydney Australia Yes Oceania
39 Kunming International Airport Kunming China No Asia
40 Shenzhen Bao’an International Airport Bao’an China Yes Asia
41 Orlando International Airport Orlando United States Yes North America
42 Leonardo da Vinci–Fiumicino Airport Rome Italy No Europe
43 George Bush Intercontinental Airport Houston United States Yes North America
44 Mexico City International Airport Mexico City Mexico No North America
45 Shanghai Hongqiao International Airport Shanghai China Yes Asia
46 Newark Liberty International Airport Newark United States Yes North America
47 Ninoy Aquino International Airport Manila Philippines No Asia
48 Narita International Airport Narita Japan No Asia
49 Minneapolis/St Paul International Airport Minneapolis/St Paul United States Yes North America
50 Hamad International Airport Doha Qatar No Asia

*Ranked by total 2016 passenger traffic, according to the Airports Council International.
Airports are considered to have a smoke-free policy if they completely prohibit smoking in all indoor areas. Airports were considered to have no smoke-free policy if they allowed smoking in any indoor areas, including designated or ventilated indoor smoking areas.

Return to your place in the textTABLE 2. Smoke-free airports among the 50 busiest airports, by region — worldwide, August 2017
Region* No. (%) of airports among 50 busiest No. (%) of airports with indoor smoke-free policies
Asia 22 (44) 4 (18)
Europe 9 (18) 4 (44)
North America 18 (36) 14 (78)
Oceania 1 (2) 1 (100)
Total 50 (100) 23 (46)

*No airports among the world’s 50 busiest were in the Africa or South America regions.
Airports are considered to have a smoke-free policy if they completely prohibit smoking in all indoor areas. Airports were considered to have no smoke-free policy if they allowed smoking in any indoor areas, including designated or ventilated indoor smoking areas.

Suggested citation for this article: Tynan MA, Reimels E, Tucker J, King BA. Smoke-Free Policies in the World’s 50 Busiest Airports — August 2017. MMWR Morb Mortal Wkly Rep 2017;66:1265–1268. DOI: http://dx.doi.org/10.15585/mmwr.mm6646a1.

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