Smoke-Free Policies in the World’s 50 Busiest Airports — August 2017
Weekly / November 24, 2017 / 66(46);1265–1268
Michael A. Tynan1; Elizabeth Reimels, JD1; Jennifer Tucker, MPA1; Brian A. King, PhD1 (View author affiliations)View suggested citation
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.
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 (5–7). 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.
Conflict of Interest
No conflicts of interest were reported.
Corresponding author: Michael A. Tynan, firstname.lastname@example.org, 404-498-1202.
- 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.htmlExternal
- 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.htmlExternal
- CDC. Smoking restrictions in large-hub airports—United States, 2002 and 2010. MMWR Morb Mortal Wkly Rep 2010;59:1484–7. PubMedExternal
- 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.pdfCdc-pdfExternal
- Pion M, Givel MS. Airport smoking rooms don’t work. Tob Control 2004;13(Suppl 1):i37–40. CrossRefExternal PubMedExternal
- 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. CrossRefExternal PubMedExternal
- 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. PubMedExternal
- 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. CrossRefExternal PubMedExternal
|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|
|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|
|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|
|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|
|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)|
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.mm6646a1External.
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