STATE System Gaming Facilities Fact Sheet
During the past 25 years, the commercial casino industry has grown from casinos in two places—Atlantic City, New Jersey, and the state of Nevada—to 465 casinos in 24 states.1 In 2018, casinos earned $41.7 billion in gross revenue.1 As the industry grows, allowing smoking in casinos presents a challenge for tobacco prevention and control efforts because of increased secondhand smoke exposure for both patrons and casino workers. In 2017, commercial casinos employed more than 361,000 people.1 The level of smoking in a casino can be especially high compared with other enclosed public places where smoking is permitted.2 For example, one study revealed that 50% of the casinos sampled had air pollution levels known to cause cardiovascular disease after only 2 hours of exposure.2 The levels of fine particle air pollution found inside a casino were four to six times that of outside air, even in a well-ventilated casino.3
In the United States, approximately 58 million nonsmokers are still exposed to secondhand smoke.4 Secondhand smoke increases the risk of heart attacks, heart disease, stroke, lung cancer, and other cancers by up to 30% among nonsmoking adults.5,6,7 According to the US Surgeon General, no amount of exposure to secondhand smoke is safe and the only way to fully protect nonsmokers from secondhand smoke is through 100% smokefree indoor air environments.6 Even brief exposure to secondhand smoke could trigger a heart attack.5
Smokefree policies are the most effective way to provide protection from exposure to secondhand smoke.8 According to the Surgeon General, separating smokers from nonsmokers, cleaning the air, and ventilating buildings are not effective protections against secondhand smoke.3,6 In some cases, casinos have been exempted from smokefree indoor air laws. Such examples exist in Iowa (on the gaming floors),9 Kansas,10 Michigan (in the gaming areas),11 New Jersey,12 and New Mexico,13 among others. Even in ventilated casinos, nicotine levels in casino workers are 300%–600% higher than employees in other workplaces where smoking is allowed during a work shift.8 By the nature of their work, casino workers cannot remove themselves from smoking areas, even for small amounts of time during a shift. Because secondhand smoke can seep into other areas of casino buildings, such as restaurants and retailers, kids and other nonsmoking patrons are also at risk.14
Communities that enact comprehensive smokefree laws report up to a 17% reduction in hospital heart attack admissions compared with communities without such laws.15 Smokefree laws and policies have a high level of public support and compliance, and research has shown that smokefree laws and policies do not negatively affect sales or employment in the hospitality industry.16,17 Scientific evidence has demonstrated that statewide smokefree policies are also effective, high-impact strategies for helping smokers quit and reducing tobacco consumption by those who smoke.17
The Centers for Disease Control and Prevention’s State Tobacco Activities Tracking and Evaluation (STATE) System tracks three types of gaming facilities—casinos, racinos (or racetrack casinos), and bingo halls. The STATE System does not cover gaming on Native American reservation lands, nor does it include slots-only or card room only facilities, though they may market themselves as casinos and racinos. Finally, the STATE System does not track smoking restrictions in facilities where wagers are placed against odds or together in a pool sometimes referred to as sports or legal bookmaking or off-track betting (OTB) facilities.
Bingo is a game of chance in which each player has one or more cards printed with differently numbered squares. Players place markers on these squares when the respective numbers are drawn and announced by a caller. The first player to mark a complete pattern (e.g., a row) of numbers wins. For STATE System tracking purposes, this includes bingo facilities that are rented out for commercial use, or for-profit bingo facilities, but not private, social, charitable, or fraternal games held at private clubs.
Racinos, or racetrack casinos, are classified by the STATE System as full casinos attached to horse or dog racing tracks or parks. Slots-only facilities, such as those in Ohio and Maryland are not included as racinos for STATE System coding purposes.
A casino is usually characterized by the offering of banked games. Banked games are those in which the house is funding the game and essentially acting as a participant,which means that the casino has a stake in who wins.14 Commercial casino gaming comes in a variety of forms. The most recognizable form consists of what are called “Las Vegas-style” casinos. Other commercial gaming venues include excursion (mobile) and dockside (permanently moored) riverboats. Players gamble by playing games of chance, such as craps, roulette, baccarat, blackjack, and poker. Most of these games have odds that are mathematically determined to ensure that the casino has an overall advantage over the players at all times.
No Such Gaming: This type of gaming is not permitted under state law, or is only authorized on tribal land.
Banned: Smoking is prohibited in all areas of a gaming facility.
Designated Areas: Smoking is permitted within certain designated parts of a gaming facility.
Separate Ventilated Areas: Smoking is permitted within certain designated parts of a gaming facility that have completely separate air systems designed to minimize infiltration of secondhand smoke into other portions of a gaming facility.
No Provision: There is no language in the law that requires any restrictions on smoking in gaming facility.
None: Smoking is permitted in gaming facilities without restriction.
Measuring the effects of smokefree gaming policies is a unique challenge because not all states allow any or all types of gaming. As of March 31, 2021 29 states, the District of Columbia and Guam do not allow for casinos to operate, 34 states, the District of Columbia, Guam, and the U.S. Virgin Islands do not allow for racetrack casinos, and 31 states, Guam, Puerto Rico and the U.S. Virgin Islands do not allow for commercial bingo facilities. Of the 22 states and U.S. territories that allow casino gambling—4 states (Iowa, Louisiana, Michigan, Pennsylvania) allow for designated smoking areas, whereas only 9 states (Colorado, Illinois, Maine, Maryland, Massachusetts, New York, Ohio, South Dakota, Washington), Puerto Rico and the U.S. Virgin Islands require them to be smokefree. Of the 16 states and U.S. territories that allow racetrack casinos—5 states (Delaware, Florida, Maryland, Massachusetts, New York) and Puerto Rico offer smokefree gaming, whereas 2 states (Oklahoma, Rhode Island) offer separately ventilated areas, and 5 states (Arkansas, Iowa, Louisiana, Maine, Pennsylvania) allow designated smoking areas. Of the 20 states that allow bingo facilities to operate— 7 states (Colorado, Illinois, Iowa, Massachusetts, New York, North Dakota, Rhode Island) are smokefree, whereas 2 states (Louisiana, West Virginia) allow designated smoking areas. These statistics show that less than 50% of the employees and patrons of these types of gaming facilities are protected by state smokefree legislation. Local and state governments are responsible for deciding whether it is appropriate to address this problem through governmental action.
1. American Gaming Association. 2019 State of the States: The AGA Survey of the Commercial Casino Industry. https://www.americangaming.org/wp-content/uploads/2019/06/AGA-2019-State-of-the-States_FINAL.pdfexternal icon. Accessed on May 28, 2020.
2. Repace J. Secondhand smoke in Pennsylvania casinos: a study of nonsmokers’ exposure, dose, and risk. Am J Public Health. 2009;99:1478–1485.
3. American Society of Heating, Refrigerating, and Air Conditioning Engineers, Inc (ASHRAE). Position Paper: Environmental Tobacco Smoke. Atlanta, GA: ASHRAE; 2005.
4. CDC. Vital Signs: Disparities in nonsmokers’ exposure to secondhand smoke — United States, 1999–2012. MMWR Morb Mortal Wkly Rep. 2015;64(04):103–108.
5. National Academy of Sciences: Institutes of Medicine: Committee on Secondhand Smoke Exposure and Acute Coronary Events. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. Washington, DC: The National Academies; 2009.
6. Centers for Disease Control and Prevention. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: US Dept of Health and Human Services; 2014.
7. Meyers DG, Neuberger JS, He J. Cardiovascular effect of bans on smoking in public places: a systematic review and meta-analysis. J Am Coll Cardiol. 2009;54;1249–1255.
8. Trout D, Decker J, Mueller C; Bernert JT, Pirkle J. Exposure of casino employees to environmental tobacco smoke. J Occup Environ Med. 1998;40(3):270–276.
9. 9. Iowa Code §142D.4 (2013).
10. K.S.A §21–6110.
11. MCLS §333.12606b.
12. N.J. Stat. §26:3D–59.
13. N.M. Stat. Ann. §24-16–12.
14. Cochran C, Henriques D, York N, Lee K. Risk of exposure to secondhand smoke for adolescents in Las Vegas casinos: an evaluation of the Nevada Clean Indoor Air Act. J Health Hum Serv Adm. 2012;35:231–252.
15. Lightwood JM, Glantz SA. Declines in acute myocardial infarction after smokefree laws and individual risk attributable to secondhand smoke. Circulation. 2009;120(14):1373–1379. Epub 2009 Sep 21.
16. Eriksen M, Chaloupka F. The economic impact of clean indoor air laws. CA Cancer J Clin. 2007;57:367–378.
17. Centers for Disease Control and Prevention. Tobacco Control State Highlights 2012. Atlanta, GA: US Dept of Health and Human Services; 2013.
DISCLAIMER: The STATE System contains data synthesized from state-level statutory laws. It does not contain state-level regulations; measures implemented by counties, cities, or other localities; opinions of Attorneys General; or relevant case law decisions for tobacco control topics other than preemption; all of which may vary significantly from the laws reported in the database, fact sheets, and publications.