STATE System Smokefree Indoor Air Fact Sheet

There is No Safe Level of Secondhand Smoke Exposure

In the United States, exposure to secondhand smoke causes more than 41,000 deaths among nonsmoking adults and an estimated $5.6 billion in lost productivity each year.1 According to the US Surgeon General, no amount of exposure to secondhand smoke is safe.1 Millions of nonsmokers remain exposed to secondhand smoke in the United States.2 In 2011–2012, approximately 58 million nonsmoking Americans were exposed to secondhand smoke.3 The effects of secondhand smoke is particularly hazardous for children because of their increased intake of air relative to their body weights as compared to adults.4 Secondhand smoke causes sudden infant death syndrome (SIDS), acute respiratory infections, middle ear disease, and more frequent and severe asthma attacks in children.1,3 It is estimated that about 15 million US children aged 3–11 years are exposed to secondhand smoke.3

Eliminating smoking in indoor spaces is the only way to fully protect nonsmokers from exposure to secondhand smoke.1,5 Smokefree policies are the most effective way to provide protection from exposure to secondhand smoke.6 In a study conducted by the Institute of Medicine, on behalf of the Centers for Disease Control and Prevention (CDC), the Committee on Secondhand Smoke Exposure and Acute Coronary Events reported that smokefree policies are effective at reducing the health risks to nonsmokers associated with exposure to secondhand smoke.5 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.7 It has been shown that communities that enact comprehensive smokefree laws see up to a 17% reduction in hospital heart attack admissions.8 Smokefree laws and policies have a high level of public support and compliance, and studies have shown they do not negatively affect sales or employment in the hospitality industry.9,10 Currently 49.5% of the total US population is covered by 100% smokefree indoor air policies in bars, restaurants, and worksites.11

*To receive credit for a worksite location ban, smoking must be prohibited in both government and private worksites (see chart).

† Effective October 1, 2018, Alaska implemented new legislation to prohibit smoking and the use of e-cigarettes in indoor areas of private worksites, restaurants, and bars. Also included in the legislation is an option for a municipality to opt out of these provisions through a voter referendum. Because municipalities in Alaska are able to exempt themselves from this legislation, it is not considered to be a comprehensive smokefree indoor air policy.

What States are Doing to Reduce Secondhand Smoke

Healthy People 2020 objectives call for all 50 states and the District of Columbia to establish smokefree laws that prohibit smoking in public places and worksites.12 Some states allow certain locations to provide separate spaces for smokers and nonsmokers, such as tobacco manufacturing facilities, retail tobacco stores, outdoor seating areas of bars and restaurants, rooms in a hotel designated as “smoking rooms,” facilities owned by fraternal groups or other private membership clubs, casinos and racetracks, and private homes. However, the US Surgeon General has concluded that separating smokers from nonsmokers, cleaning the air, and ventilating buildings are not effective protections against secondhand smoke.13,14 As of December 31, 2019, 28 states, American Samoa, the District of Columbia, Guam, the Marshall Islands, Puerto Rico and the U.S. Virgin Islands prohibit smoking in bars and 34 states, American Samoa, the District of Columbia, Guam, the Marshall Islands, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands prohibit smoking in restaurants. Thirty-four states, American Samoa, the District of Columbia, the Marshall Islands, the Northern Mariana Islands, Palau, Puerto Rico and the U.S. Virgin Islands have 100% smokefree indoor air laws in both government and private worksites. Idaho, Mississippi, North Carolina, and Oklahoma prohibit smoking in government worksites but not in private worksites.

Since 2010, several states enacted smokefree indoor air laws. As of December 31, 2019, 27 states (Arizona, California, Colorado, Delaware, Hawaii, Illinois, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington, and Wisconsin), American Samoa, the District of Columbia, the Marshall Islands, Puerto Rico and the U.S. Virgin Islands have 100% smokefree indoor air laws for bars, restaurants, and worksites (private and government).

Opportunities for Greater Protection from Secondhand Smoke

Although the number of 100% smokefree air laws has increased among states over time, there are still opportunities for greater protection from secondhand smoke.15 People can make their homes and vehicles smokefree, and states can work toward making all public places and workplaces smokefree. Twenty-three states and Guam do not yet have comprehensive smokefree indoor air laws covering all bars, restaurants, and worksites. Local and state governments are responsible for deciding whether it is appropriate to address this problem through governmental action.

References

1. Centers for Disease Control and Prevention. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, US Dept Health and Human Services; 2014.

2. Centers for Disease Control and Prevention. Vital signs: nonsmokers’ exposure to secondhand smoke-United States, 1999–2008. MMWR Morb Mortal Wkly Rep. 2010;59(35);1141–1146.

3. Centers for Disease Control and Prevention. Vital signs: disparities in nonsmokers’ exposure to secondhand smoke— United States, 1999–2012. MMWR Morb Mortal Wkly Rep. 2015; 64(04):103–108.

4. Tonkin AM, Beauchamp A, Stevenson C. The importance of extinguishing secondhand smoke. Circulation. 2009;120;1339–1341.

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 Evidenceexternal iconexternal icon. 2009. Accessed July 22, 2015.

6. Centers for Disease Control and Prevention. State-specific secondhand smoke exposure and current cigarette smoking among adults–United States, 2008. MMWR Morb Mortal Wkly Rep. 2009;58(44);1232–1235.

7. Centers for Disease Control and Prevention. Tobacco Control State Highlights 2012. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human
Services; 2013.

8. 8. Lightwood JM, Glantz SA. Declines in acute myocardial infarction after smokefree laws and individual risk attributable to secondhand smoke. Circulation. 2009;120:1373–1379.

9. Fong GT, Hyland A, Borland R, et al. Reductions in tobacco smoke pollution and increases in support for smokefree public places following the implementation of comprehensive smokefree workplace legislation in the Republic of Ireland: Findings from the ITC Ireland/UK Survey. Tob Control. 2006;15:iii51–iii58.

10. Eriksen M, Chaloupka F. The economic impact of clean indoor air laws. CA Cancer J Clin. 2007;57:367–378.

11. American Nonsmokers’ Rights Foundation. Percent of U.S. State Populations Covered by 100% Smokefree Air Lawsexternal iconexternal icon.  Accessed July 15, 2015.

12. US Department of Health and Human Services. Healthy People 2020external iconexternal icon. Washington, DC. Accessed July 22, 2015.

13. American Society of Heating, Refrigerating, and Air Conditioning Engineers, Inc (ASHRAE). Position Paper: Environmental Tobacco Smoke. Atlanta, GA:ASHRAE; 2005.

14. Centers for Disease Control and Prevention. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2006.

15. Centers for Disease Control and Prevention. State smoking restrictions for private-sector worksites, restaurants, and bars–United States, 2004 and 2007. MMWR Morb Mortal Wkly Rep. 2008;57(20):549–552.

16. Healthy People 2020 [Internet]. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Accessed September 15, 2015.

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.