Preventing Exposure to Secondhand Smoke in the Community
- Eliminating smoking is the only way to fully protect people who do not smoke from secondhand smoke (SHS) exposure.1
- Comprehensive smokefree policies* prohibit smoking in all areas of indoor spaces, at all times. These policies can fully protect people from secondhand smoke exposure. Comprehensive smokefree laws are smokefree policies that prohibit smoking in all areas of workplaces and public places, including restaurants and bars.2,3,4
- Comprehensive smokefree laws and policies can also help people who smoke quit and can help keep young people from starting to smoke.1,5
- Many disparities in exposure, illnesses, deaths, and lost productivity could be prevented if comprehensive smokefree laws prohibiting smoking in all indoor areas of worksites, restaurants, and bars were implemented throughout the U.S.2,30,33
* CDC defines a comprehensive smokefree law as one that prohibits smoking at all times, in all indoor areas of all workplaces, restaurants, and bars. If a law allows exemptions for designated or ventilated smoking areas in workplaces, restaurants, or bars, the state or community is not considered to have a comprehensive smokefree law.
- Studies have found substantial declines in cotinine, a marker of secondhand smoke, among both hospitality workers and the public following the implementation of smokefree laws.6,7,8,9,10,11,12,13,14Cotinine is a byproduct the body creates when it breaks down nicotine, a major ingredient of tobacco smoke.
- Research has found that smokefree policies lead to substantial declines in secondhand smoke exposure, with air quality improvements of up to 90% in high-risk settings, such as bars.15
- Smokefree laws lead to reductions in coronary events (especially heart attacks), making comprehensive smokefree laws one of the most effective and cost-effective approaches for reducing heart disease—the leading cause of death—in the U.S.2
- Comprehensive smokefree laws are associated with rapid reductions in hospitalizations related to heart attacks and strokes after the laws take effect.16,17
- Smokefree laws in hospitality venues—such as restaurants, bars, and casinos—protect both employees and customers from the harmful health effects of secondhand smoke exposure. These policies are associated with improved indoor air quality and with reduced secondhand smoke exposure, reduced sensory and respiratory symptoms, and improved lung function in employees who do not smoke.2,18,19
- Smokefree laws also can make it easier for people who smoke to quit, reducing their risk of disease.
- Smokefree laws in workplaces and communities reduce tobacco use and increase smoking cessation.2,20,21
- In 2010, a systematic review by the Task Force on Community Preventive Services reported that eleven studies found that smokefree laws and policies in workplaces were associated with a median 6.4% increase in tobacco use cessation, and twenty-one studies found that these laws and policies were associated with a median 3.4% decrease in tobacco use prevalence.5
- Smokefree workplaces and communities make youth and young adults less likely to start smoking due to several factors, including seeing fewer role models smoke, fewer opportunities to smoke alone or with others, and reduced social acceptability for smoking.2
- The implementation of smokefree laws increases the adoption of voluntary smokefree rules in homes.22 In turn, smokefree rules in homes may increase the adoption of smokefree rules for private vehicles.23 These rules can further protect people who do not smoke—especially those who are disproportionately affected by secondhand smoke exposure in homes and in vehicles, such as children.2,24
- While exposure to secondhand smoke has declined in the U.S., not everyone is equally protected by comprehensive smokefree laws. As of July 1, 2022,
- Only 62.5% of the US population is covered by 100% smokefree laws that apply to bars, restaurants, and worksites.25
- Twenty-eight states, Puerto Rico, the U.S. Virgin Islands, and the District of Columbia have comprehensive smokefree laws in effect that prohibit smoking tobacco in private worksites, restaurants, and bars. Twenty-two states, Puerto Rico, and the U.S. Virgin Islands prohibit smoking in state-regulated gambling venues.25
- Twenty-five states, Puerto Rico, and the District of Columbia prohibit the use of e-cigarettes in private worksites, restaurants, and bars, and 13 of those jurisdictions also prohibit the use of e-cigarettes in gambling venues.26
- Over 1,100 U.S. cities and counties have comprehensive smokefree laws in effect that prohibit smoking tobacco products in private worksites, restaurants, and bars.25 There are also 1,006 local US communities that prohibit the use of e-cigarettes in 100% smokefree venues.26
- Smokefree laws and policies have a high level of public support and compliance, and studies have shown they do not negatively affect sales of food and beverage items, or employment in the hospitality industry.27,28 Although the number of comprehensive smokefree laws has increased among states over time, variation and unequal protection remains. The tobacco industry has opposed these policies.29
- Most comprehensive smokefree laws and policies also prohibit the use of e-cigarettes. The e-cigarette aerosol that people who use e-cigarettes breathe from the device and exhale can contain harmful and potentially harmful substances. Including e-cigarettes in smokefree or tobacco-free policies can protect people who do not use e-cigarettes from exposure to e-cigarette emissions, and can help change social norms about tobacco use. More information about e-cigarettes can be found on the Electronic Cigarettes page.
- Uneven protections by smokefree laws and policies result in disparities in secondhand smoke exposure for some population groups.
- Groups of people who are more likely than other groups to be exposed to secondhand smoke include: non-Hispanic, Black people; people who live below the federal poverty level; people with less than a college degree; people who live with someone who smokes inside the home; people who work in traditionally “blue collar” industries, service occupations, or construction; people who live in rental properties; and children 3-11 years of age.30
- Almost two of every five children 3-11 years of age, including over half of non-Hispanic Black children, were exposed to secondhand smoke during 2017- 2018.30,31
- During 2017-2018, secondhand smoke exposure among non-Hispanic Black individuals and those living below the poverty level continued to be approximately twice as high compared with non-Hispanic White individuals and those living above the poverty level, respectively.31,32
Many disparities in exposure, illnesses, deaths, and lost productivity could be prevented if comprehensive smokefree laws prohibiting smoking in all indoor areas of worksites, restaurants, and bars were implemented throughout the U.S.2,30,33
- 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, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006.
- US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
- US Department of Health and Human Services. A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What It Means to You . Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010.
- National Toxicology Program. Report on Carcinogens, Fourteenth Edition. Research Triangle Park (NC): US Department of Health and Human Services, Public Health Service; 2016.
- Hopkins DP, Razi S, Leeks KD, Priva Kalra G, Chattopadhyay SK, Soler RE, et al. Task Force on Community Preventive Services. Smoke-Free Policies to Reduce Tobacco Use: A Systematic Review. American Journal of Preventive Medicine 2010;38(2 Suppl):S275–89.
- CDC. Reduced Secondhand Smoke Exposure After Implementation of a Comprehensive Statewide Smoking Ban–New York, June 26, 2003–June 30, 2004. MMWR 2007;56(28):705–8.
- Farrelly MC, Nonnemaker JM, Chou R, Hyland A, Peterson KK, Bauer UE. Changes in Hospitality Workers’ Exposure to Secondhand Smoke Following the Implementation of New York’s Smoke-Free Law. Tobacco Control 2005;14(4):236–41.
- Jensen JA, Schillo BA, Moilanen MM, Lindgren BR, Murphy S, Carmella S, et al. Tobacco Smoke Exposure in Nonsmoking Hospitality Workers Before and After a State Smoking Ban. Cancer Epidemiology, Biomarkers & Prevention 2010;19(4):1016–21.
- Wilson T, Shamo F, Boynton K, Kiley J. The Impact of Michigan’s Dr. Ron Davis Smoke-Free Air Law on Levels of Cotinine, Tobacco-Specific Lung Carcinogen and Severity of Self-Reported Respiratory Symptoms Among Non-Smoking Bar Employees. Tobacco Control 2012;21:593–5.
- Allwright S, Paul G, Greiner B, Mullally BJ, Pursell L, Kelly A, et al. Legislation for Smoke-Free Workplaces and Health of Bar Workers in Ireland: Before and After Study. British Medical Journal 2005;331(7525):1117.
- Mulcahy M, Evans DS, Hammond SK, Repace JL, Byrne M. Secondhand Smoke Exposure and Risk Following the Irish Smoking Ban: An Assessment of Salivary Cotinine Concentrations in Hotel Workers and Air Nicotine Levels in Bars. Tobacco Control 2005;14:384–8.
- Haw SJ, Gruer L. Changes in Exposure of Adult Non-Smokers to Secondhand Smoke After Implementation of Smoke-Free Legislation in Scotland: National Cross Sectional Survey. British Medical Journal 2007;335(7619):549–53.
- Akhtar PC, Currie DB, Currie CE, Haw SJ. Changes in Child Exposure to Environmental Tobacco Smoke (CHETS) Study After Implementation of Smoke-Free Legislation in Scotland: National Cross-Sectional Survey. British Medical Journal 2007;335(7619):545–9.
- Sims M, Mindell JS, Jarvis MJ, Feyerabend C, Wardle H, Gilmore A. Did Smokefree Legislation in England Reduce Exposure to Secondhand Smoke among Nonsmoking Adults? Cotinine Analysis from the Health Survey for England. Environmental Health Perspectives 2012;120(3):425–30.
- International Agency for Research on Cancer. Evaluating the Effectiveness of Smoke-free Policies. IARC Handbooks of Cancer Prevention. Vol. 13; 2009.
- Tan CE, Glantz SA. Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta-analysis. Circulation; 2012;126(18):2177-83.
- Centers for Disease Control and Prevention. Smokefree Policies Improve Health. [accessed 2022 Feb 10].
- Semple S, Creely KS, Naji A, Miller BG, Ayres JG. Secondhand smoke levels in Scottish pubs: the effect of smoke-free legislation. Tobacco Control 2007;16(2):127-132.
- CDC. Indoor air quality in hospitality venues before and after implementation of a clean indoor air law–Western New York, 2003. MMWR 2004;53(44):1038-41.
- US Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2020.
- Guide to Community Preventive Services. Tobacco Use: Smoke-Free Policies. Task Force Finding and Rationale Statement [accessed 2022 Jul 15].
- Cheng KW, Glantz SA, Lightwood JM. Association between smokefree laws and voluntary smokefreehome rules. Am J Prev Med. 2011;41(6):566-72.
- Bundy ŁT, Haardörfer R, Kegler MC, Owolabi S, Berg CJ, Escoffery C, et al. Disseminating a Smoke-free Homes Program to Low Socioeconomic Status Households in the United States Through 2-1-1: Results of a National Impact Evaluation. Nicotine Tob Res. 2020;22(4):498-505.
- Walton K, Gentzke AS, Murphy-Hoefer R, Kenemer B, Neff LJ. Exposure to Secondhand Smoke in Homes and Vehicles Among US Youths, United States, 2011-2019. Prev Chronic Dis. 2020; 17: E103.
- American Nonsmokers’ Rights Foundation. Overview List – Number of Smokefree and Other Tobacco Related Laws [PDF – 624 KB] [accessed 2022 Jul 15].
- American Nonsmokers’ Rights Foundation. States and Municipalities with Laws Regulating Use of Electronic Cigarettes. [PDF – 2 MB] [accessed 2022 Jul 15].
- Fong GT, Hyland A, Borland R, Hammond D, Hastings G, McNeill A, 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.
- Eriksen M, Chaloupka F. The economic impact of clean indoor air laws. CA Cancer J Clin. 2007;57:367–378.
- US National Cancer Institute and World Health Organization. The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016.
- Tsai J, Homa D, Gentzke A, Mahoney M, Sharapova SR, Sosnoff CS, et al. Exposure to Secondhand Smoke Among Nonsmokers — United States, 1988–2014. MMWR 2018;67:1342-1346.
- Tsai J, Homa DM, Neff LJ, Sosnoff CS, Wang L, Blount BC, et al. Trends in Secondhand Smoke Exposure, 2011-2018: Impact and Implications of Expanding Serum Cotinine Range. Am J Prev Med. 2021;61(3):e109-e117.
- Shastri SS, Talluri R, Shete S. Disparities in Secondhand Smoke Exposure in the United States: National Health and Nutrition Examination Survey 2011-2018. JAMA Internal Medicine 2021;181(1):134-137.
- Institute of Medicine. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press; 2007.
- Loomis BR, Shafer PR, van Hasselt M. The Economic Impact of Smoke-Free Laws on Restaurants and Bars in 9 States. Preventing Chronic Disease 2013;10:E128.
- Babb S, McNeil C, Kruger J, Tynan MA. Secondhand smoke and smoking restrictions in casinos: a review of the evidence. Tob Control 2015;24(1):11-7.
- Harris JK, Carothers BJ, Luke DA, Silmere H, McBride TD, Pion M. Exempting casinos from the Smokefree Illinois Act will not bring patrons back: they never left. Tob Control 2012;21(3):373-6.
- Tynan MA, Wang TW, Marynak KL, Lemos P, Babb SD. Attitudes Toward Smoke-Free Casino Policies Among US Adults, 2017. Public Health Rep. 2019;134(3):234-240.
- Cowling DW, Bond P. Smoke-free laws and bar revenues in California–the last call. Health Econ. 2005;14(12):1273-81.
- New York City Department of Finance, New York City Department of Health & Mental Hygiene, New York City Department of Small Business Services, New York City Economic Development Corporation. The State of Smoke-Free New York City: A One-Year Review [PDF – 47 KB]. 2004 [accessed 2022 Jul 15].
- Bonnie R, Stratton K, Wallace RB. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: National Academy Press; 2007.
- Hennrikus D, Pentel PR, Sandell SD. Preferences and practices among renters regarding smoking restrictions in apartment buildings. Tob Control 2003;12(2):189–194.
- CDC. Vital signs: Nonsmokers’ exposure to secondhand smoke-United States, 1999–2008. MMWR 2010;59(35):1141–1146.
- CDC. Vital signs: disparities in nonsmokers’ exposure to secondhand smoke — United States, 1999–2012. MMWR 2015;64(04):103–108.
- King BA, Babb SD, Tynan MA, Gerzoff RB. National and state estimates of secondhand smoke infiltration among U.S. multiunit housing residents. Nicotine Tob Res. 2013;15(7):1316–1321.
- American Society of Heating, Refrigerating, and Air Conditioning Engineers, Inc (ASHRAE). Position Paper: Environmental Tobacco Smoke. Atlanta, GA: ASHRAE; 2005 [accessed 2022 Jul 15].
- King BA, Peck RM, Babb SD. National and state cost savings associated with prohibiting smoking in subsidized and public housing in the United States. Prev Chronic Dis. 2014;11:140222.
- American Nonsmokers’ Rights Foundation. U.S. Laws for 100% Smokefree Multi-Unit Housing. [PDF – 306 KB] [accessed 2022 Jul 15].
- Snyder K, Vick JH, King BA. Smokefree multiunit housing: a review of the scientific literature. Tob Control 2015; 0:1–12.