Secondhand smoke (SHS) exposure causes lung cancer and cardiovascular and respiratory diseases in nonsmoking adults and children, resulting in an estimated 46,000 heart disease deaths and 3,400 lung cancer deaths among U.S. nonsmoking adults each year (1). Smoke-free laws that prohibit smoking in all indoor areas of a venue fully protect nonsmokers from involuntary exposure to SHS indoors (1). A Healthy People 2010 objective (27-13) called for enacting laws eliminating smoking in public places and worksites in all 50 states and the District of Columbia (DC); because this objective was not met by 2010, it was retained for Healthy People 2020 (renumbered as TU-13). To assess progress toward meeting this objective, CDC reviewed state laws restricting smoking in effect as of December 31, 2010. This report summarizes the changes in state smoking restrictions for private-sector worksites, restaurants, and bars that occurred from December 31, 2000 to December 31, 2010. The number of states (including DC) with laws that prohibit smoking in indoor areas of worksites, restaurants, and bars increased from zero in 2000 to 26 in 2010. However, regional disparities remain in policy adoption, with no southern state having adopted a smoke-free law that prohibits smoking in all three venues. The Healthy People 2020 target on this topic is achievable if current activity in smoke-free policy adoption is sustained nationally and intensified in certain regions, particularly the South.
This report focuses on laws that completely prohibit smoking in private-sector worksites, restaurants, and bars. These three venues were selected because they are a major source of SHS exposure for nonsmoking employees and the public (1). CDC considers a state smoke-free law to be comprehensive if it prohibits smoking in these three venues. Some states have enacted laws with less stringent smoking restrictions (e.g., provisions restricting smoking to designated areas or to separately ventilated areas); however, these laws are not effective in eliminating SHS exposure. The Surgeon General has concluded that the only way to fully protect nonsmokers from SHS exposure is to prohibit smoking in all indoor areas, and that separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate SHS exposure (1).
Data on state smoking restrictions for this report were obtained from CDC’s State Tobacco Activities Tracking and Evaluation (STATE) System database, which contains tobacco-related epidemiologic and economic data and information on state tobacco-related legislation.* State legislation is collected quarterly from an online legal research database of state laws and is analyzed, coded, and entered into the STATE System. The STATE System contains information on state tobacco-related laws, including smoke-free policies, in effect since the fourth quarter of 1995. In addition to information on state smoking restrictions in worksites, restaurants, and bars, the STATE System contains information on state smoking restrictions in other venues, including government worksites, commercial and home-based child care centers, multiunit housing, vehicles, hospitals, prisons, and hotels and motels.
The number of states with comprehensive smoke-free laws in effect increased from zero on December 31, 2000, to 26 states on December 31, 2010 (Table 1). In 2002, Delaware became the first state to implement a comprehensive smoke-free law, followed by New York in 2003, Massachusetts in 2004, and Rhode Island and Washington in 2005. In 2006, comprehensive smoke-free laws went into effect in Colorado, Hawaii, New Jersey, and Ohio, followed by Arizona, DC, Minnesota, and New Mexico in 2007; Illinois, Iowa, and Maryland in 2008; Maine, Montana, Nebraska, Oregon, Utah, and Vermont in 2009; and Kansas, Michigan, South Dakota, and Wisconsin in 2010. The years listed are the years in which the laws took effect; in some cases the laws were enacted in a preceding year. Some state laws were expanded gradually or phased in; in these cases, the year provided is the year when the law first applied to all three of the settings considered in this study. Additionally, while most of these laws were enacted through the state legislative process, Arizona, Ohio, South Dakota, and Washington enacted their laws through ballot measures.
As of December 31, 2010, in addition to the 26 states with comprehensive smoke-free laws, 10 states had enacted laws that prohibit smoking in one or two, but not all three, of the venues included in this study (Table 2). Additionally, eight states had passed less restrictive laws (e.g., laws allowing smoking in designated areas or areas with separate ventilation). Finally, seven states have no statewide smoking restrictions in place for private worksites, restaurants, or bars (Table 2). Of note, only three southern states (Florida, Louisiana, and North Carolina) have laws that prohibit smoking in any two of the three venues examined in this report, and no southern state has a comprehensive state smoke-free law in effect (Figure).
M Tynan,* S Babb, MPH, A MacNeil, MPH, M Griffin, MPH, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. *Corresponding contributor: Michael Tynan, CDC, 770-488-5286, [email protected]
|TABLE 1. Effective dates of state comprehensive smoke-free laws — United States, 2002-2010|
|District of Columbia||1/1/2007|
|Source: State Tobacco Activities Tracking and Evaluation System, Office on Smoking and Health, CDC.|