State Smoking Restrictions for Private-Sector Worksites, Restaurants, and Bars --- United States, 2004 and 2007

Secondhand smoke (SHS) contains more than 50 carcinogens and causes heart disease and lung cancer in nonsmoking adults (1). Eliminating smoking in indoor spaces is the only way to fully protect nonsmokers from SHS exposure (1). Smoking restrictions limit smoking to certain areas within a venue; smoke-free policies prohibit smoking within the entire venue. A Healthy People 2010 objective (27-13) calls for establishing laws in all 50 states and the District of Columbia (DC) that make indoor public places and worksites completely smoke-free (2). To assess progress toward meeting this objective, CDC reviewed the status of state laws restricting smoking in effect as of December 31, 2007, updating a 2005 study that reported on such laws as of December 31, 2004 (3). This report summarizes the changes in state smoking restrictions for private-sector worksites, restaurants, and bars that occurred from 2004 to 2007. The findings indicated a substantial increase in the number and restrictiveness of state laws regulating smoking in these three settings, providing nonsmokers with increased protection from the health risks posed by SHS. If current trends continue, achieving the national health objective by 2010 might be possible.

This report focuses on smoking restrictions in indoor areas in private-sector worksites, restaurants, and bars. These three settings were selected because worksites are a major source of SHS exposure for nonsmokers and because workers in restaurants and bars are especially likely to be exposed to SHS, often at high concentrations (1). The smoking restrictions in effect in each of the 50 states and DC* as of December 31, 2004, and December 31, 2007, were categorized into one of four levels (Table). The four levels were 1) no restrictions, 2) designated smoking areas required or allowed (i.e., smoking is restricted to specific areas), 3) no smoking allowed or designated smoking areas allowed if separately ventilated, and 4) no smoking allowed (i.e., 100% smoke-free). These data were compiled 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 (4). The data used for this report were collected quarterly from an online database of state laws, analyzed using a coding scheme and decision rules, and transferred into the STATE System database. The STATE System tracks state smoking restrictions in government worksites, private-sector worksites, restaurants, bars, commercial and home-based child care centers, and other settings, including shopping malls, grocery stores, enclosed arenas, public transportation, hospitals, prisons, and hotels and motels. Tobacco-control personnel in state health departments reviewed and verified the coding of smoking restrictions in their states.

This study did not include laws that were enacted or became effective after December 31, 2007. For example, Illinois and Maryland enacted smoking restrictions in 2007 that went into effect in early 2008, and were therefore not included in this study.

During December 31, 2004--December 31, 2007, based on the effective date of state laws (i.e., the date that these laws actually took effect, not the date they were enacted) and the STATE System coding scheme, the level of smoking restrictions became more protective for private-sector worksites in 18 states, for restaurants in 18 states, and for bars in 12 states. No states relaxed their smoking restrictions in any of these three settings during the study period. In addition, the number of states requiring private-sector worksites to be smoke-free increased from five to 22. As of December 31, 2004, Delaware, Florida, Massachusetts, New York, and South Dakota had banned smoking in private-sector worksites. As of December 31, 2007, an additional 17 states (Arizona, Arkansas, Colorado, DC, Hawaii, Louisiana, Minnesota, Montana, Nevada, New Jersey, New Mexico, North Dakota, Ohio, Rhode Island, Tennessee, Utah, and Washington) had done so. During the study period, the number of states with no smoking restrictions in place for private-sector worksites decreased from 24 to 13.

During the 3 years ending December 31, 2007, the number of states requiring restaurants to be smoke-free increased from seven to 21. By the end of 2004, Delaware, Florida, Idaho, Maine, Massachusetts, New York, and Utah had banned smoking in restaurants. As of December 31, 2007, 14 additional states (Arizona, Colorado, DC, Hawaii, Louisiana, Minnesota, Montana, Nevada, New Hampshire, New Jersey, Ohio, Rhode Island, Tennessee, and Washington) had done so. During this same period, the number of states with no smoking restrictions for restaurants decreased from 19 to nine.

During the same 3-year period, the number of states requiring bars to be smoke-free increased from four to 13. By the end of 2004, Delaware, Maine, Massachusetts, and New York had banned smoking in bars. As of December 31, 2007, an additional nine states (Arizona, Colorado, DC, Hawaii, Minnesota, New Jersey, Ohio, Rhode Island, and Washington) had done so. During the 3 years of this study, the number of states with no smoking restrictions for bars decreased from 43 to 31.

From December 31, 2004 to December 31, 2007, the number of states requiring all three venues included in this study to be smoke-free increased from three to 12. By the end of 2004, Delaware, Massachusetts, and New York had banned smoking in all three settings. As of December 31, 2007, Arizona, Colorado, DC, Hawaii, Minnesota, New Jersey, Ohio, Rhode Island, and Washington also had implemented such comprehensive laws. During the study period, the number of states with smoke-free provisions in place in at least one of the three settings included in this study increased from eight to 25. During this same period, the number of states without any smoking restrictions in place for any of these settings decreased from 16 to eight.

Reported by: M Tynan, MayaTech Corporation, Silver Spring, Maryland. S Babb, MPH, A MacNeil, MPH, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note:

The findings of this analysis indicate that the number and restrictiveness of state laws regulating smoking in private-sector worksites, restaurants, and bars increased substantially from December 31, 2004, to December 31, 2007. This increase has provided U.S. nonsmokers with increased protection from SHS exposure and its health effects (1).

As of 2003, the most recent data available, 77% of U.S. indoor workers aged >18 years reported that their workplace had an official policy that prohibited smoking in indoor work areas and public or common areas (5), compared with 47% during 1992--1993 (1). However, the proportion of workers covered by such policies varied by occupation. In 2003, for example, 83% of white collar workers reported working under a smoke-free workplace policy, compared with 75% of service workers, 63% of blue collar workers, and 72% of food-service workers (5). As a result of continuing gaps and disparities in policy coverage for many private-sector worksites, restaurants, and bars, millions of U.S. nonsmokers continue to be exposed to SHS and its health effects in these settings, either as employees or as patrons.

Smoke-free workplace policies are the only effective approach to ensure that SHS exposure does not occur in the workplace (1).^† Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate SHS exposure (1). Smoke-free laws and policies reduce SHS exposure and improve health among nonsmoking restaurant and bar employees, and reduce SHS exposure among nonsmokers in general, as assessed by self-report and objective measures (1,6--8). Smoke-free workplace policies also help smokers quit (1). Smoke-free policies do not have an adverse economic effect on restaurants and bars (1). Studies also have reported high levels of public support for and compliance with smoke-free laws (1).

The findings in this report are subject to at least three limitations. First, the STATE System captures only certain types of state smoking restrictions (primarily statutory laws and executive orders) and does not capture state administrative laws, regulations, or implementation guidelines. As a result, the manner in which a state smoking restriction is implemented in practice might differ from how it is coded in the STATE System. Second, some state smoking restrictions apply only to private-sector worksites with more than a specified number of employees, to restaurants with more than a specified number of seats, or to bars of at least a certain size. In these cases, the state laws were coded according to the level of these restrictions, even though these restrictions do not apply to venues that are below the specified limits. Finally, because the STATE System only collects state-level data, it does not reflect local smoking restrictions in effect in many states.

The 2006 Surgeon General's Report on The Health Consequences of Involuntary Exposure to Tobacco Smoke concluded that SHS causes premature death and disease in children and nonsmoking adults (1). The report also concluded that no level of SHS exposure is risk free and that only completely smoke-free environments fully protect nonsmokers from SHS exposure (1). States, communities, employers, business proprietors, and the public are acting on this information to reduce SHS exposure. The American Nonsmokers' Rights Foundation estimates that, as of April 2008, 33% of U.S. residents have been living under state or local laws that make worksites, restaurants, and bars completely smoke-free, and 64% of U.S. residents have been living under state or local laws making at least one of these three settings smoke-free (9). Largely because of the trend toward increased protection by state and local smoke-free laws and voluntary policies covering worksites and public places, SHS exposure among U.S. nonsmokers has decreased substantially since 1988 (10). The trends in the adoption of state smoking restrictions described in this report suggest that the national health objective of establishing laws making indoor public places and worksites smoke-free in all states by the year 2010 might be achievable.

Acknowledgments

This report is based, in part, on contributions by C Baker, SS Eidson, JD, R Patrick, JD, MayaTech Corporation, Silver Spring, Maryland; J Chriqui, PhD, Univ of Illinois at Chicago; J O'Connor, JD, Emory Univ, Atlanta, Georgia; G Vaughn, D Shelton, MPH, A Trosclair, MS, Office on Smoking and Health, and NA Blair, MPH, Div of Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

References

1. 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. Available at http://www.surgeongeneral.gov/library/secondhandsmoke/report.
2. US Department of Health and Human Services. Healthy people 2010 midcourse review. Washington, DC: US Department of Health and Human Services; 2006. Available at http://www.healthypeople.gov/data/midcourse.
3. CDC. State smoking restrictions for private-sector worksites, restaurants, and bars---United States, 1998 and 2004. MMWR 2005;54:649--53.
4. CDC. State Tobacco Activities Tracking and Evaluation (STATE) System. Atlanta, GA: US Department of Health and Human Services, CDC; 2008. Available at http://www.cdc.gov/tobacco/statesystem.
5. US Department of Commerce, Census Bureau. National Cancer Institute and CDC co-sponsored tobacco use special cessation supplement to the current population survey, 2003 (TUSCS-CPS). Washington, DC: US Department of Commerce, Census Bureau; 2006. Available at http://riskfactor.cancer.gov/studies/tus-cps.
6. Menzies D, Nair A, Williamson PA, et al. Respiratory symptoms, pulmonary function, and markers of inflammation among bar workers before and after a legislative ban on smoking in public places. JAMA 2006;296:1742--8.
7. Goodman P, Agnew M, McCaffrey M, Paul G, Clancy L. Effects of the Irish smoking ban on respiratory health of bar workers and air quality in Dublin pubs. Am J Respir Crit Care Med 2007;175:840--5.
8. CDC. Reduced secondhand smoke exposure after implementation of a comprehensive statewide smoking ban --- New York, June 26, 2003--June 30, 2004. MMWR 2007;56:705--8.
9. American Nonsmokers' Rights Foundation. Summary of 100% smokefree state laws and population protected by state and local laws. Berkley, CA: American Nonsmokers' Rights Foundation; 2008. Available at http://www.no-smoke.org/pdf/summaryuspopList.pdf.
10. Pirkle JL, Bernert JT, Caudill SP, Sosnoff CS, Pechacek TF. Trends in the exposure of nonsmokers in the U.S. population to secondhand smoke: 1988--2002. Environ Health Perspect 2006;114:853--8.

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Date last reviewed: 5/21/2008