Half of U.S. states have comprehensive smoke-free laws

In light of research in the past decade showing that even brief exposure to secondhand smoke can cause harm, half of all states in the U.S. have implemented comprehensive laws banning smoking in bars, restaurants and private-sector work sites, according to the Centers for Disease Control and Prevention. The targeted locations have been considered major sources of secondhand smoke.

Some of the nation's biggest tobacco-growing states, including North Carolina and Tennessee, recently enacted less restrictive legislation.

Public health officials consider the bans an accomplishment that is due, in part, to the work of physicians educating the public about the harm done by tobacco. But greater action is needed to reduce the public's exposure to secondhand smoke, according to a CDC study published in the April 22 edition of Morbidity and Mortality Weekly Report.

The study projects that if the current pace of states adopting smoke-free laws continues, every state could have such bans by 2020.

"Eliminating smoking from work sites, restaurants and bars is a low-cost, high-impact strategy that will protect nonsmokers [from secondhand smoke] and allow them to live healthier, longer, more productive lives," said CDC Director Thomas Frieden, MD, MPH.

The report assessed the nation's progress in meeting the Dept. of Health and Human Services' Healthy People objective to eliminate smoking in public places and work sites in all 50 states by 2020. Even limited exposure to secondhand smoke can increase nonsmokers' risk of developing heart disease and lung cancer, the CDC said.

Researchers found that 25 states and the District of Columbia implemented comprehensive smoking bans from December 2000 to December 2010. A comprehensive ban is one that completely prohibits smoking in bars, restaurants and private-sector work sites.

In 2002, Delaware was the first state to enact such a ban. California's smoking restrictions were implemented in 1994, but the law allows exemptions for smoking in designated rooms that are ventilated.

In addition to California, 17 states have enacted less-stringent smoking legislation that restricts lighting up in some public areas.

"The surgeon general has concluded that the only way to fully protect nonsmokers from secondhand smoke exposure is to prohibit smoking in all indoor areas," the study said.

Indiana, Kentucky, Mississippi, South Carolina, Texas, West Virginia and Wyoming do not have any statewide smoking restrictions. However, many communities in those states have comprehensive smoke-free laws.

The tobacco industry's strong lobbying efforts against statewide legislation are contributing to slow adoption of smoking bans in some places, said Georges Benjamin, MD, executive director of the American Public Health Assn.

But that issue can be overcome by educating legislators and the public about the health effects of secondhand smoke, said Tim McAfee, MD, MPH, director of the CDC's Office on Smoking and Health. "There is no fundamental barrier [preventing] any state from adopting comprehensive smoke-free legislation," he said.

North Carolina is a perfect example, Dr. Benjamin said. It boasted the nation's greatest number of tobacco fields in 2007, according to the U.S. Dept. of Agriculture, and tobacco fueled the growth of the state for hundreds of years. In January 2010, a smoking ban that affects nearly all restaurants and bars went into effect in North Carolina.

The goal is to ban smoking in the state's workplaces by 2020, said Sally Herndon, MPH, head of the Tobacco Prevention and Control Branch of the North Carolina Division of Public Health. "But I hope we get there before that," she said.

Heart disease risk rises

Secondhand smoke is composed of more than 700 chemicals, including hundreds that are toxic and about 70 that can cause cancer, according to the CDC. Exposure to secondhand smoke increases the risk of heart disease by 25% to 30% in adults who never smoked, the CDC said.

Exposure also boosts the likelihood of lung cancer in nonsmoking adults by 20% to 30%.

"Everyone has the right to breathe smoke-free air, and no one should have to choose between their health and a good job," said the American Cancer Society Cancer Action Network.

The American Medical Association House of Delegates adopted policy in June 2010 that recommends prohibiting smoking in multiunit buildings because of the possible adverse health impact on other people who live there. Multiunit housing often has shared ventilation systems, meaning that smoke can filter into residences where children and nonsmoking adults live.

The ACS Cancer Action Network is urging states and communities with smoking bans to continue strengthening them -- although in some cases states are weakening them.

For example, Illinois legislators are considering diluting the state's smoke-free law by exempting casinos. House Bill 1965 would permit smoking in casinos if the nearest state allows it. If approved, this will be the first time a type of venue was made exempt from a statewide law, the CDC said. The bill passed the state's House in March. It was introduced after Illinois casinos reported losing business to casinos in Indiana, where gamblers can light up.

"If [Illinois casinos] get an exception, we think bars and private clubs are going to want an exception, too. It's a slippery slope," said Kathy Drea, vice presidentof advocacy for the American Lung Assn. in Illinois. "We're going to have to keep fighting these bills."