State Smoking Restrictions for Private-Sector Worksites, Restaurants, and Bars—United States, 1998 and 2004

July 8, 2005 / Vol. 54 / No. 26

MMWR Highlights

• The number and restrictiveness of state laws regulating smoking in private-sector worksites, restaurants, and bars increased from 1999–2004. This increase has provided U.S. nonsmokers with greater protection from exposure to secondhand smoke, a known human carcinogen.
• From 1999 to 2004, ten states strengthened their smoking restrictions for private–sector worksites, nine strengthened restrictions for restaurants, and five strengthened restrictions for bars.
• At the end of 2004, however, 16 states still had no restrictions on smoking in private-sector worksites, restaurants, or bars. Many other states did not provide full protection in some or all of these settings.
• Secondhand smoke exposure has decreased sharply in recent years; however, a substantial portion of U.S. nonsmokers continue to be exposed to secondhand smoke.
• At the end of 2004:
  • seven states (Delaware, Florida, Idaho, Maryland, Massachusetts, New York, and South Dakota) banned smoking in private-sector worksites, up from one state (Maryland) at the end of 1998;
  • eight states (Delaware, Florida, Idaho, Maine, Massachusetts, New York, Utah, and Vermont) banned smoking in restaurants, up from two states (Utah and Vermont) at the end of 1998;
  • four states (Delaware, Maine, Massachusetts, and New York) banned smoking in bars, up from no states at the end of 1998;
  • three states (Delaware, Massachusetts, and New York) banned smoking in all three of these settings, up from no states at the end of 1998.
• Some states with no or minimal state smoking restrictions have strong local smoking restrictions in place in many communities. State legislative provisions that do not preempt communities from enacting more stringent local laws allow continued passage and enforcement of local smoking restrictions that can establish a greater level of public health protection.

Background

• Policies establishing smoke-free environments are the most effective method to protecting both workers and patrons from secondhand smoke exposure, and restrictions on where smoking is allowed are associated with decreased cigarette consumption and possibly with increased cessation rates among workers and the general public.
• Approximately 3,000 lung cancer deaths and 35,000 coronary heart disease deaths occur annually among adult nonsmokers in the United States from secondhand smoke exposure.
• There is no known safe level of secondhand smoke exposure, and evidence suggests that even short-term exposure may increase a person’s risk of experiencing a heart attack.
• Exposure to secondhand smoke is associated with an increased risk for lower respiratory infections, asthma exacerbation, sudden infant death syndrome, and chronic ear infections among children.
• Research has consistently shown that smoking restrictions do not have a negative economic impact on restaurants and bars, and that most of the public support and comply with strong secondhand smoke restrictions.
• As a result of continuing gaps in policy coverage for many private-sector worksites, restaurants, and bars, a substantial portion of the U.S. nonsmoking population remains at risk for exposure to a known human carcinogen in these settings, either as employees or customers.
• Although population-based data show declining secondhand smoke exposure in the United States over time, secondhand smoke exposure remains a common, preventable public health hazard.