Preventing Exposure to Secondhand Smoke in the Community

What to know

Comprehensive smokefree policies prohibit smoking in all areas of indoor spaces, at all times. These policies can fully protect people from secondhand smoke exposure.

Overview

  • Eliminating smoking is the only way to fully protect people who do not smoke from secondhand smoke exposure.1
  • Comprehensive smokefree policiesA 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.234
  • Comprehensive smokefree laws and policies can also help people who smoke quit and can help keep young people from starting to smoke.15
  • 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 United States.267

Benefits of comprehensive smokefree policies

Reduce secondhand smoke exposure

  • 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.8910111213141516 Cotinine 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.17

Improve health

  • Comprehensive smokefree laws lead to reductions in coronary events, especially heart attacks. These laws are one of the most effective and cost-effective ways to reduce heart disease—the leading cause of death—in the United States.2
  • Comprehensive smokefree laws are associated with rapid reductions in hospitalizations related to heart attacks and strokes after the laws take effect.1819
  • 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 reduced secondhand smoke exposure. They are also associated with reduced sensory and respiratory symptoms and improved lung function in employees who do not smoke.22021

Reduce smoking and encourage people who smoke to quit

  • 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.22223
  • In 2010, the Task Force on Community Preventive Services conducted a systematic review of smokefree laws and policies. It reported that 11 studies found that smokefree laws and policies in workplaces were associated with a median 6.4% increase in tobacco use cessation. In addition, 21 studies found that these laws and policies were associated with a median 3.4% decrease in tobacco use prevalence.5

Prevent smoking initiation

  • Smokefree workplaces and communities make adolescents and young adults less likely to start smoking. Reasons include seeing fewer role models smoke, having fewer opportunities to smoke alone or with others, and the reduced social acceptability of smoking.2

Increase the adoption of voluntary smokefree rules for households

  • The implementation of smokefree laws increases the adoption of voluntary smokefree rules in homes.24 In turn, smokefree rules in homes may increase the adoption of smokefree rules for private vehicles.25 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.226

How smokefree policies vary across the United States

While exposure to secondhand smoke has declined in the United States, not everyone is equally protected by comprehensive smokefree laws. As of July 1, 2022:

  • Only 62.5% of the U.S. population is covered by 100% smokefree laws that apply to bars, restaurants, and worksites.27
    • 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.27
    • Twenty-five states, Puerto Rico, and the District of Columbia prohibit the use of e-cigarettes in private worksites, restaurants, and bars. Thirteen of those jurisdictions also prohibit the use of e-cigarettes in gambling venues.28
    • Over 1,100 U.S. cities and counties have comprehensive smokefree laws that prohibit smoking tobacco products in private worksites, restaurants, and bars.27 In addition, 1,006 communities prohibit the use of e-cigarettes in 100% smokefree venues.28
    • Smokefree laws and policies have a high level of public support and compliance. Studies have shown they do not negatively affect sales of food and beverage items or employment in the hospitality industry.2930 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.31
  • 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. It can also help change social norms about tobacco use. More information about e-cigarettes can be found on the Electronic Cigarettes webpage.

Why some population groups are more likely to be exposed

  • 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 aged 3 to 11.6
    • Almost 2 of every 5 children aged 3 to 11 years, including more than 1 in 2 non-Hispanic Black children, were exposed to secondhand smoke during 2017–2018.632
    • During 2017–2018, secondhand smoke exposure among non-Hispanic Black people and people living below the poverty level continued to be about twice as high compared with non-Hispanic White people and people living above the poverty level.3233

Smokefree policies in commercial and residential settings can minimize the effects of secondhand smoke

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Content Source:
National Center for Chronic Disease Prevention and Health Promotion; Office on Smoking and Health
  1. 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.
  1. U.S. Dept of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Dept of Health and Human Services; 2006.
  2. U.S. Dept of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. U.S. Dept of Health and Human Services; 2014.
  3. U.S. Dept of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease, A Report of the Surgeon General. U.S. Dept of Health and Human Services; 2010.
  4. National Toxicology Program. Report on Carcinogens, Fourteenth Edition. U.S. Dept of Health and Human Services; 2016.
  5. Hopkins DP, Razi S, Leeks KD, et al. Smoke-free policies to reduce tobacco use: a systematic review. Am J Prev Med. 2010;38(2 Suppl):S275–S289.
  6. Tsai J, Homa D, Gentzke A, et al. Exposure to Secondhand Smoke Among Nonsmokers — United States, 1988–2014. MMWR Morb Mortal Wkly Rep. 2018;67(48):1342–1346.
  7. Institute of Medicine. Ending the Tobacco Problem: A Blueprint for the Nation. The National Academies Press; 2007.
  8. Centers for Disease Control and Prevention. Reduced Secondhand Smoke Exposure After Implementation of a Comprehensive Statewide Smoking Ban–New York, June 26, 2003–June 30, 2004. MMWR Morb Mortal Wkly Rep. 2007;56(28):705–708.
  9. 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. Tob Control. 2005;14(4):236–241.
  10. Jensen JA, Schillo BA, Moilanen MM, et al. Tobacco smoke exposure in nonsmoking hospitality workers before and after a state smoking ban. Cancer Epidemiol Biomarkers Prev. 2010;19(4):1016–1021.
  11. 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. Tob Control. 2012;21(6):593–595.
  12. Allwright S, Paul G, Greiner B, et al. Legislation for smoke-free workplaces and health of bar workers in Ireland: before and after study. BMJ. 2005;331(7525):1117.
  13. 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. Tob Control. 2005;14(6):384–388.
  14. 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. BMJ. 2007;335(7619):549–553.
  15. 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. BMJ. 2007;335(7619):545–549.
  16. 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. Environ Health Perspect. 2012;120(3):425–430.
  17. International Agency for Research on Cancer. Evaluating the effectiveness of smoke-free policies. IARC Handbooks of Cancer Prevention. Vol. 13;2009.
  18. Tan CE, Glantz SA. Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta-analysis. Circulation. 2012;126(18):2177–2183.
  19. Centers for Disease Control and Prevention. Smokefree Policies Improve Health. Accessed February 10, 2022.
  20. Semple S, Creely KS, Naji A, Miller BG, Ayres JG. Secondhand smoke levels in Scottish pubs: the effect of smoke-free legislation. Tob Control. 2007;16(2):127–132.
  21. Centers for Disease Control and Prevention. Indoor air quality in hospitality venues before and after implementation of a clean indoor air law–Western New York, 2003. MMWR Morb Mortal Wkly Rep. 2004;53(44):1038–1041.
  22. U.S. Dept of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. U.S. Dept of Health and Human Services; 2020.
  23. Community Preventive Services Task Force. Tobacco Use: Smoke-Free Policies. The Community Guide. Accessed July 15, 2022. https://www.thecommunityguide.org/findings/tobacco-use-smoke-free-policies.html
  24. Cheng KW, Glantz SA, Lightwood JM. Association between smokefree laws and voluntary smokefree-home rules. Am J Prev Med. 2011;41(6):566–572.
  25. Bundy ŁT, Haardörfer R, Kegler MC, 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.
  26. Walton K, Gentzke AS, Murphy-Hoefer R, Kenemer B, Neff LJ. Exposure to secondhand smoke in homes and vehicles among U.S. youths, United States, 2011-2019. Prev Chronic Dis. 2020;17:E103.
  27. American Nonsmokers' Rights Foundation. Overview List – Number of Smokefree and Other Tobacco Related Laws. Accessed July 15, 2022. https://no-smoke.org/wp-content/uploads/pdf/mediaordlist.pdf
  28. American Nonsmokers' Rights Foundation. States and Municipalities with Laws Regulating Use of Electronic Smoking Devices (ESDs). Accessed July 15, 2022. http://no-smoke.org/wp-content/uploads/pdf/ecigslaws.pdf
  29. Fong GT, Hyland A, Borland R, et al. Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey. Tob Control. 2006;15(Suppl 3):iii51–iii58.
  30. Eriksen M, Chaloupka F. The economic impact of clean indoor air laws. CA Cancer J Clin. 2007;57(6):367–378.
  31. National Cancer Institute. The Economics of Tobacco and Tobacco Control. U.S. Dept of Health and Human Services; 2016.
  32. Tsai J, Homa DM, Neff LJ, 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.
  33. Shastri SS, Talluri R, Shete S. Disparities in secondhand smoke exposure in the United States: national health and nutrition examination survey 2011-2018. JAMA Intern Med. 2021;181(1):134–137.