Cancer Trends Progress Report

Thirty-six states, along with the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands, have laws in effect that require one or more of the following venues to be 100% smokefree: non-hospitality workplaces, restaurants, bars and state-run gambling establishments. A total of 1,150 cities and counties have a 100% smokefree provision in effect in one or more of the following venues: non-hospitality workplaces, restaurants, and bars. In 2021, the Navajo Nation become the first tribe to pass legislation to create a commercial tobacco free environment for all public places (including the four Navajo casinos, pow wows, annual festivals, and sports and rodeos). This will protect nonsmokers living within and visitors to the Navajo Nation.

E-cigarettes (also known as vapes or Electronic Nicotine Delivery Systems) are battery-powered devices that convert a liquid (“e-liquid”) into an aerosol. E-liquids typically contains nicotine, flavorings, vegetable glycerin, propylene glycol and other chemicals. In addition tonicotine, e-cigarette aerosol may contain heavy metals, volatile organic compounds, and fine and ultrafine particles that can be inhaled deeply into the lungs by both users and by-standers. States and localities are increasingly incorporating prohibition of e-cigarette use into comprehensive smokefree air laws. As of February 5, 2022, 25 states, the territories of Guam, and Puerto Rico, and 992 municipalities have prohibited the use of e-cigarettes in 100% smokefree locations.

Secondhand smoke (SHS) is a mixture of the side stream smoke released by a smoldering cigarette, pipe, hookah/waterpipe, or cigar, and the mainstream smoke exhaled by a smoker. SHS is a complex mixture containing thousands of chemicals, including formaldehyde, cyanide, carbon monoxide, ammonia, and nicotine. More than 250 of the chemicals in SHS are known to be harmful, and at least 69 are known to cause cancer.

Conclusive scientific evidence documents that SHS causes premature death and disease in children and adults who do not smoke. Among adults, exposure to SHS has immediate adverse effects on the cardiovascular system, and long-term exposure to SHS causes coronary heart disease and lung cancer. Children exposed to SHS are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth. 

There is no risk-free level of exposure to SHS, and only eliminating smoking in indoor spaces fully protects nonsmokers from exposure to SHS. Today, comprehensive smokefree laws, covering public places and workplaces, including restaurants and bars are increasingly the norm. Additionally, smokefree policies may now extend to private spaces, including cars and multi-unit housing.