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Background
As of October 1, 2022, 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 1,159 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.
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, stroke, 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.
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 to nicotine, 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 January 1, 2023, 26 states, the territories of Guam, and Puerto Rico, and 742 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 people who don’t smoke from exposure to SHS. Not everyone in the U.S. is equally protected by 100% smokefree laws; currently, about 37% of the U.S. population is not protected at the state or community level. Smokefree laws not only protect people from SHS exposure, but also reduce youth initiation and encourage people who smoke to quit.
Measure
The percentage of indoor workers reporting a smokefree worksite rule (i.e., no smoking allowed in any indoor public/common or work areas).
The percentage of the population protected by local and state smokefree indoor air laws covering workplaces, restaurants, and bars. This measure draws on data collected and analyzed by the Americans for Nonsmokers’ Rights Foundation. Use of this information allows the National Cancer Institute (NCI) to include both local and state laws in its assessments.
Healthy People 2030 Target
- Increase the proportion of worksites that are covered by indoor worksite policies that prohibit smoking (Developmental Objective)
- Increase the number of states, territories, and DC that prohibit smoking in worksites, restaurants, and bars to 58.
While the Healthy People 2030 (HP2030) developmental objective focuses on the proportion of worksites covered by indoor worksite policies that prohibit smoking, data presented in the Cancer Trends Progress Report focus on the proportion of indoor workers reporting that smoking is prohibited in all indoor public/common or work areas. Therefore, the data presented in this report cannot be directly compared to the HP2030 developmental objective.
Healthy People 2030 is a set of goals set forth by the Department of Health and Human Services.
Data Source
National Cancer Institute. Tobacco Use Supplement to the Current Population Survey for “work place smokefree policies” measures.
Americans for Nonsmokers Right Foundation. “Percentage of the population covered by local and/or state 100% smokefree air laws”.
Trends and Most Recent Estimates
Smokefree Workplace Rules
By Sex
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018 to 2019) | |
---|---|---|---|
Percent of workers | 95% Confidence Interval | ||
![]() ![]() |
Both Sexes![]() |
80.4 | 79.9 - 80.8 |
Male![]() |
77.9 | 77.2 - 78.6 | |
Female![]() |
82.7 | 82.1 - 83.2 |
By Race/Ethnicity
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018 to 2019) | |
---|---|---|---|
Percent of workers | 95% Confidence Interval | ||
![]() ![]() |
All Races![]() |
80.4 | 79.9 - 80.8 |
Non-Hispanic White![]() |
82.4 | 81.9 - 82.9 | |
Non-Hispanic Black![]() |
79.0 | 77.6 - 80.5 | |
Hispanic![]() |
73.8 | 72.2 - 75.4 |
By Age
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018 to 2019) | |
---|---|---|---|
Percent of workers | 95% Confidence Interval | ||
![]() ![]() |
Ages 18-24![]() |
76.2 | 74.5 - 77.8 |
Ages 25+![]() |
81.0 | 80.6 - 81.5 |
By Sex and Age
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018 to 2019) | |
---|---|---|---|
Percent of workers | 95% Confidence Interval | ||
![]() ![]() |
Males, ages 18-24![]() |
73.7 | 71.1 - 76.2 |
Males, ages 25+![]() |
78.6 | 77.9 - 79.3 | |
Females, ages 18-24![]() |
78.4 | 76.1 - 80.6 | |
Females, ages 25+![]() |
83.3 | 82.7 - 83.9 |
By Poverty Income Level
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018 to 2019) | |
---|---|---|---|
Percent of workers | 95% Confidence Interval | ||
![]() ![]() |
< 200% of the federal poverty level![]() |
74.9 | 73.7 - 76.1 |
>= 200% of the federal poverty level![]() |
81.4 | 80.9 - 81.9 |
By Education Level
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2018 to 2019) | |
---|---|---|---|
Percent of workers | 95% Confidence Interval | ||
![]() ![]() |
Less than High School![]() |
67.9 | 64.9 - 70.7 |
High School![]() |
77.2 | 76.1 - 78.2 | |
Greater than High School![]() |
82.9 | 82.4 - 83.4 |
Indoor Air Laws
Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2022) | |
---|---|---|---|
Percent of population | 95% Confidence Interval | ||
![]() ![]() |
Workplaces![]() |
77.4 | Not available |
Restaurants![]() |
78.1 | Not available | |
Bars![]() |
66.7 | Not available |
Additional Information on Smokefree Workplace Rules and Laws
- Secondhand Smoke Exposure. National Cancer Institute.
- Secondhand Smoke and Cancer. National Cancer Institute.
- Health Risks of Secondhand Smoke. American Cancer Society.
- The Effects of Secondhand Smoke on Worker Health. American Cancer Society.
- Secondhand Smoke: Worker Health. American Nonsmokers’ Rights Foundation.
- Cancer Health Effects. U.S. Department of Health and Human Services, National Toxicology Program.
- Secondhand Smoke and What it Means to You. U.S. Department of Health and Human Services.
- Tobacco Control Evidence-Based Programs Listing. National Cancer Institute.
- Surgeon General’s Reports on Smoking and Tobacco Use. Centers for Disease Control and Prevention.
- 50 Years of Progress: A Report of the Surgeon General, 2014. U.S. Department of Health and Human Services.
- The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006. U.S. Department of Health and Human Services.
- American Nonsmokers’ Rights Foundation.
- Overview List – How many smokefree laws? American Nonsmokers’ Rights Foundation.
- Summary of 100% Smokefree State Laws and Protected by 100% U.S. Smokefree Laws. American Nonsmokers’ Rights Foundation.
- U.S. 100% Smokefree Laws in Non-Hospitality Workplaces, Restaurants, and Bars. American Nonsmokers’ Rights Foundation.
- State and local comprehensive smoke-free laws for worksites, restaurants, and bars—United States, 2015. Centers for Disease Control and Prevention. MMWR 2016;65(24)623-626.
- STATE System Smokefree Indoor Air Fact Sheet. Centers for Disease Control and Prevention.
- Stuck in Neutral: Stalled Progress in Statewide Comprehensive Smoke-Free Laws and Cigarette Excise Taxes, United States, 2000–2014. Centers for Disease Control and Prevention.
- Changes in self-reported smokefree workplace policy coverage among employed adults-United States, 2003 and 2010-2011. Babb S, Liu B, Kenemer B Et al. Nicotine Tob Res 2017; 00(00): 1-9.
- Smoke-free and tobacco-free colleges and universities in the United States. Blake KD, Klein AL, Walpert L, et al. Tob Control. 2020;29(3):289-294.
- Uneven Access to Smoke-Free Laws and Policies and Its Effect on Health Equity in the United States: 2000–2019. Hafez AY, Gonzalez M, Kulik MC, Vijayaraghavan M, Glantz SA. Am J Public Health. 2019;109(11):1568-1575.
- Occupation and workplace policies predict smoking behaviors: analysis of national data from the current population survey. Ham DC, Przybeck T, Strickland JR, et al. J Occup Environ Med 2011;53(11):1337–45.
- Small Area Estimation of Smoke-free Workplace Polices and Home Rules in U.S. Counties. Liu B, Dompreh I, Hartman AM. Nicotine Tob Res. 2021; [Epub ahead of print]
- Workplace Smoke-Free Policies and Cessation Programs Among U.S. Working Adults. Syamlal G, King BA, Mazurek JM. Am J Prev Med. 2019 Apr;56(4):548-562.
- State and Local Comprehensive Smoke-Free Laws for Worksites, Restaurants, and Bars — United States, 2015. Tynan MA, Holmes CB, Promoff G, et al. MMWR. 2016;65:623–626.
- Tobacco Use Supplement to the Current Population Survey. National Cancer Institute.
- Cancer Facts and Figures. American Cancer Society.
- National Health and Nutrition Examination Survey. Centers for Disease Control and Prevention, National Center for Health Statistics.
- State Tobacco Activities Tracking and Evaluation System. Centers for Disease Control and Prevention.