State Smoke-Free Laws and Health

According to the Centers for Disease Control and Prevention (CDC), tobacco use is the leading preventable cause of disease, disability and death in the United States. Beyond those who directly smoke tobacco products, secondhand smoke—a mixture of exhaled smoke with gases and particles from burning cigarettes, cigars or pipes—annually causes approximately 50,000 U.S. deaths. It contains at least 250 toxic chemicals, including more than 50 that can cause cancer. Secondhand smoke exposure can cause heart disease and lung cancer in nonsmoking adults, increasing heart disease risk by 25 percent to 30 percent and lung cancer risk by 20 percent to 30 percent. An October 2009 Institute of Medicine report concludes that research consistently demonstrates that secondhand-smoke exposure increases risk of coronary heart disease and heart attacks and that smoking bans reduce this risk.

In a growing number of states, legislators are addressing these concerns by enacting smoke-free laws or smoking restrictions for public places. Research shows that benefits of implementing smoke-free laws include:

1. A significant decline in hospital admissions for heart attack (11 studies);

2. Reducing exposure to secondhand smoke and encouraging smokers to quit; and

3. A positive effect or no decline in total restaurant or bar revenues.

Some state laws with smoking restrictions allow smoking in designated or separately ventilated areas; however, according to a 2006 surgeon general's report, separating smokers from nonsmokers, cleaning the air and ventilating buildings cannot entirely eliminate secondhand smoke exposure. Additional evidence reviewed by the Institute of Medicine suggests that even the lowest levels of smoke exposure can harm health.

Sources: CDC. "Reduced hospitalizations for acute myocardial infarction after implementation of a smoke-free ordinance—city of Pueblo, Colorado, 2002–2006;" Morbidity and Mortality Weekly Report (MMWR) 57 (2009): 1373-7; Huang, P., and M.E. McCusker, “Impact of a Smoking Ban on Restaurant and Bar Revenues—El Paso, Texas, 2002.” MMWR 53 (2004): 150-152; Institute of Medicine, Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence, National Academies Press. October 2009; U.S. Surgeon General. Health Consequences of Involuntary Exposure to Tobacco Smoke, 2006; and NCSL.

Additional Resources

• Economic Effects of Clean Indoor Air Policies on Bar and Restaurant Employment in Minneapolis and St. Paul, Minnesota
• Smoke-free Law Associated with Higher-Than-Expected Taxable Retail Sales for Bars and Taverns in Washington State
• Smoke-free Law Associated with Reduction in Hospital Admission for Childhood Asthma
• Study Links Smoke-free Law to Fewer Pre-Term Births  

 Resources Updated: February 2013