Smoke-Free Policies in United States

United States

Tobacco smoke contains at least 69 chemicals that are known to cause cancer. Besides cancer, secondhand smoke has been linked to numerous other ailments in both children and adults, including sudden infant death syndrome, middle-ear disease, low birth weight, stroke and coronary heart disease. Non-smoking regulations and smoke-free policies aim to protect people from exposure to secondhand smoke. The Centers for Disease Control and Prevention cites several studies that show that smoke-free policies improve health outcomes among workers and the general population. Exposure to secondhand smoke is estimated to cause nearly 900 infant deaths and 41,000 adult deaths in the United States every year. 

In 2000, there were no states with comprehensive smoke-free laws. Today, 35 states and the District of Columbia have policies in place prohibiting smoking inside bars, restaurants and workplaces. Expanding smoke-free laws to protect more vulnerable and high-risk populations would not only improve the health of many Americans but also reduce societal costs. In 2011, nearly 38,000 non-smoker public housing residents, including children, became sick or died due to secondhand smoke exposure in their homes. The economic burden to the U.S. was estimated at $183 million. The additional cost of all lost productivity due to secondhand smoke in the United States was last estimated at $5.6 billion in 2006.

Smoking regulations vary across the country, and differences in smoke-free policy coverage may contribute to disparities in secondhand smoke exposure. Populations of adult non-smokers with a higher prevalence of secondhand smoke exposure include:

• Adults ages 18-39 compared with those age 40 and older.
• Non-Hispanic Black adults compared with non-Hispanic white, non-Hispanic Asian and Hispanic adults. Evidence suggests that the American Indian/Alaska Native population is also exposed to high levels of secondhand smoke.
• Adults living below the federal poverty level compared with higher-income adults. 
• Adults with a high school education or less compared with those with some college education.

Strategies to strengthen and support non-smoking regulations include:

• Monitoring cigarette and tobacco companies for tactics that undermine or inhibit smoking regulations. 
• Enforcing smoke-free policies in multi-unit housing. The American Lung Association has a step-by-step guide on how best to do this.
• Implementing smoke-free policies in the workplace and providing continuous education and resources on smoking cessation and prevention. The Community Preventive Services Task Force recommends smoke-free policies to reduce secondhand smoke exposure on the basis of strong evidence of effectiveness.

Healthy People 2030 has multiple tobacco-related objectives, including:

• Increasing the number of states that prohibit smoking in indoor worksites, restaurants and bars.
• Increasing the proportion of smoke-free homes.

Brody, Debra. “Secondhand Smoke Exposure Among Nonsmoking Adults: United States, 2015-2018.” NCHS Data Brief No. 396. Hyattsville, MD: National Center for Health Statistics, February 4, 2021. https://doi.org/10.15620/cdc:101197.

Hyland, Andrew, Joaquin Barnoya, and Juan E. Corral. “Smoke-Free Air Policies: Past, Present and Future.” Tobacco Control 21, no. 2 (March 2012): 154–61. https://doi.org/10.1136/tobaccocontrol-2011-050389.

Mason, Jacquelyn, William Wheeler, and Mary Jean Brown. “The Economic Burden of Exposure to Secondhand Smoke for Child and Adult Never Smokers Residing in U.S. Public Housing.” Public Health Reports 130, no. 3 (May 2015): 230–44. https://doi.org/10.1177/003335491513000310.

Max, Wendy, Hai-Yen Sung, and Yanling Shi. “Deaths From Secondhand Smoke Exposure in the United States: Economic Implications.” American Journal of Public Health 102, no. 11 (November 2012): 2173–80. https://doi.org/10.2105/AJPH.2012.300805.

Tynan, Michael A., Carissa Baker Holmes, Gabbi Promoff, Cynthia Hallett, Maggie Hopkins, and Bronson Frick. “State and Local Comprehensive Smoke-Free Laws for Worksites, Restaurants, and Bars — United States, 2015.” MMWR. Morbidity and Mortality Weekly Report 65, no. 24 (June 24, 2016): 623–26. https://doi.org/10.15585/mmwr.mm6524a4.

U.S. Department 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.” Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010. https://pubmed.ncbi.nlm.nih.gov/21452462/.

U.S. Department of Health and Human Services. “The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General.” Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. https://www.ncbi.nlm.nih.gov/books/NBK179276/.