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States Not Doing Enough to Stamp Out Secondhand Smoke

The good news: More states are enacting restrictive laws, report finds

THURSDAY, July 7, 2005 (HealthDay News) -- State laws to protect nonsmokers from secondhand smoke are producing some positive results, but much more needs to be done, according to a new federal report.

The number -- and restrictiveness -- of state laws regulating smoking in private-sector worksites, restaurants and bars increased from 1999 to 2004. But 16 states still have no restrictions on smoking in these venues, the report found.

"I wouldn't call it good progress -- it's some progress," said Dr. Norman Edelman, chief medical officer of the American Lung Association. "It's a little less than good progress. The good news is that those states that have done it are standing by it. Bars didn't empty out. Businesses didn't go belly up."

The findings appear in the July 8 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Exposure to secondhand smoke causes about 35,000 heart disease and 3,000 lung cancer deaths among nonsmokers in the United States each year, according to the report.

Establishing smoke-free environments is the best way to attack this problem, the study authors stated. A national health objective for 2010 is for all 50 states and the District of Columbia to have laws that restrict or prohibit smoking in public places and worksites.

The CDC report assessed progress toward this objective.

Between 1998 and the end of 2004, 10 states fortified smoking restrictions in private-sector worksites, nine bolstered restrictions in restaurants, and five strengthened restrictions in bars.

At the end of 1998, only one state -- Maryland -- had a ban on smoking in private-sector worksites. By the end of 2004, Delaware, Florida, Idaho, Massachusetts, New York and South Dakota had joined the ranks.

The number of states banning smoking in restaurants increased from two in 1998 -- Utah and Vermont -- to eight in 2004, with Delaware, Florida, Idaho, Maine, Massachusetts and New York added to the list.

In 1998, not one state required bars to be smoke-free. Today, four states have that requirement: Delaware, Maine, Massachusetts and New York.

The proportion of U.S. workers reporting that their workplace was officially smoke-free increased from 46.5 percent in 1993 to 69.3 percent in 1998-1999. That percentage, however, varied by occupation: from 90.8 percent of primary-school teachers in 1998-1999 to only 12.9 percent of bartenders, the report found.

"There's been a tendency to view these laws increasingly as measures to protect workers as well as patrons and I think that has contributed to extending protections to cover restaurants and bars," said Stephen Babb, co-author of the report and a health education specialist with the CDC's Office on Smoking and Health.

Kentucky is one state with lax statewide antismoking provisions. According to an article in the Louisville Courier-Journal, the state has the highest adult smoking rate in the nation (27.5 percent) and the highest number of lung cancer deaths.

The state has set up a toll-free hotline to help smokers quit, but smoking is still allowed in the Capitol, its annex and other public buildings, the newspaper said.

But even if states don't prohibit smoking, local laws can help to compensate. This has happened in some areas of Kentucky and elsewhere, according to the CDC review.

"This report is based on a review of state-level laws so it doesn't address local ordinances which may be widespread in some states," said Ann Malarcher, senior scientific advisor with the CDC's Office on Smoking and Health. "There are many different models. Some states have passed state laws to restrict smoking in both public and private places, but there are other models where local ordinances have been passed."

A second report in the CDC review identified shortcomings in some state laws that could allow local health departments to step in and take action.

Certain "tobacco" states have pre-emptive laws prohibiting the passage of comprehensive smoke-free laws, according to the report.

North Carolina is one of these states, with a law mandating that 20 percent of space within state-controlled buildings be designated as open to smoking.

Local health departments, however, are exempt from such provisions, providing a potential opportunity to curb smoking.

But the study authors found that 37 percent of local health department directors in North Carolina believed they were prohibited from enacting a 100 percent tobacco-free policy, and 20 percent didn't know if they were prohibited from doing so or not.

The state association of local health directors used these findings to amend state smoking laws in 2005 to be more restrictive at local health departments.

"The majority of states have done nothing. It's going to take local activism," Edelman said.

More information

To see how your state measures up, visit the American Lung Association.

SOURCES: Norman Edelman, M.D., chief medical officer, American Lung Association; Ann Malarcher, Ph.D., senior scientific advisor, Office on Smoking and Health, U.S. Centers for Disease Control and Prevention, Atlanta, Ga.; Stephen Babb, health education specialist, Office on Smoking and Health, U.S. Centers for Disease Control and Prevention, Atlanta, Ga.; July 8, 2005, Morbidity and Mortality Weekly Report
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