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Smoke-free policies for indoor areas

Health Factors: Tobacco Use
Decision Makers: Educators Employers & Businesses Local Government State Government Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 100% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Smoke-free policies for indoor areas prohibit smoking in designated enclosed spaces. Private sector smoke-free policies can ban smoking on worksite property or restrict it to designated, often outdoor, locations. State and local smoke-free ordinances can establish standards for all workplaces, designated workplaces, and other indoor spaces. Policies can be comprehensive, prohibiting smoking in all areas of workplaces, restaurants, and bars, or limit smoking to designated areas via partial bans (Cochrane-Frazer 2016). Restrictions may also extend to adjacent outdoor areas (CG-Tobacco use). Some local governments cannot enact smoke-free measures due to state preemption legislation (Grassroots Change).

Expected Beneficial Outcomes

Improved health outcomes
Reduced exposure to secondhand smoke
Reduced tobacco consumption
Reduced mortality
Reduced hospital utilization
Increased quit rates
Reduced youth smoking
Reduced health care costs
Reduced preterm birth
Reduced infant mortality

Evidence of Effectiveness

There is strong evidence that comprehensive smoke-free policies for indoor areas improve health (Hoffman 2015CG-Tobacco use, Cochrane-Frazer 2016). Smoke-free policies substantially reduce acute coronary events such as heart attacks (US DHHS SG-Smoking 2014CG-Tobacco use, Tan 2012Lin 2013, Meyers 2009, Cochrane-Frazer 2016) and secondhand smoke (SHS) exposure (Hoffman 2015US DHHS SG-Smoking 2014CG-Tobacco use). Policies reduce respiratory symptoms among hospitality workers and sensory symptoms among smokers and nonsmokers (Cochrane-Frazer 2016). Smoke-free policies can also reduce asthma attacks and hospitalizations (Been 2014Hahn 2010, CG-Tobacco use), and may reduce the risk of preterm birth (Been 2014, Hahn 2010) and Sudden Infant Death Syndrome (SIDS) (Hahn 2010).

Smoke-free policies have been shown to reduce hospitalizations and mortality due to cardiovascular (CG-Tobacco use) and respiratory diseases (Tan 2012). Smoke-free policies reduce smoking prevalence (Hoffman 2015, Lupton 2015) and cigarette consumption (Hoffman 2015, US DHHS SG-Smoking 2014), and can lead smokers to quit smoking (Hoffman 2015CG-Tobacco use). Young people appear to reduce smoking more than older people following policy implementation (Meyers 2009, Hopkins 2010) and heart attack incidence appears to drop more in communities with larger reductions in smoking prevalence (Lin 2013).

Comprehensive policies reduce SHS exposure more than partial bans (Cochrane-Frazer 2016, Hoffman 2015, CG-Tobacco use) or policies targeted at specific industries (CG-Tobacco use), and appear to be associated with greater reductions in health risks (Tan 2012). Smoke-free policies reduce SHS exposure for hospitality workers and young people the most (Meyers 2009, Hahn 2010).

Some studies suggest that smoke-free policies reduce SHS exposure more in bars in low income areas (CG-Tobacco use). Other studies suggest that quit rates, prevalence, and SHS exposure may not drop as readily for lower income employees (Hill 2013a), especially if policies are not uniformly implemented (Hahn 2010). Workplaces with higher income employees may be more likely to enforce their community’s smoke-free laws. However, in communities without such laws, workplaces with low income employees appear less likely than those with higher income employees to voluntarily institute smoke-free policies (Hill 2013a).

Models suggest that smoke-free policies cost up to $25 per person to implement (CG-Tobacco use). Such policies are cost effective based on averted mortality and health care costs (CG-Tobacco use) and quality adjusted life years (QALYs) saved (CG-Tobacco use, Hopkins 2010). Over the long-term, analysts estimate such policies save between $0.15 and $4.8 million per 100,000 persons in health care costs (CG-Tobacco use). Smoke-free policies do not harm hospitality businesses’ profits (CG-Tobacco use, Cochrane-Frazer 2016, Hahn 2010).

Experts suggest that states and communities provide and promote cessation services before smoke-free policies take effect (CG-Tobacco use).

Implementation

United States

Nationally, efforts are underway to enact or strengthen smoke-free policies, eliminate exemptions, and remove state restrictions on local policies (CG-Tobacco use). As of 2013, smoke-free legislation has been adopted by 36 states (US DHHS SG-Smoking 2014). Many states ban smoking indoors on college and school campuses, and in day care centers, hospitals, restaurants, and grocery stores (CDC-STATE). Some states also ban smoking in casinos, bars, personal vehicles, and common areas of government housing. Some communities are expanding such policies to outdoor public areas such as parks, applying smoke-free policies to public multi-unit housing, or requiring landlords of multi-unit properties to disclose the property smoking policy to prospective tenants (CG-Tobacco use). State legislation pre-empts local government control of smoke-free policies in 12 states, while 27 states allow local communities to adopt restrictions that are stronger than the state-level restrictions (CDC-STATE).

Wisconsin

Wisconsin’s statewide smoking ban applies to enclosed places of employment or public spaces, but not outdoor areas (WI Statute 101.123). 

Implementation Resources

ANR-Going smokefree - Americans for Nonsmokers’ Rights (ANR). Getting started. Accessed on November 17, 2016
ChangeLab-Smokefree housing - ChangeLab Solutions. Smokefree housing. Accessed on November 4, 2016
ChangeLab-Smokefree work, outdoors - ChangeLab Solutions. Smokefree workplaces and outdoor areas. Accessed on November 4, 2016
HealthPartners-CHA - HealthPartners Institute for Education and Research. Community health advisor (CHA): Resource for information on the benefits of evidence-based policies and programs: Helping communities understand, analyze, and model costs. Accessed on April 3, 2017
PFP-Smoke-free 2007 - Partnership for Prevention (PFP). Smoke-free policies: Establishing a smoke-free ordinance to reduce exposure to secondhand smoke in indoor worksites and public places - An action guide. Washington, DC: Partnership for Prevention (PFP); 2007. Accessed on November 4, 2016
US HUD-Smoke-free - US Department of Housing and Urban Development (HUD). Smoke-free multifamily housing. Accessed on February 27, 2017

Citations - Description

CG-Tobacco use - The Guide to Community Preventive Services (The Community Guide). Tobacco. Accessed on April 3, 2017
Cochrane-Frazer 2016* - Frazer K, Callinan JE, McHugh J, et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews. 2016;(2):CD005992. Accessed on November 9, 2016
Grassroots Change - Grassroots Change. Connecting for better health. Accessed on February 13, 2017

Citations - Evidence

Been 2014* - Been JV, Nurmatov UB, Cox B, Nawrot TS, et al. Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis. The Lancet. 2014;383(9928):1549-1560. Accessed on November 4, 2016
CG-Tobacco use - The Guide to Community Preventive Services (The Community Guide). Tobacco. Accessed on April 3, 2017
Cochrane-Frazer 2016* - Frazer K, Callinan JE, McHugh J, et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews. 2016;(2):CD005992. Accessed on November 9, 2016
Hahn 2010* - Hahn EJ. Smokefree legislation: A review of health and economic outcomes research. American Journal of Preventive Medicine. 2010;39(6 Suppl 1):S66-S76. Accessed on November 4, 2016
Hill 2013a - Hill S, Amos A, Clifford D, Platt S. Impact of tobacco control interventions on socioeconomic inequalities in smoking: Review of the evidence. Tobacco Control. 2013;0:1–9. Accessed on November 30, 2016
Hoffman 2015 - Hoffman SJ, Tan C. Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health. 2015;15:744. Accessed on November 4, 2016
Hopkins 2010* - Hopkins DP, Razi S, Leeks KD, et al. Smokefree policies to reduce tobacco use: A systematic review. American Journal of Preventive Medicine. 2010;38(2 Suppl):S275-89. Accessed on November 4, 2016
Lin 2013 - Lin H, Wang H, Wu W, et al. The effects of smoke-free legislation on acute myocardial infarction: A systematic review and meta-analysis. BMC Public Health. 2013;13:529. Accessed on November 4, 2016
Lupton 2015* - Lupton RJ, Townsend LJ. A systematic review and meta-analysis of the acceptability and effectiveness of university smoke-free policies. Journal of American College Health. 2015;63(4):238-247. Accessed on November 4, 2016
Meyers 2009* - Meyers DG, Neuberger JS, He J. Cardiovascular effect of bans on smoking in public places. Journal of the American College of Cardiology. 2009;54(14):1249-55. Accessed on November 4, 2016
Tan 2012* - Tan CE, Glantz SA. Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: A meta-analysis. Circulation. 2012;126(18):2177-2183. Accessed on November 4, 2016
US DHHS SG-Smoking 2014 - US Department of Health and Human Services (US DHHS). The health consequences of smoking- 50 years of progress: A report of the Surgeon General, executive summary. 2014. Accessed on March 7, 2017

Citations - Implementation

CDC-STATE - Centers for Disease Control and Prevention (CDC). State tobacco activities tracking and evaluation (STATE) system. Accessed on March 31, 2017
CG-Tobacco use - The Guide to Community Preventive Services (The Community Guide). Tobacco. Accessed on April 3, 2017
US DHHS SG-Smoking 2014 - US Department of Health and Human Services (US DHHS). The health consequences of smoking- 50 years of progress: A report of the Surgeon General, executive summary. 2014. Accessed on March 7, 2017
WI Statute 101.123 - Wisconsin State Legislature. WI Statute 101.123: Smoking prohibited. Accessed on November 4, 2016

Page Last Updated

November 17, 2016

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