State Smoke-free Laws Research Articles

Association of smoke-free laws with preterm or low birth weight deliveries-A multistate analysis.

To assess the association between the change in statewide smoke-free laws and the rate of preterm or low birth weight delivery hospitalizations. 2002-2013 Healthcare Cost and Utilization Project State Inpatient Databases. Quasi-experimental difference-in-differences design. We used multivariate logistic models to estimate the association between the change in state smoke-free laws and preterm or low birth weight delivery hospitalizations. The analyses were also stratified by maternal race/ethnicity to examine the differential effects by racial/ethnic groups. Delivery hospitalizations among women aged 15-49years were extracted using the International Classification of Diseases, Ninth Revision, and Diagnosis-Related Group codes. Non-Hispanic black mothers had a higher rate of preterm or low birth weight delivery hospitalization than other racial/ethnic groups. Overall, there was no association between the change in smoke-free laws and preterm or low birth weight delivery rate. Among non-Hispanic black mothers, the change in statewide smoke-free laws was associated with a 0.9-1.9 percentage point (P<.05) reduction in preterm or low birth weight delivery rate beginning in the third year after the laws took effect. There was no association among non-Hispanic white mothers. A decline in the black-white disparity of 0.6-1.6 percentage points (P<.05) in preterm or low birth weight delivery rates was associated with the change in state smoke-free laws. The change in state smoke-free laws was associated with a reduction in racial/ethnic disparities in preterm or low birth weight delivery hospitalizations in selected US states.

Tobacco control policy and smoking among older Americans: An analysis of a nationally-representative longitudinal sample (1992–2014)

Smoking has decreased less rapidly among older adults than among the working age population in the United States. This study examines whether tobacco control policy, specifically smoke-free laws and increased cigarette prices, are associated with smoking cessation and lower smoking intensity among older adults. In addition, it considers whether the effect of smoke-free laws varied by labor force participation. Using geocoded longitudinal data from the Health and Retirement study collected from 1992 to 2014, I estimate survival models to evaluate the association between the implementation of city, county, and state smoke-free laws, changes in average state cigarette pack price, and smoking cessation among smokers. I then interact labor force status with smoke-free laws to assess whether the associations differ for retired versus employed respondents. Second, I estimate within-person fixed effects models to evaluate the association between the implementation of smoke-free laws, changes in average state cigarette pack price, and smoking intensity among smokers. Models were stratified by labor force status to assess whether the associations varied by labor force participation. All analyses were also stratified by age into younger (51–64) and older (65+) respondents. Neither the implementation of smoke-free laws nor increases in cigarette prices were associated with greater smoking cessation or lower smoking intensity. There was no evidence that labor force participation was associated with greater responsiveness to smoke-free laws. The results suggest that two of the most popular tobacco control policy tools in the US, smoke-free laws and cigarette prices, may be less effective among older adults.

A Tobacco Control Framework for Regulating Public Consumption of Cannabis: Multistate Analysis and Policy Implications.

Eleven US states and Washington, DC, legalized recreational (adult use) cannabis. Seven states-Alaska, California, Colorado, Massachusetts, Nevada, Oregon, and Washington-allow cannabis sales. A public health concern is that exemptions in state or local smoke-free laws for public cannabis smoking or vaping will weaken smoke-free laws, expose the public to secondhand cannabis, and renormalize smoking.We describe the experience of the seven states and challenges faced in maintaining smoke-free laws. Using elements of a tobacco control framework, we identify best practices in cannabis regulation by comparing each state's smoke-free laws and allowances for public cannabis use. All states prohibit public cannabis use; two lack 100% smoke-free protections; one lacks vaping devices in its smoke-free law; three allow cannabis use in retailers; two allow cannabis use in social consumption lounges; and two allow cannabis use in tourism venues.States should close gaps in smoke-free laws and not expand where cannabis use is permitted to ensure public health.

Factors Associated With Cancer Disparities Among Low-, Medium-, and High-Income US Counties

There are concerns about the degree to which county income level might underlie the stark disparities in cancer death rates among US counties; at the same time, there is uncertainty about the factors that may mediate the disparities. To assess county-level cancer death rates and to identify possible mediators of the association between county-level median incomes and cancer death rates. Cross-sectional study using death records from the National Center for Health Statistics in 2014, with data collected and analyzed between October 1, 2016, and July 31, 2017. All US counties and county equivalents were included. County-level median household income. County-level age-standardized cancer death rate. In 3135 counties, median incomes ranged from $22 126 to $121 250 per year. Low-income counties (median income, $33 445) vs high-income counties (median income, $55 780) had higher proportions of residents who were non-Hispanic black, lived in rural areas, or reported poor or fair health. The mean (SD) cancer death rate was 185.9 (24.4) per 100 000 person-years in high-income counties, compared with 204.9 (26.3) and 229.7 (32.9) per 100 000 person-years in medium- and low-income counties, respectively. In mediation models, health risk behaviors (smoking, obesity, and physical inactivity); clinical care factors (unaffordable care and low-quality care); health environments (food insecurity); and health policies (state smoke-free laws and Medicaid payment rates) in aggregate accounted for more than 80% of the income-related disparity. The strongest possible mediators were food insecurity (explaining 19.1% [95% CI, 12.5%-26.5%] of the association between county incomes and cancer deaths), low-quality care (17.9%; 95% CI, 14.0%-21.8%), smoking (12.7%; 95% CI, 9.4%-15.6%), and physical inactivity (12.2%; 95% CI, 9.4%-15.6%). There are wide gaps in cancer death rates between low-, medium-, and high-income counties. Future studies are needed to assess whether targeting the possible mediators might ameliorate the substantial socioeconomic cancer disparities.

State and Local Comprehensive Smoke-Free Laws for Worksites, Restaurants, and Bars - United States, 2015.

Exposure to secondhand smoke from burning tobacco products causes stroke, lung cancer, and coronary heart disease in adults (1,2). Children who are exposed to secondhand smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth (1,2). Secondhand smoke exposure contributes to approximately 41,000 deaths among nonsmoking adults and 400 deaths in infants each year (2). This report updates a previous CDC report that evaluated state smoke-free laws in effect from 2000-2010 (3), and estimates the proportion of the population protected by comprehensive smoke-free laws. The number of states, including the District of Columbia (DC), with comprehensive smoke-free laws (statutes that prohibit smoking in indoor areas of worksites, restaurants, and bars) increased from zero in 2000 to 26 in 2010 and 27 in 2015. The percentage of the U.S. population that is protected increased from 2.72% in 2000 to 47.8% in 2010 and 49.6% in 2015. Regional disparities remain in the proportions of state populations covered by state or local comprehensive smoke-free policies, as no state in the southeast has a state comprehensive law. In addition, nine of the 24 states that lack state comprehensive smoke-free laws also lack any local comprehensive smoke-free laws. Opportunities exist to accelerate the adoption of smoke-free laws in states that lack local comprehensive smoke-free laws, including those in the south, to protect nonsmokers from the harmful effects of secondhand smoke exposure.

An observational study of compliance with North Dakota's smoke-free law among retail stores that sell electronic smoking devices

ObjectiveTo determine whether retail stores selling electronic smoking devices or liquid nicotine were compliant with North Dakota's smoke-free law.MethodsDuring June 2015, retail stores selling electronic smoking devices or liquid nicotine...

Knowledge and attitude toward smoke-free legislation and second-hand smoking exposure among workers in indoor bars, beer parlors and discotheques in Osun State of Nigeria.

One of the requirements of the Osun State smoke-free legislation is to ensure smoke-free enclosed and partially enclosed workplaces. This survey was conducted to assess the knowledge and attitude of workers in indoor bars, beer parlors and discotheques to smoke-free legislation in general and the Osun State smoke-free law in particular. A convenience sampling of 36 hospitality centers was conducted. Interviewer-administered questionnaires were used to elicit responses about the objectives from non-smoking workers. The questionnaires had sections on knowledge of the Osun State smoke-free law, attitude toward the law and smoke-free legislation in general and exposure to second-hand tobacco smoke by the workers. Questions were also asked about the second-hand tobacco smoking status of these workers. The data were analyzed using SPSS version 15.0. We had 154 participants recruited into the study. There were 75 males (48.0%) and 79 females (52.0%). On the overall, respondents had a good knowledge of the effects of second-hand smoke on health (70.2%) with 75.0% of them being aware of the general smoke-free law and 67.3% being aware of the Osun State smoke-free law although none of them had ever seen a copy of the law. A high proportion (60.0%) was in support of the Osun smoke-free law although all of them think that the implementation of the law could reduce patronage and jeopardize their income. Attitude toward second-hand smoking was generally positive with 72.0% of them having no tolerance for second-hand tobacco smoke in their homes. Most participants (95.5%) had been exposed to tobacco smoke in the workplace within the past week. Despite the high level of awareness of the respondents about the dangers of second hand smoke and their positive attitude to smoke-free laws, nearly all were constantly being exposed to second hand smoke at work. This calls for policy level interventions to improve the implementation of the smoke-free law.

Smoke-free laws and direct democracy initiatives on smoking bans in Germany: a systematic review and quantitative assessment.

Background: Germany’s 16 states regulate smoking differently within health protection principles laid down in the federal law. All state smoke-free laws in Germany have undergone at least one change since taking effect. Methods: We systematically review federal and state laws regulating smoking, as well as petitions, popular initiatives and referenda that aimed at changing statutory smoking bans. Data generated through the systematic review were correlated with state smoking rates. Results: The protection from the dangers of secondhand smoke is the primary motive for smoking bans in Germany. The first smoke-free laws affecting smoking in pubs, restaurants and several other public places were introduced in 2007. In 2008, the Federal Constitutional Court of Germany ruled in a leading decision on the smoke-free laws of two states that some common smoking ban exemptions of the introduced smoke-free laws violate the basic right to freely exercise a profession and mandated revisions. All states but Bavaria and Saarland, whose smoking bans were more and less comprehensive than those judged by the constitutional court, respectively, needed to change the smoking ban exemptions to reconcile their smoke-free laws with the constitution. Direct democracy initiatives to change smoking bans were only successful in Bavaria in 2010, but a total of 15 initiatives by citizens’ or interest groups attempted to influence non-smokers protection legislation through direct democratic procedures. Early ratification of a smoking ban in a federal state correlates with a higher reduction in the smoking rate from 2005 to 2009 (Spearman’s ρ = 0.51, p = 0.04). Conclusions: The federal government structure and direct democratic participation in smoke-free legislation in Germany has produced a diversity of local smoking bans and exemptions.

The Impact of Smoke-Free Laws on Asthma Discharges: A Multistate Analysis

This is the first, to my knowledge, multistate, county-level analysis of Healthcare Cost and Utilization Project state inpatient data to examine the relationship between smoke-free laws and asthma discharges. I used treatment and control groups to examine the effects of state and county or city smoke-free laws separately and together (2002-2009). I compared quarterly county-level discharge rates before and after the implementation of 12 state smoke-free laws, accounting for counties with preexisting county or city smoke-free laws and using the data from 5 states without state smoke-free laws as a control group. I used difference-in-differences models, controlling for year and state fixed effects, state cigarette taxes, seasonality, and numerous county-level factors. I observed statistically significant reductions in asthma discharges after the implementation of county smoke-free laws but no statistically significant effect of state laws besides the effect of county laws or of state laws alone. There was also no statistically significant effect of any smoke-free law on appendicitis discharges. It may be unwise to pursue state smoke-free laws where they have yet to pass; rather, efforts might be better focused at the local level, where there is evidence of a significant impact.

Changes in Ambulance Calls After Implementation of a Smoke-Free Law and Its Extension to Casinos

Casinos are often exempted from legislation mandating smoke-free environments, potentially putting employees and patrons at risk for adverse events triggered by secondhand smoke exposure. We used an interrupted time series analysis of ambulance calls not originating and originating from casinos in Gilpin County, Colorado, a rural Colorado county with a large casino presence, from January 2000 through December 2012 to determine whether there was a change in ambulance calls originating from casinos when a state smoke-free law was extended to include them. Initial implementation of the smoke-free law (which exempted casinos) was followed by a significant 22.8% drop in ambulance calls (incidence rate ratio, 0.772; 95% confidence interval, 0.685-0.871; P<0.001) from locations other than casinos but no significant change in calls from casinos (P>0.9). The law requiring smoke-free casinos taking effect was followed by a 19.1% (incidence rate ratio, 0.809; 95% confidence interval, 0.724-0.905; P<0.001) drop in ambulance calls from casinos but no change in calls originating outside casinos (P>0.1). The observation that ambulance calls not coming from casinos dropped when the smoke-free law was initially implemented (excluding casinos) with no change in calls from casinos, followed by a comparable drop in calls originating from casinos (but not calls from elsewhere) when the law was extended to casinos, suggests that the important effects of secondhand smoke exposure occur acutely. These results also suggest that exempting casinos from smoke-free laws means that more people will suffer medical emergencies.

Economic Effects of Smoke-Free Laws on Rural and Urban Counties in Kentucky and Ohio

Numerous empirical studies have examined the influence of smoke-free legislation on economic activity, with most finding a null effect. The influence could possibly differ in rural areas relative to urban areas due to differing rates of smoking prevalence and access to prevention and treatment programs. Furthermore, the discussion of the effectiveness of smoke-free laws has been extended to consider local ordinances relative to statewide laws. This study examines these issues using 21 local laws in Kentucky and the Ohio statewide smoke-free law. The number of employees, total wages paid, and number of reporting establishments in all hospitality and accommodation services in Kentucky and Ohio counties were documented, beginning the first quarter 2001 and ending the last quarter of 2009. A generalized estimating equation time-series design is used to estimate the impact of local and state smoke-free laws in Kentucky and Ohio rural and urban counties. There is no evidence that the economies in Kentucky counties were affected in any way from the implementation of local smoke-free laws. There was also no evidence that total employment or the number of establishments was influenced by the statewide law in Ohio, but wages increased following the implementation of the law. Furthermore, there is no evidence that either rural or urban counties experienced a loss of economic activity following smoke-free legislation. The study finds no evidence that local or state smoke-free legislation negatively influences local economies in either rural or urban communities.

CANCER-RELATED NEWS FROM THE CDC: State Preemption of Local Smoke-Free Laws in Government Work Sites, Private Work Sites, and Restaurants

CANCER-RELATED NEWS FROM THE CDC: State Preemption of Local Smoke-Free Laws in Government Work Sites, Private Work Sites, and Restaurants