Comprehensive smoke-free laws are spreading across the U.S., although there remains room for improvement, an analysis of policies covering the nation's 50 largest cities showed.
At the end of 2002, only one of those cities -- San Jose, Calif. -- had a comprehensive smoke-free law, defined as one banning smoking in all indoor areas of private workplaces, restaurants, and bars without exceptions, according to Stephen Babb, MPH, of the CDC's Office on Smoking and Health, and colleagues.
By October 2012, however, 30 cities (60%) were covered by such a law at the local level, state level, or both, the researchers reported in the Nov. 16 issue of Morbidity and Mortality Weekly Report.
"The progress in extending comprehensive secondhand smoke protections to the majority of the 50 largest U.S. cities reported in this study is a major public health achievement," they wrote.
But, they added, work remains to be done.
"In particular, a number of cities in the southern United States have ineffective smoking restrictions or none at all," Babb and colleagues wrote. "This gap in policy coverage creates disparities in public health protections that are likely to both reflect and contribute to broader tobacco-related population disparities."
Smoke-free laws sprang up at the local level in the 1990s; the first came in 1993 from Shasta County, Calif. States followed about a decade later when Delaware became the first to implement a statewide comprehensive smoke-free law in 2002.
Currently, 25 states and the District of Columbia have implemented comprehensive smoke-free laws, and one will go into effect in North Dakota in December.
To look at the implementation of comprehensive smoke-free laws over time, the CDC and the American Nonsmokers' Rights Foundation (ANRF) compared coverage in the largest U.S. cities at the end of 2000 with coverage in October 2012. In 2010, populations among these cities ranged from 365,438 in Arlington, Tex., to 8,175,133 in New York City.
The researchers used data from the ANRF's U.S. Tobacco Control Laws Database and the CDC's State Tobacco Activities Tracking and Evaluation (STATE) System database. The analysis looked only at laws covering private workplaces, restaurants, and bars, and not at all settings in which a nonsmoker could be exposed to secondhand smoke.
Although there was a substantial increase in the proportion of cities that were covered by a comprehensive smoke-free law over time, 20 cities were not covered by a state or local law in 2012.
Of those, 14 did have 100% smoke-free provisions that covered at least one of the settings examined in the study, but six did not -- Los Angeles; Oklahoma City; Atlanta; Fresno, Calif.; Virginia Beach, Va.; and Tulsa, Okla.
Ten of the 20 cities without a comprehensive law are located in the South and six are located in California, "which has substantial statewide smoking restrictions that were enacted in 1994, at an early point in the evolution of smoke-free policies, and fall short of current standards for comprehensive smoke-free laws," according to the researchers.
The analysis was supported by the CDC. Authors are employees of the agency.
Morbidity and Mortality Weekly ReportSource Reference: Hopkins M, et al "Comprehensive smoke-free laws -- 50 largest U.S. cities, 2000 and 2012" MMWR 2012; 61: 914-917.