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State of Tobacco Control 2018State of Tobacco Control 2018State of Tobacco Control 2018

Smokefree Air Laws Methodology

The smokefree air laws grading system is based on criteria developed by an advisory committee convened by the National Cancer Institute with some modification to reflect the current policy environment. The criteria were presented in the article, "Application of a Rating System to State Clean Indoor Air Laws (USA)" (Chriqui JF, et al. Tobacco Control. 2002;11:26-34). This approach provides scoring in nine categories: Government Workplaces, Private Workplaces, Schools, Child Care Facilities, Restaurants, Retail Stores, Recreational/Cultural Facilities, Penalties and Enforcement. All laws are open to interpretation and our analysis may differ from those of the authors noted in the above study.  

To reflect the current policy environment, two additions have been made to the advisory committee's recommended categories of smokefree establishments. An additional category for bars has been added to all states. A second category, Casinos/Gaming Establishments, was added to the states which allow casinos or gaming establishments. Adding these categories became necessary after the committee made its recommendations in 2002, because a number of states have prohibited smoking in bars and casinos/gaming establishments since then, and states need to be recognized in the grading system for protecting workers in these places from secondhand smoke.

The smokefree air grade for each state is based on a total of all points received in all categories. The grades are based on a maximum score of 40 if the state has no casinos or gaming establishments, or 44 if the state has casinos or gaming establishments. Both these high scores have been attained by states in this year's report. The maximum score of 40 or 44 becomes the denominator, and the state's total points serve as the numerator. The percentage was calculated and grades were assigned following a standard grade-school system. States receiving scores in the top 10 percent of the range (90 to 100 percent) earned an "A." Those receiving scores falling between 80 and 89 percent got a grade of "B," between 70 and 79 percent a "C" and between 60 and 69 percent a "D." Those that fell below 60 percent received an "F." The points break down as follows:

Assigned Grade

No State Casino/Gaming Establishments

State Casino/Gaming Establishments Present

A

36 to 40

40 to 44

B

32 to 35

36 to 39

C

28 to 31

31 to 35

D

24 to 27

27 to 30

F

23 and below

26 and below

There are two situations that create exceptions to the grading system:

  • Preemption: State preemption of stricter local ordinances is penalized by a reduction of one letter grade. States with preemption that have a score of 40 points or higher (or 44 points or higher dependent on whether the Casinos/Gaming Establishments category is applicable for that state) are not penalized for preemption.
  • Local Ordinances: States without strong statewide smokefree laws may be graded on the basis of local ordinances. Strong local smokefree air ordinances that include most workplaces, all restaurants and bars are considered according to the percentage of population covered in a given state. States with over 95 percent of their population covered by comprehensive local smokefree ordinances will receive an "A," over 80 percent a "B," over 65 percent a "C" and over 50 percent a "D." Local ordinances that cover less than 50 percent of the population will not be considered for evaluation.1

Key to Smokefree Laws Ratings by Category

For all categories, laws that require that smoking be permitted or laws without any restrictions for the particular category receive a score of zero (0).

  1. Government Workplaces (4 points): Target is "state and local government workplaces are 100 percent smokefree, no exemptions." Score was lowered if restriction depended on type of ventilation, location of smoking area and/or number of employees. A bonus point (+1) was available if the laws met the target criteria and required the grounds or a specified distance from entries or exits to be smokefree.
  2. Private Workplaces (4 points): Target is "private workplaces are 100 percent smokefree, no exemptions." Score was lowered if restriction depended on type of ventilation, location of smoking area and/or number of employees. A bonus point (+1) was available if the laws met the target criteria and required the grounds or a specified distance from entries or exits to be smokefree.
  3. Schools (4 points): Target is "no smoking permitted in public and non-public schools during school hours or while school activities are being conducted." Score is lowered if restriction depends on type of school, school hours, type of ventilation and/or location of smoking area. A bonus point (+1) is available if the laws meet the target criteria and extend the law/policy to any time in school facilities, on school grounds, and at school-sponsored activities.
  4. Child Care Facilities (4 points): Target is "no smoking permitted during operating hours in childcare facilities (explicitly including licensed, home-based facilities)." Score is lowered if restrictions depend on ventilation standards, location of smoking areas and/or exemptions for certain types of facilities.
  5. Restaurants (4 points): Target is "restaurants (explicitly including bar areas of restaurants) are 100 percent smokefree." Score is lowered if restriction depends on type of ventilation, location of smoking areas and/or exemptions for some restaurants. A bonus point (+1) is available if the laws meet the target criteria and extend the law/policy to outdoor seating areas of restaurants.
  6. Bars/Taverns (4 points): Target is "bars/taverns and similar types of establishments are 100 percent smokefree." Score is lowered if restriction depends on ventilation standards, location of smoking area and/or if laws only applied to some but not all bars/taverns. A bonus point (+1) is available if the laws meet the target criteria and extend the law/policy to private clubs or similar establishments at all times.
  7. Casinos/Gaming Establishments (4 points): Target is "casinos/gaming establishments are 100 percent smokefree." Score is lowered if restriction depends on ventilation standards, location of smoking area and/or if laws only apply to some but not all casinos/gaming establishments. This category does not apply to states that do not have casinos/gaming establishments or only casinos/gaming establishments on Native American lands.
  8. Retail Stores (4 points): Target is "retail stores or retail businesses open to the public are 100 percent smokefree." Score is lowered if restriction depends on ventilation standards and/or location of smoking area, and if laws only apply to some but not all retail stores or businesses.
  9. Recreational/Cultural Facilities (4 points): Target is "recreational and cultural facilities are 100 percent smokefree." Score is lowered if restriction depends on ventilation standards, location of smoking area and/or if laws only apply to some but not all recreational/cultural facilities.
  10. Penalties (4 points): Target is "graduated penalties or fines, applicable to smokers and to proprietors or employers, for any violation of clean indoor air legislation." Score is lowered if penalties included possibilities for delay, exceptions for either smokers or proprietors/employers, or penalties that only apply to some but not all offenses. An intent requirement or affirmative defense against violation reduces the score by one (1) point.
  11. Enforcement (4 points): Target is "designate an enforcement authority for clean indoor air, require sign posting and have a phone number and/or online location to report violations." Score is lowered if there is no requirement for sign posting, there is no phone number or online location to report violations, enforcement authority only applies to some sites, or an enforcement authority or sign requirement exists, but not both. A bonus point (+1) is available if the laws meet the target criteria and require the enforcement authority to conduct compliance inspections.
  • Sources
    1. Data on percent of state populations covered by local ordinances is obtained from the Americans for Nonsmokers' Rights Foundation, www.no-smoke.org.

    Did You Know?

    1. More than 1 in 5 high school students in the U.S. use at least one tobacco product, including e-cigarettes, according to the 2016 National Youth Tobacco Survey.
    2. 7.2 percent of middle school students use at least one tobacco product, including e-cigarettes, according to the 2016 National Youth Tobacco Survey.
    3. A 2014 article in the Journal of the American Medical Association found that about 8 million lives have been saved through tobacco control efforts since 1964, including 800,000 lung cancer deaths between 1975 and 2000.
    4. Smoking is the number one preventable cause of death in the U.S., killing over 480,000 people per year.
    5. Secondhand smoke kills more than 41,000 people in the U.S. each year.
    6. 28 states and Washington D.C. have passed laws making virtually all public places and workplaces, including restaurants and bars smokefree.
    7. Connecticut and New York have the highest cigarette taxes in the country at $4.35 per pack.
    8. Missouri has the lowest cigarette tax in the country at 17 cents per pack.
    9. The average of all states plus the District of Columbia's cigarette taxes are $1.72 per pack.
    10. Ten states have taxes on other tobacco products equivalent to their state's cigarette taxes.
    11. Alaska is the only state that is funding their tobacco control programs at or above the CDC-recommended level (in Fiscal Year 2018).
    12. Three states increased their cigarette taxes in 2017.
    13. No state approved a comprehensive smokefree workplace law in 2017.
    14. 9 states – California, Connecticut, Indiana, Kentucky, Maine, Massachusetts, Missouri, Ohio and South Carolina– offer a comprehensive cessation benefit to tobacco users on Medicaid.
    15. Each of the 50 states and the District of Columbia provide tobacco quitlines, a phone number for quit smoking phone counseling. The median amount states invest in quitlines is $2.10 per smoker in the state.
    16. Maine, New Jersey and Oregon passed legislation increasing their minimum sales ages for tobacco products to 21 in 2017.
    17. Five states and over 280 communities in 18 different states have passed Tobacco 21 laws.
    18. Nationwide, the Medicaid program spends more than $22 billion in healthcare costs for smoking-related diseases each year – more than 11 percent of total Medicaid spending.
    19. In 2009, the American Lung Association played a key role in the passage of the Family Smoking Prevention and Tobacco Control Act, which gives the U.S. Food and Drug Administration authority over tobacco products.
    20. The American Lung Association played a key role in airplanes becoming smokefree in the 1990s.
    21. 42 states and Washington D.C. spend less than half of what the CDC recommends on their state tobacco prevention programs.
    22. States spend less than three cents of every dollar they get from tobacco settlement payments and tobacco taxes to fight tobacco use.
    23. Each day, more than 2,300 kids under 18 try their first cigarette and close to 400 kids become new, regular smokers.
    24. Each day, close to 1,900 kids try their first cigar. On average, close to 80 kids try their first cigar every hour in the United States – equaling close to 690,000 every year.
    25. Smoking costs the U.S. economy over $332 billion in direct health care costs and lost productivity every year.
    26. The five largest cigarette companies spent over $22 million dollars per day marketing their products in 2015.
    27. Secondhand smoke causes $5.6 billion in lost productivity in the U.S. each year.
    28. Smoking rates are over twice as high for Medicaid recipients compared to those with private insurance.
    29. A 2013 study of California's tobacco prevention program shows that the state saved $55 in healthcare costs for every $1 invested from 1989 to 2008.
    30. A 2012 study of Massachusetts' comprehensive Medicaid quit smoking benefit found that Massachusetts saved $3 for every $1 spent helping smokers quit in just over a year.
    31. In 2017, Kentucky and South Carolina made major improvements to their quit smoking coverage for Medicaid enrollees and others.
    32. Uninsured Americans smoke at a rate two times higher than people with private insurance.
    33. An estimated one third of Americans living in public housing smoke.
    34. One study found persons with behavioral health and substance abuse disorders consume about 40 percent of the cigarettes sold in the U.S.
    35. Native Americans and Alaska Natives have the highest smoking rates among any racial/ethnic group.
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