By Vishwadha Chander

(Reuters Health) – Smoke-free laws have helped Americans cut down on combustible cigarettes and helped protect nonsmokers from second-hand smoke, but not all United States regions have benefited equally, a study suggests.

As of July 2019, 25 of the 50 U.S. states had adopted comprehensive 100% smoke-free laws in workplaces, restaurants, and bars, and 11 more had laws covering at least one of these areas, the study authors report.

“The creation of smoke-free environments at workplaces and homes had a tremendously positive health impact… because it not only reduced exposure of non-smokers to secondhand smoke, but also created an environment that stimulates people to quit,” senior study author Stanton Glantz, director of the Center for Tobacco Control Research and Education at University of California, San Francisco, told Reuters Health by phone.

Many states, however, do not have strong laws, and people in those states are disproportionately burdened by tobacco use, he and his colleagues write in the American Journal of Public Health.

For their new study, Glantz and colleagues reviewed dozens of previous studies of combustible cigarette smoking and smoke-free legislation, and data from the Centers for Disease Control, the American Nonsmokers’ Rights Foundation, the U.S. Census Bureau and the U.S. Department of Housing and Urban Development.

Previous research found no-smoking laws cut non-smokers’ exposure to secondhand smoke from 52.5% to 25.5%. The laws were also associated with reductions in hospital admissions for cardiovascular and respiratory disease, and lower smoking rates among adolescents. States with no-smoking laws also had more support services to help smokers quit.

“These laws have changed the culture of smoking and its social acceptability,” said Dr. Vaughan Rees, a lecturer on social and behavioral sciences, and director of the Center for Global Tobacco Control at Harvard Chan School of Public Health, Boston.

Rees, who was not part of the study, said smoking is less visible, and adults no longer model their smoking to younger people.

“However, the study shows smoke-free policies are not applied in an equitable way,” Rees told Reuters Health in a phone interview.

Between 2000-2009, U.S. Asians and Hispanics benefited most from smoke-free laws, as many of them lived where these laws were passed, the research team found.

Non-Hispanic African Americans received the least protection from these laws, as many of them live in the tobacco-growing states of the south, or in the mid-west, where fewer smoke-free laws exist.

“Historically, tobacco was a powerful political force in these places,” said Glantz.

This began to change in 2004, after manufacturers backed a move to end a price support program for tobacco farmers. The farmers started growing other crops and no longer opposed tobacco control policies, the authors write.

“Health groups are doing better at getting tobacco control laws passed in these regions now,” Glantz said. “They haven’t caught up with the rest of the country, but things are moving there.”

At the individual level, people are generally supportive of smoke-free homes and apartments, the authors found from their analysis.

The authors believe smoke-free policies should be extended to homeless shelters and sites serving low-income populations.

The way forward, said Glantz, is a “matter of people getting organized and putting pressure on legislators and governors” to bring in smoke-free rules.

He and his colleagues conclude, “Expanding the reach of comprehensive smoke-free laws and smoking cessation services not only will facilitate the decline in smoking prevalence among subpopulations disproportionately burdened by tobacco use but will reduce exposure to second-hand smoke and further improve health outcomes in the United States.”

SOURCE: American Journal of Public Health, online October 2, 2019.

(Reporting by Vishwadha Chander)