Public smoking bans have helped smokers to quit, improved health and cut health-related costs. Although about half the states have enacted bans over determined opposition by big-tobacco lobbyists, the effort to enact statewide bans has slowed. Groups such as the American Cancer Society have increasingly turned their smoking ban initiatives to individual cities, where the bans have found a much warmer reception.
As of July 1, some 13,689 municipalities in 32 states have smoke-free laws, and 28 states and Washington, D.C., have laws that require workplaces, restaurants or bars to be smoke-free, according to the American Nonsmokers' Rights Foundation. Within the United States, 65.1 percent of the population lives in an area that is covered by a smoke-free law.
The move to restrict smoking in places where others have to breathe in secondhand smoke is almost two decades old, and it's been a state-by-state battle, or even town-by-town battle all the way, anti-smoking groups say.
"I can't think of any places where smoking bans have been a slam-dunk to implement," said Cathy Callaway at the American Cancer Society.
Coalitions of smokers, such as the National Smokers' Alliance and groups within the Center for Individual Freedom, have banded together to support smokers' rights. These groups are sometimes backed by lobbyists, and they've been remarkably effective at getting their message out despite the clear dangers of tobacco use.
"I don't think the government should tell us where we can or cannot smoke," said Scott Smith, 32, who has worked with individuals from the National Smokers' Alliance to try to promote smoking in restaurants of New York. "And it's even more ridiculous for the policymakers to make these no smoking laws apply to a state. Secondhand smoke can easily be decreased if restaurants would make their smoke-free sections better ventilated."
But the U.S. Surgeon General maintains that there is no risk-free level of exposure to secondhand smoke. "Only 100 percent smoke-free indoor spaces fully protect nonsmokers from exposure to secondhand smoke," according to the agency.
Efforts to implement smoking laws began in the 1980s, but the first smoking ban that covered all restaurants and bars dates back to Aug. 3, 1990, in San Luis Obispo, Calif.
If a strong smoke-free law was present in all public places, according to the surgeon general, the nation would see "1.3 million smokers quitting, 950 million fewer cigarette packs being smoked, 1,540 myocardial infarctions and 360 strokes being averted, and $49 million in direct medical cost savings being realized all within one year."
But getting the laws passed remains a challenge, even though the benefits are so obvious and immediate.
"We've found that the best practice is to start at the community level," the ACS's Callaway said. "You have a smaller population, a smaller elected body to educate and a lot of grass-roots power. It helps the general public to work through the process and understand what a smoke-free law is."
Most states with smoke-free laws began with citywide initiatives. For example, New York City passed its smoking ban in March 2003 and secured a statewide ban in June of the same year. The positive effects on public health increase with time, according to Stanton Glantz, a cardiology professor at the University of San Francisco who is credited with top research advances by the American Heart Association.
"In the United States, the first thing that will happen with a smoking ban is that the number of people having heart attacks will drop by about 20 percent," Glantz said. "The laws' popularity will grow over time, and people will quit smoking or cut down on their smoking, which is why the tobacco companies are so hysterical about these laws."
Even hard-core tobacco addicts tend to favor smoking bans, research shows. About 80 percent of smokers want to quit, according to Bronson Frick, the associate director of the organization Americans for Non-Smokers' Rights.
American adult smoking rates have significantly declined since 1965, when the number of adult smokers hit 42.4 percent. In 1997, this figure fell to 24.7 percent and the smoking rate for American youth, grades 9 through 12, slid to 36.4 percent. Today, approximately 21.8 percent of American adults are smokers and 20 percent of youth smokes, according to Joel London, a press officer for the Centers for Disease Control and Prevention.
The harm to smokers from their habit is well-known, but the effect on nonsmokers can also be substantial. The CDC states that secondhand smoke causes heart disease, lung cancer and sudden infant death syndrome. After smoke-free laws are implemented, many states report lower rates of secondhand smoke exposure for nonsmokers.
After smoke-free laws in the state of New York took effect, restaurant and bar employees were exposed to 98 percent less secondhand smoke. A new CDC study found that about 46 percent of nonsmokers had nicotine in their blood in tests from 1999 through 2004. In previous tests during the late 1980s and early 1990s, when few smoking bans were in force, that figure was 84 percent.
State efforts to enact bans often get bogged down in the details of how they would be implemented, proponents of the laws say. This was a factor in Iowa, which passed its statewide smoke-free air laws July 1.
At issue was a provision that allowed outdoor smoking areas, but only for bars and not restaurants. Thus, if a bar were to serve more than prepackaged food, peanuts, popcorn, ice and reheated frozen meals, it would be considered a restaurant that couldn't have outdoor smoking. The provision, after much debate, stayed in the final bill.
"This is a clear case where a state agency is going beyond the scope of the intended legislation," said Iowa bar owner Tom Baldwin on Smoking Lobby's Smoking Ban News.
There's pushback as well from smokers who don't want the government telling them what to do.
"Nobody is telling us we can't sell fried dough boys to children at carnivals anymore," said Sara Lopez, age 25, a self-proclaimed avid smoker from Queens, New York. "And we all know that those are cheap and horrible for cholesterol levels and health. Smoking should be a choice. If it is legal to farm tobacco, it should be legal to smoke it -- especially in restaurants, bars and clubs."
Not only are smoke-free laws hard to get passed, they must be defended once they're in place, said Callaway. "Illinois continues to fight off attempts to weaken their smoke-free law. Ohio has had amendments to weaken their law. It's a constant battle to keep them in place once we get them in place."
But the battle goes on, especially at the city and town level. The coalition Smoke Free Dallas is considering an expansion of the Dallas smoking ban for August. The group is pushing for a smoking ban in all indoor spaces.
"It's definitely the tobacco companies and their allies that interfere, whether they work with bar owners or casinos," Callaway said. "Sometimes the tobacco lobbyists partner with the libertarian-minded entities, who believe it isn't the government's responsibility to restrict these individual business owners."
Not all cigarette companies fight the bans. Philip Morris USA, one of the largest tobacco companies, said it does not interfere with smoke-free air laws, according to a spokesperson for the company.