Smokefree Policies Result in High Levels of Compliance

Exposure to secondhand smoke from burning tobacco products causes disease and premature death among nonsmokers.¹ There is no risk-free level of secondhand smoke, and even brief exposure can cause immediate harm.¹ Establishing a 100% smokefree environment is the only effective way to fully protect nonsmokers from secondhand smoke.¹

National and international studies have shown that comprehensive national, state, and local smokefree laws that prohibit smoking in all indoor areas of workplaces, restaurants, and bars typically result in high levels of compliance.^1-6 Studies have found that comprehensive smokefree laws are easier to enforce and achieve higher levels of compliance than smoking restrictions that contain significant exemptions (e.g., exemptions for designated smoking areas or certain types of restaurants or bars).^1,6

Selected Studies: Domestic

California

A state smokefree law prohibiting smoking in all indoor areas of bars took effect in California in 1998.

A study found that patron compliance with the smokefree law increased significantly over the course of 4 years.²

California	Before Law Took Effect	4 Years After Law Took Effect
Patron compliance with smokefree law in bars	46%	76%

New York

A comprehensive state smokefree law prohibiting smoking in all indoor areas of workplaces, restaurants, and bars in New York took effect in 2003.

A study found high levels of compliance with the law throughout the state (i.e., in bars, restaurants, and other hospitality settings).³

New York	Before Law Took Effect	1 Month After Law Took Effect	6 Months After Law Took Effect	12 Months After Law Took Effect
Proportion of bars, restaurants, and bowling alleys that were smokefree	31%	93%	94%	93%

Separately, inspections conducted in more than 22,000 New York City bars and restaurants within 1 year after the city implemented a comprehensive municipal smokefree law in 2003 found that 97% were smokefree. In other words.⁴

• No patrons or workers were observed smoking.
• No ashtrays were present.
• "No smoking" signs were properly posted.

Selected Studies: International

Ireland

A national comprehensive smokefree law prohibiting smoking in all indoor areas of workplaces, restaurants, and bars took effect in Ireland in 2004.

A telephone survey of Irish adults found a significant decrease in observed smoking in workplaces, restaurants, and pubs within 1 year after the law took effect.⁵

Ireland	Before Law Took Effect	1 Year After Law Took Effect
Adults who observed smoking in workplaces	62%	14%
Adults who observed smoking in restaurants	85%	3%
Adults who observed smoking in pubs	98%	5%

Four European Countries

Ireland and France implemented comprehensive national smokefree laws prohibiting smoking in all indoor areas of workplaces, restaurants, and bars in 2004 and 2008, respectively (with a very narrow exemption for smoking areas in bars in France). The Netherlands implemented a partial national smoking restriction in 2008. Various German states implemented partial smoking restrictions from 2007 through 2008. Among other exemptions, the Dutch and German laws allowed smoking in small bars.

An international telephone and Web survey of adult smokers found declines in the proportion of smokers who reported smoking in bars after these laws took effect.⁶

Four European Countries	Before Law Took Effect	After Law Took Effect
Self-reported smoking in bars:
Ireland (comprehensive national law)	97%	3%
France (comprehensive national law)	84%	3%
The Netherlands (partial national law)	88%	34%
Germany (partial state laws)	87%	44%

References

1. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006 [accessed 2014 May 12].
2. Weber MD, Bagwell DAS, Fielding JE, Glantz SA. Long Term Compliance with California's Smoke-Free Workplace Law Among Bars and Restaurants in Los Angeles County. Tobacco Control 2003;12(3):269–73 [cited 2014 May 12].
3. New York State Department of Health. The Health and Economic Impact of New York's Clean Indoor Air Act. [PDF–377.32 KB] New York: New York State Department of Health, 2006 [accessed 2014 May 12].
4. New York City Department of Finance, New York City Department of Health and Mental Hygiene, New York City Department of Small Business Services, New York City Economic Development Corporation.The State of Smoke-Free New York: A One-Year Review. [PDF–222.32 KB] New York: New York State Department of Health, 2006 [accessed 2014 May 12].
5. Fong GT, Hyland A, Borland R, Hammond D, Hastings G, McNeill A, et al. Reductions in Tobacco Smoke Pollution and Increases in Support for Smoke-Free Public Places Following the Implementation of Comprehensive Smoke-Free Workplace Legislation in the Republic of Ireland: Findings from the ITC Ireland/UK Survey. Tobacco Control 2006;15(Suppl III):iii51–iii58 [cited 2014 May 12].
6. Nagelhout GE, Mons U, Allwright S, Guignard R, Beck F, Fong GT, de Vries H, Willemsen MC. Prevalence and Predictors of Smoking in “Smoke-Free” Bars. Findings from the International Tobacco Control (ITC) Europe Surveys. Social Science & Medicine 2011; 72:1643–51 [cited 2014 May 12].