Trends in comprehensive smoke-free law coverage in the 50 largest U.S. cities: 2000 and 2011

Background: Secondhand smoke exposure causes disease and death in nonsmokers. Only eliminating smoking in indoor spaces fully protects nonsmokers from secondhand smoke. In response to growing evidence on the health effects of secondhand smoke, many communities have adopted local laws restricting smoking in public places and workplaces. Over the past decade, these laws have become more comprehensive, and have increasingly been adopted by large cities and states. To assess trends in secondhand smoke protection, we compared coverage by comprehensive local or state smoke-free laws in the 50 most populous U.S. cities as of December 31, 2000 and December 31, 2011. Methods: We used U.S. Census data to identify the 50 largest U.S. cities at these two points in time. We used data from the American Nonsmokers' Rights Foundation U.S. Tobacco Control Laws Database to identify comprehensive local smoke-free laws and data from the CDC State Tobacco Activities Tracking and Evaluation (STATE) System to identify comprehensive state smoke-free laws. Results: Few of the 50 largest U.S. cities were covered by comprehensive local or state smoke-free laws as of December 31, 2000. By contrast, most of these cities were covered by such laws as of December 31, 2011. However, notable gaps remained in policy coverage, especially in cities in the southern United States. Conclusions: Significant progress has been achieved over the past decade in implementing comprehensive smoke-free laws in the 50 largest U.S. cities. However, the remaining gaps in coverage are likely contributing to disparities in secondhand smoke exposure.