Millions are exposed to secondhand smoke
Despite recent advances in local smokefree laws, Hospitality workers across the state still at risk
On January 1, 2007, all Louisiana workplaces and restaurants became 100% smokefree by state law. This law also fully restored local control, providing local governments the ability to expand smokefree protections in their communities for areas not covered by the state law, such as in bars and casinos.
State law does not preempt local governments from adopting smokefree air laws. Preemption refers to situations in which a law passed by a higher level of government takes precedence over a law passed by a lower one. In such cases, preemptive state laws set a ceiling, rather than a floor, and do not allow local authorities to enact strong local laws.
Louisiana has a unique cultural heritage
• 61% of Americans enjoy comprehensive smokefree protections in all public places and workplaces, including restaurants and bars. In contrast, in Louisiana only 27.8% of the population is protected by this type of smokefree law. 
• Louisiana is 1 of 10 "Most Challenged” states based on health outcomes according to the United Health Foundation’s “America’s Health Rankings Annual Report,” ranking 50th out of 50. 
• Over 87% of the state's casino workers are not protected.
• 98,000 Louisianans currently under the age of 18 are projected to die of tobacco related disease. 
• Healthcare costs attributed to tobacco use in Louisiana amount to $1.9 billion annually. 
• Despite challenges, encouraging trends and developing strategies can help close the gaps in protections.
Bar and Gaming Hospitality staff are exposed to secondhand smoke
Current landscape of Smokefree Protections
Louisiana is trending in the right direction. Since 2012, a significant number of municipalities have passed local ordinances to include all workplaces, restaurants, bars, and gaming facilities. New Orleans and Baton Rouge/East Baton Rouge Parish (a consolidated governing body) are two of the largest population centers to include provisions for smokefree gaming. Baton Rouge/East Baton Rouge Parish implemented its law on June 1, 2018, and the percentage of the Louisiana population protected by a smokefree law increased to 27.8%. Notably, the percentage of the African American population protected in the state increased from 27.5% to 41.3%, significantly increasing the protection of this community. Baton Rouge is the second city in the state to include casinos in the smokefree law, setting a precedent for other municipalities in the region.
Who is Left Behind?
Only 22 of the 303 cities in Louisiana have adopted a 100% smokefree workplace, restaurant, and bar law to extend the partial protections provided by the 2017 statewide smokefree law. As a result, over 73% of Louisiana’s residents are still exposed to secondhand smoke in their workplace. Louisiana’s hospitality industry employs more than 238,700 individuals . There are also 20 casinos located in 10 Louisiana cities employing 19,707 people . Of these, in riverboat casinos, 8,569 people are minorities and 7,872 are women. 
Only New Orleans’ and Baton Rouge’s employees work in smokefree casinos, leaving at least 85% of casino workers in the state exposed to secondhand smoke. Considering Louisiana has one of the nation’s highest poverty rates, highest uninsured rates, and unemployment above the national average, the urgency for improving the social determinants of health – including healthy workplaces – are more important than ever.
Those most likely to be exposed to secondhand smoke work in the hospitality industry and are more likely to identify as a racial minority.
Annual health care costs in the state directly caused by tobacco use are $1.9 billion ($803 million of which are Medicaid expenditures).
Secondhand smoke exposure causes heart disease, stroke, and lung cancer among adults, as well as respiratory disease, ear infections, sudden infant death syndrome, more severe and frequent asthma attacks, and slowed lung growth in children. [4,11]
Smokefree laws help to reduce adult smoking prevalence and prevent youth and young adult smoking initiation. [4,11]
Entertainers are Exposed to Secondhand Smoke
Poor Health Outcomes and high costs
Tobacco use is the leading preventable cause of death in the United States. More than 480,000 people die from smoking or exposure to secondhand smoke each year. 
Louisiana’s smoking rate among adults is 23.1% and 12.3% for high school students, compared to national rates of 14% and 8%, respectively.  Tobacco exacts a high toll in Louisiana: 7,210 Louisianans die each year of tobacco-related illness. At current trends, 98,000 kids now under the age of 18 in Louisiana are projected to die prematurely from tobacco-related illness. 
Beyond secondhand smoke exposure, nonsmokers exposed to thirdhand smoke in a casino are at an ever higher risk than those in a thirdhand smoke-polluted home.  Further, hospitality workers and children are susceptible to thirdhand smoke exposure, as the particles cling to hair, clothing and cars. Young children are particularly vulnerable, because they can ingest tobacco residue by putting their hands in their mouths after touching contaminated surfaces. 
New Potential Challenge: Secondhand Marijuana Smoke
The Louisiana legislature legalized medical marijuana in 2015. Secondhand marijuana smoke is a health hazard for nonsmokers. Just like secondhand tobacco smoke, marijuana smoke is a potent source of PM 2.5 fine particulate matter. Marijuana secondhand smoke impacts cardiovascular function; it contains thousands of chemicals and at least 33 carcinogens.
Public health advocates are fighting for health equity, and this requires an investment of time and money.
Change doesn’t happen overnight, and partners must be committed to building relationships, identifying needs, and investing in activities and resources that will close the gaps. Collaborative efforts in Louisiana have a track record of including and mobilizing community-based partners who represent those individuals left unprotected by the current state law. Indeed, these community-based partners are key to achieving success. Funds for tobacco prevention, education, training, and cessation resources are necessary to better address disparities in smoking and exposure to secondhand smoke. The cost of prevention would be significantly less than the $1.22 billion currently being spent to address annual tobacco-use related health care costs in Louisiana, thus representing a savings to the state. 
When smoking is allowed in indoor areas of casinos, millions of nonsmoking casino visitors and hundreds of thousands of employees can be involuntarily exposed to secondhand smoke and related toxicants. 
—Office on Smoking and Health, Centers for Disease Control and Prevention
A recent study found that 75% of U.S. adults who visit casinos favor smokefree casinos.
No prior studies have exclusively assessed adult attitudes toward smokefree casinos in the United States.
This study found very high favorability among those age >64 (81.6 %), college educated (81.7%), and higher income (79.1/80.8%). Smokers made up 13% of the sample, and, of those smokers, nearly half (45%) supported smokefree casinos. 
Strategies to Close Gaps & Increase Health Equity
focus on smokeree
plan for a statewide smokefree law
Include E-cigarettes in smokefree laws
Beware of Marijuana Industry Opposition
invest in the future
Focus on smokefree policies: Other competing issues can distract from and delay work on smokefree policies. Smokefree laws have immediate and long-term health and economic benefits, and they are worth the investment of time and effort to protect everyone from exposure to a known human carcinogen. 
Let local lead the way: Since Louisiana municipalities have the authority to adopt local laws, communities should focus on passing strong local laws covering all workplaces, including bars and gambling facilities. Local control and increasing civic engagement is at the heart of our broader goal of educating the public about the health effects caused by secondhand smoke and changing attitudes regarding smoking in ways that harm other people.
Plan for a statewide smokefree law: The Louisiana Legislature considered a statewide smokefree workplace law in the 2018 legislative session. Now that a large number of cities in the state are 100% smokefree, including two cities that have casinos, the state is primed to move toward strengthening smokefree provisions at the state level. The casino industry will likely be a strong opponent; however, there is strong public support for going smokefree. Education of key stakeholders, including policy makers, casino management, and others in the business community, is critical to build understanding and to increase the political will for going smokefree so that all Louisianans can breathe clean, healthy smokefree air.
Electronic cigarettes (e-cigarettes), marijuana, and hookah should be included in smokefree laws: Smokefree laws should also prohibit the use of e-cigarettes, marijuana, and hookah to prevent secondhand smoke exposure to the toxins, carcinogens, fine particles, and volatile organic compounds that have been found to compromise respiratory and cardiovascular health. [13,14] Thirteen of the 22 strong smokefree laws in Louisiana include strong restrictions on e-cigarettes. 
Beware of opposition from cannabis/marijuana proponents: The Louisiana legislature legalized medical marijuana in 2015, but dispensaries will not open until 2019. States that legalize medical marijuana typically go on to legalize recreational, adult use marijuana after a few years. Marijuana smoke is also a form of indoor air pollution and a hazard to nonsmokers’ health. In order for indoor workplaces and public spaces to truly be safe and healthy environments, tobacco and marijuana smoke, along with secondhand e-cigarette aerosol/vapor should be prohibited.
Invest in the future by increasing funding and resources: In order to address the gaps in smokefree coverage, a great deal of effort and financial resources will be needed to explain the ongoing disparities in smokefree protections and the benefits of 100% smokefree environments, as well as to counter misinformation about the ability of ventilation systems to protect people from secondhand smoke exposure.
Thwart preemptive efforts: In an effort to curtail the growing success of local laws throughout the state, the gaming industry has expressed its intentions to push preemptive legislation at the state capitol. Preemptive laws typically contain a few very weak provisions and prevent further progress at the local level where stronger laws are more likely to pass.
The American Nonsmokers’ Rights Foundation is dedicated to improving community health and increasing health equity by ensuring that everyone is protected by a 100% smokefree law. We provide training, technical assistance, and tobacco policy surveillance data for civic engagement to improve community health.
Sources of Data:
1. “U.S. Environmental Protection Agency, Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders,” EPA/600/6-90/006F, December 1992.
2. American Nonsmokers’ Rights Foundation. U.S. Tobacco Control Laws Database. Berkeley, CA, 2019.
3. United Health Foundation. (2018). America’s Health Rankings Annual Report.
4. US Department of Health and Human Services. The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.
5. Centers for Disease Control and Prevention. (n.d.). State Highlights: Louisiana [from State Tobacco Activities Tracking and Evaluation System].
6. Louisiana Workforce Commission. Louisiana Workforce at a Glance: Data for January 2019. March 2019.
7. American Gaming Association. State of the States: The AGA Survey of the Casino Industry, September 2018.
8. Louisiana Gaming Control Board. 22nd Annual Report to the Louisiana State Legislature. 2018.
9. Matt, Dr. Georg (2018). Smoking Bans May Not Rid Casinos of Smoke. US News and World Report.
10. Matt, G E, Quintana PJ E, Hovell MF et. al. (2004). Households contaminated by environmental tobacco smoke: sources of infant exposures. British Medical Journal: Tobacco Control.
11. US Department of Health and Human Services. Preventing tobacco use among youth and young adults. A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2012.
12. Michael A. Tynan, BA1 ; Teresa W. Wang, PhD1; Kristy L. Marynak, MPP1; Pamela Lemos, MS1; and Stephen D. Babb, MPH1, Attitudes Toward Smoke-Free Casino Policies Among US Adults, Centers for Disease Control and Prevention Office on Smoking and Health, Public Health Reports, 2017 [accessed 2019 Mar 21].
13. Grana, R; Benowitz, N; Glantz, S. “Background Paper on E-cigarettes,” Center for Tobacco Control Research and Education, University of California, San Francisco and WHO Collaborating Center on Tobacco Control. December 2013.
14. Williams, M.; Villarreal, A.; Bozhilov, K.; Lin, S.; Talbot, P., “Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol,” PLoS ONE 8(3): e57987, March 20, 2013.
Huang, J., King, B.A., Babb, S.D., Xu, X., Hallett, C., Hopkins, M. (2015). Socio-demographic disparities in local smoke-free law coverage in 10 states. American Journal of Public Health, 105(9), 1806–1813.
Tynan, M.A., Baker Holmes, C., Promoff, G., Hallett, C., Hopkins, M., & Frick, B. (2016). State and local comprehensive smoke-free laws for worksites, restaurants, and bars — United States, 2015. Morbidity and Mortality Weekly Report, 65(24), 623-626.
[n.a.], "Tobacco industry interference with tobacco control," Geneva: World Health Organization (WHO), 2008.
NCI Monograph 17: Evaluating ASSIST – A Blueprint for Understanding State-level Tobacco Control Evaluation of American Stop Smoking Intervention Study for Cancer Prevention Chapter 8, Evaluating Tobacco Industry Tactics as a Counterforce to ASSIST (October 2006).