State Smokefree Air Laws Methodology

The U.S Surgeon General, in a seminal 2006 report on the health effects of secondhand smoke and re-affirmed in subsequent reports in 2010 and 2014, has concluded that secondhand smoke is a serious health hazard causing or making worse a wide range of diseases and conditions. It also concluded that there is no risk-free level of exposure to secondhand smoke and that the only way to fully eliminate exposure to secondhand smoke in indoor environments is to completely prohibit smoking. Secondhand marijuana smoke contains many of the same toxins and carcinogens found in directly-inhaled cigarette smoke, in similar amounts if not more. A 2016 Surgeon General report on youth e-cigarette use found that secondhand e-cigarette aerosol is not harmless and contains harmful and potentially harmful chemicals.  

For “State of Tobacco Control” 2024, the Lung Association has revamped the scoring system for the Smokefree Air category to a grading system based on the strength of a state’s law restricting smoking in public places and workplaces from a points-based system that had awarded a set number of points across multiple categories. An “A” grade indicates that a state has a comprehensive law prohibiting smoking and vaping of tobacco and cannabis/marijuana in virtually all public places and workplaces with only small exceptions. Grades are lowered based on the type of exemptions present in a state’s law(s). 

Grades break down as follows: 

A = All public places and workplaces, including restaurants, bars and casinos are smokefree & e-cigarettes/marijuana are completely included in state smokefree law; 

B = Broad small workplace exemptions i.e. for businesses with three or fewer employees; stand-alone bar/establishments under age 21 or casino or other gaming establishment exemptions; e-cigarettes excluded from smokefree law or use only prohibited in select public places such as schools; and/or marijuana hospitality establishment smokefree exemptions where the service of food, drink or live entertainment are present in state law; 

C = Two or more exemptions for small workplaces, casino/other gaming establishments or bar/establishments under 21 are present in state law; 

D = Restaurants/bars are smokefree, but other public places/workplaces are either completely exempted or have designated smoking areas in state law;  

F = any restrictions on smoking in public places and workplaces that are weaker than grades A through D above. 

There are two situations that create exceptions to the grading system: 

Preemption or Local opt-out: State preemption of stricter local ordinances or states that have a provision in state law allowing communities to opt-out of the law is penalized by a reduction of one letter grade. 

Local Ordinances: States with statewide laws that do not earn “A” grades may be graded based on local smokefree ordinances or regulations instead. Strong local smokefree air ordinances/regulations that include workplaces, restaurants and bars are considered according to the percentage of population covered in the state. States with over 95% of their population covered by comprehensive local smokefree ordinances will receive an “A,” over 80% a “B,” over 65% a “C” and over 50% a “D.” Local ordinances that cover less than 50% of the population will not be considered for evaluation under this exception.i  

Limitations of the grading system: Many states that receive A grades in “State of Tobacco Control” do have small, specialized exemptions where smoking is still allowed such as for cigar/tobacco/hookah bars, certain percentages or all hotel/motel rooms and/or tobacco/e-cigarette retail stores. The Lung Association opposes virtually all exemptions to smokefree workplace laws and urges state lawmakers to close these loopholes regardless of the grade they receive.