STATE System Gaming Facilities Fact Sheet Smokefree Indoor Air Laws in Nontribal Gaming Facilities in Effect As of September 30, 2018 (N=58)

The STATE System is an interactive application that presents current and historical state-level data on tobacco use prevention and control.

CDC.gov/STATESystem STATE System Gaming Facilities Fact Sheet Smokefree Indoor Air Laws in Nontribal Gaming Facilities In effect as of September 30, 2018 (n=58)

Guam Covered gaming not allowed (n=18)

No smokefree laws in allowed gaming facilities (n=18) Less than 100% smokefree laws in allowed gaming U.S. Virgin Islands Puerto Rico facilities (n=9) Alaska Hawaii 100% smokefree laws in all allowed gaming facilities (n=13)

American Samoa Northern Mariana Islands Marshall Islands Palau Covered gaming facilities for STATE System purposes are casinos, racinos, or commercial bingo halls.

Background During the past 25 years, the commercial casino industry has grown from casinos in two places—Atlantic City, New Jersey, and the state of Nevada—to 513 casinos in 23 states.1 In 2012, casinos earned $37.34 billion in gross revenue.1 As the industry grows, allowing smoking in casinos presents a challenge for tobacco prevention and control efforts because of increased secondhand smoke exposure for both patrons and casino workers. In 2012, commercial casinos employed 336,272 people.1 The level of smoking in a casino can be especially high compared with other enclosed public places where smoking is permitted.2 For example, one study revealed that 50% of the casinos sampled had air pollution levels known to cause cardiovascular disease after only 2 hours of exposure.2 The levels of fine particle air pollution found inside a casino were four to six times that of outside air, even in a well-ventilated casino.3

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STATE System: CDC.gov/STATESystem OSHData: CDC.gov/OSHData Office on Smoking and Health: CDC.gov/Tobacco

November 2018 | CS298844-C Page 1 of 4 U–13.5 T is allowed during a work shift.8 By the nature of their work,

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Communities that enact comprehensive smokefree laws

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1 c s D c admissions compared with communities without such C o e t 15 i A 5 laws. Smokefree laws and policies have a high level of s c l : i t v i i t , v n public support and compliance, and research has shown i Tobacco Use n t e o i i e e t that smokefree laws and policies do not negatively affect s g a T : 16,17 r r m sales or employment in the hospitality industry. Scientific a r c 2 o k a f n evidence has demonstrated that statewide smokefree in T i g 5 e r an o policies are also effective, high-impact strategies for helping d m E or smokers quit and reducing tobacco consumption by those va : 8 F lu 2 P. 17 at PH who smoke. ion CD Sys /NC tem (STATE), CDC Establish laws in States and the District of Types of Gaming Facilities Columbia on smokefree indoor air that The Centers for Disease Control and Prevention’s State Tobacco Activities Tracking and Evaluation (STATE) System prohibit smoking in gaming halls tracks three types of gaming facilities—casinos, racinos (or racetrack casinos), and bingo halls. The STATE System does not cover gaming on Native American reservation lands, nor does it include slots-only or card room only facilities, In the United States, approximately 58 million nonsmokers though they may market themselves as casinos and racinos. are still exposed to secondhand smoke.4 Secondhand smoke Finally, the STATE System does not track smoking restrictions increases the risk of heart attacks, heart disease, stroke, lung in facilities where wagers are placed against odds or cancer, and other cancers by up to 30% among nonsmoking together in a pool sometimes referred to as sports or legal adults.5,6,7 According to the US Surgeon General, no amount bookmaking or off-track betting (OTB) facilities. of exposure to secondhand smoke is safe and the only way to fully protect nonsmokers from secondhand smoke is through 100% smokefree indoor air environments.6 Casinos Even brief exposure to secondhand smoke could trigger A casino is usually characterized by the offering of banked 5 a heart attack. games. Banked games are those in which the house is Smokefree policies are the most effective way to provide funding the game and essentially acting as a participant, protection from exposure to secondhand smoke.8 which means that the casino has a stake in who wins.14 According to the Surgeon General, separating smokers from Commercial casino gaming comes in a variety of forms. nonsmokers, cleaning the air, and ventilating buildings are The most recognizable form consists of what are called not effective protections against secondhand smoke.3,6 In “Las Vegas-style” casinos. Other commercial gaming venues some cases, casinos have been exempted from smokefree include excursion (mobile) and dockside (permanently indoor air laws. Such examples exist in Iowa (on the gaming moored) riverboats. Players gamble by playing games floors),9 Kansas,10 Michigan (in the gaming areas),11 New of chance, such as craps, roulette, baccarat, blackjack, Jersey,12 and New Mexico,13 among others. Even in ventilated and poker. Most of these games have odds that are casinos, nicotine levels in casino workers are 300%–600% mathematically determined to ensure that the casino has higher than employees in other workplaces where smoking an overall advantage over the players at all times.

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STATE System: CDC.gov/STATESystem OSHData: CDC.gov/OSHData Office on Smoking and Health: CDC.gov/Tobacco

Page 2 of 4 Smokefree Indoor Air—Casinos, Racinos Racetrack Casinos, and Bingo Halls Racinos, or racetrack casinos, are classified by the STATE In effect as of September 30, 3018 (n=58) System as full casinos attached to horse or dog racing tracks or parks. Slots-only facilities, such as those in Location Casinos Racetrack Casinos Bingo Halls Ohio and Maryland are not included as racinos for STATE Alabama No Such Gaming No Such Gaming No Such Gaming System coding purposes. Alaska No Such Gaming No Such Gaming No Provision American Samoa No Provision No Provision No Provision Bingo Facilities Arizona No Such Gaming No Such Gaming No Such Gaming Arkansas No Such Gaming Designated Areas No Such Gaming Bingo is a game of chance in which each player has California No Such Gaming No Such Gaming No Such Gaming one or more cards printed with differently numbered Colorado Banned No Such Gaming Banned squares. Players place markers on these squares when the respective numbers are drawn and announced by a Connecticut No Such Gaming No Such Gaming No Such Gaming caller. The first player to mark a complete pattern (e.g., Delaware No Such Gaming Banned No Such Gaming a row) of numbers wins. For STATE System tracking District of Columbia No Such Gaming No Such Gaming No Provision purposes, this includes bingo facilities that are rented Florida No Such Gaming Banned No Such Gaming out for commercial use, or for-profit bingo facilities, but Georgia No Such Gaming No Such Gaming No Such Gaming not private, social, charitable, or fraternal games held at Guam No Such Gaming No Such Gaming No Such Gaming private clubs. Hawaii No Such Gaming No Such Gaming No Such Gaming Idaho No Such Gaming No Such Gaming No Such Gaming Illinois Banned No Such Gaming Banned Coding Glossary Indiana None None No Such Gaming No Such Gaming: This type of gaming is not permitted Iowa Designated Areas Designated Areas Banned under state law, or is only authorized on tribal land. Kansas None No Such Gaming No Such Gaming Kentucky No Such Gaming No Provision No Such Gaming Banned: Smoking is prohibited in all areas of a gaming Louisiana Designated Areas Designated Areas Designated Areas facility. Maine Banned Designated Areas None Designated Areas: Smoking is permitted within certain Marshall Islands No Provision No Provision No Provision designated parts of a gaming facility. Maryland Banned Banned No Such Gaming Separate Ventilated Areas: Smoking is permitted Massachusetts Banned Banned Banned within certain designated parts of a gaming facility Michigan Designated Areas No Such Gaming No Such Gaming that have completely separate air systems designed to Minnesota No Such Gaming No Such Gaming No Provision minimize infiltration of secondhand smoke into other Mississippi No Provision No Such Gaming No Such Gaming portions of a gaming facility. Missouri No Provision No Such Gaming No Such Gaming Montana No Such Gaming No Such Gaming No Provision No Provision: There is no language in the law that Nebraska No Such Gaming No Such Gaming No Such Gaming requires any restrictions on smoking in gaming facility. Nevada None No Such Gaming No Provision None: Smoking is permitted in gaming facilities without New Hampshire No Such Gaming No Such Gaming No Provision restriction. New Jersey None No Such Gaming No Provision New Mexico None No Provision None Future Implications for State Efforts to New York Banned Banned Banned North Carolina No Such Gaming No Such Gaming No Such Gaming Restrict Smoking in Gaming Facilities North Dakota No Such Gaming No Such Gaming Banned Measuring the effects of smokefree gaming policies Northern Mariana Islands No Provision No Provision No Provision is a unique challenge because not all states allow Ohio Banned No Such Gaming No Such Gaming any or all types of gaming. However, Healthy People Oklahoma No Such Gaming Separate Ventilated Areas None 2020 objectives call for all 50 states and the District Oregon No Such Gaming No Such Gaming No Provision of Columbia to establish smokefree laws to prohibit Palau No Provision No Provision No Provision smoking in gaming halls.18 As of September 30, 2018, Pennsylvania Designated Areas Designated Areas No Such Gaming 29 states, the District of Columbia and Guam do not Puerto Rico Banned Banned No Such Gaming allow for casinos to operate, 34 states, the District of Rhode Island No Such Gaming Separate Ventilated Areas Banned Columbia, Guam, and the U.S. Virgin Islands do not allow South Carolina No Such Gaming No Such Gaming No Such Gaming for racetrack casinos, and 31 states, Guam, Puerto Rico South Dakota Banned No Such Gaming No Such Gaming and the U.S. Virgin Islands do not allow for commercial Tennessee No Such Gaming No Such Gaming No Such Gaming bingo facilities. Of the 22 states and U.S. territories Texas No Such Gaming No Such Gaming No Such Gaming that allow casino gambling—4 states (Iowa, Louisiana, U.S. Virgin Isalnds Banned No Such Gaming No Such Gaming Michigan, Pennsylvania) allow for designated smoking Utah No Such Gaming No Such Gaming No Such Gaming areas, whereas only 9 states (Colorado, Illinois, Maine, Vermont No Such Gaming No Such Gaming No Such Gaming Maryland, Massachusetts, New York, Ohio, South Dakota, Virginia No Such Gaming No Such Gaming No Such Gaming Washington), Puerto Rico and the U.S. Virgin Islands Washington Banned No Such Gaming No Such Gaming require them to be smokefree. Of the 16 states and West Virginia No Provision No Provision Designated Areas Wisconsin No Such Gaming No Such Gaming No Such Gaming Page 3 of 4 Wyoming No Such Gaming No Such Gaming No Such Gaming CDC’s Office on Smoking and Health’s Interactive 5. National Academy of Sciences: Institutes of Medicine: Data Dissemination Tool Committee on Secondhand Smoke Exposure and Acute Coronary Events. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. OSHData presents comprehensive tobacco prevention Washington, DC: The National Academies; 2009. and control data in an online, easy to use, interactive 6. Centers for Disease Control and Prevention. The Health data application. Consequences of Smoking—50 Years of Progress: A Report of the Download the entire dataset from OSHData. Surgeon General. Atlanta, GA: US Dept of Health and Human Services; 2014. 7. Meyers DG, Neuberger JS, He J. Cardiovascular effect of bans on smoking in public places: a systematic review and meta- analysis. J Am Coll Cardiol. 2009;54;1249–1255. U.S. territories that allow racetrack casinos—5 states 8. Trout D, Decker J, Mueller C; Bernert JT, Pirkle J. Exposure of (Delaware, Florida, Maryland, Massachusetts, New York) casino employees to environmental tobacco smoke. J Occup and Puerto Rico offer smokefree gaming, whereas Environ Med. 1998;40(3):270–276. 2 states (Oklahoma, Rhode Island) offer separately 9. Iowa Code §142D.4 (2013). ventilated areas, and 5 states (Arkansas, Iowa, Louisiana, 10. K.S.A §21–6110. Maine, Pennsylvania) allow designated smoking areas. 11. MCLS §333.12606b. Of the 20 states that allow bingo facilities to operate— 12. N.J. Stat. §26:3D–59. 7 states (Colorado, Illinois, Iowa, Massachusetts, New York, North Dakota, Rhode Island) are smokefree, 13. N.M. Stat. Ann. §24-16–12. whereas 2 states (Louisiana, West Virginia) allow 14. Cochran C, Henriques D, York N, Lee K. Risk of exposure to designated smoking areas. These statistics show that less secondhand smoke for adolescents in Las Vegas casinos: an evaluation of the Nevada Clean Indoor Air Act. J Health Hum than 50% of the employees and patrons of these types Serv Adm. 2012;35:231–252. of gaming facilities are protected by state smokefree 15. Lightwood JM, Glantz SA. Declines in acute myocardial legislation. Local and state governments are responsible infarction after smokefree laws and individual risk attributable for deciding whether it is appropriate to address this to secondhand smoke. Circulation. 2009;120(14):1373–1379. problem through governmental action. Epub 2009 Sep 21. 16. Eriksen M, Chaloupka F. The economic impact of clean indoor References: air laws. CA Cancer J Clin. 2007;57:367–378. 1. American Gaming Association. 2013 State of the States: 17. Centers for Disease Control and Prevention. Tobacco Control The AGA Survey of Casino Entertainment. http://www. State Highlights 2012. Atlanta, GA: US Dept of Health and americangaming.org/sites/default/files/uploads/docs/aga_ Human Services; 2013. sos2013_fnl.pdf. Accessed on February 10, 2015 18. US Department of Health and Human Services. Healthy 2. Repace J. Secondhand smoke in Pennsylvania casinos: a People 2020. http://www.healthypeople.gov/2020/ study of nonsmokers’ exposure, dose, and risk. Am J Public topicsobjectives2020/objectiveslist.aspx?topicId=41. Accessed Health. 2009;99:1478–1485. July 28, 2015. 3. American Society of Heating, Refrigerating, and Air 19. Healthy People 2020 [Internet]. Washington, DC: U.S. Conditioning Engineers, Inc (ASHRAE). Position Paper: Department of Health and Human Services, Office of Disease Environmental Tobacco Smoke. Atlanta, GA: ASHRAE; 2005. Prevention and Health Promotion. Accessed September 15, 2015. Available from: http://www.cdc.gov/tobacco/basic_ 4. CDC. Vital Signs: Disparities in nonsmokers’ exposure to information/healthy_people/index.htm. secondhand smoke — United States, 1999–2012. MMWR Morb Mortal Wkly Rep. 2015;64(04):103–108.

The STATE System contains data synthesized from state-level statutory laws. It does not contain state-level regulations; measures implemented by counties, cities, or other localities; opinions of Attorneys General; or relevant case law decisions for tobacco control topics other than preemption; all of which may vary significantly from the laws reported in the database, fact sheets, and publications.

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STATE System: CDC.gov/STATESystem OSHData: CDC.gov/OSHData Office on Smoking and Health: CDC.gov/Tobacco

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