Background
Although cigarette smoking is decreasing in the U.S., hookah tobacco smoking (HTS) is an emerging trend associated with substantial toxicant exposures. The purpose of this study was to assess how a representative sample of U.S. tobacco control policies may apply to HTS.
Methods
We examined municipal, county, and state legal texts that apply to the largest 100 cities in the U.S. We developed a summary policy variable that distinguishes cities without clean air legislation preventing cigarette or HTS in freestanding bars; with anti-smoking legislation exempting HTS by name; with anti-smoking legislation providing for a different exemption under which HTS may fall; and with anti-smoking legislation and no clear exemption governing HTS. We used multinomial logistic regression to determine associations between community-level socio-demographic variables and our policy outcome variable.
Results
Although 73 of the 100 largest cities in the U.S. have laws that disallow cigarette smoking in bars, HTS may be allowed due to exemptions in 69 of these 73 cities. While 4 of these cities have passed legislation specifically exempting HTS, 65 may permit HTS via generic tobacco retail establishment exemptions. Compared with cities without clean air legislation, the cities in which HTS may be exempted had denser populations.
Conclusions
Although three-fourths of the largest cities in the U.S. disallow cigarette smoking in bars, HTS may be permitted in nearly 90% of these cities via exemptions. Closing this gap in clean air regulation may significantly reduce exposure to HTS.
Eleven US states and Washington, DC, legalized recreational (adult use) cannabis. Seven states—Alaska, California, Colorado, Massachusetts, Nevada, Oregon, and Washington—allow cannabis sales. A public health concern is that exemptions in state or local smoke-free laws for public cannabis smoking or vaping will weaken smoke-free laws, expose the public to secondhand cannabis, and renormalize smoking. We describe the experience of the seven states and challenges faced in maintaining smoke-free laws. Using elements of a tobacco control framework, we identify best practices in cannabis regulation by comparing each state’s smoke-free laws and allowances for public cannabis use. All states prohibit public cannabis use; two lack 100% smoke-free protections; one lacks vaping devices in its smoke-free law; three allow cannabis use in retailers; two allow cannabis use in social consumption lounges; and two allow cannabis use in tourism venues. States should close gaps in smoke-free laws and not expand where cannabis use is permitted to ensure public health.
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