Smoke-free policies for outdoor areas

Outdoor smoke-free policies include private sector rules and public sector regulations that prohibit smoking outside or restrict it to designated areas. Private sector policies generally ban smoking on worksite property, while state and local ordinances often establish smoke-free standards for specified outdoor public areas such as parks and beaches (CG-Tobacco use). Some local governments cannot enact such measures due to state preemption legislation (Grassroots Change).

Expected Beneficial Outcomes (Rated)

  • Reduced smoking in outdoor spaces

Other Potential Beneficial Outcomes

  • Reduced youth smoking

  • Reduced tobacco consumption

  • Increased quit rates

  • Reduced exposure to secondhand smoke

  • Improved health outcomes

Evidence of Effectiveness

There is some evidence that outdoor smoke-free policies reduce smoking in designated areas (, Okoli 2013, ), especially when implemented as part of comprehensive smoke-free efforts that ban both indoor and outdoor smoking (, ). Banning smoking in public places, including parks, is a recommended strategy to prevent tobacco use among youth (US DHHS SG Tobacco 2012). However, additional evidence is needed to confirm effects, particularly on health outcomes (CG-Tobacco use).

Policies that restrict smoking at parks and beaches appear to reduce smoking in those areas (, Okoli 2013). Comprehensive campus smoking bans which include all outdoor areas appear to reduce smoking among college students on campus within one to three years, and may also decrease their daily cigarette consumption (). An assessment of a large insurance company’s indoor and outdoor smoke-free worksite policy indicates increased quit rates and reduced relapses among tobacco dependence treatment program participants, and decreased daily cigarette consumption among participants who did not quit ().

Comprehensive smoke-free policies can reduce secondhand smoke (SHS) exposure more than weaker policies or policies targeted at specific industries (CG-Tobacco use), and comprehensive smoking bans may decrease myocardial infarction (Lin 2013, ). Smoke-free policies that primarily affect indoor areas have been shown to improve health, reduce cigarette consumption and SHS exposure, and may also reduce smoking prevalence and lead smokers to quit (Hoffman 2015, CG-Tobacco use). Smoking in outdoor smoking areas adjacent to indoor smoke-free areas appears to increase SHS concentrations in both areas (Sureda 2013).

National surveys indicate that a majority of non-smokers and smokers support outdoor smoke-free policies for schools and playgrounds (). However, such policies are in place in only 8% of the country, primarily in higher income areas (Lowrie 2018). Smoke-free park policies are most common in counties with higher socio-economic status residents and in urban and suburban counties ().

Evaluations of efforts to implement smoke-free recreation areas in California suggest having a project champion, engaging youth volunteers, collecting and using local data, and educating the community on smoke-free policies can help lead to successful adoption (Satterlund 2011).

Impact on Disparities

No impact on disparities likely

Implementation Examples

As of 2018, 28 states and Washington DC have comprehensive smoke-free laws that ban smoking in all public places and workplaces (ALA-Smoke-free air, ALA-SLATI-SF policies). As of 2017, 1,531 municipalities and counties have banned smoking in parks, 535 in outdoor transit waiting areas, 489 on outdoor dining and bar patios, and 317 have beaches that are completely smoke-free (ANRF-Smoke-free lists). State legislation pre-empts local government control of smoke-free policies in 12 states (Grassroots Change).

As of 2018, there are 2,279 smoke-free university campuses, of which 1,910 are 100% tobacco-free (ANRF-Smoke-free lists).

Implementation Resources

ChangeLab-SF work & outdoors - ChangeLab Solutions. Smokefree workplaces and outdoor areas.

HealthPartners-CHA - HealthPartners Institute for Education and Research. Community health advisor (CHA): Resource for information on the benefits of evidence-based policies and programs: Helping communities understand, analyze, and model costs.

CDC SF Toolkit - Loomis B. Evaluation toolkit for smoke-free policies. Atlanta: Centers for Disease Control and Prevention (CDC); 2008.

PHLP-SF outdoor areas - Public Health Law & Policy (PHLP). Smokefree outdoor areas ordinance: A model California ordinance regulating smoking in outdoor areas (with annotations). 2011.

PHLP-SF recreational areas - Public Health Law & Policy (PHLP). Smokefree recreational areas ordinance: A model California ordinance regulating smoking and tobacco product use in recreational areas (with annotations). 2010.

PHLC-Smoke-free outdoors - Tobacco Control Legal Consortium (TCLC). Smoke-free & tobacco-free places: Outdoors. Saint Paul: Public Health Law Center (PHLC).

ALA-Smoke-free air - American Lung Association. Smokefree air laws. 2018.

ANRF-Smoke-free lists - American Nonsmokers’ Rights Foundation. Smokefree lists and maps. 2018.

Citations - Evidence

* Journal subscription may be required for access.

CG-Tobacco use - The Guide to Community Preventive Services (The Community Guide). Tobacco.

Lin 2013 - Lin H, Wang H, Wu W, et al. The effects of smoke-free legislation on acute myocardial infarction: A systematic review and meta-analysis. BMC Public Health. 2013;13:529.

Bruintjes 2011* - Bruintjes G, Bartelson BB, Hurst P, et al. Reduction in acute myocardial infarction hospitalization after implementation of a smoking ordinance. The American Journal of Medicine. 2011;124(7):647-54.

US DHHS SG Tobacco 2012 - US Department of Health and Human Services (US DHHS). A report of the Surgeon General: Preventing tobacco use among youth and young adults; 2012.

Hoffman 2015 - Hoffman SJ, Tan C. Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health. 2015;15:744.

Hood 2014* - Hood NE, Bernat DH, Ferketich AK, Danesh D, Klein EG. Community characteristics associated with smokefree park policies in the United States. Nicotine & Tobacco Research. 2014;16(6):828-835.

Johns 2013* - Johns M, Coady MH, Chan CA, et al. Evaluating New York City's smoke-free parks and beaches law: A critical multiplist approach to assessing behavioral impact. American Journal of Community Psychology. 2013;1(1-2):254-263.

Johns 2015* - Johns M, Farley SM, Rajulu DT, Kansagra SM, Juster HR. Smoke-free parks and beaches: an interrupted time-series study of behavioural impact in New York City. Tobacco Control. 2015;24:497-500.

Lemstra 2008* - Lemstra M. Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique. 2008;101(6):445-447.

Lupton 2015* - Lupton RJ, Townsend LJ. A systematic review and meta-analysis of the acceptability and effectiveness of university smoke-free policies. Journal of American College Health. 2015;63(4):238-247.

Okoli 2013 - Okoli C, Johnson A, Pederson A, Adkins S, Rice W. Changes in smoking behaviours following a smokefree legislation in parks and on beaches: An observational study. BMJ Open. 2013;3(6):1-7.

Osinubi 2004* - Osinubi O, Sinha S, Rovner E, et al. Efficacy of tobacco dependence treatment in the context of a 'smoke-free grounds' worksite policy: A case study. American Journal of Industrial Medicine. 2004;46:180-187.

Satterlund 2011 - Satterlund TD, Cassady D, Treiber J, Lemp C. Strategies implemented by 20 local tobacco control agencies to promote smoke-free recreation areas, California, 2004-2007. Preventing Chronic Disease. 2011;8(5):A111.

Sureda 2013 - Sureda X, Fernandez E, Lopez MJ, Nebot M. Secondhand tobacco smoke exposure in open and semi-open settings: a systematic review. Environmental Health Perspectives. 2013;121(7):766-773.

Lowrie 2018 - Lowrie C, Pearson AL, Thomson G. Inequities in coverage of smokefree outdoor space policies within the United States: school grounds and playgrounds. BMC Public Health. 2018;18(1).

Thomson 2016* - Thomson G, Wilson N, Collins D, Edwards R. Attitudes to smoke-free outdoor regulations in the USA and Canada: A review of 89 surveys. Tobacco Control. 2016;25(5):506-516.

Citations - Implementation Examples

* Journal subscription may be required for access.

Grassroots Change - Grassroots Change. Connecting for better health.

ALA-Smoke-free air - American Lung Association. Smokefree air laws. 2018.

ALA-SLATI-SF policies - American Lung Association, Tobacco Policy Project/State Legislated Actions on Tobacco Issues. Smoke-free laws and policies. 2018.

ANRF-Smoke-free lists - American Nonsmokers’ Rights Foundation. Smokefree lists and maps. 2018.

Date Last Updated

Nov 5, 2018