A Tobacco Control Policy & Legal Resource Center
Supporting Smokefree Air & Tobacco-Free Lives

Health & Safety

Information on free or low-cost lung CAT scan screenings for nonsmokers exposed to secondhand smoke, and for smokers, is available at our Lung Screening Programs webpage.

Air Quality in Casinos

Ventilation Systems don’t help protect patrons and workers

The CDC has concluded that ventilation systems are ineffective against secondhand smoke. Visit the CDC’s webpage “Ventilation Does Not Effectively Protect Nonsmokers from Secondhand Smoke.”

An August 2012 tribal-casino study published in Bio-Med Central Public Health showed that on average, only 7% of patrons in 11 southern California casinos were actively smoking when observed during a visual survey. In other words, non-smoking patrons outnumbered actively-smoking patrons 13 to 1, on average. Fewer than roughly 10% of patrons smoked during any of the 22 total casino visits by the researchers (2 visits per casino). Based on both new and previously-published air monitoring results, these few individuals were found to substantially increase secondhand smoke particle exposures (PM2.5) for all patrons.

A study that analyzed nicotine levels in random bars and restaurants across St. Louis, found that ventilation systems were not only ineffective, but restaurants and bars that had them actually had higher nicotine concentrations in the air than those that didn’t have them, but where the number of patrons who smoked was similar. Read the September 8, 2010 article about the study which was a collaboration between researchers from the Center for Tobacco Policy Research at Washington University’s George Warren Brown School of Social Work, the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, and Washington University School of Medicine in St. Louis.

Borgata Casino’s online job description of the job requirements for a pit service rep, includes that employees will be subject to “exposure to casino related environmental factors including but not limited to second hand smoke.

Hazardous Exposure to Third-hand Smoke

Thirdhand smoke is beginning to be recognized as a health hazard. Thirdhand smoke is residual secondhand smoke that imbeds into upholstery, rugs, and onto walls, and other surfaces, lingering for weeks. New studies indicate that thirdhand smoke may be more dangerous than secondhand smoke, since thirdhand smoke does not dissipate quickly, and continuously emits respirable particles long after secondhand smoke takes place. Visit our Thirdhand Smoke webpage to read more about the public health concerns with thirdhand smoke, which effects casino workers and patrons when smoking is allowed.

National Institute for Occupational Safety and Health (NIOSH) released a study on secondhand smoke in Las Vegas Casinos, 5-7-09

NIOSH conducted air testing at three Las Vegas casinos, and biomarker testing of Las Vegas casino employees who work on the smoky gaming floors. NIOSH’s Health Hazard Evaluation Report’s key recommendation is (on page 21 of the report):

“We recommend eliminating tobacco from the casinos and implementing a smoking cessation program. The casinos should also eliminate smoking near building entrances and air intakes to protect employees from involuntary exposure to ETS. A physician should evaluate employees with respiratory symptoms, especially symptoms related to asthma that are associated with workplace exposures.”

Click here if you’d like to read or post a comment on the NIOSH Science Blog on Secondhand Smoke and Casino Dealers.

Click here to read the May 7, 2009 Press of Atlantic City article.

Click here to link to the NIOSH webpage on the study.

Click here to read the full NIOSH report.

Additional Supporting Studies

    • stp_new_button A March 7, 2014 study has been published in the Journal of Tobacco Control entitled, “Secondhand smoke and smoking restrictions in casinos: a review of the evidence.” This paper reviewed studies published on the subject between January 1998 and March 2011. It points out that “Workers and patrons in casinos that allow smoking are exposed to high levels of SHS, as documented by elevated levels of SHS constituents in the air of casinos and by elevated levels of tobacco-specific biomarkers in non-smokers’ blood, urine and saliva. Partial smoking restrictions in casinos do not effectively protect non-smokers from SHS”. The Conclusions states:
        “Employees and patrons are exposed to SHS in casinos, posing a significant, preventable risk to their health. Policies completely prohibiting smoking in casinos would be expected to greatly reduce or eliminate SHS exposure in casinos, thereby protecting the health of casino workers and patrons”.
    • The March 25, 2011 issue of the scientific peer-reviewed journal Environmental Research published a study entitled Fine particle air pollution and secondhand smoke exposures and risks inside 66 U.S. casinos. The study revealed that even occasional gamblers have increased health risks due to secondhand smoke particulate matter migrating from gaming areas into nonsmoking restaurants located near the gaming floors.Findings:
      • PM2.5 air pollution levels exceeded World Health Organization standards in 93% of the 66 smoking casinos.
      • Casino ventilation and air cleaning practices failed to control secondhand smoke.
      • Secondhand smoke contaminated unseparated nonsmoking areas like casino restaurants.
      • Secondhand smoke in casinos creates an acute risk of cardiovascular morbidity for casino patrons.
      • Smoke-free casinos reduced fine particle air pollution to outdoor levels.

      The study compared new data collected from eight casinos Reno, Nevada, to data collected in previous studies of secondhand smoke levels in casinos in California, Delaware, Nevada New Jersey and Pennsylvania, and to data collected from three nonsmoking casinos (including a smokefree casino in Fernley, Nevada) for comparison. Data included measuring air quality as well as cotinine levels in nonsmoking workers exposed to secondhand smoke in the workplace (cotinine is a byproduct of nicotine that is detected in body fluids). Read the Stanford University press release. The researchers are with Tufts University School of Medicine, Standford University and Repace Associates, and was funded by the Flight Attendants Medical Research Institute.

    • A February 2010 air quality study of smoking-permitted bars and restaurants showed hazardous levels of concentrated secondhand smoke being inhaled by workers and patrons. According to Science Daily, the report “Tobacco Smoke Pollution in Oklahoma Workplaces,” by the Oklahoma Tobacco Research Center (OTRC), found levels averaging 380 µg/m3 (micrograms per cubic meter of air) in the restaurant smoking rooms tested, and 655 µg/m3 in the bars. Restaurants with no smoking averaged just 26 µg/m3. The EPA scale ranks outdoor levels of particulate pollution as “unhealthy” at 66-150, “very unhealthy”‘ at 151-250, and “hazardous” at higher concentrations such as the levels found in the Oklahoma restaurant smoking rooms and bars tested for this report.
    • A February 2010 Stanford University study published in the Journal of Exposure Science and Environmental Epidemiology concluded that secondhand smoke in California’s Native American casinos often exceed concentrations associated with harmful effects. 36 Native American casinos in California were air tested. Results were startling but not unexpected: the air quality levels were similar to those in California bars and restaurants in 2004, prior to banning smoking. The U.S. Environmental Protection Agency’s health-based standard for fine particles is an average of 35 micrograms per cubic meter over a 24-hour period. This concentration level was exceeded in 90 percent of the casinos the researchers visited. The smokiest casino had an average concentration that was 26 times as high as outdoor air. Click here for the CasinoJournal.com newsclip.
    • An August 2009 study by James Repace, air – tested at Pennsylvania casinos, concluded that casinos should not be exempt from smokefree workplace law. The study states that secondhand smoke induced heart disease and lung cancer will cause an estimated 6 Pennsylvania casino workers’ deaths annually per 10000 at risk, which is 5-fold the death rate from Pennsylvania mining disasters. Click here to see the full study as published in the American Journal of Public Health.2009;99:1478–1485.doi:10.2105/AJPH.2008.146241.
    • A February 2007 comparative study shows differences in air quality between smokefree Ontario casinos and smoking permitted sections of Rhode Island and Atlantic City casinos. (Note: Testing with 25% of Atlantic City gaming floors smoking permitted as they are today.)
    • A November 2006 New Jersey Air Monitoring Study, post-New Jersey Smoke-Free Air Act (excluding the casinos) showed in return testing at sites tested in the 2005 study — restaurants, bars, and bowling alleys that formerly allowed smoking — no smoking was observed in any location, and fine particle indoor air pollution was reduced an average of 91%. Also, there was no decrease in patron counts. Employees in those hospitality venues now have workplaces with acceptable air quality. Additionally, interviews with patrons, employees, and managers found essentially unanimous and enthusiastic acceptance of the law and the newly smokefree environments.Casino gambling areas remained as polluted as before the law. Casino non-gambling areas, required to be smoking-prohibited by the law [but entirely open to gambling areas and apparently sharing a common air space], were, on average, more than half as polluted as the gambling areas. But during the July New Jersey government “shutdown”, when gambling was suspended, casino air quality was superb, with lower levels of fine particle air pollution than in outdoor air. Click to read the:
    • A November 2005 New Jersey Air Monitoring Study, pre-New Jersey Smoke-Free Air Act (excluding the casinos) showed that restaurants, bars, casinos, and bowling alleys that allowed smoking had, on average, 15 times more indoor air pollution than smokefree restaurants and bars, as measured by the concentration of particulate matter smaller than 2.5 microns in diameter. Casinos averaged eight times more pollution than smokefree workplaces and public places. Employees in all of the smoking-permitted locations tested were exposed to pollution that exceeded levels recommended by the U.S. Environmental Protection Agency (EPA); the average employee exposure was 3.4 times the EPA limit. Employees in all the smokefree locations were in workplaces with acceptable air quality. Click to read the:

Worker Health and Safety

Since 1990, the New Jersey Department of Health (NJ DOH) requires physicians to report suspected cases of work-related asthma, in accordance with N.J.A.C. 8:58-1.5, 1.6, 1.7. Reported cases may be followed-up with interviews, obtaining and reviewing medical records, and investigating the place of employment. Workplace consultations are conducted where warranted; either by sending a letter with a tailored packet of educational materials or by performing an on-site industrial hygiene evaluation. Surveillance of work-related asthma has also led to hazard surveillance research projects in which a particular agent and/or industry is targeted for study. Review the NJ DOH brochure which outlines the process for reporting work-related asthma conditions.

On August 4, 2009, ASH Australia and the SmokeFree Australia workplace coalition of employee and health groups published a Briefing Paper to Australian governments on why all gambling areas should be 100% smokefree, both indoors and outside.

US Surgeon General’s 2006 report found:

  1. There is no risk-free level of exposure to secondhand smoke; even a little smoke poses a risk.
  2. Secondhand smoke causes lung cancer, heart disease, and respiratory disease; people who are already ill are at especially high risk.
  3. No technological methods – including separate areas for smoking, air cleaners, and increased ventilation – can eliminate the risk of secondhand smoke.

A study published in Epidemiology September 2006 found that pregnant women exposed to secondhand smoke were 67 percent more likely to miscarry than those who weren’t exposed, according to the study of more than 1,300 women. Unlike previous studies, which relied on reports from study participants, this study measured participants’ blood levels for cotinine, a marker for nicotine exposure. Spontaneous abortion is the most common adverse outcome of pregnancy, and exposure to secondhand smoke is not uncommon, so the public health consequences of these facts may be substantial, according to the researchers. Read an article about the study from Scientific American.

Health impacts of SHS exposure among London casino workers

Nevada study links casino smoke, DNA damage:

American Gaming Association acknowledges 2006 Surgeon General’s report

Health improves in smokefree environments:

Hazards using portable oxygen in smoking-permitted places.

Nonsmoking casino patrons and visitors may use portable medical oxygen in public places, like a casino. By allowing smoking and lighted cigarettes on a gaming floor near portable oxygen use, casinos create a potentially hazardous and deadly environment.Casinos may need to reasonably accommodate several categories of breathing-disabled patrons, and provide a 100% smokefree casino that is free of environmental and safety hazards. Click here to learn more about the hazards of smoking near the operation of portable oxygen equipment.

Casinos may need to reasonably accommodate several categories of breathing-disabled patrons, and provide a 100% smokefree casino that is free of environmental and safety hazards:

  1. A person on portable oxygen may be classified as breathing-disabled (chronic asthma, COPD, cardiac condition), and thus require a reasonable accommodation of a 100% smokefree casino.
  2. A person (breathing, cardiac conditions, etc.) whose disability is adversely affected by secondhand smoke may qualify as breathing-disabled, and require a reasonable accommodation of a 100% smokefree casino.
  3. A person may also qualify temporarily as disabled, such as asthmatic or COPD onset due to secondhand smoke exposure, and need an accommodation of a 100% smokefree environment in a public place, such as a casino.
  4. Taking medications help to mitigate a disabling condition, no longer disqualifies a person from being qualified as disabled, since the underlying medical condition continues to exist.