United States

BMJ 1998; 316 doi: (Published 07 March 1998) Cite this as: BMJ 1998;316:723
  1. Norra Macready
  1. California

    The aggressive campaign to reduce smoking in the United States is bearing fruit. According to the World Health Organisation, daily and occasional smoking among American men aged over 18 declined from 44% in 1970 to 28% in 1993; in women, smoking declined from 32% to 23% in the same period. Adolescents, however, are proving more recalcitrant: among young people aged 12 to 17, smoking declined from 25% in 1974 to 11% in 1991, but since then the change has been negligible.

    Americans have accepted most restrictions on smoking in public places. At the federal level, smoking is not permitted in any government building. There are several tobacco bills currently before Congress that cover several issues—smoking in bars and public places, reducing smoking among young people, and addressing the concerns of tobacco farmers—but their fates remain uncertain.

    Virtually all states have antismoking regulations, although these vary in scope. Individual cities, towns, and counties are also permitted to pass their own laws, and often these are far more stringent than |anything established by the states. Five states—California, Washington, Utah, Maryland, and Vermont—have banned smoking in almost every public venue, and most states prohibit smoking in government offices. In January the California legislature outlawed smoking in bars and private clubs, making cigarettes forbidden in virtually every public area in the state. But there are signs of a backlash: last month the state assembly voted by a two to one margin to repeal the bill as of January, 1999.

    Private companies are way ahead of the law—more than half of all the major businesses in the United States forbid smoking on their premises.

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