“Do you smoke?” is often the first question health care providers ask when patients experience symptoms suggestive of acute coronary syndrome (ACS).

Aside from increasing the risk of respiratory diseases and worsening asthma, secondhand smoke is a key factor when patients develop coronary artery disease.

The 2006 US Surgeon General’s report, “The Health Consequences of Involuntary Exposure to Tobacco Smoke,” declared that there’s no safe level of secondhand smoke and that any smoking indoors puts all other occupants at risk. Notably, secondhand smoke contributes to 41,000 deaths annually.

Nonsmokers exposed to secondhand smoke are 25% to 30% more likely to develop heart disease. Brief secondhand smoke exposure damages the coronary artery epithelium and increases platelet aggregation. Cigarette smoke increases blood pressure, decreases exercise tolerance, and increases oral contraceptive-related clotting.

In 2000, no states had laws prohibiting indoor smoking. Now, 27 states have comprehensive smoke-free laws that apply to work sites, restaurants, and bars. Only 1 state, North Dakota, added smoke-free laws between 2011 and 2015.

The CDC’s State Tobacco Activities Tracking and Evaluation system database and American Nonsmokers’ Rights Foundation are updated quarterly to reflect changes in state and local level laws. The following trends for 2016 are noteworthy:

·         Half of Americans live in areas under smoke-free laws, but no Southeastern state has comprehensive state laws.

·         West Virginia lacks state-level laws, but local laws cover 60.1% of West Virginians.

·         Connecticut lacks comprehensive state laws and prohibits the enactment of local smoke-free laws.

Comprehensive smoke-free laws don’t protect workers in all settings (eg, casino workers), even though the risks are similar regardless of work location.

The CDC desires smoke-free laws at the state level in areas that don’t already have them. The agency would also like states to allow local-level law-making, including laws that cover a broader variety of settings.

Protections from secondhand smoke should lessen health disparities across the country and socioeconomic strata, as well as ensure that the 50% of Americans who live in areas without coverage can breathe easier.