title: Secondhand smoke and smoking restrictions in casinos: a review of the evidence.
abstract: OBJECTIVE
  There is no safe level of secondhand smoke (SHS) exposure. Most US casinos continue to allow smoking, thus exposing workers and patrons to the hazards of SHS. This paper reviews the scientific literature on air quality, SHS exposure, health effects and economic outcomes related to SHS and smoking restrictions in casinos, as well as on smoking prevalence among casino patrons and problem gamblers.
  
  
  METHODS
  Peer reviewed studies published from January 1998 to March 2011.
  
  
  RESULTS
  Evidence from air quality, biomarker and survey studies indicates that smoking in casinos is a significant public health problem. 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. Findings suggest that the smoking prevalence of casino patrons is comparable with that of the general public, although this prevalence may be higher among problem gamblers. Few studies have examined the economic impact of smoke-free policies in casinos, and the results of these studies are mixed.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Babb
authors.affiliation: Global Environmental Health Department, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: McNeil
authors.affiliation: Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Kruger
authors.affiliation: Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Tynan
mesh_terms: D004781:Environmental Exposure; D005715:Gambling; D006801:Humans; D016273:Occupational Exposure; D061845:Smoke-Free Policy; D012907:Smoking; D014028:Tobacco Smoke Pollution
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Cotinine; Public policy; Secondhand smoke