Alaska: Legalized marijuana and smokefree opt-out provisions threaten smokefree protections

Smoke is Smoke. Localities must prepare to defend smokefree spaces to protect all workers from secondhand smoke

EPA Classified secondhand smoke as a Group A carcinogen

Alaska is the largest U.S. state by area, yet it is the third-least populous and the most sparsely populated state. Approximately half of Alaska’s residents live within the Anchorage metropolitan area.

Alaska’s indigenous population is proportionally the highest of any U.S. state, at over 15% of the population and nearly two dozen native languages are spoken. [5] [“U.S. Census Bureau QuickFacts: Alaska”. Retrieved February 17, 2020.] 

On October 1, 2018, the “Take it Outside” smokefree statewide law went into effect, protecting all workers from secondhand smoke as long as no community attempted to follow the complicated procedure for opting out of the law.

  • 62.3% of Americans enjoy comprehensive smokefree protections in all public places and workplaces, including restaurants and bars. In contrast, in Alaska 47.1% of the population is protected by local smokefree laws. Language added in the final hour to a strong statewide smokefree law allows local communities to opt-out of the law thus weakening comprehensive protections statewide. [2]
  • 147 Alaskan Native Tribes have adopted smoke and tobacco-free policies.
  • Marijuana proponents are lobbying for smoking marijuana indoors in retail establishments, which threatens worker health and smokefree protections.
  • 88.8% of Alaskans agree that all Alaskan workers should be protected from secondhand smoke in the workplace, 83.1% agree that the Smokefree Alaska Law should include all types of smoking, including marijuana smoking, and 86.3% agree that the Smokefree Alaska Law should apply to vaping as well as smoking. [6]

Big Tobacco policy schemes like "opt-out” provisions potentially weaken public health provisions that would eliminate exposure to secondhand smoke and reduce smoking rates.

Preemption Status:

Not Preempted

State law does not preempt local governments from adopting smokefree air laws. Preemption refers to situations in which a law passed by a higher level of government takes precedence over a law passed by a lower one. Preemptive state laws do not allow local authorities to enact strong local laws.

83.1% of Alaskans support a smokefree state law

More than 1 in 3 nonsmokers who live in rental housing are exposed to secondhand smoke, and 2 out of every 5 children (including 7 out of 10 African American children) are exposed.

-Centers for Disease Control and Prevention (CDC)

Current Landscape of Smokefree Protections

100% Smokefree Workplace, Restaurant, and Bar Laws, as of December 2022 [2]
Click on any star for city name.
To see additional smokefree laws, visit our list.

Strong capacity for smokefree:
Alaska’s strong infrastructure of trained and funded local coalitions and Alaska Native community-based organizations has led to significant policy development for tobacco-free college campuses, health systems, schools, behavioral health systems, workplace campuses, and commercial tobacco-free Tribes. One hundred forty seven (147) Alaska Tribes have passed resolutions of support for smokefree policies. Tribal institutions and corporations are strong, integral partners in the Alaska tobacco control program.

100% smokefree fairs:
In 2015, the very popular Alaska State Fair went smokefree (possibly the first state fair in the nation to do so), including electronic cigarettes, providing a healthy family-friendly fair environment for everyone. The transition to a smokefree fair was so successful that many regional fairs also went smokefree in 2018.

Gaming in Alaska
There are at least 7 gaming establishments in Alaska, and all of these 7 gaming establishments are 100% smokefree.

Casinos, bingo halls, and other gaming establishments are workplaces as well as public places and should also be smokefree.


Who is Left Behind?

lady covering mouth smoke

Bar and Hospitality staff are exposed to secondhand smoke because of gaps in protections.

Alaska is a primarily rural state with many communities and villages accessible only via air travel. To galvanize advocates to support one important health issue over these past years is a huge accomplishment.

Now that the “Take it Outside” law is in effect, all worksites in Alaska are, at least for now, 100% smokefree, including the use of electronic cigarettes and marijuana. However, it is important to note that the threat of local community opt-out of the law puts workers at potential risk of exposure to secondhand smoke. Since sovereign Alaska Tribes are exempt from the state law, much work is being accomplished by Tribes passing smokefree resolutions for their villages, corporations and communities. 

Alasa Health Outcomes

  • Alaska is ranked 31st out of all 50 states based on health outcomes according to the United Health Foundation’s “America’s Health Rankings Annual Report.” [3]
  • In Alaska, the smoking rate among adults is 19.6%, and 7.5% for high school students, compared to national rates of 15.1% and 8%, respectively. [4]
Alaskans love smokefree air

Poor Health Outcomes and High Costs

Tobacco use is the leading preventable cause of death in the United States. More than 480,000 people die from smoking or exposure to secondhand smoke each year. [7]

The smoking prevalence among Alaska Native adults is over double that of non-Native adults (40.6% compared to 16.6%). [8]

Roughly 6,400 Alaska children are exposed to secondhand smoke in their homes. [9]

Secondhand smoke exposure causes heart disease, stroke, and lung cancer among adults, as well as respiratory disease, ear infections, sudden infant death syndrome, more severe and frequent asthma attacks, and slowed lung growth in children. [8,10]

Smokefree laws help to reduce adult smoking prevalence and prevent youth and young adult smoking initiation. [8,10]     

New Challenge: Secondhand Marijuana Smoke

“Smoke is smoke. Both tobacco and marijuana smoke impair blood vessel function similarly.” 

Mathew Springer, cardiovascular researcher and Associate Professor of Medicine,  

Alaska legalized recreational marijuana in 2015, via a 2014 ballot initiative and the state has the highest number of retailers per capita of any in the union. Efforts are underway to establish public use cannabis lounges and cafes, thereby exposing employees and patrons to another form of indoor air pollution. Secondhand marijuana smoke is a health hazard for nonsmokers. Just like secondhand tobacco smoke, marijuana smoke is a potent source of PM 2.5 fine particulate matter, which can be breathed deeply into the lungs and can cause lung irritation and asthma attacks, and makes respiratory infections more likely. Exposure to fine particulate matter can exacerbate health problems especially for people with respiratory conditions like asthma, bronchitis, or Chronic Obstructive Pulmonary Disease (COPD). Marijuana secondhand smoke also impacts cardiovascular function; it contains thousands of chemicals and at least 33 carcinogens.

Marijuana proponents continue to threaten strong smokefree laws by pushing for onsite, indoor marijuana smoking. The regulatory process for onsite use of marijuana in Alaska is very strong. Local jurisdictions must pass an ordinance to specifically go through the process to “opt-in” to onsite use; if localities choose to allow public use of marijuana, smoking and vaping can only be allowed in standalone buildings that are not multi-use properties. Despite overwhelming local support for smokefree, laws were passed in Ketchikan and Fairbanks to allow marijuana smoking indoors in limited ways. AnchorageHomer, and Juneau successfully pushed back on similar industry efforts and kept their indoor smokefree laws strong. In particular, Juneau’s City Council decided to treat marijuana smoking like tobacco and only allow it outdoors in areas protected from public view.

If marijuana smoking is brought indoors, a new class of hospitality employees working in the marijuana industry will be exposed to secondhand smoke at a much higher rate than the general public and will suffer the negative health effects of that exposure. 

marijuana secondhand smoke contains toxins

Ventilation is not the answer:

The American Society for Heating, Refrigeration, and Air-Conditioning Engineers (ASHRAE), the standard setting body for the HVAC industry, affirms that mechanical solutions like ventilation and other air cleaning technologies cannot control for the health hazards associated with secondhand smoke. ASHRAE bases its ventilation standard (62.1) for acceptable indoor air quality on an environment that is completely free from secondhand tobacco smoke, secondhand marijuana smoke, and emissions from electronic smoking devices.

No amount of ventilation or filtering can eliminate the health risks of secondhand smoke either from tobacco or marijuana products. Even sophisticated ventilation systems in hospitality settings do not protect people from the health impact of secondhand smoke, marijuana secondhand smoke, and secondhand vapor emissions from e-cigarettes. False claims of being able to “clean” the air by filtration or using other chemicals are not a substitute for clean air. This is affirmed by all leading health agencies, including the Office of the Surgeon General.


COVID Reminds Us That Health Prevention Policies Matter

Smoking and vaping, along with exposure to secondhand smoke and aerosols, negatively impact the respiratory system and may cause a person’s immune system to not function properly, known as being immunocompromised. Research demonstrates that current and former smokers of any age are at higher risk of severe illness from coronavirus disease (COVID) in part due to compromised immune and/or respiratory systems. Smoking leads to cardiovascular disease, as well as respiratory illnesses including bronchitis, asthma, Chronic Obstructive Pulmonary Disease (COPD), and lung cancer as a result of exposure to particulate matter, toxins, and carcinogens into their lungs. Secondhand tobacco and marijuana smoke and aerosol contain many of the same toxins, carcinogens, and particulate matter that lead to respiratory and cardiovascular diseases.

Removing masks to smoke or vape indoors undermines the proven benefit of face coverings and increases the risk of transmitting or inhaling COVID via infectious respiratory droplets, uncovered coughs, and increased touching of faces. Preventing exposure to secondhand smoke and e-cigarette aerosol or vape by adopting a smokefree policy with no smoking or vaping indoors and moving smoking or vaping to socially distanced outdoor areas away from entrances, could help mitigate worker and public exposure to carcinogens and toxins, as well as COVID.

Just as social distancing and handwashing help prevent the spread of disease, eliminating secondhand smoke is critical to prevent acute and chronic diseases, and saves lives by reducing the risk of heart disease, stroke, respiratory diseases, and lung cancer by up to 30% at a population wide level.

Strategies to Close Gaps & Increase Health Equity

Prevent local opt-out of statewide smokefree provisions: Strong smokefree laws have immediate and long-term health and economic benefits. They are worth the investment of time and effort to make sure no community opts out of these basic health protections.

Beware Opt-In for Marijuana Onsite use: Marijuana smoke is also a form of indoor air pollution and a hazard to nonsmokers’ health. In order for indoor workplaces and public spaces to truly be safe and healthy environments, tobacco and marijuana smoke, along with secondhand e-cigarette aerosol/vapor should be prohibited. Public health professionals and smokefree advocates should work to prevent roll-backs to strong smokefree laws as concessions for indoor marijuana use.  

Local has led the way: Alaska has a strong track-record for supporting local policies for smokefree indoor spaces. Most Alaska municipalities have the authority to adopt local laws that are stronger than the new state law. Indeed, many communities have done this already. Smokefree laws should also prohibit the use of electronic smoking devices or e-cigarettes, marijuana, and hookah to prevent secondhand smoke exposure to the toxins, carcinogens, fine particles, and volatile organic compounds that have been found to compromise respiratory and cardiovascular health. [13,14]

Thwart preemptive efforts: The tobacco industry and its allies regularly promote preemptive legislation in the Capitol. Preemptive laws typically contain a few very weak provisions and prevent further progress at the local level where stronger laws are more likely to pass. Despite the recent passage of a statewide smokefree law, the industry has a history of returning to the legislature in an attempt to undermine or roll back these public health protections.

Invest in the future: To protect the statewide smokefree law, a great deal of effort and financial resources will be required to explain the benefits of 100% smokefree environments, counter misinformation about the viability of ventilation systems, prevent local opt-out, and prevent exemptions for indoor marijuana use. Collaborating with and mobilizing additional community based partners who represent those individuals or classes of workers most affected by secondhand smoke is critical to reach success. Protecting the most vulnerable with smokefree multi-unit housing policies will be an important priority moving forward. 

Increase funding and resources: Tobacco prevention, education, training, and cessation funds are needed to better address disparities in smoking and exposure to secondhand smoke. In addition, funds to support the implementation of a statewide law are critical to increase community awareness of and compliance with the smokefree rules.   

Sources of data:

  1. U.S. Environmental Protection Agency, Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders,” EPA/600/6-90/006F, December 1992.
  2. American Nonsmokers’ Rights Foundation. U.S. Tobacco Control Laws Database. Berkeley, CA (2022).
  3. United Health Foundation. (2021). America’s Health Rankings Annual Report.  
  4. Centers for Disease Control and Prevention. (n.d.). State Highlights: Alaska [from State Tobacco Activities Tracking and Evaluation System]. 
  5. Tsai J, Homa DM, Gentzke AS, et al. Exposure to Secondhand Smoke Among Nonsmokers — United States, 1988–2014. MMWR Morb Mortal Wkly Rep 2018;67:1342–1346.
  6. ALA 2020 Tobacco and Marijuana Secondhand Smoke Survey Results
  7. US Department of Health and Human Services. The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.
  8. Alaska Tobacco Facts, Alaska Department of Health and Social Services Division of Public Health, 2018 Update. 
  9. Alaska Behavioral Risk Factor Surveillance System Supplemental File, combined years 2014-2016, and Alaska Department of Labor and Workforce Development Population Estimates, 2016 (from vintage 2017 population files).
  10. US Department of Health and Human Services. Preventing tobacco use among youth and young adults. A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. 
  11. Matt, Dr. Georg (2018). Smoking Bans May Not Rid Casinos of Smoke. US News and World Report.
  12. Matt, G E, Quintana PJ E, Hovell MF et. al. (2004). Households contaminated by environmental tobacco smoke: sources of infant exposures. British Medical Journal: Tobacco Control.
  13. Grana, R; Benowitz, N; Glantz, S. “Background Paper on E-cigarettes,” Center for Tobacco Control Research and Education, University of California, San Francisco and WHO Collaborating Center on Tobacco Control. December 2013.
  14. Williams, M.; Villarreal, A.; Bozhilov, K.; Lin, S.; Talbot, P., “Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol,” PLoS ONE 8(3): e57987, March 20, 2013.

Related Reading:

Respiratory Risk Factors and COVID-19:

Huang, J., King, B.A., Babb, S.D., Xu, X., Hallett, C., Hopkins, M. (2015). Socio-demographic disparities in local smoke-free law coverage in 10 states. American Journal of Public Health, 105(9), 1806–1813.

Tynan, M.A., Baker Holmes, C., Promoff, G., Hallett, C., Hopkins, M., & Frick, B. (2016). State and local comprehensive smoke-free laws for worksites, restaurants, and bars — United States, 2015. Morbidity and Mortality Weekly Report, 65(24), 623-626.

July 2022

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