Public Health


American Lung Association Releases 2021 State of Tobacco Control Grades.

The American Lung Association recently released their 19th annual State of Tobacco Control 2021 Grades. This is an annual comprehensive report that assigns grades based on strategic methodology to counties, states, and the nation regarding tobacco control policies. Some of the policy areas considered are tobacco retail licensing, flavored tobacco bans, smoke-free multi-unit housing, smoke-free outdoor areas, and smoke-free outdoor worksites. These individual grades are then combined to create an overall state of tobacco grade for each city, county, state, and the U.S. Within Sacramento County, Rancho Cordova received the only overall “A” grade, with other jurisdictions receiving “C,” “D,” and “F” grades. According to the American Lung Association’s report, out of the eight jurisdictions in Sacramento County, only one protects outdoor workers from exposure to secondhand smoke and secondhand aerosol. Citrus Heights is the only jurisdiction to have a smoke-free outdoor worksites policy that pertains to all workplace environments and includes the prohibition of electronic cigarette type products. This is concerning for the health of outdoor workers in Sacramento County.

In 1995, California passed AB-13, becoming the first state to ban smoking in indoor workspaces, specifically stating, “No employer shall knowingly or intentionally permit, and no person shall engage in, the smoking of tobacco products in an enclosed space at a place of employment.” This bill was extended in 1998 to include bars, taverns, and gaming clubs, but outdoor worksites including construction sites, agricultural facilities, plant nurseries, warehouse facilities, and other outdoor work environments are still not granted the same health protections as indoor workers.

Research shows that blue-collar workers, who mostly work in outdoor workplaces, have higher rates of smoking initiation, higher rates of smoking, and are more likely to be daily smokers when compared to white-collar workers. Exposure to secondhand smoke is a dangerous health risk, as it increases one’s risk of heart disease and stroke and research shows that blue-collar workers have a 53 times greater risk of getting lung cancer due to exposure to secondhand smoke and other workplace toxins.

 Dr. Jerome M. Adams, MD, MPH, explains that smoking leads to “decreased efficiency, errors at work, eye irritation, and reduced attentiveness” which are all issues that affect workplace productivity and safety.  Smoke-free workplaces and employee cessation support improves “employee health, reduces employer costs, and increased productivity.” Further research supports Dr. Adams, demonstrating that social and occupational factors, including workplace policies, impact public health and rates of tobacco use. After looking at Sacramento County’s report card, there is still a need to protect Sacramento County’s outdoor workers and their families from the dangers of commercial tobacco and secondhand smoke.  For further information or questions, contact Taylor Beckwith, Tobacco Control Programs Manager at BCSR via email at

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