The moment Tammy Brady felt a lump in her breast in February 2022, she knew it was cancer. The genetic predisposition to breast cancer is not known, but she suspects that working in a smoky Atlantic City casino for 38 years may have played a role.

'I was just trying to make a living,' said Brady, 56, a dealer and supervisor at the Borgata, a resort in New Jersey. You never think about getting sick on the job."

Despite the fact that the percentage of Americans who smoke has declined from about 21% in 2005 to 12% in 2021, and 35 states, the District of Columbia, and U.S. territories have banned smoking in at least some public spaces, some casinos continue to allow indoor smoking. Still, 13 of the 22 states and territories that allow casino gambling allow smoking in at least some of their facilities and they like it.

Brady, a casino employee, anti-smoking advocate, and public health expert, argues that it is long past time to end casinos' smoke-free exemptions, given the dangers of passive smoking. However, he faces stiff opposition from some gambling industry leaders, including those in Missouri, Louisiana, Kentucky, and New Jersey, who say smoking bans will drive away gamblers.

The U.S. Supreme Court Building in Washington, DC, USA, on November 01, 2022. The Supreme Court granted a temporary administrative stay blocking the release of former U.S. President Donald J. Trump's tax returns, as sought by the House Committee on Ways and Means.

U.S. Supreme Court, Washington, DC - November 01, 2022

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Even as the American Gaming Association reports record revenues from face-to-face casino gambling in 2022, beyond the growth of sports betting and online gambling, the Cobit 19 craze renewed the fight and sharpened arguments on both sides.

Casinos were closed for several months in the spring of 2020 as part of a nationwide effort to mitigate the spread of the coronavirus. Rules governing the reopening, such as masking, physical distance requirements, and smoking bans, vary from state to state and, in some cases, casino operator to casino operator and community to community.

After suffering pandemic-era losses, some casino executives and at least one union representing workers leaned on a 2021 report commissioned by the Casino Association of New Jersey to counter efforts to ban or restrict smoking at its facilities. according to this report, which uses 2019 data that if smoking were banned in New Jersey and not banned in neighboring Pennsylvania, 2,500 Atlantic City casino employees could lose their jobs in the first year, and tax revenues could decrease by $44 million. Both states considered banning smoking in casinos in 2023, but the New Jersey legislature did not pass a bill, leaving Pennsylvania in limbo.

Brian Christopher, a social media influencer who specializes in casinos and gambling, said he has heard the argument before that business would be lost, but he is not convinced. He says, "People don't drive or fly to casinos to smoke cigarettes."

Tammy Brady suspects that her 38 years of working in smoky Atlantic City casinos may have played a role in her cancer diagnosis.

Tammy Brady suspects that working in smoky Atlantic City casinos for 38 years may have played a role in her cancer diagnosis.

Still, some are persuaded by the argument that tax revenues will fall. Shreveport, Louisiana, repealed its 2020 casino smoking ban last spring. Those who pushed for the repeal said that local gambling taxes were reduced because gamblers were diverted to nearby casinos where smoking was allowed. The new ordinance allows smoking on 75% of the ghbetsites.com.

Churchill Downs also announced in June that it would move its planned gambling facility out of the city to a vacant space in a shopping mall in Owensboro, Kentucky. The company declined to comment for this article, but the city's mayor told the Messenger-Inquirer that the main reason for the move is the city's longstanding voter-approved smoking restrictions, which do not exclude casinos.

Kanika Cunningham, director of the St. Louis County Public Health Department in Missouri, had participated earlier this year in an effort to eliminate a loophole in the county's 2011 indoor smoking ban. However, after pushback from gambling company Penn Entertainment, a compromise was reached to allow smoking on 50% of the casino floor.

An unidentified young woman enjoying a cigarette outdoors. The focus is on cigarettes.

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Jeff Morris, Penn Entertainment's Vice President of Public Affairs and Government Relations, said, "We believe this is a balance and something the marketplace should decide, especially in this competitive environment with other gaming facilities in nearby and neighboring states."

Penn Entertainment employs "state-of-the-art ventilation systems, very high ceilings," and "proper separation of smoking and non-smoking areas," he wrote in an e-mail to KFF Health News.

The problem is that secondhand smoke cannot be confined to one large room, Cunningham said.

There is no such thing as a safe amount, she says, "and trying to confine it to a specific location just doesn't work."

Filtration systems can remove much of the visible smoke, along with the odor, from indoor spaces, giving the impression of clean air, even if many people smoke. However, according to a 2023 report from the American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE), existing technology cannot remove the dangerous particulates in tobacco smoke.

A National Institutes of Health study published in 2023 evaluated particulate matter in eight smoking and non-smoking casinos in Las Vegas. In casinos where smoking was allowed, particulate matter levels were significantly higher than in non-smoking casinos, even in areas designated as smoke-free.

One study also showed that nicotine levels in ventilated casinos where indoor smoking was permitted could be 600% higher than employees exposed to smoking in other workplaces.

Brady works in the casino at the Borgata Hotel in New Jersey.

Brady works at the Borgata Hotel casino in New Jersey.John Greim/LightRocket/Getty Images

Secondhand smoke can cause coronary heart disease, stroke, and lung cancer. Some studies have shown a link to breast cancer, although further research is needed, according to the National Cancer Institute.

The pandemic has raised awareness of the dangers of airborne particulates and given new momentum to smoking cessation, says Andrew Clebanow, co-founder of C3 Gaming, an independent industry consulting group.

In fact, more than 1,000 casinos and other gambling establishments in the United States are now smoke-free, including more than 140 tribal casinos, according to the Americans Nonsmokers' Rights Foundation.

Tribal leaders in New Mexico have agreed to remain smoke-free when the pandemic restrictions are lifted, says Dennis Floge, chief executive officer of Acoma Business Enterprises and Sky City Casino in North Acomita Village. Employee health improved and the casino qualified for premium reimbursement, he says. Cleaning and replacement costs for carpets and fixtures have dropped, and the tribe has "never failed" in terms of revenue, Froege says.

Some guests complain about having to go outside to smoke, but that's about it, Froege says. No one jumps up or gets angry and says, 'I'm leaving and never coming back,'" Froege said.

Casino executives who oppose smoking restrictions overlook those who "want to enjoy great food and great entertainment, but won't set foot in a casino because they are bombarded with smoke as soon as they step in," said Borgata dealer and member of the advocacy group Casino Employees Pete Nacarelli, one of three co-founders of the advocacy group "Against Smoking's Effects," said.

The group, which has chapters in New Jersey, Kansas, Pennsylvania, Rhode Island, and Virginia, was founded because casinos put out ashtrays at 12:01 a.m. on the day the pandemic-related smoking ban officially ended, he said. Borgata did not respond to a request for comment.

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According to a New Jersey industry-commissioned report, a smoking ban might increase the number of nonsmokers who frequent casinos, but it would not make up for the revenue lost when smokers choose to go elsewhere or when smokers smoke in between gambling sessions.

But Brady, who is cancer-free after chemotherapy and a total mastectomy, believes that if policymakers spent time breathing the same air as she and her colleagues, they would act more quickly to ban smoking in casinos rather than prioritize tax revenue. Our lives are more important."

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism on health care issues and is one of KFF's core operating programs, an independent source of health policy research, public opinion and journalism The KFF is a national newsroom that produces in-depth journalism on health care issues.

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