American Heart Association

The Ultimate Gamble

Walking into the game floor of a casino, you are often met with bright, neon lights, mesmerizing carpets, the dinging of slot machines and the whirring of roulette tables—each one occupied with someone hoping for a big win. In many casinos, your senses are overwhelmed even further when you are suddenly hit with a strong whiff of the tobacco smoke lingering around the air.

Once burned, a cigarette releases approximately 7,000 chemicals into the air, including cyanide, ammonia, and carbon monoxide. There are also dozens of known carcinogens in cigarette smoke, such as benzene and formaldehyde. According to the Centers for Disease Control and Prevention, 41,000 people die each year in the United States due to secondhand smoke exposure—that’s about 1,300 deaths every day. It has been found that despite ventilation systems and designated non-smoking areas, the secondhand smoke exposure in casinos is significant. 

Upon closer examination of the casino floor, you will find dealers behind each game table, slot attendants serving patrons, and cashiers distributing winnings. Across the nation, these casino employees are exposed to deadly toxins, day in and day out. Casino Employees Against Smoking’s (Harmful) Effects (CEASE) is a group of thousands of casino employees with chapters in Kansas, New Jersey, Pennsylvania, Rhode Island, Virginia, Nevada, and Indiana. For years, these employees have been working together and helping each other promote policy change and legislation that will put an end to smoking inside of casinos. 

I recently spoke with a CEASE member who shared the effects that secondhand smoke has had on her life. 

Her career in the casino business began in 1992, when she was 25 years old. In her state, legislation was passed in 2004 that exempted casinos and private clubs from being required to ban smoking indoors. However, at that time she did not realize the weight of this decision. 

“Had I known what secondhand smoke did to me, I would have thought way back then that they shouldn't have exempted that…they didn’t advertise that they were exempting casinos.”

By 2014, after 22 years in the business, she developed bronchitis. 

“I always had a cough. My husband used to yell at me because I coughed all the time. And I'm like, ‘I'm sorry, I don't know what's wrong’.”

In that same year, she was laid off and would not return to the casino business until 2018. Within that time period, she was diagnosed with chronic obstructive pulmonary disease. Although she was given medication for her condition, she remarks that she rarely required it during her time away from working within the casinos. After those four years, she would soon realize what was truly causing her health issues. 

In 2018 she returned to work, and in that same year she began to get sick again. In 2019, she was in and out of work whenever she needed due to a family-related leave of absence. When the COVID-19 pandemic hit in March of 2020, casinos were forced to close down. When they reopened in July of 2020, smoking indoors was prohibited. Within this time, her health started to improve again. Yet, she still didn’t think much of it.  

Two years later, however, in March of 2022 smoking inside casinos was reintroduced. By April, 45 days after the two-year smoke free period was broken, she got sick again. 

“At that point, the pulmonary doctor said that I didn't have COPD, I have asthma and going into the smoke was putting me into asthma attacks. So that's when I realized it was the secondhand smoke.”

The secondhand smoke worsened her psoriasis and brought back depression, anxiety, and sleeping problems. It also made her lethargic. Despite being a very active person who enjoys exercising, she was having trouble finding enough energy to get out of bed in the morning. By December of 2022 she was on 11 medications, two inhalers, and a nebulizer. 

In that same month, she and many other casino employees testified in front of the state to try and get the exemption repealed. They were unsuccessful. She notes that this was not unusual, as she and her colleagues have testified in court numerous times and have frequently spoken with local politicians without success. 

“We are literally being discriminated against and people don’t know. How many people really go to a casino? They don't even know that smoking [in casinos] exists. A lot of the politicians didn't even know that smoking existed in the casino. When I first started this, they were like, ‘where are they smoking indoors?’”

In recent years, however, the resilient efforts of the casino employees have begun to pay off as they have been gaining more and more support from their legislators. The majority of her states’ representatives and senators have either co-sponsored or pledged their votes to a bill that would ban smoking inside casinos and private clubs. The main difficulty now, she believes, is getting the leadership to release the bill from the committee to the floor. If this happens, it appears likely that the bill will be voted in. 

Furthermore, the employees need support from the casinos themselves. She feels that her employers have no interest in improving their working conditions, and the assistance that is offered is inadequate in the face of secondhand smoke.

Where she works, they offer “Wellness Wednesday” memos that promote exercise, nutrition, sleep, and stress reduction. They advocate for cancer and cardiovascular health awareness, two diseases which secondhand smoke increases the risks of. They also frequently remind employees of how to best avoid slip and fall injuries. 

Employees are strictly prohibited from smoking within the casino. In fact, her employer requires that she signs a form every year that states that she doesn’t smoke. Otherwise, she must pay a $65 monthly fee.  

“Even though they know that I'm walking into smoking, I can't smoke in my break room. I can't smoke in the hallways. I can't smoke in the offices. But I can walk out into the smoke. And I have to sign that I don't smoke.”

“They know that it's killing us.”

Like many of these employees, simply quitting her job and looking for alternatives is not a valid option. These are their careers. 

“I love my job. I'm very good at my job. And I've been doing my job for 30 years, it's the only education that I have.” 

“I love working with the people. I’m an introvert. If I go outside of the pit, I don't talk to people. I'm very quiet. I stick to myself, and I try to avoid big crowds. But inside the pit, I just love working with the people.”

For change to happen, the employees will need to gain the support and attention of the general public. Without it, they are severely outnumbered. 

“Casino workers are being discriminated against, and unless the general public stands up with us, they’re not going to stop it. Politicians need to see people show up to rallies and hear people’s voices.”

“The casino employees, just like myself, they're exhausted. We're all exhausted from the secondhand smoking.” 

Along the East coast, air quality has recently become a major area of concern due to residual smoke accumulation from the wildfires raging in Canada. What many of us fail to recognize, however, is that a marginalized group of people are constantly being subjected to far worse air quality behind casino doors. For them, it is more than just a temporary inconvenience, it is their everyday reality. 

Everyone deserves to go to work without worrying about poor air quality. Fortunately, secondhand smoke exposure is easily preventable, and there have been progressive legislation and policy changes made across the country. With the collective efforts of casino employees, the general public, and nonprofit organizations such as the American Heart Association and Americans for Nonsmokers’ Rights Foundation, it is hopeful that our future will be smoke-free.