Ten years ago, New York State passed the Clean Indoor Air Act, which banned smoking in all enclosed workplaces, including bars and restaurants, offices, movie theaters, sports arenas, and public transportation. But despite the steepening decline in smoking rates, the ban is still far from uncontroversial, especially in the face of 10 states that have yet to issue an official ban.

"The passage of New York State's Clean Indoor Air Act was a historic moment for public health," Blair Horner, vice president of advocacy at the American Cancer Society Cancer Action Network, told the Associated Press. "In 2002, the average New York bar or restaurant was essentially a hotbox of deadly carcinogens. For hospitality workers clocking an eight-hour shift, this was an incredibly dangerous situation."

As is normally the case with public health issues, people tend to fall on one side or the other when it comes to a policy infringing on what many people see as their personal freedom. Smokers and non-smokers have been particularly divided as the Clean Indoor Air Act, and others like it, cleave the population in two. Smoking rates have fallen by nearly 50 percent since 1965, yet more than a handful of states continue to allow the practice in public places.

As of June, 2013, the 10 states with no official smoking ban are Alabama, Alaska, Kentucky, Mississippi, Missouri, Oklahoma, South Carolina, Texas, West, Virginia, and Wyoming.

According to the Centers for Disease Control and Prevention (CDC), the percentage of people who smoke in a given state fluctuates substantially. In 2010, Utah saw the lowest rate at 9.1 percent while 26.8 percent of West Virginians smoked. The Midwest and South consistently display the highest smoking rates.

In fact, out of the 10 states still permitting smoking in certain public places, five of them fall into the heaviest smoking category, between 22.0 and 26.8 percent. The other five all fall into the next heaviest category, at 19.0 to 21.0 percent — excluding Texas, which has surprisingly low rates of smoking, between 13.0 and 15.9 percent.

Many of the localities within these states have bans similar to New York's statewide ban.

Since 1997, Texas' statewide smoking laws only prohibit smoking in activities of public schools on or off school property, elevators, theatres, libraries, museums, hospitals, buses, airplanes, and trains — precluding the proprietor designating specific smoking areas and posting warning signs.

Approximately 46.6 million adults in the United States smoke, with an even more sobering 88 million nonsmoking Americans exposed to secondhand smoke. Even brief exposure can cause harmful effects, the CDC says, because many of the poisonous ingredients in cigarettes can be found in the smoke as well.

The Ban In New York

In New York, the statewide ban initially ruffled the feathers of business owners who feared losing customers once they had to relegate them outside. However, in the years following the ban many opponents have yielded to the its efforts of cleanliness and safety.

"On the restaurant side of the business, our members are now saying the things the anti-smoking advocates said they would experience: It's nice going home not smelling of smoke, it's cheaper to keep the restaurant clean and they don't know how they worked in a smoking environment before," Wexler said.

Smokers, too, agreed the ban had good intentions, and were willing to sacrifice comfort for public safety.

"It was an adjustment," said Donna Twitty, 34, and a two-pack-a-week smoker from New York City. "But I prefer to do it outdoors because other people shouldn't have to breathe in my smoke."

Of course, such sweeping legislation comes with its ardent dissenters.

"The incursion into private lives over an informed legal lifestyle choice is nothing to celebrate," said Audrey Silk, founder of the national smokers' rights group Citizens Lobbying Against Smoker Harassment. "Questionable shady statistics over health and business are irrelevant."

Putting Future Generations At Risk

A 2012 Surgeon General statement claimed the greatest detriment to reducing smoking rates is not that "the evidence-based tools that drove the progress" stopped working. It's that they haven't been applied with sufficient effort.

"Even with decades of progress and recent tobacco control initiatives, however, we must do more. We have ample evidence that comprehensive, multi-component interventions are effective at reducing tobacco use. But knowledge is not enough," said Howard Koh, U.S. Assistant Secretary for Health.

"We must also have commitment-the commitment to sustain comprehensive programs," he added, "to give our young people another perspective on tobacco, to create an environment that makes it harder for youth to smoke, to make cessation services accessible and affordable."