īeyond secondhand smoke exposure, nonsmokers exposed to thirdhand smoke in a casino are at an ever higher risk than those in a thirdhand smoke-polluted home. 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. Annual health care costs in the state directly caused by tobacco use are $1.08 billion. Tobacco exacts a toll in Nevada– 4,050 Nevadans die each year of tobacco-related illness. Most Nevadans are nonsmokers, yet they are still forced to be secondhand smokers at work and in public places. In Nevada, the smoking rate among adults is 17.6% and 6.7% for high school students, compared to national rates of 14% and 8%, respectively. More than 480,000 people die from smoking or exposure to secondhand smoke each year. Tobacco use is the leading preventable cause of death in the United States.