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Health Department

Dr. Paul's Tennessean Guest Column - December 15, 2009
Remove the Exemptions Now and Save Lives

As communities around the United States and the world have banned indoor smoking, they have saved lives. This is not just some theoretical, mathematical projection of reduced future cancer deaths. It is an immediate, significant drop in heart attacks.

In Pueblo Colorado, heart attacks dropped 41% after a smoking ban, while a nearby county without a ban had only a 4% decline. In Helena, Montana, heart attacks dropped 40% with a ban, and rebounded up 46% when opponents succeeded in suspending the ban. Looking at 11 studies of heart attacks after smoking bans, researchers at the University of Kansas found the risk of acute myocardial infarction dropped 17% overall. They found younger people and nonsmokers benefited the most, and that the reductions continued in subsequent years. The Institute of Medicine—an independent, unbiased, organization--put together a group of experts to carefully review the evidence, and the committee agreed that indoor smoking bans cause a decline in heart attacks.

In 2007, the Tennessee legislature took a big step toward health and safety by banning smoking in most workplaces. They left exemptions, however, for venues that are 100% adults-only to permit smoking and for non-enclosed areas when all the garage doors or awning sides are open. Exemptions have added some confusion to the overall smoking ban for businesses and patrons. Most businesses do want to protect their workers and patrons and fully comply with the law, and complaints and violations are uncommon. However, the exemptions send a mixed message, leading some to not take the law seriously. A "strictly over 21" business illegally offers a "teen night" once a week. A restaurant with "garage doors" closed for the winter illegally serves hookah inside. A hostess at a pizza restaurant asks a family with young children if they want a table in a "smoking or non smoking" section.

Your public health inspectors can’t be everywhere every night, so we rely on complaints to trigger action on many of the violations. And if the ban isn’t simple and it doesn’t mean the same thing in every business, it sets a stage for situations that will not protect workers and patrons.

Preventing heart attacks is one compelling reason, costs are another. Preventing heart attacks means fewer hospitalizations and medical costs averted. At this time with health care costs threatening federal and state budgets, Tennessee’s leaders should take another step toward health and safety with a full ban on smoking in workplaces.

Times have changed. It is no longer "normal’ to smoke at work. It is no longer "normal" to breathe other people’s smoke on airplanes and in most public places. It is no longer normal to breathe other people’s smoke in most workplaces. And now that the effects of smoking bans in reducing heart attacks are becoming clear, it is no longer responsible to expose people to second hand smoke by maintaining exemptions in Tennessee’s Nonsmoker Protection Act.

William S. Paul, MD, MPH
Director of Health
Metro Public Health Department of Nashville/Davidson County