Sunday, February 12, 2006

Oklahoma Restaurants Must Become Smoke-Free or Smoke-Filled by March 1; When Will this Stupidity End?

As of March 1, 2006, all restaurants in Oklahoma will have a choice: (1) become smoke-free and protect all their workers from secondhand smoke exposure; or (2) create smoke-filled rooms and expose their employees to extremely high levels of secondhand smoke.

The restaurant provisions of Oklahoma's Smoking in Public Places and Indoor Workplaces Act become effective in just 2 weeks. Although the law initially went into effect in September 2003, restaurants were exempt from the law until March 1, 2006, at which time they may either eliminate smoking completely, or restrict it to enclosed, separately ventilated rooms of any size. Bars are permanently exempt from the state law, which preempts any local regulation of smoking in bars, restaurants, workplaces, or public places.

In a state Department of Health press release issued to inform restaurants of their options and explain the reasons behind the law, the State Health Commissioner explained: "We applaud and thank the restaurants that have become entirely smokefree ahead of the legal deadline of March 1, 2006. For the health of their employees and patrons, we strongly encourage all others to do so as quickly as possible. Smokefree environments benefit the health of employees and customers alike... ."

The State Health Commissioner noted that "although a restaurant may be permitted to create a smoking room under Oklahoma'’s new laws, such rooms are typically costly to build and to operate, and a smoking room would still subject employees and patrons alike to hazardous secondhand smoke exposure."

The Rest of the Story

In their infinite wisdom, legislators in Oklahoma have decided that secondhand smoke is a severe enough hazard for restaurant workers who are exposed to moderate levels so that smoking must be banned, but not severe enough for restaurant workers who are exposed to extremely high levels who will not be touched by the legislation.

Evidence demonstrates that levels of secondhand smoke in enclosed, separately ventilated rooms are, on average, more than 10 times higher than in restaurants where smoking is allowed anywhere (see: Siegel M, Husten C, Merritt R, Giovino G, Eriksen M: The health effects of separately ventilated smoking lounges on smokers: Is this an appropriate public health policy? Tobacco Control 1995; 4:22-29).

Thus, from a public health standpoint, it is far better to not regulate smoking at all in restaurants than it is to restrict it to separately ventilated rooms. While exposure among restaurant workers in establishments that allow smoking is relatively low (at least compared to smoking rooms), levels of exposure in smoking rooms are astronomical. Average nicotine levels are only about 6 ug/m3 in a restaurant that allows smoking, but 70 ug/m3 in a separately ventilated smoking room.

In fact, I have estimated that, assuming a relative risk of about 1.3 for the effect of secondhand smoke on lung cancer risk, restricting smoking to separately ventilated areas would likely result in an increase in lung cancer deaths in the population. This is because any gains from reducing secondhand smoke exposure among workers will be far more than offset by the losses due to increased secondhand smoke exposure of those in the smoke-filled smoking rooms.

While it is true that many restaurants may decide not to take on the expense of creating a separately ventilated smoking room, the state has no control over that. It is entirely possible that many restaurants will take advantage of this opportunity to continue catering to their smoking patrons, especially if it is true that smoking bans lead to decreases in revenue for restaurants.

If secondhand smoke is a hazard that requires a legislated solution, then it requires a legislated solution. And if it doesn't require a legislated solution, then it doesn't. This Oklahoma public policy makes no sense at all.

Moreover, public health advocates who supported this legislation cannot argue either that: (1) the state will simply strengthen the law in the future; or (2) localities will enact stronger laws. The former is unlikely, because once restaurant owners install expensive ventilation systems, it is unfair to require them to go totally smoke-free. The latter is not possible because of the preemption in the law.

Interestingly, there is no size limit on the allowed smoking rooms in restaurants. So a restaurant could essentially create a separately ventilated room that takes up most of the establishment, as long as it provides at least a few nonsmoking seats outside of that room. This is a method by which any restaurant could essentially skirt the law if it wants to. Just create a very small separately ventilated area for nonsmokers and then as long as it is enclosed, the rest of the restaurant can be allocated to smoking and non-smoking however the restaurant owner desires.

If secondhand smoke is as bad for workers as the Oklahoma legislature apparently feels (by virtue of their exercising the state's police powers to regulate the conduct of private businesses), then there is simply no public health logic to allowing workers to be exposed to extremely high levels of secondhand smoke in smoking rooms.

Without question, this law is going to increase secondhand smoke exposure for a number of workers in Oklahoma. And that number is totally up to the restaurant owners in the state. The legislature has absolutely no control over the health of the state's restaurant workers. They have abdicated responsibility over this health hazard to the whim of restaurant owners. To me, that's not public health. That's stupidity.

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