DES MOINES — The everyday effects of state action in 2008 to curtail smoking in public places hit home for key proponent Sen. Janet Petersen when her kindergarten-aged child did not know what an ash tray was.
Ash trays in public places have become a scarce commodity since the Iowa Legislature passed and then-Gov. Chet Culver signed a ban on smoking in most workplaces and public areas five years ago. The statewide smoke-free Clean Indoor Air Act took effect on July 1, 2008.
“It took eight years to get that bill passed,” said Petersen, who was a state representative then. “Probably out of all the legislation I’ve worked on, that’s one that I’m most proud of because I think it’s changed people’s everyday lives.”
Christopher Squier, a professor in the University of Iowa’s Department of Pathology, Radiology & Medicine who had done research on the impact of smoking bans on cardiovascular disease, goes even farther. He said Iowa’s smoke-free law and a $1-a-pack cigarette tax increase in March 2007 have reduced hospital admissions for tobacco-related conditions and saved taxpayers millions of dollars in health-care costs.
“Those two together are probably the two greatest public health measures that have ever been enacted in the state of Iowa as measured in terms of improvements in health, reduction in disease and savings in health-care dollars,” Squier said. “They have an enormous impact, and it happened quickly.”
Two years into the new law’s implementation, Squier was part of a research team that determined there had been 17,500 fewer tobacco-related hospitalizations since the law took effect with an estimated 9,800 directly tied to smoke-free air. The average cost of a tobacco-related admission at that time was $24,500, so the reduction in admissions equated to a savings of $240 million in hospital costs alone, the researchers concluded.
Squier said it can be presumed the benefits in reducing the risk of debilitative or fatal cardiovascular disease have continued since then, especially since there was improvement in the data between the first year and the second year that the new law was in place.
Not everyone was a fan of the law prohibiting smoking in nearly all enclosed workplaces, including restaurants and bars. Exemptions were made for the gambling floors in state-licensed casinos and outdoor patios or decks at bars where food is not prepared on the premises.
Opponents decried the restriction as a government-intrusion into personal choice and free enterprise that would force bars and taverns, especially in small towns and near casinos, to close because of a reduction in business.
“There have been some businesses that have closed. We have certainly gotten complaints and comments and letters about that, but I also think that businesses tend to adapt very well,” said Mariannette Miller-Meeks, director of the Iowa Department of Public Health. “Many have adapted and are doing very well, but there were some that it effectively put them out of business. I believe the vast majority adapted to the law.”
Sen. Jerry Behn, R-Boone, who voted against the 2008 smoke-free legislation, called the bill a “government over-reach, pure and simple” and thinks it should be repealed, especially given that tobacco and cigarettes are legal products.
“It’s very frankly one of those deals where an individual business owner should make that decision,” Behn said. “I don’t think it was appropriate then, I don’t think it’s appropriate now. The mere fact that it’s still legal in casinos illustrates that it wasn’t about health.”
Petersen, a Des Moines Democrat, disagreed, saying part of government’s job is to protect public health, “and I can’t think of a public health initiative that can save more lives than making sure people aren’t exposed to second-hand smoke in the workplace.”
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Sen. Brad Zaun, R-Urbandale, who campaigned for Congress in Iowa’s 3rd District after the 2008 law took effect, said he encountered examples of bars or taverns in rural areas that closed because of the smoke-free restrictions that were particularly troublesome during winter months.
“I still believe that the system the way it was, was working. There were a lot of businesses that were smoke-free, and we, as customers of these businesses, had choices whether we wanted to patronize a smoking or non-smoking business,” Zaun said. “I’m still not happy with it, although on a personal level it is nice to go into different establishments and not smell like smoke when you leave, so I’m giving you a mixed answer.”
Jim Mondanaro, owner of Fresh Food Concepts and several restaurants and bars in the Iowa City area, said he has seen no negative economic impact as a result of the statewide smoke-free law.
“The smoke-free air law has been nothing but positive for my businesses,” Mondanaro said. “It is better for everyone involved in the food and beverage industry. It protects the health of my workers and guests and even prevents wear and tear on my buildings previously caused by cigarette smoke. Overall, this law has been a great success.”
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Jessica Dunker, president and chief executive officer of the Iowa Restaurant Association, said the smoke-free air act has caused a financial struggle in some communities or small taverns and bars that are close to the casinos, while it has evened out the playing field for many restaurants.
“It really depends on the category of the establishment that you’re looking at,” she said.
Dunker said 2008 was “an extremely difficult year for the hospitality industry all the way around” because of a combination of factors that included the onset of the nation’s worst recession, an increase in the state’s minimum wage and the smoke-free air act. “There were just a number of hits that came all at once.”
Tonya Dusold, communications director for the Iowa Alcoholic Beverages Division, said that if the 2008 smoke-free air law caused a business to close, it wasn’t reflected in the state licensing data. She said there was an increase in overall state licenses and those for bars only in both 2009 and 2010 and the current total is about 550 higher than July 1, 2008.
“There was never a drop as some feared,” Dusold said. “I can’t say that it didn’t put a single person out of business. That I don’t know. But it definitely did not have the statewide impact of a bunch of bars and restaurants going out of business that some initially had claimed it would for sure.”
In the first year of the new law’s implementation, Dusold the division cited 45 state-licensed establishments for failing to comply, with the majority of violators receiving a seven-day suspension and a $1,000 civil penalty. A small number received 30-day suspensions. Non-compliance dropped to a handful each year after that with no licensees being cited in fiscal 2013, she said.
Jen Schulte, Iowa government relations director for the American Cancer Society Cancer Action Network, said the law has protected workers and patrons from the known cancer-causing chemicals in second-hand smoke by making most Iowa workplaces free of cigarette smoke.
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She said tobacco opponents still want the Iowa Legislature to end the exemption for casinos, which they contend puts the health of employees and patrons at risk by breathing second-hand smoke linked to lung cancer, asthma, respiratory infections, heart disease and other serious health complications.
“Every worker in Iowa deserves to breathe smoke-free air at work. Until the law is applied to all Iowa businesses, all workers are not safe from the toxins found in second-hand smoke,” Schulte said. “We look forward to working with state leaders to make sure in the future no Iowa worker has to choose between their health and a paycheck.”
When the issue came before lawmakers last session, Wes Ehrecke, president of the Iowa Gaming Association, which represents 18 commercial casinos licensed by the state to operate in Iowa, argued that casinos have been proactive in installing air filtration systems for the benefit of their customers and employees.
Ehrecke also noted that state-regulated casinos in Iowa would be put at a competitive disadvantage by three Native American casinos that are not subject to Iowa’s Clean Indoor Air Act.
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Lifting the exemption on gaming floors would cause a 20 percent drop in casino revenues, which he said would have a $60 million to $80 million decline in the $330 million in state taxes the facilities pay annually. He also projected that a smoking ban would cause up to 1,500 casino employees with a $40 million yearly payroll to lose their jobs in an industry that collectively is Iowa’s largest tourism attraction.
Gov. Terry Branstad is an advocate for tobacco-free environments and eliminated smoking at Terrace Hill and removed the cigarette machines from the Iowa Capitol building. He said the 2008 state law has been a positive step, but he doubted an effort to repeal the casino exemption would succeed.
“I don’t think the votes are there to do that with the casinos,” he said. “I don’t know why there needs to be an exception, but I know the votes aren’t there to change that.”
Squier said he hoped the state would do more to fund tobacco cessation and anti-smoking education programs, noting the money was cut to $3 million while the Centers for Disease Control and Prevention recommends that $37 million in a state like Iowa be devoted to a comprehensive approach.
Miller-Meeks said new CDC data to be released this month will show that Iowa’s prevalence rate for tobacco smoking has gone down. Although there is more to do to get people to stop or not start smoking, she said progress continues to be made by targeting resources in areas such as social media messages to young people, web-based coaching and community partnerships that are proving to be effective.
“I’m really, really pleased with how the law has gone into effect,” Petersen said. "When I talk to people about the Clean Indoor Air Act, I just rarely ever hear anything but positives from people in Iowa who love it, even smokers.
“The frustrating thing is that the state really has not done a good job of keeping up with the tobacco cessation programs and the programs to make sure that our youth are not starting to smoke. Those are two areas where we can’t lose ground. We certainly don’t want more Iowans starting to smoke.”