How Long Will We Hold Out?

In State News on January 19, 2011 at 12:36 pm

Opinion piece by Richard Feldman that was published recently in the Indianapolis Star.

The Indiana General Assembly again is considering a comprehensive smoke-free statute that would prohibit smoking in enclosed public places including worksites, restaurants and bars. The legislature has previously lacked the courage to overcome the powerful political influence of the tobacco industry. Hoosiers also fervently value personal liberties and resent intrusive governmental control of business. These attitudes, although understandable, are applied excessively regarding this issue.

Individual freedoms are not absolute; they are balanced by the greater public good, and they end when one’s actions injure another. Smokers do hurt those around them. Nonsmokers cannot always deliberately avoid environmental tobacco smoke. It is ubiquitous. Although the enactment of smoke-free laws has reduced the risk, studies demonstrate that Americans greatly underestimate their exposure to secondhand smoke. Commonly, people who believe that they are not exposed to smoking have significant blood levels of tobacco-smoke metabolites.

Also, workers may be trapped in smoke-filled environments. Jobs are not easily found and many workers have no alternatives. For example, I had a patient with severe asthma. She was a cocktail waitress in a smoky work environment that triggered her asthma. I advised her that she should find another job. Surprised, she looked at me and said, “Dr. Feldman, working in bars is what I do. It’s all I know. If I found another job, it would be in another smoky bar.”

Consider these additional facts as ample rationale for a smoke-free statute:

No legitimate study has ever found a negative economic effect of a smoke-free law on restaurants, bars, convention business or the hospitality industry. These include studies conducted in Bloomington and Fort Wayne. My goodness, the pubs in Ireland went smoke-free and they’re doing fine.

Environmental tobacco smoke annually kills 1,300 people in Indiana, 53,000 in the United States (including 6,200 children), and 600,000 worldwide. It is America’s third leading cause of premature death.

Secondhand smoke causes lung cancer and at least 15 other cancers in nonsmokers chronically exposed. Tobacco smoke is America’s number one airborne carcinogen.

Secondhand smoke significantly increases the risk of chronic obstructive lung disease and asthma in nonsmokers and various respiratory infections, including pneumonia, in children.

Environmental tobacco smoke increases the risk of heart disease in nonsmokers by up to 60 percent and stroke by 50 to 80 percent.

Before the era of smoke-free laws, restaurant and bar workers had up to four times the risk of lung cancer and more than twice the risk of heart disease as compared to other workers.

Numerous studies have demonstrated hospital admissions for acute heart attack have been reduced between 14 and 42 percent in the months after smoke-free laws take effect; in one study, hospital admissions for childhood asthma were reduced by 16 percent.

Pregnant women exposed to secondhand smoke have twice the risk of having a low-birth weight baby, which is associated with 40 percent of neonatal deaths. These women also have higher rates of miscarriage, premature birth and other obstetrical complications.

Secondhand smoke considerably increases direct and indirect costs to businesses and is responsible for $390 million in health-related costs yearly in Indiana.

Nearly two-thirds of likely Hoosier voters support comprehensive smoke-free laws that include restaurants and bars. That would be a landslide victory in any election.

As the Indiana legislature debated this issue last year, South Dakota became the 29th state to enact a comprehensive smoke-free statute. Minnesota, Wisconsin, Michigan, Ohio and Illinois all have good smoke-free laws.

Although there may be more momentum this year, its enactment remains an uphill battle. Will Indiana or Kentucky be the last state in the country to enact a comprehensive smoke-free statute? Tough call.

Feldman, M.D., is director of medical education and family medicine residency at St. Francis Hospitals and Health Centers and is a former state health commissioner. Contact him at


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