AT A RECENT meeting of the Kanawha-Charleston Board of Health, board members - responding to complaints of bar owners claiming their businesses were suffering because of the recently implemented expanded smoking ban - said they would be willing to look at any information presented to them.

Board chairwoman Brenda Isaac further noted that the board was "...not telling anyone they can't smoke... We're telling them their smoke hurts other people." Accepting the validity and sincerity of these statements at face value, what type of information should the Board and public seek and assess to consider enacting any revision of the policy?

A good place to start would be to review a report on secondhand smoke exposure released by the Centers for Disease Control and Prevention in early July. The good news is that by banning smoking in most public places between the late 1980s through 2002, exposure fell 70 percent. The bad news is that this reduced exposure was insufficient to eliminate any signs of exposure (still nearly 50 percent) in the population, "particularly children age four to 11." Over 60 percent of children still showed signs of recent exposure. The study further reported that between "1999 to 2004, children were four times more likely to be exposed at home than were adults - 23.8 percent versus 5.9 percent."

Although a review of bar owner revenues is certainly relevant to assess the impact of the current ban expansion, it is only part of the equation. Citizens establish Boards of Health not to regulate businesses but to protect and promote health. The question for the Board and public is how much the expansion of the ban reduced exposure (if any) to secondhand smoke for non-smokers - especially innocent children - and at what cost (if any) to bar owners? In view of the CDC study findings and bar owner claims, it is even reasonable to hypothesize, that as a result of expanding the ban, smoker exposure increased for non-smokers, especially children, as former smoking bar patrons remained at home in greater numbers. Such a finding would certainly question the cost-benefit of the recent expansion.

As a side note, it is also unclear if the current ban applies to facilities operating bingo games. Recent newspaper reports were conflicting. One writer claimed he had witnessed smoking and children exposed. Another stated smoking at such games had stopped. Clarification of the ordinance's scope and enforcement activities in this regard is necessary. The Board should take action if these venues still expose children.

Finally, although Ms. Isaac makes clear it is not her intent, many anti-smoking advocates admit they support the widest possible extension of smoking bans to make smoking difficult and inconvenient for smokers with the goal of enticing smokers to quit. Moreover, there is some evidence such efforts do just that. If so, obviously some non-smokers - previously exposed by such smokers - would have their exposure reduced through such bans.

The CDC study makes quite clear that we still have a long way to go to eliminate secondhand smoke exposure, especially in innocent children. This suggests we need to seriously look at information about the true prevalence and causation of current exposure and direct our efforts and resources where they will have the greatest impact.

Felsen is a public health physician and former health officer of Kanawha County.

AT A RECENT meeting of the Kanawha-Charleston Board of Health, board members - responding to complaints of bar owners claiming their businesses were suffering because of the recently implemented expanded smoking ban - said they would be willing to look at any information presented to them.

Board chairwoman Brenda Isaac further noted that the board was "...not telling anyone they can't smoke... We're telling them their smoke hurts other people." Accepting the validity and sincerity of these statements at face value, what type of information should the Board and public seek and assess to consider enacting any revision of the policy?

A good place to start would be to review a report on secondhand smoke exposure released by the Centers for Disease Control and Prevention in early July. The good news is that by banning smoking in most public places between the late 1980s through 2002, exposure fell 70 percent. The bad news is that this reduced exposure was insufficient to eliminate any signs of exposure (still nearly 50 percent) in the population, "particularly children age four to 11." Over 60 percent of children still showed signs of recent exposure. The study further reported that between "1999 to 2004, children were four times more likely to be exposed at home than were adults - 23.8 percent versus 5.9 percent."

Although a review of bar owner revenues is certainly relevant to assess the impact of the current ban expansion, it is only part of the equation. Citizens establish Boards of Health not to regulate businesses but to protect and promote health. The question for the Board and public is how much the expansion of the ban reduced exposure (if any) to secondhand smoke for non-smokers - especially innocent children - and at what cost (if any) to bar owners? In view of the CDC study findings and bar owner claims, it is even reasonable to hypothesize, that as a result of expanding the ban, smoker exposure increased for non-smokers, especially children, as former smoking bar patrons remained at home in greater numbers. Such a finding would certainly question the cost-benefit of the recent expansion.

As a side note, it is also unclear if the current ban applies to facilities operating bingo games. Recent newspaper reports were conflicting. One writer claimed he had witnessed smoking and children exposed. Another stated smoking at such games had stopped. Clarification of the ordinance's scope and enforcement activities in this regard is necessary. The Board should take action if these venues still expose children.

Finally, although Ms. Isaac makes clear it is not her intent, many anti-smoking advocates admit they support the widest possible extension of smoking bans to make smoking difficult and inconvenient for smokers with the goal of enticing smokers to quit. Moreover, there is some evidence such efforts do just that. If so, obviously some non-smokers - previously exposed by such smokers - would have their exposure reduced through such bans.

The CDC study makes quite clear that we still have a long way to go to eliminate secondhand smoke exposure, especially in innocent children. This suggests we need to seriously look at information about the true prevalence and causation of current exposure and direct our efforts and resources where they will have the greatest impact.

Felsen is a public health physician and former health officer of Kanawha County.