DES MOINES | The everyday effects of the 2008 state ban on smoking in public places hit home for proponent Janet Petersen when her kindergarten-aged child did not know what an ashtray was.

"It took eight years to get that bill passed," said Petersen, who was a Democratic state representative from Des Moines when the bill took effect five years ago Monday. "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."

The Iowa Smokefree Air Act bans smoking in most workplaces and public areas. Nebraska and South Dakota have similar measures. 

Christopher Squier, a professor in the University of Iowa Department of Pathology, Radiology and Medicine has researched smoking bans and cardiovascular disease. Squier says the ban -- along with a $1-a-pack cigarette tax increase in 2007 -- has reduced hospital admissions 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."

Squier was part of a research team that found two years after the law took effect there had been 17,500 fewer tobacco-related hospitalizations and an estimated 9,800 directly tied to smoke-free air. That equated to a savings of $240 million in hospital costs alone, researchers concluded.

Opponents said the restriction was a government intrusion into personal choice and free enterprise that would force bars to close due to a reduction in business. An exemption for casinos further angered opponents.

Mariannette Miller-Meeks, director of the Iowa Department of Public Health, said businesses have closed, although the impact has been positive overall. 

"We have certainly gotten complaints and comments and letters about that, but I also think that businesses tend to adapt very well," she said.

Sen. Jerry Behn, R-Boone, who voted against the 2008 smoke-free legislation, called the bill a "government overreach, pure and simple." He believes it should be repealed.

"It's very frankly one of those deals where an individual business owner should make that decision," said Behn. "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 disagrees.

"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," she said.

Jessica Dunker, president and CEO of the Iowa Restaurant Association, said the act has caused some financial hardship. She said that 2008 was "an extremely difficult year for the hospitality industry" with the recession and an increase in the state's minimum wage.

"There were just a number of hits that came all at once," Dunker said.

But if the smoking ban caused businesses to close, it wasn't reflected in the state liquor licensing data. There was an increase in overall state licenses for bars in 2009 and 2010 and the current total is about 550 higher than on July 1, 2008, Iowa Alcoholic Beverages Division data shows. 

The agency cited 45 state-licensed establishments for failing to comply with the law in its first year. The majority got a seven-day suspension and $1,000 civil penalty. Citations dropped to a handful each year after that. None were cited in fiscal 2013.

Jen Schulte, Iowa government relations director for the American Cancer Society Cancer Action Network, said the law protects workers and patrons from the known cancer-causing chemicals in second-hand smoke. Tobacco opponents still want the Legislature to end the exemption for casinos.

"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 secondhand smoke," said Schulte. "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."

The issue came before lawmakers last session. Wes Ehrecke, president of the Iowa Gaming Association, which represents the 18 state-licensed casinos in Iowa, argued that casinos have been proactive in installing air filtration systems.

Ehrecke also noted that state-regulated casinos would be at a competitive disadvantage with three Native American casinos not subject to the law.

Lifting the exemption on gaming floors would cause a 20 percent drop in casino revenues, his group estimates. That would cause a $60 million to $80 million decline in the $330 million in state taxes the facilities pay annually. Ehrecke also projects a smoking ban would cause up to 1,500 casino employees with a $40 million yearly payroll to lose their jobs.

Gov. Terry Branstad is an advocate of tobacco-free environments. He eliminated smoking at Terrace Hill and removed the cigarette machines from the Iowa Capitol. Branstad says the law was a positive step, but he doubts the casino exemption will be repealed.

"I don't know why there needs to be an exception, but I know the votes aren't there to change that," he said.

And while Petersen -- the former legislator -- is frustrated by cuts to smoking prevention and cessation programs, she says the five-year-old smoking ban has been a great success.

"I'm really, really pleased with how the law has gone into effect. When I talk to people about the Clean Indoor Air Act, I just rarely ever hear anything but positives. People in Iowa who love it, even smokers," said Petersen.

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