By Marshall Allen

Mon, Sep 25, 2006 (7:15 a.m.)

The American Lung Association is imploring all states to join the Smokefree Air 2010 Challenge by banning smoking in offices, restaurants, bars and casinos by the end of the decade.

But the organization's zeal is muted in Nevada.

Here, the American Heart and Lung Associations, as well as the American Cancer Society, are backing the Nevada Clean Indoor Air Act. The initiative, if passed by voters in November, would ban smoking in all public places where children are present. But it would permit smoking in 21-and-over taverns and in casinos.

The goal of an all-out smoking ban is taking a back seat to pragmatism and politics - at least temporarily.

"The Nevada initiative is a very positive step forward, and will protect many people in the state, but we want to protect everyone," said Paul Billings, vice president for national policy and advocacy for the American Lung Association in Washington, D.C. "We'll continue to move ahead."

Only 23 percent of Nevadans smoke, but local health advocates say gaming interests are too powerful to immediately restrict lighting up in all indoor public places. The fight has been so difficult here that current anti-smoking laws only apply to day-care facilities and school campuses. Politicians won't support more severe restrictions for fear of confronting the casino lobby, health advocates say. So the issue is being taken directly to voters.

"We look at so many states that have these complete bans now and forget they did them in very small steps," said Brooke Wong, executive director of the Nevada Academy of Family Physicians. "In Nevada, we've had to take baby steps the whole way."

Wong, who helped draft the language of the Clean Indoor Air Act, said the national cancer, heart and lung organizations are behind the initiative, though they pushed to make the ban as comprehensive as possible.

"It's a huge step in Nevada," she said.

Smoke-free legislation is a growing trend nationally, and the Center for Disease Control and Prevention says those laws are lowering smoking rates. Nine states are smoke-free, meaning smoking is prohibited in all indoor public places. Two other states and Washington, D.C., have passed smoke-free legislation that will be effective by 2009.

Internationally, anti-smoking laws are also becoming more common. Smoking was banned in Ireland's workplaces, including pubs, in 2004. In March, Scotland banned smoking in all enclosed public spaces. A report in the Annals of Oncology, the official journal of the European Society for Medical Oncology, showed that Italy's anti-smoking laws resulted in reduced tobacco use, did not harm business and increased public support for prohibiting smoking.

Michael Hackett, campaign manager for the Clean Indoor Air Act, said the initiative was drafted according to polling information that showed what the public would support. Surveys of voters indicated that "protecting children from secondhand smoke is the most important issue to Nevadans," he said. Nevadans also support allowing local municipalities to enact smoking bans, Hackett said, so that provision is also included in the Clean Indoor Air Act.

Craig Klugman, assistant professor of bioethics at the Nevada Center for Ethics & Health Policy, said there's a pragmatic aspect to public health that often requires compromise. In this case, it's essential to balance the needs of society - especially protecting children from secondhand smoke - with the rights of individual smokers, he said.

Nevada's gaming and tavern interests claim the Clean Indoor Air Act will hurt tourism. So they created their own proposal for voters, the Responsibly Protect Nevadans from Secondhand Smoke Initiative, which would create few changes other than removing smoking sections in restaurants where children are allowed. Smoking would still be allowed in grocery and convenience stores if gaming devices are present.