My summer road trip took me through the scenic State of Oklahoma.  As I drove heading north through the Sooner country, billboards line I-35.   They didn’t advertise restaurants, gas stations, insurance firms or country stores.  Billboard after billboard promoted one or more casinos in the State.   I wondered how it was possible for a rather sparsely populated locale could support what seemed like dozens of casinos.  One particular billboard caught my eye.  It read: “The only smoke-free casino in Oklahoma.”

There are 94 casinos in Oklahoma owned by 33 tribes.  Gaming is the second largest industry in the state, with annual revenues of about $3.5 Billion.   Most of the casinos have smoke-free areas on the property, but only one casino, the Kaw Nation’s Southwind casino, is completely smoke-free.  The Southwind casino opened this year and the tribe knows it is unique.  It will draw patrons because of its smoke-free status.  But the decision for the policy was not an easy one.  Just as the major restaurant associations vehemently argue against state and local bans on smoking, the Kaw Nation heard warnings that a smoke-free casino would be a bust.  Skeptics insisted that the policy would cause low revenues and the casino wouldn’t be viable.   That hasn’t been the case and the Kaw Nation has public health on their side.  Eliminating exposure to second-hand smoke saves lives.  The American Lung Association estimates that 50,000 individuals in the U.S. die each year because of exposure to it.

In the early 1970’s, researchers began publishing papers on the health effects of second-hand smoke.  Some of the studies were conducted by toxicologists and others by physician, epidemiologists and others.  Japanese researchers in the early 1980’s were the first to publish comprehensive analyses of lung cancer risk in non-smoking women who were exposed to tobacco smoke generated by their husbands’ cigarette habits (e.g., here, here, here).   In 1986, the U.S. Surgeon General issued his report “The Health Consequences of Involuntary Smoking,” followed in 1992 with the EPA’s risk assessment “Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders.”  EPA’s analysis in particular raised the ire of the tobacco industry, lead to the obstruction by the industry of regulations to protect the public from second-hand tobacco smoke.  Twenty years later, the tables have turned and public health has prevailed.

Twenty-eight states now have bans on smoking in public places, restaurants and bars.  Oklahoma is not one of them, but even if it were, native people on tribal lands would not have to comply with a State-imposed smoking ban.  Kudos to the Kaw Nation for taking the lead in the Sooner State.  I hope sooner, rather than later, public health will prevail across the state.