The Kanawha–Charleston Board of Health voted Thursday against an amendment to the local “clean indoor air” rules that would have allowed county casinos to designate a cigarette-smoking area of no more than 10% of the facility’s total floor area. The vote was 4–2. The measure was intended to bolster the gambling industry, but a majority of board members found the health risks unacceptable.
What the amendment was and what it would have allowed
The proposal was introduced by board member Jessica Hudson. The amendment applied only to gaming venues. Facilities that chose to use the exemption would have been required to meet two conditions:
- install a dedicated ventilation system in the smoking area;
- ban food service entirely in the area where smoking is permitted.
No other types of businesses were affected by the amendment.
How the board voted and who was in the minority
Only Jessica Hudson and board chair Jeremy Nelson, a senior executive at Moses Auto Group, voted for easing the rules. Opposing the amendment were OB-GYN Dara Aliff-Lao, nurses Lillian Morris and Danita Nellhouse, and physician Art Rubin.
Why the majority voted against it
“The financial impact certainly got my attention. But we’re not the Chamber of Commerce. We’re here for public health,” Aliff-Lao said after the meeting. She emphasized that deviating from established standards sets a dangerous precedent: “Once you start to water down the rules, they disappear altogether. We’ve seen this time and again in other areas of health care.”
Opponents of the amendment focused on the risks to casino workers, who would have faced continuous exposure to secondhand and thirdhand smoke. Particularly vulnerable would have been women who may not yet know they are pregnant and people with chronic conditions. “Mardi Gras gave a strong presentation, but as a health care professional I understand the health consequences. And they outweigh anything the casino could offer,” Nellhouse noted.
“We need a carve-out to stay competitive”
Nelson, who joined the meeting virtually, insisted on the need for an exemption from the rules. According to him, Mardi Gras has a huge impact on the local community, and the amount of money flowing across the state line to Ashland (Kentucky) “is alarming.” He called the situation a competitive imbalance that requires a flexible approach.
Supporters of the amendment also point out that casinos have to compete with the online gambling sector as well, which significantly complicates the situation. Online casinos are serious competitors because they let people gamble from home. And in that case, people decide for themselves whether to smoke or not.
A significant competitive advantage of online gambling platforms is also that they offer a wide variety of games. In the lineup of popular online casinos, in addition to familiar entertainment, there are plenty of new titles. These include bingo, crash games, Plinko, and games in a live-casino format. Games created based on classic board games have been especially popular. According to a comment from the authors of a review site covering the Monopoly Live game show—one we found among the top search results—the live-dealer format ranks highest among players. This is due to the opportunity to get the casino feel without needing to visit a physical venue.
Ultimately, this also allows smoking players not to limit themselves. Understandably, they would be more likely to choose that option than to visit a casino where they are restricted. This worsens the situation for brick-and-mortar casinos in West Virginia.
How Mardi Gras made its case
In October 2024, Mardi Gras Casino and Resort in Cross Lanes (West Virginia) approached the county board of health with a proposal for an exemption. The main argument was that the new Sandy’s Racing & Gaming casino in Ashland, about an hour’s drive away, allows smoking in designated areas and is drawing customers away. Mardi Gras representatives presented data on business losses and a decline in market share.
West Virginia’s alarming smoking and health statistics
Aliff-Lao recalled that smoking remains the leading cause of preventable death in the country. According to the CDC, nearly a quarter of West Virginia residents use tobacco products, the highest rate of any state. Lung cancer diagnosis rates here also exceed those of any other state. After cardiovascular disease, which is also worsened by smoking, cancer ranks second among causes of death, and lung cancer claims more lives than any other type of cancer.
Public opinion was nearly unanimous
The vote was preceded by a 30-day public comment period. Of the 36 comments received, only about five expressed support for the exemption. Those who spoke against it included casino patrons, representatives of the American Heart Association, and former smokers.
Who declined to comment after the meeting
Hudson declined to be interviewed after the vote. Nelson, who participated remotely, was also unavailable for comment.
Market share decline and an alternative view of the numbers
According to materials presented to the board, Mardi Gras’s market share fell from 41.2% at the end of 2023 to 32.8% in 2024. “Mardi Gras Casino will continue to see a steady decline unless action is taken,” the presentation said. However, Aliff-Lao pointed to another factor: the region’s ongoing population decline, which also explains the loss of customers. “We hope the casino finds other ways to make up the lost revenue. But our job as a board of health is the safety of visitors and employees,” she emphasized.
The amendment was not adopted. The decision was made following public discussion, and the existing clean indoor air rules in Kanawha–Charleston County remain in effect, with no exemptions for gaming venues.