But they need to start small.

"It's got to be done very cautiously," said Dr. Rahul Gupta, chief health officer for the Kanawha-Charleston Health Department. "You've got to have the right timing for it, and you've got to have public opinion on your side."

Last week, Sen. Dan Foster, D-Kanawha, introduced a bill banning smoking statewide. But Foster conceded the bill had little chance of passing, and was introduced mainly to spur discussion of smoking as a public health issue.

Foster believes the key to passing workable statewide smoking regulations -- that aren't rife with exemptions -- is in concentrating on passing tough county-by-county regulations. By the time 35 or 40 counties pass tougher smoking bans, Foster thinks there will be enough public support to go statewide.

"It will be politically doable by then," said Foster, a surgeon and hospital administrator.

Gupta agrees that grass-roots support is necessary before lawmakers can be convinced to pass statewide smoking regulations. "You can do it top-down or bottom-up," he said. "What we're proposing is bottom-up."

Kanawha County officials passed a countywide smoking ban that includes bars and restaurants in 2008. Now that residents and business owners are used to the idea of a smoke-free environment, county health officials want to expand their duties to include a comprehensive approach to tobacco use in the county.

In addition to enforcing anti-smoking regulations, health officials want to start educational programs to talk about the dangers of smoking and provide services to help smokers who want to quit. Eventually, Gupta wants to get state funding for smoking cessation services that go beyond pamphlets and provide counseling, nicotine patches or other supplies to help smokers quit smoking.

Gupta wants Kanawha County to serve as a model that other counties in the state can follow for their own smoking regulations. Cabell County officials passed a smoking ban that includes bars on Jan. 27. Kanawha County health officials have been talking with officials in Monongalia County about smoking regulations similar to Kanawha County's.

Gupta admits current smoking regulations aren't perfect. Smoking is still allowed in Kanawha County bingo halls under state law. And lawmakers still smoke in the state Capitol in Charleston.

"They've basically exempted themselves from the county policy," Gupta said. Members of the Kanawha County health board voted Thursday to publicly censure the Legislature for smoking in the statehouse.

But once enough counties pass smoking bans, Gupta thinks there will be enough public support to go to the Legislature for strong statewide smoking regulations.

"It won't be in the next year or two," he said. "We do need state regulations for smoking, but now is not the time."

What county health officials don't want is a statewide smoking ban full of exemptions that doesn't allow counties to pass tougher rules. That's why tough county policies already in place and public support for tough regulations are important before pushing for statewide legislation.

"I think we're well-positioned to start to push this a little bit," Gupta said.

Reach Rusty Marks at rustyma...@wvgazette.com or 304-348-1215.