Miki K. Sakamura-Low, left, an inspector with the Southern Nevada Health District, and Steve Goode, environmental health manager, enter Henry's American Grill in Henderson last month after receiving complaints of smoking in the establishment. Photo by John Gurzinski.

Outside PT's Place along Rancho Drive, the sign says it all: Drink. Eat. Smoke.

A year ago, this wouldn't have meant much to passers-by. But considering the number of businesses that continue to flout the state's new smoking ban, these types of messages, which can be seen outside numerous Las Vegas taverns, might seem like a slap in the face to Nevada voters.

"What we are encountering in Clark County with these holdouts that are showing complete resistance to the law is open anarchy,'' said Buffy Martin-Tarbox, director of government relations for the state's chapter of the American Cancer Society.

Still, Martin-Tarbox, backers of the Nevada Clean Indoor Air Act and those who have supported other anti-smoking laws across the country say the response so far isn't unexpected. Given time, they say, enforcement and compliance will follow.

"Based on what has happened in other states and cities that have passed smoke-free laws, we anticipated it would take about three to six months for full compliance," Martin-Tarbox said.

"It seemed like Nevada would be on track except for some people who tried to overturn the will of the people, in Clark County," a reference to unsuccessful legal challenges that have been filed in Las Vegas.

Danny McGoldrick, vice president for research at the Campaign for Tobacco Free Kids, agreed with Martin-Tarbox. Nevada may be unusual among states because of the prevalence of gaming, but not when it comes to tobacco control.

"Nevada is no exception from what I've seen with the laws around the country, as well as around the world," McGoldrick said.

"I've seen it in Ireland, where everyone said it was never going to work. Ireland is the pub capital of the world. It happened in New York City. It happened in Lexington, Kentucky, where smoking was practically invented. My experience is enforcement can be done and very high rates of compliance can be achieved.''

Though he believes people need time to adjust, especially businesses, McGoldrick said the key to a successful smoking ban is consistent enforcement.

"You have to send a very clear signal that the law is real and going to be enforced,'' he said. "You can't allow some businesses to send the signal that they are going to be able to do whatever they want.''

But that's what's happening across the Las Vegas Valley. Patrons have sent in more than 1,300 complaints about businesses to the Southern Nevada Health District, which is charged with enforcement, and the first $100 citation has yet to be issued.

As it stands, enforcement consists of Health District food inspectors walking into businesses with food licenses searching not only for rat droppings, appropriate freezer temperatures and clean linens, but checking for "no smoking" signs, ash trays and customers who are lighting up.

"It's what we do,'' said Steve Goode, Health District environmental health manager, during an inspection of Henry's American Grill in Henderson last month. "It's just part of our inspection.''

The Health District had received several complaints about smoking in Henry's. When Goode and food inspector Miki K. Sakamura-Low arrived, they found a sign inside that read: "No Smoking in Restaurant."

In the restaurant area, there were no ash trays, nor was anyone smoking. Ash trays were located in an adjacent bar area, however.

Goode said he could smell smoke. He also noticed the restaurant's windows were open and the curtains were blowing outward.

"It's almost as if they were airing the place out,'' Goode said.

Since the Health District is strictly doing education at this point, the two just issued a warning notice.

Reached by telephone after the inspection, a representative for the business who identified himself only as Todd said he didn't want to comment.

Martin-Tarbox said the Health District is doing the best it can, but when businesses put up signs saying customers can still smoke, it hampers enforcement.

Adding to the Health District's challenge is the fact that no funding for enforcement exists and the state-mandated fine may be too low to catch the eye of a business that earns thousands from its smoking customers who play video poker.

In an attempt to recover costs for enforcement and raise the stakes, the Health District is proposing a $600 administrative fee be added to the $100 fine.

Businesses have already indicated they will fight that proposal as well.

Other states with longer-standing smoking bans in effect have seen it before.

Dian Kiser, co-director of Resources and Education Support People Everywhere Controlling Tobacco (RESPECT) in California, said it's common for business owners to show displeasure with a smoking ban.

In California, compliance was also an issue once its smoking ban was enacted for bars and restaurants in 1998.

Business owners complained that California's law was confusing, unfair and that money would be lost. Some ignored the law. But there came a point, Kiser said, when employers realized the law wasn't going anywhere.

"There's always a certain period of time for any law to go into effect before there is compliance,'' Kiser said.

"California's seat belt law took quite a while. Today we've reached over 95 percent compliance for it, and the seat belt law has been in effect since 1987. We are at about 96 percent compliance at bars, restaurants and all work places under the smoke ban. It has been a law now for almost 10 years.''

In California, first time offenders pay a $100 fine; the second offense is $200; and a third offense within the same year is $500, Kiser said.

After the third violation, California's Occupational Safety and Health Administration organization is required to investigate complaints and may hit employers with fines of up to $7,000 for violations classified as general or serious.

For employers that show willful disregard for the law, Cal/OSHA can issue fines of up to $70,000.

In New Jersey, which enacted its anti-smoking law in 2006, fines range from $250 to $1,000; in Florida, which enacted smoking bans in 2003, fines range from $250 to more than $2,000.

According to Arizona's smoking ban, which passed in November, violators face a fine of up to $500.

If the problem is chronic, the enforcing agency can take the case to Superior Court, which may impose a fine up to $5,000 per violation, said Michael Murphy, public information officer for the Arizona Department of Health Services.

Like Nevada's law, Arizona's smoking ban passed in November. But writers of the law decided to allow a six-month grace period so that county health departments, the public and businesses could prepare.

It doesn't go into effect until May 1.

Murphy said the state is in the process of holding hearings to go over any gray areas, such as what is the reasonable distance a person needs to be from a building to smoke.

"Right now, we're doing a lot of outreach. Our goal is to have businesses on board,'' Murphy said. "Some businesses have already started doing this and are in the process of building patio areas.''

McGoldrick, who said he is confident compliance would be achieved in Nevada, said there needs to be urgent education about why the law exists and the public needs to understand it has a right to breath clean air.

If self-policing doesn't work, McGoldrick said, the state needs to consider raising penalties.

In the meantime, the patience of some local bars is wearing thin.

"How can we compete when some of our customers are leaving our bars and taking their slot-machine money to a place that doesn't care about this law,'' asked Roger Sachs, co-owner and operations manager of Steiner's, which went smoke-free upon enactment of Question 5.

"I've told my employees over the last few months, we've got to hang in there.''