CLAYTON • St. Louis County Council Chairman Mike O'Mara said Thursday that the county's year-old smoking ban ordinance "needs to be tweaked" and that he's open to suggestions for eliminating exemptions to the ban.

"A year has gone by, and there are still small neighborhood businesses being hurt by it — and we need to sit down come up with something better," O'Mara said. "It's not an even playing field for all small businesses. Part of the solution is eliminating some exemptions."

O'Mara, D-Florissant, made his comments in response to a call Thursday morning by community leaders working with the Tobacco-Free St. Louis Coalition to eliminate exemptions.

The organization also released a study showing that North County has a disproportionately high incidence of heart attacks and lung diseases, putting residents at more risk from smoking. North County also has the most exemptions to the county ban — 56 of the 145, the group noted.

Its analysis also shows the fewest exemptions, 20, for Mid County, where some municipalities have adopted stricter ordinances that supersede the countywide ban.

Pat Lindsey, executive director of Tobacco-Free St. Louis, said the group intended to go to the County Council soon to ask it to remove the exemptions.

O'Mara said that before changes are made, businesses with and without exemptions and the public needed to be consulted.

"This (the Clean Indoor Air Act) was voted on by residents of St. Louis County," he said.

The ordinance was passed by a two-thirds majority in 2009 and took effect Jan. 2, 2011. Establishments are eligible for exemptions if food sales total less than 25 percent of the annual total sales of food and beverage.

O'Mara, who had voted against putting the issue on the ballot, said Thursday he preferred a statewide smoking ban to truly level the playing field.

County Executive Charlie A. Dooley has steadfastly supported a statewide ban.

As for changing the current ban, "that's pretty much in the hands of the County Council," said Dooley spokesman Mac Scott.

At the Tobacco-Free news conference, Dr. Stuart Slavin, a board member of the organization, said its study showed "the rate of exemptions is higher in the districts where health disparities are highest — making a bad health situation worse,"

Slavin, an associate dean of the medical school at St. Louis University, said, "We're failing those who need it most."

Dr. Rance Thomas, president of North County Churches Uniting for Racial Harmony and Justice, also spoke.

"Where people are most vulnerable in our community is where they are most likely to be exposed to secondhand smoke and poisonous air," Thomas said.

Bill Hannegan, who has fought smoking bans and heads Keep St. Louis Free, said he was not surprised by Tobacco-Free's effort because its "Obama stimulus money runs out" soon.

Tobacco-Free, based at St. Louis University, is the recipient of about $545,000 of a $7.6 million federal stimulus grant that St. Louis County received and distributed. The grant is expected to run out in June, a Tobacco-Free spokesman said Thursday.