Business owners affected by the ban have five years to come into compliance.
Under the Indoor Air Regulation, restaurants were allowed to permit smoking if the smoking section was separate from the nonsmoking section. Several exemptions were granted and some businesses were grandfathered in, making it confusing, board members said.
The regulation passed in 1997, but was not enforced until 2000, said Dr. Donald Straus, the county health officer.
The amendment is not a quick fix, said board member Sandy Bienen, who called it both clear and unclear.
"It covers everything, but it doesn't specify anything," he said. He said, however, that said he favored the amendment overall.
"Smoking makes people sick," Bienen said. "Maybe there are some die-hards out there who still deny that ... or don't want to believe that."
Two public hearings held recently on the proposal netted passionate cries from those who favor and oppose the ban. Bienen said he was especially bothered by nonsmokers who oppose the ban.
"Why would people want to expose their friends and neighbors to something that's going to be unhealthy for them?" he said.
He then leaned forward and made eye contact with the 10 or so members of the audience.
"Have you ever had friends get emphysema?" he asked. "I have. And I've watched them drown in their body fluids."
Board member Ira Manley read aloud statistics that indicate of the world's 1.2 billion smokers, half will die prematurely from smoking-related diseases.
Nobody at Monday's board meeting spoke for or against the ban.
Last September, neighboring Berkeley County passed a smoking ban that went into effect shortly thereafter. All restaurants are now smoke-free.
Some restaurant owners in Berkeley County, including the proprietors of the popular downtown eatery the Blue White Grill, predicted they would close if the ban passed, said Berkeley County Health Department Administrator Jay Jack. The Grill owner recently told Jack business has been better than ever, Jack said.
Bars and the county's three tobacco shops are exempt, Jack said. Pikeside Bowl has an acceptable separate smoking room.
A business can be classified as a bar - and allow smoking - if alcohol makes up at least half of its sales, Jack said. The drawback is that anyone under 21 is not allowed to enter. Popular eateries that sell alcohol, like Applebee's, Ruby Tuesday and Outback Steakhouse, decided not to declare themselves as bars and therefore prohibit smoking, Jack said.
Jack, who lives in Morgan County and lost his mother, an uncle and a cousin to smoking-related cancer, said he "would like to see Morgan move toward what we have in Berkeley."
Jefferson County does not have a smoking ban.
A survey taken less than a year ago showed 83 percent of that county's 255 eateries either prohibit smoking or have a separate nonsmoking section, said Jim Hecker, chairman of Jefferson County's board of health.
"My belief is voluntary compliance with no smoking was pretty much under way," he said.
Hecker said he wants to wait and see how other counties resolve problems with their smoking bans. Several bans have been challenged in court, and officials in other counties have not been able to enforce their bans.
"There's no point in inventing the wheel again," Hecker said. "Somebody else is blazing the trail for me."
Regardless of the outcome of those cases, Hecker said Jefferson County officials eventually will have to decide whether to prohibit smoking.
"I don't foresee it in the immediate future," he said. "Down the line I think we're going to have to do something."