When Norfolk considered enacting its own restaurant smoking restriction ordinance in 2007 under the theory that its inherent police powers trumped preemption and allowed the city to prohibit smoking in restaurants from the dangers of secondhand smoke, VFHF focused on fighting the tobacco industry in the state legislature where the industry was strongest because VFHF did not take the preemption issue to litigation. Given the limitations of the 2009 state clean indoor air law, Virginia advocates need to carefully examine Norfolk’s now-abandoned proposal, and consider using such a challenge to over compremption and allow localities to protect their citizens. Fostering the aspirations of cities such as Norfolk that wish for stronger smoking restrictions could give Virginia’s tobacco control efforts important support outside of Richmond. Local coalitions, like the ones that exist but are underutilized in Virginia, have been successfully used to promote organized statewide tobacco control policy change in other states. In Maine, the state health department established the Healthy Maine Partnership, which funded communities to implement statewide tobacco control policies on a local level.This allowed for an active grassroots organization that could be mobilized, for example, to oppose threats to tobacco control funding posed in the state legislature, or to carry statewide media campaigns to local audiences. This grassroots advocacy helped Maine to maintain its high levels of tobacco control funding despite considerable threats.Likewise, the South Carolina Tobacco Collaborative established a network of local tobacco control coalitions to enact statewide policy change goals at a local level. SCTC was able to use the local coalition base to enact a number of local clean indoor air ordinances and build a significant capacity for statewide tobacco control planning and strategy.

Virginia advocates should closely examine these models,sliding track shelving system with an eye towards utilizing the preexisting network of local tobacco control coalitions, funded and organized by the Virginia Health Department’s Tobacco Use Control Program, for grassroots advocacy. Tobacco growing has declined and the elimination of the tobacco quota system has made tobacco less profitable for farmers and made tobacco a relatively unimportant crop in the state. Although Philip Morris is headquartered in Richmond, tobacco manufacturing is a very small contributor to the economy of Virginia. Virginia advocates initiated the program that evolved into the Southern Communities Tobacco Project, and established ties with tobacco farmers, which led to negotiations concerning how MSA proceeds would be distributed and a continuing dialogue that addresses the common ground that may exist between tobacco farmers and tobacco control advocates. Virginia advocates have an opportunity to further develop their relationships with tobacco farming interests, potentially finding common ground in opposing the tobacco industry as happened in South Carolina. In South Carolina, the tobacco quota buyout opened a significant rift between tobacco growers and manufacturers that was successfully exploited by tobacco control advocates, leading to support among tobacco farming interests for a state cigarette excise tax increase in 2008 and shifting legislators representing tobacco-growing communities towards a more favorable attitude to tobacco control measures.This situation has not come about in Virginia, despite the declining importance of tobacco as a crop. Because similar conditions prevail in Virginia as in South Carolina, advocates should exploit the divisions between growers and manufacturers in a similar way, which would have the added benefit of deconstructing the myth of tobacco’s unassailable power over Virginia politics. Virginia should follow the example of South Carolina and take advantage of the increasingly unfavorable attitudes of farmers towards tobacco manufacturers.

Virginia advocates should also cultivate strong ties to the governor’s office. In 2009, advocates trusted Governor Kaine to consult them on tobacco control matters, but ultimately Kaine cut them out of the process entirely. Advocates need to ensure that the governor’s office is continually lobbied and educated about the issues, rather than assuming that he or she will support their positions. VFHF proved in 2008 that working closely with Governor Kaine’s office on comprehensive restaurant smoking restrictions could advance strong tobacco control legislation further than it would have otherwise gone. In addition, VFHF’s Fredericksburg campaign has shown that even hostile legislators can change their position with regards to tobacco control legislation with sufficient pressure. Advocates should continue to work closely with, and if necessary apply grassroots pressure to, the governor’s office regardless of his or her stance on tobacco control issues. While the Virginia Tobacco Settlement Foundation has won awards for its youth marketing activities and has finally adopted media campaigns that contain anti-industry messaging, VTSF-conducted Youth Tobacco Survey data shows that trends in youth smoking behavior in Virginia are not significantly different from national trends. VTSF needs to incorporate the lessons learned from successful programs elsewhere, such as Legacy’s “truth” campaign. As of 2009, VTSF became Virginia Foundation for Healthy Youth, and its mission has been expanded to include childhood obesity without any provisions for additional funding. Advocates should be vigilant that the obesity focus does not result in a denuding of resources available for effective tobacco control, including funding tobacco control entities that seek to reduce tobacco use in all groups, not just youth. The Tobacco Indemnification and Community Revitalization Commission , the other MSA-funded organization in Virginia, is also a poor use of such funds. With the tobacco quota buyout and the establishment of “Phase II” payments to tobacco growers and tobacco growing communities, TICRC should not utilize 40% of all MSA revenue.

Even a portion of TICRC’s funds could be used to significantly improve Virginia’s spending on effective tobacco control measures.Despite the challenging environment facing Virginia advocates in the near term, there are opportunities for successful tobacco control measures. Virginians overwhelmingly favor strong smoking restrictions and higher cigarette taxes, and these attitudes will continue as Virginia attracts new residents and as the tobacco farmers and manufacturers continue to contribute less to Virginia’s economy. Advocates have already demonstrated that they understand and are capable of implementing effective tobacco control tactics, such as the successful district campaign in Fredericksburg, but need to avoid the tendency to compromise too soon that has served public health poorly. With more resources and an effectively utilized grassroots base, there is no reason that Virginia should not be able to follow the example of other states in the region to implement effective tobacco control strategies.. Advocates in Virginia have an opportunity to utilize the growing support for strong tobacco control measures, if they can commit the necessary political and financial resources to the fight.There are a host of studies examining heat impacts on labor productivity and health [e.g., see ], as well as a recent spate of research around COVID-19. In the case of farm workers in California’s Central Valley Region, results show that an increase of the heat index from 95◦F to 100◦F can result in losses of agricultural productivity between 4 and 8%,sliding rack system depending on labor intensity of the crop . For COVID-19, the impact of agricultural workers’ reduction of hours of labor has been estimated to be ∼$301 M as of March, 2021 . Furthermore, pre-existing conditions that make farm workers vulnerable to heat also make them vulnerable to the impacts of COVID-19. Among them are obesity, smoking status, cardiovascular conditions, and diabetes. While temperature and humidity may be inversely related to COVID-19 transmission , it remains unclear if this is due to changes in human behavior . However, to our knowledge, no research has examined the dual burden of COVID-19 and extreme heat on labor productivity and laborers’ health and livelihoods. And yet, relative to the rest of the country, COVID-19 infections are among the highest and inoculation rates among the lowest among migrant agricultural workers in the United States . This, is a quintessential example of environmental injustice with farm workers—not consumers or land owners—among those who most suffer from this dual burden. The scholarly community has an opportunity to reconcile this deficiency with more research examining the coupling of the two health burdens. With anomalous heat events due to climate change on the increase, farm workers may lose more days of work in the future. COVID-19 will increase the number of days lost and may also worsen physical symptoms during high heat periods. With extreme heat events, the body suffers water loss and potential kidney damage . Adding COVID-19 to extreme heat, in the short term, could exacerbate morbidity and increase mortality by stressing the body beyond its capacity to deal with either burden adequately, much less the combination of the two. Does the twin burden of having suffered both simultaneously worsen the symptoms of one, the other, or both? Moreover, in the long term, does organ damage from excessive heat exposure—where heatstroke can damage heart, kidneys, liver, and the brain — intensify symptoms of “long” COVID, symptoms of which we are not yet aware? To our knowledge, no research presently exists to answer these questions. COVID-19 has a detrimental effect on our most vulnerable communities, including essential agricultural laborers, considered essential workers in the U.S. .

Due to the nature of their job, agricultural workers tend to have numerous points of physical contact and few opportunities for social distancing in the workplace. Moreover, living conditions for the great majority of farm workers are substandard and often temporary as they move from place-to-place following crop harvesting . Farm workers have experienced a comparably higher rate of COVID-19 infections relative to the general population. For example, in Monterrey County, California the observed rate of positive test results for Latino/a farm workers was 22% while that of the rest of the county population was 6% in November-December 2020 . Additionally, it is not possible to carry out this form of agricultural labor remotely or virtually, making farm workers more susceptible to infections in the workplace. The negative impact of COVID-19 on farm workers is exacerbated by a decrease in the availability of farm workers and an increase in their average age . Vaccine hesitancy contributes to the negative impacts of COVID-19 on the workforce of California’s food supply. In Monterrey County, for example, only about 50% of farm workers stated they were very likely to get vaccinated, while studies show that the same figure for the rest of the country is 69% . In more rural areas of the county, women and younger farm workers are more vaccine-hesitant, largely due to a distrust of the government, lack of information on the effectiveness of the vaccine, and concerns with side effects . The pandemic poses significant economic impacts to migrant farm workers and their families. For example, when farm workers become ill due to COVID-19, lose work hours, productivity, and income. Workers often need to continue working even when testing positive for COVID-19 . Working while infected with COVID-19 is likely to result in lower worker productivity, resulting in income loss . This action also presents an additional risk of infection to the rest of the agricultural workers, which multiplies the financial impact, as well as the long-term health impacts of COVID-19 on the agricultural labor force. Furthermore, farm worker income reduction due to COVID- 19 restrictions and infection impacts not only farm workers but also those who depend on the farm worker financially. For example, an impacted farm worker may become unable to pay for basic needs such as food, housing, electricity, and/or water for the farm worker’s family and/or other household members. Furthermore, the negative impacts of COVID-19 expand beyond the immediate family of the farm worker to those who depend on remittances in their home countries. Migrant farm workers, particularly in the Central Valley of California and southern U.S. states, endure extreme heat during the summer and early fall. Prolonged exposure to intense heat combined with physical labor can be deadly to agricultural workers, and numerous migrant worker deaths occur each year due to these circumstances. The CDC reports that heat deaths among crop workers are 20 times greater than among U.S. civilian workers, even when farms are in compliance with heat related safety regulations . Moreover, research has shown that from 2005–2014, 198 non-U.S. citizen deaths occurred on farms, which is over triple that of U.S. citizens . Further, many of these deaths and illnesses may not be counted due to cause of death , linguistic or cultural barriers, immigration status, and other factors . Exposure to heat over time can lead to severe illnesses such as heatstroke, dehydration, cardiovascular disease, and critical organ failure .