Occupational exposure has also been shown to exacerbate asthma among workers previously diagnosed

Daily smoking among employees is also more common in workplaces with lax or absent smoke-free policies.Risk of SHS exposure in these environments is further compounded by potential exposure to other toxins, such as asbestos; workers in the building trades demonstrate higher risk for lung cancer and nerve damage as a result of work-place toxic exposures, including SHS.Enforcing clean indoor air laws is also a substantial task distributed among a variety of city and county agencies across the state and enforcement is unevenly applied. A study of clean indoor air policy enforcement and compliance by the California Tobacco Control Program found that about half of the agencies in the state tasked with enforcement had conducted workplace compliance checks in the previous year and approximately one-third did not report engaging in any SHS enforcement activity the year prior. Rural county agencies were also less likely to engage in enforcement activities than urban and suburban agencies.Additionally, certain types of bars may be especially resistant to adopting clean indoor air policies; for example, studies in San Francisco and Los Angeles have found persistent indoor smoking in Irish and Korean bars, respectively.SHS exposure has been linked to excess mortality and years of potential life lost, especially among non-white populations, primarily as a result of cardiovascular disease or lung cancer.It has also been associated with the development of respiratory disease among children and adolescents as well as young adults employed in workplaces without smoke free policies.Furthermore, there is growing evidence that the accumulation of SHS residue on surfaces, or third hand smoke, may also be harmful to health and that third hand smoke toxicity increases over time.Alternatively, studies measuring health exposures and effects following the implementation of comprehensive smoke-free workplace policies indicate that such policies are effective in restoring lung function in otherwise healthy workers,pot drying reducing tobacco use among employees and reducing cardiovascular disease morbidity as well as hospital admissions for heart attack.

Although young adults have been identified as having greater risk of workplace SHS exposure, we were unable to identify any study looking at occupational differences in exposure in this population. Using data from the 2014 San Francisco Bay Area Young Adult Health Survey , a probabilistic household sample of young adults aged 18–26 in Alameda and San Francisco Counties, we investigate whether differences by occupation exist and what other sociodemographic and behavioural factors may account for such discrepancies. Specifically, we hypothesise that young adults working in service, construction and trades sectors, that is, lower income occupations with greater likelihood of exemption from California’s Smoke-Free Workplace Act, will report greater SHS exposure in the workplace. This study used data that we collected as part of the 2014 San Francisco Bay Area Young Adult Health Survey, a probabilistic multimode household survey of young adults aged 18– 26 years, stratified by race/ethnicity.32 The study area included Alameda and San Francisco Counties in California. We identified potential respondent households using address lists obtained from Marketing Systems Group ; there was an ~40% chance that an eligible young adult resided at a selected address . We further used 2009–2013 American Community Survey and 2010 decennial census data in a multistage sampling design to identify Census Block Groups and subsequently Census Blocks in which at least 15% of residents were Latino or non-Hispanic black adults in the eligible age range in order to randomly select 61 blocks . We oversampled these blocks as young, non-white, urban adults are among the most difficult populations to survey.We then canvassed each selected block to create housing unit lists from which housing units were randomly selected, and on visiting each household we asked whether a young adult in the eligible age range resided there and if we could speak to the youngest or oldest young adult according to our randomisation procedure. We conducted the survey in three phases and employed four modes . In the first phase, we conducted three mailings over the course of 6 weeks with sample 1 households, and respondents returned paper questionnaires or completed surveys online using Qualtrics. In the second phase, we reached out to mail non-responders via telephone, and finally we conducted face-to-face interviews with a random selection of the remaining non-responders from sample 1 as well as all of the households identified in sample 2.

Potential sample 2 respondents did not participate in the mail or telephone phases of the survey; each of these households was visited in person to supplement the original sample and maximise the possibility for completing questionnaires among Latino and black young adults. The final sample consisted of 1363 young adult participants, reflecting a response rate of ~30%, with race, sex and age distributions closely reflecting those of the young adult population overall in the two counties surveyed. Approximately two-thirds of respondents replied via mail or online with most of the remaining responses completed in the face-to-face phase; only a handful of questionnaires were completed via telephone. Individual sample and post stratification adjustment weights were constructed after data collection. Using a representative population-based sample of young adults in the San Francisco Bay Area, we evaluated differences in self-reported workplace SHS exposure by occupation. To the best of our knowledge, this is the first study focusing on occupational disparities in SHS exposure among young adults. Consistent with past findings among employed adults across the age range and with our hypothesis, we found that young adults working in lower wage occupations report greater workplace SHS exposure.In particular, young adults employed in service, construction, maintenance, transportation and material moving sectors appear to be at greatest risk. These occupational sectors are also more likely to be exempt from California’s Smoke-Free Workplace policy.We also found very good or excellent self-rated health to be inversely related to workplace SHS exposure, suggesting that employees in better health may be less sensitive to SHS or may be more likely to work in environments with stringent smoke-free policies. Alternatively, variations in the amount of exposure within occupation may mean that employees experiencing less SHS exposure are healthier than their counterparts. Additionally, non-Hispanic black young adults were at greater risk of workplace SHS exposure before controlling for self-rated health, indicating that self-assessed health is a mitigating factor in reporting SHS exposure for this population. It is notable that nearly all of the young adults reporting SHS workplace exposure indicated that they were exposed outdoors at their workplace. Employees in the occupations implicated may have more occasion to be outdoors due to the types of job duties they perform, such as at a construction site or loading dock or serving customers on an outdoor bar patio. Thus while clean indoor air laws appear to be reducing SHS exposure indoors,cannabis drying more attention needs to be paid to outdoor areas immediately surrounding workplaces.

California as well as San Francisco and Alameda Counties do have smoke-free entrances policies in place that disallow smoking within a ‘reasonable distance’ of entrances to commercial, multiunit residential or mixed-use buildings, but the extent to which these policies are enforced or followed is an open question. Recently, the Tobacco Free Project at San Francisco County Department of Public Health implemented a media campaign under the banner ‘curb it’ designed to better inform the public and business owners about the smoke-free entrances policy,but more such efforts sustained over time and backed by enforcement procedures with teeth may be required to substantially reduce the type of outdoor workplace exposure experienced by the young adults in our sample. More than one-third of the civilian employed young adult population in California works in these occupations at greatest risk of workplace SHS exposure, equating to upwards of one million young adult workers.Latino young adults, a population identified in prior studies as at greater risk of exposure, are also disproportionately represented in service and construction sectors while those identifying as other or multiple races and women are also over represented in service sectors.Young adults employed in service occupations also have the lowest average annual earnings compared to other employees .Malaria is a significant public health problem affecting predominantly vulnerable pregnant women and children in Africa. Interestingly, in Southeast Asia, there has been a change in malaria epidemiology where the adult male population has borne a greater burden of disease. Although there is a strong correlation between malaria and poverty, malaria is both a cause and a consequence of poverty. Malaria’s devastating effects have historically been observed in countries of the Greater Mekong Subregion . Since the inception of the World Health Organization’s Mekong Malaria Program a decade ago, the malaria situation in the GMS has been greatly improved, reflected by the continuous decline in annual malaria incidence and deaths. However, as all countries within the GMS are moving towards malaria elimination, significant challenges remain, particularly in Myanmar, where the regional malaria burden is the heaviest . Malaria epidemiology in this region has several characteristics, including being an epicenter of antimalarial drug resistance, high malaria transmission in the forested fringe areas and in the remote border region, and cross-border malaria introduction due to human movement. For example, over 90% of the imported falciparum malaria in China was introduced across the China-Myanmar border.

As the GMS countries aim at malaria elimination by 2030, it is crucial to examine the current situations of malaria epidemiology and vector biology in the high-risk border region so that optimal elimination strategies can be developed. Vector control has historically been the most effective method to reduce malaria transmission. It remains the most important tool available, but its effectiveness relies on a thorough understanding of vector biology and their interactions with the environment. Due to human population expansion and an increasing demand for food supply, deforestation has become a very serious problem in the China-Myanmar border area. Consequently, previously forested areas are often converted to lands for subsistence and cash crops. The changes in the environmental conditions in the area have been shown to alter malaria vector species composition and in turn, malaria transmission. Different vector species vary in their feeding behaviors and vector competence. However, the ecological mechanisms underlying malaria vector species succession are not well understood. The objective of the present study is to determine the effects of land use and land cover on the adult survivorship of major malaria vector species in the China-Myanmar border area using the life-table experiments. We found that mosquito survivorship was strongly influenced by the micro-climatic conditions such as ambient temperature, which is directly affected by land use and land cover. This information is useful for predicting the impact of environmental and climate changes on vectorial capacity.No specific permits were required for the described field studies. For mosquito collection in banana fields, oral consent was obtained from field owners in each location. These locations were not protected land, and the field studies did not involve endangered or protected species. The use of mice in mosquito blood-feeding was performed in strict accordance with the recommendations in the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health. All of the animals were handled according to approved institutional animal care and use committee protocols of University of California at Irvine.The study was conducted in the China-Myanmar border region . The study sites were located in Kachin State, Myanmar and Yingjiang County of Yunnan Province, China . The study area covered an area of about 100 km2 , including two villages in China and one site near the town of Laiza, Kachin State in Myanmar. The two sites in China differ in elevation with Nabang at 240 m and Daonong at 660 m above sea level. The site in Myanmar, Je Yang Hka, is about 5 km from Nabang with an elevation of ~200 m above sea level. The study area is a hilly area, with mountains being covered mainly by forest or maize/banana plantations after deforestation and the valley areas being covered by banana plantations. Rubber, black pepper, and banana farming are the predominant agricultural activities, and food crops of mostly maize are cultivated at a very small scale. The average annual rainfall in the past 30 years was 1,464 mm and average monthly ambient temperature was 19.3°C.

Pyrethroids were detected in house dust in several study homes

Imiprothrin was only detected in one of the urban homes which reported usage during the study; no other urban home had detectable imiprothrin levels indoors even though some of these households reported applying imiprothrin indoors prior to the study. Concentrations in samples collected 5-8 days apart in the same home were positively and significantly correlated for the most frequently detected analytes , except allethrin; Spearman rank-order correlation coefficients ranged from 0.70 to 1.00 .We detected several pesticides in most homes, including OP pesticides previously phased-out for residential uses, pyrethroids, and the pesticide synergist piperonyl butoxide . Biological exposure metrics for these pesticides are relatively transient and highly variable, typically reflecting recent exposures. However, consistent with other studies, we found that dust serves as a stable matrix and indicator of potential indoor exposure for some pesticides. The high correlations observed indust concentrations from samples collected 5-8 days apart suggests that, for some pesticides, measurements in house dust may be relatively stable indicators of potential indoor exposure over this time frame. To our knowledge, this is the first study to evaluate the correlation of concentrations within homes for several pesticides over a short sampling period. Although the detection frequency for chlorpyrifos and diazinon was higher in Salinas than Oakland, we did not observe statistically significant differences in pesticide concentrations or loadings between locations. This is notable given that >28,000 and 65,000 kgs of chlorpyrifos and diazinon, respectively, were applied for agricultural purposes in Monterey County in 2006 and minimal applications occurred in Alameda County. Previously, we showed a significant correlation with local agricultural use and chlorpyrifos dust concentrations for homes throughout the Salinas Valley. Mapping of dust concentrations and agricultural use suggests that chlorpyrifos dust concentrations are higher in the center of the Valley , container for growing weed where agricultural use is higher. farm worker homes in the present study were from the city of Salinas where the impact of drift from agricultural applications may have been lower.

Additionally, our small sample size may have prevented us from observing significant differences in concentrations between locations for these OP pesticides as well as other analytes. Malathion was not frequently detected in homes from either location; however, higher levels were observed in urban homes. This pesticide is used in agriculture and is also registered for use in home gardens, as a building perimeter treatment, as a wide-area spray for mosquitoes, and by prescription for head-lice control.However, no parents reported treating their children for lice or using it themselves in their gardens. The main county uses for this OP pesticide in 2006 in the urban region were landscape maintenance and structural pest control. These applications were reported more than 25 km away from the nearest study home, thus it is not readily apparent why higher levels were observed in urban homes although it should be noted that we only sampled a small number of homes. We generally observed significantly lower house dust concentrations of chlorpyrifos and diazinon in the present study compared to levels measured in dust from homes located in the same zip codes sampled between 2000 and 2002, suggesting that indoor concentrations in the city of Salinas are decreasing despite continued agricultural use in the area. In New York City, air concentrations for these OP pesticides in low-income homes also significantly decreased between 2001 and 2004. The temporal declines in indoor concentrations reported here and in the New York City study may reflect the decreasing usage of these OP pesticides for home or structural applications per the U.S. EPA’s residential phase-out. Nonetheless, despite declining concentrations indoors, detection of these OP pesticides, especially in Oakland where there was little agricultural or structural use, underscores their persistence indoors. Compared to other studies in farm worker populations , we observed lower median concentrations for chlorpyrifos and diazinon. These farm worker studies generally reported a wider range of concentrations for these two OP pesticides and collected dust samples prior to the residential phase-out. One study by Curl et al. reported a wider range of diazinon concentrations, but comparable median concentrations . Although malathion was not frequently detected in our farm worker homes, a wider range of concentrations was reported in previous farm worker studies. To our knowledge, only one other study has reported OP pesticide concentrations in low-income urban homes. This study reported higher median concentrations for chlorpyrifos and diazinon in low-income urban housing units in Boston, MA. Homes in this study were sampled just after or during the residential phase-out of chlorpyrifos and diazinon, respectively .

Similar to low-income urban housing units in Boston, MA, pyrethroids and PBO were detected in higher concentrations and used more frequently in our study homes compared to other pesticides. This finding is consistent with the fact that pyrethroid insecticide formulations for residential applications have largely replaced OP pesticide residential formulations. Although over 19,000 kgs of permethrin were applied in Monterey County in 2006 for agricultural purposes, we did not observe significant differences in permethrin concentrations between locations. Allethrin and cypermethrin were also widely detected in most homes. Our findings suggest that home use likely contributed to the presence of pyrethroid pesticides in house dust since pyrethroids were commonly used indoors and negligible to no agricultural applications took place at the county level . It is also possible that structural pest control applications influenced indoor detection of certain pyrethroids in some homes. For example, it is estimated that ~80% of the non-agricultural cypermethrin use reported in Alameda County in 2006 was for structural pest control. The presence of pyrethroids in house dust is also consistent with their physical and chemical properties, including high octanol:water partition coefficient values and low vapor pressures . To our knowledge, only two studies have measured pyrethroid dust concentrations in farm worker homes. Similar to the present study, permethrins were the most frequently detected pyrethroids indoors. Median cis- and transpermethrin concentrations in our farm worker homes were higher than those observed in a previous study. The detection of chlorthal-dimethyl in all Salinas farm worker homes and none of the Oakland urban homes is consistent with other Salinas Valley studies showing an association between agricultural use and house dust contamination and a positive correlation between outdoor and indoor air concentrations. This herbicide had relatively high agricultural use in the Salinas Valley and is not found in home-use pesticides. Chlorthal-dimethyl also has a high log Kow value and low vapor pressure , and may be bound to particulate matter at room temperature. Over 16,000 kgs of malathion and iprodione were used in 2006 for agricultural applications ; however, they were not commonly detected in farm worker homes from the city of Salinas. For some of these pesticides, e.g., iprodione, LODs were higher than for other analytes. Other factors including physicochemical properties, e.g., high vapor pressure and low log Kow values ,cannabis square pot may have resulted in lower detection frequencies.

These pesticides were also not frequently detected in dust samples from our previous study in the city of Salinas. This study has several limitations. Location differences in pesticide dust levels have been reported previously when using loadings rather than concentrations; however, our small sample size limits statistical power and may have prevented us from observing statistically significant differences between locations for concentrations and/or loadings. Additionally, although homes with insufficient sample mass were demographically similar to those with adequate sample mass, exclusion of these homes may have introduced some bias and prevented us from detecting a difference in pesticide concentrations and/or loadings between locations. We also focused on low-income homes and thus the results may not be generalizable to other populations. Although estimated intakes for select pesticides were below EPA RfDs , it should not be concluded that intakes below RfDs are “acceptable” or free of any health risks. For example, recent studies have identified mechanisms of OP pesticide toxicity that were not considered in defining current U.S. EPA RfDs. Moreover, RfDs do not account for differences in vulnerability to pesticide toxicity due to genetic factors, such as paraoxonase polymorphisms. Additionally, our intake calculations for pesticides do not account for other exposure pathways ; nor did we consider that some children could have pica or other behaviors that could increase or decrease intake. Although we surveyed participants on their usage of pesticides indoors, we were not always able to corroborate whether formulation ingredients were present at high concentrations as the pesticide containers were not always available to confirm the active ingredients. Lastly, children in the homes sampled are clearly exposed to multiple indoor contaminants and our hazard evaluation does not account for exposure to complex mixtures.The number of people with Parkinson’s disease has more than doubled in the past 30 years and, absent change, will double again by 2040. Numerous genetic causes or risk factors for the disease have been identified, but the vast majority of individuals with PD do not carry any of these mutations. Several environmental toxicants, especially certain pesticides, have also been linked to PD, and head trauma is also associated with an increased risk. However, these are insufficient to explain the widespread prevalence of PD. Given the disease’s growing rates—more than can be explained by aging alone—other less visible causes must be contributing to its rise. One of these may be trichloroethylene , a ubiquitous chemical that has contaminated countless sites and poses health risks to those who are exposed via their work or their environment.The evidence linking TCE to PD to date is based on a handful of case studie, a small epidemiological study linking exposure to a 500% increased risk of PD, and numerous animal studies demonstrating that the chemical leads to the pathological hallmarks of PD. Here we introduce the chemical, describe its association to PD and other diseases, detail its widespread use and routes of contamination, and provide circumstantial evidence for its broader role in PD through illustrative cases depicting individuals with the disease who were likely exposed to TCE through their environment or occupation. We conclude with a call for greater research on its effects on PD, protection from and remediation of contaminated sites, and banning of this century-old chemical that has caused immeasurable harm to the public’s health.TCE is a simple six-atom solvent that is clear, colorless, volatile, nonflammable, and environmentally persistent. It was first synthesized in the lab in 1864 , and commercial production began in the 1920s. Because of its unique properties, TCE has had countless industrial, commercial, military, and medical applications. Among these are producing other chlorinated compounds , cleaning electronics, and degreasing engine parts for civilian and military purposes. As it readily evaporates and does not shrink fabrics, TCE was used to dry clean clothes beginning in the 1930s. A closely related chemical called perchloroethylene , which has one additional chlorine atom in place of the hydrogen atom, largely supplanted TCE in dry cleaning in the 1950s. In anaerobic conditions, PCE often transforms into TCE, and their toxicity may be similar. TCE is found in numerous consumer products , including typewriter correction fluid, paint removers, and carpet cleaners. Until the 1970s, it was used to decaffeinate coffee. The volatile TCE was also an inhaled anesthetic until the U.S. Food and Drug Administration banned it in 1977.Studies linking TCE exposure to PD and parkinsonism date back to at least 1969 when Huber reported parkinsonism in a 59-year-old man who worked with TCE for over 30 years. Thirty years later, Guehl and colleagues documented PD in a 37-year-old woman who was exposed to the chemical while cleaning houses and again while working in the plastics industry. In 2008, Gash and colleagues reported that among 30 factory workers, three developed PD after using TCE for many years to degrease and clean metal parts. These three workers were stationed closest to an open TCE vat, and 14 of 27 workers who were further from the source “displayed many features of parkinsonism, including significant motor slowing”.Four years later, researchers found that in twin pairs, the twin with occupational or hobby exposure to TCE had a 500% increased risk of PD compared to their unexposed twin. Exposure to the closely related solvent PCE also trended toward significance with an odds ratio of 10.5. Notably, the researchers found an interval of 10 to 40 years from the time of TCE exposure to PD diagnosis.

The reason for using cannabis in this patient was that pain relief was inadequate with Percocet

Consistent with these observations in other pathologies, cannabinoids may also reduce oxidative stress and pain in SCD.Erythrocyte adhesion, nitric oxide depletion, hemolysis, oxidative stress and inflammation accompany endothelial dysfunction in SCD.Endothelial activation causes upregulation of adhesion molecules including selectins, vascular cell adhesion molecule and intercellular adhesion molecule 1, which exacerbate vaso-occlusion and end-organ damage.CB1R and CB2R are widely expressed on vascular smooth muscle cells and endothelium.Both receptors have been widely studied in vascular relaxation and activation of ion channels including potassium, calcium and TRPVs.Antagonistic roles are demonstrated in different settings and disease states with respect to CB1R and/or CB2R.Thus, it is likely that cannabinoids influence endothelial function in a sickle-specific micro-environment.Cannabis and cannabinoids have been evaluated clinically for their analgesic potential in various disease states, and recently these findings have been described in a systematic review.Studies indicate that smoked cannabis may provide analgesic support in chronic and neuropathic pain, but smoking is associated with its own risks and pathologies; thus, other formulations and routes of administration are also being investigated.To date, several double-blind placebo-controlled studies have been completed to evaluate the safety and efficacy of oral THC and/or Sativex which delivers a controlled dose of 2.7 mg THC and 2.5 mg CBD per spray.Sativex has also been tested in several pain contexts, including cancer, chronic abdominal pain, multiple sclerosis, brachial plexus injury, and diabetic neuropathy.In a study of chronic abdominal pain,container for growing weed oral THC did not reduce measures of pain, but was well-tolerated and absorbed over a 2-month period.

In contrast, Sativex was effective at providing sustained relief of central neuropathic pain in patients with multiple sclerosis on fixed and self-titrating schedules compared to patients receiving placebo.Moreover,Sativex improved pain at targeted responder levels and significantly improved sleep in difficult-to-treat neuropathic pain arising from brachial plexus avulsion and allodynia-characterized neuropathic pain .The latter study was followed-up with a 52-week open-label trial in which pain relief was maintained without dose increase or toxicity.While promising, these studies must be evaluated critically due to their potential for biases related to sampling.Another growing concern is the safety of approaches to alter endocannabinoids, which was most notable with the failed study involving the fatty acid amide hydrolase inhibitor BIA 10-2474.The study was terminated following the death of a patient and irreparable side-effects in other participants.In retrospect, the compound was not as selective of an inhibitor as it was previously believed to be, and early signs of toxicity in pre-clinical studies went ignored.This instance highlights the need for careful, well-controlled pre-clinical studies before undertaking clinical trials.To date, several other clinical studies involving cannabis, THC preparations, and/or Sativex have been completed in patients with chronic pain arising from various diseases.Results from these studies indicate no effect to mild effect at reducing chronic pain, improving sleep quality, and improving patient-reported quality of life.Side-effects from these studies are also limited, and it appears that low doses are well-tolerated.The results from these studies, however, have not undergone peer review, and thus must be heavily scrutinized before any recommendations can be made.The identifiers for the aforementioned studies follow: NCT01606202, NCT00713817, NCT00710424, NCT01606176, NCT01262651, and NCT00241579.Increased access to medicinal cannabis has also shifted open use in SCD patients, with studies reporting greater disease severity and decreased in-patient hospitalizations in patients receiving medicinal cannabis.A cross-sectional study of adults with SCD was performed at the Yale New Haven Hospital, based on patient reported outcomes for pain and health-related quality of life questionnaire using the Adult Sickle Cell Quality of life Measurement Information System to assess VOC pain frequency/severity and impact of pain and Patient-Reported Outcomes Measurement Information System for qualitative assessment of nociceptive and neuropathic pain.

The effect of cannabis on baseline pain and acute pain HRQoL outcomes was examined factoring in for SCD genotype, disease severity, age, gender, genotype, hydroxyurea use, oral morphine equivalents and transfusions, etc.Approximately 20% of SCD subjects reported using cannabis daily compared to 55% non-users and others who used weekly, monthly or in between.Daily users reported significantly higher pain episode severity scores than non-users.However, propensity matched with variables on pain outcomes showed that daily cannabis users reported fewer annual ER visits and annual admissions.Matched for pain impact score for daily pain with other aforesaid variables, daily users had 1.8 and 1.2 fewer annual admissions and ER visits.Similarly, using daily opioids dispensed as a measure of pain matched for other variables showed daily users had 2.5 and 1.5 fewer annual admissions and ER visits compared with others.Since daily users had more severe pain crises, it is inferred that daily use is associated with higher severity of pain crises and that comparisons need to factor in the pain severity and account for other factors such as ability to tolerate pain better.A pilot study performed by our group investigated the analgesic potential of vaporized cannabis in SCD patients.Twenty-three patients with SCD-related chronic pain receiving opioids completed a randomized double-blind placebo-controlled crossover trial, inhaling vaporized cannabis or placebo during two separate five-day inpatient sessions that were separated by a 30-day washout period.Vapors were collected in-house by vaporizing cannabis containing 4.4% THC and 4.9% CBD, obtained from the National Institute on Drug Abuse.The crossover design allowed for each patient to serve as their own control.Pain was assessed throughout each treatment period along with pain interference measures.The crossover-pain difference between cannabis and placebo treatment was negative for each treatment day indicating a decrease in pain with cannabis treatment; however, this decrease was not statistically significant.Additionally, pain levels were generally lower in patients given cannabis when compared to those given placebo, but this difference was also not statistically significant.As each five-day study period progressed, patients given cannabis square pot reported that pain interfered less with activities, including walking and sleeping, with a statistically significant decrease in interference with mood.Importantly, this study showed that vaporized cannabis is well-tolerated and significantly improves “mood” in SCD patients with chronic pain.

The lack of significant adverse effects in this study encourages further investigation into the use of cannabis-based interventions including CBD to treat chronic SCD pain in prospective trials with a larger cohort over a longer duration.Questionnaire-based approaches have provided insight into the prevalence of cannabis use in the SCD community, and these studies have given first-hand accounts of the patients’ perceived benefits and motivations for seeking cannabis.A 2018 survey of 58 patients living with SCD revealed cannabis use in 42% of respondents.The majority of these individuals reported medicinal purposes, though some indicated recreational use of cannabis.The self-reported use further indicates the need to study cannabis to understand its potential risks versus benefits.An anonymous questionnaire study of Sickle Cell patients in the United Kingdom included 31 patients who had used cannabis and 51 patients who had never used it, although this group represents only 34% of individuals that qualified for the study and chose to participate.Responses indicated that cannabis users had more frequent and more severe episodes of pain, but many of the users indicated that cannabis was an attempt at managing their pain.Cannabis users reported improvement in mood , reduced use of painkillers , improvement in feelings of anxiety and depression , and improvement in sleep.In addition, 58% of respondents indicated an interest in participating in future clinical trials for the study of cannabis in SCD pain management.This questionnaire-based study underscores the attractiveness of cannabis as a means of self-medicating for pain, but this also presents another potential concern; to circumvent the prohibition of cannabis, individuals may resort to use of unregulated, potentially dangerous synthetic cannabinoid analogs.Neuropathic pain is disabling and impairs the HRQoL in adolescents as well.In a preliminary study of 12 adolescents with mean age of 15 years, with 75% females and 83% of subjects on hydroxyurea, higher PainDETECT scores were significantly associated with lower PedsQL scores.Cannabis use in teenagers with SCD and cystic fibrosis is prevalent, although to a lower extent than their peers, which may be due to the perception of cannabis use associating with worse self-care, more stress, and more distress.A 2017 retrospective analysis of patients with SCD indicated that patients using cannabis, confirmed by urinalysis, had higher frequency of VOCs.This study comprised 37 SCD patients that tested positive for a THC metabolite and 35 that tested negative.Notably, patients who tested positive admitted to smoking cannabis as their route of administration.Additionally, cannabis users had significantly higher use of benzodiazepine, cocaine, and phencyclidine compared to non-users.The use of other illicit compounds may potentiate the negative effects associated with cannabis use in this retrospective analysis.In addition, cannabis users had significantly fewer visits to the clinic and increased hospital admissions compared to non-users; the lack of regular treatment and increased disease severity may also represent contributing variables that are difficult to control.Priapism, mortality, and other SCD co-morbidities were not different between groups.Opioid-induced hyperalgesia and tolerance to specific opioids has been suggested to lead to cannabinoid and phencyclidine use in an individual with SCD.After switching to morphine, his urine showed the presence of phencyclidine, which provided him better pain relief than morphine.

These studies highlight the inadequacy and changing needs of patients with persistent and/or VOC pain in SCD leading to cannabis use and perhaps of other drugs that they can get to find relief.In a retrospective observational study on 9350 patients 18 years and older admitted for acute ischemic stroke who underwent urine drug screening screening, 18% tested positive for cannabis.Among cannabis users unadjusted risk ratio showed a 50% decrease in risk of AIS.However, upon adjusting for SCD, cardiovascular disease, diabetes, cigarette smoking, ethnicity, age, race, etc., the effect was lost.Many limitations in this study included dosage and duration of cannabis use, but it does not show any adverse effect of cannabis on AIS.These findings are important because stroke is one of the major comorbidities of SCD.A 2016 case study of a sickle cell patient indicated development of acute chest syndrome and failure to modify pain with opioids after the patient had been exposed to the synthetic cannabinoid K2, also known as “Spice”.The patient exhibited delirium and required oxygen support for his first 3 days following hospital admission, after which point the patient admitted to use of K2 at home.The patient’s behavior indicated to the physicians that K2 use was continuing during the hospitalization, and during day 3 acute systolic heart failure was detected.At day 10, the patient was discharged and requested treatment for substance abuse.Use of synthetic drugs labeled cannabinoids share many of the characteristics of intoxication, and also carry risks of dangerous and potentially fatal side effects that include psychosis, seizure, and myocardial infarction.The potency of synthetic cannabinoids derives from their chemical interaction with cannabinoids receptors, for which they are full agonists, whereas THC, the major psychoactive constituent of cannabis, is a partial agonist.These biochemical properties underlie the contrast between synthetic cannabinoids’ apparent toxicity and the lack thereof with THC.The lack of acute toxicity does not mean that THC exposure is without risk.Due to often life-long chronic pain, fear of emerging VOC and rising opioidphobia, SCD patients are more vulnerable to use of cannabis as pain medicine.Cannabis derived cannabinoids have been shown to be safe and well-tolerated in adults across various conditions and, most recently, in SCD.Several studies have indicated mild to moderate effectiveness of cannabis in treating pain arising from various disease states, though heterogeneity and low sample sizes mandate replication.Two major considerations for the use of cannabis products in SCD are pregnancy: the use of cannabinoids has been rising in pregnant women, and in women with SCD this may be a significant concern due to the discontinuation of hydroxyurea during pregnancy.Early preclinical studies provide mixed evidence for the teratogenicity of cannabinoids, so extreme caution must be taken during pregnancy; depression: Volkow et al.reviewed several studies on adverse health effects of recreational cannabis use and found high confidence in the association between cannabis use and addiction to cannabis, symptoms of chronic bronchitis, motor vehicle accidents, and diminished lifetime achievement, as well as medium confidence in its association with abnormal brain development and depression or anxiety.Recent data indicate the prevalence of depression associated with past month’s cannabis use in adults, thus diligent monitoring for the well-being of patients’ physical and mental health is required.The existence of anxiety, depression and cognitive impairment in SCD warrants the need for a close examination of these features in cannabis users.Innumerable medical cannabis preparations are available from “Dispensaries”, but most of them are not validated for their contents and their effectiveness through regulatory analysis and controlled clinical trials, respectively.

How do you address pest and disease management in commercial cannabis cultivation while minimizing pesticide use?

Addressing pest and disease management in commercial cannabis cultivation while minimizing pesticide use is crucial for maintaining product quality, complying with regulations,cannabis grow equipment and promoting sustainability. Here are several integrated pest management (IPM) strategies to achieve this goal:

  1. Cultural Practices:
    • Sanitation: Keep the cultivation area clean and free of debris to eliminate hiding places for pests and pathogens.
    • Proper Plant Spacing: Ensure adequate spacing between plants to improve air circulation and reduce the risk of disease transmission.
    • Rotation: Rotate crops to disrupt pest life cycles and reduce disease pressure.
  2. Resistant Varieties:
    • Choose cannabis strains that are naturally resistant to common pests and diseases whenever possible.
  3. Biological Control:
    • Predators and Parasitoids: Introduce beneficial insects like ladybugs, parasitic wasps, and predatory mites to control pest populations.
    • Microbial Inoculants: Use beneficial microorganisms, such as beneficial nematodes and mycorrhizal fungi, to promote soil health and suppress pathogens.
  4. Monitoring:
    • Regularly inspect plants for signs of pests and diseases. Early detection is crucial for effective management.
    • Employ traps and monitoring systems to track pest populations.
  5. Cannabis IPM Programs:
    • Develop and implement a comprehensive IPM program tailored to your specific cultivation site and pest/disease pressures.
    • Keep detailed records of pest and disease occurrences, treatments, and outcomes to refine your IPM strategy over time.
  6. Physical Barriers:
    • Use physical barriers like row covers or screens to prevent pests from accessing the plants.
  7. Selective Pruning and Removal:
    • Remove infected or infested plant material promptly to prevent the spread of diseases.
    • Prune and thin plants to improve air circulation.
  8. Organic Pesticides:
    • If pesticide use is necessary, opt for organic and biopesticides that are less harmful to the environment and beneficial organisms.
    • Follow strict application guidelines and adhere to local regulations.
  9. Neem Oil and Horticultural Soap:
    • Neem oil and horticultural soap can be effective against a range of pests. Use them as part of your IPM strategy.
  10. Crop Protection Nets:
    • Use nets or screens to protect plants from larger pests like birds and mammals.
  11. Quarantine New Plants:
    • Isolate new plants for a period before introducing them into the main cultivation area to ensure they are free of pests and diseases.
  12. Education and Training:
    • Train staff on proper pest and disease identification, prevention, and control methods.
  13. Regulatory Compliance:
    • Stay up-to-date with local regulations and pesticide restrictions to ensure compliance.
  14. Consult with Experts:
    • Seek advice from experts in cannabis mobile grow system and IPM to develop the most effective pest and disease management strategy for your specific situation.

By implementing these strategies and continuously monitoring and adjusting your approach, you can manage pests and diseases in commercial cannabis cultivation while minimizing the use of pesticides, promoting sustainability, and ensuring the quality of your product.

How do you select the most suitable cannabis strains for commercial cultivation based on market demand and growing conditions?

Selecting the most suitable cannabis strains for commercial cultivation involves a combination of market research, understanding growing conditions, and considering various factors that affect the success of your cultivation operation. Here’s a step-by-step guide on how to go about it:

  1. Market Research: a. Local Regulations: Understand the legal regulations in your region regarding cannabis cultivation,wholesale vertical grow factory including permitted strains, THC limits, and licensing requirements. b. Market Trends: Research the current and projected market demand for cannabis products, including the preferences of consumers (e.g., recreational or medicinal use, indica vs. sativa). c. Competitor Analysis: Analyze what strains your competitors are cultivating and whether there are gaps in the market that you can fill. d. Consumer Preferences: Consider factors such as flavor, aroma, potency, and effects to align your strains with consumer preferences.
  2. Growing Conditions: a. Climate: Consider your local climate, including temperature, humidity, and rainfall, and determine which strains are best suited to your environment. Some strains are more resilient to specific conditions than others. b. Indoor vs. Outdoor: Decide whether you will be growing indoors, outdoors, or in a greenhouse. Each environment has different requirements that may favor certain strains. c. Space and Resources: Assess the available space, equipment, and resources, including lighting, ventilation, and irrigation, to ensure they are compatible with the chosen strains.
  3. Genetic Selection: a. Genetic Diversity: Diversify your strain selection to mitigate risks associated with pests, diseases, or market fluctuations. It’s advisable to grow multiple strains. b. Stability and Reliability: Choose strains that are known for their stability and reliability in terms of yield, growth characteristics, and resistance to common problems. c. Testing: Consider conducting trials or testing with a small batch of each strain to assess their performance in your specific growing conditions.
  4. Cannabinoid Profile and Terpenes: a. Cannabinoid Content: Analyze the cannabinoid profile (THC, CBD, etc.) of each strain to ensure it aligns with the desired market demand, whether it’s for recreational or medicinal purposes. b. Terpene Profile: Terpenes influence the flavor and aroma of cannabis and can enhance its market appeal. Consider strains with desired terpene profiles.
  5. Disease Resistance: a. Pest and Disease Resistance: Prioritize strains that have a reputation for being resistant to common pests and diseases in your area. b. Mold and Mildew: If humidity is a concern in your region, choose strains known for their resistance to mold and mildew.
  6. Yield and Harvest Time: a. Yield Expectations: Calculate the expected yield per strain and compare it to your market demand to ensure you can meet supply requirements. b. Harvest Time: Consider the flowering time of each strain and stagger planting to ensure a consistent harvest schedule.
  7. Cost Analysis: a. Cost of Cultivation: Estimate the cost of cultivating each strain, including inputs like seeds, nutrients, labor,rolling grow benches and facility maintenance. b. Profitability: Calculate potential profits based on market prices and yield to determine the most economically viable strains.
  8. Customer Feedback: a. Iterative Approach: Collect feedback from customers and adjust your strain selection over time to meet changing market preferences.
  9. Legal Compliance: a. Ensure that all chosen strains comply with local regulations, including THC limits and any specific requirements for medical strains.
  10. Documentation: a. Keep detailed records of your cultivation process and results to make informed decisions for future seasons.

By carefully considering these factors and conducting thorough research, you can select the most suitable cannabis strains for commercial cultivation that align with market demand and your specific growing conditions. Regularly reassess and adapt your strain selection to stay competitive and meet evolving market preferences.

The highest level was detected in a sampler placed directly downwind of the Dunham burn

Highly elevated PM10 values were observed at the Dunham downwind monitor: a maximum hourly concentration of 6,500 µg per cubic meter occurred from 1:00 to 2:00 p.m., then a dramatic decline to 4.3 µg per cubic meter by 4:00 p.m. The average 24-hour PM10 concentration at this Dunham location was 276 µg per cubic meter, well above the federal criteria for unhealthy air, 150 µg per cubic meter . Although we only successfully deployed one monitor, the highly elevated concentrations were consistent with PM10 levels reported in another study of a burned field . Photo evidence was also consistent with visibility of less than 1 mile, which is expected at hazardous air levels . As noted, wind speed at this burn was somewhat higher than at the other burns . At several of the other 12 nephelometer locations, much smaller peaks were apparent in PM2.5 and PM10 after the burns were initiated, up to 57 µg per cubic meter of PM10 within the hour. Similar to the E-BAM findings, evening-to-morning peaks in PM2.5 and PM10 were observed. Although all of these peaks were relatively brief , these measurements were collected at places of public access, and even short-term exposures may have health risks. An increase in PM2.5 concentrations in air samples from city centers as low as 10 µg per cubic meter for as little as 2 hours has been associated with increased daily mortality in the surrounding population .At the laboratory, computer-controlled scanning electron microscopy and energy-dispersive X-ray spectroscopy were used to obtain the individual sizes and chemistry of particles collected on the samplers. Then, PM2.5 and PM10–2.5 concentrations and particle size distributions were calculated using assumed particle density and shape factors and a particle deposition velocity model . In samples from the downwind locations at the Dunham burn, concentrations of both PM2.5 and PM10–2.5 were elevated compared to an upwind sample. The fine fraction was primarily carbonaceous with a peak at the submicron range ,commercial vertical farming while the coarse fraction had a lower carbonaceous percentage .

These carbonaceous percentages were higher than those measured upwind for fine and coarse fractions, as well as those reported for fine and coarse fractions in San Joaquin Valley ambient air . The coarse fraction in the downwind sample also had higher percentages of potassium, phosphorus and chlorine . Potassium and chlorine are considered potential indicators of biomass smoke , and phosphorus is found in most plant material. We also analyzed samples of unburned and burned bermudagrass and found that among inorganic elements, they contained similar peaks of potassium, phosphorus and chlorine . Their identification here may assist air pollution researchers attempting to identify sources of particulate matter in air samples. Samples were analyzed for vapor-phase naphthalene by gas chromatography/mass spectroscopy. Concentrations were calculated using an established air-sampling rate. Naphthalene was occasionally detected at the five targeted burns with levels above the reportable limit at seven of the 23 locations near the burns and at one of the six more-distant locations .That highest level was lower than a reference level for respiratory effects , but only two samples were collected directly downwind and concentrations elsewhere in the plume could have been higher or lower. To compare, vapor-phase naphthalene measured in a laboratory from directly above the burning of agricultural debris was 60 µg per cubic meter . Responses from our key informants indicated that educational messages were needed. We developed two-page fact sheets for three Imperial County audiences — the general public, school representatives and farmers. These covered the reasons for burning, burn regulations, potential health impacts and behavioral recommendations to reduce exposures.

In our studies, elevated particulate matter levels and visible drift were observed as far as 500 feet from the edge of burning fields, and wind directions could quickly change. We advised that anyone who could see or smell smoke or was within 300 feet of a burning field should go inside. If people had to be outside near a burning field, we recommended face-piece particulate respirators , which are available at most hardware stores. A worker who must be outdoors and near a burn must be in a respiratory protection program that includes medical evaluations and fit-testing of the respirator’s seal on the worker’s face . A draft of the fact sheet for the general public was tested with community members at a health clinic and shopping center. Although there were complaints about its length, the fact sheet was highly rated for usefulness: all 20 participants gave it either a four or a five on a scale of one to five . The final fact sheets were distributed to local organizations and are available on the Internet .In our studies, agricultural burning created potentially hazardous air levels immediately downwind; during evening-to-morning hours, PM2.5 levels increased 2 to 8 µg per cubic meter. Many studies have associated total daily human mortality with mean daily particulate matter levels measured in urban centers, and some have observed a relationship at levels as low as 2 µg per cubic meter . In California, increases in children’s total daily hospital admissions for respiratory problems are also associated with increases in daily PM2.5 and potassium air levels, the latter an indicator of biomass smoke . To protect public health and potentially reduce exposures to smoke from agricultural burns, we recommend additional health education, smoke management and air quality research. Currently, CARB declares a permissive-burn day when meteorological conditions ensure the regional dispersion of smoke, for example, a wind speed at 3,000 feet of at least 5 miles per hour . Imperial County’s smoke management plan states that the Air Pollution Control District may put in place additional restrictions based on meteorological and air quality conditions, including strong ground-level or gusty winds . We observed substantial drift at a slightly greater wind speed than that previously suggested for a vertical column of smoke to occur . Local Air Pollution Control Districts could reduce ground level drift by specifying a ground-level wind speed above which burns should not take place. Additionally, evening to-morning levels of particulate matter could be reduced if warranted by other restrictions, such as shortening allowable burn hours. Interviewed residents expressed reluctance to report neighbors who might be out of compliance.

Supplemental Imperial County Air Pollution Control District activities could include online instructions about how to make a complaint. In addition, posting visibility guidelines for hazardous drift and a daily listing of the areas in the county where burns were scheduled would improve community notification.Additional air monitoring is needed to further characterize the nature and extent of ground-level plumes and how they are affected by local crop type and conditions. Although crop-specific particulate emission factors from burning bermudagrass stubble have not yet been developed, factors for other grasses, such as Kentucky bluegrass,mobile rack systems are about twice those for rice and wheat . The moisture level of burned residue can also significantly affect particulate matter emissions, with a change in moisture from 10% to 25% more than tripling particulate emissions during the burning of rice, wheat and barley straw . Ambient monitoring should also include indoor air, as outdoor PM2.5 may substantially infiltrate buildings , and we observed that outdoor particulate matter increases overnight when people are likely to be inside. Residents may be amenable to researchers installing unobtrusive passive samplers to monitor indoor air. In further studies, methods might be modified to allow the further identification of carbonaceous material, the gaseous component of other PAHs and some of the thousands of other volatile gases found in smoke . Information is also needed on whether residents are following recommendations to reduce their exposure to smoke from agricultural burning. Finally, farmers expressed a willingness to try alternative farming practices, notably tilling. We recommend further study of alternative farming techniques such as conservation tillage, which may reduce the need for burning, conserve water and soil, and reduce air quality impacts . In addition, integrating livestock grazing with grain and hay farming as a substitute for burning or tilling may reduce pests, herbicide use and erosion and provide additional income . Further study is needed on how farmers could viably integrate alternative techniques into current practices, particularly for local crops such as bermudagrass, and the estimated human health impacts of such changes. With the passage of Proposition 64 , state voters elected to integrate cannabis into civil regulation. The California Department of Food and Agriculture oversees state-licensed cannabis cultivation and defined it as agriculture . Prior to the possibility of state licensure for cultivators, however, counties can decide on other designations and implement strict limitations. In effect, local governments have become gatekeepers to whether and how cultivation of personal, medical or recreational cannabis can occur and the repercussions of noncompliance. When cannabis is denied a consistent status as agriculture, despite being a legal agricultural commodity according to the state, localities can determine who counts as a farmer and who is considered compliant, non-compliant and even criminal. In Siskiyou County’s unincorporated areas, the Sheriff’s Office now arbitrates between the effectively criminal and agricultural.

Paradoxically for this libertarian county, the furor around cannabis has seen calls for government intervention, and has led to officials passing highly stringent cannabis cultivation regulations that have been enforced largely by law enforcement, muddying the line between noncompliance and criminality. These strict regulations produced a situation where “not one person” has been able to come into compliance, according to a knowledgeable government official. Nonetheless, at the sheriff’s urging, Siskiyou declared a “state of emergency” due to “nearly universal non-compliance” , branding cannabis cultivation an “out-of-control problem.” Such a strong reaction against cannabis can be understood in terms of cannabis’s potential to reorganize Siskiyou’s agricultural and economic landscape. According to some estimates, there are now approximately twice as many cannabis cultivators as non-cannabis farmers and ranchers in Siskiyou , a significant change from just a few years ago. Although cannabis has been cultivated in this mostly white county for decades, since 2015 it has become associated with an in-migration of Hmong-American cultivators. Made highly visible through enforcement practices, policy forums and media discourses, Hmong-Americans have become symbolically representative of the “problem.” This high visibility, however, obscures a deeper issue, what Doremus et al. see as a nostalgic, static conception of rural culture that requires defensive action as a bulwark against change. Such locally-defined conceptions need to be understood , especially in how they are defined and defended and what effects they have on parity among farmers growing different types of crops. Our goals in this study were to consider the consequences of an enforcement-first regulatory approach — a common regulatory strategy across California — and its differential effects across local populations. Using Siskiyou County as a case study, we paid attention to the public agencies, actors and discourses that guided the formation and enforcement of restrictive cannabis cultivation regulations as well as attempts to ameliorate perceptions of racialized enforcement. This study attends to novel post legalization apparatuses, their grounding in traditional definitions of culture and the ways these dynamics reactivate prohibition. We used qualitative ethnographic methods of research, including participant observation and interviews. In situations of criminalization, which we define not only as the leveling of criminal sanctions but being discursively labeled or responded to as criminal-like , quantitative data can be unreliable and opaque, which necessitates the use of qualitative ethnographic methods . In 2018–2019, we talked to a wide range of people — including cannabis growers from a diversity of ethnic backgrounds, government officials, business people, subdivision residents, farm service providers, medical cannabis advocates, realtors, lawyers, farmers and ranchers, and, with the assistance of a Hmong-American interpreter, members of the Hmong-American community. We also analyzed public records and county ordinances, Board of Supervisors meeting minutes and audio , Sheriff’s Office press releases and documents, related media articles and videos, and websites of owners’ associations in the subdivisions where cannabis law enforcement efforts have focused. Some cannabis cultivators regarded us suspiciously and were hesitant to speak openly, an unsurprising phenomenon when researching hidden, illegal and stigmatized activities, like “drug” commerce . This circumspection was most intense among Hmong-American growers on subdivisions, who had been particularly highlighted through enforcement efforts and local, regional and national media accounts linking their relatively recent presence in Siskiyou to cannabis growing.

Powerful legislators have consistently supported the tobacco industry

Carter also refused to go along with the majority position of the VTSF Board to fight the governor’s proposal, saying that as an appointee of the governor, he answered to Gilmore and not the foundation.In a 2009 interview, Danish felt that Gilmore was not specifically seeking to remove funding from VTSF to impede VTSF’s mission, but rather that Gilmore was attempting to mitigate a budget crisis.However, Gilmore had close ties to the tobacco industry, having received a considerable amount of campaign contributions from the tobacco industry for his gubernatorial campaign.For example, in 1997 the Tobacco Institute conducted at least one major fundraiser for his campaign.The governor’s proposed changes to the budget, embodied in HB 2432 and SB 1180, included language that VTSF funds “may be used for health care purposes,” opening the fund to being tapped to cover health expenses not associated with tobacco use and potentially substantially reducing the amount of MSA money to fund tobacco control efforts.Two members of VTSF Board of Directors, Del. John O’Bannon and Sen. Emmet Hanger sponsored the bills to allow such diversion of funds. HB 2432 advanced into the Senate in February, where it was stricken from the calendar by a vote of 39-0 on the 24. After being introduced, SB 1180 was referred to the Senate Finance Committee on February 1, where it died without any further action. The Senate Finance Committee rejected the bill because it would have converted the securitized funds into general revenue, which the committee feared could lead to a deficit the next year.Supporters of the governor’s proposal, like Del. Phillip Hamilton viewed the proposal as a way to spend more money on healthcare without having to raise a new revenue stream. As noted above, much was made of the fact that VTSF had not spent their allotment yet. A spokesperson for the governor, Lila White,cannabis drying rack ideas described the proposal as “an effort to spend the money in a productive way for medical purposes.”ACS, ALA, and AHA rallied to VTSF’s defense with a newspaper and radio advertising campaign.

The campaign targeted HB 2432 and SB 1180, saying that they would dilute tobacco control efforts and divert funds to assist Gilmore politically in the wake of a budget crisis.The media campaign was successful; it drew the ire of Gilmore, who characterized the campaign as “deceptive” and “offensive.”In light of the governor’s criticism that VTSF had not spent their allotted funds, VTSF’s chairperson was put on the defensive. Danish argued that the members of the Board had been confused about whether VTSF would operate as a state-controlled or independent entity and their ability to award funding. VTSF had decided to thoroughly research all funding proposals before implementing them, causing the delay.Danish also acknowledged that “it’s evident that we have not let the Commonwealth know that we are doing anything.”It was eventually determined that VTSF had the ability to distribute funds out of its operating fund, but that the governor and legislature through the budget process could control the amount of money that VTSF has access to.In 2009, SB 1112, introduced by Sen. Ralph Northam , sought to change the name and mission of VTSF. The bill passed and was signed by Gov. Kaine in March 2009. SB 1112 changed the name of VTSF to the Virginia Foundation for Healthy Youth and allowed some of the Virginia Tobacco Settlement Fund monies to be used to prevent childhood obesity. No changes were made to the governance of the organization. This action had the effect splitting the VFHY into two divisions: the VTSF division, which maintained its original function, and the Virginia Youth Obesity Prevention division , which would “assist in financing efforts to reduce childhood obesity through such means as educational and awareness programs, implementing evidence-based practices, and assisting schools and communities with policies and programs.”Both divisions were to be funded out of the same pool of MSA money, the Virginia Tobacco Settlement Fund , potentially reducing the available funding for tobacco control activities. The funds were to be used “primarily” for tobacco prevention among youth, but it was up to VFHY’s discretion how much would be dedicated to VTSF and how much to VYOP. In addition, funds used for the VFHY that were not derived from the MSA Fund and instead were derived from other sources, such as grants and private funding, and would be used for obesity at the VFHY’s discretion. Therefore, there was a chance that VTSF funding could be significantly reduced due to the funding distribution structure, down to as little as 51% of their original.

Tobacco Settlement Fund allotment and 0% of non-MSA private and public funding sources, with the rest being distributed to the VYOP. SB 1112 was supported by the Secretary Health and Human Resources, Marilyn B. Tavenner, and by its sponsors, Northam and Del. John O’Bannon III , who were both members of the VTSF board of trustees as well as both being physicians.Tavenner made statements to the press indicating that childhood obesity was an issue that she wanted to take seriously in order to stem a potential type 2 diabetes epidemic.Northam and others argued that the change would not interfere with the VTSF’s original and primary purpose of youth smoking prevention, but would add obesity to the mission of the organization. Marty Kilgore, the executive director of VTSF , said stated to the press, “We don’t want to water down in any way our tobacco-use prevention initiative. This is just going to be an extension of what we do.”Amy Barkley of the Campaign for Tobacco-Free Kids stated in a 2009 interview that while youth programs are not usually effective for achieving tobacco control goals, VTSF had been “really effective … their smoking rates have come down.”However, problems with the new arrangement abounded. VTSF was already underfunded and had limited staffing, and now the organization would be forced by the legislature to take on an additional policy issue, without securing new funding or new staff for VFHY.We were unable to identify any specific actions of the health groups to actually oppose the legislation. Additionally, the national advocacy groups and the three voluntary health organizations found it difficult to protest the move, as obesity was part of their health policy focus as well, and they were reluctant to be seen as opposing obesity control measures when they were trying to ensure adequate funding for the tobacco control part of their mission.VFHF did not take a position on SB 1112. The ALA opposed the measure while AHA and ACS supported it, so the VFHF leadership decided to keep the coalition out of the issue. The ALA took the position that, if SB 1112 passed, it hoped that VYOP would only use funds that were newly raised from independent, non-MSA public and private sources for any obesity program. David DeBiasi, in his capacity as director of advocacy for the ALA, said to the press, “We don’t want to see any tobacco-prevention dollars diverted from their intended use.”ALA and other health groups opposing the measure pushed for a cap of $100,000 of MSA derived funds intended for obesity programs,vegetable farming equipment but were unsuccessful in amending the legislation to incorporate the cap.Tobacco control efforts in Virginia have been difficult from the beginning due to the well-funded and politically powerful tobacco industry’s lobbying efforts in a tobacco-growing state where Philip Morris is headquartered.Despite this situation, Virginians have demonstrated through consistent polling for more than 20 years that they support strong and comprehensive clean indoor air legislation and higher cigarette excise taxes. This public support for tobacco control has grown with demographic changes in the state, especially the growth of the Washington DC suburban areas in Northern Virginia. These new residents to Virginia are generally not concerned with preserving Virginia’s “tobacco heritage.” Virginia is also becoming less rural and more urban overall, tending to increase the support for tobacco control measures. Over time, these demographic shifts, coupled with growing support for tobacco control among established Virginia residents, have put pressure on legislators who oppose tobacco control.

Ironically, the public health advocates who have repeatedly produced evidence of broad public support have generally not been able to translate that support into advocacy successes. Instead, they have allowed the tobacco industry to dominate Virginia’s tobacco control debate, and have been willing to compromise for more than 20 years, resulting in many strong proposals for tobacco control dying or becoming weak, industry-favorable laws. Such compromises have resulted in Virginia being mired in the past while other states, including tobacco-growing Southern states with similarly strong tobacco industry lobbying efforts, have moved forward to enact stronger clean indoor air laws or larger cigarette excise tax increases. Despite the good intentions of advocates, “half a loaf” has proven to be considerably worse than “no loaf at all,” and Virginia’s tobacco control advocates must accept the fact that opposing weak measures while holding out for strong, comprehensive ones could have prevented the sort of stagnation that has afflicted Virginia. Virginia has had some notable successes and near successes in recent years. In 2004, the Virginians for a Healthy Future coalition used favorable polling data to show that Virginians supported a sizeable cigarette tax increase. The campaign included TV, radio, and print advertising. The coalition also met with legislators to educate them on the issue, recruited a strong legislative ally , and mobilized grassroots elements of many VFHF member organizations. The result was a 30 cent tax increase that generated $310 million in revenue to be dedicated to offsetting healthcare costs, and saving approximately 12,000 Virginians from tobacco-related deaths. The broad scope of VFHF’s campaign strategy for the cigarette tax increase could be replicated to lead to successes on other tobacco control issues. Advocates in Virginia should rethink their lobbying strategy, which is predominantly focused on the state legislature. The strength of the tobacco industry in the statehouse is significant, as it is in many states throughout the nation. However, advocates can defeat the industry by prioritizing local action, and strengthening and then using their grassroots capability when a fight in the state legislature cannot be avoided. The example of VFHF’s campaign to influence the Speaker of the House, William Howell, in his home district of Fredericksburg in 2009 is illustrative. This campaign was very successful in bringing constituent pressure to bear on the Speaker through phone banking and a paid media campaign. These efforts not only attracted the Speaker’s notice but caused him to change his position dramatically on the issue of restaurant smoking. The ultimate result was unfavorable primarily because the pressure was not applied broadly enough to more key legislators. The degree to which the limited campaign against Howell impacted Virginia speaks to the potential for success if such district campaigns are expanded to target more key politicians. The voluntary health organizations need to provide the resources necessary for Virginia advocates to conduct additional targeted campaigns. Virginia’s advocates also need to do a better job of maintaining cohesion in the face of a strong and unified tobacco lobby. In 1990, during consideration of the bills that would become the Virginia Indoor Clean Air Act , GASP supported a comprehensive measure without preemption, while the Tri-Agency Council backed a weaker, preemptive bill. The divisions among the advocates were exploited by the tobacco industry, whose solidarity and influence allowed them to effectively dictate the terms of what would eventually become the VICAA. Likewise, in 2009, the statewide tobacco control coalition, VFHF, disintegrated over the issue of supporting Governor Kaine’s weak restaurant smoking restriction proposal. The coalition’s inability to hold its members to their deal-breakers agreement, which problematically was never signed by coalition members, made it easier to pass a weak bill. Advocates should use this opportunity to rebuild the coalition using a strong deal breakers agreement as the foundation. Virginia had a brief but promising history of local tobacco control efforts prior to the enactment of the VICAA in 1990, which preempted further local clean indoor air ordinances. Prior to 1990, 16 localities had enacted some sort of local smoking restriction ordinance, and more were considering them.

Tobacco retailers generally opposed retailer licensing as it entailed increased cost and regulation

In any event, Grzesiek felt that even a signed deal-breakers agreement would not have prevented some of the coalition members from walking away from the principles of the dealbreakers agreement to support the Kaine-Howell proposal.As noted above, by February 4 all the remaining tobacco control bills from both the House and the Senate were before the House General Laws committee. The following day the HGL committee conducted an unrecorded voice vote to incorporate all of the outstanding House bills into HB 1703. This maneuver meant that all of these bills ceased to exist, and only HB 1703 existed in the House moving forward. The following day, the Committee also incorporated all of the extant Senate bills into SB 1105, also by a voice vote. This meant that by February 6, there were only two clean indoor air bills before the General Assembly. On the same day, February 6, the Committee adopted substitute language for the two bills that embodied the Kaine-Howell compromise, so HB 1703 and SB 1105 were thereafter identical in language . The substitute language, which represented the compromise worked out between Kaine and Howell, partially restricted smoking in a number of places used by the general public, such as elevators, the common areas of public schools, and hospital emergency rooms. Smoking in restaurants was generally prohibited, with several important exceptions: If a restaurant constructed a smoking room that was structurally separated and contained a separate smoking area, that portion of the restaurant did not have to be smoke free. Outdoor areas not enclosed by walls, windows,industrial rack system or temporary enclosures were also exempted. Local preemption was maintained. The tobacco industry and its allies in the restaurants and hospitality associations were hostile to the Kaine-Howell compromise language. These groups repeatedly characterized the bill in the media as a political or business rights issue, not a health issue. They argued that business would be lost and restaurants closed by the measure, hurting the state’s economy.

Virginia Republicans generally espoused a view that individual businesses had rights that extended to choosing whether to allow smoking or not, a view that ignored the rights of employees or potential health concerns. These free-market leanings dovetailed with the restaurant and hospitality industries’ rhetoric. Health advocates also opposed the legislation, but for different reasons. Teresa Gregson, the AHA lobbyist, was credited by Amy Barkley in a 2009 interview as putting out the strongest statements opposing the compromise bill that encompassed the VFHF position that, as Barkley paraphrased, “[the bill] isn’t a huge victory or a big change. It shows that the industry is as powerful as ever because they got their way.”VFHF attempted to use statements such as Gregson’s as an educational tool to try to alter the march of the Kaine-Howell compromise bills towards passage. Barkley recalled a significant effort was expended by VFHF to also change the tenor of the press coverage of the compromise.With these floor amendments, the House passed HB 1703 on February 10 by a vote of 61-37. Editorial observers in the press and the health advocacy community noted that the Kilgore amendments represented a push by Republicans hostile to the bill, working alongside tobacco industry lobbyists, to intentionally weaken the bill to the point where either it would not pass at all, leaving the status quo in place or be weak enough to satisfy industry interests.VFHF members who supported comprehensive smoking restrictions were very displeased with Kilgore’s amendments, which were not only weaker than the bill they originally supported, SB 1057, but weaker even than the Kaine-Howell compromise. Health advocates feared that the amendments would make an already problematic bill worse and that it could possibly pass in a weakened form. However, according to Grzesiek, the amendments did help with getting the media to understand some of the problems with the Kaine-Howell proposal, but after a short time the media backed away from criticism of the proposal. Governor Kaine and Speaker Howell were also unhappy with the amendments, which disrupted their carefully negotiated compromise, so they planned to have Kaine strip the amendments from the bill if it were to reach his desk in the amended form.Kaine told the press, “We need to get the bill back to the deal.”Furthermore, he specifically disapproved of the minors-only provisions that were included in the amendment, saying that the “health of adults is important too … this was not a minor’s health bill … it was an all-Virginians health bill.”

SB 1105 passed the House with the amendments by a vote of 59-39 on February 9 and the following day HB 1703 passed the House by a vote of 61-37. After passing the House, SB 1105 returned to the Senate floor so that the Senate could vote on the House amendments that had been offered by Kilgore. The Senate rejected the House amendments by a vote of 11-28, and because of this the House requested a conference committee. The conference committee consisted of Senators Northam, Locke, and Quayle, and the Delegates were Cosgrove, Jones, and Eisenberg. The conference committee returned the bills after stripping Kilgore’s amendments, essentially returning the bills to a form that embodied the Kaine-Howell compromise language . In this form, both bills passed and were enrolled in both houses on March 4. Governor Kaine signed the bills on March 9. After passage, Kaine announced that he would sign the bill as quickly as possible, saying that he felt that “it will be signed quite swiftly – in the quickest-drying ink I can find.”VBRA member Laura Habr’s support of the restaurant legislation led to her restaurant being selected by Gov. Kaine as the location of the signing of the legislation into law. Habr said that Kaine “wanted to reward all of us in the restaurant industry, sliding shelf system especially in Virginia Beach.”At the signing, Kaine thanked the legislative supporters of the bill, specifically the bills’ patrons Northam and Cosgrove. The president of the Medical Society, Dr. Thomas Eppes, spoke of the bill as a “victory” for Virginians that represented a “giant step forward” and was achieved “through compromise, collaboration and patience.”Kaine’s victory in securing the passage of his restaurant smoking restriction bill can be seen as a significant accomplishment in an administration that had seen the Republicancontrolled House thwart nearly every measure that the governor backed. Additionally, having been chosen in 2009 to become the chairman of the Democratic National Committee, Kaine claimed the law as a large policy achievement on his resume.While this was a political victory for Kaine, it was not a victory for public health. GASP was outside of the political process from the start, so the organization had a different perspective from VFHF when the bill passed. Hilton Oliver, speaking to the press on behalf of GASP, said the compromise was “a pretty good bill under the circumstances.”VBRA members were mostly satisfied with the final language that passed. Laura Habr was “pleased with the outcome,” which she characterized as an “across-the-board ban, in all public places, and that included restaurants.”

However, acknowledging that there was disagreement among VFHF members, especially the Virginia chapters American Heart Association, American Lung Association, and the American Cancer Society which were the most active and involved in VFHF, Habr expressed “a lot of confidence that fractured groups in [sic] this issue would reconvene and work together, for the best interests of our industry and the public health.”VFHF was disappointed that the Kaine-Howell language was ultimately passed, rather than the comprehensive language they supported. Co-chair Grzesiek felt that the coalition leadership had worked hard to provide information to legislators about the ineffectiveness of smoking rooms and the lack of clear implementation and enforcement.However, unlike in previous years, VFHF was unable to implement an effective education campaign for the general public, because they did not allocate or raise money for paid radio and print advertising to counter the Kaine-Howell proposal. Grzesiek felt that “by the time [the Kaine-Howell proposal] was announced, it was a done deal and legislators already knew how they were going to vote. There was nothing we could do to change that” in the limited period of time VFHF had to react.Ultimately, it was a combination of factors that allowed the compromise language drafted by Kaine and Howell to proceed through the legislature to the Governor’s desk fundamentally unchanged. The political situation that confronted both Howell and Kaine caused them both to agree to a course of action that once started was not easily diverted. Acting together they wielded great political strength. This is in stark contrast to the limited influence that VFHF was able to bring to bear on the political situation as a whole. Despite the successful campaign in Howell’s district, VFHF did not have the resources or political connections, especially to the governor’s office, to effectively influence the political situation in Virginia in 2009. In part, VFHF’s problems in influencing the 2009 legislative session were a lack of funding to create an impactful media campaign, in order to garner public opinion and generate pressure on legislators. Lack of funding was the primary reason that the successful campaign against Howell could not be broadened further to influence other legislators. With more funding to influence legislators and closer contacts with the governor, VFHF might have been successful in at least stopping the passage of the Kaine-Howell compromise legislation.

Another issue is an aversion among Virginia advocates from using arguments about the tobacco industry to defeat bad legislation. In discussions with VFHF co-chair Cathleen Grzesiek, she articulated the reasons why VFHF avoids confronting industry tactics directly. Virginia is different, she noted, because “big tobacco isn’t this evil other in another state … everybody knows someone who works at Altria.”She pointed to a strong feeling among Virginia advocates that because tobacco represents “an economic driver for our economy,” that the public in Virginia would not find such arguments persuasive.However, she also admitted that the strategy has not been tried on any sort of scale in Virginia.Because the role of tobacco manufacturing is diminishing in Virginia, with tobacco growing dramatically declining, VFHF could have explored anti-industry messaging to begin to level the playing field against a well-funded and organized tobacco lobby. Finally, since 2002, VFHF has focused on statewide tobacco control measures while neglecting the possibility for local action. Virginia localities, notably Norfolk, had seriously contemplated acting to strengthen their local smoking restrictions, felt restrained by preemptive state law and also held themselves back from action in order to see what came out of the 2009 push for statewide restaurant smoking restrictions. While VFHF provided some assistance to these localities, they were unable to devote the resources necessary to fight preemption in the courts. Because the tobacco industry is most effective at fighting tobacco control at the state level, repealing preemption and focusing on local smoking restriction measures would allow advocates to more effectively combat the tobacco industry. South Carolina provides an example of a Southern tobacco-growing state that has successfully enacted local clean indoor air ordinances despite apparently South Carolina’s apparently preemptive statewide law. Virginia’s tobacco control advocates should consider what lessons can be drawn from South Carolina’s experiences and push for local tobacco control activity, using the model of police power developed in Norfolk. Almand did not include PM’s language regarding retailer licensing, which was opposed by many tobacco industry allies, such as convenience store operator Southland Corporation and the Virginia Retail Merchant’s Association, despite PM’s promotion of the idea.The issue was also a divisive one among tobacco manufacturers; PM employees tracking the AAA legislation were concerned with the media portraying the licensing issue as “fan[ing] the flames of industry disharmony,” and providing help to detractors of PM’s AAA agenda.298 The bill failed to report out of the House Committee on Counties, Cities, and Towns during the 1996 session. The bill was continued to the 1997 session, but in December 1996 was struck from the docket just before the 1997 session began, killing the bill. Jay Poole, a PM regional coordinator, expressed relief in an internal PM memo because it meant that PM could spend the next year building consensus among allies about the licensing issue that had proved so contentious in the 1996 session.

Proprietors of private workplaces were also allowed to voluntarily institute smoking restrictions

The bill also “rolled” preemption forward, stating that any local ordinance enacted before January 1, 2006, would not be deemed invalid because of inconsistency with state law. After January 1, 2006, Bell’s substitute would have only required local ordinances to prohibit smoking in designated no-smoking areas of restaurants. Otherwise, localities were preempted from exceeding the law as it would have existed after January 1, 2006. The substitute was adopted and SB 648 passed out of the Senate by a vote of 28-18 with one abstaining, but was ultimately killed in the House General Laws Committee. The 2007 session opened with four bills being introduced on smoking restrictions. Sen. Brandon Bell introduced a coalition-supported bill that mirrored his 2006 effort. Additionally, Del. Vince Callahan and Del. Harvey Morgan also introduced smoking restriction bills . Del. Glenn Oder and Del. Algie Howell also introduced identical bills, HB 2689 and HB 2255 respectively. The bills were all virtually identical, expanding the VICAA to prohibit smoking in most public places where the public was invited during the normal course of business, including restaurants, common areas of apartment buildings, indoor shopping malls.In addition, the bills sought to remove the explicitly preemptive language from existing law,mobile racking systems with the bills stating that the new law could not be construed to permit smoking where prohibited by any duly enacted local ordinance, seemingly allowing localities to exceed statewide provisions. VFHF was most supportive of Bell’s bill, but the coalition also supported the Callahan, Morgan, Oder, and Howell bills because they would raise the profile of Bell’s bill and increase its chance of success.

Approximately a week after the three bills were introduced, VFHF held a well-attended news conference to release a Mason-Dixon poll that they had commissioned that showed that 71% of those polled supported smoking restrictions such as those found in the Bell bill,and received wide coverage in the media. Their press release also included statements by legislators who were supporting the VFHF push for clean indoor air. Bell noted that “momentum is building, which is evident in the sheer number of bills introduced in 2007.”Morgan stressed the importance of the U.S. Surgeon General’s 2006 report, stating “[t]he science is clear. Secondhand smoke is not an annoyance. It is a serious health hazard responsible for death and disease, and there is no safe level of exposure.”Callahan pointed to the tax burden, noting that “[e]very household in Virginia is paying $576 in taxes from smoking-caused government expenditures.”Additionally, VFHF provided the information directly to legislators and conducted grassroots mobilization around the polling.Bell’s bill was strongly opposed by tobacco industry-aligned groups, including the Virginia Hospitality and Travel Association and the Virginia Retail Merchants’ Association. These groups argued before the various assembly committees that they supported free-market positions on smoking prohibitions, and opposed any “blanket bans” such as Bell’s proposal. However, SB 1161 found support from the local Virginia Beach Restaurant Association , a 200-member group that distanced itself from the position of other restaurant and hospitality associations in the state that traditionally opposed any broad prohibitions on smoking in restaurants and bars. VBRA became involved in the measure after Matt Falvey, a former president of the VBRA and a member of VHTA, convinced the VHTA to adopt a neutral stance on tobacco control for one year, in 2004.After VHTA returned to active opposition to tobacco control in 2005, Falvey and other VHTA members resigned and took their concerns to the VBRA.The VBRA embraced the tobacco control position and approached Sen. Bell to support SB 1161.Bell put the VBRA members in touch with the VFHF and the VBRA became members of the VFHF coalition in 2007.

Particularly important to Falvey and other VBRA members was a sense that smoking restrictions were inevitably going to affect restaurants in the future, and rather than opposing them they should get “out in front” of the issue.Falvey was also concerned about protecting the health of his employees, comparing the smoking restrictions in restaurants to widely accepted regulations protecting patrons from food-borne illnesses.Finally, Falvey was frustrated that the VHTA was fighting against smoking restrictions alongside the tobacco industry, feeling that restaurateurs should not be fighting battles for the tobacco industry.The tobacco industry response to SB 1161 and its related bills was embodied in a bill introduced by Del. Morgan Griffith .This bill was a “red light, green light” bill promoted by the tobacco industry in other states that gave the power to restaurants to decide their own smoking policy by simply posting a sign telling what their policy was. The bill replaced the language requiring smoking sections in restaurants with 50 or more seats from the existing VICAA and inserted language that read “Any restaurant may allow smoking if signs stating ‘Smoking Permitted’ conspicuous to ordinary public view are placed at each public entrance.” Griffith claimed that his bill was not a workers’ health bill, stating to the press, “[t]his may not be perfect for those people who would like to protect workers, but it is better than any bill that has made it to the [House] floor.”Public health groups opposed the Griffith bill, understanding that a “red light, green light” bill was actually a step backwards that would do nothing to discourage smoking or protect the health of workers.Despite the past willingness of public health advocates to make serious compromises on substance to get some sort of legislation passed, there was consensus that Griffith’s bill was worse than the existing law.It also maintained statewide preemption of local ordinances. Despite a pledge to the public in 2005 and 2006 to refrain from lobbying on clean indoor air legislation, Philip Morris jumped into the fray in 2007 with a full lobbying effort in support of Griffith’s bill. 223 PM claimed that that the measure was enough of a restriction on property rights that they were justified in changing their lobbying stance.

Bell’s bill was assigned to the House General Laws Subcommittee, which was historically very hostile to tobacco control legislation and had killed Bell’s tobacco control legislation the previous session . Bell came under significant pressure from the subcommittee after they stalled his legislation and asked him to meet with Griffith to try to achieve a compromise in early February. Bell doubted whether he could find any common ground with Griffith and declined to compromise with Griffith, saying that he would not support any bill that public health advocates would not support. In addition, Griffith threatened to withdraw his bill if it any amendments were offered to prohibit smoking in all restaurants.Ultimately, Bell’s bill was killed in the House General Laws subcommittee. The House and Senate both passed Griffith’s measure on March 4, 2007. Bell and health advocates declined to try and change the bill in the Assembly due to Griffith’s threats to strike the bill if any changes were made; therefore, attention turned to the Governor for a possible amendment. Because all the coalition-supported bills had been either killed by or held in hostile legislative committees,shelving manufacturers using Griffith’s measure as a vehicle to enact smoking restrictions in bars and restaurants would be an end-run around the hostile committees and require any amended bill to go to the full House for an up-or-down vote. While the House committees would assuredly kill any strong measure, VFHF had tallied votes in the House and Senate and believed they had enough to pass a strong bill if they could get it out of committee.VFHF also secured an agreement with Gov. Kaine through trusted political allies, including Sen. Bell, that Kaine would amend the bill to restrict smoking in all restaurants and bars.If the legislature rejected these amendments, VFHF had commitments from the Senate to kill the measure. However, if a contingency arose where the bill passed out of the legislature retaining the red light/green light provisions, Kaine agreed to veto the bill.Therefore, VFHF was in a strong position to either enact strong legislation or kill weak legislation and felt “comfortable allowing it to come out [of the Assembly] as it stands, even though the bill itself is problematic,” according to Cathleen Grzesiek, director of VFHF.VFHF and other public health advocates began to heavily lobby the Governor for changes in Griffith’s HB 2422, such as removal of the “red light, green light” provision, that they could support.Terry Hargrove, the director of community relations for the American Lung Association, said to the press after the bill went to Kaine that his group had organized a letterwriting and phone campaign to the Governor’s offices urging him to positively amend the legislation.2008 brought changes to the balance of power in the Virginia General Assembly. Republicans had controlled the state Senate since 1999, but in 2007 Democrats regained control of the Senate. Because of this, VFHF sought a new patron in the Senate from the majority party and identified Sen. Mary Margaret Whipple . Whipple was the chair of the state’s Democratic caucus and passionate about health issues, including tobacco control.Many bills were introduced concerning smoking in both houses, building off of the momentum for enacting stronger clean indoor air laws that had started in 2007 .Whipple introduced SB 298 using language developed working with VFHF.

Whipple was the chair of the state’s Democratic caucus, and also passionate about health issues including tobacco control.VFHF had other legislators introduce bills with identical language, including HB 500 by Del. Phillip Hamilton , who was the chair of the House Health Welfare and Institutions Committee and vice-chair of the House Appropriations Committee, which gave him significant power and influence in the House.Two other bills introduced were also identical to the language of SB 298 as introduced. Del. Algie Howell, Jr. and Del. Harvey Morgan introduced HB 572 and HB 821 respectively.Morgan had carried a strong bill the year before, and continued to be a strong ally of VFHF. All of these bills completely prohibited smoking in public spaces like public buildings, healthcare facilities, retail stores, and also in restaurants and bars. They provided partial coverage for workplaces, prohibiting smoking in any workplace entered into by the public during the normal course of business. These bills also expressly repealed preemption to allow localities to enact ordinances that exceeded any part of their provisions. Three other bills, SB 202 . HB 288 and HB 1341 were introduced with a more limited purpose . These three bills redefined “restaurants” to avoid the situation in 2007 that had lead the defeat of the amended HB 2422 and partially repealed preemption by specifically allowing local ordinances to “contain provisions or standards related to smoking in restaurants that exceed those established in this chapter.” VFHF did not develop or ask legislators to introduce these bills; they were developed by the introducing legislators with input from the Governor’s office and occasional input from VFHF.After the defeats of SB 1161 and the amended HB 2422 in 2007, Gov. Kaine proposed a statewide restriction of restaurant smoking in early 2008 that was essentially the same as the amendments he had provided the year earlier. Kaine announced his support for smoke free restaurants on January 7, 2008, at a VBRA-organized press conference at Matt Falvey’s restaurant Hot Tuna. This bill was carried for the governor by Sen. Ralph Northam as SB 501. The bill redefined “restaurants” to exclude “mobile points of service” and made all restaurants and bars 100% smoke-free . Gov. Kaine said that his reasons for the proposal were based on scientific evidence on the health effects of secondhand smoke, which was “clear and convincing … Virginia must act to protect workers and consumers in restaurants.”Also, after offering the strong amendments for HB 2422, supporting SB 501 was a logical extension of his 2007 political stance.VFHF adopted a policy of supporting all these bills because they all made restaurants and bars 100% smoke free, even though some were not comprehensive.However, most of VFHF’s resources went to support the Whipple bills and those similar to it, with the main message being that all workers should be protected from secondhand smoke. Because all clean indoor air bills were considered together in the legislative hearings, VFHF was unable to testify about the differences between the individual bills, and instead had to testify about all of them together by focusing on the broader health issues regarding secondhand smoke.

The VBRA would go on to play a significant role in subsequent legislative sessions

Steve Yeakel, Representing Montana Council for Maternal and Child Health, said that he supported committing $3.2 million a year for tobacco prevention as was proposed in SB 485 , and supported an 18 cent tobacco tax increase. However, because some county health departments might lose funding for mental health medications and some individuals might lose medicaid services, he could not support more than $3.2 million for tobacco prevention.In response, HB 756 sponsor, Rep. Kaufman, stated that she believed the Legislature could find other funding sources for human services programs, without using tobacco settlement dollars.The chairman of the House Appropriations Committee, Sen. Dave Lewis , gave the bill lukewarm support at the March 25, 2003 hearing. Lewis told tobacco prevention activists that he would try to grant their wish for $9.3 million for prevention programs, but warned that less money would therefore go to human service programs for the needy.Lewis further stated that “I’m tired of getting beat over the head,” and that “I’ll vote for this, but we got to come up with the money somewhere else.” Rep. Lewis did vote in favor of HB 756, which was passed by the House Appropriations Committee on March 26, 2003 by a voter of 13 to 6.235 It would next have to be voted on by the full House. As conveyed by Rep. Lewis’ comments,vertical grow system the House Committee’s support of HB 756 resulted largely from the health advocates’ pressure on the Legislature. According to the Billings Gazette, “[t]obacco prevention lobbysist lined the Capitol’s halls and packed hearing rooms to support keeping the voter-approved funding formula intact.”In the same article, Rep.

Lewis said that the health advocates that “[t]hey won fair and square.”On March 28, 2003, the full House approved HB 756 by a vote of 59 to 38. Local newspapers, however, reported that many lawmakers were still critical of the bill’s passage, arguing that the money should be available for other programs, because the human services budget was underfunded. HB 756 sponsor Rep. Kaufman responded in news reports that she was confident that the Legislature would find other sources of money to adequately fund human services programs.Kaufman stated that “[i]n the coming weeks, we have many opportunities to find revenue… And we will.” There were only 3 individuals testifying against SB 485, and they only gave very mild opposition to the “temporary diversion” of MSA money that was proposed. Joe Mazurek, representing PMK, opposed the bill, but also stated that the groups recognized the state’s budget predicament and were willing to take less than the full amount that the voters approved. Mazurek ended his testimony by saying he hoped that the tobacco prevention would get fully funded by the 2005 biennium. Verner Bertelsen, representing Montana Senior Citizen’s Association, stated that he was reluctant to testify against SB 485, and also hoped that tobacco prevention would be fully funded in the long run. Finally, Sammy Butler, representing the Montana Nurses Association, after commending Sen. Cobb for his commitment to fund human services programs, stated that his organization felt an obligation to respect the will of the voters, and that they reluctantly opposed SB 485. The Senate Finance and Claims Committee unanimously approved SB 485, 19 to 0, on April 1, 2003. The bill then went before the full Senate, which passed the bill by vote of 43 to 6 on April 14, 2003. SB 485 would next be transferred to the House, where it would be referred to House Committee on Business and Labor.At the April 16 hearing on SB 485 before the House Committee on Business and Labor, proponent testimony was given by representatives from 4 human services groups, including Jim Ahrens of the Montana Hospital Association.

Testimony in opposition to SB 485 was again presented by Joe Mazurek of PMK and Sammy Butler of the Montana Nurses Association. The House Committee on Business and Labor approved SB 485 by 14 to 4 on April 16, 2003. The full House approved SB 485 in a 60 to 40 vote on April 23, 2003.246 According to the Associated Press, none of the House members commenting on the passage of the bill by the full house argued against the need for funding of human services programs. Instead, House members against SB 485 focused their criticisms on respecting the will of the voters expressed in I-146, and the lack of a long term solution to the state’s budget problems.With the acquiescence from the very health groups that campaigned to get I-146 approved by voters, SB 485 passed with no trouble, and almost $11.8 million was diverted away from tobacco prevention in the 2004-2005 biennium. So by the end of April 2003, voter approved I-146 was virtually voided for two years. Thus, tobacco use prevention programs was allocated $3.2 million annually for the 2004-2005 biennium, as opposed to the $9 million annually specified under I-146 . Furthermore, the amount actually allocated to the TUPP in 2005 was lowered to $2.5 million per year after reduction adjustments to the state’s MSA payment . The state also appointed 15 people as a Tobacco Prevention Advisory Board in July of 2003 as was mandated by I-146, which would advise the DPHHS on how to allocate MSA money and play a similar role as the disbanded Governor’s Advisory Council on Tobacco Use Prevention .The $220 million budget deficit projected for the 2004-2005 biennium not only provided a justification for diversion of MSA funds to other human services programs, but also affected the 2003 Legislature’s consideration of increased tobacco taxes.Several tobacco tax increases were proposed in the 2003 Legislature, though only one would actually pass, Senate Bill 407. Even SB 407, however, would have probably failed if state legislators were less desperate to find additional state revenue. In the opinion of the major health groups , “had the state’s budget crisis not existed, a tobacco tax increase would not likely have passed.

Most legislators were clearly motivated simply by the need for additional revenue generated by the tobacco tax increase.”In addition to the state’s projected budget deficit, a survey of 405 Montana voters sponsored by Protect Montana Kids.org conducted in June 2003 by Harstad Strategic Research showed that tobacco taxes were a popular source of health care funding. The survey showed that 66% of those surveyed favored increasing tobacco taxes by 50 cents per pack if the revenues were directed to Montana health care services.As a result of the lack of funding for government services in 2003 and the public popularity of tobacco taxes as a source of health care funding, a tobacco tax increase was a popular option of revenue,indoor grow shelves despite what health advocated called a “reluctance on the part of some members of the legislature to increase tobacco taxes at all…”Several tobacco taxes were proposed by both Republicans and Democrats, though all of them except for SB 407 failed . Throughout the failed attempts to increase the cigarette tax, tobacco control groups gave consistent support to the proposed bills, while tobacco industry lobbyists consistently argued against them.The tobacco tax in Montana had not been permanently increased since 1990, when it was raised from 16 cents to 18 cents per pack. Former Gov. Marc Racicot in 2000 had included a cigarette tax increase of 38 cents a pack in his final budget recommendation before leaving office, but Gov. Judy Martz, who signed a no-new taxes pledge during her campaign, rejected the proposal.Tobacco control advocates had been promoting the idea of increased tobacco taxes throughout 2002 and 2003 as a way to raise funds for state programs and reduce tobacco use. In an April 30, 2002 opinion letter to the Helena Independent Record, Kristin Page Nei of ACS, Cliff Christian of AHA, and Dick Paulsen of ALA, wrote that “[t]he debate about tobacco taxes has recently heated up,”and noted that Montana in 2002 had the 11th lowest cigarette tax in the nation. The letter also explained the health costs in Montana resulting from smoke-related illness, and the potential for an increased cigarette tax to raise revenue for healthcare programs and deter children from smoking.The major health groups and other tobacco control advocates would continue to make statements in news articles as the debate over cigarette taxes became a greater focus in local newspapers. Tobacco control advocates also showed the popularity of the tobacco tax among Montana voters to state legislators. A Harstead Strategic Research Poll conducted between November 20-25 and paid for by health groups in Protect MontanaKids.org showed that, of 602 registered voters, 69% supported raising the per pack cigarette tax from 18 cents to $1.50 for the purpose of funding health programs, 27% were opposed to the increased tax, and 3% were undecided .

The poll was released on December 11, 2002, less than a month before the 2003 Legislature was to convene.Health groups and tobacco control advocates showed support for the failed cigarette tax proposals introduced throughout the 2003 Legislature . At a January 27, 2003 House Taxation Committee hearing where HB 204, HB 355 and HB 314 were presented, supporting testimony for cigarette taxes was given by 34 people, many of them representing health groups. Many of those same individuals and health groups also testified in favor of the SB 309 at the February 6, 2003 hearing before the Senate Taxation Committee,in support of SB 351 at the February 14, 2003 Senate Taxation Committee hearing,and in support of HB 763 at the March 31, 2003 House Taxation Committee Hearing.When the idea of increasing cigarette taxes began to be reported in local newspapers as an option that legislators were willing to consider, the tobacco industry began to criticize the idea. John Singleton, a spokesman for R.J. Reynolds, told the Billings Gazette that “[i]t’s a relatively small slice of the population to be paying for health care, budget deficit reduction, whatever they’re going to use the money for.”Singleton also stated that “[e]xcise taxes are already pretty high, and these various states are collecting quite a lot of revenue from the tobacco companies as it is.”The argument that the tobacco industry and smokers were paying an unfair share of taxes would be continued throughout the legislative session. Tobacco industry lobbyists opposed the failed cigarette tax proposals throughout the 2003 Legislative session. R.J. Reynolds lobbyist Jerome Anderson, in giving opposing testimony to HB 204, HB 355 and HB 314 at the January 27, 2003 House Taxation Committee hearing, stated that HB 204 would increase the state cigarette tax by 833%, and that HB 355 and HB 314 would amount to the highest tax increases he had seen in 56 years of Legislative sessions.265 Anderson added that smokers already pay their fair share and, though he agreed that Montanan needed help with health insurance and prescription drugs, he thought “those responsibilities are the responsibilities of everyone in Montana and not just a selective few.”265 Reflecting standard tobacco industry rhetoric, Anderson also suggested that large cigarette tax increases would lead to smuggling cigarettes from states with cheaper taxes or buying over the internet without proper security against sales to minors.265 Jerome Anderson and other tobacco industry representatives repeated these arguments when testifying against SB 309 at the February 6, 2003 Senate Taxation Committee hearing,258 against SB 351 at the February 14, 2003 Senate Taxation Committee hearing,259 and against HB 763 at the March 31, 2003 Taxation Committee Hearing.260. Along with Jerome Anderson, Aimee Grmoljez, an attorney with the firm Browing, Kaleczyc, Berry & Hoven , testified as a representative of Phillip Morris against the cigarette tax proposals, as did Mark Baker, representing U.S. Smokeless Tobacco and Mark Staples, representing Montana Wholesale Distributors.Governor Martz, as late as March 2003, was standing firm to her pledge not to raise new taxes, and stated specifically that her promise to veto tax increases included any cigarette taxes.Even in the face of a reported $232 million budget deficit, and with no solution to funding human services programs, Gov. Martz told reporters that she could not support the idea of paying the state’s bills by raising “sin” taxes.Although Gov. Martz did indicate a willingness to compromise her tax veto promise in support of proposed HB 750, which proposed violating the state’s coal tax trust fund and would therefore not gain enough votes because Democrats were unwilling to violate the trust.However, because the budget deficit in March 2003 was beginning to look unsolvable, Republican legislators became less opposed to raising tobacco taxes.