Tuesday, May 24, 2016

Doctor speaks up about battle with depression, leading cause of disability for people 15-44; only 20% with symptoms are treated

By Danielle Ray
Kentucky Health News

Pitman (Paducah Sun photo)
Dr. Jay Pitman knows what it's like to feel isolated. Pitman spoke out about his battle with depression in a recent essay in The Paducah Sun.

"I'm writing a piece about my depression, about things people don't like to talk about," he told Steve Wilson, editor of the newspaper. "I'm thinking it might help some people." Wilson wrote in his column about Pitman, whose essay was published a week earlier, along with a story about him.

Pitman's depression deepened after he was the victim of a near-fatal hit-and-run accident in 2013. He was found lying unconscious in a pool of blood. He had suffered a concussion, brain hemorrhage and a broken shoulder. His physical recovery was remarkable. In fact, he recovered well enough to compete in a triathlon the next year. But he has had a much longer road to emotional healing.

Pitman is not alone in his struggle. The Anxiety and Depression Association of America estimates that about 18 million Americans suffer from depression, and notes that depression is the leading cause of disability in people aged 15 to 44. The organization distinguishes two categories of depression: major depression and persistent depressive disorder, which is characterized by symptoms that last at least two years.

Pitman's essay garnered a lot of support, but he's more concerned with opening up an honest dialogue about the issue.

"My hope is that those coping with depression will seek help and talk openly about their disease without feeling ashamed or embarrassed," he told Wilson. "I've lost several friends to suicide."

Despite its prevalence, only about 20 percent of people with depression symptoms seek professional help, according to the online health network Healthline.

Tiffany Bryant, a Lexington counselor who specializes in treating depression, said many people don't seek help or speak out about depression because of a lingering stigma surrounding mental illness. She believes popular culture has created an environment that discourages people from representing themselves honestly, flaws and struggles and all.

"I think you can blame, to a certain extent, social media, because everybody wants to show their very best," she said. "A lot of people have this mask that they wear for other people, and they never really take it off."

Even with a fairly low rate of patients seeking treatment, Healthline estimates that the number of patients diagnosed with depression increases by about 20 percent each year.

The federal Centers for Disease Control and Prevention recommends early treatment. If not effectively treated, depression can become a chronic disease. Experiencing just one episode of depression places a person at a 50 percent risk for experiencing another episode in the future, according to the CDC.

While it can affect anyone at any time, women typically experience higher rates of depression than men. The CDC also noted that nearly 10 percent of people in their 40s and 50s report current depression. The good news is that 60 to 80 percent of all depression cases can be treated with either psychotherapy ("talk therapy"), antidepressant medication or a combination of both, says Healthline.

The American Psychiatric Association defines depression as a condition with any five of these seven symptoms for a continuous period of at least two weeks:
  • sadness;
  • loss of interest in activities that used to be enjoyable;
  • change in weight or appetite, change in activity level;
  • sleeping too much or too little;
  • loss of energy;
  • feelings of guilt or worthlessness;
  • difficulty concentrating or having thoughts of death or suicide.
Depression has a variety of causes, including genetic, environmental, psychological, and biochemical factors. The CDC notes that everyone gets "down in the dumps" at times, but it becomes pathological when symptoms are persistent and interrupt daily life. To learn more about it, from the National Institute of Mental Health, click here.

Sunday, May 22, 2016

Justice secretary, drug-policy chief and ex-health boss back needle exchanges but 'political rhetoric' can trump science

By Melissa Patrick
Kentucky Health News

CORBIN, Ky. – Local officials and legislators continue to debate and sometimes reject needle exchanges, but two state officials and a former state health commissioner voiced their strong support of them at a pubic forum May 17 in Corbin.

Dr. William Hacker:
"Needle exchanges work."
"Needle exchanges work," said Dr. William Hacker, chair of Shaping Our Appalachian Region's Health and Wellness Advisory Committee and former state health commissioner. "We would, as a public health role, encourage them to be extended."

Hacker spoke at the "Cumberland River Forum on Opioid Use Disorders: A Time for Community Change," one of three public forums on the subject in Kentucky in May.

The General Assembly authorized needle exchanges in the 2015 anti-heroin bill, as a way to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They require both local approval and funding.

Kentucky's rate of hepatitis C is the highest in the nation, and a recent federal Centers for Disease Control and Prevention report said that of the 200 counties in the nation that are most susceptible to a hepatitis C or HIV outbreak, 54 of them are in Kentucky.

So far, only 14 counties in Kentucky have either approved or are operating needle exchanges: Jefferson, Fayette, Jessamine, Franklin, Clark, Kenton, Grant, Harrison, Pendleton, Carter, Boyd, Elliott, Pike and Knox.

Justice Secretary John Tilley:
"Real facts and real science"
Justice Secretary John Tilley, who was instrumental in getting the heroin bill passed when he was a state representative from Hopkinsville, encouraged communities to look at the evidence-based research that supports needle-exchange programs and to not listen to the political rhetoric.

"We've got to push aside this political rhetoric on topics like this one and talk about real facts and real science," he said. "These programs have been validated by meta-analysis. ... Those who seek out a needle exchange are five times more likely to enter treatment. These programs continue to beat back blood-borne illnesses like hepatitis C and HIV, at rates we cannot duplicate without these programs. They are universally successful at what they do."

Tilley said after the meeting that addiction is a chronic disease and should be treated as a public-health crisis, noting that other diseases are treated based on science and medicine, not opinion.

"When you go to the doctor, you don't ask him his political view of a particular health program," he said. "Well, this is no different. And for me to substitute my judgment for the science is dangerous."

Van Ingram changed his mind
Van Ingram, executive director of the Governor's Office of Drug Control Policy, said his opinion about needle exchanges changed after he researched them and learned how effective they are at decreasing the spread of hepatitis C and HIV. He also noted that these programs provide testing and treatment referral for these infectious diseases, and also help participants get treatment.

"Eleven years ago I left law enforcement, and if you had told me that I would end up being the poster boy for syringe exchange, I would have said you were crazy," he said. "But quite honestly, they do work."

Ingram also noted the CDC study and reminded the audience of the "enormous" HIV outbreak that occurred last year in Scott County, Indiana, 30 miles north of Louisville.

"So if a syringe exchange can keep us from having a rapid HIV outbreak, I think that is probably a good trade-off," Ingram said.

But evidence-based research isn't always enough to convince policy makers that needle exchange programs don't condone or perpetuate drug use.

The Georgetown newspaper answered its
question in its story. The answer is yes.
Last week it was reported that two Kentucky counties decided against needle exchanges. Boone County's Fiscal Court silently said no to a needle exchange by refusing to call up a resolution to support one, Mark Hansel reported for NKyTribune. And the Scott County Fiscal Court voted 5-3 against one, Dan Adkins reported for the Georgetown News-Graphic. Adkins followed up with a featured front-page story about the county's heroin problem.

A point of contention among Republicans in the General Assembly is that some of the exchanges don't require a needle-for-needle exchange, which they say was their intent.

Then-Attorney General Jack Conway said Dec. 18 that needle exchanges did not have to be one-for-one. It is also widely accepted that not requiring one-for-one is considered a best practice across the country to prevent the spread of HIV and hepatitis C and to stop intravenous drug users from sharing and reusing needles, Dr. Sarah Moyer, the interim director of the Louisville Metro Department of Public Health and Wellness, told Kentucky Health News in March.

Last session, as the Senate voted to amend House Bill 160 to require one-to-one exchanges, Senate Republican Floor Leader Damon Thayer of Georgetown threatened to file a bill to eliminate them altogether next session if they don't make this change during the upcoming year.

In its original form, HB 160 was a bill to educate the public about how to safely dispose of hypodermic needles in order to keep them out of landfills. The House let the bill die without another vote.

Tilley said after the meeting, "Culture and change takes a while," and noted that while he respected his colleagues differing opinions, he said it is likely that this topic is not in their "wheelhouse."

"So, I think the more they learn the more they will come along," he said. "What we should do is all come back to the table and talk about how the programs that are now in place in Kentucky are working and how the reliance on science and evidence based policy makes them work."

Nine myths about opioid drug abuse

Do you think it's a good idea to save your leftover pain pills to have "just in case" you might need one, or that heroin is primarily an inner-city problem? Think again. Those are among nine common myths that were busted at a community opioid forum in Corbin May 17 in hopes of decreasing some of the stigma that surrounds addiction.

"One of the things we know is that the stigma that exist around opioid abuse is largely propelled because of the myths that exist," said Janet Jones, a representative from Hazelden Betty Ford Foundation, the nation's largest nonprofit addiction treatment provider. Jones led the group discussion about nine opioid myths:

*Myth 1: Abusing prescription painkillers to get high is safer because they are made by a pharmaceutical company and doctors prescribe them.
Fact: Prescription drugs can be just as addictive and just as dangerous as illegal ones, like heroin. The brain and body treats heroin and prescription opioids the same.

*Myth 2: I should save my extra prescription pain pills just in case I need them for something else later, like joint pain or a toothache.
Fact: Saving pain pills that you no longer need can be dangerous because young people often gain access to them. The next time you need pain medication, talk to your health-care provider about the risk, ask them to prescribe only what you need, and properly discard unused drugs when you no longer need them.

*Myth 3: Snorting or smoking heroin or prescription opioids is safer than injecting them.
Fact: There is no "safe" way to abuse a drug. And while injecting drugs with shared needles increases the risk of HIV/AIDS or hepatitis C, any method of opioid abuse can lead to overdose and death.

*Myth 4: Heroin is primarily an inner-city problem.
Fact: Heroin use is on the rise nationwide, including in suburban and rural areas.

*Myth 5: A person addicted to heroin or prescription painkillers is a lost cause.
Fact: Treatment works. Recovery is possible with appropriate treatment and adequate social support systems.

*Myth 6: Heroin and prescription pain pills are just the latest "fad" drugs and their appeal will fade.
Fact: Opium, heroin and other opioids have been used for thousands of years. Prescription opioids have a legitimate use as effective painkillers and are not going away any time soon. And while illegal drugs come and go, communities are experiencing unprecedented use of opioid drugs, and people are dying at epidemic levels

*Myth 7: Making Narcan (naloxone) available to first responders wastes resources on people who have given up, and takes away an addict's incentive to quit by making them less likely to die of an overdose.
Fact: Addiction is a chronic disease, not a moral flaw, and the only way a person can get help is if they are alive to do so. Time is critical to overdose survival rates and naloxone helps to save these lives.

*Myth 8: Heroin and prescription painkiller abuse only hurts those who use the drug.
Fact: Opioid abuse hurts everyone. Financially, the legal, healthcare and lost productivity costs total in the billions and the intangible costs to families and friends are incalculable.

*Myth 9: Hardworking everyday people don't use heroin or misuse prescription painkillers.
Fact: Any type of person can develop an opioid use disorder.

Conference on cancer-causing HPV in Lexington June 21

The Kentucky Rural Health Association is sponsoring a summit on the human papilloma virus, "HPV - You ARE the Key!" June 21 at the Embassy Suites in Lexington.

The HPV vaccine is nearly 100 percent effective in preventing pre-cancers and noninvasive cervical cancers caused by two strains of the virus, but most parents in Kentucky and the nation are still not getting their adolescents vaccinated. Kentucky falls in the bottom 10 states for HPV vaccination, with 37.5 percent of its girls and 13.3 percent of boys aged 13-17 vaccinated as of 2014.

The conference will host several keynote speakers, including:
  • Kirk Forbes, who co-founded the Kristen Forbes EVE Foundation in honor of his 23-year-old daughter, Kristen Forbes, who passed away after a yearlong battle with HPV caused cervical cancer;
  • Dr. Daron G. Ferris, professor and director of the Gynecologic Cancer Prevention Center at the Medical College of Georgia;
  • Dr. W. Michael Brown, associate director and the director of pediatrics at the Bayfront Family Medicine Residency Program in St. Petersburg, among other positions; and
  • Dr. Alix Casler, medical director of the Department of Pediatrics for Orlando Health Physician Associates, among other positions.
The conference is also sponsored in collaboration with the Kentucky Immunization Program and the Division of Women's Health.

The event will last from 8 a.m. to 5 p.m. June 21 and costs $40 thru June 1, and $55 after that date. Continuing education credits will be offered. Click here to register and here for the draft agenda.

Saturday, May 21, 2016

CDC finds health problems are common at public pools; state requires local health departments to inspect each one twice a year

Thousands of public pools, hot tubs and water playgrounds are forced to close every year for serious health and safety violations, according to a new study by the federal Centers for Disease Control and Prevention.

Kentucky requires local health departments to conduct two full inspections of each public swimming pool during the operating season, once every six months for its continuous-operation indoor facilities, and monthly water chemistry inspections, according to the state Department for Public Health.

"The local health department environmentalists are the ones who do these inspections and monitors, so the records for these inspections are kept with each local health department, Beth Fisher, spokesperson for the Cabinet for Health and Family Services, said in an e-mail.

But you might want to do your own inspection if you go on vacation out of state, because that's not the case everywhere.

"Almost one third of local health departments do not regulate, inspect, or license public pools, hot tubs, and water playgrounds,” Michele Hlavsa, chief of the CDC's Healthy Swimming Program, said in a news release. “We should all check for inspection results online or on site before using public pools, hot tubs, or water playgrounds and do our own inspection before getting into the water.”

And even if states are checking their pools, that doesn't mean they are always safe.

A 2013 CDC study of inspection data from the five large states containing 40 percent of the nation's public aquatic venues found that almost 80 percent of them had at least one violation. It found that one in eight inspections resulted in immediate closure because of serious health and safety violations and that one in five kiddie or wading pools were closed due to violations. Most of the violations were related to improper pH (15 percent), lack of proper safety equipment (13 percent) and inadequate disinfectant levels (12 percent).

"Young children who are still learning their toileting skills are more likely to contaminate the water. They're more likely to swallow the water. Both of which can lead to outbreaks of diarrheal illness," Michael Beach, the CDC's associate director for healthy water, told Dennis Thompson at HealthDay News. He said pH levels are "critical because it determines how effective the disinfectant is killing germs."

The CDC recommends that parents change their infants' diapers often and in the bathroom, not poolside, to take children to the bathroom every hour, and to teach children to spit out any pool water they get in their mouth.

Beach said most contamination of public pools and hot tubs are the result of people swimming while suffering from diarrhea. He said adults should not swim while recovering from diarrhea, and if they do, should shower before getting in the water.

The CDC recommends individuals do a self-inspection of all public pools before getting in them and offers this checklist that identifies some of the most common swimming pool health and safety problems:
  • Use a test strip (available at most superstores or pool-supply stores) to determine if the pH and free chlorine or bromine concentration are correct.
  • Make sure the drain at the bottom of the deep end is visible.
  • Check that drain covers appear to be secured and in good repair.
  • Confirm that a lifeguard is on duty at public venues. If not, check whether safety equipment like a rescue ring with rope or pole is available.
If you find problems, do not get into the water and tell the person in charge so the problems can be fixed, says the release.

Friday, May 20, 2016

Changes coming for Nutrition Facts labels on food products: emphasis on calories, added sugar and serving size

Associated Press

By Danielle Ray
Kentucky Health News

Nutrition labels on food products will undergo a facelift over the next two years.

The U.S. Food and Drug Administration finalized plans Friday to change labeling to emphasize calorie count and added sugars in an effort to simply nutrition labels and clarify serving sizes.

First lady Michelle Obama, a longtime crusader against childhood obesity, said parents will benefit from the upcoming changes.

"You will no longer need a microscope, a calculator, or a degree in nutrition to figure out whether the food you're buying is actually good for our kids," she told The Associated Press.

The overhaul puts less emphasis on fats and more on caloric value and added sugars. Calories on upcoming labels will be listed in larger font than other nutrient facts. Added sugar will get its own line, separate from naturally occurring sugar.  Currently, both added and naturally occurring sugars were lumped under one category, "Sugars."

New labels will also include a new "percent daily value" for added sugar, which will tell consumers how much of their recommended daily intake they will get from a given item. The FDA recommends consuming less than 10 percent of total daily calories (200 calories in a typical diet) from added sugar.

"The new labels should also spur food manufacturers to add less sugar to their products," Michael Jacobson, president of the advocacy group Center for Science in the Public Interest, told AP. He said that under current labeling, it's nearly impossible for consumers to know how much sugar fits into a reasonable diet.

The footnote will better explain what "percent daily value" means. It will read: “The % Daily Value tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.”

Serving sizes will also be clearer. The biggest difference will be that serving sizes will be based on what consumers typically eat instead of what they should eat. About one-fifth of foods will undergo revised calculations. For example, a serving size of ice cream will be 2/3 of a cup; previously it was a 1/2 cup.

If you've ever been duped into consuming more calories than you intended, or tried to calculate exactly what fraction of a slice of pizza constitutes a serving size, you're in luck. Package size affects what people eat, the FDA noted. So, products that were previously between one and two servings, such as a 20-ounce soda, will be labeled as a single serving, since consumers generally eat or drink the entire contents in one sitting.

Larger containers, like pints of ice cream, will have dual column labels: one column with information for a single serving and the other with information for the entire container.

Labels will also include two additional nutrients: potassium and Vitamin D.

Industry reaction was predictable. A representative for the Sugar Association told AP that emphasis on added sugar could confuse consumers, but other industry leaders welcomed the changes.

"This update is timely as diets, eating patterns and consumer preferences have changed dramatically since the Nutrition Facts panel was first introduced," Leon Bruner, of the Grocery Manufacturers Association, told AP.

Most food manufacturers have until July 2018 to comply. Smaller manufacturers will have an additional year.

The FDA proposed the changes two years ago. They are the first major update to nutrition labels since labeling was introduced in 1994. So far, more than 800,000 foods have nutrition labels.

For more information on the changes, click here.

Obama asks public to tell Congress to fund the $1.9 billion Zika fight he wants; Senate passed $1.1 billion, House $622 million

The Zika funding package of Appropriations Committee Chair Hal Rogers and other House Republicans "doesn't make a lot of sense" and the somewhat larger Senate package backed by Majority Leader Mitch McConnell and a bipartisan Senate majority falls well short of what is needed, President Obama told reporters Friday.

The Senate has passed a $1.1 billion package and the House approved $622 million. Obama wants more than three times the House figure, $1.9 billion, to fight the virus that causes a serious birth defect.

"We didn’t just choose the $1.9 billion from the top of our heads," Obama said. "This was based on public-health assessments of all the work that needs to be done. And to the extent that we want to be able to feel safe and secure, and families who are of childbearing years want to feel as if they can have confidence that when they travel, when they want to start a family that this is not an issue -- to the extent that that's something that we think is important, then this is a pretty modest investment for us to get those assurances."

Obama said the House package is not only inadequate, "That money is taken from the fund that we're currently using to continue to monitor and fight against Ebola. So, effectively, there’s no new money there. All that the House has done is said, you can rob Peter to pay Paul. And given that I have, at least, pretty vivid memories of how concerned people were about Ebola, the notion that we would stop monitoring as effectively and dealing with Ebola in order to deal with Zika doesn’t make a lot of sense."

The president added, "This is something that is solvable. It is not something that we have to panic about, but it is something we have to take seriously. And if we make a modest investment on the front end, then this is going to be a problem that we don't have to deal with on the back end." He said each child who has a small brain as a result of Zika "may end up costing up to $10 million over the lifetime of that child in terms of that family providing that child the support that they need. . . .  It doesn’t take a lot of cases for you to get to $1.9 billion. Why wouldn't we want to make that investment now?"

Part of the money would go to develop a vaccine for Zika, and part of that work is going on at the University of Kentucky. "You don't get a vaccine overnight," Obama said. "You have to test it to make sure that any potential vaccine is safe. Then you have to test to make sure that it's effective. You have to conduct trials where you're testing it on a large enough bunch of people that you can make scientific determinations that it's effective. So we've got to get moving."

Obama said the Centers for Disease Control and Prevention and the National Institutes of Health are "taking pots of money from other things -- universal flu funds or Ebola funds or other funds -- just to get the thing rolling. But we have to reimburse those pots of money that have already been depleted and we have to be able to sustain the work that’s going to need to be done to finish the job. So, bottom line is, Congress . . . needs to get me a bill that has sufficient funds to do the job."

The president said that should happen before the summer congressional recess in August, "to provide confidence to the American people that we're handling this piece of business." He said the money would be insurance for young families or couples thinking about having children.

"To the extent that we're not handling this thing on the front end, we're going to have bigger problems on the back end," Obama said. "Tell your members of Congress, get on the job on this. This is something we can handle. We should have confidence in our ability to take care of it. We've got outstanding scientists and researchers who are in the process of getting this done, but they’ve got to have the support from the public in order for us to accomplish our goal."

1/2 of cancer deaths and maybe 1/2 of new cases could be prevented by exercise, watching food and drink, and not smoking

Half of all cancer deaths could be prevented "by applying insights that we've had for decades — no smoking, drinking in moderation, maintaining a healthy body weight and exercising," Carolyn Y. Johnson reports for The Washington Post, about a study published in JAMA Oncology.

Those measures could also cut new cancer cases by 40 to 60 percent. Those are big numbers, and especially important for Kentucky, which has some of the nation's leading rates of cancer and death from it — and, not coincidentally, is among the national leaders in smoking and obesity.

"Some of the declines we have already seen in cancer mortality — the large decline in lung cancer — that was because of efforts to stop people from smoking," Siobhan Sutcliffe, an associate professor in the division of public health sciences at Washington University in St. Louis, told Johnson. "Even while we’re making new discoveries, that shouldn’t stop us from acting on the knowledge we already do have."

Sutcliffe was not involved in the study, which used "large ongoing studies that have closely followed the health and lifestyle habits of tens of thousands of female nurses and male health professionals," Johnson reports. "They divided people into two groups: a low-risk group that did not smoke, drank no more than one drink a day for women or two for men, maintained a certain healthy body mass index, and did two-and-a-half hours of moderate aerobic exercise a week or half as much vigorous exercise.

"The team compared cancer cases and cancer deaths between the low- and high-risk groups and found that for individual cancers, the healthy behaviors could have a large effect on some cancers: The vast majority of cases of lung cancer were attributable to lifestyle, as well as more than a fifth of cases of colon cancer, pancreatic cancer and kidney cancer.

"Then, they extrapolated those differences to the U.S. population at large, finding an even larger proportion of potentially preventable cancer cases and deaths. For women, they estimated 41 percent of cancer cases were preventable and 59 percent of cancer deaths. For men, 63 percent of cancer cases were potentially preventable and 67 percent of deaths."

The researchers at Massachusetts General Hospital and the Harvard T.H. Chan School of Public Health noted some caveats: "The high-risk group in the study is healthier than the general U.S. population, so there are reasons the numbers may be slightly overestimated," Johnson writes. "But Mingyang Song, the researcher who led the work, argues the numbers are a good approximation because they may be underestimating the effects of lifestyle, too, because they selected a narrow range of lifestyle factors."

Thursday, May 19, 2016

At forum on opioid abuse in Corbin, people say they need more treatment services, community education and coalitions

Image from Lauren Osborne, WYMT-TV Mountain News
By Melissa Patrick
Kentucky Health News

CORBIN, Ky. – After a day of learning and talking about opioid prevention, treatment and mobilization, people at a forum in Corbin agreed on three things: Access to substance abuse and mental health services remains a huge barrier in southeastern Kentucky; more community education is needed; and drug-prevention programs should form coalitions to better use their limited resources.

Substance abuse affects almost every family in Kentucky, and four Kentuckians die every day from a drug overdose. That was part of the opening message from Dr. Allen Brenzel, medical director of the state Department for Behavioral Health, Development and Intellectual Disabilities.

"This is, in my opinion, one of the most pressing health-care issues facing our commonwealth today," Brenzel said. "If 1,000 people a year were dying from measles in the state of Kentucky, think about the public response that we would have. ... We would be on red-alert, we would have a complete, public-health, massive intervention to solve that problem."

Van Ingram, executive director at the Governor's Office of Drug Control Policy, said that next year's drug overdose report, which will be released in a few weeks, will show the problem is getting worse.

About 125 people, most of them health-care providers, attended the "Cumberland River Forum on Opioid Use Disorders: A Time for Community Action" May 17 at the Corbin Technology Center. It was sponsored by The Kentucky Cabinet for Health and Family Services, the Hazelden Betty Ford Foundation, and Cumberland River Behavioral Health. Similar forums were held in Lexington May 16 and Louisville May 13.

John Tilley
John Tilley, secretary of the Kentucky Cabinet for Justice and Public Safety, said he hoped the forum would "light a fire under this community" to talk to their neighbors and friends, community leaders and legislators about the value of treatment over incarceration for substance abuse and mental health issues.

Tilley, who chaired the House Judiciary Committee when he was a state representative from Hopkinsville, acknowledged that some abusers should be in prison, but said society must distinguish between "who we are mad at and who we are afraid of. ... I promise you the way to get out of this mess is not to over-criminalize addiction and mental illness."

Tilley said "The solution is right before our eyes," using for treatment some of the billions of dollars now used to incarcerate drug users.

Tim Feeley, deputy secretary for the CHFS and a former legislator from Oldham County, agreed: "We are not going to incarcerate our way out of this." He said the state needs more treatment programs and said the cabinet was fully committed to addressing the state's addiction problems to the best of its abilities.

William Hacker
Kentucky has moved away from treating mental health and substance abuse issues criminally, said Dr. William Hacker, chair of Shaping Our Appalachian Region's Health and Wellness Advisory Committee and former state health commissioner. He said other successful anti-drug efforts include grassroots advocacy groups, the online prescription-drug tracking program, needle-exchange programs, a move toward medication assisted treatments for opioid addiction, and the SMARTS initiative, which provides addiction care for pregnant and parenting women for up to two years.

Hacker also mentioned Operation UNITE, a Kentucky non-profit created by U.S. Rep. Hal Rogers that leads education, treatment and law enforcement initiatives in 32 counties in Southern and Eastern Kentucky. UNITE has held a national drug abuse conferences for the past five years, with this year's summit in Atlanta including President Barack Obama. The acronym stands for Unlawful Narcotics Investigations, Treatment and Education.

A former pediatrician in Corbin, Hacker also noted that SOAR recently held a Substance Abuse Roundtable to discuss research and emerging opportunities associated with substance abuse and intravenous drug use in Appalachian Kentucky. He said SOAR works to create a network across the region to share best practices and money opportunities and to create community level empowerment.

"Substance abuse is not a failure of moral character, it is a disease," Hacker said. "Don't give up. Never give up."

At the end of the meeting, the attendees broke into groups that represented schools, community leaders, health-care professionals, parents and the faith community to discuss what actions they could take to address opioid abuse in their communities.

Most groups reported that lack of access to substance abuse and mental health treatment is a barrier in their communities. And while it was noted that some communities offer more services than others, several groups said they did not have enough counselors to support medication-assisted therapies or enough doctors willing to prescribe it. Lack of transportation was also mentioned as a barrier toward getting treatment in several groups.

Also, most groups said community members often aren't aware of the resources, so more community education is needed. They listed schools, churches and county Extension offices as possible sources of education, and noted that a community resource website would be helpful. They also said parents would benefit from a class to learn how to talk to their children about drugs.

The groups agreed that all sectors of the community were needed to combat substance abuse and suggested that drug prevention programs in each community should form coalitions to better use resources and information.

Slicing your way to an apple a day: Americans' apple consumption is on the rise because we're eating them in small pieces

Photo from livestrong.com
By Danielle Ray
Kentucky Health News

Presentation is everything. Apple consumption is on the rise, and researchers at Cornell University think pre-sliced apples are the cause.

The 2013 Cornell study explored why so many whole apples served in school lunches ended up uneaten in the trash. Researchers found that eating whole apples can be difficult for young children with small mouths and for kids with missing teeth or braces. The study also noted that older girls find whole fruits messy and unattractive to eat.

The study found that consumption jumped by more than 60 percent when apples were served sliced. These findings back up U.S. Department of Agriculture statistical data about overall apple consumption. Data show that Americans ate more than 510 million pre-sliced apples in 2014, up from fewer than 150 a decade before.

Likewise, overall apple consumption has grown by 13 percent percent since 2010, according to USDA data. Americans ate about 17.5 pounds per capita in 2013, the most in nearly a decade.

Why does simply slicing an apple matter? The difference between a whole apple and apple slices may seem silly or superficial, especially to an adult, but the inconvenience is a barrier nonetheless, David Just, a professor of behavioral economics at Cornell and one of the researchers behind the study, told Roberto Ferdman of The Washington Post.

"It sounds simplistic, but even the simplest forms of inconvenience affect consumption," Just said. "Sliced apples just make a lot more sense for kids."

The rise of mass-produced pre-sliced apples probably has a lot to do with the fast food industry. McDonald's added apple slices to its menu in 2004 in an effort to give parents healthier options. The company began automatically serving apple slices with Happy Meals in 2012, causing apple sales to skyrocket.

McDonald's has served more than 2 billion packages since first offering apple slices as a side, a representative for the company told the Post. In 2015 alone, the company served nearly 250 million packages of sliced apples, which amounts to more than 60 million apples, or about 10 percent of all fresh sliced apples sold in the United States, the Post noted.

The USDA, which oversees school lunch programs, can't be sure of how many schools offer pre-sliced apples versus whole apples, as local school districts make that decision. However, the agency does make recommendations and encourages schools make fruit appealing in presentation.

The problem with the pre-sliced apple trend? It may lessen food waste, but it increases plastic waste, which puts a strain on the environment. McDonald's apple slices, for example, are served in plastic wrappers. These wrappers are recyclable, yes, but two important differentials exist. First, "recyclable" does not mean it was made of recycled materials, only that it has the potential to be recycled. Second, just because consumers can recycle the wrappers does not mean they will.

Wednesday, May 18, 2016

Feds strengthen anti-discrimination health rules

Photo from mdxipe.wordpress.com
By Danielle Ray
Kentucky Health News

The Department of Health and Human Services issued rules Friday in an effort to ensure equality in health care for women, the disabled and people who speak English as a second language.

The new provisions protect women from discrimination not only in the health coverage they obtain but in the health services they seek from providers. They also prohibit denial of health care or health coverage based on a person's sex, including discrimination based on pregnancy, gender identity and sex stereotyping.

The rule also requires providers to take reasonable steps to provide communication access to people with limited English proficiency. In addition, it requires that providers make electronic information and newly constructed or altered facilities accessible to individuals with disabilities, including providing auxiliary aids and services.

HHS Secretary Sylvia Burwell called the rule "a key step toward realizing equity within our health care system." She said in an agency news release that it reinforces the central goal of the Patient Protection and Affordable Health Care Act, to improve access to quality health care.

The rule covers any health program or activity that receives federal funding, such as providers who accept Medicare or Medicaid; any health program that HHS administers; and federal- and state-based health insurance marketplaces and insurers that participate in them.

The new rule implements Section 1557 of the 2010 health-reform law, which is the first federal civil-rights law to prohibit discrimination based on sex in federally-funded health programs. Previously, civil rights laws enforced by the agency's civil rights office barred discrimination based only on race, color, national origin, disability, and age.

The rule does not resolve whether discrimination on the basis of an individual’s sexual orientation status alone is a form of sex discrimination under the reform law. However, the provisions leave room for the agency's civil-rights office to evaluate complaints that allege sex discrimination related to a person’s sexual orientation to determine if they can be considered sex stereotyping, which the rule prohibits. In cases where religious freedom would be violated, health-care providers are not required to follow the regulation.

A summary of the new rule can be accessed here.

House Republicans want to make it harder for schools to get free meals for all students; could affect more than 350 Ky. schools

Photo from npr.org
By Danielle Ray
Kentucky Health News

Kentucky school officials are concerned about a proposal by Republicans in the U.S. House that would make it harder for schools to offer free meals to all students using federal money.

The House is considering changes to the 2010 Hunger-Free Kids Act, now in its second year, which allows schools who serve a high-poverty population to offer free meals to every student.

Instead of collecting individual applications for free or reduced-price meals, the Community Eligibility Provision uses data that illustrates how many students in a given school may be "food-vulnerable": how many students live in households that receive government assistance, live in foster care, are homeless, and other similar criteria.

Under current CEP rules, schools with greater than 40 percent of students who qualify as food-vulnerable are eligible to offer free meals to all students. A bill approved May 18 by the House Education and Workforce Committee would raise the threshold to 60 percent, forcing schools between 40 and 59 percent range off the program.

"Proponents of community eligibility say it spares schools from paperwork and administrative burdens, and that it allows low-income children to eat free meals without the stigma or red tape of particpation in the free meal program, which is often a barrier for participation," Evie Blad reports for Education Week. "But Republicans on the committee said the provision is wasteful, potentially allowing children from higher-income families access to free meals."

The change could affect more than 350 Kentucky schools. Kentucky has 804 schools eligible to offer free meals under current CEP rules, according to the Center on Budget and Policy Priorities. Under the proposed bill, only 441 would qualify, according to the center.

More than 10,000 students at 17 public schools in Lexington alone would be affected, according to the Lexington Herald-Leader reported. More than 190,000 students statewide could be affected, the Herald-Leader said.

Nick Brake, superintendent of Owensboro schools, told Keith Lawrence of The Messenger-Inquirer that he is hopeful that his district will be spared cuts.

"I have been working with Congressman (Brett) Guthrie’s office on this issue," Brake said. "We are still looking at the overall numbers, but our district average is 63 percent, so it looks favorable that we will be able to continue to provide the benefit of this vital program in the future."

Muhlenberg County Supt. Randy McCarty told Lawrence he thought his district would still qualify. "Once a district goes CEP, it stays in place for four years," he said.

Hopkins County, which recently expanded its use of free meals to all public schools, faces uncertainty if the changes are passed.

"I have no idea if school districts will be grandfathered in, or how Congress will write everything, but I am afraid that if we don't jump on this now, we may not get this opportunity again," Michael Dodridge, food services director of Hopkins County schools, told Laura Buchanan of The Messenger in Madisonville. "I would hate to pass this up."

The proposed CEP changes are part of House Resolution 5003, the child nutrition reauthorization bill introduced by Indiana Republican Rep. Todd Rokita. For more information on the proposed changes, click here.