Thursday, July 30, 2015

Year of perseverance pays off for advocates of school tobacco ban in a county where raising tobacco was long a way of life

Clinton County in red (Wikipedia map)
A year of perseverance, education and community input by the local and district health departments paid off as the Clinton County Board of Education voted July 20 to make its schools 100 percent tobacco free, reports The Clinton County News.

Clinton County joins Somerset, Casey County, Adair County and Russell County as school districts in the Lake Cumberland District Health Department area with tobacco-free policies. The area was home to thousands of tobacco farmers, but there are only hundreds now, 11 years after the end of federal quotas and price supports.

It all began last year when the Clinton County board told Ashley Bridgman, health educator for the Wayne, Clinton and Cumberland County health departments, that they needed more education before they could vote on a tobacco-free school policy in their district, the newspaper reports.

Bridgman said this prompted her to look at other districts as a model for Clinton County and distribute surveys to help determine public opinion on the issue. The survey was part of a larger public opinion poll conducted by the district health department.

The poll found that 86.55 percent of the survey respondents in Clinton County were in favor of completely tobacco-free schools. It also asked, "Would you like to see our school become tobacco-free at all events?" Though this included athletic events, the results were basically the same: 85.3 percent said yes. The poll of 749 residents had an error margin of plus or minus 3.6 percentage points.

The poll also found that 77 percent of teachers said they would "definitely" support making the schools 100 percent tobacco-free.

“A lot of community members want this change in our schools,” Bridgman told the newspaper.

The health department presented the survey and other findings to the school board June 15. The board took no action, but five weeks later, on July 20, members unanimously made all schools 100 percent tobacco free starting at the beginning of the 2016-17 school year. The delay is meant to give the public more time to adjust to the new rule.

The county received a $14,000 tobacco-free campus grant to be used for a 12-month media campaign and public awareness program to inform the public about the Tobacco Free School program, which will be led by Bridgman. A similar campaign was set up in Casey County, which will go tobacco-free this school year.

Now that the policy has been approved, Bridgman told the paper, “There has been a lot of tears, but I’m very excited. It’s for the community, it’s for the kids, and it’s for the health, and that’s very important.”

As of June, 44 school districts, out of 173 in Kentucky, were entirely tobacco-free, according to the state's "100% Tobacco Free Schools" website.

Wednesday, July 29, 2015

Americans are eating fewer calories, but needs to cut back more if they want to combat the obesity epidemic

Americans are eating fewer calories for the first time since the government began keeping track, more than 40 years ago. While that's a step in the right direction, one researcher says that it is not enough to reverse the obesity epidemic, Margot Sanger-Katz reports for The New York Times.

The greatest decrease in calorie intake was found among children of all major demographic groups (with some variations), by at least 9 percent, Sanger-Katz reports.

image from fitfamilytogether.com
Much of this calorie decrease has come from people drinking less full-calorie soda, of which consumption has decreased in the U.S. by 25 percent since the 1990s, Sanger-Katz reports. Credit is also given to an influx of scientific research that emerged in the 1990s about the costs of obesity, and to more recent public health campaigns.

“I think people are hearing the message, and diet is slowly improving,” Dr. Dariush Mozaffarian, the dean of the Friedman School of Nutrition Science and Policy at Tufts University, told the Times.

Americans' eating habits began to rapidly change in the mid-1970s, with calorie consumption increasing steadily to its highest peak in 2003, Sanger-Katz writes.

“This was like a freight train going downhill without brakes,” Kelly Brownell, dean of the Sanford School of Public Policy at Duke University, told the Times. “Anything slowing it down is good.”

image from The New York Times
Three large sources of data about diet have convinced many health officials that the changes in calorie consumption are meaningful, reports the Times. The first two sources, detailed daily food diaries tracked by government researchers and data from food bar codes and estimates of food production, show a reduction in calories consumed by the average American since the early 2000s. The third source shows a leveling off of the national obesity rate.

While the trend toward eating fewer calories had already begun to surface, a Centers for Disease Control and Prevention report in 1999, which showed the worsening obesity rates in the 1980s and 1990s across the nation, is thought to be the first breakthrough in understanding the magnitude of America's obesity problem. Soon after this study was released, the surgeon general issued a report that summarized the effects of obesity as a risk factor for several chronic diseases.

Now the Patient Protection and Affordable Care Act requires chain restaurants to publish the calorie content of their meals, and in 2012 the federal government introduced new healthier standards for school meals for the first since 1995. Several cities have also increased their efforts to combat the obesity epidemic by subsidizing produce for the poor, limiting unhealthy foods in day care centers, and placing taxes on sugar-sweetened beverages, reports the Times.

The most common theme of anti-obesity public health campaigns has been a focus on decreasing the consumption of sugar sweetened beverages, reports the Times. And it seems to have worked.

"Americans, on average,purchased about 40 gallons of full-calorie soda a year in 1998, according to sales data from the industry trade publication Beverage Digest analyzed by the Center for Science in the Public Interest. That fell to 30 gallons in 2014, about the level that Americans bought in 1980, before the obesity rates took off," Sanger-Katz reports.

But public officials in the article also note that while overall Americans are eating less of everything, they aren't eating a healthier diet; the consumption of fruits and vegetables remains low, and the consumption of desserts remains high.

Chart from "The State of Obesity" report, 2014
Notably, more than a third of American adults are still considered obese, which also holds true in Kentucky, which ranks fifth in obesity among the states and has moved up in rank over the years, according to the 2014 "State of Obesity" report.

“The food part of our diet is horrendous,” Barry Popkin, a University of North Carolina professor who has studied food data extensively, told the Times.

There are demographic differences, and nagging problems. White families have reduced their calories more than black and Hispanic families; families with children have cut back the most; and Americans who are considered the heaviest have cut back the least, with their weight and waist circumference continuing to increase.

A paper by Kevin Hall, a researcher at the National Institutes of Health, says that the recent reductions in calories are not enough to stem the current obesity epidemic, estimating that for Americans to return to the body weights of 1978 by 2020, an average adult would need to reduce calorie consumption by 220 calories a day.

Tuesday, July 28, 2015

Bevin says he wouldn't end Medicaid expansion immediately but would transition to modified program; Stivers talks similarly

By Al Cross
Kentucky Health News

LOUISVILLE -- Republican Matt Bevin said Tuesday that if elected governor he would not immediately end the state’s expansion of eligibility for the federal-state Medicaid program, contrary to what he said for months.

“That’s not what I’m calling for, at all,” he said at a forum with Democratic Attorney General Jack Conway at the Kentucky Chamber of Commerce’s Business Summit and Annual Meeting in Louisville.

Instead, Bevin said afterward, he favors a modified plan based on the experience of other states such as Indiana, which received federal waivers to create a complex program in which Medicaid beneficiaries pay premiums (as small as $1 a month) to get better benefits, and some clients make co-payments for non-emergency use of emergency rooms.

Republican legislators seem headed in the same direction. On Monday, the legislature's top Republican said he favored a modification, not a cancellation, of the expansion that provides free health care to more than 400,000 people – and that he liked the Indiana example.

Senate President Robert Stivers of Manchester said, “The discussion that I have heard would be transitioning to a different model of covering that population, and I know from talking to several people that they’re looking at other models. I think other states have done that and gotten waivers, particularly Indiana.”

Stivers added, “When you look at this, and I think most people will talk about when they’re discussing it, it’s more a scalpel approach than a sledgehammer.” Republican Appalachian districts like Stivers' have seen some of the largest declines in percentage of the population without health coverage.

Bevin began saying in February that he would end the expansion immediately, which would require an executive order. Stivers made clear that he thinks decisions about Medicaid should be made by the legislature.

Stivers said it was not appropriate for the 1966 legislature to authorize governors to get all the Medicaid money they could – a law Beshear used to expand the program without legislative approval – and that it would not be appropriate for future governors to leave legislators out of the equation.


(Video from The Courier-Journal)

Bevin said that if elected, he wouldn’t “have the ability to just shut things down. It’s like going to war. You don’t just come home on Tuesday.”

Told that he could issue an executive order ending it the next month, he replied, “And create what degree of chaos?”

Reminded that he had said he would end it immediately, he said “I said I would address it. I didn’t say I would end it immediately. Go back and look at what I said.”

The Lexington Herald-Leader and The Associated Press reported in February that Bevin said he would end the expansion “immediately.” Herald-Leader reporter Sam Youngman reminded Bevin of that.

Bevin said, “Yeah, well, here’s the bottom line: We need to address the situation. We need to effectively come up with a program that works for folks.”

Conway has used Bevin's "immediately" line to claim that Bevin would "on day one" remove all the expansion enrollees from the Medicaid program, and did so twice during Tuesday's forum.

Earlier in the post-forum press conference, Bevin was asked what he likes about Indiana’s Medicaid expansion.

“What I like about it is the sense of ownership” that it gives clients, he said. “It’s giving people a vested interest, because when people do not have any control over their own lives, including the decisions they make as it relates to health care, even if it’s a token amount, even if it’s five or 15 or 25 dollars a month – which seems token to some but isn’t token to some of these folks. Having skin in the game is a big, big differentiator when it comes to whether or not a person has the dignity that comes with making decisions for themselves. . . . They’re treating people with dignity and respect, and giving them the belief that they have control over their own situation and people are seizing that.”

According to the Kaiser Family Foundation, Indiana offers four separate Medicaid packages, and further differentiates among clients according to income, frailty and premium payments. Non-frail adults above the federal poverty level are taken off the program after they fail to pay premiums for six months. Also, coverage starts with the first premium payment, not the application for coverage.

In almost all other Medicaid expansion states, including Kentucky, free care is given to people with household incomes up to 138 percent of the federal poverty level. The old threshold in Kentucky was 69 percent.

Indiana limits premium payments to 2 percent of income ($27 per month for those at 138 percent of the poverty level). Premiums go into a health savings account and offers incentives for clients to follow healthy behaviors: If their health-savings account has money left over at the end of the year, they can roll it over; if they receive preventive services, the rollover balance is doubled, up to the total premium payment for the year.

The federal government pays the entire cost of the expansion through next year. In 2017, the state begins paying 5 percent, rising to the federal health-reform law's cap of 10 percent in 2020. Bevin said he would change the program before 2017.

Conway, asked during the forum how he would pay the state's share, cited a Deloitte Consulting study for the state that showed the expansion would add a net $77 million to the state budget in 2017 and $87 million in 2018, through expanded jobs in health care and taxes paid by those workers.

The study also says the expansion will pay for itself in 2019 and 2020, but not in 2021. If the study's predictions fall short, Conway said, the state could seek waivers to reduce its costs.

Bevin again dismissed the study, calling it "nonsense." He said Kentucky should "be more creative than just grabbing free money form the federal government," apply for waivers and "look at what other states are doing. Don't reinvent the wheel. Let's look for ways to do what Indiana, to the north, is pioneering."

Study finds legislative crackdown on pill mills worked, but some providers are still prescribing lots of drugs

By Al Cross
Kentucky Health News

The 2012 legislation to crack down on abuse of painkillers in Kentucky had an immediate and significant effect, according to a study by researchers at the University of Kentucky.

"Doctor shopping," defined as a patient receiving multiple prescriptions from at least four prescribers and at least four pharmacies in a three-month period, declined by 52 percent, according to the researchers' analysis of 2009-2013 data from the Kentucky All Schedule Prescription Electronic Reporting system, which tracks prescriptions for controlled substances.

Interviews with prescribers, pharmacists and law-enforcement officials found that they "believed KASPER to be more effective at reducing doctor shopping than reducing the abuse and diversion of prescription drugs," study report says. "This perception may be a direct result of the impact of mandatory registration and greater use of KASPER by these professionals."

Use of the KASPER system increased greatly, with 322 percent more pharmacists and 262 percent more prescribers using it, and making 650 percent more queries to see patients' prescription history, said UK's Institute for Pharmaceutical Outcomes and Policy.

The number of prescribers of controlled substances (CS) declined 14 percent. "A minority of prescribers indicated they no longer prescribe CS, or prescribe fewer CS, as a result of the HB1 mandate and its burden on their practices," the report says. However, "multiple analyses in this
comprehensive evaluation argue against a blanket chilling effect" of the legislation, 2012 House Bill 1.

At the other end of the spectrum, some doctors still seem to be prescribing too many drugs. "High-volume prescribers contribute significantly to the overall prescribing of CS in Kentucky and the Cabinet for Health and Family Services should continue to identify and investigate top prescribers for appropriate prescribing practices," the researchers wrote.

At a press conference held to announce the study, Gov. Steve Beshear said the Kentucky Board of Medical Licensure, which filed no CS actions against health-care providers in 2011, has since filed 196 actions against 192 providers.

"What has happened is a cultural shift among the Board of Medical Licensure," which is now working with law enforcement, said Attorney General Jack Conway, who battled with the board and the Kentucky Medical Association, the physicians' lobby, during debate over the legislation.

Conway is the Democratic nominee to succeed Beshear, also a Democrat. Senate President Robert Stivers, a Republican, credited Beshear with encouraging the board to be more active.

The legislation also targeted "pill mills" where painkillers were easy to get. Conway said, "We've shuttered just about every one of the state's non-compliant clinics."

Officials have said the legislation led to a rise in heroin use and overdoses, but the study says the causes are more complicated: "Alterations in the heroin market were underway prior to HB1 and this policy change should not be characterized as the sole contributor to the rise in heroin abuse in Kentucky."

Sunday, July 26, 2015

Fewer Ky. teens are having sex, and more teens are using birth control when they do; teen birth rates are at an all-time low

By Melissa Patrick
Kentucky Health News

Fewer teens are having sex now than did in the last generation, and of those that do, more are using some form of birth-control, according to a new report from the Centers for Disease Control and Prevention. The Kentucky Youth Risk Behavioral Survey, which offers data from 1997, shows similar trends in Kentucky.

Click on image to view larger version
The percentage of Kentucky girls who reported they have ever had sex dropped 14 percent, to 43 percent in 2013 from 50.3 percent in 1997, and the boys dropped 23 percent, to 46 percent in 2013 from 60 percent in 1997, according to the YRBS.

Nationwide, the CDC report found the percentage of teen girls who reported they've had sex at least once also dropped 14 percent, to 44 percent in 2011-13 from 51 percent in 1988. Among boys there was a 22 percent decrease, to 47 percent in 2011-13 from 60 percent in 1988. The rate of sexual activity among teens from 2002 to 2013 averaged 45 percent.

In 2013, fewer Kentucky high school students than ever, 44.7 percent, reported that they had ever had sex, compared to 53.7 percent in 1997, the highest percentage reported over the years surveyed.

Data from the national report was compiled from the 1988 and 2011-13 National Survey of Family Growth of boys and girls aged 15 to 19.

One reason for the trend toward less teen sex might be that teens have more access to information via the Internet and are more comfortable searching for credible information about sexual health, Dr. Brooke Bokor, an adolescent medicine specialist at the Children's National Health System told Danielle Paquette and Weiyi (Dawn) Cai of The Washington Post.

Dr. Boker also suggested that the growing popularity of the human papillomavirus vaccine has forced a conversation about sexual health between young patients, parents and their physician.

"They learn from doctors that you can catch HPV even if you use a condom," Bokor told the Post, emphasizing some common conditions spread through skin-to-skin contact. "They might think: How else can I stay healthy?"

Teens using more birth control

Click on image to view larger version
More teens are now using birth control and most often it's a condom, according to the CDC report.

At 97 percent usage, the condom is the most common "ever used" contraceptive among teens, followed by withdrawal at an alarming 60 percent and the pill at 54 percent. Very few teens use the patch, an intrauterine device (IUD) or a hormonal implant, even though these methods have a higher rate of effectiveness. Notably, the use of emergency contraception -- like the Plan B pill -- for teen girls grew from 8 percent in 2002 to 22 percent in 2013.

The report also found that teens who reported using some form of birth control during their first sexual encounter were half as likely to become teen moms than those who did not.

Teen birth control in Kentucky

The Kentucky YRBS approached this question by asking teens who had reported being currently sexually active if they had not used certain birth control options during their last sexual intercourse encounter. In 2013, 31.7 percent of Kentucky's high school students said they were currently sexually active.

Of this group, 46.9 percent said they did not use a condom; 80.1 percent said they did not use the birth control pill; 97.4 percent said they did not use an IUD; and 95.1 percent said they did not used a shot, patch, or birth control ring.

Click on image to view larger version
It also asked this group if they didn't use any method of birth control the last time they had had sex and found that 15.1 percent said they had not: 18.6 percent of females and 11.2 percent of males.

How effective is your birth control?

Eighteen percent of women who use condoms, 22 percent of women who use withdrawal and 24 percent of women who use fertility awareness get pregnant during the first year if they use these methods, according to the CDC. The pregnancy rate is much lower for other methods.

IUDs (.05 percent) or an implant (0.2 to 0.8 percent) offer the best protection against an unwanted pregnancy, followed by the pill (9 percent), injectable (6 percent), patch (9 percent), ring (9 percent) and diaphragm (12 percent), according to the CDC.

When are teens likely to have sex?

Click on image to view larger version
The CDC report found that it is more likely for teen boys to start sex at an earlier age than girls, but by age 17, the probabilities of having had sex were about the same. This was also found to be true in the Kentucky YRBS.

For males, 18 percent reported having sex at age 15 compared to 13 percent of females and at age 17, 44 percent of males reported having had sex,compared to 43 percent of females. And this trend continued through age 19.

The Kentucky YRBS asks who has had sex for the first time before age 13 and found that 5.4 percent of teens in Kentucky had had sex before age 13 -- 3.2 percent of the girls and 7.5 percent of the boys.

To see if the national trends related to age and sex held true in Kentucky, we looked at the Kentucky YRBS question that asks who has ever had sex broken down by grade levels among the 44.7 percent of high-school students that had ever had sex (43.3 percent girls and 45.9 percent boys): 24.6 percent were in 9th grade (21 percent girls and 28 percent boys); 35 percent were in the 10th grade (32.2 percent girls and 38 percent boys); 59.3 percent were in 11th grade (57.7 percent girls and 60.7 percent boys); and 64.5 percent were in the 12th grade (66.5 percent girls and 62.3 percent boys).

Why does it matter?

Fewer teens having sex coincides with the nationwide trend of fewer teen births. In 2013, the nation's teen birth rate was at its lowest ever: 26.6 births per 1000 females ages 15 to 19. Kentucky's teen birth rate, while higher than the national average, was also at its lowest ever at 38.7 teen births per 1000 females ages 15 to 19.

In 2010, the CDC reported that teen pregnancy and birth cost the nation an estimated $9.4 billion a year.

The Kentucky Department of Public Health "Teen Pregnancy Prevention in Kentucky" report says that in 2008, teen childbearing in Kentucky cost taxpayers at least $158 million. It also lays out the high social cost to both the teen parent and their families, such as the mother is less likely to graduate from high school; there is a nine times increase in the chance that the mother and child will live in poverty; teen mothers often receive little or no prenatal care; and there is an increased chance of infant mortality.

Saturday, July 25, 2015

Beshear touts Ky. as example to follow in drug fight, Obamacare

As the U.S. health secretary reminded the national governors' conference that the administration is trying to put another $100 million into fighting drug addiction, Gov. Steve Beshear cited Kentucky as an example for other states to follow on drugs and health reform.

After mentioning the 2012 legislation aimed at abuse of prescription painkillers, Beshear said, "This addiction situation is akin to the game of whack-a-mole. . . . You attack one and another pops up someplace else. . . . Now heroin has raised its ugly head and is killing even more people than prescription drug abuse is."

Beshear cited the anti-heroin legislation passed this year, with expanded drug treatment and locally authorized needle exchanges, he said, "I think we've all figured out that we cannot incarcerate ourselves out of this problem."

Beshear told the governors, meeting in White Sulphur Springs, W.Va., that he expects to "hear positive news" this month about efforts against prescription drug abuse in Kentucky.

The Obama administration has asked Congress for an extra $100 million to fight drug addiction. Health and Human Services Secretary Sylvia Burwell told the governors that about a third of the funds would go toward "addiction-fighting medications, which have been the cornerstone of the government’s approach to fighting opioid use," Sarah Ferris reports for The Hill. The money would "go to community health centers in 11 states that are on the frontlines of the fight against opioid addictions."

Burwell also advocated expanding eligibility for the federal-state Medicaid program under Obamacare, which 30 states including Kentucky have done but 20 led by Republican governors or legislatures have not.

Beshear said Kentucky's expansion has cut uncompensated care in Kentucky's rural hospitals to 5 percent, from 25 percent, and said many are in the black "for first the time in a long time." Many rural hospitals have said other features of the health-reform law have hurt them, but Beshear said, "From a revenue standpoint having expanded Medicaid has been a boon to our providers.

He also said it has been good for the economy, citing the study by Deloitte Consulting that says the expansion has "already created 12,000 jobs in health care" and will infuse $40 billion into the state's economy through 2021. The job figure appears to be total jobs, not in health care, which accounts for 40 to 45 percent of the total jobs generated, under the model used by Deloitte.

If the next governor continues the expansion, the state will have to start paying a small part of it in 2017. Beshear did not make the usual argument, supported by the study, that the expansion will pay for itself through 2020 by bringing formerly uninsured people into the health-care system and generating jobs and tax revenue.

He did address other arguments, that the federal government "will back away" from the expansion or that the cost will be too great. "You can stop," he said. "I know a lot of legislatures have a problem just because of the name of the act, but if you can get past that kind of politics ... It's gonna cut down on the big costs down the road," through cancer screenings and so on.

Virginia Gov. Terry McAuliffe, who has failed to persuade his Republican-controlled legislature to expand Medicaid, asked his fellow Democrat, "Steve, you want to come up to Virginia for a couple of days? I could use that."

Second annual "Hepatitis Conference: The Silent Epidemic in Kentucky" to be held Tuesday, July 28 in Lexington

The second annual "Hepatitis Conference: The Silent Epidemic in Kentucky" will be held Tuesday, July 28, the same day as World Hepatitis Day, at the Embassy Suites, in Lexington. The conference aims to provide information about prevention, diagnosis and treatment of those affected by hepatitis B and hepatitis C.

Kentucky leads the nation in the rate of acute hepatitis C, with 4.1 cases for every 100,000 residents, more than six times the national average, according to the federal Centers for Disease Control and Prevention.

Hepatitis B is a highly infectious virus that attacks the liver and can lead to severe illness, liver damage and death. It is spread through blood and certain body fluids. There is no cure for hepatitis B, but there is a three-dose vaccination for it. Hepatitis C is also a virus that attacks the liver, and is spread through blood contact. It does not have a vaccination.

The conference will host Dr. John Ward, director of CDC's viral hepatitis program, as its keynote speaker. State Health Commissioner Stephanie Mayfield will offer opening remarks.

A full day of presentations will include an array of topics including hepatitis in infants, hepatitis in children, co-infections of hepatitis and HIV, prevention, treatment. incorporating hepatitis into telehealth, and several sessions regarding hepatitis among people who inject drugs and drug addiction

The event is presented by the Kentucky Department for Public Health and its Adult Viral Hepatitis Prevention Program, and the Kentucky Rural Health Association.

Registration is full, but there is a waiting list. For more information contact Kathy Sanders at kathyj.Sanders@ky.gov or Julie Miracle at Julie.Miracle@ky.gov or call 502-564-4478.

Friday, July 24, 2015

Online database lets you check on your surgeon; some surgeons say methodology used in analysis of data isn't adequate

A new online database is available to help consumers choose a surgeon, but surgeons are pushing back and asking for a peer-reviewed study of the data.

The searchable database, "Surgeon Scorecard," was created by ProPublica, a nonprofit journalism organization, by using five years of Medicare records to calculate the death and complication rates for nearly 17,000 surgeons performing one of eight elective procedures including knee replacements, the data include knee replacements, hip replacements, cervical spinal fusion, two types of lumbar spinal fusions, gall bladder removal, prostate resection and prostate removal. The website says the scorecard was "guided by experts" and the data were adjusted for differences in patient health, age and hospital quality.

Click here to find data on Kentucky surgeons.

This analysis comes at a time when federal health officials are focusing more attention on these common surgeries, Laura Ungar reports for The Courier-Journal.

"This month, the U.S. Centers for Medicare and Medicaid Services announced a proposal to cut Medicare payments to hospitals with high rates of complications for hip or knee replacements," Ungar reports. "About a quarter of the 400,000 hip and knee replacements Medicare patients undergo each year will be affected by the proposed rule."

ProPublica's report comes with mixed reviews. Health and Human Services Secretary Sylvia M. Burwell told Ungar that this model would "reward providers and doctors for helping patients get and stay healthy."

Leah Binder, president and CEO of the Washington-based Leapfrog Group, a nonprofit organization that rates hospitals, told Ungar that she commended ProPublica for analyzing the data in a way that's useful for consumers. "Complication rates are a strong sign of a certain skill level," she said. "This information is housed by our government, and as taxpayers, we deserve to know how surgeons are doing."

Charles Mick, a spine surgeon in Massachusetts who advised on the project, told Nick Penzenstadler of USA Today that the project is "long overdue. Consider baseball, if you're a batter but never knew if you hit the pitch, how could know you know if you're getting better?" Mick argued that the "uncomfortable public exposure is a small price to pay for better patient care."

But surgeons have taken to the Internet with complaints about the report with editorial headlines like: "ProPublica's Surgeon Score Card: Clickbait? Or Serious Data?" written by Dr. Benjamin Davies for Forbes; "Why the Surgeon Scorecard is a journalistic low point for ProPublica" by Dr. Jeffry Parks on his medical blog; and an open letter titled "ProPublica's Surgeon Scorecard: Call for Peer Review" by Dr. Edward J. Schloss, to name a few.

These physicians argue that there are problems with the methodology, such as overly wide statistical confidence intervals for complication rates, questions about using readmission rates as a measure of complications, considering readmission as equal to death, and not using enough criteria to make these claims.

"ProPublica rightly has high expectations for surgeons and has courageously started a worthwhile process," Davies writes for Forbes. "What they have not done is given pause — or honest reflection — on the obvious harsh limitations of the data they have processed. Instead, we got a clickbait video and a parboiled dataset."

More overweight teens don't consider themselves fat; the problem is that they compare themselves to those around them

Another study has found that overweight teens in the U.S. don't realize they are overweight, and this lack of self-awareness has gotten worse in the past decade, Roberto A. Ferdman reports for The Washington Post

The study, at Georgia State University, tracked data from the National Health and Nutrition Examination Survey for nearly 2,000 teenagers between the ages of 12 and 16 in the early 1990s and over 2,500 teenagers in the same age range between 2007 and 2012. The survey included the body-mass index of each child in the study and also their answer to the question: "Do you consider yourself to be overweight, underweight, or just about the right weight?"

The research found that  fewer adolescents think they are overweight today, even though more of them are overweight, Ferdman reports.

"Within a short time scale, the likelihood that overweight or obese teens believe that they are overweight declined by almost 30 percent," Dr. Jian Zhang, a researcher from the university, told Ferdman.

And this misperception was more pronounced among the younger children as overweight 12-year-olds in the study were almost 40 percent less likely to recognize that they were overweight today, compared to 20 years ago, Ferdman reports.

report last year by the federal Centers for Disease Control and Protection found that almost half of America's obese youth don't know they're obese.

"The trend is very dangerous," Dr. Jian Zhang told Ferdman.

Adding to this conundrum, a different study published last year by Zhang found that parents are "significantly less likely to realize that their child is obese than they were 20 years ago." This was also the result of a study out of NYU Langone Medical Center that found most parents of overweight children consider them to be "about the right weight."

"The society as a whole is stuck with a vicious cycle," Zhang told Healthday last year. "Parents incorrectly believe their kids are healthy, they are less likely to take action, and so it increases the likelihood that their kids will become even less healthy."

Zhang attributes these misperceptions to the fact that people judge their weight based on the people around them, and the people around them are getting fatter.

This is especially true in Kentucky, which ranks first in the nation for high-school obesity, at 18 percent and eighth for obesity in 10 to 17-year-olds, at almost 20 percent, according to the "States of Obesity" report.

Zhang also notes that overweight and obese teens may be reluctant to admit that they are overweight because of the harsh messages relayed by the weight-loss industry.

Ferdman writes that the solution is not as easy as just informing teens that they are overweight, especially because teens often have fragile body images.

"We must be very careful when we, as parents, teachers, or health care professionals, make an effort to correct the misperception among teens," Zhang told Ferdman. "It has to be a pro-health, not anti-obesity, campaign."

Thursday, July 23, 2015

Bevin won't say what would happen to 430,000 new Medicaid enrollees if he cancels expansion as planned if elected

By Al Cross
Kentucky Health News

LOUISVILLE, Ky. -- Republican gubernatorial nominee Matt Bevin wouldn't say Thursday what he would do with the 430,000 Kentuckians who would lose their new Medicaid coverage if he is elected governor and cancels the expansion of eligibility for the program.

At a Kentucky Farm Bureau forum in Louisville, Bevin and Democratic Attorney General Jack Conway were asked how they would pay for the expansion of the federal-state program once the state starts paying 5 percent of the bill in 2017, rising to the federal health-reform law’s cap of 10 percent in 2020.

Conway cited a study for the Beshear administration predicting that the expansion would pay for itself through 2020, by creating health-care jobs and tax revenue. It says there would be a net loss in 2021, the last year of the study.

Conway said there are too many people on Medicaid, but said the solution for that is a better economy. “What I am not going to do is what my opponent will do on day one, which is by executive order kick half a million people off health insurance based on whether we can or can’t afford it in 2021. To me, that’s not courageous, that’s callous. . . . If we can’t afford something, we can potentially scale back.”

Bevin said the “day one” line was “an absolute lie,” but when he was asked in February about the expansion, he said “No question about it, I would reverse that immediately.”

As he has done before, Bevin conflated the Medicaid expansion with Kynect, the state health-insurance exchange where Kentuckians can get subsidized health insurance or, if their household income isn’t more than 138 percent of the federal poverty line, sign up for free Medicaid.

“With respect to the Kynect program, we cannot afford to have 25 percent and fast growing toward 30 percent on Medicaid, period, whether you like it or not, whether you think it’s fair or not, whether there’s supposedly a need or not, truth be told, we can’t afford it.”

He said later, “We’re gonna dismantle the Kynect program. We’re not gonna have 25 percent of Kentuckians on Medicaid."

At a post-forum press conference, Bevin acknowledged that Kynect and Medicaid are separate programs. But he continued his attack on the study, which during the forum he had called “nonsense” and “absolute rubbish.” He said during the forum that if putting 25 percent of Kentucky on Medicaid would create so much economic activity, “Why not put all of us on Medicaid?”

Health reform was designed to help people who couldn’t afford or were denied coverage, and as a result the uninsured population in Kentucky has dropped to less than 10 percent, from above 20 percent. Medicaid enrollment has leveled off and may be declining as the economy improves.

Bevin said the study failed to account for jobs that have been lost because of health reform. In fact, the study was about the effects of Medicaid expansion, which the state controls, not health reform in general, which is a federal issue. And it was done by an internationally respected firm, Deloitte Consulting, that rejected state Health Secretary Audrey Haynes' request to include the expected benefits of a healthier population, which would have been somewhat speculative.

It remains to be seen whether the study’s predictions will pan out. Job creation in health care fell short of the study’s projections last year, but recent monthly figures have shown significant gains, and Haynes says the expansion is still on track to pay for itself through 2020. University of Louisville economist Paul Coomes says annual figures are more reliable.

After the formal press conference, Bevin got more questions about Medicaid, and repeated an argument he has made before, that health coverage doesn’t equal health-care access – that there aren’t enough health-care providers, as shown by the increased use of many emergency rooms.

As the questioning continued, Bevin said he had explained what would happen to the 430,000 new Medicaid beneficiaries. Told that he hadn’t, he replied, “They’re Kentuckians. They will continue to live in Kentucky if they choose to.”

Marijuana product that can be smoked in e-cigarettes reported to be on the rise in Oldham County schools; heroin too

Oldham County school officials report that a waxy form of marijuana in e-cigarettes, as well as heroin, are becoming more prevalent among students, Taylor Riley reports for The Oldham Era.

"At least eight students were taken to the hospital or medical offices, just after spring break, due to the effects of using vape oils with electronic cigarettes, according to Dan Orman, assistant superintendent," Riley reports.

Orman referred to a new marijuana product on the market called Wax, which has a waxy texture and yellow color. It is made from the oils of marijuana plants and has a high level of THC, the ingredient in marijuana that makes a user high. This product melts as it heats up in an e-cigarette and can be smoked. It is much stronger than marijuana and is undetected by sight or smell.

"It’s very dangerous to the developing brain," Orman said. He presented the report at the board of education meeting and said there had been a "huge decrease" in prescription pill use in the Oldham County schools, but heroin use is on the rise, which "seems to be the trend everywhere in Kentucky," Riley reports.

Earlier this year, Carrollton police officer Tim Gividen told WLKY-TV that this product had been an issue in high schools in Carroll and Trimble counties, just north of Oldham and toward Cincinnati.

"In a 2011 survey by the Centers for Disease Control and Prevention, 5.2 percent of Kentucky’s high-schoolers reported using heroin, nearly double the national average. By the time the teens hit their senior year, use had grown to 7.7 percent, nearly 5 points higher than the nation’s average," Terry DeMio reports for The Cincinnati Enquirer.

The director of Operation Parent, Jean Schumm, told Riley that parental engagement was the key to helping kids from "going down the wrong road." She also suggested that drug and alcohol prevention needs to start earlier, in the fourth and fifth grade, instead of high school, because this is when kids start to experiment. Operation Parent is a LaGrange-based nonprofit for parents of pre-teens.

Orman agreed: "Parents should be aware of all possible substances their children may be ingesting or abusing. There are many over-the-counter and illegally obtained drugs that young people may abuse for recreational purposes. Awareness and constant vigilance are the best tools parents can use to help keep their kids safe."

Clinton County schools will go tobacco-free in July 2016, do media campaign to prepare people for the change

The Clinton County Board of Education has voted to make all of the county's school campuses tobacco free, but decided to not implement this program until the 2016 school year begins to give the public more time to adjust to the new rule, reports the Clinton County News.

"Board member Junior Cecil indicated he would rather have seen the measure take affect with the start of this school year, but board chairperson Paula Key said after considering the move, which has been discussed for the past few months, it was decided to give the public more time to become aware of the new rule and get adjusted to it," the newspaper reports.

The board also passed a second motion to collaborate with the Lake Cumberland District Health Department for a $14,000 tobacco-free campus grant to be used for a 12-month media campaign and public awareness program to inform the public about the Tobacco Free School program. A similar campaign has been used in Casey County, which will go tobacco-free this school year.

"The tobacco-free school policy will not only ban smoking on school property during in school hours or school sponsored events, (i.e. ball games) but also include the banning of any use of any type of tobacco products," the newspaper reports. The policy will also include electronic cigarettes and all vapor products.

As of June 2015, 44 school districts, out of 173 in Kentucky, were entirely tobacco-free, according to the state's "100% Tobacco Free Schools" website.