Sunday, January 25, 2015

Appalachian women are more likely to get cervical cancer and die from it, but pass up vaccine partly because of fatalistic beliefs

By Melissa Patrick
Kentucky Health News

A fatalistic belief that getting or preventing cancer is beyond a person's control is one of many reasons young women in Appalachian Kentucky are likely to not get or complete the series of HPV vaccinations to prevent cervical cancer, according to a study by researchers at the University of Kentucky, published in The Journal of Rural Health.

"Our study found that fatalistic beliefs influenced immunization behaviors, which is concerning, given the high success rates of preventing HPV infection and cervical cancer through HPV vaccination and the elevated burden of cervical cancer in Appalachian Kentucky,” Robin Vanderpool, lead author of the study, said in an email.

The human papillomavirus, or HPV, is the most common sexually transmitted infection in the U.S., affecting an estimated 79 million individuals. Two types of HPV cause two-thirds of all cervical cancers, and unlike any other cancer, there is a three-dose HPV vaccine that can prevent it, according to the federal Centers for Disease Control and Prevention.

The UK researchers found that the women in the study who believed they had limited control over their health generally and limited control over cervical cancer specifically were significantly less likely to complete the HPV vaccine series than those who did not have this belief.

"This is an important finding because rural Appalachian residents often perceive cancer as pervasive, inevitable and mostly hereditary," the authors wrote.

The 344 rural Appalachian women who volunteered for the study were given the first dose of vaccine free of charge, and surveyed about their beliefs regarding cancer. They were followed for nine months after the first dose to determine completion rates.

Other studies had determined that many Appalachian women don't get or complete the HPV vaccine because of cost, lack of transportation, cultural views, lack of knowledge about cervical-cancer prevention and limited support from parents, peers and health-care providers. A belief in fatalism can now be added to this list.

Health advocates are working to get through these barriers because Appalachian Kentucky has the state's highest rates for cervical cancer and deaths from it, according to the Kentucky Cancer Registry. This, in a state that is among the top 14 for the most cases of HPV-related cervical cancers in the nation, according to the CDC.

Kentucky has a low HPV vaccination rate, with only one in four adolescent women initiating the vaccine and less than one in nine receiving the full series, according to The Kentucky Cancer Consortium. These rates are even lower in Appalachia, says the study.

The CDC recommends routine HPV vaccination for females ages 11-12 and catch-up vaccination for females ages 13-26. The second dose should be given one to two months after the first injection; the third dose should be administered six months after the first dose. Males are also encouraged to get the vaccine.

The study acknowledged that future such studies should compare women who have received the first dose of the vaccine, as in this study, against women who had not. It also suggests that these findings indicate a need for future research in how to educate and intervene with Appalachian women in a way that is culturally sensitive to improve HPV vaccination rates and to impact cancer disparities that affect the women in the region.

Saturday, January 24, 2015

Are nutrition rules for schools and day-care centers too much regulation, or steps in the right direction, toward better health?

Commentary by Melissa Patrick
Kentucky Health News

The Paducah Sun's editorial on Jan. 20 said the Obama administration has overstepped its bounds by expecting child day-care centers to follow stricter nutrition standards. The newspaper also called for relaxation of the requirements of the 2010 Healthy, Hunger-Free Kids Act, as Republicans hope to to when the law comes up for reauthorization this year. (The editorial is behind a paywall.)

The editorial does what any good editorial should do: stirs up a bit of controversy and makes you think a bit harder. Do you agree with the editorial's views that these nutrition standards impose "too much regulation," or are you thinking,"We have to try something to combat obesity and the best place to change health behaviors is with children?"

What most everyone probably agrees on is that we have a problem: too many fat, unhealthy children who will become fat, unhealthy adults, perpetuating a chronic health epidemic that is sweeping across Kentucky and the nation. "The heaviest children are getting even heavier" and "overweight or obese preschoolers are five times more likely than normal-weight children to be overweight or obese as adults," says the Obesity Society website.

Nationwide, one in five children is overweight and more than one in three adults are obese, according to the Centers for Disease Control and Prevention. Kentucky leads the nation in both adult and child obesity, ranking fifth for adult obesity; first for high-school obesity; eighth in obesity of 10- to 17-year-olds; and sixth in obesity among 2- to 4-year-olds in low-income families, according to the States of Obesity report. These statistics don't even include the number of adults or children who are simply "overweight."

The World Health Organization says chronic disease is the leading killer in our world, with two-thirds of all deaths worldwide a result of conditions such as heart disease, cancer, diabetes and respiratory infections in 2012. Kentucky, once again, leads the way in each of these conditions.

Kentucky ranks eighth in the nation for heart-disease deaths; 17th for diabetes; fifth for high blood pressure; and first for smoking, lung cancer and lung cancer deaths.

The editorial says, "The food police are on the march again." Is it too much regulation, or could these "police" represent a concerned government trying to solve a major health-crisis that is only getting worse?

In making the day-care proposal, Agricuture Undersecretary Kevin Concannon wrote, "Providing children access to nutritious food early in life helps instill healthy habits that can serve as a foundation for a lifetime of healthy choices.”

The Department of Agriculture proposal calls for new nutritional guidelines for child and adult day-care programs, after-school programs and people who live in shelters that are part of USDA's Child and Adult Day Care Food Programs.

The guidelines would follow the Healthy, Hunger-Free Kids Act guidelines followed in schools, which require more fruits and vegetables, more whole grains, less fat and sugar, and limit calories according to age.

What seems to aggravate Sun Editor Jim Paxton the most are the proposal's suggestions to ban on-site frying and the qualification of tofu, a soybean curd, as a meat alternative. It said that while the program was originally set up to combat malnutrition, it now has decided "a little starvation is not a bad thing; ergo, tofu instead of fried chicken."

The editorial suggests that day-care facilities could no longer have french fries or fried chicken, but it fails to mention that both items could be offered with a more healthful preparation in the oven. And tofu, a cheap, low-fat protein source, would be added as an option, not a requirement.

The recommended way to lose weight is to decrease calories, eat healthful foods, and increase activity. The nutritional requirements suggested in this program include two of these efforts.

The editorial reminds us that some students are "turning up their noses at the new offerings," that "student participation in school meal programs is down," and says pre-school programs are concerned that the same thing will happen to them.

However, schools say they are tweaking their menus to find healthful foods that the kids like and purchase newer whole grain products that don't taste any different than the processed grains the kids are used to.

So, is it too much regulation or a new way to improve the health of children that will take time and tweaks to perfect?

The editorial says the Sun supports nutrition education and healthy choices on the school menu, but that the "primary responsibility for combating childhood obesity lies with parents and the rules they set in the home."

But what the editor fails to consider is that one out of three adults, many whom are parents, are obese, and are the ones responsible for teaching these lessons.

Too much regulation or a step in the right direction? You decide.

Friday, January 23, 2015

Scheduling lunch after recess, very unusual in elementaries, may lead to less food waste and better nutrition, study says

Scheduling school lunch later in the day could help children to eat more nutritious foods and reduce food waste, according to a study at seven schools in Utah. Researchers found that children threw away more food when they ate lunch before recess instead of afterward, and much of the food they threw away was fruits and vegetables, Roberto A. Ferdman writes for The Washington Post.

Cornell University and Brigham Young University researchers spent 14 days studying the behavior of children during lunch. Three schools served lunch after recess, and the other four before recess. The researchers kept track of how many fruits and vegetables children discarded and how many they ate.

"Students who ate lunch after recess ate 54 percent more fruits and vegetables than those who ate it before," Ferdman reports. The number of students who ate at least one serving of fruit and vegetables was 45 percent greater at the schools that served lunch after recess than the schools who served it beforehand. This is because students are hungrier for lunch after playing, and if they have already had recess, they will not rush eating their lunch so they can go play.

"If recess is held before lunch, students come to lunch with healthy appetites and less urgency and are more likely to eat their fruits and vegetables," David Just, one of the study's authors, told Ferdman.

A 2014 study also concluded, for about the same reasons, that providing lunch before recess leads to more food waste. It is unknown how many schools currently serve lunch before recess, but in 2011, only 4.6 percent of elementary schools reported serving lunch after recess. (Read more)

Thursday, January 22, 2015

Big majority supports domestic-violence orders for dating-only partners, and prospects for passage appear to be much better

By Melissa Patrick
Kentucky Health News

A large majority of Kentuckians say state law should allow domestic-violence protective orders involving dating partners, and the prospects for such a law appear to have improved considerably.

The poll found that 80 percent of Kentucky think dating partners should be allowed to get a protective order against a partner who had made them a victim of violence.

Under current law, such orders are available only to family members, members of an unmarried couple with a child in common, and unmarried couples who either live together or have lived together. All other states allow such orders for partners who are merely in a relationship.

The poll, taken Oct. 8 through Nov. 6, found 83 percent of women and 76 percent of men in favor of the change. Majorities in each political party also supported it: 84 percent of Democrats, 77 percent of Republicans and 75 percent of independents. The poll's error margin is plus or minus 2.5 percentage points.

"Kentucky is the last state in the country not to offer protections to victims of dating violence," said state Rep. John Tilley, D-Hopkinsville, chairman of the House Judiciary Committee. "It is time we changed that."

Tilley has sponsored the change for the past four years, but has failed to get it through the Senate, where President Robert Stivers, R-Manchester, has said dating partners already have ways to get protection from the justice system. But Tilley said in a telephone interview Thursday that he thinks Stivers has "come around."

He said this year's bill is still being drafted, but will have some significant changes from previous bills as supporters have worked to bring all of the stakeholders to the table.

"I am hopeful that this bill will pass because we seem to have key leaders prioritizing this bill, from the Senate president to the speaker of the house to the governor, and that is one difference I can point out from previous sessions," he said. "This bill will expand the current system to include victims of dating violence to be eligible to receive a protective order and be put into a national network that will then protect them wherever they go in this country."

Gov. Steve Beshear called for passage of the bill in his State of the Commonwealth address. First Lady Jane Beshear, a longtime advocate for this bill, told Linda Blackford of the Lexington Herald-Leader, "This is not only a top priority for me, it's a top priority for this office. Steve has been working with leadership to find a bill that is palatable to everyone in hopes we can pass it and then move on to other important things."

Domestic violence affects nearly one out of four American women in their lifetime, and in Kentucky one in three, according to The Center for Women and Families in Louisville.

"Domestic violence is a public health crisis of a staggering multitude," Marcia Roth, executive director of The Mary Byron Project, a non-profit that advocates for domestic violence issues, said in a phone interview. "It leads to $4.1 billion for direct medical and mental health services per year."

Not only is domestic violence a health issue because of its health-care costs, Roth said, "It goes beyond the physical wounds. Victims are more likely to be depressed, have unplanned and premature pregnancies, go to fewer prenatal visits and to miss more well-child visits with their children."

The populations most vulnerable to domestic violence are females between 16 and 19, with the numbers not much better for those 25 to 27. Most of these young women aren't married, don't live with their partner or don't share a child in common and have no immediate protections from dating violence, Tilley said.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati for the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati.

Heavy use of e-cigarettes may deliver big doses of formaldehyde, which can be a cause of lung cancer, study suggests

Vapor produced by electronic cigarettes can contain a surprisingly high concentration of formaldehyde—a known carcinogen that can cause lung cancer through prolonged exposure—researchers reported Wednesday in a study published in the New England Journal of Medicine, Rob Stein reports for NPR. (Getty Images by Dan Kilwood)

Use of e-cigarettes among rural teens has risen in recent years, prompting the U.S. Food and Drug Administration to propose rules to give it authority over e-cigarettes, an industry that accounts for about $2.5 billion in annual sales.

"E-cigarettes work by heating a liquid that contains nicotine to create a vapor that users inhale," Stein writes. David Peyton, a chemistry professor at Portland State University who helped conduct the research, told Stein, "We simulated vaping by drawing the vapor—the aerosol—into a syringe, sort of simulating the lungs. That enabled the researchers to conduct a detailed chemical analysis of the vapor. They found something unexpected when the devices were dialed up to their highest settings."

The e-cigarette industry dismissed the report, saying they found formaldehyde only when e-cigarettes were cranked up to their highest voltage levels, Stein writes. Gregory Conley of the American Vaping Association told him, "They clearly did not talk to [people who use e-cigarettes] to understand this. They think, 'Oh, well. If we hit the button for so many seconds and that produces formaldehyde, then we have a new public health crisis to report."

"If you hold the button on an e-cigarette for 100 seconds, you could potentially produce 100 times more formaldehyde than you would ever get from a cigarette," Conley said. "But no human vaper would ever vape at that condition because within one second their lungs would be incredibly uncomfortable." (Read more)

Research suggests eating only during a nine- to 12-hour time period can help maintain healthy weight

For a long time, scientists supposed that eating after midnight was unhealthy, but now a study has provided support for the notion. When scientists prevented mice from eating whenever they wanted, the animals avoided obesity and metabolic issues—even when the diet was unhealthy, Ben Wiseman reports for The New York Times.

In a previous study, researchers at Salk Institute for Biological Studies in San Diego began studying mice eating patterns. The mice in the study that weren't permitted to eat whenever they wished gained weight and became unwell, while the mice who were only permitted to eat during an eight-hour window didn't gain much weight or develop metabolic problems.

The new study, which was published in the journal Cell Metabolism in December, Salk scientists provided groups of mice with one of four diets: high-fat, high-fructose, high-fat and high-sucrose and regular mouse food. "Some of the mice in each dietary group were allowed eat whenever they wanted throughout their waking hours; others were restricted to feeding periods of nine, 12 or 15 hours," Wiseman writes. The caloric intake for all the mice was the same.

Some of the mice in the time-restricted groups were allowed to eat whenever they wanted on weekends, and some of the eat-anytime mice were moved to the restricted groups halfway through the study. At the end of the study, the mice that ate whenever they pleased became obese and metabolically ill, but the time-restricted mice stayed healthy. The mice switched from the former group to the latter lost some of the weight they'd gained, Wiseman writes.

Though scientists don't know exactly why eating during a designated timeframe helps prevent weight gain, Dr. Satchidananda Panda, who oversaw the studies, and his colleagues think it has to do with the body's internal clock. "Meal times have more effect on circadian rhythm than dark and light cycles," Panda said. Circadian rhythm influences the function of many genes in the body that have to do with metabolism.

These studies have only been performed using mice, but Panda believes the results could apply to humans. He suggests that people only eat within a 12 hour—or shorter—window each day. The clock begins with the first thing a person eats in the morning. (Read more)

Wednesday, January 21, 2015

Study finds kids eat too much pizza, too often, and it's bad for their health

While pizza consumption is lower than it used to be, kids are still eating too much of it, and it's affecting their health, Roberto A. Ferdman reports for The Washington Post.

The health issues are a result of the extra calories, fat and sodium consumed when children eat too much pizza, too often, according to a study published by the journal Pediatrics from the University of Illinois - Chicago, Ferdman writes.

"When you eat extra calories and don't compensate for it at another point of the day or week, it can lead to weight gain and even obesity," William Dietz, one of the study's authors and the director of the Sumner Redstone Global Center for Prevention and Wellness at the George Washington University, told Ferdman.

Obesity is a real problem for many of Kentucky's children. The state is ranked first for high school obesity, eighth for obesity in children aged 10 to 17, and sixth for obesity among 2- to 4- year-olds from low income families, according to the States of Obesity report.

The researchers tracked the diets of more than 11,000 children and teenagers using data from the National Health and Nutrition Examination Survey and found that "On any given day, roughly 20 percent of all children aged 2 to 11 and adolescents aged 12 to 19 eat pizza," Ferdman reports. The younger children eat roughly 400 calories and teens upward of 600 calories on the days they eat pizza, rarely with a healthy side like salad or vegetables.

This boils down to pizza days being associated with "considerably higher" intakes of saturated and sodium, and an extra 84 calories for children and an extra 230 calories for teens.

"There are a bunch of takeaways from the study. But the biggest thing is that parents are serving their kids too much pizza," Dietz told Ferdman.

It's cheap. It's convenient. It's universally loved. And an estimated 3 billion pizzas are eaten every year in the United States. "What's to be done?" Ferdman asks.

"We're not suggesting that kids avoid pizza altogether,"Dietz told Ferdman. "But when parents serve it, it's important that they understand it's extremely caloric. They should serve smaller pizzas, or at least smaller slices. They might also want to serve it with vegetables instead of sausage on top."

Sunday, January 18, 2015

Weekly paper in Carter County runs voluntary-response survey about statewide smoking ban, finds slim majority in favor

Wikipedia map: Carter County
The Journal-Times, the weekly newspaper in Carter County, is running an online "poll" of reader opinions about the proposed statewide smoking ban and finding a slim majority in favor of it. At 4:20 p.m. Sunday, 52.3 percent of the voluntary respondents said they favored the legislation, while 45.4 percent said they opposed it and 2.3 percent said they didn't care.

Despite those numbers, reporter Leeann Akers writes that the idea "seems to be unpopular in Carter County," based on "overwhelming opinion on social media." She cites the Facebook page of the Carter County Citizens For a Better Way and this post from Brandon Boggs: “If a business wants to prohibit smoking they have that right, however, we have the right to support that business or not depending on our personal preferences.”

Some posters on the page favor the ban. Travis Horton wrote: "I as a nonsmoker think people that smoke in restaurants or in businesses are showing disrespect for people with health issues and other things."

A continuing national survey by the federal Centers for Disease Control has found that between 31 and 46 percent of Carter County residents smoke, with the most likely number being 38 percent, well above the statewide figure of 29 percent in the same survey.

Akers reports that the county's two state legislators, "Sen. Robin Webb and Rep. Jill York, both say they remain undecided on how they will vote if it comes to the floor but both have a history of following their voters." She gives the legislators' email addresses and the telephone number to leave a message for them.

"This is the sort of story that most local newspapers with websites can do," said Al Cross, director of the Institute for Rural Journalism and Community Issues, publisher of Kentucky Health News. "But I suggest that they avoid calling any voluntary-response survey a poll, because that word implies that the results are from a scientific, random sample, and that they remind readers of that in giving the results."

New rule will improve reporting of antibiotic-resistant infections in health-care facilities, which are getting worse in Kentucky

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. — Kentucky will have a new weapon, in the form of data, to fight infections acquired in hospitals and other health-care facilities, with legislative approval of a regulation that changes the way antibiotic-resistant infections such as MRSA and C. difficile are reported.

Health Watch USA chart, Centers for Disease Control data
The new rule comes at a time when Kentucky has the third highest rate of MRSA bloodstream infections in the nation, according to the National Healthcare Safety Network. The state was ranked fourth last year.

Kentucky hospitals are 27 percent worse for MRSA (methicillin-resistant Staphylococcus aureus) and 21 percent worse for catheter-associated urinary tract infections than they were two years ago, according to the federal Centers for Disease Control's National and State Health-care Associated Infection Progress report.

The legislature's Administrative Regulation Review Subcommittee approved the regulation, which has been in the works since 2008, at its Jan. 13 meeting. In the meantime, hospitals have succeeded in changing the term "hospital-acquired infections" to "healthcare-associated infections" to indicate that not all such infections occur in hospitals.

"The emergence of these dangerous organisms is really a problem of our entire heath care system and it can't be fixed by any single facility or facility type," Kevin Kavanagh of Somerset, chairman of Health Watch USA, a non-profit organization that promotes health care transparency and patient advocacy, told the committee. For his testimony, click here.

The regulation redefines HAIs and HAI outbreaks for infections, and requires simultaneous data reporting to the CDC and the state Department for Public Health. The CDC already has the data, but has "no authority" to act on it, while the state health department has the authority but not the data, Kavanagh wrote in an opinion piece for the Lexington Herald-Leader. "It is imperative that we know what is happening and where, so effective action can take place."

He told the committee, "Data for action is critical. It is the first step to confront these dangerous organisms."

The regulation also will require electronic reporting via the Kentucky Health Information Exchange beginning 2016. It now goes to Gov. Steve Beshear for final approval, which is expected.

Rep. Tom Burch, D-Louisville, chair of the House Health and Welfare Committee, told the joint House-Senate regulations committee that he had worked on the regulation for many years and that the Kentucky Hospital Association supported it. It had lobbied against such regulations. "There is nobody against it right now," Burch said.

However, Sen. Alice Forgy Kerr, R-Lexington, said "This regulation seems to have caused a lot of indigestion for a lot of people," and asked for a "statement of confirmation" from someone representing a group that might have opposed it in the past.

The hospital association's vice president of government relations, Sarah Nicholson, was at the meeting but didn't speak. Dana Stephens, director of infection prevention and control at St. Joseph East Hospital and St. Joseph Jessamine, told the committee, "I have had the great pleasure and honor of working with this multidisciplinary team for the past many years to really develop legislation and regulatory language that will provide information that will improve the health of those citizens we serve."

Kerr commended the groups on reaching a compromise, but the elements of the compromise were unclear. Nicholson declined to comment after the meeting.

Kavanagh said afterward that the regulation is needed to reverse the apparent increase in hospital infections, based on the CDC data from 38 of the state's 93 hospitals. "We are going in the wrong direction, with Kentucky 27 percent worse than it was two years ago," he noted. "This regulation will help with that."
Centers for Disease Control graphic reports Kentucky data on health-care-associated infections
The regulation is expected to improve the accuracy of Kentucky's HAI data because it requires all health-care facilities to submit reports and more clearly defines HAIs, which Kananagh said will help with under-reporting of infections.

New regulations often raise questions about the cost of enforcing them. Kavanagh told the committee that the CDC had told him that it would be allocating "a lot of federal money" to state health departments through grants to confront infectious disease issues, a result of the lessons learned from Ebola. Better HAI data will support Kentucky's need for these grants, he said.

"So, I do believe the state health department, along with other entities, will have access to funds to implement this regulation change,” he said.

Friday, January 16, 2015

Low-income smokers have a harder time quitting, which helps explain why Kentucky leads the nation in smoking

Lower-income smokers have a harder time quitting than health-conscious middle- and upper-class Americans, Keith Humphreys reports for The Washington Post.

The numbers suggest one reason why Kentuckians lead the nation in smoking. Kentucky ranks 48th among the states and the District of Columbia in median household income in 2011-13, according to the Census Bureau; it ranked 45th in per-capita personal income in 2013, according to the Bureau of Economic Analysis.

The pol'ls margin of error was plus or minus 1 percentage point.
A 2008 Gallup poll of more than 75,000 Americans showed that the rate of smoking among people making less than $24,000 a year was more than double that of those making $90,000 or more. The higher the income category, the lower the smoking rate, except those making less than $6,000 per year, which was skewed because many in this bracket are students, Rob Goszkowski writes for Gallup.

Once health warnings about cigarettes became widely known, better-off Americans were more likely to quit smoking. "High-income families decreased their smoking by 62 percent from 1965 to 1999, versus only 9 percent for low-income families," Humphreys reports. Education may also be a factor; income and education are usually closely related.

Humphreys list three reasons poorer smokers have a hard time quitting:
1. They inhale more deeply on each draw from a cigarette, creating stronger addiction and making it harder to quit.
2. They don't have the same social support from their colleagues and friends as wealthier smokers. For example, a doctor is likely to be encouraged to quit smoking or get social disapproval if he or she is the last of their peers to stop; a person who works at roadside cleanup might "face precisely the reverse social incentives from his smoking coworkers," Humphreys writes.
3. They are likely to have less access to effective smoking-cessation programs and less access to address behavioral health issues, like depression, that make quitting more difficult. Kentucky has addressed those problems recently by having Medicaid cover smoking cessation and behavioral-health care by any licensed provider.

Some suggest that because lower income smokers have a harder time quitting, using higher tobacco taxes as an incentive for them to quit should be re-evaluated. Humphreys writes, "Deeply addicted, low-income smokers may face the choice between spending much-needed income on tobacco or venturing into the black market for untaxed cigarettes, which carries significant risks of its own."

Kentucky's cigarette tax of 60 cents a pack is lower than all but 10 states. New York ranks first at $4.35 per pack, which pushes the price of cigarettes to $10-$15 a pack, according to the Campaign for Tobacco-Free Kids website.

Clark County schools engage students as taste-testers in search for newly required, healthy foods the kids will eat

New federal nutrition standards "are not universally popular with students" in Clark County — some throw away recently required fresh fruits and vegetables — but "participation in school lunch programs has not been greatly affected," Whitney Leggett reports for The Winchester Sun after reading School Nutrition Director Becky Lowery's annual Wellness Report Card.

“This is a way for us to just sort of look at where we are and evaluate what we can do better,” Lowery told Leggett. The report highlights the requirements of the 2010 Healthy Hunger-Free Kids Act, such as a switch to whole-grain products, restrictions on fat and salt, and age-based calorie limits.

The greatest resistance has been to fruits, vegetables and whole-grain bread and pasta, Lowert told Leggett. Despite the complaints, participation in the school lunch and breakfast programs has only decreased by 1 percent since the 2013-14 school year, Leggett reports, along with a localized illustration.
To improve student satisfaction, Lowery implemented a student panel to taste possible new menu items. “It is much more difficult and more expensive to find good quality products that students will accept,” she told Leggett. “We’re just always trying to find good products that will still meet regulations.”

As part of the Farm to School initiative, Clark County strives to use more Kentucky Proud products, such as corn grown in Clark County, green beans from Louisville, and Western Kentucky blueberries, Lowery told Leggett. “As I hear about more things available to us that we can use, I will look into them,” she said. “We try to use as much as we can.”

Officials of hospitals and state government to discuss future of Ky. health care at Jan. 29 'summit' In Frankfort

State government and the Kentucky Hospital Association will co-host a summit for hospital CEOs, hospital board members and other elected officials and decision makers on the future of health-care delivery in Kentucky on the afternoon of Jan. 29 at the Capital Plaza Hotel in Frankfort.

“The health-care market and delivery systems all across the nation are currently undergoing an unprecedented transformation,” Gov. Steve Beshear said in a statement. “The rapid pace of this transition poses challenges to healthcare stakeholders, both rural and urban, that are facing fundamental changes to how they deliver care to patients in our communities.”

State Health Secretary Audrey Tayse Haynes said the state "has been very successful in getting Kentuckians enrolled in quality, affordable health-care coverage," but "We must now translate that coverage into quality, efficient and effective treatment. . . . The methods of treatment delivery must adapt to accommodate this new population of patients.”

Under federal health reform, hospitals are moving from volume-based to value-based reimbursements, and getting a larger share of Medicare and Medicaid patients, and for some that has meant empty beds, lower revenues and in some cases bankruptcy. Many Kentuckians have chronic illnesses, "which result in very low margins for some providers," a state news release said.

Letters of invitation have been sent to all members of the General Assembly and hospital CEOs. Space is limited, so invited guests are encouraged to register soon.