Friday, May 6, 2016

Childhood obesity rates continue to rise nationally while Ky.'s rate has leveled off, but 1/3 of kids are still overweight or obese

By Melissa Patrick
Kentucky Health News

Nationally, childhood obesity rates are not declining and severe obesity rates are still rising, especially among minority children. However, in Kentucky, child obesity rates have remained stable and the rates of obesity for minority children are not rising.

“Understanding the ongoing trends in obesity is important for public health and policymakers,” lead researcher Asheley Skinner, who is with the Duke Clinical Research Institute, said in a news release. “Our study suggests that more than 4.5 million children and adolescents in the U.S. have severe obesity."

The study, published in the journal Obesity, examined data from the National Health and Nutrition Examination Survey between 1999 and 2014 and found that 33.4 percent of children in the U.S. were overweight, meaning their body mass index (BMI) was above the 85th percentile for children their age. BMI levels estimate body fat based on height and weight.

In 2013-14, the study found that nearly 24 percent were obese, or above the 95th percentile, and that 2.4 percent were severely obese, or more than 140 percent of the 95th percentile.

The authors noted that the only statistical increase in child obesity since 2011 was found in those who were severely obese, which went up 2.1 percent, and this increase was most prevalent among African American and Latino children. The report also said that while there has been an increase in obesity in all age groups over the past 30 years, it "may be leveling off."

It could be that this "leveling off" effect is happening in Kentucky, where more than one-third of children are either overweight or obese.

The State of Obesity report found that 18 percent of Kentucky's high school students are obese, almost 20 percent of its 10- to 17- year olds are obese and 15.5 percent of its 2- to 4- year-olds from low-income families are obese. The report also shows that these rates have remained consistent for high school obesity since 2003, 10- to 17- year-olds since 2004 and the 2- to 4- year-olds since 2003.

The Kentucky Youth Risk Behavioral Survey also shows no overall statistical changes in obesity rates among  Kentucky's high-school students, including the state's African American high school students, whose rates range from from 15.5 percent obese in 2005 to 19.1 percent in 2013, or its Hispanic high school students, whose obesity rates were 15.5 percent in 2007 and 18.8 percent in 2013, the only two years with available data.

These reports did not break down the different levels of obesity.

Studies have shown that children with severe obesity are at an increased risk for heart disease, Type 2 Diabetes and even cancer when compared to children who are only considered overweight or mildly obese, says the release.

Skinner said it is time to expand local interventions and to find new treatment approaches.

"Addressing obesity in children is going to require a true population health approach, combining efforts at individual, healthcare, community and policy levels," she said in the release.

What is Kentucky doing about childhood obesity?

Kentucky's schools, as community partners in the battle against childhood obesity, are working to combat it through both nutrition and movement initiatives.

For example, most public Kentucky schools participate in the 2010 Healthy, Hunger-Free Kids Act that requires schools to provide healthier foods for their students; many schools participate in the Fresh Fruit and Vegetable Program, which provides a daily fruit or vegetable snacks to every student in participating schools; and more than 80 Kentucky school districts participate in the National Farm-to-School program.

Jamie Sparks, the school health and physical education director for the Kentucky Department of Education, said in an e-mail to Kentucky Health News that Kentucky schools are working to get students more active through several initiatives.

Sparks pointed out several successes, including school partnerships with the Alliance for a Healthier Generation initiative; a partnership with Humana Vitality called Students with Active Role Models, which encourages teachers and school staff to earn Vitality points by leading physical activity with their students; and partnerships with an online program called GoNoodle, which increases physical activity time in the classroom.

In addition, Sparks said, "Kentucky ranks second in the percentage of public schools enrolled with Let’s Move Active Schools. We have hosted 10 Physical Activity Leader trainings in the past three years."

But is that enough to make a difference?

Dr. Willian Dietz, author of an accompanying journal editorial, said there is a shortage of care-givers to treat obesity, noting that every primary care provider who takes care of children is likely to have about 50 pediatric patients with severe obesity in their practice. He also said that most of these providers aren't trained to treat childhood obesity, nor are they compensated appropriately, if at all, to treat it.

"We need more effective, cost-efficient and standardized approaches and services to manage children with the most severe obesity. This research emphasizes the urgency with which we must develop and validate a reimbursable standard of care for severe obesity in children and adolescents,"Elsie Taveras, spokesperson for The Obesity Society, said in the release.

It should be noted that Dietz, who is the director of the Global Center for Prevention and Wellness at George Washington University, said in his editorial that other data shows obesity rates have declined in two- to five- year olds. He said that this doesn't mean this study is incorrect because different time frames were used. "It all depends on how you look at it," he said. He did, however, acknowledge that severe obesity is increasing among adolescents.

He said, “The authors’ observation that severe obesity has increased is of great concern, especially because children with severe obesity become adults with severe obesity.”

Thursday, May 5, 2016

Study says intravenous drug users in almost half of Kentucky's counties are at high risk of getting hepatitis C or HIV

A preliminary report by the federal Centers for Disease Control and Prevention has identified 220 counties in the United States as being most vulnerable to outbreaks of HIV and hepatitis C among those who inject drugs in those communities, and 54 of those counties are in Kentucky.

Most are in Appalachia, but the list includes the non-Appalachian counties of Hickman, Breckinridge, Grayson, Allen, Taylor, Boyle, Mercer, Carroll, Gallatin Grant and Campbell.
Counties considered vulnerable to outbreaks are green; top 25 out of 220 in U.S. are numbered on map.
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 CDC.

“Both HIV and hepatitis C can be transmitted when people who inject drugs share their needles," Doug Hogan, acting communications director for the Cabinet for Health and Family Services, said in an e-mail to Kentucky Health News. "Many of Kentucky’s HCV cases are among rural youth, ages 12-29, who have been sharing needles."

Clark County Health Director Scott Lockard called the CDC report a "wake-up call."

"We are potentially on the leading edge of one of the biggest public-health crisis to hit our state," Lockard said in an e-mail to Kentucky Health News. "It will take a combined effort across sectors to prevent an HIV outbreak in the SOAR region such as the one that occurred in Scott County, Indiana," north of Louisville.

Lockard made these comments in April after attending a Shaping Our Appalachian Region roundtable that focused on substance abuse and intravenous drug use in the region. More than half (56 percent) of the 220 counties identified as most vulnerable for HIV or hepatitis C were located in the Appalachian regions of Kentucky, Tennessee and West Virginia.

"About 25 percent of our state’s population lives in these 54 counties," Hogan said.

The CDC began this study after an unprecedented outbreak of HIV infections occurred in Scott County, Indiana, in 2014 among its intravenous drug users to see what other counties might be vulnerable to such an outbreak.

Researchers looked at all 3,143 U.S. counties and based their rankings on six variables, including: the number of overdose deaths, per-capita-income data, unemployment data, population studies, prescription opioid sales, and prescription sales for opioid treatments such as buprenorphine.

The report points out that this does not mean that HIV or hepatitis C outbreaks are inevitable in these counties, or that there is a current problem with intravenous drug users in these counties, but says that intravenous drug users in these counties are at a higher risk.

One way to slow down the spread of HIV and hepatitis C is through needle exchanges, where intravenous drug users trade dirty needles for clean ones. Needle exchanges were authorized in Kentucky under a 2015 anti-heroin law but also require local approval.

So far, only Louisville and Lexington and the counties of Boyd, Carter, Clark, Elliott, Franklin, Grant, Harrison, Jessamine, Kenton, Knox, Pendleton and Pike are either operating or have approved such programs. Of the 54 high-risk counties, only Boyd, Carter, Clark, Knox and Pike counties have operating needle exchanges.

Hogan said, "The Kentucky Department for Public Health is working closely with (the) CDC and at-risk communities to increase HIV and hepatitis C testing, and is assisting counties in their processes of establishing syringe exchange programs."

Here's a list of Kentucky counties and their national rankings for vulnerability to the rapid spread of HIV and hepatitis C among people who inject drugs: Wolfe, 1st; Breathitt, 3rd; Perry, 4th; Clay, 5th; Bell, 6th; Leslie, 8th; Knox, 9th; Floyd, 10th: Clinton, 11th; Owsley, 12th; Whitley, 14th; Powell, 15th; Knott, 17th; Pike, 21st; Magoffin, 23rd; Estill, 25th; Lee, 30th; Menifee, 31st; Martin, 34th; Boyle, 35th; Lawrence, 39th; Rockcastle, 40th; Harlan, 45th; McCreary, 48th; Letcher, 50th; Johnson, 53rd; Russell, 54th; Elliott, 56th; Laurel, 65th; Carroll, 67th; Taylor, 75th; Grant, 77th; Adair, 93rd; Lincoln, 97th; Wayne, 99th; Cumberland, 101st; Gallatin, 108th; Bath, 125th; Grayson, 126th; Greenup, 129th; Green, 132d; Casey, 153d; Carter, 154th; Monroe, 163d; Garrard, 167th; Robertson, 175th; Lewis, 178th; Edmonson, 179th; Allen, 180th; Boyd, 187th; Hickman, 191st; Breckinridge, 202d; Campbell, 212th; and Mercer, 214th.

FDA to regulate e-cigs: ban sales to minors, require warning signs, require federal approval; did not address advertising issues

In a long-anticipated move, the U.S. Food and Drug Administration announced May 5 that it is assuming regulatory authority over all tobacco products, including electronic cigarettes, cigars, hookah, tobacco and pipe tobacco that include banning sales to anyone under 18.

“Today’s announcement is an important step in the fight for a tobacco-free generation – it will help us catch up with changes in the marketplace, put into place rules that protect our kids and give adults information they need to make informed decisions," Health and Human Services Secretary Sylvia Burwell said in a news release.

FDA's new tobacco regulations will prohibit sales of e-cigarettes and all tobacco products to anyone under 18, both in person and online, and buyers must now show photo ID.

Health warnings will also be placed on packages and in advertisements, saying, “WARNING: This product contains nicotine. Nicotine is an addictive chemical.” It also bans free samples and the sale of covered products in vending machines not located in adult-only facilities.

The regulation also requires manufacturers of all newly-regulated products introduced to the market after Feb. 15, 2007, a date that is set by the Tobacco Control Act of 2009, to require federal approval. An amendment to the legislation has been submitted to change the date so more e-cigarettes would be grandfathered in, Jayne O'Donnell and Laura Ungar report for USA Today.

The e-cigarette industry is pushing back on these regulations.

"Industry experts say treating e-cigarettes, which don't contain tobacco, the same as cigarettes could lead to such onerous and costly approval that all but the largest tobacco companies would be forced out of the market — and possibly those companies, too," USA Today writes. Jeff Stier, an e-cigarette advocate with the National Center for Public Policy Research and industry officials, told USA Today that it could cost $1 million or more per application.

Vapers also argue that e-cigs help people quit, but studies on that conflict.

Ellen Hahn, a professor at the University of Kentucky College of Nursing and co-chair of the UK Tobacco-free Task Force, told USA Today that the new rule is a good first step toward controlling e-cigarettes, noting "vaping" can get youth addicted to nicotine and threatens to prolong "the tobacco epidemic."

"From a health perspective, to reduce the social acceptance of them is good because frankly, it's the wild, wild West out there," she told the newspaper. "Vape stores are everywhere."

The Robert Wood Johnson Foundation commended the FDA for these regulations, noting the use among high school students has "rocketed from 1.5 percent in 2011 to 16 percent in 2015, an increase of more than 900 percent." But it also said the regulation did not go far enough.

"Studies have proven that tobacco advertising directly influences youth, and that such sweet e-cigarette flavors as gummy bear and cotton candy play a role in children trying these products," Dr. Risa Lavizzo-Mourey, CEO of the RWJF, said in the statement "Today's final rule did not address these issues, and we strongly urge the FDA to take aggressive regulatory and enforcement actions to prevent and reduce youth tobacco use, in any form it takes."

The regulation goes into effect Aug. 8, and gives affected industries two years to comply. The original proposal was introduced in 2014.

Wednesday, May 4, 2016

Stanford hospital is first in Kentucky to go back to laughing gas, or nitrous oxide, to relieve the pain of childbirth

Photo: Abigail Whitehouse, Interior Journal
Ephraim McDowell Fort Logan Hospital's Birthing Spa in Lincoln County is the first in Kentucky to offer nitrous oxide, often called laughing gas, as an alternative pain relief measure for women during childbirth, Abigail Whitehouse reports for The Interior Journal in Stanford.

Dr. James Miller, the unit's medical director, told Whitehouse that the Birthing Spa aims to provide support and comfort to mothers during labor and that nitrous oxide, which was commonly used for this purpose in the 1950s until epidural anesthesia became popular, provides another option to help decrease anxiety and pain during childbirth.

"We in our unit found, when we started hearing again about the nitrous oxide, that it just fit really well with our philosophy of trying to offer choices to moms," Miller told Whitehouse.

Miller said that while epidurals continue to be used most often during labor for pain management, the procedure comes with some risk and are expensive.

"Epidurals cost a lot and haven't shown the benefits. And they changed labor from a low-risk setting to a high-risk setting," Miller told Whitehouse. "With an epidural, we know that it drops the mom's blood pressure, so they have to have an IV ahead of time and load up on fluids to try to prevent the drop in blood pressure, and then it can still happen. Then you have to monitor the baby's heart tones."

In addition to nitrous oxide, the Birthing Spa also offers alternate options for pain management during childbirth, including: water births, which he said have been proven to lower cost and shorten the length of labor, showers big enough for two with multiple shower heads, a nursing staff trained to "almost function as a doula," a beautiful garden to walk in, and massage chairs. The unit also offers epidurals or an alternative intravenous medication for pain.

Miller noted that nitrous oxide, which is delivered through a mask, allows laboring mothers control over their pain management because they can put it on and remove it as needed; it can also be used earlier in the process than an epidural.

Miller told Whitehouse, "It's very fast acting so when the pain is starting to contract, they start breathing the medicine and within seconds it takes effect and then as the pain resolves, they take the mask away and the medicine wears off that quickly too."

Tuesday, May 3, 2016

Studies conclude that abstinence pledges do little to cut youth sexual activity, pregnancies, sexually transmitted diseases

Abstinence pledges—sometimes called purity pledges—don't keep young people from engaging in sex, contracting sexually transmitted diseases or avoiding pregnancy, according to a pair of studies, Denise-Marie Ordway reports for Journalist's Resource. The main problem is that students are not receiving enough sex education. A federal Centers for Disease Control and Prevention report from December 2015 found that "fewer than half of high schools and only a fifth of middle schools teach all 16 topics recommended by CDC as essential components of sexual health education."(CDC graphic)

A 2005 study by Yale and Columbia universities found that 88 percent of youth who take the abstinence pledge engage in pre-marital sex, Ordway writes. "The study found that pledgers were just as likely to get STDs as those who never made a pledge of virginity."

more recent study, published in April in the Journal of Marriage and Family, found that among students in grades 7 to 12, "as a whole, young women who did not take abstinence pledges and those who did but broke them were equally likely to acquire HPV, a common STD," Ordway writes. "Approximately 27 percent of each group tested positive for HPV. Of the young women who had two or more sex partners, pledge breakers were more likely to have HPV. The difference was largest among women who had between six and 10 sex partners. One-third of women who had not taken a pledge and had six to 10 sex partners tested positive for HPV. Meanwhile, 51 percent of pledgers who had six to 10 sex partners acquired HPV. About 30 percent of pledgers and 18 percent of non-pledgers became pregnant within six years after they began having sexual intercourse outside of marriage."

"In the U.S, the teen pregnancy rate is higher than in any other western industrialized country, according to the CDC," Ordway writes. "At the same time, a growing number of American teens and young adults have been diagnosed with sexually transmitted diseases (STDs). While individuals aged 15 to 24 make up 27 percent of the U.S. population that is sexually active, the CDC estimates that they account for half of the 20 million new infections occurring annually."

Sunday, May 1, 2016

State and national smoke-free leaders tell Ky. advocates to focus on local smoking bans because of political climate in Frankfort

By Melissa Patrick
Kentucky Health News

More Kentucky localities are likely to see efforts for smoking bans, as a statewide ban appears less likely and leading advocates are saying to go local.

Stanton Glantz
photo: ucsf.edu
Stanton Glantz, one of the nation's leading advocates of smoke-free policies, said at the Kentucky Center for Smoke-Free Policy's spring conference April 28 that California initially had trouble passing a statewide indoor smoke-free law, which forced advocates to move their efforts to the local level. By the time the statewide law passed, 85 percent of the state was covered by local ordinances.

"I'm glad it worked out that way, because we are really talking about values and social norms and community norms and you just can't impose that from the outside," Glantz said during his keynote address. "And so all of these fights that you are having in all of these towns. ... In the end, when you win, you've won. And the fight itself is an important part of making these laws work."

Ellen Hahn, a University of Kentucky nursing professor and director of the smoke-free policy center, also encouraged her colleagues to shift their efforts to localities, saying the political situation doesn't support a statewide law. New Republican Gov. Matt Bevin doesn't support a statewide ban on smoking on workplaces, saying the issue should be decided locally.

"We are in a very difficult political climate in Frankfort," Hahn said in her opening remarks."We all know it. We all recognize it. And while we would all like to see Frankfort do the right thing – and it will someday, I promise – it is not the time to let somebody else do it. It is the time to go to your local elected officials and say we want this."

Advocates made some headway last year when a smoking-ban bill passed the House, but it was placed in an unfavorable Senate committee and never brought up for discussion. This year's House version of the bill, in an election year with Bevin in the governor's office, was dead on arrival.

Glantz, a University of California-San Francisco professor and tobacco-control researcher, looked at the bright side: "You're in a tough political environment, but you are really doing pretty well." He reminded the advocates that one-third of the state is covered by indoor smoke-free ordinances, with 25 of them comprehensive and 12 of them including electronic cigarettes. He also commended the Kentucky Chamber of Commerce for supporting statewide and local bans.

What's next

Glantz urged the advocates to "empower and mobilize" the 73 percent of Kentuckians who don't smoke and get them to help change the social norms. Two-thirds of Kentucky adults support a comprehensive statewide smoking ban, according to latest Kentucky Health Issues Poll, and have since 2013.

“The whole battle is a battle about social norms and social acceptability, and once you win these fights, and you have a law that’s sticking – which takes a while – you don’t go back,' he said. "And the tobacco companies understand that, and that is why they are fighting us so hard.”

Glantz armed the smoke-free warriors with research data to support smoke-free laws, including: they decrease the number of ambulance calls; hospital admissions for heart attacks, stroke, asthma and chronic obstructive pulmonary disease; and the number of low-birth-weight babies and complications during pregnancy.

"In Kentucky communities with comprehensive smoke-free laws, there was 22 percent fewer hospitalizations for people with COPD," Glantz said, citing one of Hahn's studies. "That is a gigantic effect, absolutely gigantic, at almost no cost and it happened right away."

He noted that politicians are usually most interested in this short-term data, but he also cited long-term statistics about how smoke-free policies in California have decreased heart disease deaths by 9 percent "in just a few years," and lung cancer by 14 percent in about 10 years. Kentucky leads the nation in both of these conditions.

"I would argue that the economic argument is actually on our side," Glantz said, noting that economic benefits of smoke-free laws are almost immediate, especially because "every business, every citizen and every unit of government" is worried about health care costs. He also cited research that found "as you pass stronger laws, you get bigger effects.'

Leading tobacco foe is fighting Big Tobacco again, this time because the industry has taken over the electronic cigarette trade

By Melissa Patrick
Kentucky Health News

One of the nation's top anti-tobacco advocates told his Kentucky allies last week that the debate about electronic cigarettes makes him feel like he's "gotten in a DeLorean and gone back to the '70s," like they did in the movie "Back to the Future."

Stanton Glantz
photo: ucsf.edu
"Is it bad? Is it polluting? Does it have second-hand smoke? Blah, blah, blah, freedom, blah, blah, blah," Stanton Glantz ranted at the Kentucky Center for Smoke-Free Policy's spring conference April 28, lamenting how Big Tobacco has taken over the e-cigarette business and is using old marketing strategies to get kids to use e-cigs.

"The business is being taken over by the big multi-national tobacco companies and they are the ones who are doing all the advertising," Glantz said. "They are the ones who are doing all the marketing to kids; they are the reason the use among kids is exploding."

Glantz, a University of California-San Francisco professor and tobacco-control researcher, acknowledged that e-cigs are less toxic than cigarettes. But he said that doesn't make them safe, and most e-cig users also use tobacco, so they are not reducing harm. He also blasted the claims that e-cigarettes help people quit smoking, saying the claims are anecdotal.

However, the Royal College of Physicians, a major British medical organization, just published a report that says those who use e-cigarettes to quit smoking have a 50 percent better chance of success than if using no aids or using nicotine patches without counseling, Sabrina Tavernise reports for The New York Times.

Glantz disagreed with the report. He cited a meta-analysis he published a few months ago that found e-cigs don't help people quit smoking.

"On average, smokers who use e-cigarettes are 30 percent less likely to quit smoking than smokers who don't use e-cigarettes,"he said. "So, they are extending the tobacco epidemic."

Glantz said that the British researchers predicted what they think is going to happen, but U.S. data shows what is happening. "They have collectively lost their minds," he said.

Youth and e-cigarettes

Glantz said that he would normally not encourage advocates to focus their efforts on children, because "kids do what adults do," but he said that isn't so with e-cigs, which are being directly marketed toward them with candy flavored products.

"I think e-cigarettes are different. E-cigarettes are different because this is an epidemic that is growing from the bottom up," he said. "And the data on kids is like very scary. Non-smoking kids who use e-cigarettes, if you come back a year later, they are three times more likely to be smoking cigarettes than the non-smoking kids who aren't using e-cigarettes."

Glantz wrapped up saying, "So, the bottom line on e-cigarettes is they are likely to prolong the tobacco epidemic because they are restoring social acceptability of tobacco use. They are depressing quitting among smokers and they are attracting kids to nicotine, a lot of whom are going to convert to cigarettes."

Glantz is best known for leading the movement to call out the deceptive marketing messages of cigarette manufacturers and expose the dangers of tobacco during the 1990s, with the help of documents showing that tobacco executives were aware of the dangers of their products while marketing them aggressively toward young adults and teens.

Glantz's current research focuses on the health risks associated with secondhand smoke and the correlation between high smoking rates and heart attack deaths. He also works to change policy that would mandate an "R" rating for any movie with smoking in it.

Friday, April 29, 2016

Suicide rates are rising in the U.S.; experts attribute high rate in rural Ky. to poor mental health access, stigma and 'gun culture'

By Melissa Patrick
Kentucky Health News

After a decade of decline, suicide is becoming more common in the United States, increasing by 24 percent from 1999 through 2014, according to the federal Centers for Disease Control and Prevention.

The CDC report looked at cause-of-death data between 1999 and 2014 and found that suicide rates increased for both males and females in all age groups from 10 to 74.

Graph: CDC Age-adjusted suicide rates by sex
Overall, the suicide rate increased from 10.5 per 100,000 people in 1999 to 13 per 100,000 in 2014, showing a steady 1 percent annual increase through 2006 and a 2 percent annual increase after that.

And while the suicide rates for males continues to be higher than those for females, the report notes that the gender gap is narrowing. Among females, the rate of increase was 45 percent, compared to 16 percent for males.

Suicide rates for middle-aged women aged 45-64 were the highest, in both 1999 (6 per 100,000) and 2014 (9.8 per 100,000), showing a 63 percent increase. In females, the largest increase occurred among girls 10-14 (200 percent), though the actual number of suicides in this group was relatively small, tripling from 0.5 per 100,000 in 1999 to 1.5 in 2014.

For men, suicide rates were highest for those 75 and over, with approximately 39 for every 100,000 men in 2014. However, men 45-64 had the greatest increase among males, increasing from 20.9 per 100,000 in 1999 to 29.7 in 2014, a rise of 43 percent.

In 2014, poisoning (34.1 percent) was the most common method of suicide in females and firearms (55.4 percent) was the most common in males.

The CDC report didn't address why suicides are up, but several studies offer clues about possible reasons among the middle-aged, including a study published in 2015 in the American Journal of Preventive Medicine that found that "job, financial, and legal problems" are most common in adults aged 40-64 who had committed suicide, and a 2011 CDC study which found that suicide rates increased during periods of economic recession and declined during economic growth among people aged 25-64 years.

Rural areas have highest suicide rates

Suicide is the 10th leading cause of death in the nation and the state, and with nearly 700 Kentuckians dying by suicide annually, Kentucky is one of the top 20 states for it.

Suicide is more prevalent in rural areas, where the rate is almost twice as high as in urban areas (17.6 suicides per 100,000 vs. 10.3 per 100,000), according to a separate CDC study.

"The myth is that suicide is an inner-city, urban problem, but the reality is that it is not," Melinda Moore, a licensed psychologist and assistant professor at Eastern Kentucky University, said in a telephone interview.

Moore, also the chair of the Kentucky Suicide Prevention Group, attributed some of the increase in suicide rates in rural Kentucky to its "gun culture."

"We have a culture that is very familiar with guns and that familiarity, unfortunately, can really lead to people using very lethal means when they are suicidal," she said.

And when you add gun culture to economic distress, which is common in much of rural Kentucky, it can be a "cocktail for disaster" for those who are suicidal, she said.

Another challenge is the lack of access to mental-health care in rural Kentucky, Moore said, noting that even if people have access to mental-health providers, many providers aren't trained to work with suicidal people. She said this should be improving, since the state now requires all behavioral health providers get suicide training when they renew their licenses.

Julie Cerel, psychologist and associate professor in the University of Kentucky College of Social Work, attributed the increase in rural suicides to several things, including the Gun culture, lack of access to mental-health care and the stigma that surrounds mental-health issues that deters people from seeking help.

Cerel, also president-elect of the American Association of Suicidology, said one reason for the national increase in suicides could be that coroners have become better trained on how to report them. She said that is very important, because people who were close to a person who died by suicide need to know so that they can seek their own mental-health support.

Cerel said 47 percent of Kentuckians knew someone who died by suicide, "and people who are exposed to suicide, especially if it is someone close to them, are more likely to have their own depression and anxiety and thoughts of suicide."

What should you do if you have suicidal thoughts or are concerned about someone?

Moore and Cerel said the first line of defense, especially in areas that don't have great mental-health resources, is to call the national suicide-prevention lifeline, 800-273-TALK (8255). This is a free, 24/7 service that can provide suicidal persons or those around them with support, information and local resources. It also offers a website at www.suicidepreventionlifeline.org .

Moore said community mental health centers are also great resources for those who are suicidal in rural Kentucky, and Cerel stressed the importance of telling someone if you are having suicidal thoughts, including your primary health-care provider.

Wednesday, April 27, 2016

UnitedHealth will leave Ky. next year, leaving much of the state with only one or two choices for health insurance on exchange

UnitedHealth Group Inc. won't be participating in Kentucky's individual insurance plans offered through the Affordable Care Act marketplace next year, which could leave about 20 percent of the state with just one insurer to choose from for next year and another 22 percent with only two choices, according to an analysis by the Kaiser Family Foundation.

Including Kentucky, this brings the number of states the health insurer is quitting next year to 26, Zachary Tracer reports for Bloomberg.

"The company plans to halt sales of individual plans in Kentucky for 2017, both inside and outside the state’s Affordable Care Act exchange, as well as the small-business exchange," United said in a letter dated March 28 to the state’s insurance department, Tracer reports. Bloomberg noted that it obtained the letter through an open-records request.

United warned in November that this would likely happen after reporting that "low enrollment and high usage cost the company millions of dollars," USA Today reported.

“UnitedHealthcare’s intent to withdraw from the market was not unexpected,” Doug Hogan, a spokesman for the state Public Protection Cabinet, which oversees the state’s insurance regulator, said in an e-mail to Bloomberg. “Insurers across the country have been losing hundreds of millions of dollars in the Obamacare exchanges and can no longer sustain such heavy financial losses.”

The administration of Republican Gov. Matt Bevin is shutting down the state's Kynect exchange and moving its 100,000 or so users to the federal exchange, but plans on that exchange are offered state by state.

Bloomberg says it has confirmed that United is leaving at least 26 of the 34 states where it sold 2016 coverage, but will continue to offer small-business plans off the exchange. New York and Nevada confirmed for Bloomberg that United plans to sell ACA plans in those states next year. The company has also filed plans to participate in Virginia.

Tuesday, April 26, 2016

More than 100 at SOAR Substance Abuse Roundtable committed to work on prevention and treatment efforts in region

By Melissa Patrick
Kentucky Health News

More than 100 people attended the Shaping Our Appalachian Region Substance Abuse Roundtable April 7 to learn about current research and emerging opportunities associated with substance abuse and intravenous drug use in region, according to a SOAR news release.

SOAR is a bipartisan effort to revitalize and diversify the economy in Kentucky's 54 Appalachian counties. It has advisory councils for each of its 10 areas of focus, one of which is community health and wellness.

That council's chair, former state health commissioner Dr. William Hacker, facilitated the roundtable at Natural Bridge State Resort Park.

As part of the solutions-driven discussion, Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, told the attendees that it is important to ask the right questions when gathering information about drug abuse to accurately depict what is going on in the region.

“When you ask people if they have a problem with prescription drugs they, of course, say no,” Zepeda said. “When you ask them if they know someone, like a family member or friend, that answer is very different.”

The group also discussed the importance of getting accurate data about substance abuse and overdose into the right hands to make progress on these issues.

“We want to get data into the hands of legislators and those who can do something about prescription-drug overdose,” said Dana Quesinberry, public-health-policy and program evaluator for the Kentucky Injury Prevention and Research Center at the University of Kentucky. “Sitting in a repository, it doesn’t do anything for anyone.”

The roundtable members also discussed needle-exchange programs, authorized under the state's 2015 anti-heroin law. The program is meant to slow the spread of HIV and hepatis C, which are commonly spread by sharing of needles among intravenous drug users.

“We’ve seen a switch from using pills as an opioid to using intravenous methods,” said Greg Lee, the HIV/AIDS continuing-education program director for the state Cabinet for Health and Family Services.

Clark County Health Director Scott Lockard said the federal Centers for Disease Control and Prevention issued a "wake-up call" with its report identifying 54 Kentucky counties as being among the 220 most vulnerable in the nation for the rapid spread of HIV and hepatitis C infection among intravenous drug users. Most of the counties, and eight of the top 10, were Appalachian.

"We are potentially on the leading edge of one of the biggest public health crises to hit our state," Lockard said in an e-mail to Kentucky Health News. "It will take a combined effort across sectors to prevent an HIV outbreak in the SOAR region such as the one that occurred in Scott County, Indiana," just north of Louisville.

Although many Kentucky county officials are talking about needle-exchange programs, so far only Louisville and Lexington and the counties of Boyd, Carter, Clark, Elliott, Franklin, Grant, Harrison, Jessamine, Knox, Pendleton and Pike are either operating or have approved such programs. Of these, Boyd, Carter, Clark, Elliott, Knox and Pike are part of SOAR.

The news release noted that participants left the discussion with a commitment to continue the conversation and to build a strategic plan to address substance abuse issues in the region, with a focus on clinical practices, health systems, drug screenings and other best practices.

Monday, April 25, 2016

Levels of suspected 'hormone disruptors' in teen girls dropped after they switched to products that didn't contain them

A recent study found that after three days of not using personal-care products that contain "problematic substances," the levels of chemicals that potentially disrupt hormones in the bodies of teenage girls dropped, Environmental Working Group Vice Preisdent Alex Formuzis writes for its Enviroblog.

The study, led by Kim Harley of the Center for Environmental Research and Children’s Health at the University of California-Berkeley, asked 100 Latina girls between 14 and 18 years old to not use personal-care products such as cosmetics, shampoos and soaps, for three days and instead to only use products free of the suspected hormone disruptors: phthalates, parabens and triclosan. The girls, all volunteers, were given products that did not contain these chemicals.

After three days, the teens' urine tests showed a 44 percent decrease in the levels of methyl and propyl parapen, preservatives widely used in cosmetics, shampoos and skin lotions; a 35 percent decrease in triclosan, a commonly used antibacterial chemical that has been linked to the disruption of thyroid and reproductive hormones; and a 27 percent decrease in mono-ethyl phthalates, a common industrial plasticizer found in some nail polishes and fragrances.

“Techniques available to consumers, such as choosing personal care products that are labeled to be free of phthalates, parabens, triclosan, and oxybenzone, can reduce personal exposure to endocrine-disrupting chemicals,” the study authors wrote. “Our study did not test for the presence of these chemicals, but simply used techniques available to the average consumer: reading labels and investigating product safety through web-based databases.”

The study, published in Environmental Health Perspectives, notes that the study shows that "consumers may be able to reduce exposures to these chemicals by seeking out commercially available products with lower levels of these chemicals."

However, Formuzis pointed out that the federal Food and Drug Administration has "virtually no authority" over this industry and notes that this study helps to, "underscores the need to regulate the personal care products industry."

Legislation by U.S. Sens. Dianne Feinstein (D-Calif.) and Susan Collins (R-Maine), proposes to do just that.

"The Feinstein-Collins Personal Care Products Safety Act would give the FDA tools for ensuring the safety of personal care products as strong as those that regulate food and drugs," Formuzis writes. The bill would require the FDA to investigate the safety of five cosmetics ingredients and contaminants yearly; cosmetic makers would have to register their manufacturing facilities,disclose their ingredients, report health incidents related to their products, and label their products with disclosures and warnings as needed; and it would allow the FDA the authority to recall dangerous products.

Formuzis reports that "some of the corporations backing the Feinstein-Collins bill include Revlon, Johnson & Johnson, Proctor & Gamble, Unilever, L’Oreal, California Baby and the industry trade organization, the Personal Care Products Council."

Sunday, April 24, 2016

Zika update: Local anti-mosquito action needed; McConnell, Rogers at center of debate over Obama's request for more funds

Mosquitoes can carry Zika. (NPR photo)
By Melissa Patrick
Kentucky Health News

While all 388 Zika virus cases confirmed in the continental U.S., including six in Kentucky, have been in people who were infected abroad and then returned to the states, a health official said on "Fox News Sunday" that it is likely the U.S. will have its own outbreak.

"It is likely we will have what is called a local outbreak," said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, Diane Bartz reports for Reuters.

Fauci said he did not expect a large number of people to become ill: "We're talking about scores of cases, dozens of cases, at most."

Dr. Ardis Hoven, infectious disease specialist for the Kentucky Department for Public Health, agreed and said the potential exists for Kentucky to have a local outbreak.

"I think it would be unreasonable for us to assume that we would not be at risk," she said in a telephone interview. "So therefore, we have to plan accordingly."

Hoven said mosquito control in the state is a "top priority," but said the bulk of this will have to happen at a local level.

She encouraged Kentuckians to talk about mosquito prevention with their friends and family and ask themselves, "What can I do in my community, in my yard, on my street to prevent mosquitoes from hatching and infecting those around me?"

Zika virus prevention strategy: Dress, Defend and Drain
The state has adopted a "3 D" approach to decrease the risk of infection by mosquitoes: Dress in light-colored long sleeved shirts and pants; Defend against mosquitoes with approved insect repellents; and Drain all standing water.

"If we can control mosquitoes in our region, we will go a long way to minimize the potential risk from infected mosquitoes," Hoven said.

The World Health Organization declared Zika a global health emergency in February. Those who have traveled to affected areas, such as Central and South America, are at the highest risk of contracting the virus, which is spread primarily by infected Aedes aegypti mosquito. It can also be spread through sexual intercourse. Aedes aegypti can be found in about 30 U.S. states, including Kentucky.

Zika virus is especially dangerous to pregnant women because it has been linked to thousands of cases of microcephaly, a condition where the infants head is smaller than normal, as well as other severe fetal brain defects, according to the federal Centers for Disease Control and Prevention. The state health department has reported that one of the confirmed Zika cases in the state is a pregnant woman.

The CDC is investigating the link between Guillain-Barre syndrome, a rare disorder in which the body's immune system attacks its nerves. And Fauci said there could be other neurological conditions caused by Zika that affect adults, Bartz reports.

"There are only individual case reports of significant neurological damage to people, not just the fetuses, but an adult that would get infected. Things that they call meningoencephalitis, which is an inflammation of the brain and the covering around the brain, spinal cord damage due to what we call myelitis," Fauci said. "So far they look unusual, but at least we've seen them and that's concerning."

Common symptoms of the virus are fever, rash, joint pain and red eyes, with symptoms lasting for about a week, though many with the virus have no symptoms. Currently there is no vaccine for Zika.

Funding to fight Zika held up in Congress

In February, President Obama asked Congress for an additional $1.9 billion in emergency funds to fight the Zika virus, including funds to develop a vaccine. This is in addition to $589 million in previously appropriated funds that have already been transferred to the effort.

That money should last through Sept. 30, the end of the federal fiscal year, but "There's going to need to be additional money, I don't think there's any doubt about that," Rep. Tom Cole, R-Okla., who chairs the House health appropriations subcommittee, told Susan Cornwell of Reuters April 13.

Top senators from both parties said "they are getting close to a deal to provide at least some emergency funding to fight the Zika virus, making it likely that the Senate will move ahead on the issue without waiting for the House," David Nather writes for STAT, an online health journal.

Senate Majority Leader Mitch McConnell, R-Ky., said at a news conference April 19 that congressional Republicans were working with the administration on the funding details, Peter Sullivan reports for The Hill.

“We're working with them on it to figure out exactly the right amount of money,” McConnell said at a press conference. “You know, how is it going to be spent? And I don't think, in the end, there will be any opposition to addressing what we think is going to be a fairly significant public health crisis."

Nevertheless, House Republicans kept saying they don't have enough information to approve the request.

On April 20, House Appropriations Committee Chairman Hal Rogers, R-Ky., said the Obama administration “continues to delay response efforts by refusing to provide basic budgetary information to Congress on their Zika funding request. This includes not answering our most basic question: ‘What is needed, right now, over the next 5 months in fiscal year 2016, to fight this disease?’ In the absence of this information, the House Appropriations Committee will work with our colleagues in the House and the Senate to make our own determinations on what is needed and when, and to provide the funding that we believe is necessary and responsible.”

Five days earlier, White House Press Secretary Josh Earnest said Republicans have all the information they need to move forward, ABC reports. He said, “They've had ample opportunity to collect information, to ask questions of senior administration officials, to read letters, to read the legislative proposal that was put forward by the administration.”