Legislative lobbying reports for last session rank pharmacy-benefit managers fifth, hospitals sixth, Altria 11th, Anthem 17th, docs 18th

The legislature meets in the Kentucky State Capitol.

By Al Cross

Kentucky Health News

The trade association for pharmacy benefit managers, which act as middlemen between drug and health-insurance companies, was the fifth largest reported spender on lobbying the state legislature in the first three months of the year, according to a compilation by the Kentucky Legislative Ethics Commission. 

The Pharmaceutical Care Management Association reported spending $94,694 on lobbying the General Assembly from January through March. The session began Jan. 2 and was over for most purposes by the end of March.

On March 28, the legislature gave final passage to Senate Bill 188, which is intended to keep the state's independent pharmacies from closing. It sets dispensing fees, bans PBMs from forcing patients to get their drugs through mail order, and keeps them from steering patients to pharmacies that they own. The PBMs argued that the law will cause insurance premiums to increase and its mandates in the bill won't allow businesses to gain from savings PBMs offer.

Independent pharmacies say they are losing money because of low fees paid by PBMs. The bill sets a minimum dispensing fee of $10.64 per prescription for the state's independent pharmacies until a study of dispensing costs is completed by the state Department of Insurance. This "gap-fill payment floor" will not be available to chain pharmacies. The results of the study will eventually dictate what the dispensing fee should be going forward. The study is to be repeated every two years, with fee adjustments made accordingly.

The law, sponsored by Sen. Max Wise, R-Campbellsville, also prohibits a PBM from reimbursing a pharmacy that it owns at a higher rate than a community pharmacy, or from keeping a community pharmacy from filling a 90-day prescription for a maintenance drug. And PBM will not be able to penalize a community pharmacy from sharing information with a patient on the cheapest option to pay for their medications.

Several other major lobbying interests dealt with health-care issues. The biggest spender was the Kentucky Chamber of Commerce, at $151,010, followed by the American Civil Liberties Union of Kentucky, at $139,599. Among many other things, the ACLU wants the legislature to enact exceptions to the state's near-total abortion ban.

Ranking sixth, just behind the PBM lobby, was the Kentucky Hospital Association, at $85,835. In 11th place was Altria Client Services, a cigarette company, at $73,309; it supported the successful bill to limit legal sales of vaping products to those approved by the U.S. Food and Drug Administration.

Ranking 17th was Elevance Health and Affiliates doing business as Anthem Inc., at $59,946. The health-insurance firm was followed by the Kentucky Medical Association, the main lobby for physicians, at $54,051, and the Kentucky Primary Care Association, a trade group for health clinics, at $49,416.

Overall, spending on legislative lobbying for the first three months of 2024 was a record of $9.719 million, the Ethics Commission reported Tuesday: "The previous record for the same period was $9.343 million, set last year; 933 businesses and organizations registered to lobby in Kentucky, spending $9.427 million; 727 lobbyists were paid $8.289 million in compensation, and also reported $291,942 in expenses."

Measles, which can lead to complications and even death, threatens to come back; vaccine is 97% protective against it

Photo by Pro-Stock Studio, iStock/Getty Images

By Dr. Nicholas Van Sickels
University of Kentucky

Over two decades ago, measles – a highly contagious and potentially deadly childhood disease – was declared eliminated in the United States. As of April 18, at least 125 measles cases have been recorded nationwide this year – more than double the amount of cases observed in all of 2023.

Measles most commonly affects unvaccinated children, and 20 to 40% of infected children require hospitalization. Ear infections, pneumonia, long-term neurologic issues and even death can occur. In general, most will recover, but some will have complications from the infection.

The sharp increase in cases is due to:

• A national and international decline in measles vaccination rates.
• International travel to areas with active outbreaks.
• The extreme contagiousness of the measles virus. On average, one infected person can infect nine to 10 other people, if unvaccinated.

Experts still consider measles to be eliminated in the U.S. but that could change if we don’t continue to take proper preventative measures. In response to the increase in cases, the Centers for Disease Control and Prevention has issued warnings to health professionals and the general public throughout the spring.

How do I protect myself from measles?

Fortunately, the best tool for preventing a measles infection is still highly effective. Measles is almost entirely preventable through vaccination. One dose of measles, mumps, and rubella (MMR) vaccine is 93% protective. Two doses – the recommended number – are 97% protective against the disease.

Because of the inherent contagiousness of measles, 95% or more of a population needs to be vaccinated for the entire population to be protected from an outbreak. Currently the U.S. has 93.1% vaccination coverage.

 
Kentucky has 91.6% coverage (of greater than one dose of MMR vaccine).

This last week of April is World Immunization Week – a good opportunity to discuss the importance of measles vaccination with family and friends, especially those who are planning to travel internationally or to parts of the U.S. where a measles outbreak is active. The latest tracking of measles cases and more information about the disease can be found on the CDC’s measles webpage.

What are the symptoms of measles?

• Measles symptoms typically include: Fevers (can be very high)
• Cough
• Runny nose
• Red eyes

After the above symptoms, the characteristic red rash appears, starting from the head and spreading downward.

People with measles are thought to be contagious from about four days prior to developing the rash to four days after the onset of the rash (with the onset being day zero).

What to do if you think you’ve been exposed: If you’re concerned you or your child have been exposed to measles, contact your health care provider immediately.

Many of us, fortunately, have never seen a case of measles in our lifetime. With a renewed focus on prevention, hopefully, we never will.

Nicholas Van Sickels, M.D., is infectious-disease specialist and director of infection prevention and control at UK HealthCare.

Vaping and substance use in Kentucky schools has spiked in the last five years, especially in the younger grades; up 147% overall

Kentucky Department of Education graph from Infinite Campus data; the overall increase was 147%.

By Melissa Patrick
Kentucky Health News

The number of drug, alcohol and tobacco events recorded by schools have increased in schools at all levels across Kentucky, according to data collected by Infinite Campus, an online student information tracking system.

A look at the data from 2017-28 through 2022-23 found that Kentucky's elementary schools saw a 475% increase in drug, alcohol and tobacco events, from 140 events to 805. Kentucky middle schools saw a 281% jump, from 2,336 to 8,912. High schools saw a 107% increase, from 8,995 to 18,651. 

"The biggest increases are with the younger students. So it tells us like forecasting ahead, what we need to be thinking about as we develop the guidance that goes around this," said Florence Chang, with the Kentucky Department of Education's Division of Student Success. "Parallel with this, it would be irresponsible to not also mention that correlated and associated with the increase in substance abuse and vaping that there's also been this increase in psychological distress." 

The data were shared at an April 24 Education Department Student Advisory Council meeting, where students discussed the increase in substance use and what they thought were reasons for it. One said that the real vaping numbers are likely higher because many incidents or events are not recorded.

Department of Education graph from Kentucky
Incentives for Prevention survey of students

Information from the latest Kentucky Incentives for Prevention survey shows an association between serious psychological distress and substance abuse. The study found that students who experienced and reported having psychological stress were 2.5 times more likely to vape, 2.5 times more likely to use cannabis, 2.2 times more likely to binge drink and 3 times more likely to use cigarettes. 

The students suggested several reasons beyond psychological distress for the increases in vaping, including peer pressure, an increase in use of social media among elementary students, and easy accessibility to the products. 

Another student suggested it was a learned behavior. “We see a lot of adults in our lives, said Ava Benson, a senior at Henderson County High School. “They've had a rough day at work, so they're going to have a glass of wine or they smoke cigarettes because of stress." 

Judi Vanderhaar of the Education Department's Division of Student Success said the department's recommendations for districts and schools include implementing prevention efforts, supportive responses for students and updating school policies.

During its recent session, the General Assembly passed House Bill 142, which requires school districts to adopt specific policies that penalize students for possession of "alternative nicotine products, tobacco products or vapor products" and report nicotine-related incidents to the Education Department. Senate language, adopted by the House, allows schools and governing bodies to apply for grants related to nicotine usage and remove the requirement that schools suspend students with a third possession violation.

London police told Phil Pendleton of WKYT that they have been called to schools to investigate serious situations because of vaping. “We have had several instances where EMS was called to schools, and it came out as an overdose, but it turned out it was more to do with vaping,” London Officer Hobie Daugherty told Pendleton.

University of Kentucky will buy St. Claire Hospital in Morehead

University of Kentucky trustees Friday approved buying St. Claire HealthCare in Morehead. (UK photo)

The University of Kentucky Board of Trustees voted Friday to approve plans to acquire St. Claire HealthCare in Morehead. The targeted date for UK's takeover is July 1. 

The move will expand clinical and academic programs and provide more access to high-quality patient care for more Kentuckians, UK said in a news release.  

“UK is committed to growing clinical services in the Morehead area as well as expanding programs in many clinical areas to grow the future health care workforce for Kentucky,” President Eli Capilouto said in the release.  

St. Claire is one of the largest employers in the Morehead region, with more than 1,300 employees, including over 50 physicians and nearly 50 advanced-practice professionals in more than 20 medical specialties.

St. Claire has partnered with UK on a number of academic and clinical programs since the 1960s, co-developing the Rural Physician Leadership Program along with Morehead State University and establishing a training and residency site for UK's colleges of Medicine, Pharmacy and Health Sciences. It is also home to the College of Health Sciences's Physician Assistant Program.

St. Claire President and CEO Donald H. Lloyd II, who will remain in that position, said in the release that "UK identified as the natural partner that could carry forward the previous work and ongoing investment while growing the health-care workforce."

He added, “In an ever-changing health care landscape, both St. Claire and UK are deeply committed to accessible and high-quality patient care and strategic collaborations that will enhance services to benefit Kentuckians throughout northeastern Kentucky for many decades to come.”

According to the release, St. Claire HealthCare includes a hospital with 139 licensed beds and seven primary-care clinics in five counties, a multi-specialty medical pavilion, two urgent-care centers, a pediatrics clinic, a retail pharmacy, a counseling center, an outpatient center and a medical equipment and supply store. St. Claire also provides home health and hospice services in eight counties.

This is UK's second major foray into hospital care in northeastern Kentucky in recent years. In 2021, the university created a joint venture with King's Daughters Memorial Hospital in Ashland in which UK holds the assets and manages the hospital system.

Biden administration indefinitely postpones ban on menthol cigarettes amid election-year pushback from Black voters, others

Menthol cigarettes and other tobacco products are displayed at a store in San Francisco on May 17, 2018. For the second time in recent months, President Joe Biden’s administration has delayed a plan to ban menthol cigarettes, a decision that is certain to infuriate anti-smoking advocates but could avoid angering Black voters ahead of November elections. (Associated Press file photo by Jeff Chiu)

By Matthew Perrone and Zeke Miller

Associated Press

President Joe Biden’s administration is indefinitely delaying a long-awaited menthol cigarette ban, a decision that infuriated anti-smoking advocates but could avoid a political backlash from Black voters in November.

In a statement Friday, Biden’s top health official gave no timeline for issuing the rule, saying only that the administration would take more time to consider feedback, including from civil rights groups.

“It’s clear that there are still more conversations to have, and that will take significantly more time,” Health and Human Services Secretary Xavier Becerra said in a statement.

The White House has held dozens of meetings in recent months with groups opposing the ban, including civil-rights organizers, law-enforcement officials and small business owners. Most of the groups have financial ties to cigarette companies.

The announcement is another setback for Food and Drug Administration officials, who drafted the ban and predicted it would prevent hundreds of thousands of smoking-related deaths over 40 years. The agency has worked toward banning menthol across multiple administrations without finalizing a rule.

“This decision prioritizes politics over lives, especially Black lives,” said Yolonda Richardson of the Campaign for Tobacco-Free Kids, in an emailed statement. “It is especially disturbing to see the administration parrot the false claims of the tobacco industry about support from the civil rights community.”

Richardson noted that the ban is supported by groups including the NAACP and the Congressional Black Caucus.

Previous FDA efforts on menthol have been derailed by tobacco industry pushback or competing political priorities. With both Biden and former President Donald Trump vying for the support of Black voters, the ban’s potential impact has been scrutinized by Republicans and Democrats heading into the fall election.

Anti-smoking advocates have been pushing the FDA to eliminate the flavor since the agency gained authority to regulate certain tobacco ingredients in 2009. Menthol is the only cigarette flavor that wasn’t banned under that law, a carveout negotiated by industry allies in Congress. But the law instructed the FDA to continue studying the issue.

More than 11% of U.S. adults smoke, with rates roughly even between white and Black people, but about 80% of Black smokers smoke menthol, which the FDA says masks the harshness of smoke, making it easier to start and harder to quit. Also, most teenagers who smoke cigarettes prefer menthols.

For decades, cigarette companies focused menthol advertising and promotions in Black communities, sponsoring music festivals and neighborhood events. Industry documents released in litigation show companies viewed menthol cigarettes as a good “starter product” because they were more palatable to teens.

The FDA released its draft of the proposed ban in 2022. Officials under Biden initially targeted last August to finalize the rule. Late last year, White House officials said they would take until March to review the measure. When that deadline passed last month, several anti-smoking groups filed a lawsuit to force its release.

“We are disappointed with the action of the Biden administration, which has caved in to the scare tactics of the tobacco industry,” said Dr. Mark Mitchell of the National Medical Association, an African American physician group that is suing the administration.

Separately, Rev. Al Sharpton and other civil rights leaders have warned that a menthol ban would create an illegal market for the cigarettes in Black communities and invite more confrontations with police.

The FDA and health advocates have long rejected such concerns, noting FDA’s enforcement of the rule would only apply to companies that make or sell cigarettes, not to individuals.

An FDA spokesperson said Friday the agency is still committed to banning menthol cigarettes. “As we’ve made clear, these product standards remain at the top of our priorities,” Jim McKinney said in a statement.

Smoking can cause cancer, strokes and heart attacks and is blamed for 480,000 deaths each year in the U.S., including 45,000 among Black Americans.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

MedCenter Health, chain based at Bowling Green hospital, to expand medical specialty offices at new building in Glasgow

The ceremonial groundbreaking
(Photo by Michael Crimmins, Glasgow News 1)

Kentucky Health News

The small hospital chain based in Bowling Green, MedCenter Health, is expanding its medical-specialty offerings in its largest close neighbor, Glasgow.

MCH has had a presence in Glasgow for “a number of years,” but will now have a building of its own and start providing specialty medical care, Wade Stone, executive vice president of MCH, said Thursday at the groundbreaking for the facility on South L. Rogers Wells Boulevard.

Stone said the facility will allow MCH to continue combating the nationwide physician shortage, especially with regard to specialty services, spurred by the chain's partnership with the University of Kentucky College of Medicine, reports Jack Dobbs of the Bowling Green Daily News.

“As Med Center Health has evolved into an academic teaching institution we’ve been able to successfully recruit many of those specialties and grow those programs,” Stone said. “We can deploy those specialists to other rural communities.”

MCH Glasgow, which is expected to open in about a year, will also "allow patients to complete pre-op and post-op procedures locally, instead of having to commute to Bowling Green," Dobbs notes.

One of the specialists will be Paul Moore, who has been cardiothoracic surgeon in Bowling Green for 30 years, Dobbs reports: "He said he has been treating patients in Barren and surrounding counties for the past six or seven years, but described MCH Glasgow as a central location."

Dobbs told Glasgow News 1, “We have a number of patients that come from here, not just from Barren County but Adair County, Clinton County, Monroe County; this seems to be a central location they can all get to easily. I’m at the point now where I want to get out and see the patients who really need access and the care I can give that’s not given locally and that’s really important.”

Other specialties listed in a press release were Vascular Surgery, ear/nose/throat, hematology/oncology, neurosurgery, urology and orthopaedics/sports medicine. Stone said three or four full-time primary-care physicians will also practice at MCH Glasgow, which will have 22,000 square fete of floor space,

Glasgow's hospital is the locally owned T.J. Samson Community Hospital, which has a branch in Columbia. MedCenter Health, which grew out of the publicly owned Bowling Green-Warren County Hospital, has hospitals in Albany, Franklin, Horse Cave and Scottsville.

National report on health-system performance ranks Kentucky low, but disparities among its racial and ethnic groups are also low

Commonwealth Fund graph (click to enlarge) shows Kentucky with low performance but low disparity.

By Melissa Patrick
Kentucky Health News

A new report from The Commonwealth Fund, a New York-based foundation, shows racial and ethnic disparities persist in health-care access, quality, and outcomes in Kentucky and across the nation.

"In every state we find wide disparities in health and health-care experiences for people of different racial and ethnic backgrounds," David Radley, a senior scientist for The Commonwealth Fund, said during an online press conference. "And that health system performance is markedly worse for people of color when compared to the experience of white people." 

The Commonwealth Fund, which says it aims to promote a high-performing health-care system, issued its 2024 State Health Disparities Report on April 18. 

The report used 25 measures to determine health-system performance, evaluating states on health-care access, quality, use of services, and health outcomes for people of different races and ethnicities in each state. It then gave a health-system performance “score” for each racial and ethnic group.

In Kentucky, white people had the highest score,in the 52nd percentile among all population groups nationally, making them about average. Hispanic Kentuckians had the state's lowest health-system performance, scoring in the 22nd percentile. Black Kentuckians scored in the 32nd percentile.

Despite those health disparities, when compared to other states in the Southeast, Kentucky has smaller disparities among its racial and ethnic groups. That's largely because Kentucky's whites rank lower than whites in all states except Wyoming, Arkansas, Oklahoma, West Virginia and bottom-ranking Mississippi.

The report says health disparities are influenced by a number of factors, including a lack of affordable, quality health-care options, and whether a person has health insurance or a primary-care provider. It is also influenced by social determinants, such as whether a person lives in an area of high crime, has access to transportation or lives in poverty. And it is also influenced by whether they have to deal with racism and discrimination in healthcare settings. 

“Where a person lives matters, and this is especially true for people of color,” Radley said. “We also see big differences in people’s abilities to access care. Not only do uninsured rates vary from state to state, we also find big differences within states where we see large coverage gaps between people from different racial and ethnic groups.”

The researchers said their work points out that only looking at how a state performs overall can mask the "profound inequities" that many people experience. 

Dr. Laurie Zephyrin, senior vice president for advancing health equity at The Commonwealth Fund, said improving health equity will require policy action and health system action. 

"One key area is around insurance coverage and affordability. Insurance coverage is a key part of this. It is however the floor in terms of ensuring that everyone has access to health care. And it is really critical," Zephyrin said. "When we look at the data about 25 million people in the United States are still uninsured, and they're disproportionately people of color. And even for people who are insured about a quarter of working age adults are underinsured." 

Kentucky made a big policy decisions to increase access when it expanded Medicaid in 2014 to people with incomes up to 138% of the federal poverty line under the Patient Protection and Affordable Care Act. 

Nevertheless, 28% of Hispanic adults in Kentucky have no health coverage, compared to 8% of Black adults and 6% of white adults. Having no insurance, or having plans that require high out-of-pocket costs relative to a person's income, cause people to not seek care when they need it.

Two of the nine health-outcome measures that the researchers looked at were premature treatable and preventable deaths before the age of 75.

In Kentucky, Blacks had the highest death rate for treatable conditions,171 per 100,000 people. This was followed by Whites with 119 deaths per 100,000, Hispanics with 57 per 100,000, and Asian American, Native Hawaiian and Pacific Islander (AANHPI), with 58 per 100,000.  

Black Kentuckians also led the state for deaths before the age of 75 from preventable causes per 100,000 people, with 402 deaths per 100,000. This was followed by whites, at 328; Hispanics, 173; American Indian and Alaska Native, 111; and AANHPI, 104. 

"Premature preventable mortality rates are higher for both Black and White residents in several Southern and South Central states — Arkansas, Mississippi, Louisiana, Tennessee, Kentucky, and Missouri — compared to most other parts of the country," says the report.  

Compared to other states, Kentucky's health system performance for Black people was better than average, ranking 18th of the 39 states where calculation of a Black rate was statistically reliable. 

 

Kentucky's health-system performance was ranked worse than average for Hispanics, ranking 29th of 47 states.

And with a ranking of 46th of 51 states, Kentucky's health system performance for white people was considered among the worst compared to other states. 

The researchers said the hope is that policymakers, health system leaders and community stakeholders will use this information to inform future policy that will ensure a more equitable health care system in the future. 

The report offered four policy options toward this goal, with detailed suggestions for each of them on how to accomplish them. The policy options would ensure universal, affordable and equitable health coverage; strengthen primary care and improving the delivery of services; reduce inequitable administrative burdens affecting patients and providers; and  invest in social services.

"This analysis will give policymakers and health-care leaders a critical roadmap to enact targeted policies and make the key investments to eliminate disparities and achieve health equity," said Dr. Joseph Betancourt, president of The Commonwealth Fund. "Just as deliberate choices have been made that have put us in the situation, we can now be deliberate about promoting high quality equitable health care for all. This undoubtedly will create healthier, more resilient communities that would ultimately benefit the entire nation." 

Warmer weather means ticks are active and looking to suck your blood; they can make you sick; here's how to deal with them

Mosquito Squad of Louisville graphic, adapted by Kentucky Health News; click on it to enlarge

State wildlife officials are reminding Kentuckians to take precautions against tick bites, which can transmit disease.

“Ticks are common across the state, and whether you’re hunting, hiking or spending time in your backyard, you’re probably going to encounter them,” said Dr. Christine Casey, wildlife veterinarian for the Deparment of Fish and Wildlife Resources. “The key to avoiding any health risk from a tick bite is by taking steps to protect yourself from being bitten in the first place.”

The most common tick species in Kentucky are the blacklegged tick or deer tick, the American dog tick and the lone star tick. The type of tick can determine whether you get sick from a single bite; other factos include where it was acquired and how long it was attached.

"While few ticks transmit disease, tick bites should always be taken seriously," the department said in a news release. "Lyme disease, transmitted by infected blacklegged ticks and common in the northeast and north central U.S., is of growing concern to Kentucky.

"Ticks don’t have to ruin a day outdoors," the department says, offering these precautions to avoid tick bites and deal with them if you are bitten:

Before going outdoors

• Use Environmental Protection Agency-registered insect repellents containing DEET (the oldest, most common and most effective insect repellent), picaridin, or oil of citronella.

• Treat clothing and gear with products containing 0.5% permethrin, which kills ticks on contact. Permethrin should not be applied directly to the skin.

• Take extra precaution if walking through wooded or brushy areas, tall grasses, woodpiles and leaf litter.

After spending time outdoors

• Perform tick checks. Ticks are known to be found under the arms, in and around the ears, the back of the knees, in and around hair, between the legs and around the groin and waist. Be sure to check gear and pets as well.

• Shower soon after coming indoors; this can remove any unattached ticks.

• Tumble-dry clothes in a dryer on high heat for 10 minutes to kill ticks attached to clothes.

If you are bitten by a tick

If a tick is found attached to the skin, remove it as soon as possible. Use tweezers to grab the tick close to the skin and gently pull on the tick with steady pressure. Do not jerk or twist the tick; this can cause mouth parts to break off and remain in the skin.

After removing the tick, clean the bite site and wash hands with soap and water or use an alcohol-based hand sanitizer. Dispose of a tick by submersing it in alcohol, placing it in a sealed bag or other container, wrapping it tightly in tape, or flushing it down the toilet. Do not attempt to crush a tick between the fingers.

If symptoms of a fever, rash, muscle or joint aches, or other types of illness arise within several weeks of removing a tick, consult a health-care professional and tell them about the recent tick bite, when it occurred and where the tick was acquired.

Kentuckians who are interested in contributing to the study of tick-borne diseases and their distribution across the state are encouraged to submit samples of ticks to the Kentucky Tick Surveillance Project. This project, produced by the University of Kentucky Martin-Gatton College of Agriculture, Food and Environment, aims to improve knowledge about where ticks are found and the diseases they might carry.

For more information about ticks and tick prevention, visit www.cdc.gov.

Community pharmacies can help smokers quit, study finds

Photo illustration from QuitSmokingPharmacies.com

Kentucky Health News

Community pharmacies may play a key role in helping smokers quit, according to a study done in California and published in the peer-reviewed journal Pharmacy.

Kentucky' adult smoking rate, 17.4%, is tied for fourth in the nation with MIssissippi. For a partial list of pharmacies that advertise their help with smoking cessation, go to QuitSmokingPharmacies.com.

"Although two-thirds of people who smoke would like to quit, many individuals trying to quit on their own are not successful," notes a news release from the University of California, Davis, where the study was done in cooperation with  other academic institutions across the country and the Community Pharmacy Enhanced Services Network, involving 22 California pharmacists and 26 pharmacy technicians who underwent tobacco cessation training.

"Pharmacists have shown to be effective in helping patients quit," the release said. "They can reach uninsured and under-resourced patients as well as patients living in rural areas who might experience barriers to accessing primary care. However, the study showed certain barriers exist to making pharmacy cessation programs effective," such as billing complexities, software limitations and training gaps for handling complicated patient cases.

“Compatibility with existing workflows, staff buy-in and the crucial role of pharmacy technicians significantly helped” pharmacy custiomers quit smoking, said the study's senior author, Karen Hudmon of the Purdue University College of Pharmacy.

Vape retailers and hemp association file suit to block new law that limits sale of vape products to those approved by the FDA

Only vaping products authorized or pending approval by
the FDA can be sold in Kentucky as of Jan. 1. (Getty Images photo)

By Sarah Ladd
Kentucky Lantern

Four vape shops, the Kentucky Vaping Retailers Association and the Kentucky Hemp Association have filed suit in Franklin Circuit Court seeking to strike down a new state law outlawing the sale of some of their products.

Greg Troutman, a lawyer for the Kentucky Smoke Free Association, which represents vape retailers, said he’s “hoping that we can get a resolution to this well before” the law is scheduled to take effect Jan. 1.

The lawsuit, which was filed Friday, argues that House Bill 11’s definitions of “vapor products” and “other substances” lump electronic cigarettes and vapable hemp and marijuana products together, making it too broad and arbitrary to satisfy the state constitution.

It also violates due process by requiring retailers to comply with a nonexistent regulatory process for hemp and other non-nicotine products, Troutman said.

Retailers will be subject to fines and penalties for selling vapable hemp-derived products once the law takes effect, the lawsuit says.

HB 11’s backers tout the bill as a way to curb underage vaping by limiting sales to “authorized products” or those that have “a safe harbor certification” based on their status with the U.S. Food and Drug Administration.

The bill was backed by Altria, the country’s largest manufacturer of cigarettes, which also markets FDA-approved vape products. Altria has spent more than $500,000 lobbying the legislature since January 2022, according to records filed with the Legislative Ethics Commission.

The suit alleges that the new law requires FDA approval for products that cannot possibly win FDA approval because the FDA has no regulatory process for them, such as those containing amanita muscaria (a mushroom) and hemp-derived products. The law would also apply to vapable marijuana products set to become available in Kentucky 2025 under a law the legislature passed last year, the lawsuit says.

“Unless the manufacturers are making a therapeutic claim — that is, they’re intended to cure, treat, mitigate disease — they’re not subject to an FDA regulatory process,” Troutman said. “So how can you condition market approval in Kentucky upon complying with a nonexistent process? That is absolutely Kafkaesque.”

In 2009, Congress required the FDA to regulate tobacco products to “protect the public health of the U.S. population and create a healthier future.” The FDA began regulating “electronic nicotine delivery systems” — e-cigarettes — under that authority in 2016.

The suit also alleges the new law violates a provision in the state constitution limiting laws to one subject. HB 11 is titled an “Act relating to nicotine products” but applies to non-nicotine vaping products such as those derived from hemp, the lawsuit says.

The defendants are Allyson Taylor, in her capacity as commissioner of the Kentucky Department of Alcoholic Beverage Control, and Secretary of State Michael Adams.

In the final days of the session, lawmakers merged HB 11 with Senate Bill 344, which created an e-cigarette registry. Gov. Andy Beshear signed the combined bill  into law April 5. Some advocates fear it could force more people back to traditional cigarettes, which are worse for bodily health than vaping.

Vape-store owners also testified the law could create a monopoly for big retailers and hurt small businesses.

A spokeswoman for House Republicans said Tuesday that she could not comment on pending litigation, but believes “the legislature’s efforts to keep potentially dangerous e-cigarettes out of the hands of our children will stand the test.”

Tobacco use can lead to all sorts of health problems, according to the Centers for Disease Control and Prevention. They include cancer, diabetes, heart disease and more. Nicotine is the addictive chemical in tobacco and can harm the developing brain, the CDC says.

Kentucky is No. 4 in smoking, down from No. 2, but at 17.4% of adults, experts say the state's smoking rate is still way too high

By Melissa Patrick
Kentucky Health News

Kentucky still has one of the nation's highest adult smoking rates, but has fallen to fourth among the states, after many years of either ranking first or second. The rate for 2022, the last year for which a rate has been calculated, is 17.4%.

Asked why Kentucky might have seen a drop in its ranking, Amanda Fallin-Bennett, director of the Kentucky Center for Smokefree Policy, said it could be because Kentuckians have good access to treatment programs. 

"Compared to other states, it does have pretty good access to tobacco-treatment services for most all Kentuckians," she said, adding later, "The majority of people who smoke cigarettes would like to quit. So we know that making cessation services available and accessible is a big help."

Kentucky passed a law in 2017 to require all insurance policies sold in Kentucky to cover all smoking-cessation medications and counseling approved by the U.S. Food and Drug Administration. This also includes Medicaid, which covers one in three Kentuckians. The law also removed many of the barriers to such treatment, such as co-payments and limits on length of treatment.

Kentucky offers a program called Quit Now Kentucky. The quit line can be reached at 1-800-QUIT-NOW(784-8669); through text QUITKY to 797979; or online at www.quitnowkentucky.org. The services are free and confidential. 

Fallin-Bennett added that it's important to consider that another reason that Kentucky's smoking rate has dropped could be because of increases in the uses of alternative tobacco products, like vapes. or heat-not-burn devices.

1 in 4 in Ky. smoked five years ago; now 1 in 6

With 17.4% of Kentucky adults reporting they smoke every day or some days, Kentucky ties with Mississippi for the fourth highest smoking rate in the nation, behind West Virginia (21%); Arkansas (18.7%); and Tennessee (18.5%). The figures are from the Behavioral Risk Factor Surveillance System, a continuing national survey by the Centers for Disease Control and Prevention.

Kentucky's smoking rate has been on a steady decline since 2011, even though it was nearly 20% in 2021 and nearly 25% just five years ago, according to America's Health Rankings, using CDC data.

This means that instead of more than one in four people smoking in Kentucky just five years ago and one in five in 2021, now just over one in six Kentucky adults are considered "current smokers."

Fallin-Bennett said any decrease in smoking is to be celebrated: "Smoking is the leading cause of preventable death and disease and so anytime someone stops smoking, they are dramatically reducing their risk for cancer, heart disease, stroke, preterm birth, just a myriad of adverse health outcomes that are associated with smoking."

Shannon Baker, advocacy director for the American Lung Association for Kentucky and Tennessee, said she had no data to analyze why Kentucky now ranks fourth among states instead of second, and cautioned that the focus should remain on the fact that Kentucky's smoking rate is still among the worst in the nation.

"I can tell you that 17.4% of Kentucky adults smoke compared to the national average rate of 14%. So still, it's still a terrible statistic, right? . . .  So I guess I would caution us to look at that, instead of how we rank," she said. 

Baker said any drop in the state's smoking rate is great news, but noted that Kentucky continues to have the nation's highest rates of lung cancer and lung-cancer deaths: "We still have miles to go." 

What next? 

Asked what needs to happen to bring this rate down further, Fallin-Bennett said increasing tobacco taxes would help, as would more Kentucky counties and cities passing  comprehensive smoke-free policies.

"So only 38% of Kentuckians are covered by comprehensive smoke-free policies where smoking is not allowed in restaurants, bars and workplaces," she said. "So that is an area that Kentucky continues to struggle with and that would likely further reduce smoking rates." 

Baker praised the efforts of the state's Lung Cancer Screening Advisory Committee, but said more Kentuckians and providers need to be educated about the availability of low-dose CT screening for smokers and former smokers who qualify for it.

She said she thinks the committee is the first in the nation "that's really focusing on what we can do to increase the number of eligible individuals actually getting the low-dose CT scan done, and making making it more accessible and affordable statewide," she said. "That's a huge opportunity for us."

A missed opportunity, she said, was in the recent legislative session, when legislators removed strict enforcement measures from House Bill 11, aimed at decreasing youth vaping. She said that the current laws that prohibit retailers from selling nicotine products to youth is "not effectively enforced." 

Baker added, "We need three things: We need licensing, and we need regular compliance checks, and we need penalties for violations that escalate for repeat violations all the way up to the point of suspension and revocation of your license for the worst actors, the scofflaw, and we know that they're out there. And those things together represent a tremendous opportunity to address youth e-cigarette use and nicotine addiction, and we missed the boat."

Gov. Andy Beshear signed HB 11 into law on April 5. It limits legal sale of vape products to those approved by the FDA. It will create a database of retailers that sell the products and set fines for retailers, manufacturers and wholesalers who violate the law, but penalties for retailers are much less than in the bill's original version.

UK hosts national meeting to raise immunization rate for vaccine against cervical and other HPV cancers, in which Ky. leads U.S.

Kentucky Department for Public Health illustration

By Melissa Patrick

Kentucky Health News

Kentucky leads the nation in the rate of cases of and deaths from cervical cancer, a disease that is largely preventable by a vaccine.

The vaccine targets the human papillomavirus, which can cause cancers of the cervix, genitals, anus, neck and head. Kentucky also leads the nation in cancers caused by the HPV.

"The good news is that the HPV vaccine can prevent the vast majority of those cancers, but not everybody knows about it," said Pamela Hull, associate director of population science and community impact for the University of Kentucky's Markey Cancer Center. 

Between the HPV vaccine and cervical screening, cervical cancer could be virtually eliminated, Hull said. The combination wouldn't prevent all cases, she said, but "Within the next few decades, we can eliminate cervical cancer as a public-health threat in this country." 

Cervical cancer screening is done through a pap smear, which looks for cancerous cells on the cervix, which connects the uterus and vagina. It can also find precancerous changes that have not yet developed into cancer. Screenings usually begin at age 21 or three years after the first sexual intercourse.

The HPV vaccine protects against six cancers: cervical, anal, penile, vaginal, vulvar and head or neck. According to the Centers for Disease Control and Prevention, it can prevent over 90% of sexually transmitted cancers caused by the HPV from ever developing, 

Hull said these cancers cause 36,000 new cancer cases every year in the U.S. in men and women, but only about half of Kentucky teenagers have received it because state law does not require it.

The vaccine's greatest obstacle appears to be that that it is associated with a sexually transmitted disease. Researchers have said improving the vaccination rate depands on changing the perception that the vaccine is something that prevents STDs to the knowledge that it primarily prevents cancer.

Conference discusses anti-HPV strategies

Raising awareness about the importance of HPV vaccination was the focus of a national conference held in Lexington on April 16-17 by the Markey center and the National Cancer Institute. 

Hull, who spke with reporters before the conference, said researchers all over the country are collectively working to answer this question: "How can we work with health-care providers and community organizations and parents to make sure more and more kids get vaccinated to protect them from cancer as they grow older?" 

A "social organization" program called "Operation WIPE OUT Cervical Cancer Alabama" aims to do just that through a program that involves a number of community partners, Isabel Scarinci of the University of Alabama at Birmingham told attendees at the conference in Lexington. 

Scarinci said the program first engaged the support of the Rotary Club of Birmingham and the state health department. Together, they launched a program to increase HPV vaccination rates in the Alabama county that had the highest rates of cervical cancer in the state.

She said through the involvement of groups in the county and the local school superintendent, they started an education program in the school system that resulted in the students organizing an HPV vaccination campaign, which has become part of an official plan for the state. 

Scarinci said there is no official funding for the program because they "want this to belong to everybody." Thus, funding comes from a number of sources. 

According to a post on the Alabama health department website, the program offers free HPV immunizations for children and adults; provides free cervical cancer screenings for low-income and uninsured women; and provides follow-up tests for those who need it. All services are offered through county health departments.   

HPV vaccines and Kentucky

While the HPV vaccine is not required in Kentucky, it is given around the time students enter middle school and are required to get an initial vaccine for meningitis and a booster for diphtheria, tetanus and pertussis (more commonly known as whooping cough), collecitvely called TDaP.

The timing of the two required vaccines and the HPV vaccine create a good opportunity to include it in the children's immunizations. "Even though it's not required," Hull said, "we really, really strongly encourage it because it's one tool that parents can use to prevent cancer for their children."  

Two doses of the HPV vaccine are recommended for all 11- and 12-year-olds, but the series can begin at 9. It is also recommended for those 13 to 26 if unvaccinated; three doses are recommended for people who get their first dose at 15 or later, and for people with certain conditions that weaken immunity.

In addition, it is also recommended that anyone between 27 and 45 who is not vaccinated should talk to their health-care provider about their risk of infection and the benefits of getting vaccinated.

Asked why boys and girls as young as 9 should get the vaccine, Hull said they have a better immune response than older chuildren. As a person gets older, she said, they need an extra dose of the vaccine for protection against the cancers because it takes more of the vaccine to build up their immunity.

"We really want to see our rates of HPV vaccination go up in Kentucky," Hull said. "Right now, just over half of teenagers have gotten the vaccine, all the doses of the vaccine, and we really want to get that up to, closer to, 80% or even higher." 

In 2022, Kentucky ranked 44th in HPV vaccination, with only 55% of teens 13-17 having received all recommended doses, according to America's Health Rankings. That was a decline from the 57% reported in 2021 and well below the national average of 63%.

"What I like to explain to a parent is . . . you're not going to put your seatbelt on after you get in a car accident, you have to have it on before," Hull  said. "So age for the vaccine is really important to get it early, build up the body's defenses so then one day when the body is exposed to the virus, it is ready to fight it." 

Hull said there is an emphasis on getting more people vaccinated in rural areas because HPV vaccination rates are lower in rural areas, and they have higher rates of HPV cancers.

UK professor Alex Elswick overcame opioid addiction to work with others in recovery and start a community organization to aid them

By Grace Sowards
University of Kentucky

Alex Elswick grew up with everything he needed. With two great parents, a roof over his head and good grades in school, he was a young person who wouldn’t lead people to believe drug addiction would be in his future.

Elswick stands in front of the wall of hope at Voices of Hope,

The board is full of reasons to persevere through addiction,

and messages of gratitude. (UK photo by Sabrina Hounshell)

“I come from a really privileged background,” said Elswick. “My dad is a doctor, I grew up in the suburbs and kind of had every advantage. That mattered; it mattered in terms of my addiction and my recovery.”

Today, Elswick is an assistant extension professor in the University of Kentucky's School of Human Environmental Sciences. He has master’s and doctoral degrees from the Martin-Gatton College of Agriculture, Food and Environment, which includes the school. His work focuses on substance-use prevention and recovery across the state. He is a founding member of Lexington’s Voices of Hope, a substance-use disorder community center focused on research-based recovery treatment.

Elswick’s passion for recovery education did not initially blossom from research. For many, addiction can start before an individual ever touches a substance. At age 18, he underwent wisdom-tooth surgery and was prescribed opioid painkillers. Risk factors, such as family history or mental illness, can seriously increase one’s likelihood for addiction. Elswick faced both.

“I took it exactly as it was prescribed by my provider, but with all those risk factors, I got addicted,” Elswick said. “Two years later, I woke up and I had a $200-a-day opioid addiction.”

Elswick describes his addiction in the years following his surgery as ‘nothing special.’ He experienced homelessness, unemployment and isolation. Finally, after checking into a treatment shelter in Dayton, Ohio, Elswick was able to get and stay sober for six months.

While his sobriety was an exciting milestone, Elswick confrontd barriers and questions that many people face when leaving addiction treatment. Where could he go for housing? How would he find employment? This is where his connections to the UK community made him luckier than most.

“I told everybody I was going to do tobacco research, but really I was just digging holes,” Elswick chuckled. “It was such a great job for me early in my recovery. I got to be outside, working with my hands.”

For Elswick there was a sense of healing in this work. Through it, he discovered his own healing wasn’t the whole story; he wanted to work in drug and alcohol counseling. One afternoon, colleague Kenny Hunter asked him if he had put any thought into his future. Elswick shared his new dream of working in recovery, and it opened a door he didn’t even know was there.

Hunter’s wife is Jennifer Hunter, an extension professor and director of the School of Human Environmental Sciences. She and Elswick were introduced, and it wasn’t long before he returned to the classroom.

With the support of Hunter and other UK faculty, Elswick used his own experience with addiction to address needs he noticed in his community.

“We looked at all of the help I had in my recovery,” Elswick said. “With my employment, education, mental and physical health—you could go down the list of everything I had access to that put me in a better position to recover. But 99% of folks who have addictions in our community don’t have access to most of those resources.”

Elswick knew they needed to create a one-stop-shop for recovery. This model already exists in recovery community organizations. After researching as much as they could on the topic, Elswick and his colleagues traveled to see some RCOs making real change in their communities.

Thus was Voices of Hope born. An RCO in the heart of Lexington working to prove to those struggling that change can be made at any stage. The Voices team upholds the unique approach of supporting other pathways of recovery besides complete sobriety, or abstinence. Voices of Hope supports individuals who want to practice abstinence and provides programming from organizations like Alcoholics Anonymous for those interested. However, the team of coaches at Voices encourage any and all steps toward recovery, no matter the pace.

“If you think about any other kind of behavior change, people typically don’t change all at once,” said Elswick. “If I want to lose weight, it’s usually a process. Even if I have 50 pounds to lose, if I go to my doctor and say I’m only willing to lose 10, he or she will not kick me out of their office. It’s an improvement in your health, and at Voices, we recognize that by meeting you where you are.”

Voices of Hope began in 2014 as a group that provided access to naloxone (brand name Narcan), the drug that reverses drug overdoses, when it was very stigmatized and difficult to find. Now, they are a fully operational RCO with two Lexington locations and thousands served.

It provides servics to the deaf and hard-of-hearing, has a partnership with the state Department of Corrections to place recovery coaches in prisons, and has created mobile recovery units to provide resources in hard-to-reach areas of Louisville and Lexington. Those are just a few of the major projects Voices has achieved in the last few years.

Today, Elswick continues to be motivated by the same community that lifted him out of his substance use disorder and into his life of service. This includes his family and those at UK who encouraged him to work and do research in the substance use disorder space.

“It’s a cliché, I suppose, to say I wouldn’t be here without them, but I think it’s literally true,” said Elswick. “There’s no single job on the planet better suited for me than exactly the job that I have, and I believe strongly that if it weren’t for Kenny and Dr. Hunter advocating for me, I would not be where I am now.”

In his college, Elswick teaches the course Addiction is a Chronic Disease and has taught classes on Substance Use, Family and Society, Family Resource Management. Working with students and inspiring change is something he’s immensely grateful for.

“The University of Kentucky, from the beginning, supported me and supported recovery,” Elswick said. “I never experienced stigma and I never experienced shame from the university. I always heard university leadership saying ‘this is an issue that we want to get behind.’”

For more information on Voices of Hope, visit https://voicesofhopelex.org.

Elswick stands outside Voices of Hope at 644 N. Broadway in Lexington. (UK photo by Sabrina Hounshell)