Tuesday, May 31, 2011

Health care is top-spending legislative lobby in Kentucky

Kentucky's health-care industry spent about $1.5 million, more than any other industry, to lobby state legislators in  in the first four months of the year.

"Health care spending was led by hospital operators, who spent about $300,000, including Kentucky Hospital Association ($56,000), Norton Healthcare ($44,631), Baptist Healthcare System ($42,800) and St. Elizabeth Healthcare ($28,182)," the Lexington Herald-Leader's Jack Brammer writes, from a report by the Kentucky Legislative Ethics Commission.

Pharmaceutical companies and pharmacies spent the second highest amount, about $281,000. That includes contributions from the Consumer Healthcare Products Association ($67,333), Pharmaceutical Research & Manufacturers of America/PhRMA ($23,362), Amgen ($19,389), Glaxo SmithKline ($18,500), American Pharmacy Cooperative ($18,000) and Pfizer ($15,000).

Other big spenders include the Kentucky Medical Association ($71,415); All Things Good, a Louisville-based chiropractic business ($65,000); Kentucky Optometric Association ($61,604); and Kentucky Academy of Eye Physicians & Surgeons ($26,000).

A total of about $7 million was spent on legislative lobbying in Kentucky in the first four months of 2011. About $6.5 million of that was spent by 660 employers of lobbyists and about $445,000 was spent by lobbyists themselves. The insurance industry, which is often related to the health industry, spent about $354,000. Energy and utility interests like coal and natural gas spent $516,000. Reports filed by employers and legislative agents are compiled on the Legislative Ethics Commission's website. For the Herald-Leader story, go here.

Watching 3-D movies may strain eyes but doesn't harm them and can help detect vision impairment, optometrists say

With summer blockbusters set to be released in the coming months, the Kentucky Optometric Association says watching 3-D movies is not harmful to eyes, but can cause eye strain and headaches.

To help with those conditions, the association recommends sitting farther back from the movie screen.

In some cases, some viewers won't be able to recognize 3-D pictures because they lack binocular vision. "Although this doesn't pose any problem viewing the screen, it serves as a vision screening that something is abnormal with the viewer's binocular vision," the association says in a news release used by the Journal-Enterprise of Providence.

"That means 3-D actually has a benefit," said Dr. Joe Ellis, an optometrist in Benton and president of the optometric association. "It can alert people to undetected vision disorders and eye diseases that, if caught early, are fully treatable."

Viewers might consider seeing an optometrist or ophthalmologist if they get headaches while watching 3-D, if they feel nauseous or dizzy after viewing or if it is difficult for their eyes to adjust back to normal after viewing. (Read more)

National system needed to battle pill abuse, newspaper says

Despite Georgia's recent move to implement a system that will track prescription pill use, a national system is needed to help prevent the problem flowing "to the next crack in the system," the Lexington Herald-Leader says in an editorial today.

"We know it's popular now to howl about big government," the paper says. "But if a national government has any legitimate use, it is certainly to stop something like the pill pipeline that operates across state lines. . . . "As long as even a few states don't have monitoring systems the market will move to those areas of opportunity."

The piece cites a story that ran in the Herald-Leader May 17. In it, reporter Bill Estep discussed Georgia's move to approve a tracking system, meant to prevent people from "doctor shopping," filling the resulting prescriptions and selling the pills illegally. "Florida has been the leading source of pills flowing into Kentucky from outside the state, but Georgia has been a growing source of concern," Estep reported.

While Georgia's monitoring system is approved, money is still needed to fund it. "We hope Georgia will get those grants. But we'd be more optimistic if funding weren't based on hope," the paper says. "There's every indication the rate of prescription drug abuse is outpacing the monitoring system."

The editorial notes that overdose deaths in Kentucky continue to rise, doubling from 403 in 2000 to 978 in 2009: "Confirmed overdose deaths in Floyd County jumped from 15 in 2009 to 43 in 2010, according to Brent Turner, the commonwealth's attorney there. Florida averages seven overdose deaths a day." (Read more)

More Americans are choosing health insurance with high deductibles, lower premiums; study says that strategy pays off

In order to pay lower premiums on their health insurance, Americans are opting for plans that have cheaper  monthly premiums but higher deductibles, USA Today's Kelly Kennedy reports.

In 2007, about 4.5 million people opted for high-deductible plans. By 2010 that number had more than doubled to 10 million, an America's Health Insurance Plans survey found. Having high deductibles saves $85 to $100 a month on premiums, but runs the risk of paying more when services are used. It's important for purchasers to understand that lower premiums can mean higher doctors' bills, said Karen Ignagni, president of the industry group.

However, a RAND Corp. study found that people on high-deductible plans pay considerably less than people on traditional plans. "RAND researchers also found that people on high-deductible plans — no matter their income level — received less preventive care: fewer annual exams, fewer cervical cancer screenings and fewer colonoscopies," Kennedy reports. The federal health reform law is preventing some of that from happening, however. Now, most high-deductible plans have to include basic preventive care like colonoscopies.

High-deductible plans are expected to become more common, especially since 47 percent of people who are insured through their employers have high-deductible plans. "Employers like the plans because it's cheaper to insure an employee — about $133 less per family at companies that offer only the high-deductible plans, according to a study in the American Journal of Managed Care," Kennedy reports. (Read more)

Teenager set to return to Haiti after Louisville docs fix her heart

After Louisville doctors performed a life-saving operation on her failing heart, a 16-year-old girl is set to return to her native Haiti. Stephanie Privert, left, came to Kentucky after she became ill following the deadly 7.0-magnitude earthquake that devastated the country, The Courier-Journal's Chris Kenning reports. (C-J photo by Pam Spaulding)

"We hate to see that she's obliged to return to a tough situation, but we can't keep her here forever," said Dr. Erle Austin, the lead heart surgeon during Privert's operation. "She's so much better than when she arrived."

Privert was watching her mother cook soup when the earthquake struck. Her family was able to escape, but her home near Port-au-Prince was destroyed. Privert's health quickly deteriorated and she was brought to a clinic run by American doctors from Medical Teams International. Deciding she could not be treated in hospitals in Haiti or neighboring Dominican Republic, the doctors got in touch with non-profit group Healing the Children, which has a chapter in Louisville. Its members helped her fly to Kentucky. She arrived weighing just 70 pounds.

Doctors determined she had a leaking heart valve, which was causing severe pulmonary hypertension and lung problems, Kenning reports. In August, doctors at Kosair Children's Hospital decided to repair the valve, rather than replace it with a mechanical one, which would require expensive anti-rejection drugs, or a pig valve that would wear out more quickly.

Since, she has been recovering, staying with host families, learning English and attending school. The Haitian Christian Outreach has raised money needed to start rebuilding Privert's family home in Haiti. (Read more)

Saturday, May 28, 2011

Rural Training Track programs get more health professionals to rural areas, but live 'on the edge' of funding and personnel

By Tara Kaprowy
Kentucky Health News

With the Obama administration offering more funding to improve rural health care, Rural Training Track programs to steer medical students to rural areas are hoping to expand, a move that would benefit underserved areas of Kentucky.

"Over 62 million Americans live in rural America and there is a significant crisis in terms of having access to care for these people," said Amy Elizondo, vice president of program services at the National Rural Health Association. "There is a very uneven distribution of health care professionals and an acute shortage of primary care physicians in rural areas. If we can recruit and retain physicians to serve rural areas, we improve access for rural America." (University of Washington map; click for larger version)
RTT programs aim to educate family physician residents in rural environments with the hope they will continue to practice there, Candi Helseth reports in a deailed article for the Rural Assistance Center. "These residency programs are a proven model for addressing rural family physician workforce shortages, with more than 70 percent of graduates praticing in rural areas," Helseth reports. The first such program started in Colville, Wash., in 1985. There are 25 RTTs in 17 states, including one in Morehead by the University of Kentucky and St. Claire Regional Medical Center. Eight physicians have graduated from the program there since it was established in 2000, five of whom are practicing in Kentucky. Of those five, three have joined the SCR medical staff.

There are similar success stories across the country. In Caldwell, Idaho, 95 percent of graduates have chosen to practice in rural areas over the past 16 years. "We heavily recruit residents who are rural-oriented," said Dr. Samantha Portenier, a practicing physician and director of the Caldwell RTT. "We've had some who were not and we converted them. Part of it was that they really saw where the training we give them and the skills they learn are so needed in rural areas. I emphasize that in rural areas you can specialize in areas that particularly interest you."

Despite the success, 10 RTT programs have closed in the past 10 years. "Every RTT lives on the edge in terms of funding," said Dr. Randall Longenecker, who is project director of Rural Training Track Assistance Demonstration Project. "In general RTTs are small, have limited faculty and are vulnerable to personnel changes, a bad year for recruiting, loss of funding and many other factors beyond their control."

Morehead's RTT is funded by St. Claire. Residents spend their first year at the UK College of Medicine in Lexington and their second and third years at St. Claire, which is accredited by the Accreditation Council for Graduate Education. Carla Terry, St. Claire's graduate medical education coordinator, acknowledged the difficulty in maintaining an RTT program. "The reason why the RTTs are in jeopardy is that all the faculty that teach them are voluntary," she told Kentucky Health News. "They are not paid to teach, they still have to keep their patient load. If it were a university program, all the faculty would be paid."

But St. Claire physicians believe strongly in rural-based education and also see how they can benefit from their investment. "We actually had a physician that when he came here he was interested in starting a residency because he wanted to use that as future recruitment," she said. "We look at it as training future partners."

Now, RTTs are under a federal microscope. The health care reform law created the Rural Training Track Assistance Demonstration Project, a three-year pilot program that plans to "collect comprehensive information to better understand the collective forces challenging RTT models and develop solutions that will strengthen existing RTTs and encourage development of new RTTs," Helseth reports.

The time is ripe, given that more medical students are choosing to be family medicine physicians, up by 11 percent last year and 8 percent the year before. "We have a real opportunity here to redefine the importance of primary care being foundational in rural workforces," Dr. Ted Epperly, past president and past board chairman of the American Academy of Family Physicians, told Helseth. "Right now, only 9 percent of physicians are choosing to practice in rural areas while 20 percent of the population lives there. RTTs offer a way to give family physicians a broad scope of practice, which they need practicing in a rural area, and to get them to stay in those rural areas." (Read more)

Fight is on against mosquitoes, West Nile virus after flooding

The fight is on to rid Western Kentucky of a mosquito infestation  worsened by recent flooding. Treatment to kill adult mosquitoes began Wednesday night, The Gleaner of Henderson reports.

The effort is partly to prevent the spread of the West Nile virus, a potentially serious illness. Mild infection can result in fever, headache, body ache and a skin rash. Severe infection, which affects about 1 in 150 infected people, can lead to high fever, disorientation, sleepiness and even coma, paralysis and death. Mosquitoes can transmit the infection to humans with a bite. (Centers for Disease Control and Prevention diagram)

The state's plan is a two-part process, killing adult mosquitoes and their larvae. It uses aerial spraying over 700,000 acres in Western Kentucky, concentrating on areas along or near waterways where flooding was most problematic. Planes will spray from dusk until after midnight until treatment is complete. Afterward, ground crews with the Transportation Cabinet will treat against mosquito larvae in standing water. The state Department of Agriculture will also spray ditch lines along roads. Chemicals used in the treatments are only harmful to mosquitoes, gnats and black flies, a state press release reads. It is safe for humans, pets and livestock.

Residents are asked to eliminate standing water in containers on their property and wear insect repellent and long-sleeved clothing. (Read more)

Friday, May 27, 2011

Bidders to manage Medicaid unknown; contracts July 1?

It is not known who bid on taking over the work, but Kentucky is advancing plans to turn Medicaid over to managed-care organizations. The move, which will allow the organizations to take over the day-to-day operations of Medicaid in the state, is meant to improve efficiency and save money, The Courier-Journal's Deborah Yetter reports.

"The proposed changes will dramatically reshape the program for more than 500,000 of the roughly 800,000 Kentuckians who depend on Medicaid for health care," Yetter writes. "It will not affect those in nursing homes or in certain programs that serve individuals with mental disabilities."

Gov. Steve Beshear promised the move earlier this year in his proposal to fill a $166 million gap in Medicaid funding, which comes mainly from the federal government. His administration believes moving to managed can save about $139 million in Medicaid costs next year. There are concerns about the plan, not the least of which how to make a smooth transition for patients. "We want to make sure people are able to access their doctors and access to care is not threatened," said Jodi Mitchell, executive director of Kentucky Voices for Health.

Rural pharmacists are also worried about the impact, since legislators "have not ruled out allowing mail-order prescriptions for maintenance drugs, such as blood pressure pills," Yetter reports. If mail-order is allowed, pharmacists are concerned there would be less contact with patients and that rural, independently-owned pharmacies would be threatened. "With mail order you are taking revenue out of the state," said Clay Rhodes, president of the Kentucky Pharmacists' Association. "Mail order can survive on the thinnest of margins and your rural pharmacy more than likely can't."

The bidding process is a complicated one, Yetter reports, and it is unclear how Passport Health Plan, a managed-care organization that already takes care of 30 percent of the state's Medicaid recipients in the 16-county Louisville region, fits in. Bidders are asked to submit bids "for the Passport region alone, another for the whole state and the other for the entire state except for Passport," Yetter reports.

Contracts will be awarded July 1. Yetter confirmed Humana Inc. has chosen not to bid. (Read more)

World No Tobacco Day to be observed Tuesday

World No Tobacco Day 2011 will be observed Tuesday, with goals of encouraging tobacco abstinence for a 24-hour period, as well as drawing attention to the dangers of tobacco use.

The observance, created by the World Health Organization in 1987, occurs each May 31. This year's theme is WHO's Framework Convention on Tobacco Control, a treaty that "reaffirms the right of all people to the highest standard of health and provides new legal dimensions for cooperation in tobacco control," said a WHO press release.

The 2005 treaty has been embraced by 170 parties. It protects public health policies from companies with vested interests in the tobacco industry; regulates tobacco products; adopts price and tax measures for tobacco products; regulates packaging and labeling of tobacco products; bans tobacco advertising; bans sales to minor; and supports alternatives to tobacco farming. The key message of the day will be "that countries must fully implement the treaty to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke," a press release reads.

In recognition of World No Tobacco Day, the Foundation for a Healthy Kentucky has noted latest smoking-related data for the state.

Among Adult Kentuckians, 26 percent are smokers. Fayette County has the lowest rate (17 percent) and Breathitt, Owsley, Perry and Wolfe counties are tied for highest at 36 percent. The data were collected from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System for the years 2007 to 2009. Smoking rates for every county are available by clicking here.

This year, more than 5 million people will die from a tobacco-related heart attack, stroke, cancer, lung ailment or other disease, according to the WHO press release. It said more than 600,000 people, more than a quarter of whom are children, will die from second-hand smoke. (Read more)

Thursday, May 26, 2011

Bowling Green American Legion post tests smoking ban, is fined

An American Legion post in Bowling Green has been fined $25 for violating the city's no-smoking ordinance. The Bowling Green Code Enforcement Board decided unanimously Tuesday to uphold the citation that Post 23 received April 28 after two plainclothed police officers went into the facility during bingo night and found people smoking inside, Justin Story of the Bowling Green Daily News reports.

Officers Tammy Britt and Rebecca Robins testified they bought two sheets of bingo cards and a soda at the facility. They said they were not asked at any point if they were members of the Post. The city's smoking ordinance "defines private organizations as establishments that are exempt from federal income taxes, are not profit-oriented, maintain a selective membership that operates the organization and does not sell food, drinks, entertainment or lodging to anyone who is not a member or a member's guest," Story reports.

More members started to smoke after Jim Manley, the Post's chief finance officer, told the crowd they were free to do so. "He said that if a citation were issued it would be to (the post) and not the individual, and after that more people started smoking," Britt said. The citation indicates the facility violated three provisions of the ordinance: allowing smoking in a building/enclosed area; failure to remove ashtrays; and failure of owner or person in control to ensure compliance.

Malcolm Cherry, an officer of Post 23, "said that he wanted it to be cited by allowing smoking during charitable gaming on April 28 in an effort to prove it was exempt," Story reports. "Our whole intention was for the officers to be there and have the citation issue to us personally," Cherry said. City Attorney Gene Harmon argued the post does not meet all the criteria to be considered a private club, in part because it sells bingo cards and refreshments during bingo night. The board agreed. (Read more)

Wednesday, May 25, 2011

Cervical cancer initiative launched to promote education, vaccination, screening, prevention and treatment

The Cervical Cancer-Free America initiative launched earlier this month, bringing together six states, including Kentucky, and more than 75 organizations to help eradicate the disease. Promoting education, vaccination and effective screening are the cornerstones of the effort.

"Cervical cancer is a preventable and, if found early, a curable disease," said Dr. Baretta R. Casey, director of Cervical Cancer-Free Kentucky. "Education of every woman, young and old, is important."

Though it is largely preventable, nearly 400 Kentucky women develop cervical cancer each year, and 66 die of it. Kentucky has one of the highest incidence rates and mortality rates of cervical cancer in the country, mostly affecting rural, white women.

CCFA will bring together public health professionals, foundations, private partners and cancer survivors like Marissa Winokur, right, to build a public health campaign. "The goal of making the United States free of cervical cancer is ambitious but eminently achievable. Just like the polio vaccine nearly eradicated polio globally during the 20th century, we now have the opportunity to nearly eradicate cervical cancer collectively through screening, vaccination and treatment," CCFA Director Jennifer S. Smith said.

Cervical cancer is caused by various types of the human papillomavirus, which three of four adults contract at some point in their lives. A vaccine against two types of this virus, which are responsible for 70 percent of all cervical cancers, is available for girls and young women ages 11 to 26. But only a fourth of them have received all three doses of the vaccine.

The vaccine does not protect against all types of cervical cancer, so screening is still needed. The Pap test, which is generally performed annually, can detect cervical cancer when it is still treatable. At least half of all cervical cancer deaths are due to lack of regular screening. (Read more)

Tooth varnish saving smiles in Clark County

To protect about 3,000 Clark County children from tooth decay, local dentists and volunteers headed to schools to apply a fluoride varnish earlier this month. "We knew this material worked, although it was a new material, and there wasn't a lot of research on it at the time," dentist Rankin Skinner told The Winchester Sun's Rachel Parsons.

Skinner became concerned after learning that Kentucky children have more tooth decay than anywhere else in the country, a fact he gleaned from a Christmas Eve 2007 article in The New York Times. The same day, one of Skinner's friends read the article by Ian Urbina and called him to come up with a plan. "Skinner had recently completed a study on tooth decay in Ecuador, and the participating dentists had seen great improvement in oral health using a material new to the market at that time called amorphous calcium phosphate," Parsons reports.

Local dentists and the Clark County Community Foundation, of which Skinner's friend was a member, got together to get the varnish in Clark County. Twice a year, the dentists go to elementary and pre-schools to apply it on students' teeth, such as those of Emily Havens (above, Sun photo by James Mann). "We wanted to get the material on there as soon as the teeth came in," Skinner said. "There's just too much decay out there to be fixed. We knew we needed a preventative program."

Dentists found evidence of tooth decay in half the students the first year, but noted an 11 percent drop in decay in sixth-grade students after the first year. They track progress annually and conduct full exams on sixth-grade students to check for cavities. If any are found, parents are informed. Students are also given tooth brushes at the beginning of each school year. (Read more)

CDC names top 10 public health achievements in past decade, including tobacco control; Ky. still leads nation in tobacco use

The Centers for Disease Control and Prevention have named the top 10 public health achievements of the last decade. They include controlling infectious diseases like AIDS and tuberculosis; fighting tobacco use; improving motor-vehicle safety by having safer vehicles, roads and driving; reducing heart disease and death; and improving public safety preparedness following Sept. 11, 2001.

The 10 were not ranked. "Others include improvements in vaccine-preventable diseases, better maternal and infant health, better cancer prevention, improved occupational safety, and the aggressive steps that have led to fewer childhood lead poisonings," reports Bill Hendrick of WebMD Health News.

"Americans are living longer, healthier and more productive lives than ever before thanks in part to extraordinary achievements in public health over the past decade," CDC Director Thomas R. Frieden said in a press release. "Continued investments in prevention will help us and our children live even longer, healthier and more productive lives while bringing down health care costs."

The report shows the improvements have saved billions of dollars nationwide. Fortifying food with folic acid, which reduced neural tube defects like spina bifida, has alone resulted in a savings of $4.6 billion in the past 10 years. Preventing motor vehicle crashes could save $99 billion in medical and lost work costs each year. Preventing lead exposure in children could save $213 billion each year.

While tobacco control has advanced nationally, and Kentucky's smoking rate has dropped slightly, the state continues to lead the nation in tobacco use, at 25 percent of adults. While about two dozen Kentucky communities have passed smoke-free laws, a statewide ban has never gotten anywhere in the legislature. The number of states with comprehensive smoke-free laws increased from zero in 2000 to 25 states (plus Washington, D.C.) in 2010.
Motor vehicle safety has improved, a trend that has been noted in Kentucky. The number of traffic-related fatalities in Kentucky has decreased for the past six years. In 2010, 759 people died on Kentucky roads compared to 791 the year before. This year so far, 220 people have died in traffic-related accidents compared to 237 last year. Nationwide, the death rate related to motor vehicle accidents went from 14.9 per 100,000 people in 2000 to 11 per 100,000 in 2009. (Read more)

Pew gives Ky. a "C" for looking after dental health of children

Kentucky received a "C" grade from the Pew Children's Dental Campaign for meeting the dental health needs of children, the same grade it was given last year.

The Courier-Journal reports the state met or exceeded four of eight benchmarks: The majority of Kentuckians (99.4 percent) have fluoridated community water supplies; the state pays medical providers for early preventive dental health care; the state tracks data on children's dental health; and the percentage of Medicaid-enrolled children getting dental care (40.8 percent) exceeds the national standard of 38.1 percent.

The state fell short of Pew's standards when it came to offering sealant programs at high-risk schools; allowing hygienists to place sealants without a dentist's prior exam; and authorizing new primary-care dental providers. Kentucky also lost points because the rates it pays to dentists for providing Medicaid services is below the norm — only 52 percent, compared to the national average of 60.5 percent.

None of the 50 states assessed in the report met all eight benchmarks. Seven states received an A and 20 states received a B. "An A does not stand for 'all done,'" said Shelly Gehshan, director of the Pew Children's Dental Campaign. "It means a state has the key ingredients in place, but it still needs to monitor progress and explore new ways to improve children's access to dental health." Florida, Hawaii, Indiana, Montana and New Jersey received an F.

More than 20 states improved their grades over 2010. "These gains were achieved primarily by adopting policies to reimburse physicians for preventive dental services, expanding water fluoridation and increasing the percentage of Medicaid-enrolled children who receive care," the report reads. (Read more)

Tuesday, May 24, 2011

Slap on sunscreen, avoid UV rays this Memorial Day Weekend

This Friday has been designated "Don't Fry Day," a reminder to sun worshippers to be mindful of the dangers of skin cancer on Memorial Day weekend, the traditional start of the summer recreation season.

The National Council on Skin Cancer Prevention strongly urges the use of sunscreen if in the sun, but also recommends seeking shade, wearing sun-protective clothing and avoiding getting a suntan or sunburn altogether. It also recommends extra caution if near the water or sand. "While most everyone enjoys a sunny day, keeping your skin safe from overexposure to UV radiation can be easy by practicing simple sun-safety tips," said Dr. Sandra I. Read, Council co-chair.

The Council also recommends consulting the UV Index forecast, which assess the strength of solar UV radiation on a scale from 1 (low) to 11+ (extremely high).

Skin cancer is by far the most common type of cancer in the United States, research-reporting news service Newswise reports. More than 2 million new cases are diagnosed each year, more than new cases of breast, prostate, lung and colon cancers combined. Though the incidence of many common cancers is falling, the incidence of melanoma, which can be deadly, continues to rise. It is one of the most common cancers in young adults ages 15 to 29. (Read more)

Never leave kids in a hot car, officials say in press conference planned even before Louisville toddler died

Following a 2-year-old Louisville boy's death from hyperthermia after he was left alone in a hot car Saturday, health officials warned of the dangers of vehicle-related heat stroke at a news conference in Frankfort yesterday.

"The loss of a child due to hyperthermia is a horrific tragedy that, sadly, we are seeing every year in this state," said Dr. Susan Pollack, coordinator for Kentucky's Safe Kids Coalition.

According to the group, one of 600 such coalitions and chapters around the country, two other child vehicular deaths — one in Texas, another in Louisiana — have already happened this year. Last year was the worst on record with 49 deaths nationwide. There have been 494 deaths in the country from 1998 to 2010, 13 of which happened in Kentucky.

About half the deaths occur when a parent forgets their child is in the car and leaves. "Something in a caregiver's daily routine changes, and the caregiver forgets to drop off the child at day care or with another caregiver and leaves the child in the car," Beth Musgrave of the Lexington Herald-Leader reports. As such, Safe Kids recommends setting a cell phone alarm to remind parents or placing a purse or cell phone near the child to act as a similar memory prompt.

In some cases, parents know they've left their child in the car, but do not realize how hot the car can get. "If you crack the windows, it doesn't make it cooler," Pollack said. One study found the temperature in a vehicle can rise 20 degrees in 10 minutes during warm weather. Moreover, a child's body temperature rises three to five times faster than adults.

About 30 percent of related deaths happen when a child is playing in a car and becomes trapped inside. Safe Kids recommends always locking a vehicle to prevent kids from getting in.

The news conference was planned before the death of 2-year-old Kenton Brown, Musgrave reports. Anyone who intentionally leaves a child in a hot car can face manslaughter charges if the child is younger than 8, Kentucky State Police Lt. David Jude said. (Read more)

Flexibility Act would give states more Medicaid authority, but it could mean that fewer children would have health coverage

Children's advocates are concerned the proposed State Flexibility Act would result in more children living without health insurance in Kentucky.

The act "would repeal protections put in place for states to maintain current eligibility and enrollment requirements for Medicaid and the Children's Health Insurance Program, known in Kentucky as K-CHIP," Renee Shaw of the Public News Service reports.

The goal of the act, its sponsors say, is to give states more flexibility so they can balance their own budgets. "The onerous federal mandates on states today make it especially challenging for states to solve the unprecedented budget crises, and governors have asked Washington for relief from these excessive constraints," the act reads. In Kentucky, there is a a projected budget shortfall of $780 million for Fiscal 2012, $166.5 million of which is due to a gap in Medicaid funding.

But Lacey McNary, deputy director of Kentucky Youth Advocates, say the move would only further burden families. "Children who in Kentucky are up to 200 percent of the poverty level can enroll, and they're eligible for K-CHIP," she said. "In order to save some money, the state could say, 'We're only going to cover kids up to 150 percent of poverty' — thus, covering less children and saving money."

Estimates show almost half of Kentucky's children have government-supported health insurance. About 60,000 kids are enrolled in K-CHIP every month and another 386,000 Kentuckians are enrolled in Medicaid, which serves low-income and disabled Americans, including children. "It's been proven that K-CHIP is a very successful program to get kids covered," McNary said. "This bill is a permission slip for governors to reduce coverage for kids, to balance the budget."

If the bill passes, about 14 million children nationwide could be at risk for losing their health insurance, Shaw reports. (Read more)

New Kentucky optometry law prompting legislators in other states to consider same or similar changes

Now that Kentucky lawmakers have allowed optometrists to expand their scope of care, legislators in Nebraska, South Carolina and Texas may follow suit. They are looking at legislation that would allow optometrists to perform minor surgeries that were previously only allowed to be done by ophthalmologists, who are medical doctors.

Despite objections from several physician organizations — who say optometrists lack the medical training to perform the surgeries or deal with the complications — The Better Access to Quality Eye Care law was signed by Gov. Steve Beshear this winter. It lets optometrists perform a range of new procedures, including post-cataract surgery and two types of glaucoma surgery, reports Carolyne Krupa of American Medical News. The bill caused controversy partly because of the amount of campaign contributions, totaling almost $400,000, that optometrists made to all but one legislator and Beshear in the past two years.

Bills being considered in Nebraska and Texas would allow optometrists to "remove skin lesions from eyelids" and perform the same eye surgeries now permitted in Kentucky. The bills in Nebraska, Texas and South Carolina would also let optometrists make injections in the eyelid.

In 1998, Oklahoma because the first state to allow optometrists to perform some eye surgeries. Earlier this year, Kentucky became the second state nationwide. (Read more)

Studies conclude cigarette packaging misleading, needs changes

Tobacco manufacturers have misled consumers about the risks of their products and action is needed to help consumers make informed decisions about the products they intend to buy, three studies published in the American Journal of Preventive Medicine have concluded.

"Tobacco companies have used attractive packaging and persuasive images to market their products for decades," said lead author Maansi Bansal-Travers, a behavioral research scientist at the Roswell Park Cancer Institute. "These studies support efforts by the Federal Food and Drug Administration to regulate cigarette pack labeling."

Tobacco manufacturers have used design, colors and wording that create the illusion that filtered or "light/mild" cigarettes are safer, which is not the case, research-reporting news service Newswise reports. Since June 2010, tobacco companies have been prohibited from using "light" or "mild" terms on their packaging, according to provisions in the Family Smoking Prevention and Tobacco Control Act. "While the removal of these obviously misleading terms was a good first step, we discovered that cigarette manufacturers have circumvented the regulation by using different terms such as 'gold' and 'silver' and changing the colors on the pack to continue to mislead consumers about their products," Bansal-Travers said.

The first study, "What Do Cigarette Pack Colors Communicate to Smokers in the U.S.?", recommended color-coding be restricted. The second paper found "larger graphic health warnings that convey negative messages are the most effective in communicating health risks to adults," Newswise reports. The third study, "Correcting Over 50 Years of Tobacco Industry Misinformation," found putting statements on tobacco packaging that correctly warn of the use of tobacco products makes a different in correcting false beliefs about smoking and health. (Read more)

Two nutrition workshops will address school lunch, local foods, childhood obesity

Two workshops focusing on school nutrition and the overall health of Kentucky children will be hosted at the end of next month. The Coordinated School Health Institute workshop will focus on how schools and communities can work toward creating healthier schools. The Growing Healthy Kids in Kentucky workshop will address how to create healthy, hunger-free communities.

The CSHI event will be June 29. The Growing Healthy Kids gathering will be June 30 and July 1. Both events will be at the Marriott Griffin Gate Hotel in Lexington. All school staff, community organizations, parents, dietitians, nurses, school food service staff, journalists and any stakeholder in the health of Kentucky children are welcome.

The CSHI workshop will cover topics focusing on fitness, staff wellness, school health services, mental health, school nutrition and Medicaid managed care.

The two-day Growing Healthy Kids event will address physical activity, farm to school success stories, local foods, the Let's Move initiative, Kentucky Proud, breastfeeding, worksite wellness and culinary arts programs.

The CSHI event is presented by the Foundation for a Health Kentucky. The Kentucky Dietetic Association will host the Growing Healthy Kids in Kentucky workshop.

Registration deadline is June 21. Click here to register online. Cost for both events is $205. For more information, click here.

Monday, May 23, 2011

Employers will have to pay 8 percent more for employee health insurance next year

"Employers will likely face health-care cost increases of 8.5 percent in 2012, but they'll mitigate that burden by pushing more costs onto employees and making other changes to benefits," reports The Wall Street Journal's Katherine Hobson.

All told, employers will pay 7 percent more in health-care costs next year, a PricewaterhouseCoopers report has concluded. The report surveyed 1,700 employers, as well as hospital executives and health-plan actuaries.

Provider consolidation, cost shifting from Medicare and Medicaid by providers, and stress related to the bad economy are all causing costs to rise. "Several health plans interviewed indicated they were seeing more claims for stress-induced illnesses," the report states. "Specifically, as stress levels increase, health becomes less of a priority and people are less likely to maintain a healthy lifestyle."

Cost sharing and a large number of drugs that will go off patent next year are helping to keep costs down somewhat, however.

But employee health plans are getting less attractive, with employees being asked to pay higher deductibles. "We're projecting by 2012, most (covered) employees will have a deductible of $500 or more in-network and $1,000 or more out-of-network," said Michael Thompson, principal with PricewaterhouseCoopers' human resources practice. (Read more)

Foundation for a Healthy Kentucky asks Kentuckians to participate in online survey about state's health issues

The Foundation for a Healthy Kentucky is seeking participants for an ongoing survey to identify the most important health issues facing Kentucky. Responses to the online survey are due by June 3. The foundation says it will use the data, and responders' suggestions for addressing the issues, to shape its work over the next five years.

The estimated time to complete the survey is less than 15 minutes, and all individual responses are confidential. The foundation encourages everyone to participate, and to share the survey with friends and colleagues. Take the survey by visiting the foundation website at healthy-ky.org.

Kentuckians think cancer is biggest threat to adults, but heart disease kills more men in the state

Cancer is the leading health concern identified by Kentuckians, and is the principal cause of death among women in the state, though heart disease is the main killer of Kentucky men, the Kentucky Health Issues Poll found.

Thirty-six percent of Kentucky adults identified cancer as the most important health issue for men, followed by heart disease at 31 percent, according to a news release for the Foundation for a Healthy Kentucky, which co-funded the poll. Heart disease was the leading cause of death for Kentucky men in 2009, followed closely by cancer.

Only about 7 percent of Kentuckians identified obesity as the top health issue facing Kentucky adults, but 29 percent said it was the greatest concern for children, perhaps reflecting considerable public attention to concern about child obesity. "While childhood mortality is rare, there are lifelong health implications that can be linked to struggling with obesity and diabetes at an early age," the release said.

“Even though the results suggest some confusion about our biggest health threats, there are ways to reduce Kentucky’s chronic disease risks: eat healthy foods, exercise regularly, stop smoking or don’t start,” said Dr. Susan Zepeda, CEO of the foundation, which co-sponsored the poll with the Institute for Policy Research at the University of Cincinnati. The poll interviewed a random sample of 1,677 adults, 1,469 by landline phones and 208 via cell phones. In 95 of 100 cases, the estimates are accurate within a 2.4 percent margin of error. To see the report, click here.

Alternative medicine can help patients manage chronic pain

Patients can turn to health practices like meditation, massage, yoga and acupuncture rather than pills to help manage their chronic pain, says Dr. Josephine Briggs, director of the National Center for Complementary and Alternative Medicine at the National Institutes of Health.

"Much of health care involves helping people find solutions for tough problems like pain," Briggs said in a release distributed by research-reporting news service Newswise. "I think all physicians are well aware of how difficult it is to manage chronic pain patients. For example, with back pain we see that large numbers of patients are turning to these approaches with the hope of decreasing discomfort, improving function and quality of life, and minimizing side effects of pharmacologic treatments."

A nationwide survey released in 2008 found about 38 percent of U.S. adults ages 18 and over and about 12 percent of children use some form of complementary and alternative medicine. Back pain is the most condition for which treatment is sought. These types of therapies are even being used in military health care. New military guidelines released by the Office of the Army Surgeon General include some alternative modalities for treating pain. (Read more)

Losing just a little weight can reduce the risk of cancer

Losing even just a little weight — just 5 to 10 percent of total body mass — can help reduce the risk of getting common types of cancer, the National Cancer Institute has found. That's an important fact for Kentucky, which has high obesity and cancer rates.

Officials with the Office of the Surgeon General and the American Cancer Society say being overweight or obese can increase the risk of a wide variety of cancer, including prostate, kidney, colon, ovarian, cervical, thyroid, gall bladder and post-menopausal breast cancer.

"Fat cells produce estrogen, which promotes cell growth," reports Karina Christopher, a Lexington Herald-Leader contributor. "They also make a variety of proteins that cause inflammation and insulin resistance, which can promote cell growth and reproduction. People who tend to be 'apple-shaped' have even more fat activity, because fat cells around the middle of the body divide even more rapidly. The faster the cells divide, the higher the risk of developing cancer."

But losing just a small amount of weight by controlling food portions, getting active and planning meals ahead of time can help. (Read more)

Tuesday, May 17, 2011

Study finds new prostate-cancer test is better than current one

Researchers at the University of California at Los Angeles say they have developed a new test for prostate cancer that is "more sensitive and more specific" than the usual test for prostate-specific antigen, the UCLA Health System says in a news release on a new, peer-reviewed study.

"The conventional PSA test for prostate cancer has been used for nearly 30 years and is not specific enough in delineating between malignancies and non-malignant diseases of the prostate, such as benign prostatic hyperplasia (BPH), an enlarging of the prostate common in aging men that increases PSA levels," the release said, citing urology professor Gang Zeng, senior author of the study, published in the May issue of the Journal of Translational Medicine.

The new test "measures levels of PSA as well as six specific antibodies found in the blood of men with the disease," the release says. "The test, called the A+PSA assay, also reduced the rate of false-positives, tests that indicate the presence of cancer when no disease is actually present." For more from Newswise, click here.

Friday, May 13, 2011

Cavities can be contagious, researchers have found

A new study has found that cavities are contagious. "Just as a cold virus can be passed from one person to the next," so can cavity-causing bacteria that cling to teeth and eat food particles lodged on and between them, The New York Times' Anahan O'Connor reports.

Infants and children are especially susceptible, with bacteria often transmitted to them by their caregivers. One prime example is when mothers test food to confirm it's not too hot for a child. Couples can also spread the bacteria between each other. "In one instance, a patient in her 40s who had never had a cavity suddenly developed two cavities and was starting to get some gum disease," said Dr. Margaret Mitchell, a cosmetic dentist in Chicago. The woman realized she'd been dating a man who hadn't been to the dentist in nearly 20 years and had gum disease.

Daily flossing, frequent brushing and chewing sugar-free gum, which washes away plaque and bacteria, can help. (Read more)

Summit and local groups focus attention on oral health, a big problem for Kentucky and one that can hurt overall health

By Sarah Vos and Al Cross
Kentucky Health News

When it comes to dental health, Kentucky is down in the mouth. It ranks among the worst in the nation, with high numbers of working adults who don’t have all their teeth, and a high percentage of children with untreated tooth decay.

These and other unflattering facts about the state’s dental health, and ways to change them, were part of frank discussions at the Kentucky Oral Health Summit in Lexington on Wednesday, May 11.

Part of the problem is that Kentucky doesn’t have enough dentists to serve its population, especially in rural areas. (New York Times photo by Stephen Crowley: A student awaits treatment at First Kids Dental in Barbourville.)

“We don’t have enough dentists to fight basic disease,” said Julie McKee, dental director for the state Department of Public Health.

For those who rely on Medicaid, including more than 460,000 Kentucky children, dentists are even harder to find. Only 25 percent of dentists in the state regularly take Medicaid patients, McKee said.

Another part of the problem is a basic lack of understanding about oral health and its role in overall health, several participants said.

Research has shown that gum disease and cavities are closely related to other health issues and that a healthy mouth is key to a healthy body. Diabetes, heart disease, and premature birth are all associated with poor oral health. In children, poor oral health can affect school performance.

“Healthy teeth don’t hurt,” McKee said. “Sick teeth hurt. People with sick teeth can’t learn.”

In some parts of Kentucky, local and regional oral health coalitions are working to raise awareness about the problem and encourage people to get dental care. They face many obstacles.

A large number of Kentuckians don’t have dental insurance, and dental bills paid with private funds can be expensive. Inside the dental profession, there are turf battles between dentists, dental assistants and dental hygenists.

The Oral Health Summit attracted dozens of representatives from county and school oral-health programs and public-health clinics, and some dentists. However, no one from the Kentucky Dental Association, which represents practicing dentists, attended the conference.

Mike Porter, the association's director, said that the group's leaders could not attend because they were all in Washington at a national leadership conference. Porter said that the KDA was "totally committed" to improving the state's oral health. "It was just a logistics issue," he said.

To increase the number of kids getting preventive care, mobile units visit schools to examine and treat children during the school day. But these efforts are sometimes opposed by dentists who worry that the competition will hurt their businesses.

“The dentists are concerned these mobile units are going to come in and take their clientele,” Teresa Morehead, a Lawrence County school nurse, said in an interview. “Right now, they’re not anybody’s clientele.”

School-based programs are also hindered by the fact that many parents don’t understand the importance of baby teeth to long-term oral health. Parents think that because baby teeth fall out, it doesn’t matter if a child gets a cavity, McKee said, but baby teeth hold spaces for the adult teeth, allow children to eat a variety of foods, are used for speech, and affect children’s self-esteem.

“They don’t understand the importance of needing that follow-up,” said Felicia Elliott, a nurse and health specialist for the Audubon Area Head Start in Western Kentucky. “They don’t understand how it will affect their future life.”

But these workers on the front lines of children’s health often have trouble finding a dentist who will take new Medicaid patients, or ones who will see patients who can’t afford to pay.

Stacy Trowbridge, who runs the Barren River District Health Department’s dental services, said she often sees children with severe problems who need more care than she can give in the mobile clinic. One boy, for example, had 17 cavities and was in the nurses’ office every day because of tooth pain. But Trowbridge couldn’t find a dentist who would take him, and his parents couldn’t afford to pay for the care on their own.

“We don’t know where to send them,” Trowbridge said.

Another barrier to improving oral health in Kentucky is that many nurses and doctors have not been taught to look inside patients’ mouths, visually examine their teeth and identify problems.

“If you’re not trained, you’re not comfortable,” McKee said. She that is part of the “headless horseman of health care,” which also includes the limited extent of insurance for dental and mental health services and eye care.

The conference attendees, who were working on the state’s strategic plan for oral health, identified several things Kentucky could do to improve its oral health. These included expanding the services dental hygenists can provide, educating communities and legislators about the importance of oral health, and getting high-profile figures such as athletes to promote good oral health.

The goal, McKee said, is to change attitudes and help Kentucky’s citizens, businesses, and policy makers see the value of oral health and realize that their teeth, baby or adult, are worth keeping healthy.

“Oral health,” she said, “is everybody’s business.”

Shingles vaccine available, but expensive, and can be hard to find

Though it's expensive and can be hard to find, a vaccine against shingles is now available to people 60 and up, and in some cases to those 50 and up. Until this year, the vaccine, approved by the U.S. Food and Drug Administration in 2006, was only available to people 60 and older, The Courier-Journal's Darla Carter reports.

The painful, contagious rash, which is caused by a reactivation of the chickenpox virus, affects about 1 million Americans each year. It usually appears on one side of the face or body and results in blisters, fever and pain. It can also result in permanent pain, a condition called post-herpetic neuralgia or PHN.

Though the FDA had approved the vaccine, "Some medical facilities are waiting until action by the U.S. Centers for Disease Control and Prevention before agreeing to provide the vaccine to people 50 to 59. The topic is expected to be discussed at the June meeting of the Advisory Committee on Immunization Practices, which makes vaccine recommendations to the CDC," Carter reports.

The vaccine can cost more than $200, must be frozen and isn't always covered by insurance or Medicare. It is only covered through Medicare Part D, but not Medicare Part B. Many insurance companies are deciding whether or not to cover the vaccine pending the advisory committee's decision.

At Kroger pharmacies, the vaccine is available without a prescription for people 60 and up, but younger patients need a prescription, Carter reports. Take Care Clinics and Walgreens pharmacies require that customers be 60 or older to receive the vaccine. (Read more)

Kicking smoking habit not that hard, Philip Morris CEO says

The CEO of cigarette giant Philip Morris International said kicking the smoking habit isn't that tough, though he acknowledged that cigarettes are bad for one's health and are addictive.

Louis C. Camilleri's comment was made to nurse Elisabeth Gundersen of the University of California- San Francisco, one of many members of anti-tobacco groups who attended Philip Morris' shareholder meeting in New York Wednesday. She said one of her patients told her last week "that of all the additions he's beaten — crack, cocaine, meth — cigarettes have been the most difficult," reports Michael Felberbaum of The Associated Press.

Camilleri, right, responded, "We take our responsibility very seriously, and I don't think we get enough recognition for the efforts we make to ensure that there is effective worldwide regulation of a product that is harmful and that is addictive. Nevertheless, whilst it is addictive, it is not that hard to quit. . . .  There are more previous smokers in America today than current smokers." Camilleri is a longtime smoker.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, called Camilleri's comments the "most irresponsible form of corporate double-speak."

Worldwide, there are 1 billion tobacco users, according to the World Health Organization. The U.S. Public Health Service has said about 45 percent of American smokers try to quit every year, but only 4 to 7 percent are successful. About 25 percent of Kentucky adults smoke, the highest percentage nationwide, according to Kentucky Public Health Commissioner Dr. William Hacker. (Read more)

Prescription pill problem in Kentucky, elsewhere under microscope on NPR program

The growing prescription-drug abuse problem in Kentucky and other states was under the microscope Thursday during National Public Radio's "On Point," hosted by Tom Ashbrook.

The Courier-Journal's Laura Ungar, who wrote an extensive series on pain-medicine abuse this year, was one of three journalists who spoke about the epidemic. Dealers visit various pain-management clinics, which have been labeled "pill mills," fill the prescriptions and then sell the drugs at a high profit.

Ungar, left, called the prescription drug trade "akin to the illegal drug trade, where many of our folks in Kentucky are getting drugs that originated in Florida." Indeed, 98 of the nation's top 100 prescribers of drugs Oxycontin and Xanax are in Florida, the journalists conveyed.

One caller to the show, identified as Michelle of Carter County, Kentucky, shared what it was like when her mother was a pain-meds addict. "We would wake up in middle night and have to put her to bed because she was like a zombie," she said. "It was like no one was there."To read more and listen to the show, click here.

Construction, expansion at UK HealthCare boosting Lexington's economy; total payroll now exceeds 8,700

The construction and expansion at UK HealthCare, which comprises the University of Kentucky's College of Medicine and Albert B. Chandler Hospital, is giving Lexington a fiscal boost in an otherwise difficult economy. More than 8,700 people now work at the hospital and medical school.

The school's number of employees has grown by 900 since 2004, topping out at 3,989, reports Margaret Buranen of Business Lexington. In the same period, the number of full-time hospital employees grew from 2,562 to 4,722, an 84 percent jump. The payroll, including salary and benefits, has risen to $677 million, about $300 million more than in 2004.

Another notable change in the past seven years is the ratio of full- and part-time faculty members at the College of Medicine. "The number of part-time faculty members has decreased nearly one-third, while full-time basic science and clinical faculty members have both increased. The net result is a 21 percent increase in faculty members," Buranen reports.

Construction of the new Chandler Hospital has produced a payroll of $72 million in the private construction sector, which translates to 300 full-time jobs during construction. In addition, the fact that UK HealthCare used Kentucky vendors for building materials and supplies whenever possible results in an economic impact of $88.6 million., Buranen reports.

Phase I of the hospital construction includes a parking structure, trauma center and emergency department, which opened in July 2010. The hospital pavilion, which includes two floors of patient rooms, opens May 22 and will be dedicated Sunday. Phase II will cost $230 to $250 million. (Read more)

State health commissioner encourages smoke-free ordinances

Kentucky's public health commissioner said communities are moving in the right direction by enacting smoke-free ordinances and hopes Kentucky can become a smoke-free state. "We have communities in Letcher County, as well as areas in far Eastern Kentucky, Western Kentucky and Northern Kentucky implementing second-hand smoke ordinances because it's dangerous for people who are non-smokers," Dr. William Hacker said.

Hacker, who spoke at the Breathing Clean Air Summit in Owensboro Thursday, said 25 percent of Kentuckians smoke, the highest percentage in the country, reports Jasmin Embers of WFIE-TV in Evansville. "We're ranked number one in lung cancer deaths, so if you're number one in smoking, you can expect to be number one in lung cancer deaths," Hacker said.

Hacker encouraged communities that already have smoke-free efforts or laws to go farther. Change can be seen at Owensboro Medical Health System, which now has four smoking huts on its campus. Those will be eliminated by the end of the year, a move that was decided after employees responded to a smoking survey. "Half of the respondents said they felt that smoking on OMHS grounds contradicted our mission statement to heal the sick and improve health of our community," wellness committee member Gordon Wilkeron said. (Read more)

Fort Campbell using simulated battlefields to assess brain injuries

Doctors at Fort Campbell are using a mock battlefield to assess whether or not soldiers who have suffered a traumatic brain injury are ready to return to combat. The clinic has been recognized by the Department of Defense as a national model.

"Soldiers are making life and death decisions, so doesn't it make sense to use demonstrated competence as the standard for returning someone to duty?" Dr. David Twillie told National Public Radio's Blake Farmer.

In exercises meant to simulate scenarios they face when fighting in Iraq and Afghanistan, soldiers sweep a gravel road for possible roadside bombs, take fire from insurgents and are told to insert chest tubes and tie tourniquets while listening to sound from a scene in Saving Private Ryan. The goal is to assess how well the soldiers handle the stress of the situations. Patients must also take written tests that assess their competence. The combination of both simulated and written assessments is important.

"Very recently we had a soldier that had a desire to stay in, had done well in all our simulations," Twillie said. "But when all the different sights, sounds, smells came back, he just wasn't able to change his focus, and that's very important in combat."

Memory loss, mood swings and difficulties balancing are common symptoms of a traumatic brain injury. About 115,000 soldiers have experienced such an injury, the Defense Department estimates. (Read more)

Wednesday, May 11, 2011

Eating local: Farm-to-school gaining ground as way to fight childhood obesity and otherwise improve students' nutrition

By Tara Kaprowy
Kentucky Health News

With the faint hue of green appearing in thousands of gardens and farms, the growing season has officially begun in Kentucky. While most of the resulting produce is destined for store shelves and personal pantries, there is growing demand for it to appear in kitchens that haven't seen locally-grown fruit and vegetables for decades but are keys to children's nutrition.

Schools are the newest frontier in sustainable farming, with their collective power not only capable of transforming the agricultural landscape, but also fighting childhood obesity, one of the biggest health crises facing the nation. (Kentucky Department of Agriculture photo: Montgomery County farmer Gayle Arnold picking tomatoes)

This growing trend is called "farm to school," in which school cafeterias serve food grown by local farmers. Across the state, food-service directors in 78 school districts have made their schools Kentucky Proud institutions, meaning they serve local products in their school lunches.

This map shows that nearly 50 counties had some type of farm-to-school program in place in 2010; more have started.

"It's a growing movement," said Tina Garland, coordinator for the Kentucky Department of Agriculture's Farm-to-School Program. "Producers are being added every day. We've got orchards that can turn off their freezers in the fall because the schools buy all of their apples."

John Cain, state co-chair of Kentucky Action for Healthy Kids, attributed the trend to several factors, including efforts to find viable markets for former tobacco farmers, a concern about food security and the obesity epidemic. "We're having to revisit where does our food come from and what does the source of our food have to do with our obesity problem," he said.

This year, 10 school districts will receive $5,000 grants from the Kentucky Department of Public Health's Obesity Prevention Program so they can establish farm-to-school programs. Last year, Jackson, Lee and Owsley counties established their own programs using the grants. Owsley Food Service Coordinator Charolette Thompson served locally-grown watermelons and cantaloupes in her cafeterias. "The students noticed the difference in taste and the better quality in the produce," she said. "They love it."

In Jackson County, in addition to developing ties with farmers, students grew tomatoes, left,  and canned salsa, which will be used in the school cafeteria. They also made jam, which they sold under the label "Jammin' Generals." "Not only did they learn how to grow their own food, they learned how to market it and how to preserve it," said Elaine Russell, nutrition coordinator for the Obesity Prevention Program. (Cumberland Valley District Health Department photo)

This trend is likely to continue, especially since it now has federal support. On April 26, the U.S. Department of Agriculture established a rule that will let schools give preference to local, unprocessed farm products when they buy for the National School Lunch Program and other USDA programs.

While farm to school is gaining traction, it is not a new concept. Julie Tuttle, food nutrition coordinator at Montgomery County Schools, is one of a handful of food-service directors who have been serving locally-grown produce for several years. "We started using apples in 2006," she said. "Now we're up to four producers." (Kentucky Department of Agriculture photo: Students Macy Tabor and Makayla Donathan at Montgomery County High School)

The latest is Marksbury Farms, where Tuttle is buying beef, chicken and pork. Last week, in honor of the Kentucky Derby, Montgomery County High was one of the first Kentucky schools in decades to serve local meat. The students had the option of either burgoo or hot browns, left. "I had one student who came up to me and said, 'I just wanted you to know this is the best school lunch I've had since I've been here,'" Tuttle said. "That's what it's all about, getting those comments from students." (Kentucky Department of Agriculture photo)

Julia Bauscher, director of school and community nutrition services for Jefferson County Public Schools, teamed with Sullivan University to develop recipes, and was able to buy local squash, peppers and zucchini that she and her team processed and froze for year-round use. This year, she is buying local foods from about 12 providers, three of whom have contracts to grow for the schools.

In addition to raising awareness, she's found farm to school improves the reputation of the school cafeteria in general. "This gives everyone something to feel good about and opens everyone's eyes a little more about the program," she said. "And how we really do have to work hard to make this happen."

Farm-to-school programs have been slow to start in many places because they face logistical, legal and other challenges. Many school districts want their suppliers to carry a $1 million liability insurance policy, which they may not be able to afford, and be certified through the Good Agriculture Practices Program, education they may not be able to get.

Farm to school's biggest drawback is that it takes more work. Unlike food delivered to schools by huge providers, locally-raised produce may need to be washed and processed, which takes more staff or volunteers.

"The market has evolved a very convenient system," said Mark Swanson, an assistant professor in the University of Kentucky College of Public Health. He said school food-service directors "have one or two providers they can call and they can get what they need. Farm to school gets a lot more complicated. ... It takes a really motivated person to tackle that on their own."

Swanson said that hurdle can be lowered by social connections in rural communities. He spoke of one farmer who was selling her tomatoes to a Wendy's restaurant. Though she'd had a bad harvest, the restaurant manager was willing to use the product, in part because they went to church together. "He knew that his business arrangement would be cushioned by social ties," Swanson said.

In Owsley County, ties between the school and farmers have become so strong farmers will now host a farmers market on the grounds of the high school there. "It's the social connection with farm to school that gives it the most potential," Swanson said.

Federal procurement guidelines keep schools from paying much of a premium for local products, but "Farmers are pretty uniformly willing to accept a lower price for their produce because of the volume and they can sell it all at once," rather that waiting for single buyers at a farmers' market, Swanson said. "It's a good trade," he said. "It's a whole lot easier."

That was the case for Jeremy Hinton, owner of Hinton's Orchard and Farm Market, and the schools in LaRue County and nearby Elizabethtown, which buy 1,000 of his apples a week.

"It was a cost savings to them over what they were paying at the time," Hinton said. "Even when wholesale apples are available for less, they continue to buy our apples because of the quality and supporting locally grown. . . . Probably the biggest compliment we've gotten is talking to some cafeteria managers who said they're seeing more apple cores in the trash bin instead of apples with one or two bites out of them."

While farm to school is gaining ground in Kentucky, it is more established in the upper Midwest, the Northeast and California. Kelly Crossley, food-service director at Independence School District in Iowa, started her program in 2008. Though she is interested in supporting farmers and shrinking the district's carbon footprint, Crossley's main goal is the same as most food-service directors in the program: healthier eating.

"If you can get kids to eat more fruit and vegetables, hopefully those items will replace something more fattening they would have eaten otherwise," she said. To reinforce the effort, students meet the farmers in the classroom and travel to the farms, and Crossley posts in the cafeteria signs noting where the local foods were grown. Crossley said her staff only casually monitors what students take in the lunch line, not what actually gets eaten, but "The cooks have told me ... that they can tell which kids have been exposed because they're taking more."

Swanson is doing research in Lee County to see if farm-to-school actually improves children's nutrition. He will establish a program and photograph trays of food coming off the lunch line and being returned once the students have eaten. "There's a general assumption that farm-to-school programs work and no one has really studied the effects on nutrition," he said. "The reason I don't sell it on the nutritional benefits is we really don't know."

While the empirical evidence may be short, the anecdotal evidence is strong. Crossley said she witnessed an unforgettable success late last fall in Iowa.

"Brussels sprouts were the only thing left in the garden," she said. "The kids went out and actually harvested them off the trunks. We sautéed them, put a little bit of parmesan cheese on them and we passed them out to the kids. I'm telling you, they ate it up ... That day, we heard stuff like, 'I like Brussels sprouts and I didn't even know it.'"

Bauscher looks forward to the day that happens all over Kentucky. "As more districts become more involved in this," she said, "we ought to be able to create something that's really worthwhile, not only for the students, but for the farmers."