Frankfort approves needle exchange; Northern Kentucky remains resistant though that's where the heroin problem is worst

By Melissa Patrick
Kentucky Health News

The Franklin County Health Department can now operate a needle exchange program in Frankfort, following a 3-2 vote by the Frankfort City Commission, Seth Littrell reports for The State Journal.

This brings the number of needle exchange programs in Kentucky to seven. Others are or will be in Louisville, Lexington, Pendleton County, Jessamine County and one that will serve both Carter and Elliott counties. They are designed to thwart the spread of HIV and hepatitis C, a disease that is commonly spread by intravenous drug use and is expensive to treat. Kentucky leads the nation in hepatitis C cases and suffers more than 1,000 drug overdose deaths a year.

Franklin County's program will operate one day a week from a mobile unit using various locations around the county, Health Director Judy Mattingly told the commission at its December meeting, Littrell reported. The program will supply enough clean needles for someone to get through a week and will offer counseling with each visit.

Under the state anti-heroin law passed in 2015, needle exchanges require local government approval. The Franklin County Fiscal Court gave its approval in October. The commission deadlocked 2-2 in December, with Commissioner Lynn Bowers abstaining for "more time to think" even though she seconded the motion to approve it.

This month, Bowers voted a "hesitant yes" but added a requirement that the commission receive updates on the program every six months, Littrell reports. She told health officials, "You all have recommended this, and you are the experts in the area and it’s for the public health."

The commissioners who voted no have voiced typical concerns, including a belief that its "immoral" to give needles to addicts, a belief that the issue belongs in the courts and a belief that needle exchanges enable drug users, despite evidence to the contrary. Commissioner John Sower, one of those who voted no, is running for mayor against incumbent Bill May, who voted yes.

Northern Kentucky struggles with the issue

The heroin problem is worst in Northern Kentucky, but Pendleton County is the only jurisdiction to approve a needle exchange.

The Florence City Council didn't say no to an exchange at its Jan. 19 meeting, but Mayor Diane E. Whalen said she wanted the approval of the Boone County Fiscal Court before allowing more discussion or taking a vote, Chris Mayhew reports for The Cincinnati Enquirer.

Mark Hansel reported in December for the Northern Kentucky Tribune that the fiscal court and the City of Florence "have no intention of approving needle exchange in their communities any time soon." The Northern Kentucky Health Department wants to operate exchanges at existing health centers in each county in Covington, Florence and Newport.

Mayhew also reported that the city of Williamstown in Grant County passed a resolution approving a needle exchange in August, but the department has not yet gotten approval from Grant County Fiscal Court, according to Emily Gresham Wherle, public information administrator for NKHD.

Mina "Mike" Kalfas, a family-medicine physician in Northern Kentucky, called for governments in the region to allow needle exchanges, reiterating in an Enquirer op-ed that the area has done nothing in the 10 months since the law passed.

"Since the law was passed, almost 800 people in Northern Kentucky have been diagnosed with hepatitis C and more than 100 have been diagnosed with hepatitis B," Kalfas wrote. "While a syringe access exchange program won’t eliminate these viruses, it can reduce their spread. When faced with outbreaks of communicable disease, public health officials look to interventions to stop the spread."

Ten hospitals and hospital groups to collaborate on improving Kentucky's health, reduce cost of care and share best practices

Ten major hospitals and hospital groups have created the Kentucky Health Collaborative in an effort to reverse the state’s poor health statistics, share best practices and reduce the cost of care through greater operational efficiencies. The 10 and their headquarters towns are:

• Appalachian Regional Healthcare, Lexington
• Baptist Health, Louisville
• Ephraim McDowell Health, Danville
• LifePoint Health, Brentwood, Tenn.
• Norton Healthcare, Louisville
• Owensboro Health, Owensboro
• St. Claire Regional Medical Center, Morehead
• St. Elizabeth Healthcare, Edgewood
• The Medical Center, Bowling Green
• UK HealthCare, Lexington

Appalachian Regional Healthcare will serve as the organization’s headquarters. The collaborative says it is still in early development, and many details are to be finalized, such as the issues it will tackle first. As it develops its structure needed, it will invite other members.

“The Kentucky Health Collaborative has created a governance structure that supports the inclusion and participation of healthcare providers regardless of location within the Commonwealth, size or profit structure, said its executive director, William 'Bill' L. Shepley. “The solutions we expect to develop through the collaborative have worked well for similar networks across the country, and I am honored to be a part of this important process.”

Newly diagnosed diabetics treated for gum disease have lower health costs; shows need to integrate oral health and primary care

Newly diagnosed diabetics who are monitored and treated for gum disease have lower health-care costs, according to a study by the American Dental Association Health Policy Institute.

The study, published Jan. 22 online in the journal Health Economics, examined whether patients newly diagnosed with Type 2 diabetes had lower healthcare costs if they received care for their gums and all of the structures that support teeth, such as bones and ligaments.

The authors found the patients who received such care paid $1,799 less in total health-care costs over two years, calling it a ""statistically significant association," Jennifer Garvin reports for ADA News. The researchers said they controlled for other factors. They note that they couldn't identify the periodontal disease status of the patients because the coding system didn't include it.

Dental experts said the study shows the need to integrate oral health care and primary health care.

“Hopefully this will reach a tipping point soon, and the integration of oral health and primary care will undergo serious transformation,” Raynor Mullins, emeritus dental faculty, University of Kentucky Center for Oral Health Research, told Kentucky Health News.

“The health care landscape is shifting dramatically in the U.S. and the dental care sector is part of this,” Marko Vujicic, chief economist and vice president of the ADA Health Policy Institute, said in the news release. “With health care moving toward integrated models with much more provider collaboration, we knew it was important to shed light on the benefits of oral health beyond the mouth.”

Zika virus, which can cause small heads and brains in newborns, will get to Kentucky, but experts disagree on its likely impact

The Zika virus that has been linked to birth defects (abnormally small heads and brains in newborns) is exploding in South America and will eventually show up in Kentucky, but its impact in the state is hard to predict.

The virus, for which there is no cure or vaccine, "seems destined to reach the United States, and probably sooner rather than later," Lena H. Sun and Brady Dennis report for The Washington Post. "What is far less certain, say public health and infectious disease experts, is Zika’s potential reach and impact here. The South is seen as especially vulnerable because of its warm, humid climate and pockets of poverty where more people live without air conditioning or proper window screens. Plus, the region is already home to mosquitoes that can transmit the virus."

The mosquito of main concern, the Asian tiger mosquito, has been reported many times in Kentucky; one of potential concern, the yellow-fever mosquito, has been reported in Indiana.

Washington Post graphic emendated by Kentucky Health News

"Nearly three dozen cases have been confirmed to date in 11 states and the District of Columbia," but the federal Centers for Disease Control and Prevention "acknowledges that the number is growing rapidly," the Post notes. "In each, the person was believed to have been infected while out of the country." The CDC has extended its travel warning northward to the Caribbean.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, "is playing down the potential for a significant eruption of Zika here," the Post reports. "He notes that dengue and chikungunya, diseases transmitted by the same kinds of mosquitoes, are widespread in Latin America, but their foothold in the United States has been controlled, with only small clusters of cases."

However, Peter Hotez, dean of the National School of Tropical Medicine at Baylor University in Waco, Texas, told the Post, “I think we’re in for real trouble in the United States,” because Zika can spread quickly. "He focuses on conditions throughout the Gulf Coast, where stagnant water sources — in uncollected garbage, discarded tires, untended bird baths — can be ideal breeding grounds for mosquitoes much of the year."

New Planned Parenthood clinic in Louisville suspends abortions after order from Bevin; anti-abortion bills abound in legislature

Planned Parenthood of Indiana and Kentucky started offering abortions for the first time in Kentucky Jan. 21, but stopped a week later when Republican Gov. Matt Bevin's administration raised objections about its license application and he sent the organization a "cease and desist" order.

Planned Parenthood officials said in a letter to the licensing agency that their staff started performing abortions "only after receiving assurance from your office, in emails dated Dec. 1 and Dec. 7, that it would be appropriate," Deborah Yetter of The Courier-Journal reports.

Bevin took office in the first minutes of Dec. 8, succeeding Democrat Steve Beshear. He has included language in his proposed budget that would bar any organization that provides abortions from receiving state funds, Yetter reports.

Yetter reports that a Planned Parenthood spokeswoman told her that the organization "applied for an abortion facility license and commenced services under the guidance of the Office of the Inspector General, the state office that is responsible for licensing health facilities," though it didn't say whether it had yet received the license. That office is part of the Cabinet for Health and Family Services.

"Emails last year between a Planned Parenthood lawyer and the top state official then in charge of licensing health clinics show that the official told the organization it must open without the license in order to get one," Yetter reports in a later story. "That's because the state won't issue a final license until a state inspector makes an unannounced visit to the facility and inspects it after it has opened for business." Bevin General Counsel Steve Pitt said that policy did't appear to have ever been applied to an abortion clinic.

"Inspector General Stephanie Hold, who joined the new Bevin administration on Dec. 22, wrote in a letter to PPINK dated Jan. 28 that there is no such clearance, as they now deem the application deficient due to problems concerning the clinic’s written agreements with an acute care hospital and a local ambulance service," reports Joe Sonka of Insider Louisville, who first reported the start of abortions at the clinic.

"Hold stated that both written agreements only reference the old address of the Planned Parenthood clinic, and not their new clinic on South Seventh Street, which opened in December," Sonka reports. "She also wrote that while PPINK submitted a written agreement with a hospital capable of treating a patient with unforeseen complications related to an abortion procedure, that hospital 'has not agreed to unconditional acceptance' of such patients. . . . PPINK Chief Operating Officer Suzannah Wilson Overholt responded to Hold in a letter Friday, stating that they are revising those agreements to resubmit with their application."

Kentucky previously had only one abortion provider, a private clinic in Louisville that also operates a part-time clinic in Lexington.

Margie Montgomery, president of Kentucky Right to Life, told Yetter that the group was dismayed by the presence of a new clinic and said it would continue to educate women about abortions and provide "positive" alternatives such as free pregnancy counseling centers.

Supporters of abortion rights welcomed the clinic. "We believe Kentucky is vastly underserved when it comes to health care options for women," Derek Selznick, reproductive freedom project director for the American Civil Liberties Union of Kentucky, told Yetter.

PPINK President Betty Cockrum told Yetter the decision to offer abortions was based on women's medical needs, not politics. Its new site on Seventh Street in Louisville offered both surgical and non-surgical abortions (those induced by medication), as well as cancer screenings, medical exams, birth control services and testing for HIV and other sexually transmitted diseases.

Yetter writes, "The move to provide abortions is sure to be controversial in Kentucky's political climate as bills aimed at curbing abortion are pending in the current session of the General Assembly."

Face-to-face consultation with a medical provider 24 hours before an abortion would be required by Senate Bill 4, which passed the House with an amendment to allow consultation by teleconference. The Senate is set to vote on the amended bill Monday, Feb. 1.

The bill's sponsor, Sen. Julie Raque Adams, R-Louisville, told Yetter that she was sorry to learn Planned Parenthhood had begun offering abortion services in Louisville.

But Rep. Mary Lou Marzian, a Louisville Democrat and one of only three in the House that voted against SB4, welcomed the news. "Any time we have safe, legal health care services for women so desperately needed in this state, it's a step forward for women in Kentucky," she told Yetter.

Other abortion-related bills this session include Senate Bill 25, which passed out of the Senate Jan. 27 with a 36-2 vote. This bill would make the sale of fetal tissue from an aborted fetus a class C felony. Senate Bill 7 would set a priority system to fund state and federal family planning services. It is set for possible passage in the Senate, with an amendment, on Feb. 1.

The governor's proposed budget, House Bill 303, on page 116 mandates that public funds, including money received from the federal government, shall not directly or indirectly be paid to any entity "that provides abortions or abortion services, or that is any affiliate of an entity that provides abortion services," Tom Loftus reports for The Courier-Journal. He notes that the wording is nearly identical to SB 7.

Click here to see Kevin Wheatley's report on these bills for cn|2's "Pure Politics;" here for his story that includes the links to the letters about the clinic.

Attorney General Andy Beshear says Bevin's moves to 'pull back' on father's health policy would compromise a 'basic human right'

By Al Cross

Kentucky Health News

New state Attorney General Andy Beshear, a son of former Gov. Steve Beshear, criticized Gov. Matt Bevin's reversal of his father's health-care policies at an appearance with Lt. Gov. Jenean Hampton on Wednesday. The Beshears are Democrats and the new administration is Republican.

At a University of Kentucky law school symposium marking the 50th anniversary of the state civil-rights law, Beshear objected to "efforts in Kentucky to pull back different programs that help address the remnants of discrimination," including the expansion of Medicaid and establishment of the Kynect health-insurance exchange under federal health reform.

Beshear did not mention his father, but said the programs are "close to my heart." Bevin is moving to abolish the exchange, saying the federal exchange can serve Kentuckians' needs, and to scale back the Medicaid expansion.

“I believe the ability to see a doctor, the ability to have good health, is a basic human right, and that right has been denied to so many people because of the remnants of discrimination,” Beshear said. They approximate right now that just in the West End of Louisville, there are 60,000 people, primarily minorities, who have health care for the first time because of these programs.”

After another round of applause, Beshear said, “If we are going to achieve the objectives of that civil-rights act, if we are ultimately going to grow up in a world that is equal with equal opportunity, we have to ensure that we stand up for that basic human right of health care.”

Hampton, who spoke before Beshear, did not have an opportunity to respond. Beshear acknowledged and complimented her repeating her introduction as the first African American lieutenant governor and the second woman to hold the office, said “That's a big deal.”

Bevin's office did not respond to a request for comment.

Circuit Judge Tim Feeley, former state legislator, appointed deputy secretary of Cabinet for Health and Family Services

Judge Tim Feeley

Circuit Court Judge Timothy Edward Feeley of Oldham County has been appointed deputy secretary of the Cabinet for Health and Family Services.

Feeley has served as circuit judge for the Family court in Oldham, Henry and Trimble counties since 2005. He ran for attorney general in the 2003 Republican primary after holding a state House seat for more than 12 years and serving as an assistant U.S. attorney for the western half of Kentucky.

"As a Family Court judge, Tim Feeley has firsthand experience dealing with the variety of difficult matters that confront citizens across the Commonwealth," Gov. Matt Bevin said in the news release. "I have great confidence that Tim will provide empathetic solutions and tremendous insight into how we can better care for and serve Kentucky families and children."

Feeley received an economics degree from the University of Pennsylvania in 1978 and a law degree from West Virginia University in 1985. While serving in the Army, he rose to the rank of major and served four years as judge advocate general at Fort Knox immediately after getting his law degree.

He has been married for 32 years to Dr. Sue Feeley, a dentist in private practice. They reside in Crestwood and have three daughters and a son.

House passes Senate's abortion-consultation bill, after adding a teleconference option

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- The Democrat-led House of Representatives voted 92-3 Thursday to require women seeking an abortion to have a face-to-face consultation with a health-care provider 24 hours before the procedure, or -- in an option the House added -- such a consultation by teleconference.

Current law allows women seeking an abortion to have the consultation by telephone or a recording. Critics have said the original bill would create an unfair burden on women, adding additional days off work and cost, especially to those in rural Kentucky who would have to travel in to Lexington or Louisville, the only locations in the state that performs abortions, for the consultation.

The bill returns to the Senate for consideration of the teleconference option, which the House added in a dramatic day of legislative maneuvering. The bill has been posted for a vote on Monday, Feb. 1.

It was a major victory for opponents of abortion and Republicans, who had been trying for more than a decade to require face-to-face consultations. The legislation never made it out of the House Health and Welfare Committee until this session, when Republicans forced floor votes to give the bill readings required before passage, and finally forced a compromise.

On Wednesday, House Minority Leader Jeff Hoover, R-Jamestown, moved to convene the House as a committee on the whole to consider the bill, but he did not get the necessary 51 votes.

Not knowing what would happen today, the Democrats did some maneuvering of their own.

The House session began about 45 minutes late, after Speaker Greg Stumbo and Democratic leaders extended their daily meeting in his offices. Then, after opening ceremonies, Democrats went into a private caucus that lasted well over an hour.

After the House reconvened around 4 p.m., it almost immediately let out again for an emergency Health and Welfare Committee meeting, which produced a new version with the teleconference option.

This meeting was held in a very small office that barely had room to fit its 15 committee members, with journalists and other interested parties hanging out the door.

Republican committee members Richard Benvenuti of Lexington, Phil Moffett of Louisville and Tim Moore of Elizabethtown complained that they had not had time to study the substitute bill.

"This is a six-page document we've had for eight seconds and you want us to vote on it?" Moffett asked. "...This is an awful way to run a railroad."

"We are giving you what you want," replied committee Chair Tom Burch, D-Louisville.

Moffett was the only one to vote against the substitute in commitee, but the other Republican members went on record saying that they reluctantly voted yes "to move this legislation forward."

Before the final vote, Hoover found a drafting error in the substitute, which after some lengthy debate was corrected and then voted on favorably.

Reps. Mary Lou Marizian, D-Louisville, Joni Jenkins, D-Louisville and Ruth Ann Palumbo, D-Lexington, voted against the bill, which is sponsored by Sen. Julie Raque Adams, R-Louisville. It passed the Senate 32-5 on Jan. 19.

Marzian told the House that this issue was not one that Kentuckians were outraged about, but instead, "This is purely a political vote." She called for increased programs to decrease pregnancy, including better access to birth control and better age-appropriate sex-education in schools.

Hoover said afterward, "I am just pleased that the bill has passed and it's gone to the Senate and I hope they will concur so the governor can sign it next week. That is a big day for Kentucky if that happens."

UK offers new master's degree in medical sciences, with College of Agriculture, Food and Environment's ag biotech program

Robert Houtz, Ellis Shelley, Joe Springer
(Photo by Matt Barton, UK Agric. Communications)

The College of Agriculture, Food and Environment and the UK College of Medicine at the University of Kentucky have collaborated to create the first master's degree in medical sciences, and Ellis Shelley will be its first student.

Shelley, an Albany native, is finishing up his bachelor's degree at UK in agricultural biotechnology. His undergraduate research has focused on helping a local truffle farmer use biotechnology to take a lot of guesswork out of his production practices, says a UK news relase. His long-term goal is a medical career.

Medical professor Joe Springer, director of the program, said in the release, “This partnership across our two colleges is a unique approach that will greatly enhance the placement of our students in professional schools, graduate degree awarding programs and industry.”

Bob Houtz, chair of the UK Department of Horticulture and member of the coordinating committee for the agricultural biotechnology program, said “All our agricultural biotech students already do research; we’re trying to make the transition seamless, so that many of them can continue the same research in their master’s of medical sciences studies.”

Chefs to show how to get fresh, healthy, local food in Boyle, Clark, Grayson, Harlan, Martin, Morgan, Oldham, Pike county schools

image: nkyhealth.org

Chefs will help eight Kentucky schools learn to incorporate fresh, local foods in their menus as part of a "Chefs in Schools Collaborative" pilot project, according to a news release from the Kentucky Department of Agriculture.

 "School food service workers want to serve healthy, delicious meals to Kentucky children, and these projects will help them do that," Agriculture Commissioner Ryan Quarles said in the release. "These investments will help the next generation of Kentuckians grow up healthy and strong, and they also will teach them to value farmers and local food systems as a way of life."

The project will educate food service employees on how to incorporate fresh, local foods into their menus, help them develop new recipes that include local foods and provide opportunities for local farmers to engage with the staff and students. 

The pilot program will run from February through May and is led by the Agriculture Department's Farm to School Program in partnership with the Community Farm Alliance and the National Farm to School Network. 

The National Farm to School Network will use a grant from Seed Change to support the program in Boyle, Clark, Grayson, and Oldham counties. The Community Farm Alliance will use funding from the Central Appalachian Network to support the program in Harlan, Martin, Morgan, and Pike counties.

Study: health warnings on sugary drinks make a difference; 3 states seek legislation to add them; beverage lobby pushes back

By Melissa Patrick
Kentucky Health News

Health warning labels on sugary beverages, like those found on tobacco products, could make parents less likely to buy them for their children, according to a study from the Perelman School of Medicine at the University of Pennsylvania.

“Regardless of the specific wording, results show that adding health warning labels to sugary-sweetened beverages may be an important and impactful way to educate parents about the potential health risks associated with regular consumption of these beverages, and encourage them to make fewer of these purchases,” Christina Roberto, lead author of the study, said in the news release. “The findings are in line with similar studies conducted on the effects of warning labels on tobacco products, which have been shown to increase consumer knowledge of health risks related to tobacco use, and encourage smoking cessation."

Warning labels used in the study

The online study, published Jan. 14 in the journal Pediatrics, included about 2,400 demographically and educationally diverse parents of six to 11 year olds. The online survey tested the effects of five different warning labels about the potential health effects of sugary beverage intake, including labels about calories, weight gain, obesity, diabetes and tooth decay.

The study found that 40 percent of participating parents said they would choose a sugar-sweetened beverage for their child after viewing a warning label, compared to 60 percent of participants who saw no labels on the beverages, and 53 percent of parents who only saw the calorie label. There was no significant buying difference between the groups seeing the calorie-only label and no label, says the report.

The research found that the specific words on the warning label didn't make a difference in the parent's purchasing choice, but the presence of the label did, says the report.

Soft drinks and juices marketed for children have as many as seven teaspoons of sugar per 6.5 ounces, which is nearly twice the recommended daily serving for that age group, says the report. Lead author Roberto noted that more than half of children (66 percent) under the age of 11 drink sugary-sweetened beverages on a daily basis.

Graph: USDA Dietary Guidelines 2015-20

The Harvard T.H. Chan School of Public Health documents that sugary beverages "are a major contributor" to childhood obesity, a real problem in Kentucky which is first in high school obesity rates (18 percent); eighth for 10- to-17- year olds (19.7 percent) and sixth for children ages 2 to 4 from low-income families (15.5 percent), according to the "State of Obesity" report. The Kaiser Family Foundation reports that 35.7 percent of children ages 10-17 in Kentucky are either overweight or obese.

The U.S. Department of Agriculture recently decreased its recommended daily amount of added sugar by 5 percentage points, now recommending added sugar be limited to 10 percent or less of calories per day, Kimberly Leonard reports for U.S. News & World Report. The USDA Dietary Guideline report notes that almost half (47 percent) of all added sugars consumed in the U.S. is from sugar-sweetened beverages.

BJC HealthCare in St. Louis offers specific guidelines about the amount of sugar children should consume.

• Preschoolers averaging 1,200 to 1,400 calories per day should limit added sugar to about 4 teaspoons (16 grams) per day.
• Children ages 4 to 8 who average 1,600 calories per day should limit added sugar to about 3 teaspoons (12 grams) a day. To fit in all the nutritional requirements for this age group, there are fewer calories available for added sugar.
• Pre-teen and teens averaging 1,800 to 2,000 calories per day should not have more than 5 to 8 teaspoons (20 to 32 grams) of added sugar per day.

The study found that 75 percent of the participating parents support warning labels being added to the containers, but support for such legislation hasn't gained much traction and is getting push-back from the beverage lobby.

NPR reports that while no city or state has been able to pass a law to add health warnings to sugary beverages, "California, New York and Baltimore all have legislation in the works requiring these labels on sugary drinks."

Leana Wen, Baltimore's health commissioner, told NPR that the beverage industry is pushing back hard in Baltimore, lobbying legislators to reject the warning label policy and using fear tactics with the small businesses, telling them they will be hurt by this law.

In addition, ,"Legislation in Congress to tax sugar and high-fructose corn syrup failed to advance last year, and a few years ago a court overturned a ban on jumbo-sized sodas in New York City. Last summer the beverage industry sued San Francisco over a law that required health warning labels on sugary drinks and that prohibited ads of them on city property, saying the law violated the First Amendment," Leonard writes for the U.S. News & World Report.

HealthDay reports that the American Beverage Association reviewed the study and issued this statement: "Consumers want factual information to help make informed choices that are right for them, and America's beverage companies already provide clear calorie labels on the front of our products. A warning label that suggests beverages are a unique driver of complex conditions such as diabetes and obesity is inaccurate and misleading. Even the researchers acknowledge that people could simply buy other foods with sugar that are unlabeled." The organization added: "With our Balance Calories Initiative, we are working toward a common goal of reducing beverage calories in the American diet."

Bevin says ending Kynect will cost 'small fraction' of estimate; warns lack of deal with feds means Medicaid expansion ends

By Al Cross
Kentucky Health News

FRANKFORT, Ky. -- Gov. Matt Bevin says shutting down the Kynect health-insurance exchange will cost "a small fraction" of the $23 million estimate given by then-Gov. Steve Beshear's administration.

"It's not going to be anywhere close to 23 million dollars," Bevin told journalists in a Tuesday afternoon briefing on the state budget, which he was to present to legislators with his State of the Commonwealth address a few hours later.

Bevin told Terry Meiners of WHAS Radio on Jan. 13 that the shutdown of Kynect would cost $1 million to $2 million, but be would not confirm that figure when asked about it in the briefing. He said then that he had discussed the matter with Deloitte Consulting, which set up the exchange.

"We don't know what the number is, but it's going to be a fraction of 23" million, he said, urging reporters not to "hype people who are just making stuff up," such as saying the cost could be even more. "The exact number we don't know, but it will be a fraction of that, a small fraction." In his speech, he said it would be "small single digits."

Former state health secretary Audrey Tayse Haynes told Kentucky Health News that Deloitte has lowered its estimates due to experience in another state, but by about half for less. Haynes said Bevin appeared to be counting on the federal government to pay 90 percent of the cost, which she said is in doubt. "They told us back in the spring or summer that there wouldn't be any match to take down something that was working successfully," she said.

Kynect has garnered national praise, but Bevin reiterated that it is redundant because the same functions -- buying federally subsidized health insurance or signing up for Medicaid -- can be performed on the federal insurance exchange, HealthCare.gov. Advocates of Kynect say Medicaid signup would be more difficult, because the federal exchange refers potential Medicaid recipients to their state agencies.

As for the 1 percent fee on all Kentucky health-insurance policies that funds Kynect, Bevin said "if it does not serve a purpose then it will go away." The fee is in law, which only the legislature can change. An executive order by Beshear changed the original purpose of the fee and created Kynect, so Bevin can abolish it. "Kynect is going away," he said. "A year from today there will not be Kynect."

However, Haynes said the state will still have to have a call center for its residents, in addition to the federal call center. "We're going to have a different kind of duplication of services," she said. The current call center, in Lexington, employs 175 people, she said.

The much larger part of Kentucky's embrace of federal health reform, expansion of Medicaid through higher household-income limits, is untouched by Bevin's budget because his administration is negotiating with federal officials for changes to the program that would make it less costly.

The federal government is paying the entire cost of the extension through this year. States will begin paying 5 percent next year, rising in annual steps to the law's limit of 10 percent in 2020.

"We have budgeted . . . as if we are making no change," Bevin said. "It would be imprudent of us not to budget for that." Medicaid is one of the areas exempt from the 9 percent budget cuts that Bevin's budget calls for in most state agencies, with the goal of shoring up state pension systems.

The Beshear administration, citing a study it paid for, argued that the expansion would pay for itself by bringing hundreds of thousands of people into the health-care system, generating jobs in the system and tax revenue from it. The state gained about 10,000 health-care jobs last year, but that was less than the projections, and some of those jobs would have been created anyway.

"Expanded Medicaid does not pay for itself," Bevin said in his speech. "Let's dispel that myth right now."

Bevin said the negotiations to change Medicaid will be for the entire program, not just the expansion. "All of that will ultimately lead to a change in structure that will be affordable to the people of Kentucky, or it will not," he said.

He said much the same in his speech, but added, "If we cannot get it done we will not have the ability have expanded Medicaid in the state of Kentucky."

Budget Director John Chilton said in the briefing, "Those are very complicated issues there that require a lot of thoughtful consideration."

Other areas exempt from the 9 percent cut include basic funding for school districts, including health insurance; and money for implementation of the anti-heroin bill the General Assembly passed last year. A few areas other than pensions would get increases, such as drug treatment, social workers, correctional employees, state police and children's advocacy centers, which fight child abuse and neglect.

Due to the exemptions and increases, the proposed reduction in non-pension spending from the last budget is only 2.5 percent. That is still a major cut, but Bevin starts with a huge political advantage, a state Senate that is controlled by Republicans. And he seems to think that they will stick with him, telling journalists, "I will not sign a bill that's tremendously different from what we're going to put out."

Foundation for a Healthy Kentucky lists its 2015 grants

The Foundation for a Healthy Kentucky invested more than $1.6 million in 2015 with community-based organizations, health-care providers, universities and health advocacy groups across the state, with a focus on polling and policy initiatives, according to a news release.

"Foundation funding supports innovative approaches to reducing health risks and promoting health equity and health care access for Kentuckians throughout the Commonwealth," Susan Zepeda, CEO of the foundation, said in a news release.

"Promoting Responsive Health Policy," one of the foundation's 2012-17 initiatives, includes a multi-year study of the Patient Protection and Affordable Care Act's impact in the state, including its impact on Kentucky's children; a three-year study of the state's transition to Medicaid managed care; the Kentucky Health Issues Poll; and support for Kentucky Voices for Health, Kentucky Equal Justice Center, Kentucky Youth Advocates, the Center for Smoke-Free Policy at the University of Kentucky, and the Kentucky Population Health Institute.

Another initiative, "Investing in Kentucky's Future," supports seven communities in developing and implementing strategies to reduce chronic disease risks in children to help them grow up to be healthier than their parents.

Six of the seven communities in this initiative received money in 2015 to implement their strategies, including: Kentucky River Community Care - Breathitt County ($115,800), Clinton County School District ($158,361), Fitness for Life Around Grant County ($182,033), Louisville Metro Department of Public Health & Wellness ($161,850), United Way of Paducah-McCracken County ($150,000) and Partnership for a Healthy McLean County ($87,065).

The foundation's grants to improve health literacy and communication includes support for Kentucky Educational Television; the Institute for Rural Journalism and Community Issues at the University of Kentucky, mainly for Kentucky Health News; the Next Louisville: Community Health project at WFPL-FM public radio; and the foundation's local health data website: www.kentuckyhealthfacts.org.

Several groups, including the Kentucky Public Health Association, Community Catalyst, The Healing Place, and Health Watch USA received conference support grants to help host health policy and equity conferences, seminars, and symposiums.

The foundation was created in 2001 from the charitable assets of Anthem Inc., recovered in a lawsuit by then-Attorney General Ben Chandler after the company converted from a mutual insurance firm to a stock company. Under a settlement, the $45 million was invested and only the earnings from it may be spent.

Three more Kentucky counties, two of them rural, recently approved needle exchanges, making six counties with them

By Melissa Patrick
Kentucky Health News

Jessamine, Carter and Elliott counties are the latest Kentucky counties to approve needle exchange programs, joining Fayette (Lexington), Jefferson (Louisville) and Pendleton counties.

The approval of exchanges in Carter and Elliott counties, in northeastern Kentucky, creates a major rural beachhead in a state where officials have said rural officials will be slow to adopt the strategy of preventing HIV, hepatitis and other diseases transmitted by illict drug users.

The major obstacle is a widespread belief that needle exchanges enable drug users, despite studies that say otherwise. That has created another big hurdle, lack of federal funding. However, Congress removed that obstacle last month at the behest of two Kentuckians: Senate Majority Leader Mitch McConnell and U.S. Rep. Hal Rogers, chair of the House Appropriations Committee.

The two Republicans had opposed federal funding for needle exchanges, but recently led the charge to get Congress to lift a ban that was enacted in 1988, lifted in 2009 and reinstated in 2011 The latest change was included in the omnibus spending package passed in December. The measure still doesn't allow federal funds to be spent on the syringes themselves, but it can be spent on relayed costs such as staff, transportation, counseling, treatment referral and outreach.

Not only does the lifting of this ban potentially bring much needed dollars into Kentucky to help pay for the exchanges, but the support of two top Republicans and the federal government could go a long way in convincing local governments to support needle exchanges in the state, Laura Ungar reports for The Courier-Journal..

Kentucky's needle-exchange program is part of the landmark heroin bill the General Assembly passed in 2015. It is intended to prevent the spread of disease and steer drug users toward treatment. Kentucky leads the nation in hepatitis C and suffers more than 1,000 drug overdose deaths each year.

However, the law requires local-government approval for needle exchanges, which has proven to be a challenge in many counties, even Northern Kentucky an urbanized area that has been hit hardest by heroin.

Jessamine County

Jessamine County Public Health Director Randy Gooch said about 20 county health boards have approved needle exchanges, but most have been thwarted by city or county governments, reports Rosalind Essig of The Jessamine Journal.

Gooch said he hoped Jessamine County's action would encourage other communities to start talking about needle exchanges and hoped that to do likewise.

“The more that smaller communities — maybe like Jessamine and Pendleton County — are able to engage the community and create these programs, the stronger that we become, from a public health perspective,” Gooch told Essig.

Jessamine County is the most recent county to get approval for a needle exchange. Its Fiscal Court voted 4-2 in favor of it Jan. 19. The Nicholasville City Commission, with a 4-1 vote, and the Jessamine County Board of Health had already given approval, Essig reports.

The county and city officials struggled with such concerns cost, efficacy, mandated counseling and whether the program enables drug use.

“I am excited, and it's been a long road," Gooch said after the final vote. "It's a difficult thing, I know, for elected officials and for the community, as well, because most people are very skeptical, because they think it's enabling the users.” Gooch told Essig that addicts will inject drugs regardless of whether they have clean or dirty needles.

As for the cost, Gooch said in the meeting that the health department would involve community partners and existing staff to do the work so that it would not incur a high cost, stating that he did not foresee a tax increase to pay for it. He noted that one of their partners is St. Joseph Jessamine, which will dispose of the needles for free. He estimated the program could grow to about 200 participants, putting the cost of the one-time-use-only syringes at about $4,300 a year.

Jessamine's program will operate one day a week at the local health department during normal business hours, and will provide a separate entrance for the participants. After initially providing addicts with clean syringes based on their level of drug use, the program will then require future needle exchanges to be one-for-one.

The Jessamine Journal recently published the first of a series of stories about heroin and its impact on the local community. The Woodford Sun has published a similar series, but its health board has not acted. Both communities are largely suburbs of Lexington.

Carter and Elliott counties

The Little Sandy District Health Department, which serves Carter and Elliott counties, has received a $3,900 grant from the Kentucky Agency for Substance Abuse Policy to help fund a needle exchange program through June. 30, at which point the district will cease to exist because Carter County is quitting it, Joe Lewis reports for the Journal-Times in Grayson. "The needle exchange program would presumably fall under the direction of the new Carter County Health Department," Lewis writes.

Carter County will have to re-evaluate whether it can maintain the program, Trena Greene, nursing supervisor for the health department, told Kentucky Health News.

Greene said the final protocol for the program was submitted Jan. 13 at the board meeting and awaits approval. She said it will be a one-for-one needle exchange, held on set days and times. It will be conducted at two offsite locations, one in Grayson and the other in Olive Hill.

Hepatitis C cases are being reported to our health department at "two or three or four a week," Greene said. It is "just phenomenal."

"When they come for the needle exchange, we can offer rapid hepatitis C and HIV testing," Greene said. "And of course, we will offer them resources and counseling at the time we make the connection," with the goal of getting the users into a treatment program.

Greene said Carter and Elliott counties and the Carter County towns of Grayson and Olive Hill gave approval for the exchange some time ago, and the state grant allowed it to move forward.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

As ads for electronic cigarettes increase, more teenagers are using the devices; Kentucky health officials notice trend

By Melissa Patrick
Kentucky Health News

Teenagers' use of electronic cigarettes tripled between 2013 and 2014, surpassing the use of all tobacco products, and federal officials are blaming unrestricted advertisement of the products.

Seven out of 10 middle-school and high-school students (69 percent) say they've seen e-cigarette ads in stores, online or in other media, with most of the ads using the same themes that have been used to sell traditional cigarettes for years: sex, independence and rebellion, according to a recent report from the U.S. Centers for Disease Control and Prevention.

"The same advertising tactics the tobacco industry used years ago to get kids addicted to nicotine are now being used to entice a new generation of young people to use e-cigarettes," Tom Frieden, director of the CDC, said in an online statement.

The "Vital Signs" report, published Jan. 5 in the CDC's Morbidity and Mortality Weekly Report, attributes the increase in e-cigarette use in youth with the increase in e-cigarette advertising.

"Spending on e-cigarette advertising rose from $6.4 million in 2011 to an estimated $115 million in 2014," says the report. "During 2011 to 2014, current e-cigarette use among high school students soared from 1.5 percent to 13.4 percent, and among middle school students from 0.6 percent to 3.9 percent."

Kentucky health official also links the two

A health educator at the Barren River District Health Department, Carol Douglas, told Wes Swietek of the Bowling Green Daily News that the regional agency has also seen an increase in e-cigarette use.

“We’re seeing more and more adolescents who have never smoked smoking e-cigarettes,” she said. “This is the new fad."

Several studies have found that e-cigarettes are often a gateway to smoking traditional cigarettes, including one from the CDC that found "never-smokers who had ever used e-cigarettes were nearly twice as likely to have an intention to smoke conventional cigarettes than never smokers who had not used e-cigarettes." Another study from the University of California came to the same conclusion.

“We’re hearing more and more about that,” Douglas told Swietek. “We’re doing more presentations at schools” as young people are “getting bombarded with ads for e-cigarettes."

E-cigarettes come with risks

“They are not just water vapor,” Douglas told Swietek. “There’s a [false] perception that it’s safe."

The Kentucky Center for Smoke-free Policy said e-cigarette cartridges and vapors often contain harmful and even cancer-causing chemicals such as formaldehyde, glycol, acetone and nicotine, Swietek reports.

In addition, some of the flavorings include diacetyl, a butter-flavored chemical, or a chemically similar substitute, acetyl propionyl, which are known to cause lung disease.

"The largely unregulated mixtures used to produce the vapors can leave particles in user’s lungs that can cause disease and respiratory problems," Swietek writes.

The center, at at the University of Kentucky, lists several other problems with e-cigarettes, including: e-cigarettes are not a proven cessation aid and could derail true cessation attempts; some e-cigarettes are marketed as “green” and “healthy,” which may encourage youth to experiment and become addicted; lack of regulation hinders research about safety and efficacy because the product keeps changing; and five minutes of e-cigarette use has lung effects similar to tobacco smoking.

"E-cigarettes typically deliver nicotine, which at a young age may cause lasting harm to brain development, promote addiction, and lead to sustained tobacco use," Brian King, deputy director for research translation at CDC's Office on Smoking and Health, said in an online statement.

Call to action

The CDC wants the U.S. Food and Drug Administration to regulate the manufacturing, distribution, and marketing of e-cigarettes. The FDA proposed regulations on e-cigarettes April 2014, but they have not been finalized.

The CDC report says, "This unrestricted marketing of e-cigarettes, coupled with rising use of these products among youth, has the potential to compromise decades of progress in preventing tobacco use and promoting a tobacco-free lifestyle among youths."

For a larger version of this map, click on it

For now, the CDC offers these strategies to decrease youth access to e-cigarettes: Limit product sales to places that never admit minors; restrict the number of stores that sell tobacco and e-cigarettes and how close they can be to schools; require face-to-face transactions; ban e-cigarette sales over the Internet; and require age-verification to enter vendor websites, to make purchases or to accept deliveries of e-cigarettes.

Kentucky school districts typically prohibit e-cigarettes when they go tobacco-free. Kentucky also restricts selling e-cigarettes to minors.

Jan. 31 is last day to sign up for health insurance; CareSource says 1/3 of its new enrollees are from old Ky. Health Cooperative

Sunday, Jan. 31, is the last day to sign up for subsidized health insurance through Kynect, the state's online insurance marketplace, or face a penalty when you file your tax return.

The 2010 federal health-reform law requires most people to have health insurance, or pay a penalty. For 2016, the penalty for not having health insurance is 2.5 percent of your income, or $695 per adult and $347 per child, with a maximum of $2,085 per family, whichever is higher.

There are a few exemptions, including: certain hardships, membership in some groups, some life-changing events, incarceration, if health coverage is considered unaffordable, or if household income is below the threshold for filing a tax return, according to Healthcare.gov.

For help getting coverage, you can call 1-855-459-6328, visit Kynect's website at kynect.ky.gov, or visit one of its two retail locations, at Mall St. Mathews in Louisville or Fayette Mall in Lexington. Kynectors, trained assisters who help people choose and sign up for plans, are also available in every county.

After Jan. 31, the only way to buy health insurance on Kynect will be if there's a major life event, like marriage or a change of employment. Those who qualify for Medicaid can apply year round. Gov. Matt Bevin is moving to close Kynect and transfer its function to the federal exchange.

Kynect has 10 companies selling health insurance to individuals and families, more than in the last enrollment period, but every company still doesn't offer plans in every county.

CareSource, a non-profit health plan that has been around for 26 years, serves 46 Kentucky counties, up from 16 last year, and reports that it has doubled its enrollment in the state this year, in large measure by picking up former customers of the Kentucky Health Cooperative, which was forced to close. The co-op, which is now in liquidation, sold 75 percent of the policies bought through Kynect last year.

The company said in an e-mail that its Just4Me plan "offers the lowest or second lowest premiums in the six major markets in Kentucky depending on age, size of family and other factors." Scott Streator, senior vice president of CareSource, said, "As of mid-January, one-third of new CareSource Just4Me enrollees were co-op members last year."

CareSource said it reached out to former co-op members by creating a webpage for them, dedicating a phone line for them and holding educational events focused on co-op members.

There's a big difference in hospitals, as various ranking systems show; op-ed analyzes the leading hospitals in Kentucky

Being a responsible health consumer requires some homework, especially when it comes to choosing a hospital, but if you wait until the emergency occurs it is likely too late to do a "thoughtful search," Dr. Kevin Kavanagh of Somerset, chairman of Health Watch USA writes in an opinion piece for the Lexington Herald-Leader.

Kavanagh explained that there are three types of reports available to consumers. U.S. News & World Report ranks mostly on the institutions’ capabilities, while patient safety is the main factor for Consumer Reports, The Leapfrog Group and Medicare’s penalty system for hospital-acquired conditions. Finally, there are patient surveys "which are largely decried by the industry as not truly reflective of quality," although others say "this is the score facilities have to worry about most," Kavanagh writes.

Kavanagh summarizes an analysis that revealed patterns across these ranking systems for high- and low-performing hospitals in Kentucky, along with a chart.

  (4) Centers for Medicare and Medicaid Services readmission penalty, up to 3% penalty on Medicare payments.

  (5) Rates of MRSA bloodstream infections. The national benchmark of 1.00 is the starting point, not the goal, so a value of 1 shows no improvement. Percentage is the penalty or bonus on the facility's Medicare payments.

  (6) CMS patient survey results, on a scale of 1 to 5 stars. This data is from Medicare's Hospital Compare site.

(+) Listed as: St. Elizabeth Healthcare - Edgewood/Grant/Covington

(++) Listed as Norton Hospital, Norton Hospitals, or Norton Healthcare

(+++) Listed as Jewish Hospital, Jewish Hospital & St. Mary's Healthcare or Sts. Mary's & Elizabeth Hospital; Consumer Reports only lists Jewish Hospital. CMS combines the data from Jewish and St. Mary's Healthcare; The Leapfrog Group(sm) surveys the hospitals separately and reports a safety score for both Jewish and Sts. Mary's & Elizabeth Hospital.

Read more here: http://www.kentucky.com/opinion/op-ed/article54997560.html#storylink=cpy

Here are some highlights of Kavanagh's analysis:

• Baptist Health Louisville, Baptist Health Lexington, St. Elizabeth Medical Center and Frankfort Regional Hospital appear to be the top performers.
• St. Joseph Hospital East in Lexington has fallen from a C to an F on the Leapfrog score and is receiving a penalty for hospital-acquired conditions, along with a 2.42 percent penalty for readmission of patients for the same condition within 30 days, more than twice that of other regional institutions.
• University of Louisville Hospital scored a C on the Leapfrog survey, has a high rate of methicillin-resistant staphylococcus areus (MRSA) bloodstream infections and is doing poorly on patient surveys.

"Bloodstream infections are only the tip of the MRSA iceberg," Kavanagh writes. "Overall, Kentucky has the nation’s second-highest rate of MRSA bloodstream infections, with the University of Kentucky and the University of Louisville being worse than the national benchmark."

He notes that only one hospital, Baptist Health Louisville, was ranked as better than the national benchmark, but writes that the benchmark should not be the goal, going so far as to calling it a failing grade because it is set at an "unacceptably high pre-intervention rate."

Other findings included:

• Baptist Health Lexington, Baptist Health Louisville, St. Joseph Hospital, St. Joseph East and St. Joseph Hospital London were cited in a U.S. Department of Justice settlement for false billing of non-Medicare approved insertions of cardiac devices, although the U.S. attorney "stated the settlements were heavily based on evidence-based medicine."
• St. Joseph London was also involved in a $16.5 million settlement for unnecessary heart procedures in 2014 and one of its staff cardiologists is currently serving a 30-month federal prison sentence.
• Baptist Health Lexington, Baptist Health Louisville, Frankfort Regional and St. Elizabeth Medical Center have achieved the prestigious Magnet designation, given by the American Nurses Credentialing Center. The University of Kentucky lost this designation in 2011 and has applied to regain it.

And while the Joint Commission accredits hospitals, almost all receive its Gold Seal of Approval, he writes, noting that St. Joseph East scored low on several ranking systems but has a Gold Seal. "Not achieving this designation would be a sign of major problems," he writes.

"Substantial quality improvements are needed in our health-care system in Kentucky and nationwide," Kavanagh opines. "Until this takes place, one should preemptively study and evaluate treatment options. As the old saying goes, 'Let the buyer beware,' for in health care, there is little opportunity to return or redo the service."

Paducah Sun and New York Times cross editorial swords over Gov. Bevin's plan to abolish Kynect health-insurance exchange

Gov. Matt Bevin's decision to close down the Kynect health-insurance exchange drew editorial criticism from The New York Times but an endorsement from The Paducah Sun.

"His shortsighted and pointless show of defiance against the Obama administration’s health care reforms could harm thousands of people in Kentucky, who may fall between the cracks as the state shifts their coverage from its own exchange, known as Kynect, to the federally run exchange," the Times opined.

The editorial said the change could be hard on people who want to sign up for Medicaid, the expansion of which Bevin has said is unsustainable and should be scaled back.

"If someone tries to sign up for private insurance but is judged by the exchange to be poor enough to qualify for Medicaid, the application is forwarded to Medicaid, which enrolls the person. If someone tries to sign up for Medicaid but is deemed ineligible by that program, the application is forwarded to the exchange for enrollment," the editorial said. "With the switch from Kynect to HealthCare.gov, the transfer of electronic information from the exchange to Medicaid is likely to be cumbersome, at least initially. People rejected by the exchange will need to submit a new application to Medicaid; some may not realize their information was not automatically forwarded or could get annoyed by the process and end up uninsured. Mr. Bevin needs to put a very high priority on providing a smooth exchange of information and enough enrollment assistants to help people find the right coverage."

Jim Paxton, editor of The Paducah Sun, said in an editorial the day before that Bevin is right to abolish Kynect because "there is no reason Kentuckians should underwrite the expense of the operation when the federal government is willing and able to do the task. In announcing he would deliver on his promise, Bevin noted that the state's exchange is paid for by a 1 percent tax on all health insurance policies sold in the state, both on and off the exchange. Bevin said during the most recent enrollment period only 85,000 Kentuckians, or 2 percent of the state population, bought policies on Kynect. An administration spokesperson said that policies sold on Kynect generate something less than $4 million of the $27 million it takes to operate the exchange annually, such that the vast majority of people paying to support the exchange are people who do not use it. When Kentucky moves to the federal exchange, there will be a 3.5 percent tax on policies purchased there, but it will only apply to people buying policies on the federal exchange."

Paxton concluded that since Bevin ran on the issue and was elected, "so it should come as no surprise that he is following through now. The issue over Kynect has never been whether it is functional or well-run. The question is whether it is needed. Voters have concluded that it is not."

87 cases of whooping cough reported in Kentucky during the last five months of 2015; best prevention is vaccination

Health officials are reminding people to get vaccinated for whooping cough, formally called pertussis, noting that there were 87 cases reported in Kentucky between August and December last year, The Courier-Journal reports. The highest concentration of cases during that period occurred in Jefferson County and in Northern Kentucky.

Image from the CDC; click on it for a larger version

Whooping cough is a highly contagious respiratory disease caused by bacteria transmitted by droplets from sneezing, coughing or close contact. Infected people are most contagious up to about two weeks after the cough begins.

Early symptoms of whooping cough look like a common cold, including runny nose, sneezing, mild cough and low-grade fever. After one to two weeks, long coughing spells develop, which often occur in explosive bursts, sometimes ending with a high-pitched whoop and vomiting. This can go on for up to 10 weeks or more, according to the federal Centers for Disease Control and Prevention.

Vaccination is the best way to prevent the spread of whooping cough, according to the CDC.

Whooping cough can cause severe or life-threatening complications in infants who are too young to have been fully vaccinated, making it especially important for those who care for them to be up-to-date on their immunizations.

"About half of babies younger than 1 year old who get pertussis need care in the hospital, and one out of 100 babies who get treated in the hospital die," says the CDC.

Infants are recommended to receive their first dose of pertussis vaccine, in combination with diphtheria and tetanus, at 2 months, 4 months and 6 months of age. Boosters are given as early as 12 months through 18 months and then around age 4 or 5. Older children and adults are encouraged to get a pertussis booster called TDaP.

“It’s important for communities to work together to control the spread of the disease,” Dr. Kraig Humbaugh, senior deputy commissioner at the state health department, told The Courier-Journal. “Developing community-wide immunity through vaccination is an important strategy for pertussis control. We strongly encourage those who haven’t done so to get an adolescent or adult pertussis booster vaccine.”

"Though anyone can get whooping cough, the illness can be particularly dangerous for pregnant women, infants younger than 12 months and anyone with a pre-existing health condition that could worsen with a severe cough," the Louisville newspaper reports.

More information about whooping cough can be found at www.cdc.gov/pertussis.

U of L gets grant for care for seniors, Alzheimer's and Hispanics in Barren, Hart, Metcalfe, Bullitt, Shelby and Henry counties

The U.S. Department of Health and Human Services has awarded the Institute for Sustainable Health & Optimal Aging at the University of Louisville $2.55 million to create the Kentucky Rural & Underserved Geriatric Interprofessional Program.

The three-year initiative will include partnering organizations from six rural counties: Hart, Metcalfe and Barren in Southern Kentucky; and Bullitt, Henry and Shelby, counties in the Louisville metropolitan area with large rural populations.

The project will addresses the shortage of workers in geriatric and primary care, the need to train health-care providers for culturally appropriate services to Kentucky’s growing Hispanic population, the need to decrease the chronic disease burden in rural Kentucky, the lack of supportive environments to promote health among seniors, and the need for supportive education and resources in Alzheimer’s disease and related dementias.

The institute, created in 2014, will develop an interprofessional education center for geriatric education for students and professionals in medicine, nursing, social work, dentistry, pharmacy, community health and law; help primary care sites deliver integrated patient-centered geriatric primary care; and provide training and community engagement resources for Alzheimer's and other dementias in the six counties.

“This project is unique in its integration of community health teams and mental health specialists within geriatric primary care delivery systems,” Institute Executive Director Anna Faul said in a press release. “We are going to use a systemic approach of collaborative care and develop an inter-agency consortium that strengthen the links among related services for older adults.”

Partner sites in the first year will be Glasgow Family Medicine Clinic serving Barren, Hart and Metcalfe counties; Shelby Family Medicine and Mercy Medical in Shelby County; Kentucky River Medical Partners in Henry County and UofL Geriatrics Home Care Practice in Bullitt County.

West Virginia researcher says mountaintop-removal mining correlates with poor health in Central Appalachia, including Ky.

Michael Hendryx

By Tim Mandell
Kentucky Health News

No apparent health disparity exists in Appalachia except in areas where mountaintop removal is occurring, said Michael Hendryx, professor at the School of Public Health at Indiana University, during a lecture Thursday at the University of Kentucky. Hendrix's lecture, "Mountaintop Mining and Public Health," examined scientific research—conducted by him and others—into health effects in Appalachia since large-scale mountaintop removal was introduced in the 1990s. Hendrix, who was part of a 2010 study that called for an end of mountaintop removal, did most of his research in West Virginia, which shares most of the Central Applachian coalfield with Kentucky.

Hendrix presented data comparing Appalachian areas that have mountaintop removal with Appalachian areas without it, showing that heart, lung and kidney disease, cardiovascular and respiratory disease, and birth defects are all typically more common in areas with mountaintop removal. Also, air and drinking-water pollution—consisting of both well water and public water—are usually higher in mountaintop removal areas.

Hendryx said politicians have stood in the way of eliminating mountaintop removal, despite plenty of scientific evidence of its negative impact on public health. "It's surprising the political and economic power that the coal industry still has," he said. "It doesn't produce the jobs that it used to. It's clearly in decline. Yet it seems to me that politicians will still fall all over each to see who's more pro-coal, and that still seems to influence voters."

While some have called efforts for clean energy a "war on coal," Hendryx argues that coal-depressed communities can find other ways to improve local economies. "Some of the regions have coal; some don't," he said. "They're hilly, they're forested, they're rural . . . the places that didn't have coal developed other ways for people to make a living. . . . If you look at the data, it's clear that the areas that have the heaviest mining have the highest unemployment rates, the highest poverty rates, the lowest income levels. The other areas that didn't have coal developed better alternatives to generate better economies."

Asked for a reply, Kentucky Coal Association President Bill Bissett said, “Anti-coal ideologue Michael Hendryx continues his road show against coal production and use by, once again, committing sins of commission in discussing his research. He won’t tell you that he gathers his data by employing environmental groups, like Restore Eden, to do his interviews, so should we expect any result than one that agrees with this anti-coal agenda?"

CDC is starting new round of 'Tips from former smokers' ads, mainly targeting Kentucky and other heavy-smoking states

The federal Centers for Disease Control and Prevention is starting a new round of anti-smoking advertisements, aimed primarily at Kentucky and other heavy-smoking states: West Virginia, Ohio, Mississippi and Louisiana. West Virginia leads the nation in smoking, at 27.3 percent of adults; Kentucky ranks second at 26.5 percent.

The $70 million campaign, starting Jan. 25, will continue the "Tips from former smokers" theme. "The new round of ads will run on TV, print, radio, online, and outdoors for 20 weeks," reports John Tozzi of Bloomberg News. "They include stories from an Air Force veteran in Texas who smoked heavily from a young age and had a heart attack in his 30s. Another new ad shows a woman who smoked while struggling with depression and anxiety. It shows pictures of her mouth after she lost teeth to gum disease." In another, a Tennessee woman says using electronic cigarettes didn't help her quit:

The ads would run-year round if Congress gave the agency more money, CDC Director Tom Frieden told Bloomberg. "The Tips From Former Smokers messages helped about 100,000 people quit in 2012, the first year of the campaign, according to research from CDC authors," Tozzi writes. "At less than $400 spent per additional year of life gained, the agency considers it one of the most cost-effective public-health interventions."

However, some think the ads aren't as effective as the could be, Tozzi reports: "John Ayers, a computational epidemiologist at San Diego State University, compared Google search patterns during the first two years of the Tips campaign. He says the similar ads didn’t pack the same punch the second time around, as measured by search queries for smoking cessation terms."

Nevertheless, "The CDC sees a clear link between when the ads run and calls to the 1-800-QUIT-NOW line that the messages promote to connect smokers with cessation aids," Tozzi writes. "Frieden is also aware that the message is dramatically outgunned by the tobacco industry. Tobacco companies spent $9.2 billion on promotion and marketing in the U.S., mainly in the form of price discounts, according to the Federal Trade Commission’s most recent tobacco report, which covered 2012."

In 2014, the three largest cigarette manufacturers spent a combined $257 million on advertising, "an amount that's nearly doubled in two years, according to company securities filings," Tozzi reports. "Tobacco companies are back on TV with ads for e-cigarettes after being banned from advertising on television since the Nixon administration. . . . The Food and Drug Administration is considering new rules for e-cigarettes but hasn’t suggested advertising restrictions."

Though he's being far outspent, "Frieden believes the ads help shrink the territory tobacco occupies on our cultural map," Tozzi reports. Frieden told him, “We went as a society from where a polite thing would be to say, 'Would you like a cigarette?' to where the polite thing was, 'Would you mind if I smoke?' to where you wouldn’t even ask that. That’s a huge shift in how we view smoking as a society.”

More in state say they know someone hurt by use of heroin, especially in Northern Kentucky

Foundation for a Healthy Kentucky chart; click on it for larger version

Northern Kentucky is the hotbed of heroin addiction in Kentucky, but use of the narcotic appears to be rising elsewhere in the state, according to the latest Kentucky Health Issues Poll.

Residents of Northern Kentucky residents are more than twice as likely as those elsewhere in Kentucky to report knowing someone with heroin problems, the poll found: 35 percent in Northern Kentucky and 13 percent statewide, with an error margin of plus or minus 2.4 percentage points.

Figures for other areas were: Greater Louisville, 17 percent; greater Lexington, 14 percent; Appalachian Kentucky, 10 percent; and Western Kentucky, 8 percent.

Overall, the poll found that 13 percent of Kentucky adults knew someone who had experienced problems from using heroin, up from 9 percent in 2013 and 11 percent in 2014.

The poll also found, not surprisingly, that young adults between the ages of 18-29 are the most likely to know someone with problems due to heroin; 25 percent of them said they did, and the numbers grew smaller as the age group grew older.

Many people who were using prescription painkillers switched to heroin after the state cracked down on "pill mills" that dispensed the painkillers, but prescription drug abuse remains a problem. Statewide, 25 percent of adults reported having family members or friends who experienced problems as a result of abusing the drugs, the same figure since 2013. Eastern Kentucky led with 33 percent and Western Kentucky trailed with 16 percent. The poll found that younger, white, lower-income adults are more likely to know someone with problems because of prescription drug misuse.

"This information can help Kentucky policymakers as they devise strategies to curb our state's drug problems," said Susan Zepeda, President/CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll with Interact for Health, formerly the Health Foundation of Greater Cincinnati.

The foundation notes that Kentucky ranks second in drug overdose deaths, tied with New Mexico and lower than only West Virginia. "Drug overdose deaths in Kentucky have quadrupled from 241 in 2000 to 1,077 in 2014," the foundation said. "Since 2008, more Kentucky adults have died each year from drug overdoses than from motor vehicle accidents.

The poll was conducted Sept. 17 through Oct. 7 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,608 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones.