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

By Melissa Patrick
Kentucky Health News

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

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

Graph: CDC Age-adjusted suicide rates by sex

Overall, the suicide rate increased from 10.5 per 100,000 people in 1999 to 13 per 100,000 in 2014, showing a steady 1 percent annual increase through 2006 and a 2 percent annual increase after that.

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

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

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

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

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

Rural areas have highest suicide rates

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Melissa Patrick
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mosquitoes can carry Zika. (NPR photo)

By Melissa Patrick
Kentucky Health News

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

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

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

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

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

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

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

Zika virus prevention strategy: Dress, Defend and Drain

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

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

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

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

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

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

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

Funding to fight Zika held up in Congress

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

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

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

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

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

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

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

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

UK study finds e-cigarettes aren't replacing traditional cigarettes, but their sales rise as unregulated TV ads for them increase

A study led by a University of Kentucky researcher found that electronic cigarettes have not become a substitute for traditional cigarettes, but their use is increasing, especially as television commercials for the products increase, Carol Lea Spence reports for UK AgNews.

“Cigarette purchases have dropped a bit, from about 90 percent to 80 percent of all tobacco products during the past 15 years, but it’s still a big player. Other tobacco product sales are growing, though—particularly e-cigarettes,” Yuqing Zheng, lead researcher and an agricultural economist in UK's College of Agriculture, Food and Environment, told Spence.

The study, published in The American Journal of Agricultural Economics, looked at the habit formation of non-cigarette products and studied usage in five categories, including: cigarettes, e-cigarettes, smokeless tobacco, cigarillos and cigars, Spence reports.

The study collected data from convenience stores in 30 U.S. markets, looking for evidence to support that e-cigarettes had become a substitute for traditional cigarettes. It also investigated whether consumers purchased products based on cost and advertising.

They found that when the price of e-cigarettes went up, it did not increase the demand for traditional cigarettes. And not surprisingly, it also found that the purchase of e-cigarettes increased with increased TV advertising, but not with increased magazine advertisements.

“This adds to the policy discussion,” Zheng told Spence. “While cigarettes are strictly regulated in terms of advertising, there are no advertising restrictions on e-cigarettes.”

The study also found that based on consumption patterns, all five tobacco products in the study were habit forming, and e-cigarettes had the "highest degree of habit formation," Zheng told Spence.

Zheng attributed that to three things: Most e-cigarettes contain nicotine, which is addictive; they can be used in places where traditional cigarettes are banned; and because they don't burn out, people use them for longer periods of time, Spence reports.

Zheng told Spence that there is no scientific evidence to prove e-cigarettes are less harmful than cigarettes, and noted that the study found that people will generally buy traditional cigarettes regardless of the price, but in general are "more responsive to price increases" of non-cigarette tobacco.

National Drug Take-Back Day is April 30; dispose of unused or expired drugs at most State Police posts from 10 a.m. to 2 p.m.

Kentuckians can get rid of their unused or expired prescription drugs Saturday, April 30 from 10 a.m. to 2 p.m. as part of National Drug Take-Back Day. The service is free and anonymous, no questions asked. Most collections will be made at Kentucky State Police posts.

"The goal of these programs is to reduce the volume of drugs that could end up on the streets and then used illegally," says the Kentucky Office of Drug Control Policy website.

All but two of the 16 KSP Posts will have "Take Back" locations on-site. Post 11 will have its collection at the Laurel County Health Department in London, and Post 8 will have a location at the Morehead Covention Center.

Sgt. Michael Webb, KSP spokesperson, said in the news release that the the program is designed to be easy for citizens and offered the following tips for those interested in participating:

• Participants may dispose of a medication in its original container or by removing the medication from its container and disposing of it directly into the disposal box located at the drop off location.
• All solid-dosage pharmaceutical products and liquids in consumer containers will be accepted.
• Liquid products, such as cough syrup, should remain sealed in original containers.
• The depositor should ensure that the cap is tightly sealed to prevent leakage.
• Intravenous solutions, injectables and syringes will not be accepted due to potential hazard posed by blood-borne pathogens.
• Illicit substances such as marijuana or methamphetamine are not a part of this initiative and should not be placed in collection containers.

Not including this Take-Back Day, "Kentucky has collected a total of 59,719 pounds of unused and/or unwanted prescription medications at all Drug Take-Back events and locations since October 2011," says the ODCP website. For more information about the Take-Back program, contact KSP at 502-782-1780 or click here.

Top deputy in state health department named commissioner of Lexington health department

Kraig Humbaugh

Dr. Kraig Humbaugh, senior deputy commissioner of the Kentucky Department for Public Health, has been named the Lexington-Fayette County commissioner of health, starting in June. He will replace Dr. Rice C. Leach, who died April 1 following a battle with cancer.

“I am honored to serve and look forward to working with the Board of Health, the hard-working team at the health department and the community to make Lexington a healthier place to live, work and visit,” Humbaugh said in a news release. “It’s important that we build on Dr. Leach’s legacy and the already strong foundation that the health department has in the community.”

A pediatrician by training, Humbaugh has extensive experience in public health, including epidemiology of communicable diseases and emergency preparedness and response.

“We are very excited to have Dr. Humbaugh join us as the next commissioner of health,” Paula Anderson, chair of the Lexington-Fayette County Board of Health, said in the release. “In addition to his exceptional background in public health, he has widespread leadership experience on the state level. He also knows Kentucky and has worked closely with the Lexington-Fayette County Health Department on many previous projects. All of those attributes made him the right choice to lead our health department.”

Humbaugh earned his undergraduate degree from Vanderbilt University and his medical degree from Yale University. He was a Fulbright Scholar at the University of Otago in New Zealand and received a Master of Public Health degree from Johns Hopkins University.

Want to avoid prostate cancer? Evidence suggests that one thing you could do, if you're a smoker, is to stop smoking

As fewer men are smoking, fewer are dying from prostate cancer, and the trends appear to be related, especially in Kentucky.

"From 1999 through 2010, decreasing prostate cancer mortality rates were consistent with a reduction in cigarette smoking at the population level," says the report, published in the journal Preventing Chronic Disease.

The study looked at four states: Kentucky, with the highest smoking rate (24.8 percent), Utah, with the lowest rate (9.1 percent), and Maryland (15.2 percent) and California (12.1 percent), with average rates.

Researchers found that in Kentucky and Maryland, smoking rates declined by 3 percent and prostate cancer deaths declined by 3.5 percent annually. Among black men in Kentucky, there was little change in the smoking rate or the prostate-cancer death rate.

In California and Utah, smoking declined by 3.5 percent annually, and prostate cancer deaths declined by 2.5 percent and 2.1 percent respectively each year.

The report says current cigarette smoking, rather than past or cumulative smoking, is a risk factor for prostate cancer development, progression, recurrence and death. The U.S. surgeon general named smoking as a cause of prostate cancer in 2014.

Men were classified as current smokers if they reported smoking at least 100 cigarettes in their lifetime and continued to smoke at least occasionally.

The researchers note that these findings do not prove causation, only that the two time trends were similar. They also noted that further studies should be done to include more states.

FDA launches its first advertising campaign aimed at rural youth about the dangers of smokeless tobacco

The U.S. Food and Drug Administration today launched a campaign on the dangers of smokeless tobacco among rural teens. FDA is expanding its “The Real Cost” campaign "to educate rural, white male teenagers about the negative health consequences associated with smokeless tobacco use," it says. "For the first time, messages on the dangers of smokeless tobacco use—including nicotine addiction, gum disease, tooth loss, and multiple kinds of cancer—are being highlighted through the placement of advertisements in 35 U.S. markets specifically selected to reach the campaign’s target audience."

FDA’s Population Assessment of Tobacco and Health study found that 31.84 percent of rural, white males ages 12 to 17—629,000 total youths—either experiment with smokeless tobacco or are at-risk, says FDA. "According to the Substance Abuse and Mental Health Services Administration, each day in the U.S. nearly 1,000 males under the age of 18 use smokeless tobacco for the first time—almost as many male teenagers who smoke their first cigarette—making early intervention critical and highlighting a need for targeted youth smokeless tobacco prevention."

The campaign will be conducted through advertisements on television, radio, print, public signs, billboards, the internet and social media, says FDA. The agency is also partnering with Minor League Baseball teams, with stadiums promoting tobacco-free lifestyles "by displaying campaign advertising and providing opportunities for fans to meet and interact with players who support the campaign’s public health messages." (Read more)

Here's a link to the campaign’s bites and B-roll package; the ads are also available on YouTube: https://www.youtube.com/playlist?list=PLgf1d4CujVYYl8IZmTz5hedERt3f19hED

Women in small-town America aren't living as long as before; alcohol, drugs, food, housing, jobs, education, pollution to blame

By Trudy Lieberman
Rural Health News Service

Those of us who grew up in small rural communities in the 1950s and '60s expected to have longer life spans than our parents.

The trends were in our favor. White women born in 1900 could expect to live, on average, just shy of 49 years; white men 46.6 years. Those were our grandparents and our neighbors. By 1950, life expectancy had climbed to 72 years for white women born that year and 66.5 for white men. By 2000, life expectancy was still increasing, with female babies expected to live to nearly 80 and males to almost 75.

America was on the rise, jobs were plentiful, antibiotics kept us from dying of strep throat, and polio vaccine kept us out of the iron lung. We thought things would only keep getting better. So I was dismayed to read a story in The Washington Post in April that blew holes in those childhood expectations.

The Post found “white women have been dying prematurely at higher rates since the turn of this century, passing away in their 30s, 40s, and 50s in a slow-motion crisis driven by decaying health in small town-America.”

That “small town America” was where I grew up. I contrasted the Post’s findings to the claims made by all those politicians who have told us we have the best health care in the world and who point to gobs of money lavished on the National Institutes of Health to find new cures and to hospitals promoting their latest imaging machines.

The Post found that since 2000, the health of all white women has declined, but the trend is most pronounced in rural areas. In 2000, for every 100,000 women in their late 40s living in rural areas, 228 died. Today it’s 296.

If the U.S. really has the best healthcare, why are women dying in their prime, reversing the gains we’ve made since I was a kid? After all, mortality rates are a key measure of the health of a nation’s population.

Post reporters found, however, that those dismal stats probably have less to do with health care – which we like to define today as the latest and greatest technology and insurance coverage albeit with high deductibles – and more to do with what health experts call “the social determinants of health,” such basics as food, housing, employment, air quality, and education.

Landmark studies examining the health of British civil servants who all had access to health insurance under Britain’s National Health Service have found over the years that those at the lowest job levels had worse health outcomes. Some of those outcomes were related to things like work climate and social influences outside work like stress and job uncertainty.

In its analysis, the Post found that the benefits of health interventions that increase longevity, things like taking drugs to lower cholesterol and the risk of heart disease, are being overwhelmed by increased opioid use, heavy drinking, smoking and obesity.

Some researchers have speculated that such destructive health behaviors may stem from people’s struggles to find jobs in small communities and the “dashed expectations” hypothesis. White people today are more pessimistic about their opportunities to advance in life than their parents and grandparents were. They are also more pessimistic than their black and Hispanic contemporaries.

A 42-year-old Bakersfield, California, woman who was addicted to painkillers for a decade explained it this way: “This can be a very stifling place. It’s culturally barren,” she said. There is no place where children can go and see what it’s like to be somewhere else, to be someone else. At first, the drugs are an escape from your problems, from this place, and then you’re trapped,” she told Post reporters.

I recently heard U.S. Surgeon General Dr. Vivek Murthy talk about his upcoming report on substance use. About 2.2 million people need help, he said, but only about one million are actually getting it. Murthy wants his report to have consequences as far reaching as the 1964 surgeon general’s report linking tobacco use to lung cancer. In 1964, Murthy noted, 42 percent of Americans smoked; today fewer than 17 percent do.

The Post story concludes that the lethal habits responsible for increasing mortality rates are cresting in small cities where the biggest manufacturer has moved overseas or in families broken by divorce or substance abuse or in the mind and body of someone doing poorly and just barely hanging on.

The Surgeon General has taken on an enormous task, but his efforts just might help the nation move its life expectancy trends back in the right direction.

What do you think is causing poor health in your community? Write to Trudy at trudy.lieberman@gmail.com.

Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed by the Nebraska Press Association.

Teens now more likely to use e-cigs than tobacco; health officials call for regulations and better education about the products

By Melissa Patrick
Kentucky Health News

The number of adolescents using electronic cigarettes has risen so much that more of them use e-cigs than tobacco products, says the federal Centers for Disease Control and Prevention.

The findings come from the National Youth Tobacco Survey, which collected data from about 20,000 middle- and high-school students across the country from 2011 to 2015.

Only 1.5 percent of high schoolers used e-cigarettes in 2011, but that zoomed to 16 percent in 2015, with most of the increase seen between 2013 and 2014. The number of middle-school students using e-cigarettes increased from less than 1 percent in 2011 to 5.3 percent in 2015.

Tobacco smoking with hookahs, or water pipes, showed a lesser but significant increase, rising to 7.2 percent from 4.1 percent among high-school students and to 2 percent from 1 percent among middle-school students.

During this same time frame, children's use of cigarettes, cigars and other tobacco products decreased. The share of high-school and middle-school students who reported smoking a cigarette in the last month dropped, respectively, to 9.3 percent from 15.8 percent; and to 2.3 percent from 4.3 percent.

The rise in e-cigarette and hookah use offset the decrease in traditional tobacco use, meaning there was no overall change in use of nicotine or tobacco products among middle and high school students between 2011 and 2015.

An estimated 25.3 percent of high school students and 7.4 percent of middle school students say they have used a tobacco or nicotine product in the past 30 days. That amounts to 3.82 million high school students and 880,000 middle school students.

The study did not give state-by-state figures, but Kentucky has long ranked high in youth tobacco use.

One of the reasons for the rise in popularity of e-cigarettes is that there are no restrictions on buying them on the internet, Carina Storrs reports for CNN after interviewing Brian A. King, deputy director of research translation in the CDC Office on Smoking and Health, who led the current research.

"The fact that we have a flavored product that is easier to access and possibly cheaper has created a perfect storm to lead to increased use," King said.

Also, King said, e-cigarette companies appeal to youth by advertising heavily on social media, selling trendy accessories and employing celebrities to market the products. King said older peers and family members could also be providing e-cigs, just as they have provided conventional cigarettes to.

Pediatricians have called for raising the smoking age to 21 and for the regulation of e-cigarettes.

As of April, 2016, 141 cities in 10 states and the state of Hawaii have raised the legal age to buy tobacco or vaping products to 21, according to the tobacco21.org website.

In Kentucky, Democratic Rep. David Watkins, a retired physician from Henderson, filed a bill this year to raise the legal age for buying tobacco or vaping products to 21, which made it out the the House Health and Welfare Committee, but was not called up for a vote on the House floor. Kentucky banned the sale of e-cigarettes to minors in 2014.

The Food and Drug Administration introduced a proposal in 2014 to oversee and regulate electronic cigarettes, but it has still not been finalized.

Dr. M. Brad Drummond, associate professor of pulmonary and critical care medicine at Johns Hopkins University School of Medicine, told Storrs that tighter restrictions are needed around purchasing, taxation, flavoring and advertising of e-cigarettes, noting that this would have an effect on "denormalizing their use." He also said teens need to be better educated about the harms associated with e-cigs.

If legislature won't help protect Kentuckians from the health threat of tobacco, local governments should, Herald-Leader says

Since the Kentucky General Assembly "adjourned without tackling the addiction that kills the most Kentuckians, tobacco," local communities need to take up the challenge, the Lexington Herald-Leader said in an editorial Sunday.

To drive home the primary role that tobacco plays in Kentucky's poor health, the newspaper ran a map of the most recent County Health Rankings, showing that "the places where smoking rates are highest have the worst health outcomes."

The Democrat-controlled state House passed a statewide ban on smoking in workplaces last year, but the bill got nowhere in the Republican-controlled Senate, and with new Republican Gov. Matt Bevin opposed to it and all House seats on the ballot this year, the bill didn't get a vote in the House.

Bevin has said smoking bans should be a local decision. The editorial says, "One of the cheapest, most effective ways to do that (since the legislature won’t) would be to join the places across Kentucky that have enacted local smoke-free laws." About one-third of Kentucky's population lives in jurisdictions with comprehensive smoking bans.

Read more here: http://www.kentucky.com/opinion/editorials/article72143017.html#storylink=cpyThe

Read more here: http://www.kentucky.com/opinion/editorials/article72143017.html#storylink=cpy

Study indicates fast food contains industrial chemicals linked to health problems such as infertility, diabetes and allergies

People who eat a lot of fast food have higher levels of chemicals that "have been linked to a number of adverse health outcomes, including higher rates of infertility," especially among men, Roberto Ferdman reports for The Washington Post.

Researchers at George Washington University in Washington, D.C., say the connection could have "great public health significance," Ferdman writes. "Specifically, the team found that people who eat fast food tend to have significantly higher levels of certain phthalates, which are commonly used in consumer products such as soap and makeup to make them less brittle. . . . The danger, the researchers believe, isn't necessarily a result of the food itself, but rather the process by which the food is prepared."

Here's how the study was done: Researchers analyzed diet and urinalysis data for nearly 9,000 people, collected as part of federal nutrition surveys in 2003-2010. "Food eaten at or from restaurants without waiters or waitresses was considered fast food. Everything else — food eaten at sit-down restaurants and bars or purchased from vending machines — was not," Ferdman writes. "The first thing the researchers found was that roughly one-third of the participants said they had eaten some form of fast food over the course of the day leading up to the urine sample collection," which fits with government estimates.

People who said they had eaten fast food in the previous 24 hours "tended to have much higher levels of two separate phthalates," Ferdman reports. Those who said they ate only a little fast food had levels 15 and 25 percent higher than those who said they had eaten none. "For people who reported eating a sizable amount, the increase was 24 percent and 39 percent, respectively. And the connection held true even after the researchers adjusted for various factors about the participants' habits and backgrounds that might have contributed to the association between fast-food consumption and phthalate levels."

The study was reported in Environmental Health Perspectives, a peer-reviewed journal funded by the National Institutes of Health.

"There is little consensus on the harms of phthalates, which are widely used in commerce and give materials such as food packaging added flexibility, except that exposure to them is widespread," Ferdman writes, citing the federal Centers for Disease Control and Prevention. "But there is growing concern that the chemicals could pose a variety of risks, particularly when observed in the sort of levels seen in the study."

Noting several other studies, such as those linking the chemicals to diabetes and allergies, Ferdman reports, "Many governments have moved to limit exposure to the industrial chemicals. Japan disallowed the use of vinyl gloves in food preparation for fear that their use was compromising health. The European Union, which limits the use of the chemical, has been nudging manufacturers to replace it. And the United States restricted its use in toys."

So, why do people who eat fast food seem to have much higher levels of these chemicals? That is unclear, Ferdman writes, "but it's easy enough to guess: the sheer amount of processing that goes into food served at quick-service restaurants. The more machinery, plastic, conveyor belts, and various forms of processing equipment that food touches, the more likely the food is to contain higher levels of phthalates. And fast food tends to touch a good deal more of these things than, say, the food one purchases at a local farmers' market."

Ferdman concludes, "It certainly seems as though eating fast food is more toxic than avoiding it, and not for the obvious reasons." He quotes Marion Nestle, the Paulette Goddard professor of nutrition and food studies at New York University: "Traditional fast food was never meant to be daily fare, and it shouldn’t be," said  "It’s too high in calories and salt and, as we now know, the chemicals that get into our food supply through industrial food production."

Governor kills bill that would have encouraged donation of organs and bone marrow; sponsor's primary foe is son of Bevin appointee

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin has vetoed a bill that would have allowed Kentuckians to take time off of work to be "living donors" or donate bone marrow without risk of losing jobs or income. The bill would have required paid leave of absence for such reasons, and offset the cost to the employer with tax credits.

Rep. Ron Crimm

"I was deeply disappointed," Republican Rep. Ron Crimm, sponsor of the bill, said in a telephone interview. "I thought it was a very good bill."

Crimm, from Louisville, said the Republican governor called him and told him it was a good bill, but that he wasn't accepting anything that would generate a cost to the state.

Bevin said in his veto message, "House Bill 19 is a noble and well-intentioned piece of legislation designed to encourage the generosity of time and financial resources by both individuals and employers. However, the financial costs and administrative burden on the Department of Revenue to implement House Bill 19 far outweigh the limited benefit this legislation can provide."

The Legislative Research Commission's fiscal note on HB 19 says it would cost about $100,000 to set up the system, but future cost would be "minimal." Crimm said he didn't think it would cost that much to set it up and that he told the governor so.

HB19 is modeled after a similar program in Pennsylvania, which allowed LRC staff to look at the fiscal impact of its tax credit as a point of comparison. They found that in a four-year period, Pennsylvania had only three taxpayers claiming a donor credit for a total of $3,505.

"Therefore,staff estimates that the revenue impact of the credit permitted by HB 19 would also be minimal," says the fiscal note. Crimm said, "It's nothing."

Tom Loftus of The Courier-Journal noted that Crimm faces a "stiff primary election" May 17 against Jason Nemes and that Nemes' father, Mike Nemes, a former state representative, is Bevin's deputy labor secretary.

Asked if he thought this might have influenced the governor's veto, Crimm laughed and said, "If that is true, then I'm very, very disappointed that I supported him." Then he said, "I don't think the governor would have done that." But then he said, using what he said is an old "Pennsylvania Dutch" expression, "It wonders me. ... Everybody, one-hundred-percent of the people in the House and the Senate, voted yea on the bill." The legislation passed 95-0 in the 100-member House and 37-0 in the 38-member Senate.

Study says proton-pump inhibitors, used to treat heartburn, acid reflux and ulcers, could increase the risk of kidney disease

webmd.com

Long-term use of commonly prescribed medications called proton-pump inhibitors, used for heartburn, acid reflux or ulcers, could increase the risk of chronic kidney disease, kidney failure or lead to a decrease in kidney function, according to new research  published in the Journal of the American Society of Nephrology.

In 2013, about 15 million Americans were prescribed proton-pump inhibitors, but the number of users is likely higher, because many are sold without a prescription, the American Society of Nephrology said in a news release.

Proton-pump inhibitors are sold under the brand names Prevacid, Prilosec, Nexium, Protonix, Aciphex and others. Nexium is one of the top ten drugs prescribed in the U.S., Troy Brown reports for Medscape Medical News.

The study looked at data from the U.S. Department of Veterans Affairs and found 173,321 people who used PPIs and 20,270 who took histamine H2 receptor blockers, an alternative class of drugs also used to treat heartburn.

Histamine H2 receptor blockers are sold under the brand names Tagamet, Pepcid, Axid and Zantac

Researchers analyzed the data over five years and found that patients who took PPIs had a 96 percent increased risk of developing kidney failure and a 28 percent increased risk of chronic kidney disease compared to the patients who took the histamine H2 receptor blockers. And those who used PPIs over a long period of time, were at a higher risk of having kidney issues, says the release.

"The findings suggest that long-term use of PPIs may be harmful to the kidneys and should be avoided. PPI use may not only increase the risk of developing chronic kidney disease, but may also increase the risk of its progression to complete kidney failure," says the release.

“The results emphasize the importance of limiting PPI use only when it is medically necessary, and also limiting the duration of use to the shortest duration possible,” Dr. Al-Aly, one of the researchers, said in the news release.” A lot of patients start taking PPIs for a medical condition, and they continue much longer than necessary.”

Kentucky is in the bottom 10 states for cancer-preventing HPV vaccination, probably because it has to do with sex

The human papillomavirus vaccination is nearly 100 percent effective in preventing precancers and noninvasive cervical cancers caused by two strains of the virus, but most parents in Kentucky and the nation are still not getting their adolescents vaccinated.

HPV is a group of more than 150 related viruses, which together are the most common sexually transmitted infections in the U.S.

An estimated 79 million Americans are infected with HPV and about 14 million more become infected each year, according to the federal Centers for Disease Control and Prevention. And while most HPV strains cause no symptoms and go away on their own, 10 percent of HPV infections lead to cancers of the cervix, vagina, vulva, penis, anus and throat.

The HPV vaccination was approved by the federal government 10 years ago and is recommended for all adolescent girls and boys 11 and 12 years old. Nationwide, fewer than half of girls and only one-fifth of boys are getting immunized.

Kentucky falls in the bottom 10 states for HPV vaccinations, with 37.5 percent of its girls and 13.3 percent of boys aged 13 to 17 vaccinated as of 2014.

The vaccine can be given to females as old as 26 and males as old as 21, but early vaccination is important. The vaccine is less effective if a person has already been exposed to the virus, because it works to prevent HPV before exposure, and not to treat existing HPV infections or associated diseases. Vaccinating adolescents better protects them before they are likely to become sexually active and exposed to the virus.

And therein lies the key reason health experts say most parents don't get their children vaccinated and health providers are hesitant to push this potentially life-saving vaccine: It has to do with sex, Michael Ollove reports for Stateline.

But guess what? Almost 42 percent of Kentucky's high-school students say they have had sexual intercourse, and almost one-third of them say they are currently sexually active, according to the 2015 Kentucky Youth Risk Behavior Survey. And, almost 10 percent of the state's middle-school students say they have had sex.

Opponents of the vaccine being given to adolescents argue that it encourages them to engage in sex because it removes the fear of contracting HPV, but at least one study shows no increase in sexual activity in girls who have been immunized, Ollove reports.

Health officials often lament that the vaccine wasn't originally sold to the public as an anti-cancer vaccine rather than one to prevent a sexually transmitted disease, Ollove reports.

“It should have been pushed out as an anti-cancer drug,”Walt Orenstein, a professor of medicine at Emory University and the former director of the National Immunization Program at the CDC, told Ollove. “People didn’t understand why their children needed this drug when they were still years away from being sexually active.”

Ollove notes other reasons for low vaccination rates: Health-care providers often don't stress the importance of the vaccine; many don't promote the vaccine because they aren't comfortable talking about sex with their young patients or their parents; and many providers feel the vaccine is not urgent because most adolescents in middle school are not sexually active. Another barrier is that the the HPV vaccine requires three inoculations over several months; the CDC shows a dramatic drop-off between the first and last doses.

Citing Noel Brewer, who does research on immunizations at the University of North Carolina and has studied parental and provider attitudes toward HPV, Ollove writes, "Contrary to what doctors may believe, parents are interested in the vaccine and a strong recommendation from a physician correlates highly with youngsters getting the full course of vaccinations."

Ollove notes that mandatory HPV immunizations have not proven to be successful. “Mandates are a last resort after you’ve built consensus that they are a good thing to do,” Orenstein told him.

Health policy researchers say that "reminder and recall" notices are the best way to keep patients up to date on vaccinations, and yet this is not a common practice, Ollove reports.

Insurance will cover the cost of the HPV vaccine and the Vaccines for Children Program will cover the vaccine at no cost for children who don't have insurance and are younger than 19. Call 800-232-4636 for more details.

The Kentucky Rural Health Association in collaboration with the Kentucky Immunization Program and the state Division of Women's Health will be hosting Kentucky's HPV Summit, "HPV: You ARE the Key!," at the Embassy Suites in Lexington June 21. The cost is $40 until June 1 and $55 afterward. Click here to register.

Teens who talk to their parents about sex make the best choices; Clark County will offer parenting classes on sex communication

In an average Kentucky high school class of 30 students, almost 13 of the teenagers say they have had sexual intercourse at least once, but many of them have never discussed sex with their parents.

And while Kentucky parents may think their children are learning about sex in the classroom because Kentucky mandates sex education, they may not realize that the state has no set curriculum for fact-based, comprehensive sex education, and the only thing required to be taught is abstinence -- an approach that has been proven ineffective, Aaron Yarmuth reports for Leo Weekly in an in-depth article about sex education in the state.

This lack of parent-teen communication about sex has prompted a study in Clark County that will include classes to help parents become more comfortable talking about sex with their children, Whitney Leggett reports for The Winchester Sun.

The classes will be led by Shannon Phelps of Winchester as part of her research to earn a doctorate in interdisciplinary education sciences from the University of Kentucky, Leggett reports. It is funded by a $15,700 grant from the Clark County Community Foundation.

“Because the subject matter is not one that many people are comfortable with, part of the objective is to help increase parents’ comfort in discussing sexual health topics so they will be more likely to address those topics with their children,” Phelps told Leggett.

"The overall goals of the program are to increase frequency and quality of parent-child sexual health communication, improve parents’ comfort and confidence in their communication with their children about sexual health topics and increase openness of sexual communication between parents and their children," Leggett writes. "Topics will range from abstinence to safe sex, contraception, resisting peer pressure and communicating with potential partners, among others."

Phelps said the six week courses will promote parent-child sexual health communication, which is associated with better sexual health outcomes for young people.

“Research tells us that children, especially adolescents, who have parents who communicate with them about sexual health topics have better sexual health outcomes,” Phelps told Leggett. “That follows logic... Sometimes parents are hesitant to talk to their children for fear that they’ll go and have risky sexual behaviors, but research tells us the opposite.”

Phelps told Leggett that studies show that when parents talk to their children about sex, "it can delay the onset of sexual behaviors and reduce unintended outcomes like sexually transmitted infections and unintended pregnancies," Leggett writes.

For more information email Phelps at shannon.phelps@uky.edu, or call 859-621-1065.

A study published in the Pediatric Journal of the American Medical Association found that nearly one-fourth of youth report that they have not discussed sexual topics with their parents, and even fewer report that they have had meaningful, open conversations with them about this subject. The study attributes this poor communication to parental embarrassment, parents' lack of accurate knowledge of the subject, and poor self-efficacy.

It's a topic that needs discussion in Kentucky because almost 10 percent of the state's middle-school students have had sexual intercourse and almost one-third of its high school students are sexually active, according to the 2015 Kentucky Middle and High School Youth Risk Behavior Survey.  The survey found that overall, 41.7 percent of Kentucky's high school students have had sexual intercourse at least once.

And there is an obvious disconnect related to birth control. Kentucky ranks seventh in teen births, at 39.5 births per 1,000 females aged 15 to 19, according to America's Health Rankings. The 2015 YRBS found that 14.5 percent of high school students did not use any birth- control during the last time they had sexual intercourse.

Peanut butter can be a healthy choice, but you have to read the labels; gimmicks to improve taste not the best for nutrition

Peanut butter has long been considered a healthy food choice, and for the most part it still is, but with the advent of low-fat brands, flavored peanut butters and companies adding preservatives to lengthen shelf life, not all peanut butters are equally nutritious, Jose Aguayo and Ryan Canavan report for the Environmental Working Group.

Originally, peanut butter was made from one ingredient: ground roasted peanuts. But now, commercial brands have added sugars, salt, hydrogenated oils and other preservatives, and some are less acceptable than others.

For example, "reduced-fat peanut butters are some of the worst offenders," the authors write. To reduce the fat calories, manufacturers will often take out the healthy monosaturated fats but then add sugar and salt to improve the taste.

Most commercial brands also add hydrogenated oils, as well as preservatives like potassium sorbate, to extend peanut butter's shelf life. The authors note that over 80 percent of peanut-butter brands have hydrogenated oils, which introduce "artery-clogging saturated and trans fats to peanut butter's otherwise-healthy fat profile."

"For a healthy heart, the American Heart Association recommends avoiding foods with hydrogenated oils, including peanut butter," the authors write. So, read the labels when choosing a peanut butter to determine which ones have the least salt, sugar, hydrogenated oils and preservatives, remembering that the healthiest peanut butters are made from just ground roasted peanuts and a pinch of salt.

It should also be noted that while peanut butter can be a healthy choice, it is high in calories and should be eaten in moderation. A standard serving of peanut butter is 2 tablespoons, which is about the size of a golf ball. This amount has about 190 calories.

Spring fever: If over-the-counter medicines don't quell your allergies, it's a good time to see an allergist

By Ann Blackford
University of Kentucky

The beauty of spring is upon us, but as lovely as it may be to look at, it can wreak havoc in your nose, throat and eyes. The higher the pollen count, the greater the misery.

Seasonal allergies are the result of a chain reaction that starts in your nose. If you are allergic to pollen, the immune system will overreact by producing allergic antibodies. The antibodies attach cells in your airway and cause release of chemicals, causing an allergic reaction.

Many people find relief in some very effective over-the-counter medications. If OTC medications don't provide relief, or cause significant side effects, this is a good time to visit an allergist. An allergist/immunologist is a pediatrician or internist who has spent an additional two to three years of training specifically in this field.

Allergists will discuss treatment options: typically allergy avoidance, followed by medical management, and lastly allergy injections.

Allergy shots are the only known cure to date for allergic rhinitis (nasal allergies). The concept behind allergy shots — allergy immunotherapy — is that the immune system can be desensitized to specific allergens that trigger allergy symptoms, thereby building up resistance or tolerance to the allergens.

Allergy shots generally work in two phases. The buildup phase can last from three to six months and involves receiving injections in increasing amounts of the allergen and are taken once or twice a week.

The maintenance phase begins when the most effective dose is reached. The dose can be different for each person, depending on how allergic you are and your response to the build-up injections. Once the maintenance dose is reached, there are longer periods of time between injections, typically two to four weeks.

Some people will experience relief of their symptoms during the build-up phase, but for others, it may take as long as 12 months on the maintenance dose. If there is no improvement after a year, your allergist may discuss other treatment options.

Allergy shots are a good option for people with allergic rhinitis (hay fever), allergic asthma, conjunctivitis (eye allergy) or stinging insect allergy. Shots can be given to children as young as four to five years old.

Shots are not recommended for food allergies, but can help in patients with oral allergy syndrome. This syndrome occurs in patients highly allergic to pollens; the body reacts to cross-reacting foods, and causes itching of the mouth and tongue. Allergy shots are not started on pregnant women but can be continued on patients who become pregnant while on shots.

Recently the Food and Drug Admimistration approved allergy drops or sublingual immunotherapy for grass and ragweed allergy. However, most patients have many confounding allergens (i.e. trees, molds, mites, animal danders), which can be included in allergy shots, thus making shots much more effective.

Poll finds many Kentuckians continue to struggle with cost of health care, though fewer are uninsured and struggling

While having health insurance certainly eases the cost burden of health care, nearly one-third of Kentucky adults struggle to pay their medical bills whether they have health insurance or not, and two in 10 say they often delay or skip needed medical care because of the cost, according to the latest Kentucky Health Issues Poll.

The poll, taken Sept. 17-Oct 7, found that in 28 percent of Kentucky households, someone had trouble paying medical bills in the previous 12 months. This didn't vary much between those with or without insurance, and was about the same as in 2014.

However, fewer Kentucky adults without insurance said they had difficulty paying their medical bills in 2015 than in 2014: down to 31 percent from 47 percent. In 2014, the Patient Protection and Affordable Care Act was fully implemented in Kentucky with expansion of the federal-state Medicaid program to people with incomes up to 138 percent of the federal poverty level.

According to the Kaiser Family Foundation, the average annual out-of-pocket cost per person for health care in the United States in 2014 was $1,036,which includes costs for any expenses not covered by insurance, says the report.

The Kentucky Health Issues Poll also found that 20 percent of Kentucky households did not get the medical care they needed, or delayed care because of the cost, in the past 12 months. This was more common among Kentucky's uninsured (27 percent) than those with insurance (19 percent).

However, these figures were an improvement from 2009, when 58 percent of uninsured Kentucky adults said they delayed or didn't get needed care, and from 2014, when 38 percent said so.

Poorer adults, those eligible for Medicaid, were more likely to forgo health care because they can't afford it; 29 percent of them said they had in the previous year, while only 16 percent of people with higher incomes said so.

"Being able to access medical care and being able to afford that care are two important factors to improve health in Kentucky," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in a news release. "KHIP data indicate that fewer Kentucky adults are delaying medical care. This helps Kentuckians get and stay healthier, getting timely preventive services and early help with management of chronic conditions like diabetes and asthma and with smoking cessation counseling."

The poll was conducted by Institute for Policy Research at the University of Cincinnati and for the foundation and Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed a random sample of 1,608 adults via landline and cell phone, and has a margin of error of plus or minus 2.4 percentage points.

Mary Hass of Louisville gets national brain-injury advocacy award

Mary Hass (image
from BIAK Facebook page)

Mary Hass, the volunteer advocacy director at the Brain Injury Association of Kentucky, was one of four medical professionals recognized for their accomplishments in the field of brain injury during the North American Brain Injury Society's 13th annual conference.

Hass, of Louisville, is the first ever recipient of the NABIS Michael Davis Advocacy Award, named in recognition of a board member who passed away last year.

The award was given in honor of her "commitment and dedication to the field of brain injury and her advocacy work to establish programs and service for persons with brain injury in Kentucky, many of which serve as models for similar efforts around the country," says the release.

The conference, recently held in Florida, was attended by almost 400 multidisciplinary brain injury professionals from around North America who gathered to learn and share the latest developments from the field of brain injury. The principal mission of the organization is moving brain-injury science into practice.

Kenton County embraces its once-controversial smoking ban as chances of a statewide ban have dimmed

Five years after Kenton County's smoking ban took effect over great opposition, the county has embraced it, Scott Wartman reports for the Cincinnati Enquirer.

"I'm a smoker, but I'm glad we're non-smoking," Justin Meade, a bartender at Molly Malone's in Covington, told Wartman. "I don't want to smell like smoke."

Kenton is the only Northern Kentucky county with any type of indoor smoking ban. Its partial ban allows establishments that don't serve people under 18, like bars, to have smoking.

Wartman reports having trouble finding anyone who didn't support the smoking ban as he walked among the Covington bar scene, and noted that a Northern Kentucky Health Department report cites very few complaints.

"I think what folks should take away from this is comprehensive smoke-free laws are easy to enforce, that most people like them and that they protect everyone," Stephanie Vogel, population-health director for the health department, told Wartman.

"The nonchalant acceptance, and even enthusiasm from some, of the partial smoking ban in Kenton County contrast with the controversy when it was enacted five years ago," he writes, noting that five years ago some bar owners thought the ban would put them out of business and patrons "lamented" that it was "an attack on their rights."

Amy Kummler, owner of Up Over bar, which can still allow smoking because it doesn't serve anyone under 18, told Wartman that she wouldn't mind if indoor smoking were banned statewide, but "feels smoking bans limited to one county or city are unfair," he writes.

"I don't even want to sit in my bar when it's smoky a lot," Kummler said. "I would be thrilled if the state went non-smoking, but I don't think it would be fair unless everybody did it."

Kentucky legislators have tried to pass a statewide smoke-free workplace law for years, but to no avail. Last year a bill passed out of the House, but was not called up for a vote in the Senate. This year, an election year, the bill wasn't even called up for discussion in committee. New Republican Gov. Matt Bevin opposes a statewide smoking ban.

"Last year we thought it was our year," Heather Wehrheim, chairwoman of Smoke-Free Kentucky, told Wartman. "It was the perfect scenario ... the public support was there; we thought we had the votes. It was Senate leadership that blocked it. Their argument, and whether it's true or not, is that it should be left up to local communities to pass smoke-free laws. We know that is going to take years and years and years."

The latest Kentucky Health Issues Poll found that two-thirds of Kentucky adults support a comprehensive statewide smoking ban, and have since 2013. The ban has support from solid majorities in each political party and has majority support in every region of the state. But more than one-fourth of Kentucky adults are smokers.

Rural drug-overdose rates, high in Kentucky, blamed partly on limits on treatment medication and mental-health services

"People in rural areas of Appalachia are more likely to die early deaths than in other parts of the country," and a big reason is that they "die from drug overdoses at greater rates than the rest of the country," writes Kery Murakami, the Washington, D.C., reporter for Community Newspaper Holdings Inc.'s CNHI News Service.

Murakami notes that in Leslie County, Kentucky, 7.9 of every 10,000 residents overdosed each year in 2012-14. "That’s six times the national rate," and third in the nation, he writes, citing the annual County Health Rankings done for the Robert Wood Johnson Foundation by the University of Wisconsin Population Health Institute. Several other Appalachian counties in Kentucky and West Virginia rank high.

The rates are high partly because "addicts in some parts of the country get turned away by doctors and are not given a drug called buprenorphine that is used to kick opioid addictions," Murakami reports, citing addiction experts. "Buprenorphine causes less euphoria and physical dependence and can ease withdrawal and cravings."

However, "Federal law caps the number of patients to whom a doctor is allowed to prescribe the drug, out of concern of creating places where large numbers of addicts receive opioid-based medication. Such treatment hubs, much like methadone clinics, bring unwanted community opposition, said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. That limits treatment choices in rural areas, where one doctor might be the only one licensed to prescribe buprenorphine for hundreds of miles."

The Department of Health and Human Services is moving to ease the limits, and Sens. Ed Markey, D-Mass., and Rand Paul, R-Ky., want to go even further. "But some addiction experts are concerned that raising the caps on buprenorphine will nudge the country toward treating addiction with medication rather than counseling, Murakami reports. The department’s proposed rules would require mental-health care, which is often hard to get in rural areas. The senators’ bill would not.

“Turning people away from the most evidence-based treatment we have for a chronic, life-threatening disease is heart wrenching for a doctor,” Dr. Kelly Clark, president-elect of the American Society of Addiction Medicine, told CNHI. “Rural areas have been hit hardest by this round in overdoses, which is the worst round of overdose deaths in our country.” She said medication is especially important in rural areas because opioid use spreads among families. “In rural areas, you’re treating the person, their parents and grandparents,” she said. “Entire families are addicted. It’s not like saying, ‘Stay away from certain friends,’ if they’re shooting up with their sister and their mother.”

In Pineville, a new administrator from a Texas management firm is shaking up the local hospital in an effort to save it

Kentucky Health News

The crisis in rural hospitals is driven not only by changes in federal reimbursement and patients' increasing preference for larger hospitals, but in some towns by managerial shortcomings that may follow local tradition but hurt the bottom line. Changing those practices can be difficult, but the new administrator of the Pineville Community Hospital appears to be having success as he grabs the bull by the horns.

Stace Holland (Modern Healthcare photo by Harris Meyer)

Longtime rural hospital administrator Stace Holland has put PCH "on the road to recovery by cutting costs, bringing in more federal funds and getting staffers to change their ways," Modern Healthcare reports in a long story than delves into the details, from specific expense cuts to clashes with physicians.

The 120-bed hospital is staffed for only 30 (not counting a 26-bed nursing unit) and was losing $6 million a year. Eight months after taking over as CEO, "Holland is well on the way to turning around a struggling not-for-profit facility that still expects to lose $3 million this year. With support from the Plano, Texas-based Community Hospital Corp., which took over management of the hospital in October 2014, Holland already has made significant progress toward stabilizing its finances," Harris Meyer reports.

"Holland faced a challenge that is all too familiar to rural hospital leaders around the country: declining patient volumes; a preponderance of low-paying Medicare, Medicaid and uninsured patients; public and private rate squeezes; high incidence of chronic disease and drug abuse; difficulty in recruiting physicians; and a shortage of funds to invest in new equipment and services. . . .  To save the hospital, whose previous CEO served nearly 40 years, Holland, Chief Nursing Officer Dinah Jarvis, and CHC knew they had to take tough steps that would unsettle physicians, staffers and local residents accustomed to the old comfortable ways."

The new ways included a partnership with the Baptist Health hospital in Corbin to help PCH compete with the Appalachian Regional Hospital in nearby Middlesboro, partly with a 12-bed geriatric psychiatry unit; a federal rural health facility license that significantly boosted Medicare and Medicaid payments," and "clinical protocols to improve quality of care and reduce readmissions," which were so frequent in 2013 and 2014 that they drew Medicare's maximum penalty, Meyer reports. But the new protocols, such as "pre-discharge education of congestive-heart-failure patients about medication use and weight monitoring," riled some physicians.

Dr. Steven Morgan told Meyer, “They want to pound square pegs into round holes.” Dr. Shawn Fugate said he had to fight with CHC for "what he thought were adequate nurse staffing levels, and that CHC is making too many important decisions from afar," Meyer reports. As an employee of CHC rather than the hospital, Holland can "speak frankly," Meyer writes. "He recently told an older surgeon who serves on the board that it was time for him to retire."

Pineville is on the old Wilderness Road (in red) and US 25-E.

Pineville Mayor Scott Madon told Meyer, “Stace has an unbelievable task in what he's dealing with. He's trying to reinvent the rural hospital. He has to change the whole thinking, and people don't like it.” But longtime hospital board member David Gambrell, a real-estate agent whose son will start as a family physician there soon, said Holland's approach has been “refreshing. . . . We need that kind of honesty. It's taken Stace coming here to see we needed a new vision.”

Meyer reports, "Local leaders see the Pineville hospital's survival as pivotal to the future of the town and Bell County, which has no other hospital and has lost many coal-mining jobs. They say the hospital, the city's largest employer, is key to their economic redevelopment efforts. . . . The Pineville hospital has strong customer loyalty. Its staff—most of whom are local residents who have worked there for many years—have deep ties to the patient population." Wilma Sizemore, a 70-year-old disabled woman who was admitted in mid-February for bronchitis and dizziness, told him, “I wouldn't doctor nowhere else but this hospital. They treat me like family here.”