State Medicaid boss says program won't charge premiums but may have fewer benefits; Bevin's office says all is still on the table

The state's revised Medicaid program won't require any beneficiaries to pay premiums, but it may offer fewer benefits, Medicaid Commissioner Stephen Miller told Adam Beam of The Associated Press.

But Gov. Matt Bevin's office told Beam that Miller's comments were preliminary: "Everything is on the table and no decisions have been finalized," spokeswoman Jessica Ditto told him.

Bevin has said Medicaid recipients should have some "skin in the game" and has pointed to Indiana, which received a federal waiver allowing it to charge premiums based on income levels to people who want benefits beyond the basic Medicaid program.

The idea drew strong opposition from health-care providers, consumer advocates, public-health professionals and representatives of higher education in a May 12 meeting, according to the Foundation for a Healthy Kentucky, which convened the gathering.

"Miller said negotiations with officials at the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services, indicate they will not approve a plan that requires Kentucky's expanded Medicaid population to pay for a portion of their health insurance," Beam reports.

Miller told him, "That, today, is not part of the plan. That is something that's going to be a tough sell."

Bevin is seeking changes that will save the state money. Starting Jan. 1, it will have to pay 5 percent of the costs of those who have joined Medicaid under the expanded eligibility created by the federal health-reform law. Its share will rise in annual steps to the law's limit of 10 percent in 2020. The state's expected bill for 2017 and the first half of 2018 is $257 million.

Now it seems that savings are likely to come by cutting benefits. "Miller said some Medicaid recipients could see fewer benefits under the new plan," Beam reports. "He said the health insurance plan for the state's Medicaid recipients is better than the basic plan offered to state employees. He said the new plan will likely bring the Medicaid plan more in line with the health plan offered to state workers." Miller said, "That would be a reduction in some benefit levels, such as in vision, dental."

Also, Miller said the program could encourage healthier behaviors by funding health savings accounts if they did such things as participating in smoking-cessation and weight-loss programs. "It may sound like we are rewarding them for that, but the long-term effect is it makes their health care coverage less expensive,"  Miller told Beam.

He said the state hopes to submit its waiver application in September. HHS spokesman Ben Wakana, told Beam that any changes "should maintain or build on the historic improvements Kentucky has seen in access to coverage, access to care, and financial security." Before the expansion; 20 percent of Kentuckians had no health coverage; now the figure is 7.5 percent.

Clark County schools to provide mental health services via contract with agency that can bill Medicaid or private insurance

Facing a surge in behavioral health cases among students, the Clark County Board of Education has contracted with a mental-health agency services for all preschool through high school students in the district.

Mountain Comprehensive Care will place a mental health therapist in every school to address issues immediately, at no cost to the district, Whitney Leggett reports for The Winchester Sun: "In the past three years, the district has seen the number of students in the home-hospital program because of mental-health issues surpass those with physical ailments."

Greg Hollon, director of pupil personnel and support services, told Leggett, “Previously, about 80 percent of home-hospital students were for physical ailments and 20 percent for mental. Fast forward a couple of years later, and that has switched to 65 percent mental, 35 percent physical.”

Hollon said the therapists at each school will help the district stay on top of problems. “This puts someone in the buildings full time to be there to address issues as they occur,” rather than requiring staff to call Mountain or some other agency.

Mountain, based in Prestonsburg, is able to provide the service without charge because it can bill Medicaid or private insurance.

Pediatricians' national group calls for at least one nurse in every school; Ky.'s schools have a long way to go to meet that goal

By Melissa Patrick
Kentucky Health News

Kentucky's high schools fall far short of new recommendations by the American Academy of Pediatrics that call for every school in the United States to have at least one nurse on site.

Only 42.2 percent of Kentucky's high schools have a full-time nurse, 37.4 percent have a part-time nurse and 20.4 percent do not have one at all, according to research led by Teena Darnell, assistant professor of nursing at Bellarmine University.

"School nurses improve school attendance and decrease the dropout rate which leads to better academic outcomes. . . . Most importantly, they help keep the nearly 680,000 children attending public school in Kentucky safe, healthy and ready to learn," Eva Stone and Mary Burch said in an e-mail to Kentucky Health News.

Stone, an advanced-practice registered nurse, is the director of student support services for Lincoln County Schools. Burch is the health coordinator for Erlanger-Elsmere Schools.

The pediatrics academy's policy statement, published in its journal Pediatrics, replaces a previous recommendation that districts have one nurse for every 750 healthy students, and one for every 225 students who need daily professional nursing assistance.

"The use of a ratio for workload determination in school nursing is inadequate to fill the increasingly complex health needs of students," says the policy statement.

School nurses today monitor more children with special needs, help with medical management in areas such as attention-deficit/hyperactivity disorder, diabetes, life-threatening allergies, asthma and seizures and also provide immunizations, work on obesity prevention efforts and provide substance abuse assessments, among other things, says the statement.

As school nurses have been eliminated from school budgets, school-based health centers, which provide health care to students through a public-private partnership, have become popular. This model allows schools to bill private insurance or Medicaid for services to offset some of the costs.

Most recently, the Carter County Board of Education unanimously approved a one-year contract with Kings Daughters Medical Center of Ashland to provide its school health services, Joe Lewis reports for the Grayson Journal Times. The hospital will provide a nurse practitioner who will rotate throughout the district's schools.

That doesn't comply with the new guidelines to have one nurse in every school, but the program plans to use telemedicine to keep the nurse practitioner connected to the schools throughout the day.

"Unfortunately, Kentucky has no requirement to have a registered nurse in every school," Stone and Burch write. "Every school needs a nurse. What we see in the schools is a reflection of the health of the community. Kentucky is missing an incredible opportunity to not only keep children safe at school but also to implement a system of improving long term health in the commonwealth."

Study says if Ky. cut its smoking rate to the national average, it could save $1.7 billion in health-care costs the very next year

Illustration from University of California-San Francisco

By Melissa Patrick
Kentucky Health News

If Kentucky could cut its smoking rate to the national average, it would save an estimated $1.7 billion on healthcare the following year, a study says.

Kentucky's smoking rate is 26 percent, and the national average is 18 percent.

The study at the University of California-San Francisco estimates that a 10 percent decline in the national rate would save $63 billion the next year in health-care costs.

"What it adds to our knowledge is that we can save money quickly," Ellen Hahn, University of Kentucky nursing professor and director of its smoke-free policy center, told Kentucky Health News. "We are not talking 18 to 20 years down the road. ... If we reduced our smoking rate at least 10 percent, we would see dramatic reductions in health-care cost in just one year."

The study also found that smoking makes Kentucky spend $399 more per person per year on health care than it would if the state's rate equaled the national rate. That was the highest figure of any state.

Conversely, low rates of smoking save Utah and California, respectively, $465 and $416 per person per year compared to what they would spend if their smoking rates were the national rate.

“Regions that have implemented public policies to reduce smoking have substantially lower medical costs,” the study's authors said in a news release. “Likewise, those that have failed to implement tobacco control policies have higher medical costs.”

Lexington's smoking rates dropped 32 percent in just one year after it enacted its smoking ban, which amounted to an estimated $21 million in smoking-related healthcare costs savings, according to a University of Kentucky study led by Hahn and published in the journal Preventive Medicine.

The UCSF study, published in PLOS Medicine, looked at health-care spending in each state and the District of Columbia from 1992 to 2009, and measured the year-to-year relationship between changes in smoking behavior and changes in medical costs.

Many studies have shown that smoking bans and other smoke-free policies decrease smoking rates, reduce smoking prevalence among workers and the general population, and keep youth from starting to smoke.

These have been some of the arguments for a statewide smoking ban, but efforts to pass one have stalled because new Republican Gov. Matt Bevin opposes a statewide ban and says smoke-free policies should be a local decision.

Bevin won big budget cuts from the legislature to set aside hundreds of millions of dollars for shoring up the state's pension systems, but the study hasn't made the administration look at a smoking ban as a source of savings. A ban passed the House last year but died in the Senate.

Asked how this study might affect the administration's position on a statewide smoking ban, Doug Hogan, acting communications director for the Cabinet for Health and Family Services, said in an e-mail, "Smoking bans are a local issue, rather than a one-size-fits-all solution." Bevin's office and Senate President Robert Stivers did not respond to requests for comment.

Hogan said the cabinet is committed to helping people quit smoking: "Education and proper policy incentives are critical tools that the state can use and as our commonwealth crafts its Medicaid wavier, it is looking very closely at ways to best incentivize smoking cessation to improve health and decrease cost to the commonwealth."

Dr. Ellen Hahn

Hahn said, "Kentucky has the dubious honor of leading the nation in cigarette smoking, and we have for many years. ... it is a major driver of health-care cost. And in a climate where we are trying to save every dollar ... I think that we should pay attention to this study because what it really says is that we can save a boatload of money if we help people quit and we can save it quickly."

Other possible tobacco-control measures include raising cigarette taxes, anti-smoking advertising campaigns and better access to smoking-cessation programs. Hahn said the state gets some money from the federal Centers for Disease Control and Prevention and the tobacco master settlement agreement for prevention and cessation efforts, but the state needs to do more.

"We spend very little on the things that we know work, like helping people quit smoking, like doing widespread media campaigns on television, radio and print," she said. "We just don't do that in our state. We never have. In fact, we spend very little, about 8 percent of what the CDC say we should."

The study says significant health-care savings could occur so quickly because the risks for smoke-related diseases decreases rapidly once a smoker quits.

"For example, the risk of heart attack and stroke drop by approximately half in the first year after the smoker quits, and the risk of having a low-birth-weight infant due to smoking almost entirely disappears if a pregnant woman quits smoking during the first trimester," says the report.

"These findings show that state and national policies that reduce smoking not only will improve health, but can be a key part of health care cost containment even in the short run," co-author Stanton Glantz, director of the UCSF Center for Tobacco Control Research and Education, said in the release.

Hahn said, "People don't realize how effective quitting smoking really is, how much money it really saves. So that is the value of this paper. It is a wake-up call for those of us doing this tobacco control work and for elected officials who are trying to save money and redirect funds and shore up the economic health of Kentucky. ... Doing all we can to reduce smoking saves lives and money. What's better than that?"

Foundation for a Healthy Kentucky seeks nominations for seats on its board of directors and Community Advisory Committee

The Foundation for a Healthy Kentucky is seeking nominations for two seats on its board of directors and three seats on its Community Advisory Committee, which drive the foundation's policy work and investments. Nominations are due July 22.

Board members represent the interests of Kentucky's medically under-served and include individuals working in health policy, health-care services and health-care finance. However, the board also seeks members who are not employed by health-care organizations and can provide varying perspectives.

The two board seats available are in Jefferson County and an at-large seat that can be filled by anyone in the state.

The Community Advisory Committee, which advises the board and appoints some of its members, is seeking new members from areas not represented: the Purchase, Buffalo Trace, Gateway, Fivco, Big Sandy and Cumberland Valley area development districts. The greater Lexington area is over-represented, the foundation says.

The committee is seeking two additional members who are executive directors or trustees of organizations working to address the unmet health care needs of Kentucky. It is also seeking members with expertise outside health care, such as in business, law and education.

"Service on the board or CAC is an opportunity to help improve the health of Kentucky through policy changes, grantmaking and other means, while creating lasting connections with other individuals who have different backgrounds but similar interests," the foundation said in a news release. "It is anticipated that the board and CAC will be developing a new strategic plan during 2017, making this a particularly exciting time to join. The Foundation has a highly skilled and dedicated staff to manage day-to-day activities, enabling the Board and CAC to focus on strategic direction and efforts to improve the Foundation's programs."

The full call for nominations and a nomination form can be found on the Foundation's website, http://healthy-ky.org/.

Medicaid stakeholders OK with healthy behavior incentives, oppose penalizing recipients who don't take part in cost sharing

By Melissa Patrick and Al Cross
Kentucky Health News

Groups of people concerned about changes in Kentucky's Medicaid program are open to the state offering incentives for healthy behaviors, but they don't want to penalize recipients who can't or won't pay premiums, deductibles or co-payments.

So reports the Foundation for a Healthy Kentucky, which convened a meeting May 12 to hear from people with stakes in the program: individual health-care providers, health systems, consumers, consumer advocates, payers, public-health professionals and representatives of higher education.

“Participants were unified in opposing penalties to enforce cost-sharing provisions” such as premiums, deductibles or co-payments, the foundation's consultant said in a report on the meeting.

However, they supported cost sharing for procedures not deemed medically necessary and “had diverse perspectives on this matter, ranging from opposing any cost-sharing in Medicaid to proposing specific premium and co-payment amounts,” such as $5 monthly premiums.

Also, “Participants were generally very supportive of implementing incentives for healthy behaviors such as smoking cessation and health risk assessments,” the report said. “Incentives might be reductions in the amount of cost-sharing or themselves supportive of healthy behavior,” such as gym membership.

Gov. Matt Bevin has said he wants Medicaid recipients to have "skin in the game" through cost-sharing, arguing that Kentucky can't afford to have more than a fourth of its population getting free medical care.

Under federal health reform, then-Gov, Steve Beshear expanded Medicaid eligibility to households with incomes up to 138 percent of the federal poverty level, adding more than 400,000 more people to the rolls. The federal government pays for the expansion through this year, but next year the state will be responsible for 5 percent, rising in annual steps to the reform law's limit of 10 percent in 2020.

Bevin's administration is working on getting a waiver from the federal Centers for Medicare and Medicaid Services to create new ways to cover those in the expansion. Six states have such waivers, including Indiana, which Bevin has cited as an example of how Kentucky might change its program.

In Indiana, recipients who pay premiums based on income levels, ranging from $1 a month to 2 percent of income ($27 a month for those at 138 percent of poverty) get expanded benefits and are charged co-payments only for non-emergency use of emergency rooms, according to the Kaiser Family Foundation. Those above the poverty level who fail to pay are disenrolled and barred from re-enrolling for six months, in what is known as a "lock-out" rule.

Bevin has indicated that he wants to announce his plan this summer. By law, states that seek a waiver must hold at least two public hearings: one at least 20 days before submitting the application to CMS, and the second after CMS accepts the application.

Stakeholders who attended the foundation's May 12 convening wanted to make sure their voices were heard early on in the process.

"Our goal is to help inform the process of changing the way Kentucky provides Medicaid services to ensure that we maintain the gains achieved under the Affordable Care Act, while also enabling the state to try new methods of ensuring access to affordable quality health care for Medicaid beneficiaries," Foundation President and CEO Susan Zepeda said in a news release.

"The biggest takeaway for me was the energy and commitment in the room," Zepeda said in a telephone interview. "A lot of thoughtfulness clearly went into sharing their experience and making suggestions on how to make the system more cost effective."

Before breaking into groups to offer their imput, stakeholders were given an overview of the state's Medicaid expansion and an overview of an issue brief created by the State Health Access Data Assistance Center at the University of Minnesota that looked at how waiver provisions are set up in five other states. Foundation staff wrote the 25-page "Stakeholder Input Report" that summarized suggestions and concerns and broke them into eight areas:

Cost-sharing and penalties: Health-care providers strongly opposed any cost-sharing, and uniformly opposed to any measure that involved "lock-out" penalties for failure to pay premiums, co-pays or deductibles.

"Our shared experience has been that we’ve been prohibited from denying care if a patient refuses or is unable to pay," the Physical and Oral Health Provider group said. "Therefore, the desired behavior isn’t actually enforced."

The Behavioral Health Provider group offered a compromise: “If the administration chooses to explore lock-outs we recommend that lock-outs be immediately lifted (upon payment) and payment be retroactive to the date the consumer re-enrolls.”

Participants in general were open to the idea of low co-payments, cost-sharing for non-medically necessary services, using Medicaid dollars to pay premiums for employer-sponsored insurance plans and charging co-payments for non-emergency use of the ER. They also agreed that certain groups, like those with chronic illnesses or disabilities, should be exempted.

Incentives: Most post-ACA waiver programs have implemented incentives for healthy behavior, and those at the meeting generally supported implementing evidence-based incentives, such as smoking cessation and health-risk assessments.

Zepeda said that most of the stakeholders wanted to see healthy behavior incentives used as credits against premiums, especially for recipients who can't afford them. "There is a recognition that people have a role to play in their own health care and the health decisions that they make," she said.

Benefits: Benefits include services covered under the health insurance plan. Some participants opposed any changes to current benefits; others wanted to expand existing benefits and still others suggested adding new benefits like housing. All agreed that medically necessary services should be covered for all enrollees.

Reimbursement: Kentucky shifted Medicaid in 2011 to managed care, in which managed-care organizations (usually insurance-company subsidiaries) are paid a flat fee per person as an incentive to limit claims. Providers have complained about the slow and low reimbursement, and participant suggestions included streamlining and accelerating the reimbursement process, increasing provider reimbursement rates, and adding new categories of reimbursed services and providers, like telehealth.

Systems improvement: Participants suggested simplifying administrative processes for providers; expanding providers' scope of practice; adding review panels; reducing the number of managed-care organizations; and creating a single list of drugs for all MCOs.

Health system transformation: Waivers allow states to explore ways to provide care differently through various transformation approaches. Suggestions included creating price transparency, through an all-payer, all-claims database; improving consumer health literacy; and moving beyond coverage issues to addressing access and quality.

“There was also interest among our group in examining a PCMH (patient-centered medical home) or health homes model to promote care coordination, and we feel strongly that pharmacists are essential part of the team and should be used in novel and more expansive ways,” the Colleges and Universities group said.

Evaluation: Waivers require states to perform an evaluation and make it public. Participants agreed that the process should include stakeholders and that findings should be made public periodically.

The Physical and Oral Health Provider group suggested the evaluation should answer the questions, “Have we maintained coverage levels? Have we improved access to care?”

Overarching themes: Many of the stakeholders mentioned two issues that were not included in the issue brief or discussion: integrating behavioral, physical and oral health services, and addressing the wide set of social factors that shape Kentucky's relatively poor health.

“Waivers should include methods to address social determinants of health as these areas are proving most effective in improving outcomes and reducing cost,” the Physical and Oral Health Provider group said. “We encourage inclusion of community health workers, peer support, medical respite care and other innovations to support social needs of patients.”

Zepeda said the Medicaid waiver drafting team faces many challenges. "We consider the rich conversation that happened on May 12 to be the start of the conversation," she said. "We have to find the cost effective win/win strategies that can reduce the cost of Medicaid going forward and let us continue to serve this expanded number of Kentuckians who now have health insurance."

Woman stuck by needle faces up to one year of testing for HIV and hepatitis; dirty needles becoming common in public places

By Melissa Patrick
Kentucky Health News

A Monroe County woman was stuck by an insulin needle found in a pair of sweatpants she purchased at the Walmart in Tompkinsville and now faces up to a year of testing to make sure she hasn't been infected with HIV or hepatitis, Jacqueline Nie reports for WBKO-TV in Bowling Green.

Insulin syringes are commonly used by IV drug abusers

"I had to be tested for HIV and hepatitis and a drug screening," said Mary Crawford, who was stuck by the needle. "I have to go back from that in 30 days and be tested again, and again in 6 months from that 30 days."

"Crawford says through at least these next 7 months, she cannot share anything with her husband or children," Nie repports. Crawford warned others to be careful: "It could happen to anybody, anywhere."

The latest Kentucky Health Issues Poll found that 13 percent of Kentuckians said they knew someone with heroin problems. And insulin syringes and needles are commonly used to inject it.

Clark County Public Health Director Scott Lockard said that while this was the first time he had heard of a needle being placed in an article of clothing in a department store, he said it is not unusual for dirty needles to be found in public.

"Unfortunately it is becoming more common for used needles to be found by the public," Lockard said in an e-mail. "I have had reports of needles being found locally on streets, in parks, public parking lots, unoccupied buildings, and in restrooms in public venues."

The problem is so bad in Northern Kentucky, where 35 percent in the poll said they knew someone with a heroin problem, that they released public service announcements before Easter to remind children to look for needles before eggs. The Northern Kentucky Heroin Impact Response Taskforce organized police and egg-hunt organizers to search parks for needles prior to the hunts, and said it will continue to search public places for needles throughout the summer, Ben Katko reported for WXIX-TV (Fox 19).

One way to keep dirty needles off the street is through needle exchanges, which allow intravenous drug users to exchange dirty needles for clean ones. These programs were authorized in Kentucky by the 2015 anti-heroin bill, but require both local support and funding.

So far, only 14 counties in Kentucky have either approved or are operating needle exchanges: Jefferson, Fayette, Jessamine, Franklin, Clark, Kenton, Grant, Harrison, Pendleton, Carter, Boyd, Elliott, Pike and Knox. Some jurisdictions have rejected exchanges, saying they encourage drug use, despite pleas from experts who say that's not true and the programs lead users to treatment.

"Needle exchanges work," former state health commissioner William Hacker said. "It decreases the spread of infectious diseases. It takes dirty needles off the street. It is safer for the law enforcement and EMS. It also provides an opportunity to interact with people and divert them to effective treatment."

Health-insurance companies ask state for rate increases averaging 17 percent; failure of non-profit insurer blamed

Department of Insurance website

Health insurers want rate increases averaging 22.3 percent in 2017 for individual policies in Kentucky. Counting small-group plans, the overall increase would be 17 percent, "continuing a national trend of hefty hikes as insurers adapt to a market reshaped by President Barack Obama's signature health care law," Adam Beam reports for The Associated Press.

"But the rate increases, if approved by state regulators, do not guarantee double-digit increases in the monthly premiums people have to pay," Beam notes. "The base rate is one of many factors companies use to determine how much someone pays in a monthly premium. Other factors include age, where a person lives and whether the person smokes."

Read more here: http://www.kentucky.com/news/politics-government/article79766917.html#storylink=cpy

Read more here: http://www.kentucky.com/news/politics-government/article79766917.html#storylink=cpy

The average requested increases for individual policies range from 7.6 percent for Aetna Health Inc. to 33.7 percent for Louisville-based Humana Inc., which said recently that it was losing money on Obamacare plans and is working on a merger with Aetna (to which Missouri objected this week). Baptist Health Plan wants 26.68 percent more, Anthem Health Plans 22.9 percent, and CareSource 20.55 percent, all on average.

“The Department of Insurance will fully investigate all proposed rate increase requests to make sure they are warranted,” Commissioner Brian Maynard said in a release. “Insurance rate increases are not specific to Kentucky; states across the nation are dealing with this issue.”

The department said some of the rate increases "appear to be attributed to the failure of the Kentucky Health Cooperative Inc.," a non-profit that was created under the reform law to provide more competition but then was not fully funded by Congress.

"The co-op went bankrupt and was placed into liquidation earlier this year, leaving other insurance companies to cover the more than 51,000 former co-op customers," the department noted. "Many of those customers were high-risk, and Kentucky’s remaining insurers appear to project that those high-risk customers will affect the risk pool." Anthem spokesman Mark Robinson told AP that the expectation of insuring co-op customers was responsible for its rate request.

UnitedHealth Group Inc. said recently that it would stop selling exchange policies in Kentucky, leaving many counties with only one insurer on the exchange. The only company that seeks to sell individual policies statewide is Anthem. It will be the only choice on the exchange in 54 counties.

However, Indianapolis-based Golden Rule Insurance Co., a United subsidiary, will sell "in all counties, off the exchange," the department said. Golden Rule, which still won't sell exchange policies, is seeking a rate increase of 65 percent.

Anthem, Aetna and Baptist will also offer non-exchange policies. Aetna plans to sell in only 10 counties: Jefferson, Fayette, Kenton, Campbell, Boone, Oldham, Trimble, Henry, Owen and Madison. Baptist will sell in 38 counties off the exchange and 20 on the exchange. Humana will sell on the exchange in nine counties (Bourbon, Bullitt, Clark, Fayette, Jefferson, Jessamine, Oldham, Scott and Woodford) and off the exchange in nine (Boone, Bullitt, Campbell, Gallatin, Grant, Jefferson, Kenton, Oldham and Pendleton). CareSource will sell in 61 counties, all on the exchange.

Consumers in Fayette, Jefferson and Oldham counties will have five insurers to choose from on the exchange. Jessamine, Woodford, Bullitt, Henry, Madison and Trimble counties will have four. Thirteen counties will have three choices, and 44 will have two. An Excel spreadsheet listing the policies for each county is available at www.uky.edu/comminfostudies/irjci/Kyhealthinsbycounty2017.xlsx.

The filings are online at insurance.ky.gov/ratefil/default.aspx. Rates must be approved within 60 days of each filing, or no later than July 11.

The administration of Gov. Matt Bevin is dismantling the Kynect health-insurance exchange and will use the federal exchange, HealthCare.gov, as a portal for enrollment in exchange policies.

Kentucky is the only truly Appalachian state to have put a brake on fatal overdoses from narcotics

Kentucky is the only truly Appalachian state to have put a brake on fatal drug overdoses, report Rich Lord and Adam Smeltz of the Pittsburgh Post-Gazette as part of a series in the about the deadly epidemic of prescription painkillers in the region.

A chart with the series' story about Kentucky shows that fatal drug overdoses were less numerous in the state in 2013 than in 2012, when the General Assembly cracked down on "pill mills," and that while fatal overdoses rose in 2014, they were still not as numerous as in 2012. Official numbers for 2015 are expected soon, and may rise because of the spread of heroin.

The series also credited a crackdown by the Kentucky Board of Medical Licensure, which "took disciplinary action for prescribing irregularities against 135 of the state’s roughly 10,600 doctors" from 2011 to 2015. "The board also moved against 33 doctors during that time for abusing narcotics themselves."

"Getting tough on doctors works," Lord wrote in the series' main story. The state story reported, "Kentucky’s per-capita opioid consumption -- though still seventh in the nation -- dropped by a steepest-in-Appalachia 12.5 percent from 2012 to 2014, according to IMS Health Inc.," Lord and Smeltz report. "Kentucky is the only state, among the seven studied by the Pittsburgh Post-Gazette, in which fatal overdoses have plateaued. Elsewhere, they have climbed relentlessly."

The story quotes Kerry B. Harvey, U.S. attorney for the eastern half of Kentucky: “In much of Eastern Kentucky, the workforce is engaged in difficult, manual labor,” like mining, farming and logging, “so people would injure themselves and be prescribed these very potent narcotics, because the medical profession changed the way it looked at prescribing these kinds of narcotics for pain.” The drugs dulled the “sense of hopelessness” people had about the area’s economy, “and so for whatever reason, this sort of culture of addiction took hold.”

"Harvey said that as physicians have gone to jail, and others have faced board discipline, the painkiller business model has adapted. . . . Now the doctors take insurance, and bill the insurer or the government not just for the office visit, but for the MRI, urine screen and back brace they use to justify the addictive narcotic." Harvey said, “So instead of a cash business, in many cases now the taxpayers or the insurance companies pay. The result is the same. We end up with our communities flooded with these very potent prescription narcotics.”

Bevin says he will transform programs for kids with special health needs constructively and in a 'forward-thinking way'

Gov. Matt Bevin told stakeholders for children and youth with special health-care needs May 25 that his administration  is “committed to transforming, in a positive, constructive, proactive and forward-thinking way, the services you provide. We truly are grateful for what you do day in and day out.”

A state press release said almost 100 doctors, public-health specialists, insurers, health-care providers, state and federal officials, family members and others attended the Kentucky Summit on Access to Care for Children and Youth with Special Health Care Needs, cosponsored by the Commission for Children with Special Health Care Needs.

“There is an absolute need for us to take care of these children,” Bevin said. “We owe them that as a society, as Kentuckians, as human beings. It’s our obligation.”

CCSHCN Executive Director Jackie Richardson said Kentucky is estimated to have 197,916 children and youth with special health-care needs, a rate higher than the national average. Children and youth with special health care needs are defined as those who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond what is generally required.

The summit in Frankfort was part of a learning collaborative sponsored by several national groups, including the National Governors Association and the National Conference of State Leguislatures. “We wanted this summit to provide a national perspective on the access to care provided through the commission,” she said. “With the group discussions we had today, we identified strategies to improve access to care and increase awareness of our programs.”

The commission has clinics that help with conditions like otology, orthopedics, severe cleft lip and palate and cerebral palsy. The commission also has a growing neurology program and has introduced autism clinics to improve access to diagnostic and medical resources for families in Eastern and Western Kentucky. “Many of them will need a lifetime of special care, and summits like today's help ensure they will have consistent, coordinated and comprehensive access for as long as they need it,” Richardson said. For more information about the commission's programs and services, see chfs.ky.gov/ccshcn.

Doctor speaks up about battle with depression, leading cause of disability for people 15-44; only 20% with symptoms are treated

By Danielle Ray
Kentucky Health News

Pitman (Paducah Sun photo)

Dr. Jay Pitman knows what it's like to feel isolated. Pitman spoke out about his battle with depression in a recent essay in The Paducah Sun.

"I'm writing a piece about my depression, about things people don't like to talk about," he told Steve Wilson, editor of the newspaper. "I'm thinking it might help some people." Wilson wrote in his column about Pitman, whose essay was published a week earlier, along with a story about him.

Pitman's depression deepened after he was the victim of a near-fatal hit-and-run accident in 2013. He was found lying unconscious in a pool of blood. He had suffered a concussion, brain hemorrhage and a broken shoulder. His physical recovery was remarkable. In fact, he recovered well enough to compete in a triathlon the next year. But he has had a much longer road to emotional healing.

Pitman is not alone in his struggle. The Anxiety and Depression Association of America estimates that about 18 million Americans suffer from depression, and notes that depression is the leading cause of disability in people aged 15 to 44. The organization distinguishes two categories of depression: major depression and persistent depressive disorder, which is characterized by symptoms that last at least two years.

Pitman's essay garnered a lot of support, but he's more concerned with opening up an honest dialogue about the issue.

"My hope is that those coping with depression will seek help and talk openly about their disease without feeling ashamed or embarrassed," he told Wilson. "I've lost several friends to suicide."

Despite its prevalence, only about 20 percent of people with depression symptoms seek professional help, according to the online health network Healthline.

Tiffany Bryant, a Lexington counselor who specializes in treating depression, said many people don't seek help or speak out about depression because of a lingering stigma surrounding mental illness. She believes popular culture has created an environment that discourages people from representing themselves honestly, flaws and struggles and all.

"I think you can blame, to a certain extent, social media, because everybody wants to show their very best," she said. "A lot of people have this mask that they wear for other people, and they never really take it off."

Even with a fairly low rate of patients seeking treatment, Healthline estimates that the number of patients diagnosed with depression increases by about 20 percent each year.

The federal Centers for Disease Control and Prevention recommends early treatment. If not effectively treated, depression can become a chronic disease. Experiencing just one episode of depression places a person at a 50 percent risk for experiencing another episode in the future, according to the CDC.

While it can affect anyone at any time, women typically experience higher rates of depression than men. The CDC also noted that nearly 10 percent of people in their 40s and 50s report current depression. The good news is that 60 to 80 percent of all depression cases can be treated with either psychotherapy ("talk therapy"), antidepressant medication or a combination of both, says Healthline.

The American Psychiatric Association defines depression as a condition with any five of these seven symptoms for a continuous period of at least two weeks:

• sadness;
• loss of interest in activities that used to be enjoyable;
• change in weight or appetite, change in activity level;
• sleeping too much or too little;
• loss of energy;
• feelings of guilt or worthlessness;
• difficulty concentrating or having thoughts of death or suicide.

Depression has a variety of causes, including genetic, environmental, psychological, and biochemical factors. The CDC notes that everyone gets "down in the dumps" at times, but it becomes pathological when symptoms are persistent and interrupt daily life. To learn more about it, from the National Institute of Mental Health, click here.

Justice secretary, drug-policy chief and ex-health boss back needle exchanges but 'political rhetoric' can trump science

By Melissa Patrick
Kentucky Health News

CORBIN, Ky. – Local officials and legislators continue to debate and sometimes reject needle exchanges, but two state officials and a former state health commissioner voiced their strong support of them at a pubic forum May 17 in Corbin.

Dr. William Hacker:
"Needle exchanges work."

"Needle exchanges work," said Dr. William Hacker, chair of Shaping Our Appalachian Region's Health and Wellness Advisory Committee and former state health commissioner. "We would, as a public health role, encourage them to be extended."

Hacker spoke at the "Cumberland River Forum on Opioid Use Disorders: A Time for Community Change," one of three public forums on the subject in Kentucky in May.

The General Assembly authorized needle exchanges in the 2015 anti-heroin bill, as a way to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They require both local approval and funding.

Kentucky's rate of hepatitis C is the highest in the nation, and a recent federal Centers for Disease Control and Prevention report said that of the 200 counties in the nation that are most susceptible to a hepatitis C or HIV outbreak, 54 of them are in Kentucky.

So far, only 14 counties in Kentucky have either approved or are operating needle exchanges: Jefferson, Fayette, Jessamine, Franklin, Clark, Kenton, Grant, Harrison, Pendleton, Carter, Boyd, Elliott, Pike and Knox.

Justice Secretary John Tilley:
"Real facts and real science"

Justice Secretary John Tilley, who was instrumental in getting the heroin bill passed when he was a state representative from Hopkinsville, encouraged communities to look at the evidence-based research that supports needle-exchange programs and to not listen to the political rhetoric.

"We've got to push aside this political rhetoric on topics like this one and talk about real facts and real science," he said. "These programs have been validated by meta-analysis. ... Those who seek out a needle exchange are five times more likely to enter treatment. These programs continue to beat back blood-borne illnesses like hepatitis C and HIV, at rates we cannot duplicate without these programs. They are universally successful at what they do."

Tilley said after the meeting that addiction is a chronic disease and should be treated as a public-health crisis, noting that other diseases are treated based on science and medicine, not opinion.

"When you go to the doctor, you don't ask him his political view of a particular health program," he said. "Well, this is no different. And for me to substitute my judgment for the science is dangerous."

Van Ingram changed his mind

Van Ingram, executive director of the Governor's Office of Drug Control Policy, said his opinion about needle exchanges changed after he researched them and learned how effective they are at decreasing the spread of hepatitis C and HIV. He also noted that these programs provide testing and treatment referral for these infectious diseases, and also help participants get treatment.

"Eleven years ago I left law enforcement, and if you had told me that I would end up being the poster boy for syringe exchange, I would have said you were crazy," he said. "But quite honestly, they do work."

Ingram also noted the CDC study and reminded the audience of the "enormous" HIV outbreak that occurred last year in Scott County, Indiana, 30 miles north of Louisville.

"So if a syringe exchange can keep us from having a rapid HIV outbreak, I think that is probably a good trade-off," Ingram said.

But evidence-based research isn't always enough to convince policy makers that needle exchange programs don't condone or perpetuate drug use.

The Georgetown newspaper answered its
question in its story. The answer is yes.

Last week it was reported that two Kentucky counties decided against needle exchanges. Boone County's Fiscal Court silently said no to a needle exchange by refusing to call up a resolution to support one, Mark Hansel reported for NKyTribune. And the Scott County Fiscal Court voted 5-3 against one, Dan Adkins reported for the Georgetown News-Graphic. Adkins followed up with a featured front-page story about the county's heroin problem.

A point of contention among Republicans in the General Assembly is that some of the exchanges don't require a needle-for-needle exchange, which they say was their intent.

Then-Attorney General Jack Conway said Dec. 18 that needle exchanges did not have to be one-for-one. It is also widely accepted that not requiring one-for-one is considered a best practice across the country to prevent the spread of HIV and hepatitis C and to stop intravenous drug users from sharing and reusing needles, Dr. Sarah Moyer, the interim director of the Louisville Metro Department of Public Health and Wellness, told Kentucky Health News in March.

Last session, as the Senate voted to amend House Bill 160 to require one-to-one exchanges, Senate Republican Floor Leader Damon Thayer of Georgetown threatened to file a bill to eliminate them altogether next session if they don't make this change during the upcoming year.

In its original form, HB 160 was a bill to educate the public about how to safely dispose of hypodermic needles in order to keep them out of landfills. The House let the bill die without another vote.

Tilley said after the meeting, "Culture and change takes a while," and noted that while he respected his colleagues differing opinions, he said it is likely that this topic is not in their "wheelhouse."

"So, I think the more they learn the more they will come along," he said. "What we should do is all come back to the table and talk about how the programs that are now in place in Kentucky are working and how the reliance on science and evidence based policy makes them work."

Nine myths about opioid drug abuse

Do you think it's a good idea to save your leftover pain pills to have "just in case" you might need one, or that heroin is primarily an inner-city problem? Think again. Those are among nine common myths that were busted at a community opioid forum in Corbin May 17 in hopes of decreasing some of the stigma that surrounds addiction.

"One of the things we know is that the stigma that exist around opioid abuse is largely propelled because of the myths that exist," said Janet Jones, a representative from Hazelden Betty Ford Foundation, the nation's largest nonprofit addiction treatment provider. Jones led the group discussion about nine opioid myths:

*Myth 1: Abusing prescription painkillers to get high is safer because they are made by a pharmaceutical company and doctors prescribe them.
Fact: Prescription drugs can be just as addictive and just as dangerous as illegal ones, like heroin. The brain and body treats heroin and prescription opioids the same.

*Myth 2: I should save my extra prescription pain pills just in case I need them for something else later, like joint pain or a toothache.
Fact: Saving pain pills that you no longer need can be dangerous because young people often gain access to them. The next time you need pain medication, talk to your health-care provider about the risk, ask them to prescribe only what you need, and properly discard unused drugs when you no longer need them.

*Myth 3: Snorting or smoking heroin or prescription opioids is safer than injecting them.
Fact: There is no "safe" way to abuse a drug. And while injecting drugs with shared needles increases the risk of HIV/AIDS or hepatitis C, any method of opioid abuse can lead to overdose and death.

*Myth 4: Heroin is primarily an inner-city problem.
Fact: Heroin use is on the rise nationwide, including in suburban and rural areas.

*Myth 5: A person addicted to heroin or prescription painkillers is a lost cause.
Fact: Treatment works. Recovery is possible with appropriate treatment and adequate social support systems.

*Myth 6: Heroin and prescription pain pills are just the latest "fad" drugs and their appeal will fade.
Fact: Opium, heroin and other opioids have been used for thousands of years. Prescription opioids have a legitimate use as effective painkillers and are not going away any time soon. And while illegal drugs come and go, communities are experiencing unprecedented use of opioid drugs, and people are dying at epidemic levels

*Myth 7: Making Narcan (naloxone) available to first responders wastes resources on people who have given up, and takes away an addict's incentive to quit by making them less likely to die of an overdose.
Fact: Addiction is a chronic disease, not a moral flaw, and the only way a person can get help is if they are alive to do so. Time is critical to overdose survival rates and naloxone helps to save these lives.

*Myth 8: Heroin and prescription painkiller abuse only hurts those who use the drug.
Fact: Opioid abuse hurts everyone. Financially, the legal, healthcare and lost productivity costs total in the billions and the intangible costs to families and friends are incalculable.

*Myth 9: Hardworking everyday people don't use heroin or misuse prescription painkillers.
Fact: Any type of person can develop an opioid use disorder.

Conference on cancer-causing HPV in Lexington June 21

The Kentucky Rural Health Association is sponsoring a summit on the human papilloma virus, "HPV - You ARE the Key!" June 21 at the Embassy Suites in Lexington.

The HPV vaccine is nearly 100 percent effective in preventing pre-cancers 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. Kentucky falls in the bottom 10 states for HPV vaccination, with 37.5 percent of its girls and 13.3 percent of boys aged 13-17 vaccinated as of 2014.

The conference will host several keynote speakers, including:

• Kirk Forbes, who co-founded the Kristen Forbes EVE Foundation in honor of his 23-year-old daughter, Kristen Forbes, who passed away after a yearlong battle with HPV caused cervical cancer;
• Dr. Daron G. Ferris, professor and director of the Gynecologic Cancer Prevention Center at the Medical College of Georgia;
• Dr. W. Michael Brown, associate director and the director of pediatrics at the Bayfront Family Medicine Residency Program in St. Petersburg, among other positions; and
• Dr. Alix Casler, medical director of the Department of Pediatrics for Orlando Health Physician Associates, among other positions.

The conference is also sponsored in collaboration with the Kentucky Immunization Program and the Division of Women's Health.

The event will last from 8 a.m. to 5 p.m. June 21 and costs $40 thru June 1, and $55 after that date. Continuing education credits will be offered. Click here to register and here for the draft agenda.

CDC finds health problems are common at public pools; state requires local health departments to inspect each one twice a year

By Melissa Patrick
Kentucky Health News

Thousands of public pools, hot tubs and water playgrounds are forced to close every year for serious health and safety violations, according to a new study by the federal Centers for Disease Control and Prevention.

Kentucky requires local health departments to conduct two full inspections of each public swimming pool during the operating season, once every six months for its continuous-operation indoor facilities, and monthly water chemistry inspections, according to the state Department for Public Health.

"The local health department environmentalists are the ones who do these inspections and monitors, so the records for these inspections are kept with each local health department, Beth Fisher, spokesperson for the Cabinet for Health and Family Services, said in an e-mail.

But you might want to do your own inspection if you go on vacation out of state, because that's not the case everywhere.

"Almost one third of local health departments do not regulate, inspect, or license public pools, hot tubs, and water playgrounds,” Michele Hlavsa, chief of the CDC's Healthy Swimming Program, said in a news release. “We should all check for inspection results online or on site before using public pools, hot tubs, or water playgrounds and do our own inspection before getting into the water.”

And even if states are checking their pools, that doesn't mean they are always safe.

A 2013 CDC study of inspection data from the five large states containing 40 percent of the nation's public aquatic venues found that almost 80 percent of them had at least one violation. It found that one in eight inspections resulted in immediate closure because of serious health and safety violations and that one in five kiddie or wading pools were closed due to violations. Most of the violations were related to improper pH (15 percent), lack of proper safety equipment (13 percent) and inadequate disinfectant levels (12 percent).

"Young children who are still learning their toileting skills are more likely to contaminate the water. They're more likely to swallow the water. Both of which can lead to outbreaks of diarrheal illness," Michael Beach, the CDC's associate director for healthy water, told Dennis Thompson at HealthDay News. He said pH levels are "critical because it determines how effective the disinfectant is killing germs."

The CDC recommends that parents change their infants' diapers often and in the bathroom, not poolside, to take children to the bathroom every hour, and to teach children to spit out any pool water they get in their mouth.

Beach said most contamination of public pools and hot tubs are the result of people swimming while suffering from diarrhea. He said adults should not swim while recovering from diarrhea, and if they do, should shower before getting in the water.

The CDC recommends individuals do a self-inspection of all public pools before getting in them and offers this checklist that identifies some of the most common swimming pool health and safety problems:

• Use a test strip (available at most superstores or pool-supply stores) to determine if the pH and free chlorine or bromine concentration are correct.
• Make sure the drain at the bottom of the deep end is visible.
• Check that drain covers appear to be secured and in good repair.
• Confirm that a lifeguard is on duty at public venues. If not, check whether safety equipment like a rescue ring with rope or pole is available.

If you find problems, do not get into the water and tell the person in charge so the problems can be fixed, says the release.

Changes coming for Nutrition Facts labels on food products: emphasis on calories, added sugar and serving size

Associated Press

By Danielle Ray
Kentucky Health News

Nutrition labels on food products will undergo a facelift over the next two years.

The U.S. Food and Drug Administration finalized plans Friday to change labeling to emphasize calorie count and added sugars in an effort to simply nutrition labels and clarify serving sizes.

First lady Michelle Obama, a longtime crusader against childhood obesity, said parents will benefit from the upcoming changes.

"You will no longer need a microscope, a calculator, or a degree in nutrition to figure out whether the food you're buying is actually good for our kids," she told The Associated Press.

The overhaul puts less emphasis on fats and more on caloric value and added sugars. Calories on upcoming labels will be listed in larger font than other nutrient facts. Added sugar will get its own line, separate from naturally occurring sugar.  Currently, both added and naturally occurring sugars were lumped under one category, "Sugars."

New labels will also include a new "percent daily value" for added sugar, which will tell consumers how much of their recommended daily intake they will get from a given item. The FDA recommends consuming less than 10 percent of total daily calories (200 calories in a typical diet) from added sugar.

"The new labels should also spur food manufacturers to add less sugar to their products," Michael Jacobson, president of the advocacy group Center for Science in the Public Interest, told AP. He said that under current labeling, it's nearly impossible for consumers to know how much sugar fits into a reasonable diet.

The footnote will better explain what "percent daily value" means. It will read: “The % Daily Value tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.”

Serving sizes will also be clearer. The biggest difference will be that serving sizes will be based on what consumers typically eat instead of what they should eat. About one-fifth of foods will undergo revised calculations. For example, a serving size of ice cream will be 2/3 of a cup; previously it was a 1/2 cup.

If you've ever been duped into consuming more calories than you intended, or tried to calculate exactly what fraction of a slice of pizza constitutes a serving size, you're in luck. Package size affects what people eat, the FDA noted. So, products that were previously between one and two servings, such as a 20-ounce soda, will be labeled as a single serving, since consumers generally eat or drink the entire contents in one sitting.

Larger containers, like pints of ice cream, will have dual column labels: one column with information for a single serving and the other with information for the entire container.

Labels will also include two additional nutrients: potassium and Vitamin D.

Industry reaction was predictable. A representative for the Sugar Association told AP that emphasis on added sugar could confuse consumers, but other industry leaders welcomed the changes.

"This update is timely as diets, eating patterns and consumer preferences have changed dramatically since the Nutrition Facts panel was first introduced," Leon Bruner, of the Grocery Manufacturers Association, told AP.

Most food manufacturers have until July 2018 to comply. Smaller manufacturers will have an additional year.

The FDA proposed the changes two years ago. They are the first major update to nutrition labels since labeling was introduced in 1994. So far, more than 800,000 foods have nutrition labels.

For more information on the changes, click here.

Obama asks public to tell Congress to fund the $1.9 billion Zika fight he wants; Senate passed $1.1 billion, House $622 million

The Zika funding package of Appropriations Committee Chair Hal Rogers and other House Republicans "doesn't make a lot of sense" and the somewhat larger Senate package backed by Majority Leader Mitch McConnell and a bipartisan Senate majority falls well short of what is needed, President Obama told reporters Friday.

The Senate has passed a $1.1 billion package and the House approved $622 million. Obama wants more than three times the House figure, $1.9 billion, to fight the virus that causes a serious birth defect.

"We didn’t just choose the $1.9 billion from the top of our heads," Obama said. "This was based on public-health assessments of all the work that needs to be done. And to the extent that we want to be able to feel safe and secure, and families who are of childbearing years want to feel as if they can have confidence that when they travel, when they want to start a family that this is not an issue -- to the extent that that's something that we think is important, then this is a pretty modest investment for us to get those assurances."

Obama said the House package is not only inadequate, "That money is taken from the fund that we're currently using to continue to monitor and fight against Ebola. So, effectively, there’s no new money there. All that the House has done is said, you can rob Peter to pay Paul. And given that I have, at least, pretty vivid memories of how concerned people were about Ebola, the notion that we would stop monitoring as effectively and dealing with Ebola in order to deal with Zika doesn’t make a lot of sense."

The president added, "This is something that is solvable. It is not something that we have to panic about, but it is something we have to take seriously. And if we make a modest investment on the front end, then this is going to be a problem that we don't have to deal with on the back end." He said each child who has a small brain as a result of Zika "may end up costing up to $10 million over the lifetime of that child in terms of that family providing that child the support that they need. . . .  It doesn’t take a lot of cases for you to get to $1.9 billion. Why wouldn't we want to make that investment now?"

Part of the money would go to develop a vaccine for Zika, and part of that work is going on at the University of Kentucky. "You don't get a vaccine overnight," Obama said. "You have to test it to make sure that any potential vaccine is safe. Then you have to test to make sure that it's effective. You have to conduct trials where you're testing it on a large enough bunch of people that you can make scientific determinations that it's effective. So we've got to get moving."

Obama said the Centers for Disease Control and Prevention and the National Institutes of Health are "taking pots of money from other things -- universal flu funds or Ebola funds or other funds -- just to get the thing rolling. But we have to reimburse those pots of money that have already been depleted and we have to be able to sustain the work that’s going to need to be done to finish the job. So, bottom line is, Congress . . . needs to get me a bill that has sufficient funds to do the job."

The president said that should happen before the summer congressional recess in August, "to provide confidence to the American people that we're handling this piece of business." He said the money would be insurance for young families or couples thinking about having children.

"To the extent that we're not handling this thing on the front end, we're going to have bigger problems on the back end," Obama said. "Tell your members of Congress, get on the job on this. This is something we can handle. We should have confidence in our ability to take care of it. We've got outstanding scientists and researchers who are in the process of getting this done, but they’ve got to have the support from the public in order for us to accomplish our goal."

1/2 of cancer deaths and maybe 1/2 of new cases could be prevented by exercise, watching food and drink, and not smoking

Half of all cancer deaths could be prevented "by applying insights that we've had for decades — no smoking, drinking in moderation, maintaining a healthy body weight and exercising," Carolyn Y. Johnson reports for The Washington Post, about a study published in JAMA Oncology.

Those measures could also cut new cancer cases by 40 to 60 percent. Those are big numbers, and especially important for Kentucky, which has some of the nation's leading rates of cancer and death from it — and, not coincidentally, is among the national leaders in smoking and obesity.

"Some of the declines we have already seen in cancer mortality — the large decline in lung cancer — that was because of efforts to stop people from smoking," Siobhan Sutcliffe, an associate professor in the division of public health sciences at Washington University in St. Louis, told Johnson. "Even while we’re making new discoveries, that shouldn’t stop us from acting on the knowledge we already do have."

Sutcliffe was not involved in the study, which used "large ongoing studies that have closely followed the health and lifestyle habits of tens of thousands of female nurses and male health professionals," Johnson reports. "They divided people into two groups: a low-risk group that did not smoke, drank no more than one drink a day for women or two for men, maintained a certain healthy body mass index, and did two-and-a-half hours of moderate aerobic exercise a week or half as much vigorous exercise.

"The team compared cancer cases and cancer deaths between the low- and high-risk groups and found that for individual cancers, the healthy behaviors could have a large effect on some cancers: The vast majority of cases of lung cancer were attributable to lifestyle, as well as more than a fifth of cases of colon cancer, pancreatic cancer and kidney cancer.

"Then, they extrapolated those differences to the U.S. population at large, finding an even larger proportion of potentially preventable cancer cases and deaths. For women, they estimated 41 percent of cancer cases were preventable and 59 percent of cancer deaths. For men, 63 percent of cancer cases were potentially preventable and 67 percent of deaths."

The researchers at Massachusetts General Hospital and the Harvard T.H. Chan School of Public Health noted some caveats: "The high-risk group in the study is healthier than the general U.S. population, so there are reasons the numbers may be slightly overestimated," Johnson writes. "But Mingyang Song, the researcher who led the work, argues the numbers are a good approximation because they may be underestimating the effects of lifestyle, too, because they selected a narrow range of lifestyle factors."

At forum on opioid abuse in Corbin, people say they need more treatment services, community education and coalitions

Image from Lauren Osborne, WYMT-TV Mountain News

By Melissa Patrick
Kentucky Health News

CORBIN, Ky. – After a day of learning and talking about opioid prevention, treatment and mobilization, people at a forum in Corbin agreed on three things: Access to substance abuse and mental health services remains a huge barrier in southeastern Kentucky; more community education is needed; and drug-prevention programs should form coalitions to better use their limited resources.

Substance abuse affects almost every family in Kentucky, and four Kentuckians die every day from a drug overdose. That was part of the opening message from Dr. Allen Brenzel, medical director of the state Department for Behavioral Health, Development and Intellectual Disabilities.

"This is, in my opinion, one of the most pressing health-care issues facing our commonwealth today," Brenzel said. "If 1,000 people a year were dying from measles in the state of Kentucky, think about the public response that we would have. ... We would be on red-alert, we would have a complete, public-health, massive intervention to solve that problem."

Van Ingram, executive director at the Governor's Office of Drug Control Policy, said that next year's drug overdose report, which will be released in a few weeks, will show the problem is getting worse.

About 125 people, most of them health-care providers, attended the "Cumberland River Forum on Opioid Use Disorders: A Time for Community Action" May 17 at the Corbin Technology Center. It was sponsored by The Kentucky Cabinet for Health and Family Services, the Hazelden Betty Ford Foundation, and Cumberland River Behavioral Health. Similar forums were held in Lexington May 16 and Louisville May 13.

John Tilley

John Tilley, secretary of the Kentucky Cabinet for Justice and Public Safety, said he hoped the forum would "light a fire under this community" to talk to their neighbors and friends, community leaders and legislators about the value of treatment over incarceration for substance abuse and mental health issues.

Tilley, who chaired the House Judiciary Committee when he was a state representative from Hopkinsville, acknowledged that some abusers should be in prison, but said society must distinguish between "who we are mad at and who we are afraid of. ... I promise you the way to get out of this mess is not to over-criminalize addiction and mental illness."

Tilley said "The solution is right before our eyes," using for treatment some of the billions of dollars now used to incarcerate drug users.

Tim Feeley, deputy secretary for the CHFS and a former legislator from Oldham County, agreed: "We are not going to incarcerate our way out of this." He said the state needs more treatment programs and said the cabinet was fully committed to addressing the state's addiction problems to the best of its abilities.

William Hacker

Kentucky has moved away from treating mental health and substance abuse issues criminally, said Dr. William Hacker, chair of Shaping Our Appalachian Region's Health and Wellness Advisory Committee and former state health commissioner. He said other successful anti-drug efforts include grassroots advocacy groups, the online prescription-drug tracking program, needle-exchange programs, a move toward medication assisted treatments for opioid addiction, and the SMARTS initiative, which provides addiction care for pregnant and parenting women for up to two years.

Hacker also mentioned Operation UNITE, a Kentucky non-profit created by U.S. Rep. Hal Rogers that leads education, treatment and law enforcement initiatives in 32 counties in Southern and Eastern Kentucky. UNITE has held a national drug abuse conferences for the past five years, with this year's summit in Atlanta including President Barack Obama. The acronym stands for Unlawful Narcotics Investigations, Treatment and Education.

A former pediatrician in Corbin, Hacker also noted that SOAR recently held a Substance Abuse Roundtable to discuss research and emerging opportunities associated with substance abuse and intravenous drug use in Appalachian Kentucky. He said SOAR works to create a network across the region to share best practices and money opportunities and to create community level empowerment.

"Substance abuse is not a failure of moral character, it is a disease," Hacker said. "Don't give up. Never give up."

At the end of the meeting, the attendees broke into groups that represented schools, community leaders, health-care professionals, parents and the faith community to discuss what actions they could take to address opioid abuse in their communities.

Most groups reported that lack of access to substance abuse and mental health treatment is a barrier in their communities. And while it was noted that some communities offer more services than others, several groups said they did not have enough counselors to support medication-assisted therapies or enough doctors willing to prescribe it. Lack of transportation was also mentioned as a barrier toward getting treatment in several groups.

Also, most groups said community members often aren't aware of the resources, so more community education is needed. They listed schools, churches and county Extension offices as possible sources of education, and noted that a community resource website would be helpful. They also said parents would benefit from a class to learn how to talk to their children about drugs.

The groups agreed that all sectors of the community were needed to combat substance abuse and suggested that drug prevention programs in each community should form coalitions to better use resources and information.

Slicing your way to an apple a day: Americans' apple consumption is on the rise because we're eating them in small pieces

Photo from livestrong.com

By Danielle Ray
Kentucky Health News

Presentation is everything. Apple consumption is on the rise, and researchers at Cornell University think pre-sliced apples are the cause.

The 2013 Cornell study explored why so many whole apples served in school lunches ended up uneaten in the trash. Researchers found that eating whole apples can be difficult for young children with small mouths and for kids with missing teeth or braces. The study also noted that older girls find whole fruits messy and unattractive to eat.

The study found that consumption jumped by more than 60 percent when apples were served sliced. These findings back up U.S. Department of Agriculture statistical data about overall apple consumption. Data show that Americans ate more than 510 million pre-sliced apples in 2014, up from fewer than 150 a decade before.

Likewise, overall apple consumption has grown by 13 percent percent since 2010, according to USDA data. Americans ate about 17.5 pounds per capita in 2013, the most in nearly a decade.

Why does simply slicing an apple matter? The difference between a whole apple and apple slices may seem silly or superficial, especially to an adult, but the inconvenience is a barrier nonetheless, David Just, a professor of behavioral economics at Cornell and one of the researchers behind the study, told Roberto Ferdman of The Washington Post.

"It sounds simplistic, but even the simplest forms of inconvenience affect consumption," Just said. "Sliced apples just make a lot more sense for kids."

The rise of mass-produced pre-sliced apples probably has a lot to do with the fast food industry. McDonald's added apple slices to its menu in 2004 in an effort to give parents healthier options. The company began automatically serving apple slices with Happy Meals in 2012, causing apple sales to skyrocket.

McDonald's has served more than 2 billion packages since first offering apple slices as a side, a representative for the company told the Post. In 2015 alone, the company served nearly 250 million packages of sliced apples, which amounts to more than 60 million apples, or about 10 percent of all fresh sliced apples sold in the United States, the Post noted.

The USDA, which oversees school lunch programs, can't be sure of how many schools offer pre-sliced apples versus whole apples, as local school districts make that decision. However, the agency does make recommendations and encourages schools make fruit appealing in presentation.

The problem with the pre-sliced apple trend? It may lessen food waste, but it increases plastic waste, which puts a strain on the environment. McDonald's apple slices, for example, are served in plastic wrappers. These wrappers are recyclable, yes, but two important differentials exist. First, "recyclable" does not mean it was made of recycled materials, only that it has the potential to be recycled. Second, just because consumers can recycle the wrappers does not mean they will.