Friday, June 29, 2018

Federal judge blocks new Medicaid plan, which was to go into effect Sunday

By Al Cross
Kentucky Health News

A federal judge has blocked Kentucky's new Medicaid plan, which was to go into effect Sunday, July 1.

U.S. District Judge James Boasberg of Washington, D.C., vacated the U.S. Department of Health and Human Services' approval of the plan, saying federal officials "never adequately considered whether" it "would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid." Calling that a "signal omission," Boasberg declared the waiver of normal Medicaid rules "arbitrary and capricious," keys for overturning an administrative decision.

The plan calls for Medicaid members to pay small, income-based premiums, and has "community engagement" requirements for "able-bodied" members who are not primary caregivers: work, volunteering, job training or drug treatment at least 80 hours a month.

The community-engagement rules were to be phased in, starting in Campbell County on Sunday and in all but eight counties by Dec. 1.

Lawyers for the 16 Kentucky Medicaid members who filed the suit argued that the plan was not likely to promote the objectives of the program, and that Health and Human Services Secretary Alex Azar "entirely failed to consider" or alter the state's projection that in five years, Kentucky Medicaid would have 95,000 fewer members than it would without the waiver. Academic health experts said in a friend-of-the-court brief that a more likely range was 175,000 to 297,500.

Medicaid covers 1.4 million Kentuckians, almost half a million of them under the previous state administration's 2014 expansion of eligibility to people with incomes up to 138 percent of the federal poverty level, as provided by the 2010 Patient Protection and Affordable Care Act. Most on the expansion work.

"The record shows that 95,000 people would lose Medicaid coverage, and yet the secretary paid no attention to that deprivation," wrote Boasberg, who was appointed by Barack Obama. Actually, the state's projection is not that 95,000 particular individuals will lose coverage, just that the rolls would be that much lower than otherwise. That many people enroll in or go off Medicaid in just a few months; the program has a lot of what officials call "churn."

The state said in its application that some of the reduction would be a result of members not complying with requirements of the program, which include regular reporting and premium payments. Violation would result in a six-month "lock-out" from the program, unless the member completed a course in health literacy or financial literacy. The Kaiser Family Foundation has estimated that a clear majority of lock-outs would be a result of failure to report.

Boasberg noted that experts who submitted comments to the state and HHS cited "extensive research, including from past Medicaid demonstrations . . . would likely reduce health-care access and utilization. To top it off, numerous comments also suggested that these new administrative requirements would increase “clerical and tracking errors and delays,' which in turn would 'cause inadvertent terminations'."

The requirements for work or other "community engagement" activities were to take effect in Campbell County Sunday, July 1. They are part of a plan the state calls Kentucky HEALTH, for "Helping to Engage and Achieve Long Term Health."

Boasberg's ruling sends the issue back to HHS for review. State Health Secretary Adam Meier issued a statement calling Boasberg's ruling "very narrow" and saying the state would work with the Centers for Medicare and Medicaid Services "to quickly resolve the single issue raised by the court so that we can move forward with Kentucky HEALTH."

However, other issues may stand in the way. Boasberg said he didn't have to rule on some issues raised by the plaintiffs because Azar's omission was enough to invalidate the waiver.

Meier added, "Without prompt implementation of Kentucky HEALTH, we will have no choice but to make significant benefit reductions." He told a legislative committee June 20 that in case of an adverse ruling, the state would likely have to cut dental, vision and possibly prescription-drug coverage for some people. Kentucky HEALTH had already shifted dental and vision benefits from being free to an option that requires members to participate in certain activities.

The state and federal governments are expected to appeal Boasberg's ruing; Gov. Matt Bevin has said the issue will ultimately be decided by the Supreme Court. Bevin said in his executive order for the plan that if courts ruled against it and the state's appeals failed, six months later the Medicaid expansion would end.

"Bevin is trying to take Medicaid expansion hostage, arguing that if Kentucky isn’t allowed to impose a work requirement, then there will be no more expansion," writes Dylan Scott of Vox. "By the Bevin administration’s logic, work requirements do advance the goals of Medicaid, because without them, Kentucky is going to end its expansion and hundreds of thousands of the state’s most vulnerable citizens will lose their insurance."

Kentucky is one of four states where HHS has approved Medicaid work requirements. "Seven others — Arizona, Kansas, Maine, Mississippi, Ohio, Utah, and Wisconsin — have proposals waiting for approval," Scott reports.

Boasberg's decision is at

Adam Meier, the state's new health secretary, has moved from creating policy to delivering it

By Melissa Patrick
Kentucky Health News

The state's new health secretary moved from a policy job that he loved to one that puts him squarely into a position of delivering those policies he helped to create, a decision that he didn't take lightly.

Gov. Matt Bevin "didn't have to twist my arm," Adam Meier told Kentucky Health News in an interview. "It was a big decision for me and my family. It was something we thought long and hard about."

Secretary Adam Meier
Bevin put Meier in charge of the Cabinet for Health and Family Services on May 17, the state's largest cabinet with 7,500 employees and an annual budget of nearly $14 billion. He succeeds Vickie Yates Brown Glisson, who left the office at the end of January to run against Democratic Rep. John Yarmuth in Louisville's Third Congressional District.

He had been Bevin's deputy chief of staff for policy, and in that job was responsible for overseeing development of the state's new Medicaid plan, called Kentucky HEALTH, for "Helping to Engage and Achieve Long Term Health," authorized by a federal waiver.

A federal judge in Washington blocked the plan on Friday, June 29, which among other things, included work or community engagement requirements; monthly reporting; lock-out periods for failure to comply; and premiums and co-payments based on income. The plan was set to kick in July 1, with the exception of the work or "community engagement" requirements, which were to be phased in across almost all of the state by Dec. 1.

Meier lives in Fort Thomas with his wife and three young children, but he said he grew up in a working-class neighborhood on the west side of Cincinnati.

"I personally witnessed the value of hard work, often helping my father with various construction jobs on weekends or summers," he said. "Through continuous hard work of both of my parents, I watched as our quality of life and opportunities continued to improve."

Meier said he first came to Kentucky to attend Georgetown College on a combination of athletic and academic scholarships, graduating in 2005 with a degree in political science and communication and media studies. After graduation from the Florida Coastal School of Law, he returned to Kentucky and has lived in the state since.

"I want others to have the same opportunities that my parents gave our family," he said. "The Cabinet for Health and Family Services can provide the support needed to allow those willing to be engaged to improve their quality of life."

Asked why he thought Bevin hired him, Meier said his relationship with the governor had developed in an "organic" kind of way; they connected when he volunteered for Bevin's campaign and discussed policy ideas -- including what it would take to implement a new Medicaid program in Kentucky as a way to "drive innovation in a way that is sustainable" that would "result in better health outcomes, and not just coverage."

"I think he wanted to bring me in because he trusted my opinion and my view points and valued my thoughts on how to approach different issues," Meier said. "We were aligned philosophically and that helps, obviously."

But now he moves from philosophy to practicality.

"Moving from a policy role to this role, I think a big difference is dealing with things like facilities and personnel, there are more operational details. It's not as fun," he said. "I think I went into it knowing I wouldn't enjoy it as much, but I also felt that there is an opportunity for us to lead."

Meier acknowledged that he came into his initial role in the governor's office with little policy or political experience, having been a contracting officer in a field office of the U.S. Environmental Protection Agency and serving one year on the Fort Thomas City Council.

But he said he has never hesitated to share his policy ideas with others -- whether that be at work, with politicians or people in positions to effectuate change -- and that he knew he eventually wanted to work where he would have a direct impact on policy.

"As I came into the policy shop, this was a new role for me. I had never worked in state government," he said. "In my new role I had the opportunity to really drive innovation and change through directing policy for the governor."

As the deputy chief of staff for policy, Meier said he worked on many different issue areas, but most of his focus was been on health care and services, education and workforce and the opioid epidemic.

"It's been a lot to learn," he said.

Scott Brinkman, secretary of the Governor's Executive Cabinet, who served as acting health secretary between Glisson and Meier, said Meier was a "superb" choice to lead the cabinet.

"Although he was involved in a whole host of policy issues, I would say probably 80 percent of his time was spent on policy initiatives that originated within the Cabinet for Health and Family Services, so he has developed over those two and a half years a very good understanding of the workings of the cabinet," Brinkman said.

Meier said his close work with the cabinet allowed him to build "good relationships" with the people who are now his commissioners, whom he trusted and respected.

"I understand that we have good people and I want them to manage their divisions," he said. "My job is to challenge them to be innovative, to think outside of the box, and to be willing to take risk and try different things, calculated risk, but risk that will drive purposeful change towards an outcome that we want."

Meier said his top priorities for the health cabinet will continue to be the Medicaid waiver, and the related education, workforce and human service reforms that go along with it; child welfare and adoption issues; and the opioid epidemic.

He also said he would focus on efficiency and finding ways to improve customer service, "so that we can maximize the ROI [return on investment] for the taxpayer and we can run an efficient and effective agency." He said he sees untapped opportunities for improvement in the areas of child welfare, foster care and adoption.

Meier said the cabinet's greatest strength is a culture of leadership that lends itself toward service and collaboration. He said its greatest challenge is "the need and the funding," which often requires it to find ways to do more with less, while still doing it well.

Deputy Health Commissioner Kristi Putnam said of Meier, "There is no job that he won't do. It's lead by example. Adam's willing to jump in and work on anything next to people and that makes a big difference."

Brinkman said, "He is just extremely bright on policy, very intuitive, insightful. He's got a very good grasp of technology and the appropriate uses of technology. He's a very good manager, he's very organized, he's highly respected, very good with people, knows how to draw the best out of people."

Thursday, June 28, 2018

Feds charge 10, mainly in Louisville, with various health-care fraud schemes, call them 'drug dealers in lab coats'

A doctor, a psychiatrist, a chiropractor, a medical assistant and six other people in Louisville and Cave City have been indicted as part of a federal crackdown on health-care fraud across the nation.

The charges allege "schemes to divert thousands of powerful opioid painkillers and submit millions of dollars in false medical billings . . . in a state struggling with a drug overdose epidemic," reports Bruce Schreiner of The Associated Press.

"We will not tolerate drug dealers in lab coats," D. Christopher Evans, special agent in charge of the Drug Enforcement Administration's Louisville field division, said at a news conference. "If you're a doctor and you're prescribing dangerous narcotics in a reckless or irresponsible manner, we're coming after you."

The six cases, as described by Western District U.S. Attorney Russell Coleman, include:

  • Perez and Chinea Martinez of Louisville are accused of operating "false-front" clinics that stole the identities of five physicians and numerous patients and generated $4.7 million in false billings to three insurance companies.
  • Osmaro Ruiz of Louisville was charged with operating a false-front pharmacy that stole identities of patients and doctors to bill for prescriptions that patients never received, but that generated $858,000 in fraudulent proceeds.
  • Dr. Chandra Reddy of Cave City and his wife, Vinodini, allegedly conspired to commit fraud, and he was charged with unlawfully allowing nurse practitioners to use his DEA number to prescribe controlled substances.
  • Reddy's medical assistant, Monica Berry, is accused of using a doctor's DEA number to dispense 17,750 doses of hydrocodone, 2,580 doses of oxycodone and 1,895 doses of Xanax to a patient, Brandon Gordon, who diverted the drugs to the streets.
  • Dr. Peter Steiner, a Louisville psychiatrist, is charged with prescribing medically unnecessary drugs and unlawfully distributed opiates.
  • Dr. Bingston Crosby of Louisville and employee Lacy Black are accused of a recruiting Medicaid patients and others to be treated at his chiropractic clinic. "Black promised the patients cash or other remunerations to receive treatment at the chiropractic clinic. Crosby billed for services not rendered when he added charges for treatment patients did not receive," a Justice Department news release said. "Crosby and Black were charged with one count of conspiracy to commit healthcare fraud and one count of paying or offering healthcare kickbacks," Beth Smith reports for the Henderson Gleaner. "Crosby is also charged with eight counts of health-care fraud, seven counts of money laundering and seven counts mail fraud."

Kentuckians are encouraged to let the pros handle the fireworks; even sparklers, firecrackers and bottle rockets are dangerous

By Melissa Patrick
Kentucky Health News

Fireworks are often synonymous with the Fourth of July, but they are also a common cause of injury, so the state Division of Fire Prevention recommends attending a community firework event instead of celebrating with fireworks at home.

"Let the professionals entertain your family," Mike Haney, state fire marshal and director of fire prevention for the Department of Housing, Buildings and Construction, said in a news release. "By celebrating at a public event instead of at home, you reduce the risk of injury and property damage. You may also avoid violating the law."

Consumer Product Safety Commission graphic, using data from the 2017 Fireworks Annual Report
The latest U.S. Consumer Product Safety Commission fireworks report found that in 2017, 12,900 consumers were treated in U.S. emergency rooms for fireworks-related injuries and eight people died from them, with  victims ranging from age four to 57. Seven of the deaths were a result of direct impact from fireworks and one of them was the result of a house fire caused by misusing a firecracker.

The report adds that children between the ages of 10 and 14 were seen most often in emergency rooms for fireworks injuries, followed by young adults between the ages of 20 to 24.

Haney also reminded Kentuckians to pay attention to state and local fireworks laws.

For example, state law prohibits people under 18 from buying fireworks, and from selling them unless supervised by a parent or guardian. The law bans fireworks from being used within 200 feet of a structure, vehicle or other person; and fireworks cannot be sold to anyone who is under the influence of drugs or alcohol.

"Local governments set their own firework ordinances, so be aware of the regulations in your own town," Haney said.

Here are some safety tips from the National Council on Fireworks Safety:

 * Read and follow the instructions on the label.
 * A responsible adult should supervise all firework activities.
 * Never allow children to play with or ignite fireworks.
 * Alcohol and fireworks do not mix. Have a "designated adult shooter."
 * Wear safety glasses when shooting fireworks.
 * Light one firework at a time and then quickly move away.
 * Never light fireworks in a container, especially a glass or metal container.
 * Use fireworks outdoors in a clear area away from buildings and vehicles.
 * Always have a bucket of water and charged water hose nearby.
 * Never relight a "dud" firework; wait 20 minutes and soak in a bucket of water.
 * Do not experiment with homemade fireworks.
 * Wet down used fireworks and place them in a metal trash can.
 * Place disposed of fireworks away from buildings or combustible materials.
 * Report any illegal explosives to the fire or police department.

The CPSC report says that on average,  280 people went to the emergency room every day with fireworks-related injuries in the month around the July 4th holiday in 2017, with about 1,200 of those visits related to sparkler injuries, 800 of them relate to firecrackers and 300 related to bottle rockets.

Michael Spencer, a pilot from Bowling Green, told attendees of a CPSC fireworks event about the dangers of fireworks, having lost several fingers on both hands in 2015 from a shell-and-mortar style firework device. Spencer is now committed to making sure this doesn't happen to anyone else, CPSC writes in a news release about its latest fireworks report, released June 27.

 “Fireworks can be extremely dangerous, even if they are legal,” Spencer said in the release.“My advice would be to leave them to the professionals.”

KidsHealth also stresses that kids should "never play with fireworks," writing that this includes "firecrackers, rockets and sparklers" because they are "just too dangerous."

"If you give kids sparklers, make sure they keep them outside and away from the face, clothing and hair," they write. Sparklers can burn at nearly 2,000 degrees Farenheit and bottle rockets are known to stray off course or to throw shrapnel when they explode.

If a person is injured by fireworks, KidsHealth says to immediately seek medical care.

If the injury is to an eye, KidsHealth says not to rub it, since that may cause more damage; don't flush the eye with water or to put any ointment on it. Instead, cut out the bottom of a paper cup, place it around the eye, and get medical care right away, because your eyesight may depend on it.

If a person is burned, KidsHealth recommends removing the clothing from the burned area and to call your doctor immediately.

Wednesday, June 27, 2018

"Kentucky Substance Use Epidemic: A Solutions Update" is title of Bost Health Policy Forum to be held in Lexington Sept. 24

As Kentucky continues to struggle with the health and economic impacts of the opioid epidemic, the Foundation for a Healthy Kentucky's 16th annual health policy forum will explore medical marijuana and other alternative pain therapies, as well as the rise in infectious disease associated with the crisis.

"We need to understand the truth behind the push for medical marijuana, hear the facts about whether it works to relieve pain, and learn the risks associated with its use," foundation president and CEO Ben Chandler said in a news release. "This year's speakers will give us the latest updates on the causes and impacts of Kentucky's substance use crisis, and will zero in on how we're doing in addressing what continues to feed the crisis and the resulting symptoms."

The 2018 Howard L. Bost Memorial Health Policy Forum is titled "Kentucky's Substance Use Epidemic: A Solutions Update." The forum is sponsored by the foundation with support from Centerstone and, organizations that care for patients with mental, developmental and behavioral issues. It is named for Dr. Howard L. Bost, who helped create Medicare and Medicaid, developed the Appalachian Regional Hospitals system, improved mental-health services in Kentucky, and created the vision for the foundation.

It will be held at the Griffin Gate Marriott Resort on Newtown Pike in Lexington on Monday, Sept. 24. Attendance is free, but registration is required. Click here to register.

This year's keynote speaker is Pulitzer-Prize-winning reporter Barry Meier, the author of Pain Killer: An Empire of Deceit and the Origin of America's Opioid Epidemic. Meier's book chronicles the aggressive marketing of the highly addictive drug OxyContin by Purdue Pharma, and the role it played in creating the nation's opioid crisis.

The forum will feature two morning panels, one titled "Kentucky's Addiction Burden," which will provide the latest updates on how substance addiction is impacting both the heath and economy of Kentucky, and the other "Agency Exchange: Views from the Front Lines," which will discuss various approaches being used by the state to deal with the crisis.

Attendees will be able to attend two of the three afternoon breakout sessions: "Infectious/Chronic Diseases Caused by Addiction," "Medical Marijuana: What is the Truth?," or "Treating Chronic Pain: Alternatives to Opioids. "

The full agenda and speaker biographies are available on the foundation's website. All speaker presentations will be made available on the website after the forum. Meier will also be available to sign copies of his book, which will be for sale at the forum.

Saturday, June 23, 2018

Both Affordable Care Act insurers in Kentucky seek rate hikes; Anthem is returning to 17 unspecified counties, for a total of 76

By Melissa Patrick
Kentucky Health News

The two health insurers offering government-subsidized health plans in Kentucky's individual market for 2019 are both requesting an overall rate hike, the most popular one seeking increases averaging 3.5 percent and the other asking for 19.4 percent.

Insurers offering plans for small groups under the Patient Protection and Affordable Care Act are asking for average hikes of nearly 11 percent. These overall percentages reflect an average that will vary, depending on whether individuals smoke, how old they are, and where they live.

Anthem Health Plans, which has covered most of the ACA-subsidized customers in Kentucky, requested an average 3.5 percent increase for its 13 different plan offerings.

Anthem has also asked to expand its service area to include 17 more counties. If approved, that would increase its footprint from 59 counties to 76. Materials made public by the state Department of Insurance did not list the counties; an Anthem spokesman told Kentucky Health News that it was not releasing the list yet "for competitive reasons."

Anthem, based in Indianapolis, had offered plans in all 120 Kentucky counties in 2017, but scaled back to 59 counties in 2018.

CareSource's current counties
are in pink, Anthem's in blue.
CareSource of Kentucky, which covers the remaining 61 counties, submitted rate increases averaging 19.4 percent for its 12 plans, with no change in the counties it serves.

The requests are preliminary and subject to change. The Insurance Department can approve, lower or raise the rates. The department said in a press release that it expects to finalize the rates by late August.

“The initial rate increase percentages for 2019 are not as high as in previous years and some policyholders could see rate decreases,” Insurance Commissioner Nancy Atkins said in the release.

Last year, Anthem asked for an average 34.1 percent increase and CareSource asked for a 20.8 percent hike, and the Insurance Department gave both more than they asked for: increases averaging 41.2 percent and 56 percent, respectively.

Kentucky had 89,569 residents enroll in subsidized coverage through its health-benefit exchange and during the 2018 open enrollment period. That was more than a 10 percent increase over the 81,155 who had enrolled in 2017, but lower than the 2016 and 2015 totals: 93,687 and 106,330, respectively. The state shifted enrollment to the federal exchange in 2016, away from the state-based exchange called Kynect.

Open enrollment for 2019 begins Nov. 1.

National HIV Testing Day is Wednesday, June 27, a reminder for everyone between the ages of 13 and 64 to get tested

By Melissa Patrick
Kentucky Health News

The only way to know for sure if you have the human immunodeficiency virus is to get tested, and here's a reminder to do so: National HIV Testing Day, which is Wednesday, June 27.

This year's theme is #DoingItMyWay, which delivers the message that HIV testing should be part of everyone's regular health routine and encourages people to share on social media what motivated them to get tested.

Every county health department in Kentucky and many community-based organizations offer free anonymous or confidential HIV testing, according to the stae  Cabinet for Health and Family Services. Click here to find a test site near you. The state also offers a new HIV confidential hotline that is open 24 hours a day: 1-844-294-2448.

In 2015, 339 new cases of HIV were diagnosed in Kentucky, according to the the state's 2017 HIV/AIDS Surveillance Report. More than 1 million Americans are living with HIV, and one in seven don't know it, according to the federal Centers for Disease Control and Prevention. 

The CDC recommends that everyone between the ages of 13 and 64 should get tested for HIV at least once, and that people who are in high-risk groups should get tested at least once a year.

A person is considered to be in a high risk if he or she answers yes to any of these questions:
  • Are you a man who has had sex with another man?
  • Have you had sex—vaginal or anal—with an HIV-positive partner?
  • Have you had more than one sex partner since your last HIV test?
  • Have you injected drugs and shared needles or other works (for example, water or cotton) with others?
  • Have you exchanged sex for drugs or money?
  • Have you been diagnosed with, or sought treatment for, any sexually transmitted disease?
  • Have you been diagnosed with or treated for hepatitis or tuberculosis?
  • Have you had sex with someone who could answer yes to any of the above questions or someone whose sexual history you don’t know?
HIV is spread only through direct contact with another person's body fluids and is most commonly transmitted through anal or vaginal sex without a condom, or by sharing needles or syringes with a person who is infected with the virus.

HIV attacks and destroys a certain kind of infection-fighting cells in the body, which then makes it difficult for the body to fight infections and certain cancers. Without treatment, HIV can eventually destroy the immune system and advance to AIDS, acquired immunodeficiency syndrome.

The best ways to reduce your risk of getting HIV is to use condoms correctly every time you have sex, limit your number of sexual partners, and never share drug injection equipment, according to the U.S. Department of Health and Human Services.

Kentucky has about 40 syringe exchanges that allow intravenous drug users to trade dirty needles for clean ones as a way to prevent the spread of HIV and hepatitis C.

There is also medication available called pre-exposure prophylaxis, or PrEP, for those who are HIV-negative but at high risk for HIV.

Friday, June 22, 2018

House passes 58 opioid bills, 2 from Rogers; work continues in Senate, where McConnell aide says it's a priority for the leader

The U.S. House passed a massive opioids package Friday that includes two measures sponsored by Rep. Hal Rogers, Republican from Eastern Kentucky's 5th Congressional District.

"The Treating Barriers to Prosperity Act will expand the Appalachian Regional Commission's efforts to combat the deadly drug abuse epidemic in the Appalachian region, where the opioid-related overdose rate is 65 percent higher than the rest of the nation," Rogers said in a press release, "The Substance Use Disorder Workforce Loan Repayment Act offers student loan repayment of up to $250,000 for students who agree to work as a substance use disorder treatment professional in areas most in need of their services. Both bills were previously approved by the House."

The package combines 58 bills the House passed in the last two weeks, giving more lawmakers the ability to say in an election year that they passed bills. Rogers called it "one of the most significant bipartisan measures to combat a single drug crisis in the nation's history." Titled the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, it includes "expanding access to medication-assisted treatment, cracking down on over-prescribers of opioids, increasing telehealth services for treatment of substance use disorder, and encouraging non-opioid pain management techniques," Inside Health Policy reports.

But Lev Facher of The Boston Globe's medical publication Stat reports, "Outside experts, while applauding Congress for its focus on the issue, say they believe the current package fails to match the scope of the current crisis." The first example: "It does not expand syringe exchange services, which have been shown to reduce infectious-disease transmission among injection drug users."

CNN reports, "A key provision in the bill would allow Medicaid to pay for treatment in certain inpatient facilities that treat mental illness -- rolling back a federal prohibition in order to target opioid addiction -- for up to 30 days. The provision was initially tailored only for opioid treatment, drawing criticism from Democrats for focusing on too small a population." A deal between Energy and Commerce Committee Chair Greg Walden and Rep. Bobby Rush, D-Illinois, "broadened the provision to expand its reach to crack cocaine as well."

Now the package heads to the Senate, "where multiple committees are working on their own package of bills to address the crisis," CNN reports. "Aides in both chambers say they expect to reconcile the bills and get something to the President's desk to be signed into law before the end of the year. A spokesman for Senate Majority Leader Mitch McConnell said the bipartisan bills reported out of the four committees are 'priorities for the majority leader'."

Stat reports, "Lobbyists and Democratic congressional staffers have predicted that McConnell will wait until November — so that the roughly one dozen vulnerable Democrats in hard-hit states like West Virginia can’t advertise a 'yes' vote on opioids legislation." Stat has a point-by-point rundown of what's in and not in the package.

In a region and state with many teen births, E. Ky. program helps young women teach sex education outside the classroom

All Access EKY trains young Eastern Kentucky women to
push reproductive health. (Photo by Hero Images/Getty Images)
A group called All Access EKY is hiring young women between 17 and 22 to create media campaigns for reproductive health, with a focus on increasing access to a full spectrum of birth-control options in Eastern Kentucky, Ivy Brashear reports for Yes! Magazine.

Barriers to getting birth control in Eastern Kentucky are "profound," Brashear reports, and extend way beyond the ordinary obstacles of cost and access to care, to things like having access to reliable transportation (there is no public transportation), knowing if the employees at the clinic go to the same church as your parents, or simply finding a doctor who is willing to prescribe it.

"This is all assuming she knows anything about her birth-control options in the first place," Brashear writes, adding that many young women in Eastern Kentucky "must battle abstinence-only sex education in their schools and a cultural veil of secrecy about their bodies in order to fully understand their options."

She reports that only six of the 19 health departments and federally qualified health clinics in All Access EKY's seven counties offer the full range of birth-control options, and have only four nurse practitioners at public health clinics who are qualified to insert intrauterine devices (IUDs).

All Access, which began in 2016, is working to overcome these barriers by offering young women from the region an eight-week paid fellowship to create educational films that focus on birth control, with interviews of local women about their reproductive health experiences.

The women have also produced social-media campaigns, set up tables at local festivals, and distributed printed materials through clinics and local businesses, Brashear reports in her story, titled "Where Birth Control is Scarce, Young Women Create Sex Education Outside the Classroom."

All Access is a collaboration between the Kentucky Health Justice Network, the national nonprofit Power to Decide, and Appalshop, the media and arts organization in Whitesburg, where the project is housed.

Project director Stacie Sexton told Brashear that All Access works to bridge the reproductive health information gap between the publicly funded health-care providers and community members and helps clinics educate providers about birth control, using materials created by the fellows.

“That’s what makes this project unique,” Sexton told Brashear. “It’s community-centric rather than focusing on just the media side of it, or just the institutional side of it.”

Brashear reports that All Access has completed two eight-week fellowships, hired 13 fellows, and produced 20 media pieces. This summer, seven are in a six-week media workshop in partnership with Appalshop’s youth media program, Appalachian Media Institute.

“We’re trying to build some of these bridges in our communities so it’s not just teenage girls on an island and health care providers on an island and educators on an island,” All Access Media Director Willa Johnson told Brashear. “They all need to be working together to give young people a better opportunity.”

Johnson added that the program has allowed the fellows to explore a career path other than nursing or education, and that many of them have provided birth control education outside of the fellowship.

The program has also worked with policymakers on this issue. Sexton noted that Rep. Chris Harris, a Democrat from Pikeville, sponsored a bill to make it easier for women to get their birth control, and even though it didn't pass, she said their work with him was important.

She said they have also worked to find ways to work with Sen. Brandon Smith, a Republican from Hazard, who sponsored a successful bill in 2017 to ban abortions after 20 weeks. She told Brashear that his political views don't deter her from reaching out to him, stating that that would be a disservice to the the region to not work with as many people as possible to increase access to birth control.

“At the end of the day, if [Smith] wants to increase access [to birth control] to reduce abortions, we have a common goal,” Sexton told Brashear. “We come from different places, but I think we both have our hearts in the right place based on our personal value systems. He’s doing what he thinks is right; I’m doing what I think is right, but we do have a shared interest in increasing access to birth control. I can work with that.”

Why does it matter?

The 2017 Youth Risk Behavior Survey found that 38 percent of Kentucky's high-school students report that they'd had sex, and 29 percent reported being sexually active, defined as having had sexual intercourse with at least one person during the three months prior to the survey.

Of the 29 percent who were sexually active, 16.5 percent of them reported not using any method of birth control the last time they had sex; and nearly 89 percent of them didn't use both a condom and another method of birth control as is recommended.

The survey also showed that Kentucky's sexually active teens aren't using the most reliable forms of birth control; 75.5 percent reported that they did not using birth control pills the last time they had sex; 92.3 percent did not use an IUD or an implant; 94 percent did not use a patch, birth control ring or get a shot; and 51.3 percent of them did not use a condom.

And while teen birth rates in Kentucky continue to drop, to an average of 34.6 per 1,000 between 2013 and 2015, down from 37.9 between 2012 and 2014, and 48.9 five years ago -- Kentucky's teen pregnancy rate continues to be significantly higher than the national average of 22.3 per 1,000, according to the 2017 Kentucky Kids Count report.

The report also found that 16 Kentucky counties had teen-birth rates of 60 or more per 1,000, with Wolfe County leading the way at 80.9 per 1,000. That's up significantly from 68.2 five years ago. The report shows teen birth rates for every Kentucky county.

Brashear reports that out of all the pregnancies in Kentucky, 47 percent are unplanned.

A much debated bill about sex-education standards, passed during the past legislative session, requires any Kentucky school that offers sex ed to include instruction that says abstinence is the desirable goal for children, that abstinence is the only certain way to avoid unintended pregnancy or getting a sexually transmitted disease, and to teach students that the best way to avoid sexually transmitted diseases is to establish a "permanent, mutually faithful, monogamous relationship."

The new law does not require abstinence-only education, but opponents say it should have required comprehensive sex education in Kentucky schools, and by that omission sends a message to schools to teach abstinence-only curriculums, which the critics say have been proven ineffective.

Kentucky has no specified standards for sex education curriculums, though the state Department of Education has said that it is working on them. That was before the recent ouster of the department's commissioner.

Major drug distributor Cardinal Health gives seven grants in Ky. to teach students about being safe with prescription drugs

Seven Kentucky health-care or social-service organizations are recipients of Cardinal Health Foundation grants to teach students in kindergarten through college about being safe with prescription drugs. Cardinal Health, a leading drug distributor, has been criticized and sued for its alleged role in worsening the nation's opioid epidemic.

They are Northeast Kentucky Area Health Education Center in Morehead, the Southern Kentucky AHEC in Mount Vernon, Centerstone Kentucky in Louisville, Children Inc. in Covington, Community United Methodist Hospital in Henderson, Juniper Health in Beattyville and Kings Daughters Medical Center in Ashland.

The Morehead AHEC said in a news release that it will use its $35,000 from the foundation's Generation Rx Prescription Drug Misuse Prevention Education for Youth grant program to create Prescription Education for Appalachian Kentucky Students, or PEAKS,.

Using Generation Rx education materials, the PEAKS project will deliver prevention information about prescription-drug misuse to about 500 high school and college students across northeastern Kentucky.

The program, which runs through spring 2019, will focus on students in Boyd, Clark, Fleming, Greenup, Lawrence, Powell and Rowan counties, chosen because of their overall high drug use and mortality rates.

“This project will be crucial for local students, as research indicates people are most likely to begin abusing drugs during adolescence and young adulthood," David Gross, director of the Northeast Kentucky AHEC, said in the release. " We look forward to helping prevent future prescription drug misuse even while efforts are underway to battle the current opioid epidemic.”

PEAKS is one of several opioid-related projects the Northeast Kentucky AHEC is working on, including one that focuses on medication-assisted treatment, says the release.

Thursday, June 21, 2018

Health secretary says some benefits will likely be cut if Medicaid changes are ruled illegal; three counties to start a month early

By Melissa Patrick
Kentucky Health News

Kentucky's new Medicaid plan is set to kick in July 1, but the state's top health official said some of the program's benefits could be cut if a federal judge in Washington rules against the changes.

The new program, called Kentucky HEALTH, for Helping to Engage and Achieve Long Term Health, includes, among other things, work or other community engagement requirements; monthly reporting; lock-out periods for failure to comply; and premiums and co-payments based on income.

Secretary Adam Meier
Sixteen Kentucky Medicaid members are suing the federal government, arguing that it lacked the authority to let Kentucky require Medicaid beneficiaries to work, volunteer, attend job training or go to school in order to keep their health coverage. U.S. District Judge James Boasberg has said he would rule by Saturday, June 30; the changes are due to start in Campbell County on July 1.

Adam Meier, secretary of the Cabinet for Health and Family Services, told legislators at the June 20 joint health committee meeting that if Boasberg rules against the changes, the state would likely have to cut dental, vision and possibly prescription-drug coverage for some people.

Kentucky HEALTH had already shifted the dental and vision benefits from being free to a "My Rewards" program that requires most adult Medicaid recipients to participate in certain activities to get dental and vision care.

Meier added that an adverse ruling would also force the state to consider rolling back the expansion of the Medicaid program to nearly 500,000 Kentuckians. In all, Medicaid covers nearly 1.4 million Kentuckians, or nearly one in three.

Gov. Matt Bevin has said Kentucky will end the expansion of Medicaid if a court blocks the changes, and has issued an executive order putting the termination into effect within six months of the final appeal.

“Kentucky HEALTH is our way of maintaining expansion, maintaining coverage and maintaining access,” said Meier. “Without having the waiver approved, we lose our ability to do that effectively.”

The state has estimated that 95,000 fewer Kentuckians will be enrolled in Medicaid in five years with the changes than without them, partly because of noncompliance, and that the new plan will save an estimated $2.4 billion over the next five years: about $300 million in state money and the rest federal.

Meier added that any disruption to the roll-out of the new Medicaid program would also add significant technology costs to the state and would create communication challenges and confusion among the affected recipients.

In a separate meeting on the same day, Meier told the legislative Medicaid Oversight Committee that the state projects spending of about $300 million in excess of appropriations over the next biennium.

And though he said the state expects to save money by implementing Kentucky HEALTH, he couldn't say how much.

He added that the state expects to spend more than $300 million over the next two years to upgrade its computer systems, most of it federal money, but he couldn't say how much the state would spend on administrative costs. He said the state has spent less than $10 million of on the project so far.

The most controversial part of the new plan has been the 80-hour-per-month "community engagement" requirements that are to be in place in all but eight counties by Dec. 1.

The Kentucky HEALTH website says activities that count toward the "Partnering to Advance Training and Health" or PATH Community Engagement requirements, include: working, looking for a job, training for a new job or skill, attending classes, volunteering, caretaking, and participating in treatment for substance use disorder .

Kristi Putnam, deputy secretary of the health cabinet, said three counties have asked to begin their community engagement requirements one month before other counties in their respective regions.

Christian County is now scheduled to start Oct. 1, with the rest of the Western Kentucky region to start Nov. 1; and Taylor and Russell counties will start Nov. 1, with the rest of the Cumberlands region (except Whitley County) to start Dec. 1. Seven other counties in southeastern Kentucky will be delayed because they are part of a pilot program to find jobs for food-stamp recipients.

These requirements will largely impact the nearly 500,000 Kentuckians who gained Medicaid coverage through the expansion to people with incomes up to 138 percent of the federal poverty level, which is $16,394 for an individual and $33,534 for a family of four.

For more information on Kentucky HEALTH, go to

A county-by-county spreadsheet of enrollment in Medicaid, as of January 2018 can be downloaded from:

Bevin featured at Washington event to unveil Obamacare repeal-and-replace effort; leaves door open to challenging McConnell

Bevin on CNBC, where he disagreed with Sen.
McConnell's view about tariffs on bourbon.
Most congressional Republicans appear to have give up, at least for now, on the idea of repealing the Patient Protection and Affordable Care Act, which they usually call Obamacare. But Gov. Matt Bevin, who may harbor aspirations to be a congressional Republican, went to Washington June 20 to help announce a new plan to repeal and replace the law.

Bevin "is spearheading a drive to get Congress to take another stab at revoking the 2010 law," Lesley Clark reports for the Washington Bureau of McClatchy Newspapers, which includes the Lexington Herald-Leader.

"Promises have been made, and this is something the American people need and want," Bevin said at a forum sponsored by the Galen Institute, "which unveiled an effort to repeal and replace Obamacare," Clark reports. "The plan would eliminate the act's Medicaid expansion and the subsidies that allow people to buy coverage would be converted into block grants for states."

Senate Majority Leader Mitch McConnell and other Republicans "turned to taxes after the collapse last year of their effort to repeal Obamacare" last summer, Clark notes. "McConnell has said he wants the Senate to spend this summer working on spending bills and presidential nominees."

Clark asked Bevin if he had spoken with McConnell about the proposal. The governor said he talks regularly with both senators and the congressional delegation on a regular basis, but wouldn't discuss those conversations. However, he said, "At times my sense of urgency is different than some of those with whom I'm speaking."

"Bevin did not rule out a bid against McConnell," Clark reports. When she asked him about that, he said, "No, I'm worried about being governor. I'm the governor, that's my focus." But he added, "There is a dearth of leadership everywhere in politics, including in this town," adding that many "traipse around under the guise of leadership. Maybe it's even part of their title."

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Murray City Council passes a smoking ban on 8-2 vote, but the mayor, who pledged to pass it, says it could still be 'tweaked'

Murray City Council members voted 8-2 on June 14 to prohibit smoking in all public places and places of employment within the city limits, but John Wright reports for the Murray Ledger & Times that it may not be a "done deal." After about an hour of debate, Mayor Jack Rose suggested that the council pass the ban, but leave the issue open. (Wright's story is behind a paywall.)

Sperling's Best Places map
“I think we need to go ahead and pass it tonight, then come back and tweak it if need be,” Rose said. “I’m interested in listening if someone has an idea to make this the best situation we can find. If we see that there’s an element of difficulty with it, then we can look at it later.”

The ordinance, which is set to take effect in September, prohibits the smoking of cigarettes, as well as electronic cigarettes and vapor devices, in parking lots and areas within 15 feet of entrances, windows and ventilation systems. In restaurants and bars there must be a 15-foot buffer between outdoor seating and serving areas, and the rules also apply for numerous outdoor areas, Taylor Inman reports for WKMS-FM.

"Heartfelt congratulations to Mayor Jack Rose," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "He committed to getting it done before he retired. And, by gosh, he has done that! Even better, the ordinance that he was able to shepherd through to passage follows all the guidelines for truly making a difference in the health of those who live, play and work in Murray."

Local restaurant owners voiced opposition to the ban. Ron Gladden, owner of the Big Apple Cafe, one of only six restaurants in Murray that still permits smoking, told the council that smokers often outnumber non-smokers in his restaurant, and non-smokers had 62 non-smoking restaurants in the area to choose from.

“The citizens of Murray and Calloway [County] essentially vote every day on where they want to eat," Gladden said, adding that at the Big Apple, "the vote" is pretty clear. “I don’t believe it is the city council’s right to make decisions on smoking. It should be the business owners and the citizens of Murray, Kentucky," he said.

Robin Floyd, a longtime radiologist at the local hospital and also the owner of Tap 216, a restaurant that allows smoking, acknowledged that smoking is unhealthy, but said he thought restaurants that had created ways to separate the smokers from the non-smokers should be allowed to "opt-out" of the ordinance.

Supporters of the ordinance also spoke out. Local hospital CEO Jerry Penner said he had worked to strengthen smoke-free rules at the facility over the past two years, and though he recognized how hard these rules are for smokers, he said, "I think we have to err or the side of health here."

Penner also pointed out that far Western Kentucky, including Murray, ranks first in the state for lung cancer cases and deaths from it. “I’m tired of burying people," he said.

Rose, citing studies proving the danger of secondhand smoke, said the ordinance is needed to improve health in the city, Kentucky's 20th largest. “Let’s just say they get all kinds of secondhand smoke and are lucky and don’t get cancer or some other kind of disease because of that,” Rose said. They’re still more comfortable, so we’re making a comfort level.” Here is a video report from Paducah's WPSD-TV.

Tuesday, June 19, 2018

Clinton County's obesity rate falls after years of foundation-funded program for improvement of the community's health

Five years ago, the Foundation for a Healthy Kentucky gave the Clinton County schools the first installment of a $400,000 grant to help improve the county's health status, with emphasis on children. Now, in the last year of the grant, foundation and school officials say it has helped children achieve a healthier weight and reduced the county's overall obesity rate.

"The obesity rate in Clinton County has improved so much that we no longer qualify for a CDC grant we had been receiving for the past three years, and using collaboratively with the Healthy Hometown Coalition," Dr. Paula Little, assistant superintendent of schools, chair of the coalition and a director of the foundation said in a foundation press release.

Little said she didn't know the rate, just that it had fallen below the 40 percent required for the grant from the Centers for Disease Control and Prevention's High Obesity Program, which through the University of Kentucky promotes healthy eating and active living in Clinton and five other counties: Elliott, Letcher, Lewis, Logan and Martin.

Albany Mayor Nicky Smith, vice-chair of the Clinton County coalition, said "We have seen positive changes in community activity and awareness of health issues. I feel that our children have benefited from improvements in healthy eating and physical activity that they will carry with them throughout their lives."

The coalition has spent grant money on "walking paths, playgrounds and other spaces to provide more places where children can be physically active," said the press release, which has a complete list of grant activities. "The coalition has increased physical education and added programs in the schools to increase classroom movement, expanded nutrition programs, and supported policy changes to ensure increased physical activity and better nutrition for area students."

"The Clinton County coalition is a great example of a community coming together to identify a significant local health issue and develop a comprehensive plan to make an actual, measurable improvement," said Ben Chandler, president and CEO of the foundation.

The Clinton County grant was one of seven in the foundation's $3 million "Investing in Kentucky's Future" program, focused on children. "We'll be taking what Clinton County and the other six IKF grantee communities have learned and sharing it all over the state," Chandler said, "so other local health coalitions can implement in their own areas what has proven successful here."

Hepatitis A keeps spreading; 'Wash your hands,' editor says

Philanthropist Christy Brown gives U of L $5 million for institute to study environmental conditions that affect human health

Christy Brown, U of L President Neeli Benapudi and Dr. Aruni
Bhatnagar, director of the Envirome Institute. (U of L photo)
With a $5 million gift from leading Louisville philanthropist Christina Lee Brown, through the Owsley Brown II Family Foundation, the University of Louisville has established an Envirome Institute in its School of Medicine to "develop integrated knowledge of the environmental determinants of health."

The name of the institute is not missing three letters. The word "envirome" is a knock-off from "genome," which is the "map of our genetic code, revealing how our genes relate to our health, and potentially our susceptibility to disease," the university says in a press release. "Built on a new vision of health, the Envirome Institute pioneers actionable knowledge about all forms of health and how they are affected by the environment beyond genomics. This gift from Brown catalyzes existing resources and adds new capabilities toward the ambitious, long-term mission of studying the human envirome with the same precision and rigor applied to decoding the human genome."

What's an envirome? Wikipedia says it "includes all of the environmental conditions required for successful biological life that affect human health. In genetic epidemiology, an envirome the total set of environmental factors, both present and past, that affect the state, and in particular the disease state, of an organism."

The Envirome Institute is the successor to the university's Kentucky Institute for the Environment and Sustainable Development. "Like KIESD, the institute will support research and applied scholarship, teaching and educational outreach activities, but with greater emphasis on community engagement and health," the university said. "The Envirome Institute is the first institute dedicated to the study of the human envirome. Taking a holistic approach to researching how the human-environment interrelationship impacts peoples’ lives, the institute will build on the pioneering work of Dr. Aruni Bhatnagar, the institute’s director, in the field of environmental cardiology. The institute will incorporate community engagement and citizen science to introduce a singular, new approach to the study of health."

The university has also created a Center for Healthy Air, Water, and Soil as part of the Envirome Institute. Brown had previously created a private nonprofit called the Institute for Healthy Air, Water and Soil. Its work will shift to the center, which "will support outreach activities to promote collaborations and interactions with the community for information exchange, partnership in scientific studies, dissemination of environmental information to the community and consultation by the community on issues relevant to the environment and health," the university said.

Sunday, June 17, 2018

Weekly newspaper tells the story of a transgender woman, 19

Crystal Stine Hahn (CMW Photography)
The Lebanon Enterprise, which under Editor-Publisher Stevie Lowery has a record of tackling sensitive subjects, broke new ground last week with a story about a 19-year-old transgender woman.

The story by reporter Emily LaForme is mainly about the experiences of Crystal Stine Hahn, 19, and started out by calling her "smart, honest, kind, bold… brave."

But it touches on some health aspects, and is an example of how to report and write about a sensitive subject, as some health topics are. It gets to a key point very quickly:
Born in a male body, Crystal, formerly known as Christian, always knew there was something wrong, but it took years to put those feelings into words. And, it took nothing short of fate to place the right champion into her life to answer her cries for help - her stepmother, Lebanon native Jeri Stine Hahn.
“She came to me and said there was something wrong with her, and that she needed to go to the doctor,” said Jeri. “I asked her what was wrong, and she wouldn’t say right away.”
Crystal eventually professed that she didn’t feel right in her body.
“She finally told me there was something wrong ‘down there,’” Jeri said. “I asked her if she wanted the doctor to make it bigger.”
Crystal said no.
“I finally said, ‘Do you want the doctor to take it away?’ Jeri said. “And, she said ‘yes.’” 
Hahn at 11, then named Christian
Crystal Hahn began her transition, which is still continuing, in the fifth grade in Lawrenceburg, LaForme reports: "Most of the staff and students were accepting, she said, but there were still lingering tensions between the community and extended family, so they opted to move to Lexington for a fresh start." At first she told no one but "a select few teachers" that she was transgender, but "keeping such a big secret was weighing heavily on her and her relationships with classmates, so she came out to her entire school in the ninth grade."

Hahn explained to LaForme, “I can’t date a boy without disclosing that to them, and I was tired of lying to my friends and not being true to myself. My parents were worried it would make my life harder, but I felt like my life was harder by lying to myself and to everyone else.”

Jeri, Crystal and stepfather Marty Hahn
The Enterprise shows it knows its audience with this paragraph: "Wrapping your head around the existence of transgender people is still not easy for everyone. However, thinking about the idea that some people are born with an extra finger, or no hands, or even conjoined with their twin, makes the idea that someone could have been born with the wrong sexual organ not seem so outlandish."

And the weekly paper, published by Landmark Community Newspapers, lists eight "important terms to know, from and," and Jeri Hahn's tips for parents of transgender Kentucky children. Here they are:

Terms to know
Transitioning: Altering one's birth sex is not a one-step procedure. It is a complex process that occurs over a long period of time. Transition can include some or all of the following personal, medical and legal steps: Telling one's family, friends, and co-workers; using a different name and new pronouns; dressing differently; changing one's name and/or sex on legal documents; hormone therapy; and possibly (though not always) one or more types of surgery. The exact steps involved in transition vary from person to person. Avoid the phrase "sex change.”
MTF: male to female
FTM: female to male
Transgender: An umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth.
Top surgery: Chest surgery such as double mastectomy, breast augmentation, or periareolar (keyhole) surgeries.
Bottom surgery: Genital surgeries such as vaginoplasty, phalloplasty, or metoidioplasty.
Gender dysphoria: Anxiety and/or discomfort regarding one’s sex assigned at birth.
Body dysmorphia: A disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one's appearance.
Tips for parents
* Educate yourself by reading as much as you can about the transgender diagnosis. 
* Allow your child to dress in a way that he/she is comfortable and not in a way that makes you comfortable.
* Also allow your child to play with opposite-gender toys if they enjoy them. 
* Call Cincinnati Children's Hospital's gender clinic to make an appointment with a gender specialist if your child is displaying insistent, consistent and persistent cross gender play or dress. This consistent behavior is usually not a "phase.”
* Health insurance plans are beginning to cover cross-gender surgeries.

Saturday, June 16, 2018

Fewer Ky. teens smoke, but the rate is still high, and new vaping products like the Juul create worry that this trend will reverse

By Melissa Patrick
Kentucky Health News

Kentucky's high-school students continue to smoke at higher rates than their national counterparts, but the good news is that their rates continue to drop. The bad news: An influx of new vaping products could reverse this downward trend.

2017 Youth Risk Behavior Survey
The recently released 2017 Youth Risk Behavior Survey found that 14.3 percent of Kentucky high-school students reported smoking cigarettes; 14.1 percent said they smoked e-cigarettes, 10.6 percent used smokeless tobacco; 11 percent smoked cigars; and 26 percent of those who reported using tobacco products use more than one product.

All of these numbers are "significantly higher" than the national averages for the same measures, which Foundation for a Healthy Kentucky President and CEO Ben Chandler says is a real problem, because most adult smoking habits are "hard-wired" by the age 18 -- and Kentucky has the second highest adult smoking rate in the nation, 26 percent.

"The cigarette smoking rate for Kentucky high schoolers remains 62 percent above the national average, and nearly twice as many use smokeless tobacco. A third more Kentucky youth are dual users, which exacerbates their exposure to nicotine and the damage tobacco use does to their developing brains," Chandler said in a news release.

Chandler commended the state's efforts to keep young people from smoking, but cautioned that Kentucky's progress is slower than other states.

"We have proven measures to ensure the trend in youth tobacco use continues downward, but we have to have the courage to enact them and the common sense to fund them," he said. "We need smoke-free laws, higher tobacco taxes, including taxes on new tobacco products, and more youth tobacco prevention funding."

A look at some of the state's most recent anti-smoking efforts shows there is room to do more to protect children from smoking:
  • Only 70 of the state's 173 school districts have adopted 100 percent tobacco-free school policies and only 49 of those have included electronic cigarettes in their policies, Elizabeth Anderson-Hoagland, youth tobacco-policy specialist with the state health department, told Kentucky Health News.
  • Bills to require school properties and school events to be tobacco-free were introduced but not called up in the legislature's education committees this year. The Senate passed a similar bill last year, but the House didn't take it up. A recent Kentucky Health Issues Poll found that 87 percent of Kentucky adults support such a law, and the poll has shown consistent support for such policies since 2013.
  • A strong lobbying effort by the Coalition for a Smoke-free Coalition to get lawmakers to raise the cigarette tax by $1, to $1.60 per pack, failed. The coalition, chaired by Chandler and staffed by the foundation, said among other health benefits, such a hike would have kept more than 23,000 Kentucky teens from ever smoking and would have resulted in over 29,000 adults quitting. The tax was raised 50 cents, to $1.10, but Chandler said tobacco companies will be able to ease its impact with coupons and discounts.
  • Though 71 percent of Kentucky adults support a statewide smoking ban, the last bill to get any traction on this issue was introduced in 2015, when the House passed a ban that was not called up in the Senate. Republican Gov. Matt Bevin, who took office in December 2015, has said this should be a local decision, so it's not likely such a bill would pass while he is in office. Only 35 percent of Kentuckians are protected from exposure to secondhand smoke by local smoke-free ordinances, according to the Kentucky Center for Smoke-free Policy.
On top of all of that, Chandler said he worries that teens' use of electronic cigarettes will undermine all the progress the state has made. About 45 percent of the state's high school students in the survey said they had ever tried an electronic vapor product.

A vaper uses a Juul device. (Photo by Adrian Leuthauser, Kentwired)
"And the explosion in teen popularity of new e-cigarette products threatens to undermine all the progress we've made by hooking teens on nicotine products that are proven gateways to smoking," Chandler said. "How sad it would be if we ended up back where we were a generation ago!"

One such product is the Juul device, a highly popular vaping tool that packs a powerful nicotine punch, with dozens of flavors that attract teens. And because it is small and looks like a USB drive, they are easy to hide them from parents and teachers.

The sale of these products to minors has become such a problem that the Food and Drug Administration conducted a nationwide undercover "blitz" to crack down on their sales. "They are a huge problem in the schools because they are so easy to conceal," Hoagland said. "Teens themselves are saying they are a problem, as well as administrators."

Chandler concluded, "Tobacco-related illness already costs the commonwealth 8,900 lives and $1.92 billion a year in health care expenditures. And even with the progress we've made, 119,000 kids currently under age 18 will die prematurely from smoking. That's nearly a thousand kids per county in Kentucky!"