State suspends July 1 order that required Medicaid patients in managed care to make co-payments for treatment

Kentucky Medicaid officials have suspended collection of co-payments by patients in managed care, a change they had ordered at the start of July. "The co-pays caught health providers by surprise and caused alarm among patients who didn't know about or understand the changes," reports Deborah Yetter of the Courier Journal.

The Cabinet for Health and Family Services said on its Facebook page, "The only recent change to co-payments was removing the ability for managed-care organizations to waive co-pays," which the MCOs have typically done. "It has come to our attention that there has been inconsistent implementation of co-pays among MCOs. This has highlighted a need to suspend mandatory collection of co-pays."

A man gets a prescription filled at Portland Family Health
Center in Louisville. (Courier Journal photo by David R. Lutman)

The initial change was part of Gov. Matt Bevin's new Medicaid plan, which a federal judge blocked on June 29. It would have established small monthly premiums for people above the federal poverty level (about $16,000 for a single person) and co-payments for those with lower incomes.

"The judge's order "removed the premium category, which caused all members to fall into a co-pay plan, and not all MCOs were prepared to implement this change in the same manner," the cabinet said. "Thursday, we notified the MCOs that we were suspending enforcement of co-payments, and as of Friday we are withdrawing the regulation requiring mandatory collection of co-payments. We will revisit how best to implement co-pays in the near future."

Yetter reports, "The sudden announcement that co-pays were mandatory July 1 caught many health providers and advocates off guard. . . . Health providers say they weren't sure who had to pay, who was exempt, how to collect the co-pays and what to do when patients couldn't pay. For example, pregnant women and children generally have been exempt from such requirements. But several health providers said it appeared that children covered through the Children's Health Insurance Program ... for children of low-income working parents, were expected to pay co-pays."

Health-care providers generally treat patients who say they can't make a co-payment, but in such cases, the payment comes out of the provider's Medicaid reimbursement, Yetter notes. "It could become a big issue for providers that operate with a very slim margin," Ramona Johnson, CEO of Bridgehaven, a Louisville mental-health center, told Yetter.

Bridgehaven clients "typically visit the center three times a week and may receive three or more services per day, such as a visit with a therapist, a support group and a peer counseling session," Yetter reports. "The state required providers to charge $3 per office visit for a service, so that means clients could end up owing $9 a day, Johnson said. . . . In addition, Bridgehaven clients would have to pay $3 for visits to a primary-care physician or psychiatrist and co-pays for medication of up to $8 per prescription — medication she said is essential for people with mental illness to remain stable."

Johnson told Yetter, "They don't have that kind of money. They struggle to pay their rent, their utilities, buy their groceries."

Washington Post says unnamed 'insiders' think McConnell is playing politics with opioid bill; his spokesman says he is not

Mitch McConnell and other leaders of the Senate's Republican
majority (Associated Press photo by Jacquelyn Martin)

Unnamed "industry insiders in the health-care sector . . . believe Senate Majority Leader Mitch McConnell could delay a vote on legislation tackling the opioid crisis because passage would give vulnerable red-state Democrats an accomplishment to campaign on back home," The Washington Post reports.

"McConnell's spokesman, Don Stewart, pushed back on the assertion that anyone wants to delay a vote on tackling the opioid crisis until after the election," Colby Itkowitz reports, quoting him: "This is obviously a priority for the leader and he's encouraged his chairmen to come to an agreement quickly and I predict they will."

Four Senate committees have reported bills, similar to a massive package the House passed in June. The bills are similar: expanding prevention and treatment, and cracking down on distribution. "But the political imperatives diverge in a year when House Republicans are fighting to maintain their majority -- see the number of vulnerable House GOPers who have sponsored opioid legislation -- and Senate Republicans are trying to pick off Democrats," such as Joe Donnelly of Indiana, Claire MacCaskill of Missouri and Joe Manchin of West Virginia, Itkowitz notes "The vulnerable incumbents are almost all Democrats, many from states hit hardest by the opioid problem." Kentucky is among them.

The unnamed sources who say McConnell may be slow-walking the bill suspect he doesn't want "those senators going back to their states, which are ravaged by abuse of prescription painkillers, and tell their constituents they worked across the aisle to get something done," Itkowitz reports. "Those who are following the issue closely don't feel there's a true sense of urgency to get an opioid bill to the Senate floor sometime soon, let alone before the election."

Itkowitz reports she heard a less cynical view from Jessica Hulsey Nickel, founder and CEO of Addiction Policy Forum, who "believes a delay until after the election is actually an attempt to save the opioid bills from getting muddied by politics." Nickel said, “It feels like they’ve been trying to plot this out to be a little less partisan and not fall in a single pothole along the way. To rush it or make it one party’s versus the other's, would go against the spirit of how this was constructed."

As feds crack down on clinics accused of being pill mills, patients are left without their painkillers, and sometimes nowhere to turn

Courier Journal photo by Beth Warren

Thousands of patients with chronic pain in the Louisville area have been displaced by local, state and federal crackdowns on clinics accused of being pill mills, defrauding Medicaid, or both, and it's likely to get worse, Beth Warren reports for the Courier Journal.

One of those patients is retiree Michael Anderson, 67, who suffers from occipital neuralgia: electric-shock-like chronic pain in the neck and back of the head. He told Warren that depended on opioids to manage his pain, and his supply was abruptly cut off when investigators raided his pain clinic. "I'm in dire need," he said.

Such cases are likely to become more common, Warren writes, because Russell Coleman, U.S. Attorney for the Western District of Kentucky, says more investigations are underway as part of a national effort. Attorney General Jeff Sessions created a task force in February to target opioid abuse, including over-prescribing of pain and addiction medicines.

"Doctors say the federal raids on medical clinics lead to unintended consequences — patients thrust into painful withdrawals and left vulnerable to suicide or dangerous street drugs," Warren writes.

Dr. Kelly Clark, a Louisville addiction specialist who heads the American Society of Addiction Medicine, told Warren there aren't enough addiction or pain specialists to accommodate the influx of patients from clinic closures, and the problem will only get worse.

Dr. Wayne Tuckson, president of the Greater Louisville Medical Society, told Warren that area physicians are working on a coordinated response to help these patients, including creating a hotline with a list of resources, including pain-management physicians willing to care for them.

When investigators "go in with a sledgehammer and shut down a practice without consulting community physicians, suddenly we have patients thrown loose," Tuckson told Warren. "We do have a significant overdose problem and we have to do something about that. But we have to be careful that our actions do not jeopardize the care of patients."

Displaced patients may have trouble finding new doctors because investigators have seized their patient histories and doctors are wary of getting caught up in the crackdown. Many general practitioners who haven't received pain-management training refuse to prescribe high doses of narcotics, largely out of fear of losing their licenses, Tuckson said.

"Docs are very much afraid when it comes to writing pain medications," he told Warren.  "We don’t want patients to become addicted. And we don’t want to have our licenses — and therefore our livelihoods — at stake."

Clark told her, "If a practice is closed, the patients who are legitimately taking their medications as prescribed can be in a dire situation. They look and feel extremely sick."

He added, "Some patients likely will end up in emergency rooms from opioid withdrawals, which can cause cramps, chills, sweats, vomiting, diarrhea, sleeplessness and dehydration. For patients who are dependent — not addicted — they will feel better after a few days of withdrawals. Those who are addicted wouldn't be able to voluntarily taper off and going through withdrawals wouldn't stop cravings."

One-year project aims to help 10 Ky. critical-access hospitals deal with substance-abuse issues and treatment access

A one-year project aims to help 10 rural Kentucky hospitals address substance abuse, with one community outreach event educating health-care providers about the "disease of addiction" and another providing Naloxone training to community members at their local hospital.

Both events were part of KORH's Critical Access Substance Abuse Project, which is funded by the federal Office of Rural Health Policy, according to news releases from the Kentucky Office of Rural Health.

The July 18 CASAP event in West Liberty hosted Dr. John Sanders, the medical director for hospice and palliative medicine at St. Claire HealthCare in Morehead, who told a group of providers about the "disease of addiction," and explained how our understanding of addiction and the treatments for it have evolved, stressing that a purely punitive approach to end addiction simply won't work.

He also explained how some physicians have contributed to the problem and discussed the history of 12-step programs and how they work.

“Any time that we can get medical professionals together in the same room talking about one of the state’s most serious health issues, I think we’re doing some important work,” KORH Director Ernie Scott said. “We hope that the health-care professionals attending Dr. Sanders’ presentation walked away with an enhanced understanding of the complexities of addiction and the work that still needs to be done in our communities to deal with the everyday realities of substance abuse.”

This event was co-sponsored by the Northeast Kentucky Area Health Education Center.

The July 17 event in Hyden offered free Naloxone training to 60 community members at the Mary Breckinridge Appalachian Regional Hospital. Participants also received two doses of the life-saving drug that can reverse the effects of an opioid overdose, says the release.

Scott called the Naloxone training and distribution event a success, adding that the hope of the project was to have communities and hospitals working together and that this event had certainly met this goal.

"We're really excited to see community members come to one of our CASAP-sponsored events, be engaged with one of the most serious health issues impacting rural Kentucky today and learn about what they can do to help out," he said in the release.

The project is designed to provide support to ten critical access hospitals in Kentucky, chosen because they are in rural areas with high rates of poverty, unemployment and substance abuse.

"The overarching goal of the project is to address substance abuse issues and concerns at the hospital and community level through education and working to improve patient access to treatment options," says the CASAP website.

The release adds that the project will also work to better link the participating hospitals to their surrounding communities to meet the needs of their patients with substance-use disorders.

Besides Morgan County ARH and Mary Breckinridge, the other critical-access hospitals in the project are ARH Our Lady of the Way and McDowell ARH in Floyd County, Barbourville ARH, Ephraim McDowell Fort Logan Hospital in Harrodsburg, Ohio County Hospital in Hartford, Russell County Hospital and Wayne County Hospital.

Health and Human Services Secretary Azar says he learned from lawsuit and ruling on Ky. Medicaid plan, will keep pushing for it

HHS Secretary Azar at White House
(Photo by Andrew Harrer, Bloomberg)

Health and Human Services Secretary Alex Azar said Thursday that the Trump administration had learned from the ruling that struck down his approval of work and other "community engagement" requirements for 460,000 Kentuckians on Medicaid, and would keep pushing for such requirements.

Azar said in a speech at the Heritage Foundation that the ruling of U.S. District Judge James  Boasberg of Washington was "one blow" to the administration's efforts, but "We’re fully committed to work requirements and community participation in the Medicaid program. … We’ve learned some things from that piece of litigation of which we disagree. But we’re moving forward."

The Centers for Medicare and Medicaid Services said recently that it would reopen Kentucky's proposal for public comment, which would give the administration an opportunity to get into the record evidence addressing Boasberg's concern that Azar's Department for Health and Human Services failed to address the state's forecast that in five years, Kentucky's Medicaid rolls would have 95,000 fewer people with the plan than without it.

Azar's remarks, his first public reaction to Boasberg's ruling, "were striking, and showed just how determined the administration is to press forward on giving states' flexibility to require 'able-bodied' adults to work in some way to qualify for the government-funded health insurance," Colby Itkoiwtz writes for The Washington Post's daily Health 202 report. "Since its creation in 1965, work has never been a prerequisite for Medicaid benefits. But many Republicans argue that the program's expansion under the Affordable Care Act went beyond the original intent of the law to cover the absolute poorest Americans, and gives people an incentive not to work."

Azar is clearly one of those. He said, "Supporting legislation to undo those perverse incentives is a priority for this administration. But in the meantime, we want to rethink how Medicaid serves able-bodied, working-age adults, which is why we have encouraged states to consider work and community engagement requirements for these populations. For these enrollees, Medicaid should be not just a government insurance card, but a pathway out of poverty, to fuller purpose and better health."

Itkowitz writes, "Critics of the work requirement see the push as part of a public-relations campaign by conservatives to change the narrative around Medicaid from a health-care program to a welfare one. Andy Schneider, a professor of health policy at Georgetown University, wrote in a blog post this week that he believes the administration's ultimate goal is to undermine a largely popular program and gin up public support for capping federal Medicaid payments to states."

The administration also acknowledges that its moves on Medicaid are part of its effort to undermine the Patient Protection and Affordable Care Act, which allowed Kentucky and other states to expand Medicaid to people who earn up to 138 percent of the poverty level (about $16,000 for a single person). Kentucky's community-engagement rules would apply to those covered by the expansion.

Study finds young people are now more likely to start smoking after they turn 18, not before; calls for more prevention efforts

Huffington Post photo

The celebration in recent years about lower smoking rates among teenagers could end up being all for naught, as a new study shows that more people are likely to now start smoking after they turn 18, not before.

The study at the University of Texas Health Science Center at Houston, looked at data from the National Survey on Drug Use and Health from 2006 to 2013. It found that the start of cigarette smoking among young adults was more than three times higher than that among teens: 6.3 percent and 1.9 percent respectively.

“Historically, it used to be that nearly everything started by age 18. That’s no longer the case, as young adults are experimenting with things once more common during high school years. Young adults are starting to act like adolescents,” said Cheryl Perry, senior author of the study, said in the news release.

Like the rest of the nation, smoking rates among Kentucky teens have dropped recently, to 14.3 percent in 2017 from 47 percent in 1997. Nationally, the teen smoking rate dropped to 8.8 percent from 36.4 percent respectively. Kentucky ranks second highest for adult smoking rates, 24.5 percent.

Perry, a professor and regional dean at UT's School of Public Health in Austin, was the senior scientific editor of the 1994 Surgeon’s General Report on Preventing Tobacco Use among Young People, which said, "Tobacco use primarily begins in early adolescence, typically by age 16; almost all first use occurs before the time of high-school graduation."

Perry called the shift toward later starts of smoking a “potentially watershed situation, which could have very alarming health implications.”

A news release about the study said, “In all cases, young adults were significantly more likely than youth to both have ever tried and be a current user of cigarettes, cigars, e-cigarettes and hookah.”

The research report, published in the Journal of Adolescent Health, also cited three other studies, including the national Population Assessment of Tobacco and Health Study and two in Texas that included not only cigarettes, but also e-cigarettes, cigar products and hookah.

“The fact that Texan cohorts looked the same nationally makes this evidence of later onset more compelling,” Perry said. “It indicates a massive cultural shift, relating to a behavior that still kills half of its regular customers.

The researchers note that one reason for later onset of smoking could be that adolescents are putting off activities that have been traditionally associated with being a teenager, like hanging out with friends, drinking alcohol, dating and driving.

Another possible reason: Policies to reduce tobacco use among teens have been highly effective, like banning various flavors of cigarettes, banning sponsorship at entertainment and sports events and stricter guidelines around youth marketing of these products..

The report notes that retailers' compliance with bans on sale of tobacco to minors increased to more than 90 percent by 2012, according to the U.S. Department of Health and Human Services.

But that apparently led to tobacco companies marketing more explicitly toward their youngest legal target group -- young adults, according to research cited in the study.

“According to the Federal Trade Commission cigarette report, price discounts accounted for the vast majority (80 percent) of cigarette marketing dollars in 2014 as tobacco companies try to attract price-sensitive young adults,” the study report says.

With young adults putting off starting a career, getting married and having children, the authors noted that this “could create a window of opportunity for risky behavior.”

The researchers warn that more needs to be done to prevent this behavior in young adults, but notes that there are few programs or policies that focus directly on the age group.

Perry adds that more research is needed, including on adults into their 30s, “to see whether this is a part of seismic change.”

“Just when we thought we were nearing the end game, we might have been outsmarted,” Perry said. “It’s a challenge, which will demand new ways of trying to communicate with and influence young adults who may be much harder to reach than adolescents.”

NE Area Health Education Center wins national award for getting Appalachian students into med school; program going statewide

The award was one of three in the nation.

The Northeast Kentucky Area Health Education Center at Morehead won the Center of Excellence Award in Distribution at this month's national AHEC conference for working to improve the health-care workforce in rural and under-served areas.

The AHEC was nominated for its Successfully Training and Educating Pre-medical Students program. STEPS was created in 2013 to level the playing field for their local students who are interested in applying to medical school.

Most of the 17-county Northeast Kentucky AHEC service region is in Appalachia, which has long been short of physicians.

"Studies have shown these physician shortages to be partially attributable to factors including Appalachian students’ inadequate academic preparation, limited exposure to health care occupations, low self-confidence, and financial considerations," a news release said.

The STEPS program helps the participants prepare for the Medical College Admission Test with courses, mock interviews, assistance with the application, physician shadowing, and other activities.

“The purpose of STEPS is to produce not just more, but more competitive, medical-school applicants from our region,” said David A. Gross, director of the Northeast Kentucky AHEC. “In part because of this program, we continue to see meaningful increases in the number of local students applying to and being accepted by in-state medical schools.”

The release says three groups of students have completed the program, and 22 of the 25 students who met all program requirements enrolled in medical school.

The Northeast Kentucky AHEC has also recently entered into a two-year contract with the Kentucky Primary Care Office to replicate the STEPS program with the other seven Kentucky AHECs.

“It’s quite an honor to be chosen by our peers for one of only three Center of Excellence awards among the nation’s nearly 250 regional AHECs,” Gross said.

Beshear and other Democratic AGs sue to block rule allowing 'association health plans' pushed by U.S. Sen. Rand Paul

Kentucky's Andy Beshear is one of 12 Democratic attorneys general suing the federal government over its new rules allowing "association health plans," a product long advocated by Republican U.S. Sen. Rand Paul and recently approved by President Trump.

Paul argues that AHPs would make health insurance more affordable and accessible, but the Democrats say the administration's rules allowing them would undermine "essential protections such as coverage of pre-existing conditions, newborn, maturity and pediatric services, substance abuse treatment and oral and vision care," a Beshear press release said.

The attorneys general are asking a federal judge to reject a Department of Labor rule allowing AHPs for employers, on grounds that it redefines "employer" in a way that conflicts with the Patient Protection and Affordable Care Act of 2010, generally known as Obamacare.

Beshear said, “If the rule allows spin-off employer association health groups that meet the ACA’s requirement of minimum essential health care coverage, then employees in these groups will lose their ability to garner federal tax credits.This will increase the cost of health care coverage for many Kentuckians.”

Dan Diamond of Politico notes, "In announcing the new rules last month, the administration said they would make it easier for small businesses to band together to purchase cheaper health insurance — and, not coincidentally, serve as a key part of the president's strategy to destroy Obamacare. Today's complaint puts that point in legal terms — from the opposite side."

Drug overdose deaths in Kentucky rose 11.5% in 2017; highest rates in Estill, Kenton, Campbell, Boyd, Mason, Jessamine

Chart by Chris Ware, Lexington Herald-Leader

By Melissa Patrick
Kentucky Health News

Kentucky saw an 11.5 percent increase in drug-overdose deaths in 2017, with more than half of the them from fentanyl, a synthetic opioid that can be up to 50 times more potent than heroin. The number of heroin deaths decreased, but overdose deaths from methamphatime surged, according to to the annual Kentucky Office of Drug Control Policy report.

The state recorded 1,565 overdose deaths in 2017, and has toxicology reports for 1,468. Among those, fentanyl was found in 763, or 52 percent, up from 47 percent in 2016. The 2016 report is available here.

"Fentanyl is the deadliest and most addictive drug our nation has ever seen,” Van Ingram, executive director of the ODCP, said in a news release. “The fact that people continue to use it – despite the obvious risk – shows just how addictive these drugs are. People have become powerless against them. That’s why we have to make every effort to intervene with a comprehensive treatment response.”

Fentanyl has been a leading factor in overdose deaths since 2015 and is often mixed with heroin or put in pills, making it difficult to determine the dosage. Ingram notes that drug cartels in China and Mexico have turned to fentanyl because it is cheap to produce and provides a higher profit margin.

Lethal amounts of heroin, fentanyl
and carfentanil (Photo: Kensington
Police Service via Courier Journal)

Beth Warren of the Louisville Courier Journal reports that "a dose as small as two milligrams, the size of Abraham Lincoln's cheek on a penny, can be lethal." Carfentanil, a synthetic opioid that is used as an elephant tranquilizer, is even stronger.

The report also said three other drugs contributed to more overdose deaths last year than heroin: alprazolam, gabapentin and methamphetamine.

Alprazolam is an anti-anxiety medicine that is often known by its brand name Xanax. It was detected in 36 percent of the toxicology reports. Gabapentin, which is sells under the brand names Neurontin, Gralise and Horizant, and is often taken along with other illicit drugs to enhance their effects, was found in 31 percent. Methamphetamine, a stimulant that has long plagued Kentucky, was found in 29 percent, more than double last year's total.

"Autopsies and toxicology reports from coroners show that approximately 22 percent of overdose deaths involved the use of heroin in 2017, down from 34 percent in 2016," the report says.

County numbers

Estill County, with a population of 14,375, had 11 overdose deaths in 2017, giving it the state's highest rate of drug-overdose deaths, 7.7 per 10,000 residents, according to a table in the report.

Kenton and Campbell counties in Northern Kentucky had the next highest rates, 6.95 and 6.6 per 10,000. Then came Boyd, at 6.46, Mason, 5,82; Jessamine, 5.65; Montgomery, 5.37; Harrison, 5.32; Franklin, 4.95; Madison, 4.71; Jefferson, 4.56; Grayson, 4.17; Nelson, 4.16; Knox, 4.16; Greenup, 3.94; Fayette, 3.82; Harlan, 3.74; Floyd, 3.31; and Whitley, 3.31.

Other counties' rates were less than the state average of 3.3 per 10,000, or their rates were not published because they had fewer than five overdose deaths last year. The latter group included Leslie, Bell, Powell and Gallatin counties, which led last year's list with rates of 6.6 to 5.6 per 10,000.

The state's two most populous counties, Jefferson and Fayette, had the most overdose deaths in 2017, 426 and 123 respectively. The largest numerical increase in overdose fatalities occurred in Jefferson, which had 62 more than in 2016. Fayette went up by 49, Campbell by 26 and Kenton by 17. The largest decrease was in Madison County, which had nine fewer last year than in 2016.

Like last year, most of the Kentucky deaths were among people between 35 and 44, followed by those 25-34, then 45-54.

Gov. Matt Bevin said the report “underscores just how much is at stake in the ongoing battle against the nation’s opioid epidemic. This is a fight we must win for the sake of our families, our communities, and the commonwealth as a whole. We will continue to leverage every available resource to close off the funnel of addiction and to help our fellow Kentuckians who are struggling against this scourge.”

Kentucky has launched a number of initiatives to battle the epidemic, including a public awareness campaign called "Don't Let Them Die" that offers information on substance use disorder, treatment and naloxone, a drug that can reverse an overdose.

Kentucky State Police have launched the Angel Initiative, which allows those seeking treatment to visit a KSP post, where they would be directed to treatment.

The General Assembly has passed several laws in recent years, including a crackdown on pain clinics, limiting opioid prescriptions for acute pain to a three-day supply (with exemptions), tougher penalties for heroin dealers, more funding for drug treatment, and paying for increased access to naloxone. The attorney general's office has sued pharmaceutical companies.

Data for the report was compiled from the Kentucky Medical Examiner’s Office, the Kentucky Injury Prevention & Research Center and the state Office of Vital Statistics.

Seven counties in Southern Kentucky stand out as 'Bright Spots' in study, pointing the way to healthier communities

By Melissa Patrick
Kentucky Health News

Nine counties in Appalachian Kentucky have been recognized as "bright spots" when it comes to health, and seven of them adjoin in Southern Kentucky: Green, Adair, Russell, Wayne, McCreary, Pulaski and Lincoln. The other two counties were Lewis and Morgan.

"The Bright Spots project offers hope and a path forward to a healthier Appalachian Kentucky," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "Congratulations to the hardworking leaders in the nine Kentucky counties that have formed strong, cross-sector coalitions to address pressing health issues in their communities."

The study, which looked for Appalachian counties that had better than expected health outcomes given their resources, analyzed 19 health indicators in each of the 420 Appalachian counties and identified 42 as Bright Spots.

The goal of the research was to to identify successful activities, programs and policies that other struggling communities could replicate. A report is scheduled to be released later this year to identify them. The study was sponsored by the foundation, the Appalachian Regional Commission and the Robert Wood Johnson Foundation.

All the adjoining Bright Spots counties except Lincoln are served by the Lake Cumberland District Health Department. Its health education director, Tracy Aaron, told Kentucky Health News that improving the district's health has been a group effort, and each county has a health coalition made up of numerous organizations, agencies and individuals that meets monthly to choose what health issues they want to address and to then create plans to work on them.

"Our communities are rural and have limited resources, so we all work together to identify and leverage resources," she said in an e-mail. "Many times we may facilitate the discussion around health and improving the health of the community, but we are very fortunate to have dedicated organizations and individuals [working with us] as we continue to improve the health of people that live in Lake Cumberland."

McCreary and Wayne counties were part of a 10-county case study that took a deeper dive into what they were doing to improve the heath of their citizens, despite their many challenges. Both of these counties were named "Healthy Kentucky Policy Champions" by the foundation, citing the stuidies.

"What's happening in Wayne and McCreary counties is changing our understanding of what is possible for health in these and other Appalachian counties," Chandler said in the release announcing the awards. "They show us that there's always somewhere to start when working to improve health, and that dedicated individuals volunteering and working together with a few focused community leaders can change health outcomes for the better."

The report says Wayne County was one of three in the 10 case studies that stood out "for both the range of outcomes that were better than expected and the extent to which the outcomes exceeded expectations." The county performed better than expected on 16 of the 19 measured health outcomes, falling short in the areas of obesity, physically bad days and opioid prescriptions.

Cover page of report section on Wayne County

The Wayne County Health Department, part of the district health department, and the local office of the Cooperative Extension Service play "critical roles in improving community health," the report said.

It noted the department's program to increase access to healthy, local foods; its diabetes education work; and its strong HANDS (Health Access Nurturing Development Services) program, a voluntary home-visitation program for new and expectant parents, which the researchers say could be partly responsible for lower-than-expected rates of infant mortality and low birth weight.

"Wayne County’s strong community partnerships and social connections, integration of health services, and focus on healthy foods, are likely contributing to the better-than-expected health outcomes," the report says.

The county performed 36 percent better than expected for poisoning deaths, including drug overdoses; 34 percent better than expected for stroke deaths, 30 percent better than expected for heart disease hospitalization; 26 percent better than expected for the percentage of Medicare patients with depression; and 25 percent better than expected for years of potential life lost.

For example, the study found that 35.2 people per 100,000 in Wayne County actually died from a stroke, but when using a statistical model that factored in barriers to good health, the predicted stroke-death rate was 53.7 per 100,000. (The county's population is about 21,000.)

Cover page of report section on McCreary County

McCreary County, which has about 18,000 people, performed better than expected on 14 of the 19 measured health outcomes. It fell short in mentally bad days, suicide, diabetes, physically bad days and opioid prescriptions.

The report says the county has strong local volunteer organizations and emergency medical services, and a library that connects residents to health and social services.

Researchers found that the county performed 40 percent better than expected for injury deaths, 37 percent better than expected for stroke deaths; 34 percent better than expected for poisoning deaths; 19 percent better than expected for percentage of Medicare enrollees with depression; and 15 percent better than expected for years of potential life lost.

The report adds that local practices contributing to the overall health in McCreary County include intra-county cooperation and resource sharing, sustainable, community-focused nonprofit organizations, a strong integration of health services and systems, a shared value for health in the community and community engagement and dedicated local leaders.

Among other things, the report notes a strong health education program run by the district health department, which gives school-age children information on reproductive health, tobacco-use cessation and risky-behavior prevention. It also provides a health consultant for children and supports preventive initiatives like farmers' markets and smoke-free restaurants.

Among the other four Lake Cumberland counties named Bright Spots:

• Adair was 41 percent better than expected for poisoning and overdose deaths; 36 percent better than expected for unintentional injury deaths; and 26 percent better than expected for deaths from chronic obstructive pulmonary disease.
• Green scored 34 percent better than expected for poisoning and overdose deaths, and 31 percent better than expected for both years of potential life lost and opioid prescriptions as a percentage of Part D Medicare claims.
• Russell was 36 percent better than expected for heart-disease hospitalizations; 33 percent better than expected for opioid prescriptions as a percentage of Part D Medicare claims; and 18 percent better than expected for diabetes.
• Pulaski scored 39 percent better than expected for poisoning and overdose deaths; 26 percent better than expected for unintentional injury deaths; and 20 percent better than expected for stroke deaths.

The researchers report that while the counties in the case studies offered individual approaches to address their local health challenges, there were common themes, including: community leaders engagement, cross-sector collaborations, resource sharing, a commitment from local health care providers, active faith communities and grassroots initiatives to combat substance abuse.

In addition to a community of people with a shared value for health, the report says the Bright Spot communities also benefited from "anchor institutions," like schools, businesses, churches and hospitals that worked together to improve the health of their communities.

"The Bright Spots research is a roadmap for struggling Appalachian communities, showing how building strong coalitions and focusing resources in particular on reducing teen births and smoking, increasing physical activity and treating and preventing substance abuse can have an outsized impact on improving local health," Chandler said. "It also is a call to action for policy makers, funders and advocates to support laws and programs that are proven effective in addressing these issues."

The 10 case studies are at https://www.healthy-ky.org/res/images/resources/BrightSpotsCaseStudiesJuly2018.pdf. Data for all 420 Appalachian counties are at https://www.arc.gov/research/researchreportdetails.asp?REPORT_ID=144. The data can be mapped at https://healthinappalachia.org/.

This is the second report in the "Creating a Culture of Health in Appalachia: Disparities and Bright Spots" research initiative. The first report focused on health disparities in the region.

Poll shows opinions in five Ky. regions on substance use and other issues; people say they're getting fewer pain pills

The 2017 Kentucky Health Issues Poll found that significantly fewer Kentucky adults are getting prescriptions for pain medication; that they strongly support smoke-free schools; and that most would like to see the age to purchase cigarettes raised to the age of 21. But the numbers vary by region.

To show regional attitudes about the issues of substance abuse and smoking, which were the main foci of the 2017 poll, the Foundation for a Healthy Kentucky has released reports on the findings in regions defined as Eastern, Western and Northern Kentucky, Greater Lexington, and Greater Louisville.

The results may help individual communities and the state decide important health policies that affect everyone, whether that be smoke-free workplace laws, smoke-free school policies, substance-abuse treatment and recovery programs, and access to health care.

Herald-Leader chart shows results for its areas and the state 

The Eastern Kentucky report says that while the responses from people in this region were largely comparable to the state results, there were a few key differences. For example, adults in the region (22 percent of the state) were less likely to hold favorable opinions about the Patient Protection and Affordable Care Act, often called Obamacare, than the rest of the state.

That said, fewer people in Eastern Kentucky and the rest of the state are reporting an unfavorable opinion of the ACA -- dropping to 36 percent in 2017 from 52 percent in 2016. Statewide results for an unfavorable opinion of the ACA dropped to 33 percent from 46 percent.

Adults in Eastern Kentucky were also less likely to report having "excellent" or "very good" health and to have a household income more than double the federal poverty level. They were more likely to say they believe addiction is not a disease, and to report they they did not get a prescription pain pill in the past five years. That trend was seen statewide.

"We can see that prescribing practices have changed," Rachelle Seger, community health research officer for the foundation, told Linda Blackford of the Lexington Herald-Leader.

The Western Kentucky report, covering 27 percent of the state's population, says that in general, poll results were comparable to the state as a whole. For example, the number of Western Kentucky adults being prescribed pain pills dropped from 54 percent in 2011 to 35 percent in 2017, similar to the statewide drop from 55 percent to 34 percent.

The poll found that just like the rest of the state, more than 80 percent of adults in Western Kentucky support providing affordable, quality health care for all Americans; favor tobacco-free school campuses; and support schools taking a more active role in helping families get health care for their children. Respectively, the percentages for those three were 86, 87 and 82.

The Northern Kentucky report, covering 10 percent of the state's population, says most of the responses from this region were comparable to the rest of the state results, but there were some key differences in this region.

Adults in Northern Kentucky were more likely to have unfavorable opinions about the Affordable Care Act; report knowing friends or family members who have had problems with heroin; report higher rates of being uninsured; and to report excellent or very good personal health.

The report notes that the percentage of Northern Kentucky adults without health insurance more than doubled from 2016 to 2017, rising from 11 percent to 26 percent.

The Greater Lexington report, covering 17 counties and 18 percent of the population, found just a few key differences with the rest of the state. Residents of then Bluegrass Region were less likely to hold unfavorable opinions about the Affordable Care Act and more likely to report excellent or very good personal health.

Also of note, the report found that while support for a statewide smoke-free law remains high in the Greater Lexington area, support dropped to 74 percent in 2017 from 82 percent in 2016.

The Greater Louisville report, covering seven counties and 23 percent of the population, also largely found responses similar to the rest of the state to the poll questions, with a few differences. One was 80 percent support for a comprehensive, statewide smoke-free law, the highest level in the state. The statewide support was 71 percent.

They also held a more favorable opinion of the ACA, 52 percent compared to 44 percent statewide and showed a significant drop in unfavorable opinions about the health reform law, to 33 percent in 2017 from 46 percent in 2016.

The poll, taken Oct. 24 -Dec. 2, is sponsored by the foundation and Interact for Health, a Cincinnati-area foundation. It surveyed a random sample of 1,692 Kentucky adults via landlines and cellphones. The margin of error for each statewide result is plus or minus 2.4 percentage points and varied between plus or minus 5.2 percentage points and 5.6 percentage points in the regional report.

Wisconsin health executive to become chief operating officer of Baptist Health, Kentucky's largest hospital group

Baptist Health, which got a new CEO in January, is getting a chief operating officer, a new position for Kentucky's largest hospital chain. It announced that the job will be filled Sept. 4 by Brian Falvey, who has been a major executive for "one of the country’s top performing health-care systems."

Patrick Falvey

Falvey was executive vice president and chief transformation officer for Advocate Aurora Health in Milwaukee, the 10th largest not-for-profit, integrated healthcare system in the country, serving about 3 million patients a year, the Baptist Health news release said.

Falvey, who worked at Aurora for 26 years, half his life, will report to CEO Gerard Colman. The release said his "key accomplishments include having the facilities under his leadership achieve top marks in hospital quality and productivity while making improvements to services, and redesigning the clinical research departments."

Baptist Health owns eight Kentucky hospitals (in Corbin, La Grange, Lexington, Louisville, Madisonville, Paducah and Richmond) with more than 2,400 beds and one in New Albany, Ind., and is buying a ninth, Hardin Memorial in Elizabethtown. It says it has "more than 300 points of care in 75 Kentucky counties, seven counties in Illinois, six counties in Southern Indiana and two counties in Tennessee." It has more than 20,000 employees.

Catholic hospital in Paducah gets a new name: Mercy Health - Lourdes Hospital

Hospital is at 1530 Lone Oak Rd. (US 45)

Paducah's Lourdes Hospital, which has long been part of Mercy Health System of Ohio and Kentucky, is now officially known as Mercy Health - Lourdes Hospital.

"As part of Mercy Health, we can leverage the strength of being part of one of the largest not-for-profit Catholic health systems in the country," hospital CEO Michael Yungmann said. "This ministry-wide name change is an important visual sign that all of Mercy Health is coming together as one team to better serve our patients and communities by more closely connecting our points of care across Kentucky and Ohio."

The name change comes nearly 30 years after Lourdes joined Mercy Health Systems in 1989," Derek Operle reports for The Paducah Sun. The chain has 23 hospitals and 34,000 employees. The hospital, founded in 1905, was once known as Riverside Hospital. The hospital says it has region's largest multi-specialty physician network, Mercy Medical Associates, with more than 100 providers in more than 30 locations in Western Kentucky.

State's hepatitis A outbreak is worst in nation, but seems to be fading in Louisville, which feds say is 'gold standard' for response

Kentucky’s hepatitis A outbreak is now the biggest outbreak in the United States. As of July 7, the outbreak had struck 65 of Kentucky's 120 counties with 1,094 hepatitis A cases and eight deaths. But federal officials say Louisville is a national example for how to respond to an outbreak, reports Phillip M. Bailey of the Courier Journal.

Epidemiologist Rui Zhao meets with others at Louisville Metro
Health and Wellness. (Courier Journal photo by Marty Pearl)

As of July 17, Louisville had 540 cases and four deaths. While the liver disease continues to spread around the state, there is evidence that it may be declining. "It feels like we’re coming out of it," Rui Zhao, epidemiologist for the Louisville Metro Department of Public Health and Wellness told Bailey.

"New reports of hep A infections reached as high as 4.1 cases per day in April," Bailey reports. "Since then, that figure has plummeted to about 3.8 in May; 2.5 in June; and 1.67 in July."

Officials of the U.S. Centers for Disease Control and Prevention came to Louisville July 21 to praise the health department's work, WDRB-TV reports: "Louisville has set the gold standard for responding to the hepatitis A outbreak and set standard for the rest of the country," CDC epidemiologist Doug Thoroughman said.

Since the outbreak was declared on November, the Louisville health department has vaccinated more than 78,000 people by focusing on homeless camps, health clinics and the jail. "It also has an aggressive campaign to shake the general public's consciousness that they, too, can catch the disease," Bailey reports. "About 10 percent of Louisville's hep A diagnoses aren't in those high-risk groups, according to health officials."

State and local officials urge everyone in Kentucky that is part of the outbreak to get vaccinated. They also reminded everyone to practice good hand hygiene, particularly after using the restroom and before eating or preparing food.

Health officials stressed the virus in the outbreak is being passed person-to-person. There has been no evidence that it is being spread by food or drink as was the case during the hepatitis A outbreak that struck Louisville in 1988. However, "Louisville restaurants have taken the lead by vaccinating their staff," Bailey reports.

WKYT-TV map; for interactive version, showing the number of cases per county, click here.

Boyd County and Ashland, its largest city, "recently passed measures requiring all food service workers to be vaccinated against the virus," and adjoining Greenup County "is poised to join them," reports Will Wright of the Lexington Herald Leader. "Boyd County has one of the highest infection rates of hepatitis A per-capita in the state, with 134 reported cases since August 2017." Greenup has had 46 cases; Carter County, which adjoins them both, has had 85.

While the outbreak leads the nation, Dr. Jeffrey Howard, commissioner of the Kentucky Department for Public Health, said “Our surveillance and the fact that we’ve hospitalized about 60 percent of all cases has kept our death rate below that of other states experiencing hepatitis A outbreaks.”

Communication problems may linger for alcoholics even after they give up drinking, study suggests

A survey that measured emotional communication among alcoholics found that long after they give up drinking, they still struggle to control their voice pitch and relay subtle emotional cues.

Help Guide image

The study, published by the Research Society on Alcoholism, first surveyed 30 people and asked them to say sentences in a certain emotional tone. Of these 30, 15 had been diagnosed with alcohol dependence and had stopped drinking at least a year before the survey. The other 15 were a control group with no alcohol-addiction history.

The second part of the study asked listeners to analyze the attempted emotion in the sentences. It found that the persons with alcohol addiction had more trouble expressing vocal emotion.

The researchers said in a press release that it is unknown if this is a result of brain damage from excessive drinking that affects motor control and vocal cords, but more research should look into the possibility. 

State restores dental, vision and non-emergency transportation benefits for 460,000 people covered by 2014 Medicaid expansion

Susan Wells of Louisville, who lost her dental benefits during a
series of extractions of decayed teeth, got them out at Shawnee
Christian Healthcare. (Photo: Mike Clevenger, Courier Journal)

By Al Cross
Kentucky Health News

State officials reversed course Thursday and said they would resume paying dental, vision and non-emergency medical transportation costs for 460,000 Kentuckians on expanded Medicaid.

The benefits were supposed to become optional July 1, under a new Medicaid plan in which those members could regain the benefits by participating in certain self-improvement activities, such as such as passing a GED exam, completing job training, or completing wellness activities such as stop-smoking classes, weight-loss programs or diabetes education. They could also earn credits by working; most on the expansion, which began in 2014, work.

On June 29, two days before the overall plan was to take effect, a federal judge in Washington, D.C., blocked it, and state officials said that left no way for people to earn the benefits, or for the state to keep providing them.

The abrupt change created confusion, chaos and complaints. Democrats demanded that the administration of Republican Gov. Matt Bevin restore the benefits. At 5:40 p.m. ET Thursday, the Cabinet for Health and Family Services issued a press release saying that it would.

In a statement that quoted no one directly, the cabinet said "We had hoped for a quick federal re-approval" of the plan, which it calls Kentucky HEALTH for "Helping Engage and Achieve Long-Term Health." However, this week federal officials said they would not act for at least 30 days, as they sought more public comment on the plan. That move that could allow them to submit evidence aimed at overcoming the judge's concerns that they had not addressed the state's forecast that the plan would cause tens of thousands of people to lose their medical coverage.

Since "the program will not begin as soon as we hoped," the cabinet said, "In order to mitigate the consequences of the judge’s ruling, and avoid a prolonged coverage gap prior to the re-approval of Kentucky HEALTH, we have begun the process to reinstate vision and dental coverage, as well as non-emergency transportation services, for those whose benefits were affected by the June 29 court action."

The cabinet said it had "spent the last few weeks working on a temporary solution for restored benefits to be implemented by Aug. 1," and "is close to completing a manual system work-around that will allow payment of claims incurred by any eligible Medicaid beneficiary for dental, vision, and non-emergency transportation services incurred during the month of July."

The issue arose in the latest skirmish between Bevin, who has not said whether he will seek re-election in 2019; and Democratic Attorney General Andy Beshear, who announced his candidacy for governor this month, and Beshear's father, who expanded Medicaid under the Patient Protection and Affordable Care Act when he was governor in 2014.

When Bevin doubled a $500,000 contract with a Cincinnati law firm to investigate Steve Beshear's administration, the ex-governor said Bevin “has now decided to waste another half a million dollars and another two years to continue his fruitless search. Mind you, a million dollars wasted at a time when he is ripping vision and dental care away from hundreds of thousands of Kentuckians.”

State officials have said that about 10 percent of the eligible beneficiaries use those benefits.

"Advocates were delighted with the prospect that dental benefits would be restored," Deborah Yetter reports for the Louisville Courier Journal, quoting Jennifer Hasch, manager of dental services for the Shawnee Christian Healthcare Center in West Louisville: "That is such good news. I think people are going to be thrilled. I think it's weight lifted for our office, both for our patient population and our team."

Yetter writes, "While health advocates say all three services cut—dental, vision and transportation are important—the loss of dental services were most critical because of the very poor dental health of some Kentuckians and the fact that dental abscesses and infection can be life-threatening."

The legislature's top Democrat, House Minority Leader Rocky Adkins, told the Lexington Herald-Leader, “The governor and his administration were wrong to blame this cruel action on the federal court ruling . . . but I’m glad they appear to be back on the right track. I’m hopeful that our citizens will not be faced with the devastation of losing these benefits again.”

Feds to reopen Medicaid plan for public comment; state officials say they haven't decided on appeal of judge's ruling against it

Federal officials say they will hold another round of public comment on the Kentucky Medicaid plan that was blocked by a federal judge and sent back to them for more review. Meanwhile, state officials told legislators that they’re working “toward a re-approval” of the plan and haven't decided on an appeal.

The Centers for Medicare and Medicaid Services plans to announce the 30-day comment period, "allowing the administration to potentially show it's addressing the court's concerns" that Kentuckians would lose coverage, Politico reports.

U.S. District Judge James Boasberg of Washington, D.C., vacated the Department of Health and Human Services' approval of the plan on June 29, saying HHS had not adequately considered the state's estimate that its Medicaid rolls would have 95,000 fewer people with the plan than without it -- in large measure for non-compliance with its requirements.

The plan would require "able-bodied" adults who are not primary caregivers to work, take job training or volunteer 80 hours a month, or enroll in drug-treatment program. Kentucky was the first of four states where HHS approved such requirements. The plan also includes small monthly premiums based on income.

"Trump administration lawyers are said to be confident that the strategy will allow them to surmount" Boasberg's concerns, but "advocates and external observers have doubts," Politco reports. Boasberg "specifically criticized HHS Secretary Alex Azar for disregarding public comments that were overwhelmingly against the plan."

A new comment period "could allow the administration to address the judge's concerns," politico notes. "Reopening the comment period would permit the inclusion of new material — such as a White House report touting work requirements in safety-net programs, which was released last week — that could substantiate the administration’s arguments that they’re considering evidence on the plan’s impact. CMS also could use the comment period to revise its plan so it’s better protected against further legal challenges."

Gov. Matt Bevin has said the Supreme Court will ultimately decide the issue, but officials of the state Cabinet for Health and Family Services told the General Assembly's Medicaid Oversight Committee Wednesday that the Bevin administration has not decided whether to appeal Boasberg's ruling. Normally, such appeals must be filed within 30 days.

Domestic abuse is about as common in male couples as in heterosexual couples, study in three major cities finds

Pride photo

Around half of American men in a three-city survey said they experienced abuse in their same-sex relationships -- about the same percentage reported by women, a new study shows.

The study at the University of Michigan surveyed 160 male couples in Atlanta, Boston and Chicago. It found that 46 percent said they experienced physical, emotional, sexual, or control abuse from a partner. Research on domestic violence usually only surveys the assumed victims (usually women in opposite-sex couples), this researched surveyed both perpetrators and victims.

"We're stuck in this mental representation of domestic violence as a female victim and a male perpetrator, and while that is very important, there are other forms of domestic violence in all types of relationships," said Rob Stephenson, a UM professor. He said about 25 to 30 percent of male-only relationships include violence, around the same as female victims in heterosexual relationships.

The study found that male couples, while facing many of the same challenges that heterosexual couples face such as financial problems or drug abuse, also face homophobia, a challenge unique to same-sex couples. Sometimes, the homophobia comes from within, when one member of the couple is struggling with his identity, Stephenson said. Such a man "might lash out at his partner with physical or emotional abuse as a stress response behavior—similar to heterosexual couples, where an unemployed man lashes out at his female partner because he feels inadequate," a UM press release said.

The research also shows a correlation between HIV prevention and abuse, said Stephenson, because men who are in abusive relationships may not be able to negotiate for condom use, when or how they have sex, or communicate their HIV status.

Sunlight is antidote to obsessive-compulsive disorder

Do you have obsessive-compulsive disorder? New research may direct you to retire in a sunny spot.

A study at Binghamton University in New York and published in the Journal of Obsessive-Compulsive and Related Disorders, found that those people who live in shady areas are more likely to develop OCD or make it worse.

The findings come after researchers at the university studied stories and reports about OCD, and noted the location of each case. They noticed a pattern: people who live in higher latitudes (areas with less sunlight) are more likely to have an off-sleep pattern, and thus throwing off their internal clocks. The sleep cycle is interrupted in these areas because a person may not be able to fall asleep when they need to, and "often times, they will then sleep in very late in order to compensate for that lost sleep, thus adopting a delayed sleep-wake pattern that may have adverse effects on their symptoms," a press release said.

When a sleep cycle is disrupted, a person loses his or her natural exposure to morning light, which is a crucial part of the day. “People who live in areas with less sunlight may have less opportunities to synchronize their circadian clock, leading to increased OCD symptoms," said Meredith Coles, a professor of psychology at Binghamton. "The results of this project are exciting because they provide additional evidence for a new way of thinking about OCD."

The university plans additional research to determine if persons suffering from OCD can be treated with exposure to more sunlight.

Study: Infants are not as susceptible as older children to food allergens, and if exposed early, less likely to develop allergies

Med Shadow image

If you're wary of exposing an infant to food that might be allergic, think again. New medical guidelines say that infants should be exposed to potentially allergic foods because that makes them less likely to develop allergies.

A study done in conjunction with the new guidance  found that food-induced, multiple-symptom allergic reactions that can cause death in older children and toddlers have a much milder effect in infants.

The study published in Annals of Allergy, Asthma and Immunology out of Ann & Robert H. Lurie Children’s Hospital of Chicago shows that infants under the age of 1 are much less susceptible to the severe side effects of food-induced allergic reactions, such as death, than their older peers.

The study was a reaction to new guidelines from the National Institute of Allergy and Infectious Diseases that encourage parents to introduce their children to foods with peanuts between four and six months. This new recommendation contrasts with previous advice to avoid introducing young children to peanut products. Now, the institute claims that if introduced early on to potential allergens, children are less likely to develop food allergies.

Waheeda Samady, a doctor at Lurie Children's Hospital, said in a press release that with the new guidelines, "It is understandable that parents might be fearful of triggering a serious reaction", but said the new research should be "reassuring."

The researchers examined 357 cases of children with food-induced allergies i 2015-17. Of these, 47 were infants (under the age of 1), 43 were toddlers between 1 and 2; 96 were 2 to 6; and 171 were school-aged children over 6. They found that 83 percent of the infants in the study experienced vomiting due to exposure, but none died. Still, the researchers warned that anytime an infant has a negative reaction to trying a new food, the child's primary doctor should be consulted or 911 should be called.

Here's your chance to get a question about a health-related topic asked in a statewide poll

The Foundation for a Healthy Kentucky is seeking suggestions for topics and questions in the next Kentucky Health Issues Poll. The deadline for suggestions is close of business Aug. 1.

The annual telephone survey asks Kentuckians their views on health policy issues likely to come before the General Assembly or local governments, and their opinions on other health-related topics. The poll is funded by the foundation and Interact for Health.

Suggestions can be made on the foundation's website. For more information, contact Rachelle Seger, the foundation's community health research officer, at 502-238-2139 or rseger@healthy-ky.org.

The poll data are used by a variety of governments, nonprofits, news media "and other organizations focused on improving health and providing health care in Kentucky, to help them better understand the health issues Kentuckians face and their perceptions about potential solutions," the foundation said in a press release. "KHIP has asked questions on a variety of timely topics, including tobacco use, health care coverage, and substance abuse, in recent years."

For example, last year the poll found that nearly half of young adults in Kentucky had tried electronic cigarettes, 86 percent want tobacco-free schools, most favor raising the minimum legal age to purchase tobacco products to 21, and 71 percent favored a statewide smoke-free law to protect people from secondhand smoke in all public buildings and enclosed workplaces.

Another question revealed that one in four non-senior Kentucky adults who had health insurance said they were worried about losing their coverage in the coming year. Another found that seven in 10 Kentucky adults see addiction as a disease, and eight in 10 favor court-mandated treatment programs for drug offenders. About two in 10 said they know someone who has experienced problems with heroin, or someone abusing methamphetamine. One in four knew someone who struggled with prescription pain relievers. Details about previous KHIP topics and questions are available here.

Half of parents in poll admit to indulging in risky behavior of using phone and texting while driving with children in the car

Alamy Stock Photo

About half of Americans in a survey said they talk on cell phones while driving with children aged 4 to 10. Worse yet, a third said they read text messages, a fourth of them sent such messages, and one out of seven said they used social media while driving with children.

"The study also found a correlation between cell phone use while children were in the car and other risky driving behaviors, such as not wearing a seat belt and driving under the influence of alcohol whether or not children were present in the car," said a press release from Children's Hospital of Philadelphia, which did the research with the University of Pennsylvania School of Nursing. It was published in the Journal of Pediatrics.

The study was conducted online among 760 adults in 47 U.S. states who said they were a parent or routine caregiver of a child between the ages of 4 and 10, and had driven their oldest child between those ages at least six times in the preceding three months. The poll found that 52.2 percent of parents had talked on a hands-free phone while driving with a young child in the car, while 47 percent had done so with a hand-held phone. It also found that 33.7 percent read text messages, 26.7 percent sent text messages, and 13.7 percent reported using social media while driving with children.

"The results from this research reinforce that risky driving behaviors rarely occur in isolation, and lay the groundwork for interventions and education specifically aimed at  parents who drive with young children in their cars," said lead author Catherine McDonald, of the hospital's Center for Injury Research and Prevention and the university's Community Health Department.

McDonald said doctors need to warn parents about such risky behaviors. "This type of education is especially pivotal today, as in-vehicle technology is rapidly changing and there is increased – and seemingly constant – reliability on cell phones," she said. "However, it is also important to note that even parents who did not engage in risky behaviors, such as not wearing a seat belt as a driver or driving under the influence of alcohol, still used their cell phones while driving."