Sunday, April 28, 2019

As pensions threaten school-nurse programs, schools can get new Medicaid money for both physical and behavioral health

By Melissa Patrick
Kentucky Health News

Many of Kentucky's school districts have long struggled to pay for school nurses, let alone professionals in behavioral health care. And now some health departments may no longer be able to provide nurses because they will have to pay more into their employees' pension system.

But schools are about to get some help with their students' health needs, under state officials' plan to allow schools to use Medicaid funding to cover both physical- and behavioral-health services. More than two in five of the state's children are covered by Medicaid.

Deputy Secretary Kristi Putnam
Kristi Putnam, deputy secretary of the Kentucky Cabinet for Health and Family Services, who has spearheaded this effort, said that by the start of the next school year, schools will be able to use Medicaid to serve all students enrolled in the program.

"I'm a former school teacher and I know how valuable it is to have health services and behavioral health services for kids right there at your school," Putnam said. Research shows that children who don't get needed care can suffer academically.

What's it all about?

Until December 2014, schools could only bill Medicaid for students who were disabled or met other limited criteria. That's when the Centers for Medicare and Medicaid Services changed the guidelines to allow states to provide services to any student who is enrolled in Medicaid, and get federal reimbursement for those services.

Only now has Kentucky decided to seek the money, a decision that seems largely driven by an increase of behavioral-health issues in schools.

Gaining access to these funds varies by state. In Kentucky, it requires an amendment to the Medicaid state plan and putting an appropriate billing process in place. Putnam said the amendment and fiscal analysis will be submitted May 1, with a request for an Aug. 1 start date and that they are still working on the billing aspect of the requirements.

She said the administration is working on the assumption that the funding will be approved and will start informing schools about it on May 1, because participation is optional.

States must provide matching money to get federal Medicaid dollars, 30% in Kentucky's case. Putnam said existing school-based Medicaid expenditures can count toward the match.

"The state and local funding that is being used right now for any health and behavioral-health service can be used as the match to draw down additional federal funds," she said. "So there is no increased costs to the state or to the school district."

Putnam said the amendment will be broadly written, so the new money can cover both physical- and mental-health care, along with provisions for telehealth.

"You have to have both," she said. "It's just exciting because there has been limited funding for behavioral-health services . . . but this will allow us to expand both, and we need to expand both."

Kentucky adults are strongly supportive of schools taking a more active role in helping families get health care services for their children, with 84% saying in the latest Kentucky Health Issues Poll that they favor such action.

So far, 14 states, including Kentucky, are either considering, actively pursuing or have already taken advantage of this additional Medicaid funding in their schools, according to a policy brief penned by three non-profits dedicated to health: Community Catalyst, Healthy Schools Campaign and Trust for America's Health.

Why does it matter?

For years, Kentucky schools have struggled to find funding for health care in schools. And while Putnam has pointed to the need for more behavioral health funding, school nurses have been on the chopping block for years as school and health-department budgets have decreased.

Kentucky Department of Education photo
These cuts have forced schools to find creative ways to provide health care to students. Some have moved to school-based health centers, which provide care to students through a public-private partnership; others have used fewer nurses to cover more students. Others have relied on health departments, but cuts in federal and state funding have forced the departments to ask for more money from schools to fulfill this role.

That said, health departments' school-nurse programs could be at further risk because of the state's pension crisis, which on July 1 will require health departments to increase their pension obligation from 49.47% to 83.43% of payroll -- unless a special session of the state legislature changes that.

In the regular session, Gov. Matt Bevin vetoed a bill that would have offered some temporary relief to the health departments and has said he will call a special session to deal with the state's pension system early this summer.

The Marshall County Health Department decided last week to end its school-nurse program, in order to help pay for its possible extra pension obligation of $566,200 a year. In a news release, local health officials called it an "agonizing decision."

"The Marshall County Health Department school health program has been in our schools for over 25 years," they said. "Our school nurses have truly made a positive difference in the lives of our children, their families, the school system, and our community. Discontinuing this program is a tremendous loss for all of us."

Meanwhile, the need for health services in Kentucky schools is greater than ever, with students showing up at school with a long list of chronic physical-health and behavioral-health conditions, an electronic-cigarette epidemic that no one saw coming, as well as schools having to deal with issues around bullying, suicide, the drug epidemic and gun violence.

Mahak Kalra, the health policy director at Kentucky Youth Advocates, who has worked with the cabinet on this project, pointed to research that shows students with health problems, whether they be physical or behavioral, struggle to do well in school.

"So, providing those health services in the school setting can address their immediate health-care needs and can connect them to the services they need and really keep them learning," Kalra said.

She added that it will also reduce many of the barriers parents have to get their children health care, like transportation, non-flexible work schedules or simply finding a provider who will accept Medicaid.

Kalra and Putnam both noted that this additional funding will help support the School Safety and Resiliency Act, or Senate Bill 1, that among other things calls for one trained school resource officer in every school and one guidance counselor for every 250 students by July 1, 2021 or as funds and qualified personnel become available. School-based mental health service providers fall under a subsection of the guidance counselor requirements and are listed as optional.The bill has no funding attached to it.

"This is one way to have those school-based mental health providers provide those services," Kalra said.

Eva Stone, district health coordinator for the Jefferson County Public Schools, pointed out that Medicaid will only pay for licensed mental-health providers, not guidance counselors -- unless they have a special certification, which most of them don't.

Stone, who is also an advanced practice registered nurse, added that amending the state plan to define what this additional Medicaid funding will cover provides a great opportunity for Kentucky to meet all of the needs of the state's children, whether they be physical, mental or social -- like whether a child is homeless or has access to food or is being abused at home.

Stone has long said that school nurses are the best situated to coordinate all of these efforts because "that's what nurses are educated to do." Further, she said, making coordination of care reimbursable in the state health plan would allow for that coordination to happen.

"We have the opportunity to craft this in Kentucky in a way that would make all those players work together," she said.

The state says Kentucky has 1,688 students for each school psychologist; the national standard recommends 500 to 700.

The 2018 School Health Profiles Report shows that 41% of all middle and high schools in Kentucky have a part-time registered nurse and 58% have a full-time registered nurse. The Kentucky Health Issues Poll found that 92% of Kentucky adults would support a law to require a nurse in every school.

Friday, April 26, 2019

Kentucky leads the way on many opioid-related efforts, and was well represented at the four-day drug abuse summit in Atlanta

By Melissa Patrick
Kentucky Health News

Kentucky officials, researchers and clinicians were front and center at the eighth annual national summit on prescription drug abuse and heroin, started by Rep. Hal Rogers of Kentucky, participating in panels covering a range of topics, such as caring for babies who are born addicted to drugs and procedures that help with early detection of substance-use disorders among young people.

U.S. Rep. Hal Rogers spoke at the 2019 National Rx Drug
Abuse and Heroin Summit in Atlanta. (Photo via Twitter) 
“This public-health crisis has damaged our nation and ripped families apart. More than 70,000 people died of drug overdoses in 2017 alone and sometimes it’s hard to find hope in the midst of America’s deadliest drug epidemic,” said Rogers in a news release.

The summit was founded by Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education), a Kentucky non-profit created by Rogers that leads education, treatment and law enforcement initiatives in 32 counties in Southern and Eastern Kentucky.

“Operation UNITE leaders were determined eight years ago to reach across state lines and share best practices with other communities looking for life-saving solutions,” Rogers said. “Each year at this summit, a little more hope shines through as we see shifts in more access to treatment, better policy and legislation, and more prevention programs.”

Attendance at the National Rx Drug Abuse and Heroin Summit in Atlanta April 22-25 was the largest yet, about 4,000. Kentucky was well represented, with a large contingent of researchers and health-care providers from the University of Kentucky on several panels. UK President Eli Capilouto, who introduced Rogers on the first day, pointed out in a video about the event that the summit often sets the national agenda that drives the research around this topic.

One panel covered topics that centered around changes to Kentucky's laws and their potential impacts on patient care and the expansion of prescription data for public health surveillance. Another discussed a multidisciplinary model of care that allows people who come into the emergency room or hospital at UKHealthCare to get immediate treatment for their opioid-use disorder with medication assisted treatments, like buprenorphine, and then get an immediate referral to the First Bridge Clinic for further treatment and recovery care. In its first year of operation, over 300 individuals were referred for treatment with over one-third initiated care, according to a university news release.

Dr. Roger Humphries, the chair of emergency department, talked about how his views on addiction have evolved. He said that years ago he would have never considered treating a person with an opioid-use disorder in the emergency room, but that is no longer the case as evidence by his emergency room's participation in this innovative partnership with First Bridge Clinic.

"I used to think responsibility was fully on patients," he said, " but now I know this is a brain disorder -- one of my kids could fall into a problem like this."

President Donald Trump and First Lady Melania Trump addressed the attendees of the summit on Wednesday. She first highlighted her "Be Best" campaign that among other things raises awareness of neonatal abstinence syndrome and maternal health. The president presented a long list of efforts by his administration, including an investment of $6 billion over two years to combat the crisis. "Everyone here today is united by the same vital goal: to liberate our fellow Americans from the grip of drug addiction and to end the opioid crisis once and for all," he said. "We will never stop until our job is done."

Justice Secretary John Tilley at the summit (Photo via Twitter)
Kentucky Justice Secretary John Tilley was one of four speakers to follow Trump's keynote address. A state news release said Tilley spoke about the state's many innovative reforms and initiatives including "strengthening treatment in prisons, establishing the KY Help Call Center, local-option syringe exchange programs, expanded access to naloxone, a three-day prescription limit for acute pain, the Kentucky State Police Angel Initiative, and the newly-announced $87 million Kentucky CAN HEAL Project," which aims aims to reduce opioid-overdose deaths in 16 counties by 40 percent over the next four years with grants from the National Institutes of Health.

Effort mounted to find and treat hepatitis C, which is spreading; most people who have it probably don't know they have it

"A multimillion-dollar effort to fight hepatitis C was introduced Thursday in Louisville with the help of Gov. Matt Bevin as well as medical professionals and health advocates," Darla Carter reports for Insider Louisville.

The five-year, five-state project in Kentucky and four other states will use screenings, community partnerships and prevention programs, and strengthen the health-care infrastructure to fight the liver disease, Carter reports. The project, called HepConnect, will serve Kentucky, Indiana, North Carolina, Tennessee and West Virginia.

"We can't afford to ignore it," Gov. Bevin said. (Darla Carter photo)
Many people who have hepatitis C don’t know it because it often doesn't present symptoms, said Derek Spencer, a lobbyist for Gilead Sciences, the drug maker funding the project. The state of Kentucky estimates that more than 40,000 Kentuckians have the disease, but “The actual number is likely four to five times that amount,” said the state Cabinet for Health and Family Services.

The opioid epidemic is spreading the hep-C virus, Spencer said: “The majority of new HCV infections in the Appalachian region are attributed to the results of syringe-sharing practices and other equipment associated with injecting drugs.”

Carter notes, "Other ways of acquiring the virus include sharing personal items, such as razors and toothbrushes; getting a tattoo or body piercing in an unregulated setting; or even sometimes through sexual activity." If the illness goes undetected, it “can progress to liver damage, liver failure, liver cancer and death,” Spencer said.

Research by the federal Centers for Disease Control and Prevention in Kentucky, Tennessee, Virginia and West Virginia showed a 364% increase in the number of acute hep C cases "from 2006 to 2012 among young people, mainly whites living in urban and non-urban areas," Carter notes.

Gov. Matt Bevin said at the announcement that hep C was once considered a chronic disease of baby boomers, but we’ve now seen it “leap into younger generations,” he said. “We can’t afford to ignore it.”

Other at the April 25 event "talked about the need to lessen the stigma surrounding hepatitis C and drug use, and a panel of experts from the University of Louisville Hepatitis C Center and elsewhere spoke of the need to address not only the person injecting drugs but also family members who might be infected or impacted," Carter reports..

“Pregnant women can pass hepatitis C on to their babies,” nurse practitioner Barbra Cave said.

The first year of the project will cost $11 million. "The project is being led by the Harm Reduction Coalition, a national organization that promotes the health and dignity of people and communities affected by drug use," Carter reports. It has a Kentucky branch.

Thursday, April 25, 2019

Kentucky teens' use of electronic cigarettes and vapes doubled from 2016 to 2018, and is higher than national rates, survey finds

Use of electronic cigarettes and vapes, tracked since 2014, is shown by the blue lines.
By Melissa Patrick and Al Cross
Kentucky Health News

A survey of Kentucky teenagers shows that their rate of using electronic cigarettes and vapes doubled from 2016 to 2018, and all four grades surveyed had rates higher than the national rates.

When Kentucky high-school seniors were asked if they had used e-cigarettes or vapes in the past 30 days, 26.7% said they had. That was more than double the 12.2% rate found by the 2016 survey.

Use by sophomores, or 10th graders, increased to 23.2% from 11.3%; researchers consider the 10th-grade figures to be the better indicator for use by high-school students. Use by eighth graders jumped to 14.2% from 7.3%, and sixth-grader use increased to 4.2% from 2.3% over 2016.

The 2018 National Youth Tobacco Survey, which uses slightly different wording, found that 21 percent of students in high school and nearly 5 percent in middle school reported using e-cigarettes and vapes. (Those numbers represented increases of 78 percent 48 percent, respectively, in high-school and middle-school use, from 2017.)

The Kentucky Incentives for Prevention survey is taken every two years. In 2018 it was taken by more than 159,000 students in 151 of the state's 173 public-school districts. For the first time, it included Jefferson County, the state's largest district, but still did not include Fayette County, Hardin County, Warren County, Bowling Green and 18 other districts.

"This unprecedented two-year surge in Kentucky youth vaping and e-cigarette use underscores the urgency of our efforts to warn kids and the adults in their lives about the dangers of these tobacco products for youth," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky.

"E-cigarettes and vapes are chock-full of nicotine that can cause both immediate and permanent brain damage to youth. They prime the developing brain for addictions to other substances. They can cause cancer and lung damage. And they have been known to explode and cause poisoning among very young kids," Chandler said.

"We urge every Kentucky school district that doesn't already have a tobacco-free campus policy to expedite their plans to comply with the new tobacco-free schools bill. We also urge parents, teachers and other adults to talk to kids about e-cigs and help them understand that they are absolutely not safe for kids or young adults."

On April 22, the foundation released public-service announcements and other free resources about youth e-cigarette use. The "I Just Didn't Know" campaign features Kentucky youth sharing with their peers what they've learned about the dangers of e-cigarettes. The PSAs are available on YouTube and are accompanied by a website and an Instagram page.

The survey was released April 25 by the Substance Abuse Prevention Program in Kentucky's Department for Behavioral Health, Developmental and Intellectual Disabilities. A report by region, based on 10th graders, is to be released in early summer.

The survey primarily assesses alcohol, tobacco and other drug use, but also looks at suicide and other high risk behaviors.

It showed continued declines in use of several substances, including alcohol, combustible cigarettes and smokeless tobacco. It found that in 2018, students were less likely than before to perceive that it is easy to obtain alcohol, combustible cigarettes, and marijuana.

However, reported psychological distress and associated mental-health measurements, as well as reports of suicidal behavior, have risen steadily since 2014. Feeling unsafe at school increased substantially in 2018.

These school districts did not participate in the survey: Anchorage, Barbourville, Beechwood, Berea, Bowling Green, Dawson Springs, East Bernstadt, Fayette County, Fort Thomas, Glasgow, Hardin County, Hopkins County, Kenton County, Laurel County, Lee County, Logan County,  Paintsville, Raceland, Rockcastle County, Russellville, Science Hill and Warren County.

Wednesday, April 24, 2019

Roundtable at Marion County High School explores the phenomenon of electronic cigarettes among teenagers

Marion County High School in Lebanon (Photo from Marion County Public Schools)
By Emily LaForme
The Lebanon Enterprise

“Over the past two years it’s become more common,” said student Brianna Meeks. “I started seeing it more in school this year, in the bathrooms and in the parking lot after school.”

Meeks was talking about the use of electronic cigarettes, including Juuls and other vapes, inside Marion County High School. It isn’t just a fad here; it’s becoming prevalent across the country.

“They hide it in their shirts, or you see them coming up the hill with a big puff of smoke, you kind of know what’s going on, between classes in the bathrooms,” said instructional assistant Robert Spalding.

Student Kelly Miles said, “You’ll see three girls going into one stall in the bathroom.”

Miles and Meeks were among MCHS students who participated in a roundtable discussion with school staff last week about the rise of e-cigarette products in school. Every student said they had at least one friend that smokes an e-cig product or had tried it. The senior students estimated that approximately 75 percent of the senior class use e-cigs, and around 90 percent have tried them.

According to, 3 million high-school students, or 20 percent of the total, are vaping, and the percentage grows every year.

“As far as the effects of it, we don’t necessarily understand it yet, so that is concerning,” said Principal Thad Elmore. “We are treating it much like we would treat the use of tobacco products; we confiscate it and can enforce consequences for repeat offenders, like in-school suspension. We do also try to offer support, medical help in regards to it or other assistance, because it is addictive and we understand that.”

According to the federal Centers for Disease Control and Prevention, studies have shown that young people who use e-cigarettes are more likely to begin smoking cigarettes in the future.

The CDC also reported that e-cigarettes do not release harmless vapor, but contain substances such as nicotine, ultrafine particulate, volatile organic compounds and cancer-causing chemicals, and heavy metals such as nickel, tin and lead, which can be inhaled into the lungs and cause further damage. The flavor chemicals can contain diacetyl, which has been linked to lung disease.

According to the CDC, Juuls have a high level of nicotine. A single pod contains as much nicotine as 20 cigarettes.

The staff members at the roundtable seemed pretty stumped about what goes into the e-cig products, and worry that the students don’t seem to understand how harmful nicotine can be.

“I wonder, is it more concentrated, does it get you some sort of high or hit from it because the nicotine is more concentrated?” asked School Resource Officer William Walsh. No one had an answer to give him. 

Student Elise Carpenter said, “That’s just something I’ve never been interested in. I’ve never taken a hit off one. . . . I’ve heard people say they’ll get a high or a buzz off it, but I don’t understand it.”

Miles said, “I think teens know the effects, but they don’t want to face them. You can’t see the damage it’s doing to your body. If you see someone with a cigarette, you see the ashes and the smoke has a grayer look and distinct smell. With the Juuls and stuff, it doesn’t seem harmful.”
The students said vaping products can cost $20 or more, and you have to pay for the refillable flavor pods, which can become costly.

“It’s expensive. Some kids go through them like crazy,” said Miles. “I hear kids bragging about how often they go through pods. I always wonder, why you would want to spend your money on that?”

So where does MCHS go from here?

“What I would like to do is consider the conversation, work with our Youth Services staff members, and have another conversation next year again and keep the conversation going,” Elmore said. “We definitely need to start talking about further educating our students, and parents, about e-cigarettes.”

Health foundation creates public service announcements about dangers of teen e-cigarette use and offers them free to anyone

By Melissa Patrick
Kentucky Health News

An explosion of electronic-cigarette use by Kentucky teenagers has prompted the launch of a statewide campaign to debunk the myths that many teens have about these products, such as the belief they produce only water vapor. The campaign features Kentucky students and is called "I Just Didn't Know."

In addition to the 30-second public service announcements, the Foundation for a Healthy Kentucky campaign includes an Instagram account, a website with information and tools for both youth and adults, and a YouTube channel. The campaign materials are free to anyone who would like to use them, including schools, health departments, youth groups and all media organizations. The launch was announced Tuesday, April 22.

"We have an epidemic raging right now all across the country and we want to do whatever we can to stem it here in Kentucky," Ben Chandler, CEO and president of the foundation, said in an interview. "One of the best ways to do that is to have young people talking to other young people. . . . and we love the tag line, "I Just Didn't Know," because anybody that we talk to about this, that is typically their response."

A 2018 federal report found that one in five high school students and one in 20 middle schoolers used e-cigarettes in 2018, which was a 78 percent jump for high schoolers over 2017 and a 48 percent jump for middle schoolers. It was reported at the 2019 Tobacco Conference last week that Kentucky data shows that e-cigarette use is as high as 75% among students in some Kentucky high schools.

"For decades we've been making progress in reducing smoking rates among youth in the country and in Kentucky, but recently we've made a u-turn. Now we are going in the wrong direction," he said.

E-cigarette aerosol includes cancer-causing chemicals; ultrafine particles that include heavy metals, such as nickel, tin and lead; flavorings like diacetyl, which has been linked to a serious lung disease called "popcorn lung"; and other toxic gases that pose health risk to users and bystanders, according to the  federal Centers for Disease Control and Prevention. They also have high levels of nicotine, which not only creates a powerful addiction but can also harm the brain development of youth.

In one of the PSAs, Claire Ramsey, a student from Henry County, says: "It has just as much nicotine as a pack of cigarettes does. I could get addicted to this. I'm only 11 years old. . . . I thought it was just water vapor, but it's not. I just didn't know."

Sen. Julie Raque Adams, a Louisville Republican who has long been a champion of tobacco-free policies, said her two teenage boys had told her that they "just didn't know" that there was so much nicotine in e-cigarettes.

Adams applauded the PSAs and said they could also be used to educate policymakers who also "just don't know" about the dangers of e-cigarettes.

Alivia Hackworth and Chloe Dyer of the Community
Problem Solving club at Johnson County Middle School
Alivia Hackworth, a Johnson County Middle School student who was featured in one of the PSAs along with classmate Chloe Dyer, was part of a group that worked with state Sen. Brandon Smith, R-Hazard, to create a bill that would have created an anonymous hotline for students to report concerns about e-cig and tobacco use.

The club won first place for its efforts at the state Governor's Cup competition and will be in an international contest at the University of Massachusetts Amherst in June.

The bill almost passed the General Assembly, and Alivia said the Community Problem Solving club plans to get it introduced again next year.

The legislature did pass a tobacco-free schools bill that Gov. Matt Bevin signed into law. It will take effect July 1, 2020. School districts have three years to opt out of its provisions.

Another thing to worry about, Alivia said, is that these products are causing students in her school to get chemical burns in their mouths and also causing them to have persistent coughs.

"I just want help for my friends, because they are getting sick from this, and they are scared to tell an adult because they feel like they are going to get in trouble," she said.

Richard Hackworth, Alivia's father and a science teacher at her middle school, told Kentucky Health News that their school district had implemented all elements of the students' bill, including an educational component and the recommendations for how to handle violations.

"Until our Community Problem Solving team identified this problem, we just didn't know," he said.

A day after the statewide campaign was announced, Jefferson County Public Schools announced its own anti-vaping campaign, called "Vaping Equals," an intentionally incomplete sentence that is meant to be filled in with facts about e-cigarettes, Spectrum News reports. This campaign includes a classroom component, informational posters and a new website

E. coli outbreak keeps spreading, but may be slowing down

The outbreak of E. coli infection centered in Kentucky has spread to nine other states, the federal Centers for Disease Control and Prevention announced April 23. However, preliminary evidence suggests the number of new cases is declining.

Officials said they are still trying to find the source of the outbreak, which evidence suggests is ground beef.

"CDC is not recommending that consumers avoid eating ground beef at this time," the agency said. "Consumers and restaurants should handle ground beef safely and cook it thoroughly to avoid foodborne illness. At this time, CDC is not recommending that retailers stop serving or selling ground beef."

Escherichia coli is a common bacterium found in the digestive tracts of mammals. Certain strains, such as the one numbered O103, which is identified with this outbreak, can produce Shiga toxin, which causes diarrhea (often bloody), severe stomach cramps, and vomiting.

The strain of E. coli has been identified in 156 sick people, 20 of whom were hospitalized. No deaths have been reported from the outbreak. Kentucky has 65 cases; Tennessee has 41, Georgia 33 and Ohio eight. A CDC chart indicated that fewer cases have been reported in recent weeks, but it can take as long as four weeks for the disease to develop.

U.S. Centers for Disease Control and Prevention chart, adapted by Kentucky Health News; click on it for a larger version

Boyd County extension agents teach children healthy living

By Katie Pratt and Jeff Franklin
University of Kentucky College of Agriculture, Food and Environment

Young children in Boyd County are learning healthy habits thanks to programming efforts by the University of Kentucky Cooperative Extension Service that include planting their own vegetables.

Susan Grimmett, program assistant for Supplemental Nutrition Assistance Program education, has worked with 300 students at four schools within the county to teach them about the importance of nutrition and physical activity within the school year. To do so, she used Organ Annie and other characters from The OrganWise Guys, a program initiated by two doctors to spread awareness about the importance of a healthy lifestyle to battle childhood obesity. Grimmett has used the program with Boyd County preschool through second-grade students for the past three years as students and teachers continue to request it.

“The students have enjoyed it, and they have learned a lot,” said Kelly Smallwood, a preschool teacher at the Early Childhood Learning Center-North in Ashland. “Every time Susan comes, she has something for them, and they enjoy that also.”

For one of the program’s culminating events this school year, Grimmett collaborated with Lori Bowling, Boyd County horticulture extension agent, to help the children grow their own pots of leaf lettuce. They chose lettuce, because the students could very quickly see growth. After the lettuce sprouts in the classroom, the children will take their pots home with the goal of sharing the message of nutrition and healthy eating with their families, many of which have limited resources and low incomes. The ultimate goal is for the children to harvest the lettuce and work with their parents to incorporate it into a family meal.

“If we teach them at this age about what’s healthy and the kind of diet they should be eating, hopefully as they progress through school, they will make wiser food choices and have a healthier lifestyle,” Bowling said. “We also want them and their parents to understand that you can grow your own food, regardless of where you live, as long as you have a container, seeds, sunlight and water.”

Even though their pots of lettuce are still small, Grimmett has heard many of the children are excited about growing the produce as some teachers have already received positive emails from parents about the project.

“They are eating healthier, and their parents are getting involved more and buying healthier foods at their children’s request,” Grimmett said.

Tuesday, April 23, 2019

Walgreens will raise age for tobacco sales to 21 on Sept. 1

Photo by Mike Mozart
"Walgreens has decided to raise its minimum age for tobacco sales several weeks after a top federal official chastised the drugstore chain for violating laws restricting access to cigarettes and other tobacco products," starting Sept. 1, The Associated Press reports. The chain has stores in 51 Kentucky cities and towns.

In March, before he resigned as commissioner of the Food and Drug Administration, Dr. Scott Gottlieb called Walgreens a top violator of sales restrictions among pharmacies that sell tobacco products. CVS Health Corp. stopped selling them several years ago.

The American Lung Association says most states have set a minimum legal age of 18 to buy tobacco products, but a dozen have raised that to 21. Several have done so recently at the request of Altria Corp., the nation's largest tobacco company, which recently bought 35 percent of Juul Labs, which makes the most popular electronic cigarette. Altria sees a higher legal age as a way to curb the push for more regulation of e-cigarettes.

The state Senate rebuffed Altria's effort in Kentucky, but in the U.S. Senate, "Majority Leader Mitch McConnell said last week that he plans to introduce legislation to raise the minimum age to 21 nationally," AP notes. "The Kentucky Republican called the legislation a top priority." Like most lobbying interests, Altria is a major giver to McConnell's political causes.

Sunday, April 21, 2019

Smoke-free advocates say the policy can be more palatable if part of a wellness campaign; also say to include smokers at the table

By Melissa Patrick
Kentucky Health News

If you're trying to win passage of smoke-free policies in communities that have been resistant to such efforts, you should focus on the broad issue of improving the health of those communities. That's what one told more than 250 attendees at a conference, saying that efforts to make a community healthier naturally lends itself to policies that minimize exposure to second-hand smoke.

Onjewel Smith of the Southern States Regional Project of
the American Nonsmokers' Rights Foundation discussed
smoke-free campaigns in rural communities at the 2019
Kentucky Tobacco Conference. (Photo by Melissa Patrick)
Onjewel Smith, who works for the American Nonsmokers' Rights Foundation Southern States Regional Project, offered examples of how rural communities in Mississippi and Louisiana have successfully passed smoke-free laws by focusing on "healthy community initiatives." She told the group that these strategies have worked because advocates have framed smoke-free in a way that matters to these communities.

"It's about getting people to think about wellness and not necessarily smoke-free," she said. Later adding, "I don't care what the motivation is. I really don't. At the end of the day we want these policies in place. We want people protected. "

She also reminded the group that getting folks ready for a smoke-free policy requires a whole lot of community engagement to bring awareness to the issue. "We can't ask for change until people understand there is a problem," she said.

As of April 1, 35.5% of Kentuckians are protected by smoke-free laws covering all indoor workplaces and public places.

The 2019 Kentucky Tobacco Conference "Envisioning a Smoke-Free Future" was held April 16 and 17 in Lexington. It was hosted by the Kentucky Center for Smoke-Free Policy, the Kentucky Department for Public Health, the University of Kentucky College of Nursing and the Kentucky Tobacco Prevention and Cessation Program.

Another recurring theme at the conference was to make sure people who would be most affected by a smoke-free policy are included at the table. Speakers at a harm-reduction summit shared a similar message last week, stressing the importance of partnering with drug users to make syringe exchanges truly successful.

For example, the speakers said African Americans, people from the LGBTQ community, people in addiction and recovery, and people from low socioeconomic status, all need to be involved in policy making. These groups were mentioned because they tend to use tobacco products at high rates, largely because they have been targeted by the tobacco industry.

Vivian Lasley-Bibbs, acting director of the Office of Health
Equity at the state Department for Public Health, engaged
with the advocates at the conference. (Photo by Melissa Patrick)
Vivian Lasley-Bibbs, acting director of the Office of Health Equity at the state health department, talked about the importance of looking at tobacco policies from the lens of health equity, which she said requires us to think about how a policy, decision or practice is unfair to one group or another.

She asked, "How many times have you worked around an issue or gone into a community and sat around the table where those who are impacted aren't there?"

Dr. Valerie Yerger, an associate professor of health policy at the University of California, San Franscisco, had a similar message as she spoke about the tobacco issue: "Look around; if you are dealing with an issue that affects marginalized people, make sure that they are there and let them participate. And think in terms of how you can make the work very, very relative to them."

Another hot topic at the conference was use of electronic cigarettes among teenagers, which has increased nearly 80 percent in the last year among high-school students.

Mindy Ickes, an associate professor at UK and the director of several programs that promote tobacco-free college campuses, told the group that Kentucky data shows that e-cigarette use is as high as 75% among students in some Kentucky high schools.

Jelaine Harlow, a Lake Cumberland District Health Department health educator who works with youth in Casey and Adair counties, said they have largely focused on e-cigarette education with teachers and youth this year, adding that they have even had to deal with a first-grader on the school bus with a Juul, which is the most popular e-cigarette device among teens.

"Juuling has consumed us," she said. "Our kids are using them and they are using them tremendously, it's unbelievable."

Awards were also given for work in several categories, including:

The city of Williamstown was one of six Kentucky cities to be
recognized for success in enacting a smoke-free workplace
ordinance. Mayor Rick Skinner (far left) was also the recipient
of the Smoke-free Advocate of the Year award. (UK photo) 
The city of Elizabethtown received the Smoke-free Excellence in E-Cigarette Policy Award for expanding its smoke-free ordinance to include e-cigarettes.

The Lee T. Todd Jr. Smoke-free Hero Award recipient was Liz Burrows, health educator for Oldham County Health Department, for her commitment to smoke and tobacco free environments in the face of adversity.

The Timothy W. Mullett M.D. Lung Cancer Prevention Award recipient was Ashley Gibson, research coordinator for St. Claire Healthcare in Morehead, for her devotion and passion for preventing lung cancer through education, advocacy and policy change.

David Nunery received the Brian Early Mattone Esq. Legal Counsel Smoke-free Support award for outstanding smoke-free legal service.

The Smoke-free Youth Advocate Award recipient was Monroe County CARES Youth Prevention Ambassadors for excellence in promoting secondhand smoke education and smoke-free policy.

The Smoke-free Indoor Air Excellence Award recipients were the cities of La Grange, Martin, Murray, Paducah, Stanford and Williamstown, and Hardin and Oldham counties.

The recipient of the David B. Stevens M.D. Smoke-free Advocate of the Year, for promoting the secondhand smoke education and smoke free policy, was Rick Skinner, mayor of Williamstown.

Saturday, April 20, 2019

Report offers five strategies to fight opioid epidemic in Appalachia; central part of region had high death rate from overdoses

By Melissa Patrick
Kentucky Health News

The third report in a series that offers "replicable best practices" for Appalachian communities to improve their health offers strategies to address the opioid epidemic, which has swept through much of the region. The other two address smoking and obesity.

The report, Health Disparities Related to Opioid Misuse in Appalachia, Practical Strategies and Recommendations for Communities was created by the Appalachian Regional Commission and the Foundation for a Healthy Kentucky, and also funded by the Robert Wood Johnson Foundation.

Prior research sponsored by ARC shows that residents of Appalachia are more likely to die prematurely than those who live outside the region. And while the report recognizes that multiple factors contribute to this, it says, "Notable trends in opioid-related deaths significantly contribute to the loss of life in Appalachia."

The report says the poisoning-mortality rates in Appalachia is 20.4 per 100,000 residents, compared to 14.4 elsewhere. The rate is 36.6 in Central Appalachia, the ARC subregion that includes all of Kentucky's Appalachian counties. The report points to four Appalachian states, West Virginia, Ohio, Pennsylvania, and Kentucky, which have some of the highest rates of drug overdose in the country.

The report focuses on five specific recommendations in the areas of prevention, increased access to treatment and recovery for opioid-use disorders, harm reduction, long-term recovery supports, and community-based solutions.

“While our nation’s opioid crisis seems to have most significantly impacted Appalachia, I believe the region can be known as a leader in innovative solutions to this pervasive threat to communities throughout our country,” ARC Federal Co-Chair Tim Thomas said in a news release. “I am pleased to see such efforts ongoing in the region, and I hope that the information provided in this brief will help other communities as they work to strengthen their response to this epidemic.”

Before implementing any of the recommended strategies, the report first encourages communities to do a "community needs assessment" to better understand the cultural norms and attitudes around opioid-use disorder and opioid overdoses. The report offers tips on how to do such an assessment, state- and county-level health data, and funding strategies to pay for opioid-related initiatives.

Youth prevention strategies are discussed in detail in the report, including one in McCreary County that is led by the Adanta Regional Prevention Center that has helped its schools implement a teacher-led evidence-based drug prevention program.

The report also encourages increased use of the the prescription drug monitoring programs as a way to decrease the over-prescribing of opioids in the region. The report says a "gold standard" for monitoring if Kentucky's KASPER system, which stands for Kentucky All Schedule Prescription Electronic Reporting.

Another recommendation in the report is to make sure providers understand the appropriate use and dosing of prescription opioids, which continues to be a problem. Kentucky passed a law in 2017 to address this issue that limits most painkiller prescriptions to a three-day supply for acute pain, but it passed with a long list of exceptions and some have suggested that it is not being strictly adhered to.

Strategies to increase access to treatment for opioid use disorder include increasing access to medication-assisted treatment. MAT combined with counseling is considered the gold standard of treatment for opioid-use disorder. Three MAT drugs have been approved, including methadone, buprenorphine and naltrexone.

"To improve access to MAT, communities may seek to increase the number of providers who offer MAT, invest in telehealth programs and integrate behavioral health into primary care and emergency department settings," says the report.

The report also notes the importance of harm-reduction programs. These include syringe exchange programs, the distribution of naloxone, safe drug disposal programs and the prevention and treatment of neonatal abstinence syndrome.

In Kentucky, local governments have approved 52 syringe exchanges, with all but four of them operational. However, about 54 counties that are considered at high risk for HIV and hepatitis C outbreaks among IV drug users still don't have one -- and most of those counties are in Appalachia.

The report encourages the use of drug courts, which are designed to get people with opioid-use disorders into treatment and out of the criminal justice system. Kentucky recently implemented an educational program, called RESTORE, to teach judges and the court staff about opioid-use disorders, treatment and recovery as a way to help them make informed decisions in related cases.

It also points out that supporting long-term recovery for people with opioid-use disorders often involves helping them with "upstream factors," like housing or jobs or passing policies that support them. It also notes the value of providing access to peer support specialist, who can act as mentors to people with opioid-use disorders.

Additionally, it stresses the importance of forming community coalitions that brings everyone to the table to address this issue, including law enforcement, social service providers, schools, health providers and policymakers.

Friday, April 19, 2019

In last decade, cost of opioid-related treatment at UK rose 733% and number of opioid patients rose 481%, Herald-Leader reports

There are several ways to measure the depth of the opioid epidemic that has spread across Kentucky and much of the nation in the past decade; the most common is the number of overdose deaths,which rose from 1,010 in 2013 to 1,565 in 2017.

The most recent measuring stick is the cost of hospital treatment at the University of Kentucky for problems related to opioid addiction. It went up more than 700 percent from 2009 to 2018, reports Linda Blackford of the Lexington Herald-Leader, who got UK to run the numbers.

Traffic rushes past Chandler Hospital in this slow exposure.
In 2009, UK's A.B. Chandler Hospital and Good Samaritan Hospital treated about 1,500 people for opioid-related issues, "ranging from overdoses to blood infections to hepatitis C," Blackford writes. "The cost of those treatments: $7.6 million. By 2018, the number of patients treated for problems caused by opioid addiction had skyrocketed 481 percent to 8,782 and the cost had soared 733 percent to $63.3 million."

According to the data compiled by UK, about 54 percent of the bill was paid by Medicaid, 19 percent is by Medicare "and the rest by private insurers or the patient," Blackford writes. "Figures from the Kentucky Cabinet for Health and Family Services show that 63,000 Kentucky Medicaid patients were diagnosed with opioid use disorder in 2018. The agency estimates the annual per capita cost to treat each of those patients tops $15,000. Using a conservative estimate, that’s almost $1 billion a year from federal and state coffers." The federal government pays 75 to 80 percent of the cost.

"The numbers, while jaw-dropping, are just one small but instructive sliver of the real cost this epidemic is demanding of state and federal coffers as it decimates Kentucky families and communities with one of the highest overdose death rates in the nation," Blackford writes.

“This is just the tip of the iceberg,” Sharon Walsh, executive director of the UK Center for Drug and Alcohol Research, told the Herald-Leader.

Blackford reports: "For UK, which serves as the regional hub for complex medical care for the eastern half of the state, the opioid crisis has affected nearly every facet of health care delivery," from reworking emergency-room procedures to tightening pain-control protocols. "Many doctors now recognize that the crisis was fueled by the over-prescription of pain pills that turned out to be far more addictive than they realized," Blackford notes.

UK collected $264 million in the decade for treating the effects of the epidemic, and has used part of that money to improve its treatment, such as "a special neonatal intensive care area for babies born addicted to opioids. They now stay longer in the hospital with their moms, which is a big expense. From 2009 to 2015, the annual costs for neonatal abstinence syndrome went from about $1.4 million to more than $6.1 million. In recent years, that number has dropped slightly."

The Herald-Leader offers caveats about the data: "The numbers provided by UK only account for in-patient and out-patient treatment . . . and includes only those patients whose billing codes included opioids. They don’t include UK physician visits or the numerous clinics and programs where doctors and counselors work with substance abuse disorder patients. . . . Billing codes are an imperfect way to track opioid-use disorder because many physicians might not include it as part of a diagnosis if a patient is seeing them for a seemingly unrelated disorder."

UK gets $87 million federal grant to reduce opioid-overdose deaths in 16 counties by 40 percent in the next four years

The National Institutes of Health has awarded the University of Kentucky up to $87 million over the next four years, with the goal of reducing opioid-overdose deaths by 40 percent in 16 counties: Fayette, Bourbon, Franklin, Jessamine, Clark, Madison, Boyle, Jefferson, Knox, Floyd, Carter, Boyd, Greenup, Mason, Campbell and Kenton.

"These counties aren’t necessarily the worst hit by the crisis, but each had to meet certain criteria, which included having a jail, at least 25 opioid overdose deaths per 100,000 population, a needle exchange program, and one or more providers who offer medication assisted therapy, such as buprenorphine, for opioid addiction," reports Linda Blackford of the Lexington Herald-Leader. "State health officials have tried to increase the amount of medication assisted therapy available for opioid addiction, but it is not standard practice in numerous treatment centers or hospitals. Drugs such as buprenorphine can satisfy the addictive cravings of opioid use disorders, but they also can be abused or resold on the street."
Read more here:

Blackford adds, "Combined, the 16 rural and metropolitan counties had 764 opioid overdose deaths in 2017, with two-thirds of them involving fentanyl, UK officials said. They also represent about 40 percent of the state’s overall population."

The grant, by far the largest competitive award UK has ever received, is one of four totaling $350 million. The others went to the Boston Medical Center in Massachusetts, Columbia University in New York City and Ohio State University. It also involves the National Institute on Drug Abuse.

U.S. Rep. Hal Rogers, R-Somerset, said in a release, "This partnership between the NIH, NIDA and UK was sparked several years ago during the National Rx Drug Abuse and Heroin Summit, when I invited [UK President] Dr. Eli Capilouto to share his vision for this project with Dr. Francis Collins, director of the NIH and Dr. Nora Volkow, director of NIDA."

The grant's leader in Kentucky will be In Kentucky, the grant’s principal investigator will be Sharon Walsh, director of the UK Center on Drug and Alcohol Research. She will work with the state health and justice cabinets "to lead a team of 20 researchers and community partners," Blackford reports.

Walsh told her, "The goal is to show meaningful change in the overdose death rate in a short period of time and to do so in a way that can reveal what evidence-based interventions are effective in the community. What will work? Is it distributing more naloxone? Is it educating people better about evidence-based treatment? Is it expanding access to treatment and decreasing barriers? For example, if we pay for someone to have transportation to get to their treatment program will that help them stay in treatment?"

Read more here:

Rogers' release said, "The first year of the study will focus on collecting data, assessing local needs, and determining the best prevention and treatment interventions to implement in each community through healthcare, behavioral health and justice systems. . . . The four-year grant will allow UK to earn full funding each year as benchmarks are achieved."

Thursday, April 18, 2019

Report offers Appalachian residents four strategies to decrease high obesity rate, aimed at deadly obesity-related diseases

By Melissa Patrick
Kentucky Health News

A new report offers practical strategies to help Appalachian communities tackle their high rates of obesity, which is causing many in the region to develop chronic, obesity-related conditions.

The report, Health Disparities Related to Obesity in Appalachia: Practical Strategies and Recommendations for Communities, was created by the Foundation for a Healthy Kentucky, the Appalachian Regional Commission and the Robert Wood Johnson Foundation.

Previous ARC reports have documented the region's high rates of obesity and obesity-related conditions, like heart disease, stroke and diabetes, which have contributed to people dying from these chronic conditions more frequently than those elsewhere.

The report notes that in 2012, 31% of Appalachian adults were obese, compared to 27% elsewhere in the U.S. The rate was highest, 35%, in Central Appalachia, which is the subregion of the ARC service area that includes all of Kentucky's Appalachian counties.

The report details four strategies to help Appalachians battle obesity: establishing healthy behaviors in young people, increasing access to healthy food and beverages, creating safe communities that support physical activity, and increasing physical activity and healthy eating among adults.

Before getting started on any of these prevention strategies, the report suggests doing a "community needs assessment" to determine what the community is already doing about obesity and establish what else could be done. The report offers tips on how to do such an assessment, links to state- and county-level health data, and a long list of recommendations for funders.

The report emphasizes establishing healthy behaviors in early childhood, pointing out that child care and schools are uniquely positioned to influence healthy habits. The focus is two-fold, including strategies to increase the availability of healthy foods and beverages in schools and programs that promote physical activity among youth.

The report notes that "farm to school" programs are one of many ways Appalachian schools are working to increase the availability of healthy foods. According to the Kentucky Department of Agriculture, Kentucky has more than 900 schools participating in these programs, Brenda R. Kelly reports for the Kentucky School Board Association website.

Focusing on strategies to decrease obesity in young children is important because studies show that children who are overweight in kindergarten are four times more likely to be obese in eighth grade, compared to those who are not overweight in kindergarten.

"Policies that ensure healthy foods are available for purchase in rural Appalachian communities - such as the tax credit for farmers who donate their products to local food banks that has been enacted in Kentucky and West Virginia - are essential," Ben Chandler, president and CEO of the foundation, said in a news release. "But grocers cannot afford to stock fresh produce that rots on the shelf, so we also must enact policies and strategies shown to increase consumption of these foods."

The report notes that such policies could include ones that allow farmers markets to accept Supplemental Nutrition Assistance Program, commonly known as food stamps, and Women, Infants and Children nutrition program benefits; or policies that increase taxes on sugar-sweetened beverages.

The report offers several suggestions for creating safe communities that support physical activity, including ones to create safe routes to school or that invest in public trails, parks and recreational facilities, noting that grants are often available for such endeavors.

One such grant program featured in the report was funded by the foundation through its Investing in Kentucky's Future initiative. The $3 million grant was used to implement various health programs across seven communities, including one in Clinton County that used its funds to build walking trails to schools and add exercise equipment to public parks.

Strategies are also offered to increase physical activity and healthy eating among adults, like offering tax credits for worksite wellness programs, community-wide campaigns to promote physical activity, and social support interventions, like walking clubs.

McConnell says he will introduce bill to raise to 21 the legal age to buy tobacco products anywhere in the nation

By Al Cross and Melissa Patrick
Kentucky Health News

Senate Majority Leader Mitch McConnell said Thursday that he would sponsor legislation to make 21 the legal age to buy tobacco products in every state – a change that 12 states have recently adopted, but one that failed to pass the Kentucky legislature this year.

McConnell said at a Louisville news conference that his move was prompted by the epidemic of "vaping" with electronic cigarettes among students in high schools and even middle schools.

"The most serious threat involves the use of vaping devices for teens under 18," who can get them from 18-year-olds at school, he said. "By raising the age that you can legally purchase to 21 tobacco won't be in most high schools presenting fewer opportunities for children to get their hands on vaping devices."

The change is favored by the nation's largest tobacco company, Altria Group, which recently bought 35 percent of Juul Labs, maker of the most popular vaping device. Altria tried unsuccessfully to get a "tobacco 21" bill passed in the recent session of the Kentucky General Assembly. Like most major lobbying interests, it has been a major contributor to McConnell's political causes.

Altria Vice President David Fernandez told lawmakers at the Feb. 25 committee meeting why they supported the bill : "Putting tobacco on par with alcohol makes sense and we do hope that doing that will also persuade policymakers to approach tobacco regulation a bit more reasonably."

Speaking in general on April 17 at a tobacco conference, Elizabeth Anderson-Hoagland, who was recently the policy analyst with the Kentucky Tobacco Prevention and Cessation Program, outlined some of the restrictions Altria is trying to avoid, like a ban on flavors and menthol, or rules that would limit the amount of nicotine allowed in e-cigarettes, or "pre-market review" requirements that are placed on new products.

Amy Barkley, regional advocacy director for Campaign for Tobacco Free Kids, said that while her organization has supported legislation to raise the nationwide age to purchase tobacco to 21 in the past, they couldn't comment specifically on the bill that McConnell will introduce because they haven't seen the language.

"While we strongly support raising the age of sale for tobacco to 21, we are deeply concerned that tobacco companies have worked to add special interest provisions to state and federal Tobacco 21 bills that shield the industry from other regulations to protect kids and public health, such as prohibitions on flavored tobacco products," she said in an e-mail.

She added, "We also urge Congress not to exempt active military personnel from Tobacco 21 legislation as Sen. McConnell is proposing, particularly in light of the military’s recognition that tobacco use harms troop readiness and health and costs the government billions in health care costs annually. The military is actively working to reduce tobacco use within its ranks, and Congress should support these efforts by passing a tobacco 21 bill without a military exemption."

L-R: State Sen. Julie Raque Adams, state Rep. Kim Moser,
Foundation CEO Ben Chandler, U.S. Sen. Mitch McConnell .

(Photo: Foundation for a Healthy Kentucky)
McConnell spoke at the offices of the Foundation for a Healthy Kentucky, with foundation President and CEO Ben Chandler and two Republican state legislators who have pushed for legislation to limit young people's access to tobacco products.

Sen. Julie Raque Adams of Louisville said the vaping epidemic has reached her own family. She said that when her two teenage sons got physical exams for health insurance, nicotine showed up in their blood. "They said, 'We don't smoke, Mom. ... All we've done is vape.' . . . Even my own kids didn't understand that there was nicotine and addiction in that vape."

She said many teenagers "think that it's an innocent kind of habit," and "By raising this age to 21 we send a very clear message that we're doing this for the health of those young people."

When a reporter noted that higher taxes on tobacco products have been shown to be the most effective way to prevent use by young people, Adams noted that the legislature didn't include electronic cigarettes in its big tobacco-tax increase last year, but "I think you'll see that on the table." The proposed tax on e-cigs was removed at the eleventh hour after lobbying by Altria.

Rep. Kim Moser of Taylor Mill, who sponsored the new law that will make all Kentucky schools that don't opt out tobacco-free in July 2020, said raising the legal-purchase age to 21 "in no way is telling adults what they should do." But when questioned, she acknowledged that 18-year-olds are considered adults: "Point taken, but I think it's still about exposure to a very addictive substance."

McConnell, asked why people who are old enough to vote shouldn't be able to buy tobacco products, acknowledged, "Some people will look at it that way." Asked what he would say to them, he said, "We're gonna do it this way."

Earlier, McConnell said, "As you all know, I'm in a particularly good position to enact legislation and this is gonna be a top priority that I'll be working on."

As he turned the microphone over to Chandler, a Democrat who won a seat in Congress over candidates he supported, McConnell said, "Probably the first time we had a first joint press conference." Chandler said they had one about the Blue Grass Army Depot.

"We're very excited about your interest in this subject," Chandler told McConnell. "The health of our people, the health, particularly, of our children is a nonpartisan issue if there ever was one."

Altria's tobacco-21 bill failed in Kentucky after one state senator said "Tobacco is still king," but Chandler and McConnell said Kentucky is finally getting away from the culture of raising, using and defending tobacco. "We had an enormous number of people who made some or all of their income off of tobacco in one way or another," McConnell said.

A 1997 poll by the Louisville Courier Journal found that 18 percent of Kentucky adults had some economic interest in tobacco, many from their shares of farm estates that included federal tobacco allotments. Chandler said that the state once had 60,000 tobacco farmers but now has fewer than 4,000. "It's unbelievable how we have receded from the tobacco culture in a fairly short period of time," he said.

Those allotments, and the price supports that went with them, were abolished in 2004 by a bill McConnell sponsored, but he noted that farmers were compensated "for the asset created when Alben Barkley was majority leader" of the Senate in 1940 and got the tobacco program passed. Barkley had won re-election in 1938 by defeating Chandler's grandfather, then-Gov. A.B. "Happy" Chandler, in the Democratic primary.

Raising the legal age to 21 won't hurt tobacco farmers because most of their crop is grown for export, said U.S. Rep. James Comer of Tompkinsville, a farmer and a former state agriculture commissioner. He told WKMS in Murray that McConnell's proposal is "the right thing to do," 

Wednesday, April 17, 2019

Report offers Appalachian residents ways to decrease smoking rates; they are more likely to die from smoking-related diseases

By Melissa Patrick
Kentucky Health News

It's well documented that people in Appalachia die sooner than other Americans, and are more likely to die from smoking-related diseases. It doesn't have to stay that way; a new report offers a detailed list of strategies and policies proven to decrease smoking, the cause of many premature deaths.

The report was created by Appalachian Regional Commission, the Foundation for a Healthy Kentucky and the Robert Wood Johnson Foundation.

The report notes that in 2014, about 20% of Appalachian adults were smokers, compared to 16% of adults elsewhere in the U.S. Those rates were highest, 25%, in Central Appalachia, the subregion of the ARC service area that includes all of Kentucky's Appalachian counties.

The report adds that smoking is a key factor in deaths from heart disease, cancer and chronic lower-respiratory disease, which are three of the four leading causes of death in the U.S., and that these diseases occur more frequently in Appalachia than in the rest of the country.

As a way to decrease smoking-related deaths, the report recommends four approaches to reduce smoking in the region: youth prevention, increased access to tobacco cessation, strong anti-tobacco campaigns and policies that decrease exposure to second-hand smoke.

"Here is a fresh set of evidence, practical advice, and local examples of the tactics and tools Appalachian communities have used to reduce tobacco use and improve health," Ben Chandler, president and CEO of the foundation, said in a news release. "Some of Appalachia's most glaring health disparities are found in the central region that includes Kentucky and West Virginia, so the approaches can have an outsized benefit here."

Before settling on any of these approaches, the report encourages communities do a "community needs assessment" to best determine which strategies their residents are willing to undertake. The report offers tips and links on how to do such an assessment; recommendations for funders; and links to state- and county-level data on a range of tobacco and health related topics.

The report offers several community-based strategies to decrease youth smoking, which is important because 90% of adults report they started using tobacco products when they were teens.

Suggested youth prevention strategies included educating parents, teachers, health professionals and youth about the risks of smoking and electronic cigarettes, restricting access and expanding smoke-free policies. The report also encourages Appalachian communities to form coalitions to promote and support these strategies.

The General Assembly recently passed a law to ban the use of all tobacco products in all Kentucky public schools and events. It will go into effect July 1, 2020 and gives school boards three years to opt out.

Policy-based strategies in the report include raising the minimum age to buy tobacco products from 18 to 21 and increasing the price of tobacco products. In Kentucky, such policies would have to be passed statewide since state laws pre-empt any local regulations on distribution, sale and regulation of tobacco products.

Last fall's Kentucky Health Issues Poll found that 66% of Kentucky adults supported such a law and 30% opposed it. Bills to raise the age to buy tobacco products from 18 to 21 have been introduced for several years, but haven't gained much traction.

As for raising the cigarette tax, it's not likely that Kentucky's lawmakers will do that again anytime soon since they increased it by 50 cents to $1.10 per pack in 2018, which at 83 percent was the largest increase in the state's history.

The report also advises Appalachian communities to increase their access to tobacco-cessation products. One way it says to do this is to partner with work and faith-based organizations. As an example, the report points to the Faith Moves Mountains program, which provided cessation treatment to 590 smokers across 26 rural churches in Appalachian Kentucky. The state has a quitline (1-800-QUIT-NOW).

Further, the report says Kentucky serves as an example of how states can pass laws to reduce out-of-pocket costs for cessation treatment, pointing to Senate Bill 89, which requires all insurance policies sold in Kentucky, including Medicaid, to cover all tobacco cessation services recommended by the U. S. Preventive Services Task Force.

Medicare was not included in this bill, but anyone on Medicare, or Kentuckians who are uninsured, can call the quitline to get access to cessation treatments.

The report also encourages Appalachian communities to launch anti-tobacco communication campaigns that are designed to resonate with their local residents, as some have done with the "tobacco prevention barns" found throughout Appalachia.

It also recommends implementing policies that reduce exposure to secondhand smoke. As of April 1, 35.5% of Kentuckians are protected by smoke-free laws covering all indoor workplaces and public spaces.