Flu cases reported at increasing rate; 6 deaths in Ky. this season

Kentucky Health News

Kentuckians are getting the flu at an increasing rate, and more are dying from it.

In the week ended Dec. 14, there were two deaths, bringing the statewide total for the flu season to six, according to the state Department for Public Health.

During that week, 814 new cases of the flu were confirmed by laboratory testing. Five of the deaths were people 18 or older and one was under 18. Twelve of the state's 17 health regions reported increased flu activity during the week.

The federal Centers for Disease Control and Prevention estimates that the flu has killed between 12,000 and 61,000 Americans each year since 2010. It recommends that everyone over 6 months of age get an annual flu vaccination.

Dr. Angela Dearinger, Kentucky's health commissioner, says is especially important for children and high-risk adults to get vaccinated, since they are at higher risk of complications and negative consequences, including death. She also encouraged anyone with flu to stay home and avoid contact with others.

It's also important to practice good hygiene, covering your cough and making sure you are washing your hands with soap and water for at least 20 seconds -- or the time it takes to sing "Happy Birthday" twice. The CDC recommends washing hands with soap and water whenever possible, and if not, to use a hand sanitizer with at least 60 percent alcohol.

Because flu germs linger on surfaces, it's also important to wash your hands after coughing, touching a door knob or handrail, or shaking hands. One regional health official has even advised Kentuckians to avoid handshaking during the flu season, calling it "the worst thing you can do."

For a larger version of this map, with more legible numbers, click on it.

Gov. Beshear rescinds Bevin's Medicaid waiver plan but asks federal government to let Kentucky keep four parts of it

By Melissa Patrick
Kentucky Health News

As he promised in his campaign, Democratic Gov. Andy Beshear rescinded defeated Republican predecessor Matt Bevin's Medicaid plan, which included highly controversial work requirements. But Beshear said he also wants to keep using four parts of it.

Beshear signs executive order on Medicaid. (Melissa Patrick photo)

"We were convinced that the only way to address this waiver initially was to fully rescind it and then move forward on addressing or creating those programs that might be beneficial inside of it," he said at a Dec. 16 news conference, where he signed an order rescinding Bevin's request for a waiver of federal rules to implement the plan.

The plan would have required "able-bodied" adults on Medicaid to work or participate in approved "community engagement" activities 80 hours a month and pay small, income-based premiums monthly to stay covered.

Bevin's original proposal projected that in five years the Medicaid rolls would have 95,000 fewer people with the plan than without it, largely because of non-compliance with its requirements, including monthly reporting.

"My faith teaches me that rescinding this waiver is not only the right thing to do, it is the moral, faith-driven thing to do," Beshear said. " I believe health care is a basic human right."

"That's spot on," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. "That's what I was always taught Jesus Christ was about, is about including people and giving them a hand up when and where you could. And that's what this is and I think it's a great thing."

Chandler noted that the foundation had committed to helping the state keep people from losing coverage under the waiver, and could now use those resources for other efforts.

"We had been concerned about the hundred thousand or so people who were predicted to ultimately lose their coverage had the waiver been implemented." Chandler told Kentucky Health News.

Bevin's proposal had already been struck down twice by a federal judge in Washington, D.C., and was awaiting the decision of an appeals court. Beshear told reporters that by ending the waiver, Kentucky would no longer be involved in that lawsuit. Arkansas, which implemented a similar plan before being sued, will remain in the suit.

Beshear's office hinted in a news release that he might use his order as partial grounds for also rescinding "the $8 billion in Medicaid managed care contracts that the previous administration awarded with just 11 days left in the administration. Those contracts were awarded based on the waiver." Legislators in both parties have objected to the awards.

Two days after signing the executive order, Beshear's administration sent a "clarification" letter to the Centers for Medicaid & Medicare Services saying his request did not apply to four provisions in the waiver.

Two of those provisions involve substance use disorder. One allows non-emergency medical transportation for methadone treatment for most people on Medicaid; the other involves the substance-use disorder program that is available to all Kentucky Medicaid beneficiaries.

The third involves a provision that extends Medicaid coverage to former foster-care youth who were the responsibility of another state before moving into Kentucky; the fourth allows a family to coordinate its annual Medicaid re-determination with an open-enrollment period for an employer-sponsored insurance plan. It would include any children who are enrolled in Medicaid or in the Children's Health Insurance Program and are covered by a parent or caretaker's plan.

The judge's rulings against the waiver had no effect on those four elements, as the letter to CMS notes. It also points out that the four have operated without interruption in Kentucky during the suit.

"I am glad Governor Beshear sees the importance of keeping these positive policy changes," Marcie Timmerman, executive director for Mental Health America of Kentucky, told Kentucky Health News in an e-mail. "Mental health and substance use disorders affect people from every race, class, ethnicity, and orientation. The commitment of Kentucky to help our citizens have access to substance use disorder recovery is something we can all build on."

Kristen Arant of Newport, who receives coverage through expanded Medicaid, told reporters at the news conference that it had saved her life, allowing her to receive treatment for her substance-abuse disorder. She's now a college graduate and a social worker.

“Health care is not a luxury," she said.  “It is not a commodity. It is a God-given right. People who do not feel well have the right to feel well. People who need medications have the right to have access to those medications."

The expansion has increased by more than a 500% the number in Medicaid beneficiaries receiving treatment for a substance-use disorder, said Emily Beauregard, director of Kentucky Voices for Health. She called Beshear's order a tremendous victory for the 16 plaintiffs who challenged Bevin's plan in federal lawsuits.

The Kentucky Equal Justice Center, which was largely behind the lawsuits that kept the plan from taking effect, are "real heroes in this," Chandler said.

Center Director Richard Seckel diverted his appreciation to the 16 plaintiffs, calling them courageous. "We do hope that as this suit goes on with Arkansas that there will be findings that this waiver never should have been approved in the first place," he said.

Kentucky's Medicaid program covers about 1.3 million people; about 600,000 of them are children, and nearly 450,000 of the total are covered the expansion. Each month, tens of thousands of Kentuckians go on and off the program as they gain or lose eligibility.

"On any given day, most Kentuckians are simply a lost job, reduced work hours, a new baby, an accident or an illness away from qualifying for programs like Medicaid," Beauregard said. "That's why we call it a safety net."

Ky. legislative leaders talk favorably of taxing electronic cigarettes

By Al Cross
Kentucky Health News

Electronic cigarettes, which escaped taxation in the General Assembly last year and were then labeled an epidemic among teenagers, are in line to get taxed when the legislature convenes Jan. 7.

That was clear from statements by legislative leaders at the Kentucky Chamber of Commerce's legislative preview Dec. 16.

"There does appear to be some pretty solid support behind the vaping taxes," House Speaker David Osborne said, using the common term for use of electronic cigarettes. Many don't produce a vapor, which has liquid particles suspended in the air, but an aerosol, which has liquid and/or solid particles suspended in a gaseous medium.

Senate President Robert Stivers said the health effects of e-cigarettes make it easy "to have a two-fold conversation -- health and revenue -- so I think there's interest" in extending the state's tobacco excise tax to e-cigs. Afterward, he said, "I'm very much interested in it."

Chamber of Commerce President Ashli Watts said later that some legislative observers have said that revenue from taxing e-cigarettes "would be a pretty good start on school safety," a law the legislature passed last year but did not fund.

In an earlier session, Senate Majority Floor Leader Damon Thayer said, "On the vaping tax, I think that's something we probably need to consider. I don't favor it being as high as a cigarette tax, but I think there's probably a happy medium that we can find."

In the 2019 legislative session, Rep. Jerry T. Miller, R-Louisville, unsuccessfully sponsored an e-cig tax bill that would have dedicated the estimated revenue of $35 million a year to the state's unfunded pension liability. His latest version doesn't do that, on the advice of Osborne, who said the lack of earmarking would get the bill more support, Miller said in July.

In 2018, an e-cigarette tax was included in legislation that raised the tax on traditional cigarettes, but the e-cig tax was removed in the Senate, just before final passage and after lobbying by Altria Group, the largest tobacco company and 35 percent owner of Juul Labs, the largest e-cig company.

Sen. Chris McDaniel, chair of the Senate Appropriations and Revenue Committee, said in July that he wasn't sure what happened, but thought that a staff member may have raised "a definitional problem" that couldn't be resolved at the last minute.

Stivers has said he couldn't recall what happened, but in an interview after his appearance he said he did not recall Altria lobbying him on the e-cig tax. Altria's top lobbyist came to Frankfort in the final days of the 2018 session, but Stivers said the company may have done that in an effort to revive a bill that would have raised the legal age to but tobacco and e-cig products to 21 from 18.

Teenagers' use of e-cigarettes soared in 2019, increasing to more than 5 million in 2019 from 3.6 million in 2018, a 39 percent jump, according to the latest annual National Youth Tobacco Survey. The devices are increasingly being used with marijuana and other cannabis products, the National Institute on Drug Abuse reported Dec. 18.

Other legislative issues

Gov. Andy Beshear campaigned on the idea of legalizing and taxing medical marijuana, but McDaniel threw cold water on that idea. He said the legislature's decision on medical cannabis would be driven by policy, and if it is deemed to be "a pharmaceutical, we don't tax pharmaceuticals in this state, and we're not going to start." Prescription drugs are exempt from the sales tax.

More broadly, the 2020 legislative session will be like none other: a governor of one party dealing with a legislature controlled by the other party -- and more powerful than it was in 1967-71, when Republican Louie Nunn was governor and pushed a sales-tax increase and other programs through a relatively weak legislature controlled by Democrats.

Stivers told the crowd that Gov. Andy Beshear "surely realizes" that his election wasn't a mandate, since the average Republican vote margin was 213,000, except for "one anomaly race," Beshear's defeat of unpopular Republican incumbent Matt Bevin. Later, he said "The governor needs to be careful what he says and does" with helping Democrats seeking GOP-held legislative seats because trying to unseat Republicans and failing "would weaken him tremendously."

Osborne said Republicans "sometimes" worked well with Bevin but "had a really productive relationship" with the governor's father, Steve Beshear, who was chief executive in 2007-2015, before Republicans gained a majority in the House. "I think you will see people anxious to work cooperatively," Osborne said.

Osborne said he is "a little bit hesitant" about senators' idea to limit the governor's pardon power with a constitutional amendment in the wake of controversial pardons and commutations Bevin issued on his way out of office. Stivers said he agreed that the legislature needs to move carefully, but "The shock value of what happened has created quite a bipartisan atmosphere" about addressing the issue.

Stivers said the legislature needs to do more to help the economy in Kentucky's rural areas, many of which are falling farther behind the rest of the state and are "donee regions" to the commonwealth. He said 87 percent of admissions at the University of Kentucky's main hospital come from outside Fayette County.

Kentucky hospitals have benefited greatly from the 2014 expansion of Medicaid, which was initially covered by the federal government under the 2010 Patient Protection and Affordable Care Act. In 2017-19, the state has paid 5, 6 and 8 percent, respectively; in 2020 it will begin paying the reform law's limit of 10 percent. "We know Medicaid costs are going to dramatically increase," Osborne said.

Information for this story was also gathered by Kentucky Health News reporter Melissa Patrick.

Health officials warn outbreak of drug-resistant bacteria is likely coming from petting puppies in pet stores; 3 of 30 cases are in Ky.

By Melissa Patrick
Kentucky Health News

Getting a puppy for Christmas? Keep clean and take it to a vet. At least 30 people in 13 states have been sickened by a drug-resistant bacteria that federal health officials say was likely picked up from puppies in pet stores, three of them in Kentucky.

Getty Images photo, via WJW-TV, Fox 8 Cleveland

The infection is from a multi-drug-resistant strain of the bacterium Campylobacter jejuni. The outbreak has caused four hospitalizations, the federal Centers for Disease Control and Prevention said in a news release.

The CDC noted that the hospitalized ranged in age from 8 months to 70 years old.

Among 24 people with infections who were interviewed, 21 said they had recently touched a puppy and 15 of those said they did so in a pet store. All of the cases were reported between January and November.

"Campylobacter bacteria can spread to people through contact with poop of infected animals and contaminated food or water," says the release.

Infection from the Campylobacter bacteria is one of the most common causes of diarrheal illness in the United States, infecting more than 1.5 million people every year, says the CDC. Most cases are not part of a recognized outbreak.

The release notes that a single, common supplier of puppies has not been identified. However, 12 of those who had contact with a puppy did so at a Petland store, and five of the 12 were Petland employees. Petland has two locations in Kentucky, in Florence and Ashland.

The CDC adds that the strain of Campylobacter in this outbreak appears to be related to a strain that caused a similar outbreak of puppy-related human illness in 2016.

In a statement, Petland said that just like a 2016 outbreak, this specific Campylobacter strain has not originated at any specific Petland store. The company said it implemented all recommended protocols from federal and state officials to prevent human and dog illness after that outbreak.

Campylobacter jejuni oubreak as of Dec. 11, 2019

"For perspective, more than 12 million guests visit our stores annually, and during this specific time period, Petland estimates more than 2.4 million customer socializations of Petland puppies," says the statement.

Illnesses have been reported in Connecticut, Florida, Georgia, Illinois, Kentucky, Maryland, Minnesota, Nevada, Ohio, South Carolina, Tennessee, Utah and Wyoming.

Symptoms of Campylobacter infection include diarrhea, fever and stomach cramps that begin two to five days after being exposed to the bacteria. The illness usually lasts about a week and most people recover without antibiotics. Antibiotics are needed for patients who are very ill or those with severely weakened immune systems.

The CDC encourages people to make sure they take a new puppy or dog to a veterinarian for a checkup within a few days after getting it because puppies and dogs can carry the Campylobacter germs even while appearing healthy and clean.

The agency also advises people to always wash their hands thoroughly with soap and water after touching a puppy or dog, after handling their food and after cleaning up after them. Also, don't let dogs lick around your mouth and face, open wounds, or areas with broken skin.

The release says the CDC the investigation is ongoing and the agency will provide updates when more information is available.

McConnell and electronic-cigarette firms' bill to raise legal age to buy tobacco and e-cigarettes to 21 awaits president's signature

By Melissa Patrick
Kentucky Health News

Legislation to raise the nationwide legal age to buy tobacco produces, including electronic cigarettes, from 18 to 21 passed Congress as part of the year-end spending bill and went to President Donald Trump for his expected signature. It passed the House Dec. 17 and the Senate Dec. 19.

“I’m proud the Senate approved legislation today including our Tobacco-Free Youth Act to help address this urgent crisis and keep these dangerous products away from our children," Senate Majority Leader Mitch McConnell, who engineered the move, said in a news release.

U.S. Sen. Tim Kaine, a Democrat from Virginia, who co-sponsored the measure, called its passage an "enormous victory for the health of our young people" and said in addition to reducing youth tobacco use, it would save 223,000 lives.

"This is one of many steps we should take to tackle the youth e-cigarette epidemic that touches every corner of our nation," Kaine said in a news release.

More than 6 million U.S. middle and high school students are current users of tobacco products, and 5.3 million of them, or 85 percent, are using e-cigarettes, according to the latest annual National Youth Tobacco Survey.

The latest data for e-cigarette use by Kentucky teens, from 2018, shows e-cig use had nearly doubled since 2016, with more than one in four high-school seniors and one out of seven eighth-graders reporting they used the devices, the Kentucky Incentives for Prevention study found.

“The dangers of nicotine on young people’s development—especially on their brains and lungs—can inflict life-long damage. Raising the minimum tobacco purchase age to 21 will help keep these harmful products away from our kids, and I can’t thank Senator McConnell enough for his vision and leadership for our children’s future," state Rep. Kim Moser, R-Taylor Mill, chair of the state House Health and Welfare Committee, said in McConnell's release.

In a separate release issued earlier this week,  Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, praised McConnell's work. He added that the state legislature, which convenes Jan. 7, will need to change state law to comply with the federal statute. Sen. Ralph Alvarado, R-Winchester, has prefiled a bill to raise Kentucky's legal age to 21 from 18.

"This bill is a critical step toward reversing the skyrocketing rates of youth vaping nationwide and in Kentucky," Chandler said. "We encourage the Kentucky legislature to demonstrate similar leadership in passing Sen. Alvarado's Tobacco 21 bill quickly this coming year."

A similar bill was introduced in the last legislative session, but tobacco-friendly senators blocked it.

Terry Brooks, executive director of Kentucky Youth Advocates, also praised the legislation.

"Kentucky Youth Advocates thanks Leader McConnell for leading the way in Congress on this critical issue to help keep Kentucky kids—and kids across the nation—healthier and prevent life-long addiction to nicotine," Brooks said in a statement.

Already, 19 states have raised the tobacco age to 21, along with Washington, DC and over 530 localities, although the strength of their laws vary substantially, according to the Campaign for Tobacco-free Kids. E-cigarette companies see the law as a way to limit other forms of regulation aimed at limiting smoking and e-cig use by teenagers.

In the latest Kentucky Health Issues Poll, six in 10 Kentuckians said they would support increasing the minimum age to purchase tobacco products to 21, with majorities in each political party.

In addition to Alvarado's bill, Kentucky lawmakers have pre-filed several other bills to thwart the surge in teen use of e-cigs, including one to ban the sale of flavored e-cigs; one to impose registration and licensing requirements to sell them; and one to tax them at the same rate as traditional cigarettes.

ACA open enrollment has been extended until 3 a.m. ET Wed., Dec. 18, but federal officials haven't made a very big deal of it

Open enrollment for "Obamacare" health insurance has been extended until 3 a.m. ET on Wednesday, Dec. 18, because of extensive computer glitches that happened over the weekend.

The original deadline was 11:59 p.m. on Sunday, Dec. 15. The last day is always the busiest, but many people trying to enroll via the website or by phone ran into delays and other issues. Despite the problems, the Centers for Medicare and Medicaid Services said in a statement that more than half a million people were able to enroll on Sunday. According to CMS, "people who already left their names and contact information with the call center on Sunday don’t need to come back and reapply because a representative will follow up with them later in the week," Ricardo Alonso-Zaldivar reports for The Associated Press.

The nonprofit Get America Covered urged the administration to extend the sign-up. The group was founded by ex-Obama administration officials to get the word out about ACA open enrollment after the Trump administration halved the sign-up period and slashed budgets for advertising, outreach and "navigators," people who help others sign up for coverage, Alonso-Zaldivar notes.

Get America Covered co-founder Joshua Peck applauded the extension, but said he worries that the administration isn't doing much to publicize or clarify it. The HealthCare.gov home page still says in big letters that open enrollment is over. A banner with much smaller letters at the top of the page says it has been extended, which could confuse users, Sarah Gantz reports for The Philadelphia Inquirer.

"Senior lawmakers of both major parties are urging the administration to publicize the availability of a redo for seniors who got inaccurate or confusing results using the Medicare Plan Finder. A redesign of the Medicare site produced search results that didn’t automatically rank the prescription drug plan with the lowest total cost first," Alonso-Zaldivar reports.

Peck noted that there were serious glitches on the first day of open enrollment too, and called on CMS to not only extend the deadline and publicize it more, but to also commit to being transparent about what caused the glitches and what the agency has done to ensure they won't happen again, Gantz reports.

Kentucky had nation's third largest increase in 2016-18 in percentage of children under 6 without health insurance

By Melissa Patrick
Kentucky Health News

Over the past two years, Kentucky saw the third largest increase in the nation for the percentage of children under 6 years of age with no health insurance, says a Georgetown University study.

The university's Center for Children and Families' analysis of the most recent census data found the rate of uninsured children under 6 in Kentucky rose from 2.7 percent to 4 percent between 2016 and 2018. That was a bigger jump than the increase in the national rate during the period, from 3.8% to 4.3%.

The state's rate had been trending down since 2014, when the state fully implemented the 2010 Patient Protection and Affordable Care Act.

The rate was 5.2% in 2013, 4.1% in 2014, 3.5% in 2015 and 2.7% in 2016, before increasing in 2017 to 3.5% and to 4% in 2018.

The estimated number of uninsured Kentucky children under 6 rose from 8,608 in 2016 to 12,973 in 2018, meaning that 4,365 more didn't have coverage, a 50.7% increase.

Chart from Georgetown report; click on it for larger version

Kentucky was one of 11 states that showed a significant increase in both the rate and number of uninsured young children, says the report. It doesn't say whether the increase is specific to any one type of coverage.

In a blog post about the report, the liberal-leaning Kentucky Center for Economic Policy reports that the Georgetown finding is in line with the broader coverage losses seen in Kentucky from 2016 to 2018. "But the increase in the number of uninsured young children (50.7%) far outpaced the increase in the number of uninsured Kentuckians as a whole (10.9%)," writes KCEP policy analyst Dustin Pugel.

Pugel told Kentucky Health News in an email that the increase could be partly a result of "practices in Kentucky that enforced stricter paperwork requirements, which led to 97,438 Kentuckians losing Medicaid coverage in state fiscal year 2019." He provided a month-by-month list of discontinuances due to paperwork, based on state data. "Although it’s not clear how many of these would not have been eligible had they presented the paperwork in time, how many were children, or how many may have regained coverage since," he wrote, "an enrollment loss of that magnitude must have contributed to the increase in uninsured to some degree."

A spokesperson for the state Cabinet for Health and Family Services said Friday that it would need time to review the report before commenting.

The Georgetown report says it is critical for children under 6 to have health insurance, not only for medical care during a time that includes rapid brain development and physical growth, but also because it protects families from financial risk that can come from an unexpected injury or illness. Further, it points to research that shows health insurance for children is linked to better health, educational, and economic outcomes well into adulthood.

The American Academy of Pediatrics recommends that children get 15 checkups before age 6. These early visits include not only vaccinations and preventive care, but screenings that can detect developmental delays to allow for early intervention.

The Georgetown report notes that the increases occurred during a time of economic growth, "when children should be gaining health care coverage," not losing it. The report says a number of factors could have contributed to this coverage reversal, including declines in Medicaid and in the Children's Health Insurance Program.

It adds that these declines have likely been influenced by the Trump administration's "policies and rhetoric targeting immigrant families," which has reportedly deterred many parents from signing up eligible-citizen children in available Medicaid and CHIP coverage. It also points to ongoing national policy debates and decisions that it says have "undoubtedly sowed confusion among parents and caregivers about whether coverage would be available to their children."

Specifically, the report points to 2017 efforts in Congress to repeal the ACA and cut Medicaid, along with a months-long delay in funding the children's insurance program, as well as cuts to outreach grants designed to boost enrollment.

Adding to Kentuckians' confusion, Pugel notes, they also had to keep up with the status of the Medicaid program, which then-Gov. Matt Bevin was trying to change with, among other things, work requirements. The proposal has been blocked by a federal judge, and new Gov. Andy Beshear has said he plans to rescind the proposal.

Kentucky's numbers would likely be higher if Beshear's father, then-Gov. Steve Beshear, had not expanded Medicaid to adults with incomes up to 138 percent of the poverty line, because the report shows that young children were more likely to be uninsured in states that did not expand Medicaid.

"Research shows that when adults have access to coverage, they are more likely to enroll their eligible children," says the report. This is often called the "welcome mat."

The report adds that young children tend to be uninsured at lower rates than their school-aged peers. However, Kentucky and six other states have shown an opposite trend; in Kentucky, 4% of its young children are uninsured, compared to 3.7% of school-aged children.

"For these states," the report says, "the inversion serves as a potential warning sign that more could be done to reach uninsured young children."

Northern Ky. Health Dept. declares hepatitis A outbreak over in 4 counties it serves; statewide, it may never be considered 'over'

This story was updated Dec. 16 with comments from Doug Thoroughman, the state epidemiologist. 

With no new cases in the past four months, the Northern Kentucky Health Department has declared the hepatitis A outbreak to be over in the four counties it serves. However, the state Department for Public Health says the outbreak continues statewide, at a much lower level.

“Even though the current outbreak is over, it is still important to get vaccinated against hepatitis A,” NKY Health’s district director of health, Dr. Lynne Saddler, said in a news release. ”Not only will it protect you for the future, but it can also help prevent the future spread of hepatitis A in the community.”

During the region's outbreak, which began in August 2018, there were 319 documented cases of hepatitis A in the four counties served by the health department: Boone, Campbell, Grant and Kenton, including four deaths. In 2017 there were zero cases, says the release.

 Top map shows rate of cases per county since outbreak
began in August 2017. Bottom map shows rate of cases
in November 2019. Both maps are from weekly report.  

State numbers for hepatitis A are also way down. Kentucky saw five new cases between Nov. 17 and 30, according to the state's weekly report. That's compared to 175 at the same time last year.

State Epidemiologist Doug Thoroughman said in an e-mail, "Although our hepatitis A numbers are very low now, Kentucky is still seeing sporadic cases around the state. For the last two months, we have identified between two and four new cases each week across the state. About this time last year we had the peak of our outbreak, with over 100 cases identified statewide each week,"

Health officials in Lexington told Garrett Wymer of  WKYT-TV that the drop is largely due to increased awareness and vaccination, but the statewide outbreak isn't officially over.  Lexington has had no new cases since July.

“In terms of the definition of an outbreak for epidemiologists, this outbreak may never be considered 'over.' In terms of what the state is telling us, it's slowed down,” Kevin Hall of the Lexington-Fayette County Health Department told Wymer. “It's not over, it's not stopped. Definitely though, it's under better control that is has been, and it's definitely under control compared to last year."

As of Nov. 30, more than 4,900 Kentuckians had been sickened by the highly contagious liver disease, and 61 of them had died from it. The primary risk factors for this outbreak have been drug use and homelessness.

Hepatitis A vaccination is now required to attend school in Kentucky, but health officials stress that adults should be vaccinated too. Getting two doses at least six months apart can provide life-long protection.

Four flu-related deaths have been reported in Kentucky; state health commissioner urges everyone to get vaccinated

By Melissa Patrick
Kentucky Health News

The Kentucky Department of Public Health has reported the first four influenza-related deaths of the 2019-2020 flu season, which runs through May.

“We extend our condolences to the families who have suffered losses during this flu season,” Dr. Angela Dearinger, commissioner of the agency, said in a news release. “These personal losses are a reminder for all of us that flu can be a serious illness, for young and old alike, and we strongly encourage people to protect themselves by getting a flu vaccination.”

Dearinger added that it is especially important for children and high-risk adults to get vaccinated, since they are at higher risk of complications and negative consequences, including death. She also encouraged anyone with flu to stay home and avoid contact with others.

It's also important to practice good hygiene, covering your cough and making sure you are washing your hands with soap and water for at least 20 seconds -- or the time it takes to sing "Happy Birthday" twice.

Because flu germs linger on surfaces, it's also important to wash your hands after coughing, touching a door knob or handrail, or shaking hands. One regional health official has even advised Kentuckians to avoid handshaking during the flu season, calling it "the worst thing you can do."

The federal Centers for Disease Control and Prevention recommends washing hands with soap and water whenever possible, and if not, to use a hand sanitizer with at least 60 percent alcohol.

Mortality and Morbidity Weekly Report map; click to enlarge

The state health department has also upgraded the state's flu activity level to "widespread," which is the highest classification and is applied when increases in flu cases have been confirmed in at least half of the state's 17 health regions.

During the week of Dec. 1-7, Kentucky saw 511 new confirmed cases of flu, with increases in 10 of the state's 17 health regions. Since Aug. 4, there have been 1,622 confirmed cases in the state, and all four of reported deaths were adults, according to the weekly influenza surveillance report. The number of cases is likely under-reported; health officials have said many health-care providers stop submitting cases for laboratory confirmation once flu becomes widespread.

Last season, the state had 17,665 lab-confirmed cases and 196 flu-related deaths, including two children.

Flu symptoms include fever, headache, cough, sore throat, runny nose, sneezing and body aches. It is highly contagious. Persons who develop symptoms should contact their medical provider immediately to determine if they are a good candidate for treatment with an antiviral drug, which could shorten the course of the illness or reduce its severity.

The CDC says everyone over six months old should get a flu shot, and especially encourages people who may be at higher risk for complications or negative consequences to get one, including children 6 months to 5 years old and their caregivers; women who are or might be pregnant during flu season; people 50 and older and their caregivers; obese people; those with chronic health problems; residents of long-term care facilities, and health-care workers.

Vaccinations can be given any time during the flu season, but take about two weeks following the administration of the vaccine for the recipient to develop protection from the flu.

If you're looking for a place to get your flu shot, the CDC offers an interactive "flu vaccine finder" that allows you to type in your ZIP code and find nearby locations that offer shots. Local health departments offer the vaccine. Medicaid and Medicare and most private insurance providers cover flu vaccination at no cost, as a preventive service.

Kentucky legislators have filed four bills targeting teen use of e-cigarettes; Coalition for a Smoke-Free Tomorrow is supporting two

By Melissa Patrick
Kentucky Health News

As teen use of electronic cigarettes continues to surge, Kentucky lawmakers in both parties will be working to pass bills aimed at decreasing their use in the legislative session that starts Jan. 7.

Through Dec. 12, four such bills had been pre-filed, including one to raise the legal age to buy all tobacco products to 21; one to ban the sale of flavored e-cigarettes; one to impose registration and licensing requirements to sell e-cigs; and one to tax them at the same rate as traditional cigarettes.

Teen use of e-cigarettes increased to more than 5 million in 2019 from 3.6 million in 2018, a 39 percent jump, according to the latest annual National Youth Tobacco Survey.

The latest data for e-cigarette use by Kentucky teens, from 2018, shows e-cigarette use had nearly doubled since 2016, with more than one in four high-school seniors and one out of seven eighth-graders reporting they used e-cigs in 2018, the Kentucky Incentives for Prevention study found.

Sen. Ralph Alvarado

Sen. Ralph Alvarado, R-Winchester, most recently pre-filed Bill Request 967 to raise Kentucky's legal age for buying all tobacco products, including e-cigarettes, from 18 to 21. Alvarado chairs the Senate Committee on Health and Welfare and is a practicing physician.

"Youth tobacco use had been declining for decades, but it has suddenly skyrocketed since the introduction of e-cigarettes and vapes," Alvarado said in a news release. "The science is clear that adolescents and teens are particularly vulnerable to the health risks of nicotine and other toxins in tobacco products. This bill is a common-sense, widely supported measure to help keep tobacco out of the hands of kids."

A similar bill was introduced in the last legislative session, but tobacco-friendly senators blocked it. At the federal level, U.S. Senate Majority Leader Mitch McConnell, R-Kentucky, has proposed a bill to raise the legal age to buy tobacco products to 21.

Already, 19 states have raised the tobacco age to 21, along with Washington, DC and over 530 localities, although the strength of their laws vary substantially, according to the Campaign for Tobacco-free Kids. Some companies see the law as a way to limit other forms of regulation.

The latest Kentucky Health Issues Poll found that six in 10 Kentuckians would support increasing the minimum age to purchase tobacco products to 21, with majorities in each political party.

Most teens get tobacco from older friends who can buy the products legally, but youth under age 18 typically don't hang out with people who are 21 or older, so the bill helps cut off a major social source of tobacco for kids," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. He noted that the bill would put more enforcement responsibility on retailers.

Rep. Buddy Wheatley

"We can't wait any longer to act," Chandler said. "Focus groups the foundation conducted in partnership with Kentucky Youth Advocates made clear that teens in the commonwealth who never would have touched cigarettes are using e-cigarettes, and they mistakenly believe they're safe. We have to raise the age from 18 to 21 in this legislative session," Chandler said.

Another bill to thwart teen e-cigarette use has been filed by Rep. Buddy Wheatley, a Democrat from Covington. He prefiled Bill Request 925 to ban the sale of flavored e-cigarettes and vapes. It also includes fines upwards of $2,500 to those who would continue to distribute them.

“My bill follows the similar model our country set a decade ago, when the FDA banned certain flavors in cigarettes because of their appeal to our children,” Wheatley said in a news release. “That was the right move then, and it’s the right move now." He added, "The hope is that the federal government will take similar steps regarding a ban of e-cigarette flavors, but until that happens, my bill will at least make sure this is in effect here in Kentucky.”

However, that doesn't seem likely to happen any time soon. President Donald Trump said in September that he would ban all e-cigarette flavors except tobacco and menthol, but has since backed off this decision in the face of protests from users, retailers and manufacturers.

The Foundation for a Healthy Kentucky also applauded Wheatley's bill and said it was time to take "bold steps" to reduce the youth vaping epidemic.

 ("Vaping" is a term used by manufacturers, sellers and users of electronic cigarettes, but many of the devices do not produce a vapor, which is liquid particles suspended in the air. They produce an aerosol, which has liquid and/or solid particles suspended in a gaseous medium.)

"Adolescents and teens are drawn to e-cigarettes because of the flavors and then get addicted to the nicotine," Chandler said in a separate news release. Rep. Wheatley's bill would cut off a primary reason kids use these dangerous products and keeps them from becoming the next generation addicted to nicotine. It's an addiction that will haunt them the rest of their lives."

Rep. Jerry Miller

Two other bills to combat the surge of youth e-cigarette use have been filed by Louisville Republican Rep. Jerry Miller.

Bill Request 468 would require all retailers or manufacturers of vapor/aerosol products that come with "enhanced cartridges" to register with the Department of Alcoholic Beverage Control and pay a $500 annual licensing fee per location annually.

It would also prohibit retailers and manufacturers from selling such products online, by catalog or by phone; prohibit home delivery by outside vendors; require real-time age verification for purchase through an electronic third-party source no later than Jan. 1, 2021; and call for fines on any person under the age of 18 who tries to purchase electronic cigarettes or related products. His other measure, Bill Request 32, would impose a 27.5 percent excise tax on e-cigarettes and related devices.

Miller told the Louisville Courier Journal in October that he recognized the lure of the flavored products to teens and doesn't banning them, but said any such ban needs to be on the federal level. "If Washington wants to ban it, fine, that's their deal," he said. "In terms of Kentucky, how we're going to reduce teen vaping, I see it as more effective to regulate it."

The Coalition for a Smoke-Free Tomorrow will hold a rally at 10 a.m. Tuesday, Jan. 14, in the Capitol rotunda to support of the excise tax and the higher age limit. It will also call for more funding for prevention and cessation programs. The rally is titled "Answers to Kentucky's Youth Vaping Epidemic: A rally for laws to protect youth from tobacco!"

Bonnie Hackbarth, vice-president for external affairs at the foundation, which staffs the coalition, said in an e-mail that the rally will support only the bills that have unanimous support of the coalition's steering committee, comprising representatives of 20 organizations. She said there is not unanimous support for Wheatley's bill or Miller's regulation and licensing bill, for various reasons.

"Some members believe the flavor ban should extend to all tobacco products, for example. Some would support the Wheatley bill but not the Miller bill. Others, including the foundation, support both," Hackbarth said. "The coalition – which now has more than 220 members and partners – is led by the steering committee of representatives from 20 organizations, and all steering committee members must agree for a measure to become a coalition priority."

Bill would create first-aid training program for mental-health and substance-use crises; hope is to make it as common as CPR

By Melissa Patrick
Kentucky Health News

A bill to create a training program for mental-health first aid has been pre-filed by state Rep. Kim Moser, a Kenton County Republican who chairs the House Health and Family Services Committee.

Rep. Moser explains mental-health first aid.

If passed, the program would train people in how to best address the needs of someone experiencing a mental-health or substance-use crisis.

"The goal of this legislation is to make this program widely accessible across the state to those who work with at-risk populations," Moser said at a Dec. 9 news conference about the bill. "I would like to see mental-health first aid become as commonplace as CPR training" for cardiopulmonary resuscitation.

Moser noted that mental health is the underlying cause of many issues in society, such as substance-use disorders, suicide and violence, but little has been done to help those who might be dealing with such issues in a crisis.

"This certification does not replace a licensed counselor, but it builds mental-health and substance-misuse literacy so that the folks who get this training will be able to help the public in identifying, understanding and responding to a mental-health issue or crisis," Moser said.

According to the 2019 America's Health Rankings, suicide is the 11th leading cause of death in Kentucky and the second leading cause of death for people ages 15 to 34. The U.S. suicide rate for veterans is 17 per day, according to the National Veteran Suicide Prevention and Annual Report.

State Behavioral Health Commissioner Wendy Morris said at the news conference that one in five Americans will have a diagnosable mental-health condition, fewer than half of those will get treatment, and if they do get treatment, it typically 11 years after the onset of symptoms.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, applauded Moser's legislation, which will be known as Bill Request 313 until the legislative session begins Jan. 7. He said the training would help decrease the stigma around mental illness and substance use.

"We fear what we don't understand and what we can't fix," Chandler said. "But if we knew more, we could do more. This training increases understanding and awareness and gives us tools to help."

The training would be geared toward anyone, but individuals such as first responders, faith leaders, social workers, and educators are likely to benefit the most from it, says a news release about the bill.

The training would be administered by the Cabinet for Health and Family Services and would be funded through state and federal appropriations, grants and private donations.

Medicaid contracts rejected by legislative committee; members of another panel see secrecy and a rush to award $8 billion in deals

On Gov. Matt Bevin's last day in office, a legislative committee voted unanimously to reject his administration's recent approval of $8 billion in Medicaid managed-care contracts covering 1 million Kentuckians. Later in the day, legislators on another committee asked the outgoing health secretary why the contracts were approved so quickly, and without legislative oversight.

On Dec. 9, the Government Contract Review Committee voted unanimously to reject the contract, saying the Bevin administration failed to give them the contracts in advance for review, Deborah Yetter reports for the Louisville Courier Journal.

The committee has only advisory power, but its vote could add weight to the promised appeals of major health insurer Anthem Inc. and Louisville-based Passport Health Plan, which the Bevin administration dropped as managed-care organizations (MCOs) for Medicaid.

Sen. Stephen Meredith

Sen. Stephen Meredith, a member of the committee, told Yetter that the Bevin administration claimed the contracts were exempt from review by the committee, but the committee determined that they were not. The administration ended up sending the contracts to the committee for approval, but only after it had already awarded them to five MCOs.

"It's like we're being strong-armed into doing something," said Meredith, a Republican from Leitchfield, later adding, "We should have seen these contracts before they were awarded. If we're not seeing these contracts, I'm truly wondering about what else we're not seeing."

At a meeting of the Medicaid Oversight and Advisory Committee, which Meredith co-chairs, "Lawmakers demanded to know why the contracts were awarded in apparent haste and why lawmakers were not consulted about details that affect their communities," Yetter reports.

"This looks like, from my perspective, this was a very rushed procedure with the intention of trying to limit any legislative input," Meredith told Adam Meier, secretary of the Cabinet for Health and Family Services, which runs Medicaid.

"I've got some great concerns with the process," said Senate Minority Leader Morgan McGarvey, D-Louisville. He asked Meier, "Why has there been such secrecy around this process, and why was there an $8 billion contract award issued after the election?"

Health Secretary Adam Meier at the Medicaid
Oversight and Advisory Committee meeting

Meier defended the contract process, saying, "They're not secret, they're confidential."

He said the contract bids were independently evaluated by a five-member committee that scored them for how well it met state specifications, adding that they have been working for months on the awards. "The idea that this was rushed is absurd," Meier said.

The lawmakers also wanted to know why the administration chose contract with five companies (including two new ones) when federal regulations only require two.

Legislators have repeatedly said five companies are too many because they create administrative burdens for health-care providers that are not necessary or sustainable. They have suggested no more than three companies, and Meredith has filed bills calling for this change.

"This body has made it clear, abundantly clear, that we expect three," said Sen. Danny Carroll, R-Paducah. "Why do we have five? Is there something I'm missing?"

Meier said the state chose five MCOs to create more competition. "I don't see us trying to limit competition," he said.

The administration announced the contract awards Nov. 27 to Aetna Better Health of Kentucky, Humana Health Plan and Wellcare Health Insurance of Kentucky, all of which hold existing contracts with the state, and two newcomers, United Healthcare and Molina Health Care. The contracts take effect on July 1.

The contracts were re-approved over the committee's objection by Finance Secretary William Landrum on his last day in office, Yetter reports. Gov. Andy Beshear, who took office the next day, has promised to review them. Meredith said he wouldn't be surprised if the dispute ends up in court. 

Man who led implementation of Obamacare under Gov. Andy Beshear's father will be acting health secretary, then deputy

By Melissa Patrick
Kentucky Health News

Just hours before being sworn in as the state's next governor, Andy Beshear named the remaining secretaries of his cabinet, including Eric Friedlander as acting secretary of the Cabinet for Health and Family Services, the state's largest cabinet.

Andy Beshear and Eric Friedlander

Friedlander is holding both the deputy secretary and acting secretary positions and will stay on as deputy once a permanent secretary is hired.

Beshear called Friedlander "an accomplished and mission-driven executive with more than 30 years of experience leading and managing complex organizations in challenging and politically charged environments."

Friedlander led and managed the implementation of the Patient Protection and Affordable Care Act, otherwise known as Obamacare, under then-Gov. Steve Beshear, Andy Beshear's father. He has been chief resilience officer for Louisville Metro Government.

"Eric is one of those gems that can work, understand and help move the mission in both parts of that cabinet," said Beshear. "You have one part of that cabinet that is Medicaid and is public health. You have another part of that cabinet that is supposed to protect our most vulnerable children that are out there. Eric brings the experience in to hit the ground running on day one to be able to do both."

Friedlander said he had worked for the cabinet since 1985, and in thanking Beshear for the appointment recognized the dedication of the men and women in the health cabinet, calling them "unsung heroes."

"I look forward to serving in an administration that believes in improving the health and well being of every Kentuckian," he said. "Thank you for that opportunity."

Asked about the state's persistent bottom-10 health ranking and what was next for the Affordable Care Act and its Medicaid expansion, which has been touted as one way to improve the state's health status, he said, "I think the answer is actually quite simple. I think we need to build on the success that we had in expanding Medicaid. I think we need to build on the success of having more people insured and not try to back away from that."

Beshear has said he would drop then-Gov. Matt Bevin's attempt to require many if not most people on the expansion to work, volunteer or attend school or job training, a move that Bevin's administration initially predicted would reduce Medicaid rolls by 95,000 over five years. The proposal was blocked by a federal judge and an appeal has been argued.

Beshear appointed former Kentucky Supreme Court Justice Mary Noble as justice secretary. Terry Brooks, executive director of Kentucky Youth Advocates, applauded the appointments, saying in a statement, "There are perhaps no two positions more vital when it comes to child well-being."

In particular, Brooks noted that KYA was looking forward to working with Friedlander and his team to implement the federal Families First Prevention and Services Act, which aims to reduce the number of children in the foster care system by providing funding for prevention and preservation services, including substance abuse and mental health services for families and children.

U.S. Supreme Court, by refusing to hear challenge, upholds Ky. law requiring pre-abortion ultrasound and script reading by doctor

https://www.washingtonpost.com/politics/courts_law/supreme-court-wont-review-abortion-law-challenged-by-doctors-who-say-it-violates-their-right-to-free-speech/2019/12/09/68c3adae-1a99-11ea-8d58-5ac3600967a1_story.html?utm_campaign=the_daily_202&utm_medium=Email&utm_source=Newsletter&wpisrc=nl_daily202&wpmm=1

Dollar General plans to open 1,000 stores in 2020; some worry they contribute to poor nutrition in rural areas

Dollar General Corp., one of the fastest-growing retailers in the country, has announced it will open 1,000 new stores in 2020, just as it did last year. That's on top of the more than 16,000 stores it already has (dozens of which are in Kentucky). "Dollar General's growth is nearly unrivaled in the industry at a time in which many brick-and-mortar retailers are closing stores or folding," Nathaniel Meyersohn reports for CNN."Walmart, which swept into new towns for decades with massive superstores, has essentially stopped opening new ones. By contrast, Dollar General is entering new cities and towns with small stores and opening up in areas where it has already gained hold."

One reason dollar stores are so popular: despite the low unemployment rate, "wages for a vast number of Americans have grown only modestly," Meyersohn reports. "Americans living paycheck-to-paycheck have been a boon to Dollar General, and wages for a vast number of them have grown only modestly. The chains have also reached higher-income shoppers seeking discounts." And Dollar General appeals to convenience, offering many of the same goods as Walmart with a shorter drive.

The chain's growing presence has hurt some small-town retailers. Small, full-service groceries in some towns have been put out of business by Dollar General Markets, which sell fresh produce and meat, though usually not with as wide a selection as the grocery they dislodged.

Most Dollar Generals sell only prepackaged food, which worries nutritionists concerned about rural health. Barry Popkin, a nutrition professor at the University of North Carolina at Chapel Hill, has been a long-time critic of dollar stores. "At a time when poor diets are linked to nearly 900 deaths a day in this country, Popkin says to look at what Dollar Stores sell: rows and rows of sugary drinks, candies, and processed foods high in salt and fat," Allison Aubrey of NPR reports for CBS News. Dollar Generals are frequently located in "food deserts," where residents have little access to fresh food and are often obliged to buy the pre-packaged food Popkin warns against.

For example: in Dekalb County, Georgia, which includes part of Atlanta, there are 68 dollar stores (a mix of Dollar General, Family Dollar, and Dollar Tree, the latter two with the same owner). County Commissioner Lorraine Cochran-Johnson told Aubrey that a quarter of the county's residents live in food deserts, and that dollar stores target such areas. "When you look at the trends and you look at the pattern of growth of the dollar store as well as the areas that have the highest levels of obesity, hypertension, high blood pressure, there is a direct correlation," Cochran-Johnson said.

Food-desert concerns have led some cities and towns to pass laws limiting dollar-store expansion. "Advocates of tighter controls on dollar stores claim the big chains intentionally cluster multiple stores in low-income areas, a strategy that strategy discourages supermarkets from opening and threatens existing mom-and-pop grocers, critics say," Meyersohn reports. "Opponents also express concerns that most dollar stores don't offer fresh produce."

Dollar General spokesperson Crystal Ghassemi objected to the perception that dollar stores contribute to poor eating habits, and told Aubrey that even their regular stores have plain vegetables and chicken in the frozen-foods section. Only about 3 percent of Dollar General outlets sell fresh produce.

E-cigarette use among nation's youth up 39% from last year; Fayette County school board votes to sue e-cig companies

National Youth Tobacco Survey graphic

By Melissa Patrick
Kentucky Health News

Teenagers' use of electronic cigarettes continues to surge, increasing to more than 5 million in 2019 from 3.6 million in 2018, a 39 percent jump, according to the latest annual National Youth Tobacco Survey.

The survey found that 6.2 million middle- and high-school students are using tobacco products, and that 5.3 million of them, or 85%, are using e-cigarettes, which are generally called "vapes." (Many of the devices don't produce a vapor, which has liquid particles suspended in the air; they make an aerosol, which has liquid and/or solid particles suspended in a gaseous medium.)

Use of e-cigarettes, particularly those with high levels of nicotine, places youth at risk for nicotine addiction, which could harm brain development, experts say. It also exposes them to other harmful substances such as heavy metals, volatile organic compounds and ultrafine particles that could harm the lungs. Further, research shows that youth who use e-cigs are more likely to start smoking tobacco.

"The youth vaping epidemic continues to threaten the immediate and long-term health of adolescents and teens in this country by exposing them to nicotine and a host of other toxins that are known to damage their developing brains and bodies," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release.

The Fayette County Board of Education voted Dec. 5 to become the second school district in Kentucky to sue e-cig companies, following the lead of Bullitt County. Both boards say the booming use of e-cigs disrupts learning and causes discipline problems.

Nick Gregory, 26, a manager at Botany Bay in Lexington,
used a Juul. (Herald-Leader photo by Charles Bertram) 

A new Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report says tobacco use is the leading cause of preventable disease, disability and death in the U.S., and about nine in 10 adult cigarette smokers start before age 18.

The National Youth Tobacco Survey collected data from about 19,000 middle and high schools students across the country.

It found that in 2019, an estimated 53.3% of high-school students (8 million) and 24.3% of middle school students (2.9 million) reported having ever tried a tobacco product, including e-cigarettes.

Current use, which includes those who said they had used any tobacco product in the past 30 days, was reported by 31.2% of high-school students (4.7 million) and 12.5% of middle school students (1.5 million).

E-cigarettes were the most commonly cited tobacco product currently used by 27.5% of high school students (4.1 million) and 10.5% of middle school students (1.2 million), followed in order by cigars, cigarettes, smokeless tobacco, hookahs (water pipes) and pipe tobacco, says the CDC report. This is the sixth year in a row that e-cigs were the most commonly used tobacco product for both middle- and high-school students.

Among the young e-cig users, the survey indicated that nearly 1 million use them daily, and about 1.6 million use them 20 or more days per month. Most users reported Juul as their usual brand.

"More than one in four high school students and one in 10 middle schoolers are using e-cigarettes in 2019, and at least a quarter of them are likely addicted. Many of these kids would never have touched a cigarette," Chandler said. "And too many of them think e-cigs are 'cool,' and that there's little or no harm in even intermittent vaping. Neither is true. E-cigs are just as insidious for youth as any other tobacco product."

The survey asked the students about their perceived harm. It found that among all of the students surveyed, 28.2% perceived "no harm or little harm" for intermittent use of e-cigs; 16.4% for hookahs; 11.5% for smokeless tobacco products; and 9.5% for cigarettes.

The survey showed signs of nicotine addiction. Among current users of any tobacco product, 24.7% reported experiencing cravings to use such products during the 30 days before they were surveyed, and 13.7% said they wanted to use a tobacco product withing 30 minutes of waking. Also, 57.8%, said they wanted to quit, and 57.5% said they had stopped using them for at least one day or more because they were trying to quit.

In an effort to help Kentucky's teenagers stop vaping, the state Department for Public Health has launched a free service called "My Life, My Quit," which allows teens to text or call a toll-free number, 1-800-891-9989, and be connected with a "quit coach" who will provide up to five confidential, free sessions to help the teenager create a personalized quit plan.

Chandler said the tobacco industry, which has invested in e-cigs, is using its same old tactics to manipulate a new generation of nicotine addicts. The survey found that 86.3% of students had been exposed to tobacco-product advertisements or promotions; 69.3% reported exposure to e-cigarette marketing; and 81.7% reported exposure to cigarettes or other tobacco products.

One of the primary initiatives of the foundation is to raise awareness about the dangers of smoking and vaping, including promoting policy initiatives to decrease tobacco use, especially among youth.

Chandler said, "We have several policy answers and they're proven to work. We need to tax vapes, at least the same amount as cigarettes. We need to raise the age for buying tobacco from 18 to 21, and assess stiff penalties on retailers that sell to underage buyers.

"The tobacco industry outspends public health more than 73 to one on marketing campaigns, so we also need to invest more resources into youth prevention. Kentucky gets more than $500 million in revenues from tobacco, yet spends less than $4 million on prevention.

 "And we should ban flavors. They're a key reason kids are drawn to e-cigarettes, and their appeal to kids is why the FDA banned flavored cigarettes a decade ago. The only thing that's changed is that the industry has found a new kind of tobacco product to dress up with kid-friendly flavors. " 

The CDC report says that among students who reported ever having tried e-cigarettes, the three most commonly selected reasons for use were curiosity (55.3%), use by a friend or family member (30.8%), and the flavors (22.4%).

The latest data for e-cigarette use among Kentucky's teens is from 2018. It shows that e-cigarette use  nearly doubled between 2016 and 2018, with more than one in four high Kentucky school seniors and one in seven of its 8th graders reporting use in 2018, according to the Kentucky Incentives for Prevention study.

Award-winning regional network organized by Norton Healthcare works to quickly treat the most deadly type of heart attack

Hospitals in the Louisville region partner with
Norton to give their patients access to the care.

Norton Healthcare has received the American Heart Association's 2019 Mission: Lifeline Regional Trailblazer Award for its regional program that provides care for a certain type of heart attack that is deadly if not treated quickly. Norton was Kentucky's only winner of the award this year, reports The Lane Report.

The program is designed to treat a type of deadly heart attack called an acute ST elevation myocardial infarction, or STEMI heart attack. ST is the distance between two junctures of an electrocardiogram.

“A STEMI heart attack begins with a sudden disruption of a mild cholesterol plaque in the wall of the coronary artery that supplies blood the heart. This leads to a buildup of a clot in an attempt to heal it. However, this clot formation results in total blockage of the artery,” Dr. Vipul R. Panchal, interventional cardiologist with Norton Heart & Vascular Institute, and medical director of interventional cardiology at Norton Brownsboro Hospital, told The Lane Report.

“It usually occurs in an artery with only mild blockage initially and can occur suddenly without warning. Unfortunately, the rapid progression to total blockage leads to loss of blood supply to the heart. The heart muscle stops working within minutes of this and dies within minutes to hours unless the artery can be opened back up.”

For a larger version of the image, click on it.

With a STEMI heart attack, quick intervention is important to restore blood flow. Diagnosis requires an electrocardiogram, and treatment requires an emergent cardiac catheterization to open the blocked artery or to administer clot-busting medication directly to the artery -- but not every hospital has emergency cardiac catheterization capability.

To combat this issue, Norton Heart & Vascular Institute established a regional STEMI network to ensure that patients from across the region have access to this lifesaving care. The network includes 12 community hospitals, emergency ground and air medical services, and three Norton Healthcare STEMI-ready hospitals, notes The Lane Report: "The goal of the network is to stabilize patients wherever they seek help and transport them to one of the receiving hospitals for cardiac catheterization to restore blood flow to the coronary artery as quickly as possible."

Panchal told The Lane Report that in 2018 Norton Healthcare had a median time of 46 minutes for its care of STEMI heart attack patients; the AHA's goal is 90 minutes or less from the time a patient seeks help to an intervention to restore blood flow.

“We see dramatically different outcomes depending on the time it takes to restore blood flow,” Panchal said.

Norton Heart & Vascular Institute STEMI Network members in Kentucky are: Breckinridge Health, Hardinsburg; Carroll County Memorial Hospital, Carrollton; Flaget Memorial Hospital, Bardstown; Jane Todd Crawford Hospital, Greensburg; Louisville VA Medical Center; Spring View Hospital, Lebanon; Twin Lakes Regional Medical Center, Leitchfield; and Norton Women’s & Children’s Hospital, Louisville. Four of the hospitals are in Indiana: Harrison County Hospital, Corydon; King’s Daughters Health, Madison; Clark Memorial Health, Jeffersonville; and Scott Memorial Health, Scottsburg.

The network receiving hospitals are Norton Audubon Hospital, Norton Brownsboro Hospital, and Norton Hospital. All three receiving hospitals have been recognized by the American Heart Association with Mission: Lifeline STEMI Receiving Center Gold awards.