Mental-health care access can be a challenge in Eastern Kentucky; on top of that, the subject still carries stigma for some

Appalachian Regional Healthcare Behavioral
Health Facility (Photo submitted to WEKU)

By Stan Ingold

WEKU

Experts are concerned about a growing mental-health crisis nationally. This story looks at the struggles faced by those dealing with access to mental-health care in Eastern Kentucky.

“We're Appalachian people, so we're seen as being strong and that's how we want to portray ourselves, and if you have any kind of mental illness it is seen as a weakness," Kasey Wright says.

Wright is the system director of behavioral health, education, and psychological support for Appalachian Regional Healthcare. She said mental health carries a stigma for many people in Eastern Kentucky, and she and her colleagues try to persuade their patients otherwise.

“We try to tell our patients . . . if you have diabetes you have to treat that, its a medical condition. It's the same if you have depression, you have to treat that, it's a medical condition.”

For some, it takes a major incident for them to make the decision to seek help.

“I had a suicide attempt when I was 21,” said Valeri Jones of Morehead. She reached her tipping point almost 20 years ago. She said dealing with substance abuse and anxiety was getting to be too much for her to handle.

“I just couldn't live like that. I couldn't live feeling depressed and I couldn't function. I couldn't work. I lost my job. I just couldn't function,” she said. “So, that is when I was like, 'It's time to do something. It's a true, real chemical imbalance.'”

But it hasn't been an easy road. Once she started getting help, it was hard to find consistency with her treatment, she said: “My appointments would get canceled, they would get rescheduled and every third or fourth appointment that I would finally make it in for, now, some of that was my fault, I would have work or scheduling conflicts or whatever, when I would make it in, I was constantly with a new therapist.”

And she said seeing a new therapist every other visit was a struggle in and of itself.

Jones said it is frustrating because she is constantly told she needs to pair her medications with therapy.

“I'm told by my doctors that 'You need to pursue counseling, you need to be in therapy while taking these medications, because this is the most effective way to deal with your issues.' But then I'm trying to keep up my end of the bargain; but then I keep getting canceled and told, 'Basically, it doesn't really matter.'”

She said sometimes it makes her lose heart. “And it makes me not want to go, and I'm limited with what providers I have access to.”

Jones works in the mental-health field herself. She knows it isn't easy for those trying to help.

“I get it; the pay is not great, the work is demanding, it's mentally exhausting, but as someone on the other end of that, who is trying to get those services for myself, and someone with anxiety, it's hard to, it's hard to just go in and talk to someone period.”

This isn't the only hurdle people face. Kasey Wright, with ARH, said that in southeastern Kentucky, sometimes even just getting to an appointment is difficult.

“We don't have Uber. We don't have taxis here. We don't have things like that. Most of our people live in hollers and things like that, that aren't close to town, so it's really hard for our people to get a ride to any of their appointments.”

Paulina Jones is the director of counseling and psychological services at ARH. She said public transportation isn't much of an option either.

“Our public transportation, when you have to make an appointment for them to come and get you, you have to do it three days in advance. So, some of our patients don't even have telephones, and even for wi-fi, there isn't good wi-fi service either.”

Paulina Jones said another stumbling block for those seeking help is finances. Many of the people who get help from ARH are on Medicaid, but for others, it can be much more difficult to pay for treatment.

“But if you have Medicare, only certain providers can get paid for that. And if you have private or insurance, you're only allotted so many days of like, outpatient therapy, so you may be only getting like 10 days to clear up whatever the issue is. And if you have trauma and something like PTSD you're probably not going to get that healed up in 10 sessions.”

Both Paulina Jones and Kasey Wright say they are seeing more funding being directed toward mental healthcare, but they would like to see officials do more.

Jones said while they have several inpatient facilities for those dealing with substance use disorder, there needs to be something set up for long-term, lower-level mental-health care, for exemple, because there are few personal-care homes in the region.

She said there are "no nice facilities for our chronically mentally ill to go and live and live the rest of their lives and not have that high recidivism, keep coming into the hospital because of the living conditions or not having a safe place to go.”

Along with funding, other efforts are underway. Earlier this year, Gov. Andy Beshear signed into law House Bill 385, known as Seth’s Law. Officials say the law will result in fewer citizens needing to be placed under state guardianship to access health care.

The bill honors the memory of Seth Stevens, who was an advocate for mental health reform, who died by suicide in 2023.

Anyone who may be experiencing suicidal thoughts or any kind of mental health crisis can call or text 988, 24 hours a day, seven days a week to speak to someone qualified to help. Click here to learn more about the 988 Suicide and Crisis Lifeline. 

Recovering alcoholic built Kentucky's largest substance-use treatment provider, which has 1,800 beds and 1,350 employees

Map from Addiction Recovery Care website, via Kentucky Lantern, adapted by Ky. Health News

By Deborah Yetter
Kentucky Lantern

LOUISA, Ky. — Around the office at Addiction Recovery Care, Vanessa Keeton is still known as “Client One” — marking her status as the first client of the first recovery center ARC opened as a group home in Lawrence County.

But her official title is vice president of marketing, where she has worked since 2012, a little more than a year after she entered the program known as Karen’s House — choosing it over jail for a string of drug and alcohol-related offenses.

Vanessa Keeton
(Lantern photo by Matthew Mueller)

“Dec. 2, 2010, that was my first day,” she said. “That’s a day I’ll never forget as long as I live. That’s the day that everything changed.”

ARC, too, has changed dramatically since it started as a treatment home for women run by volunteers, based largely on Bible study and prayer.

It now operates as a for-profit company paid $130 million last year by Medicaid, the federal-state health plan which in 2014 expanded access to addiction treatment, or substance-use disorder, as it’s now known.

Gov. Andy Beshear has praised ARC for helping Kentucky — ravaged in recent years by addiction and overdose deaths — become the state with the most treatment beds per resident in the nation, according to an East Tennessee State University study.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said, speaking at an ARC ribbon-cutting for a new facility in March.

Owned by founder and CEO Tim Robinson and his wife, Lelia, the company provides the couple an annual income of about $533,400, according to a 2022 tax-filing by Odyssey Inc., a non-profit affiliated with ARC.

Tim Robinson (Lantern photo by Matthew Mueller)

Robinson said he and his wife struggled financially for years while establishing the treatment business — facing potential foreclosure on their home and repossession of their car. He doesn’t think that income is unreasonable.

“We took a lot of risks,” said Robinson, 48, a lawyer and recovered alcoholic who says he has been sober since 2006 — two years before he started building the faith-based treatment business that would become ARC. “I’m living the American dream. I’m doing better than I ever thought I could be doing financially.”

Kentucky’s largest provider

The fast-growing company is by far the state’s largest substance-use treatment provider, with 1,800 residential beds in 24 Kentucky counties, and reaches hundreds more clients through outpatient services. ARC, which estimates it provides 75% of treatment beds in Kentucky, also is planning programs in Ohio and Virginia.

Earlier this year, ARC opened a 40-bed behavioral health unit with plans to expand to 300 at the former Our Lady of Bellefonte Hospital in Ashland, which closed in 2020. In 2020, ARC opened its largest center — with a capacity for 700 — on the campus of St. Catharine College in Springfield, which closed in 2016.

ARC is no longer simply a treatment organization, said Matt Brown, a former ARC client who overcame addiction and now serves as ARC’s chief administrative officer and president of ARC Healthcare. “We view ourselves as a behavioral health system,” Brown said.

While Christian faith remains at the heart of its mission, ARC relies on professional therapists, medical specialists including nurses and doctors, a structured treatment program and medication such as Suboxone to reduce the cravings of some patients for drugs and help them maintain sobriety, Robinson said.

Its religious component — which includes tracking how many clients decide “to follow Christ” (1,320 in 2023) — is strictly voluntary, according to Robinson, who said he was able to get sober in 2006 with the help of a local pastor and friend who “led me to the Lord.”

More importantly, he said, is that the number of clients who agree to stay in long-term treatment up to six months has increased steadily, which he thinks is the best indicator of effectiveness of the program.

Medicaid, which funds the majority of substance treatment, doesn’t require programs to measure outcomes.

But ARC measures its own outcomes, which it reports to Medicaid quarterly, Robinson said. That includes a retention rate of around 70% of its clients in treatment for up to six months and even longer through periodic contact with a case manager.

“I’ve been in this a long time,” Robinson said. “Long-term residential treatment is the reason people recover.”

As an indicator of success in addressing addiction, the Beshear administration points to the decline, for the second year in a row, of overdose deaths in Kentucky.

The state’s latest overdose report, released in June, shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

Last year, ARC received about $130 million in payments from Kentucky’s Medicaid program — more than double the amount of its closest competitor, Spero Health, a Nashville- based company that received $60 million in Kentucky Medicaid funds in 2023, according to the Cabinet for Health and Family Services, which licenses and oversees treatment facilities and Medicaid.

ARC accepts private insurance, but Robinson and Brown said almost all of the company’s revenue is from Medicaid, since their clients generally have lost jobs and any health insurance because of addiction.

The state spent $1.2 billion on substance-use-disorder services in the fiscal year that ended June 30, 2023, with most funds coming from the federal government, according to the cabinet.

Robinson, a former county prosecutor who started his business from a home office in Louisa, has emerged as a major political donor and well-connected business leader who recently joined the Kentucky Chamber of Commerce board.

Beshear singled out Robinson for recognition in his State of the Commonwealth speech in January, calling him “an essential partner in our fight against addiction.”

Robinson, a lifelong Republican, is effusive in praise for Beshear, a Democrat, in part because of the governor’s emphasis on addiction treatment and the governor’s frequent references to his own religious faith.

“I’ve never been for anybody like I’ve been for Andy Beshear,” Robinson said. “I hope he runs for president.”

‘Treatment on demand’

ARC employs 1,350 people, 500 at its headquarters in Louisa, population 2,600, perched above the forks of the Big Sandy River, across from West Virginia. The company is Lawrence County’s largest employer, even more than the school system.

About 40% of its workers are “graduates” of its treatment program, Robinson said, and most of its upper management — himself included — are in recovery from addiction.

ARC promises “treatment on demand,” and operates a 24-hour hotline people can call to identify help within 15 minutes, including transportation, if needed, to one of its centers. Last year it served more than 12,000 individuals from 119 of Kentucky’s 120 counties.

Tim Robinson in front of one of his buildings in 
downtown Louisa (Lantern photo by Deborah Yetter)

It has developed a network of job-training programs including welding, automotive repair, lawn service, culinary arts, chaplaincy and food service. As part of that, ARC has rebuilt more than a block of rundown buildings in downtown Louisa into a coffee shop, commercial kitchen, community theater and an event space.

It offers clients a chance to get certification toward a trade and get college credit for some training.

ARC owns a pharmacy used to provide medication to clients, a laboratory for medical testing and operates a health clinic in Louisa. Also, Tim and Lelia Robinson founded the private Millard School, a Christian academy in Louisa attended by some children of their employees.

Vanessa Keeton and her husband James live in Louisa and their son attends the Millard School. James, a 2011 ARC graduate, manages the Second Chance garage which repairs and restores vehicles for the public as well as maintaining an ARC fleet of about 200. “We restore cars and we restore lives,” he said.

ARC runs a sophisticated marketing program complete with a website, billboards, television and radio commercials, a social media presence, sponsorships and news releases, contracting with the Louisville-based public relations firm, RunSwitch. Scott Jennings, a CNN commentator and Republican political consultant, is one of RunSwitch’s founding partners. ARC spends about 4.5% of its revenue, or about $5.8 million a year on marketing.

Vanessa Keeton said the marketing is important to promote awareness of its services to those in need, “to meet people where you are.”

‘Dangerously brilliant’?

Some outsiders criticize ARC for its rapid growth, its size and Robinson’s political giving, including Mark La Palme, the founder and former CEO of Isaiah House, a treatment program based in Harrodsburg.

La Palme, now retired, said he worked with Robinson on a project in the mid-2000s but parted ways over disagreement with practices including designating clients as “interns” in ARC programs for low pay while in treatment, saving the company the cost of paying a regular employee.

He calls ARC “huge,” has called it a “bully” in a social media post and questions its rapid expansion. La Palme also questions the prolific giving of Robinson and ARC entities, which rank among the state’s major political contributors.

“It seems like you’re buying political influence,” he said.

But he acknowledges that Robinson has been highly effective in building ARC into the state’s largest treatment system: “He’s dangerously brilliant.”

Robinson said he considered La Palme a friend and colleague but they parted ways after a proposed collaboration fell through. Robinson said ARC’s programs meet all state standards, are accredited and the company works to provide high quality care.

He said internships are a way of introducing people to job skills they will need to succeed once they leave treatment and interns in various job training programs receive a paycheck either through ARC or an outside employer.

Robinson said he doesn’t apologize for political giving, seeing it as a way to support causes and politicians he believes in.

And he doesn’t think ARC is too big, saying that the company had to expand to remain viable within the constraints of Medicaid reimbursement, which pays for most of its clients. “We had to grow to survive,” he said.

The Robinson employees who spoke with Kentucky Lantern, including Brown, are highly enthusiastic about the boss.

Brown, trained as a physical therapist, battled addiction for 18 years before coming to ARC as a patient and remaining as an employee.

Robinson is “a visionary,” Brown said during a tour of ARC properties in Louisa, “He sees things in people before they see it in themselves.”

‘Papaw taught me’

Robinson said he grew up in adjoining Martin County, in “the poorest part” of a poor county. His introduction to business came from his grandfather who owned a country store. “He put me on a pop carton to run the cash register,” he said. “Papaw taught me about business.”

Another boyhood business venture of Robinson’s — selling baseball cards — would provide a life-changing entrée into college and law school, when he was befriended by Inez banker and businessman Mike Duncan, a former Republican national chairman and mentor to many young people in Martin County.

Robinson said he and Duncan crossed paths when he began selling baseball cards to Duncan's son, Robert M. “Rob” Duncan, who was appointed U.S. attorney for Eastern Kentucky under Donald Trump. Duncan is now the top deputy to state Attorney General Russell Coleman.

Robinson said he considers both Duncans friends but remains closest to Mike Duncan, a trusted friend and adviser. He said Mike Duncan, showed interest in his boyhood baseball-card venture and became a mentor, encouraging Robinson to go to college — a prospect he hadn’t considered.

“Nobody in my family ever went to college,” Robinson said.

But with Duncan’s encouragement, Robinson graduated from the University of the Cumberlands in Williamsburg, earned a law degree from the University of Kentucky and was elected student body president at both institutions.

Good times and bad times

“He helped me through the good times and the bad times,” Robinson said.

Among the worst times: Robinson’s 2003 indictment for felony vote fraud while he was student body president at UK, after some 750 voter registration cards collected during a student government drive were never turned in. Apparently forgotten, they were later found in a student-government office, according to a 2003 Lexington Herald-Leader story.

“It was devastating,” Robinson said. “I thought my whole life was over.”

Instead, with the help of his lawyers, Robinson pleaded guilty to a lesser misdemeanor charge of failing to turn in the registration cards and paid $90 restitution. Robinson said he dropped out of law school during the legal case, but was readmitted and graduated.

But that ordeal, plus the death of his mother while he was at UK, “finished my mental health off,” Robinson said. He returned home to Eastern Kentucky to work but alcohol by then had a powerful hold on his life.

Back in Lawrence County, Robinson joined in law practice with a friend and became an assistant county attorney but by then said he had become a “raging alcoholic” though still somehow able to perform his job.

He would drink on weekends, come to work on Mondays hung over and avoid alcohol on days he had to be in court. Toward the end of the week, Robinson said, he’d resume drinking and stay drunk till the following Monday. “I was leading kind of a double life,” he said.

That continued until a deputy sheriff at the courthouse where Robinson worked intervened. The deputy, also a pastor and a recovering alcoholic, helped Robinson stop drinking through prayer and support — taking him with him to nightly events where he would preach and play Bluegrass music.

Though Robinson said he knew nothing about treatment or programs such as Alcoholics Anonymous, he decided he needed to expand services in the region that in the mid-2000s offered little.

“I was convinced God was calling me to stop practicing law and start a recovery center,” Robinson said.

So he did, leaving his law job and starting out of a home office on Nov. 3, 2008.

Robinson got help from Rev. Ralph Beiting, a Catholic priest who founded the Christian Appalachian Project. Together they opened a recovery house for women in Lawrence County called Karen’s House.

It was a makeshift operation run by volunteers with donated goods, including some old Army cots. Meanwhile, Robinson was taking men to the closest treatment center, Chad’s Hope in Clay County, getting occasional funding from Operation UNITE, launched in 2003 by U.S. Rep. Hal Rogers to help Kentucky battle rising addiction — in particular the tide of opioid pain pills engulfing the state.

But broke and discouraged, Robinson was close to quitting when he contacted a consultant who suggested he expand by opening a second recovery center for men. He located a site in Fleming County and in 2013, Belle Grove Springs was opened by the company that would become ARC.

Brown, now ARC’s chief administrative officer, was among the first clients admitted to the men’s center.

The following year, under the expansion authorized by the Patient Protection and Affordable Care Act, Medicaid began funding substance use disorder services and a reliable funding stream opened. Kentucky was among the first states to include addiction as a service covered by Medicaid.

While the income was welcome, it wasn’t enough to finance ARC’s operation and Robinson said the company’s only choice was to expand and recoup more money through a higher volume of clients. “People thought we were growing because we were booming but we had to grow to survive,” he said. “You cannot make it on a couple of small facilities.”

ARC didn’t show a positive cash flow until 2019, he said.

‘Take our time’

While ARC expansion has slowed, Robinson said the company is still looking at other opportunities, including expansion into Virginia, which has far fewer treatment beds than Kentucky. “We’re going to take our time,” he said.

ARC also was flagged in a budget item this year by the state General Assembly with a $12 million allocation over two years directed to the Life Learning Center in Covington, an organization aimed at helping people develop skills to improve their lives “through gainful employment.”

The budget line says the funds are to be distributed to the center to support “treatment, rehabilitation, and community reintegration in partnership with Odyssey Inc.,” the non-profit arm affiliated with ARC.

Robinson said he expects Odyssey to submit a proposal as treatment provider for a program the center plans to establish in Somerset.

And while his work has expanded statewide and beyond, Robinson said he’s committed to staying in Louisa and keeping his company headquartered there.

“I’m where I’m going to be,” he said. “This is my adopted hometown.”

Deaths from colorectal cancer in Appalachian Kentucky have declined, but far less than in the rest of the nation, UK study says

County rates per 100,000 are seen in five ranges or quintiles.(Map adapted by Kentucky Health News)

Kentucky Health News

Deaths from colorectal cancer in Appalachian Kentucky declined from 1999 to 2020, but far less than the rate of decline in the rest of the nation.

That's the upshot of a University of Kentucky study analyzing death data.

It found that in the 54 Kentucky counties served by the Appalachian Regional Commission, the mortality rate fell from 31.24 deaths per 100,000 residents in 1999 to 24.46 per 100,000 in 2020. But the national rate dropped by almost half, from 27 deaths per 100,000 Americans in 1999 to 14.81 in 2020. In non-Appalachian Kentucky, the rate dropped from 27.6 to 17.1.

During the entire 21 years covered by the study, the colorectal-cancer death rate in Appalachian Kentucky was 25.8 per 100,000 residents. In the 66 non-Appalachian counties, the rate was about 22 per 100,000. The national rate was 19.43 deaths per 100,000. Kentucky has the fourth highest death rate. 

The Kentucky county with the highest age-adjusted rate from 1999 through 2020 was Fleming, at 39.6 deaths per 100,000 residents. The next highest were Harlan, 34.4; Bath, 33.2; Pike, 32.1; Breckinridge, 31.6; Henry, 31.5; Todd, 31.1; Carter, 30.7; Lewis, 30.7; Cumberland, 30.6; Mason, 30.5; Lawrence, 30.4; Morgan, 30.4; Clay, 30.2; Letcher, 29.7; Washington, 29.4; Nicholas, 28.6; Breathitt, 28.5; Perry, 28.5; Floyd, 28.3; Monroe, 28.3; Powell, 28.2; and Nelson, 27.9 (all in dark blue on the map).

The counties with the 10 lowesr rates were Lyon, 14.9 per 100,000; Trimble, 16.97; McCracken, 17.7; Jessamine, 18.2; Shelby, 18.3; Madison, 18.4; Bullitt, 18.7; Trigg, 18.8; and Owen, 18.8.  Rates for Hickman and Robertson counties were not reported due to small case numbers.

The study, in the journal Gastroenterology, used data from the Centers for Disease Control and Prevention on the causes of death for Americans 15 or older. Its lead author is Dr. Syed Hassan, a research coordinator and clinical research scientist in UK's Department of Internal Medicine.

Hassan "said efforts to enhance screening rates should be improved and more education on colorectal cancer is needed," according to a UK news release.

He noted that In Appalachian Kentucky, nearly 41% of the colorectal cancer deaths occurred at home, suggesting that many victims might not have been seen by a doctor until the cancer had significantly advanced.

“That’s concerning, in my opinion,” Hassan said. “Access to health care, lifestyle related modifiable risk factors and education are important factors we should further work upon.”

Hassan also said anxiety about colonoscopies and other cancer screenings, and lack of education about the disease, may also play a role: “Many of these patients might’ve believed that they probably wouldn’t be able to afford as much care due to their socioeconomic status.”

Screening for colon cancer is recomended to start at age 45, because cancers of the colon and rectum tend to occur after age 40, but recent studies have shown increases in younger people, especially those with risk factors.

These cancers tend to run in families; studies show that if a close relative has had colorectal cancer, you can be predisposed to polyps — pre-cancerous lesions that can lead to the development of the cancer,

Other risk factors include age and lifestyle factors such as smoking, sedentary living, obesity, a diet rich in red meat, salt and saturated fats or a low-fiber diet.

UK diabetes research featured in group's annual research report

Brittany Smalls, Ph.D., is at upper right.

By Hilary Smith
University of Kentucky

One of the cover stories in the annual reserach report from the American Diabetes Association is about a University of Kentucky researcher devoted to helping rural Kentuckians — specifically in Appalachia — better manage their diabetes.

highlighting investments in advancing diabetes research and clinical practice. ADA research grants focus on innovative projects with high impact and help researchers establish collaborative networks to move their innovations into the hands of people living with diabetes.

Brittany Smalls an associate professor and the Dr. Claire Louise Caudill Professor in Family Medicine in the UK’s Department of Family and Community Medicine. Her futire work in Appalachia will look at intergenerational households, where large extended families often live together in the same home or throughout shared pieces of land. These families share everything from living spaces, meals, household chores, caregiving and more.

Such househodls are common in Appalachia, and so is a disproportionately high risk for Type 2 diabetes. The prevalence of Type 2 diabetes reaches 23% in Kentucky’s most rural counties, more than twice the state average.

Throughout her career of helping older adults with type 2 diabetes, Smalls quickly noticed that the adult children and grandchildren of those she worked with could also benefit from her research.

Thanks to an award from the ADA, Smalls will expand her focus from older adults with type 2 diabetes to entire families living with or who are at risk for the disease.

“By tapping into tight-knit family units, we can start to shift how people think about their health and how they think about each other,” Smalls said.

The cover story from the ADA’s report details Smalls’ work resulting from the award:

“She is piloting a health intervention that leverages social support within family units to promote nutrition and physical activity, which are key to mitigating obesity and type 2 diabetes. Each participating family will receive a tailored six-month lifestyle plan. 

“Only one adult needs a type 2 diabetes diagnosis for a household to be eligible, and a dietitian will engage them in medical nutrition therapy based on available foods. Participating families will receive ADA-backed recommendations for physical activity based on family members’ physical ability.”

Eastern Ky. towns fight to recover from opioid epidemic, with help from newcomers and recovering addicts, national author reports

An event in downtown Hazard: “When somebody gets clean, they want to change the world,” Stephanie Callahan, a former addict and current business owner in Hazard, said of the town’s new can-do spirit. “You do something just to prove you can do it.” (Photos by Stacy Kranitz for The Free Press)

By Sam Quinones
Republished from The Free Press

In early 2020, Mandi Fugate Sheffel, 42, opened a tiny bookstore in her hometown of Hazard. Everyone thought she was crazy.

Downtown Hazard was a forbidding place to start any business, much less a bookstore. Most coal mines that once supported the area had closed. Many brick buildings from Hazard’s heyday were gone, bequeathing a gap-toothed look to Main Street.

What’s more, Fugate Sheffel couldn’t afford a website or employees. She had never run a business before. And she had a complicated personal history to wrestle with.

But she loved to read—particularly contemporary Appalachian authors like Silas House, James Still and Gurney Norman, who told stories that felt real to her. She figured others in town were tired, like her, of driving two hours to Lexington to buy books.

So, on January 30, she opened Read Spotted Newt in a 250-square-foot space—the size of a small bedroom.

 
I met Fugate Sheffel last spring when I visited Hazard for the first time. I came to speak about my book, The Least of Us, about America’s drug-addiction epidemic. I had heard about the town, and had formed an image of it as the buckle on Eastern Kentucky’s opioid belt.

Mandi Fugate Sheffel poses outside her bookstore in Hazard.

From Fugate Sheffel, though, I heard another story—one that I heard elsewhere in the Appalachian coalfield.

“When you don’t have industry, you’re having ecological disaster and a drug epidemic—you would think all those things would get us to a place where the town would be uninhabitable,” Fugate Sheffel told me. “But that’s not what I’m seeing at all. I’m seeing a lot of people rally.”

The loping hills of Eastern Kentucky are studded with scores of towns like Hazard—and nearby Prestonsburg and Pineville and Corbin—that, over the centuries, emerged in the valleys and along its rivers. By the early 20th century, coal dominated the region, with roughly 700,000 men and boys toiling in the mines of Kentucky and neighboring West Virginia.

In the 1990s, “as one declined and things got worse, the other increased and things got worse,” Les Stapleton, the mayor of Prestonsburg, pop. 4,000, 35 miles northeast of Hazard, told me about the correlation between jobs and drugs.

Larger forces over which locals had little or no control exacerbated things: the rise of natural gas for power plants, new environmental standards, our shifting political and cultural landscape.

By the early 2000s, the region had become the epicenter of the new opioid epidemic, which had its epicenter in Eastern Kentucky, West Virginia, and southwest Virginia.

Downtowns emptied out. Buildings were abandoned. Business startups seemed dominated by “pill mills”—clinics that prescribed huge quantities of prescription painkillers. In the little evangelical churches, they prayed for an end to “hillbilly heroin.”

The state cracked down on the pill mills, but by 2017, Perry County was the worst-hit county in the United States when it came to hospitalization for opiate addiction.

But then, weirdly and unexpectedly, at the same time that everything was falling apart, things started to get better—and that old world started, very tentatively, to build itself back up.

In the past few years, some 43 businesses have opened in Hazard, creating 171 new jobs, said Bailey Richards, the town’s coordinator of downtown development. That includes a toy store, a café, a women’s boutique, a quilt and apparel place, and a smoothie shop. A longtime restaurant just moved downtown.

The population, which declined for most of the latter half of the 20th century, now appears to be inching up. The growth was driven mostly by outsiders—new families, mostly from cities in Kentucky, in search of a better future, and immigrants, including health-care workers a nascent Latino community.

Shane Barton, the downtown-development coordinator at the University of Kentucky’s Community and Economic Development Initiative, went so far as to call Hazard “a hip destination for young people.”

It was hard to say why this was happening. Gradually, people were becoming more aware of the crisis of Appalachia and were doing things trying to help. Covid-19 pushed people to move out of the cities. And there were the recovering addicts; they weren’t expensive to hire if you needed a barista or someone to stock your shelves or paint your walls, and they were eager to work, to live.

In Hazard, about a quarter of the new jobs are held by recovering addicts. In Pineville, an hour and a half southwest of Hazard, one-third of new jobs are filled by people in recovery, said Jacob Roan, who oversees economic development in the Bell County seat.

“When somebody gets clean, they want to change the world, and have ideas of how to change the world,” Stephanie Callahan, a former addict and current business owner in Hazard, told me. “You do something just to prove you can do it.”

Joey Jones poses in his Ready Set Play toy store in Hazard.

That’s what inspired Joey Jones—the can-do spirit.

Jones and his wife, Nikki, grew up in Hazard, went to the University of Louisville, and in 2019, returned home after ten years away, now with two kids.

Though a trained social worker, Joey Jones opened a toy store. This was last year. He called it Ready Set Play, and it’s on Main Street. Jones advertises on social media and, despite selling toys that are available online, he is expanding.

“The small business community here feels like family,” Jones said. Mandi Fugate Sheffel, who knew something about hard times and people coming together, agreed.

She had been in high school in the 1990s, as the mines were closing and pain pills were invading. “One day, we were drinking beer in the back of a truck,” she said. “Then, all of a sudden, these pills were everywhere.” By 1997, she was an OxyContin addict.

The addicts dubbed a local park “Pillville,” and Fugate Sheffel got out. She moved to western Kentucky, came home in 2002, got sober, married, had a son. She survived.

So did her bookstore, against all odds.

A few days after she opened it, in 2020, it was flooded. Then Covid hit and Kentucky’s governor banned in-store shopping, and Fugate Sheffel thought this might really be it for Read Spotted Newt.

But after news media reported on Read Spotted Newt’s woes, Fugate Sheffel started getting orders from all over. Soon, she said, “I was shipping books everywhere—Boston, Florida, Texas, L.A.  Anybody who had any tie to Eastern Kentucky who knew this was going on were like, ‘We gotta make sure she makes this work.’”

By late 2020, she had moved to a larger space—a triangular building on a corner that once housed Hazard’s tourist welcome center. The city renovated it for her.

There are other pockets of hope scattered across the region.

In Prestonsburg, an hour north of Hazard, there are five locally owned restaurants, all but one of which opened in the last five years. An Indian restaurant is coming soon. The two-block historic downtown once had eleven abandoned buildings. Now, all are occupied.

In Pineville, pop. 1,600, the downtown was similarly decimated. Now there are boutiques, a hair salon, a furniture store, and several restaurants. Importantly, noted Roan, the economic-development director, “Those businesses are still in business six, seven years after opening.”

In Corbin, pop. 8,000), just up the Cumberland Gap Parkway from Pineville, several old buildings have been redone. They now house restaurants, a clothing boutique, a print shop, a café, an ice cream parlor, a record store, and a pinball museum.

“Everybody is like, ‘What can I start? What’s missing around here?’ ” Corbin Mayor Suzie Razmus told me.

Something else locals are starting to see in these places: people. On the street, outside their favorite coffee shop, chatting with a friend through an open car window.

In the past, a town grew from a big factory that employed hundreds or more people. But no one’s waiting any longer for factories or big-box stores—to say nothing of the mines or unions—to save them.

Prestonsburg Mayor Les Stapleton: “If a deer gets killed on the

highway, I pull over and put it in the truck and get rid of it . . .

I don’t want people seeing that the first time they drive into town.”

“Too many have come in to try to save us, and they don’t,” said Stapleton, the Prestonsburg mayor. “We got to do it ourselves.”

Now, he’s facing a problem he could never have anticipated: a shortage of affordable housing. This has been driven, he added, by outsiders who, since Covid, have been moving to Prestonsburg and other towns across the region.

Jeff Siegler, whose firm Revitalize, or Die advises small towns on rebuilding, said the area’s success “has to be about small, incremental victories—one business at a time.”

The new generation of mayors, town councilors, and city planners across much of Appalachia, who had come through the disaster of the last three decades and seemed inspired by recovering addicts in their own communities, understood what Siegler was saying: small is good; local is good; people are good.

Instead of trying to lure massive out-of-state companies with tax incentives, they were thinking about beautification projects and homeowners and places where people could congregate.

“That’s the shift,” said UK's Shane Barton. “How can we make our communities people-ready as opposed to industry- or investment-ready?”

Still, progress is uneven, and many small-town economies are frail. Self-reliance may take them only so far.

The drug problem rages on. Fentanyl seems to be mixed into everything on the street, creating staggering numbers of overdoses. On top of all this, a form of perverse gentrification has taken hold that’s peculiar to this birthplace of the opioid epidemic. Legions of national drug treatment centers catering to the addicts have moved to the region—sopping up cheap real estate and pricing lower-income buyers and start-ups out of the market.

But at this point, that seems like a minor, mostly surmountable hurdle, at least to the people here who have stopped waiting for outsiders—coal companies, big-box retailers, Frankfort, Washington—to save them.

That is definitely the way Stephanie Callahan, in Hazard, sees things.

Now in her early forties, Callahan, like Mandi Fugate Sheffel, was part of the generation consumed by Oxycontin. She got clean when she had a baby—this was 15 years ago—and built a career as a showroom saleswoman at a local furniture company. But she yearned to do something on her own.

She loved fashion. For two years, she had been running a side hustle out of her bedroom, selling plus-size clothes. She hated that she had to go to Lexington every time she needed a new top or skirt.

So, in the summer of 2021, Callahan quit her full-time job and rented a space in downtown Hazard that had once been a gym. Her father said she’d lost her mind, opening a women’s clothing store during Covid. She did it anyway, calling it Hot Mess Express, which is what her mother and friends often called her.

She showed them: in her first two years, Callahan had 2,000 repeat customers. She now has nine part-time employees and will soon open a men’s store.

It wasn’t just about the clothes. It was about people in Hazard, like so many towns, trying to find their way back to each other.

“When I was growing up, we had arcades, movie theaters, mom-and-pop restaurants,” Callahan said. Now, “there’s no place for people to go talk to each other.”

So, she put a brown leather couch, almost as an afterthought, in the middle of the store, intending it for men accompanying their wives and girlfriends to sit and scroll through their phones or read a magazine—kill time. Instead, it became the focal point of the store, and it made Hot Mess Express a community hangout as well as a women’s boutique. A little place, or nook, where people would say hi, catch up, laugh, hug, gossip.

“It’s comfortable,” Callahan told me, referring to the couch. “I have a photo of the mayor asleep on it.”

Sam Quinones is the author of four books, including his latest, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. You can follow him on X at @samquinones7.

Kentucky rises to No. 2 in the nation in screening for lung cancer, which lowers the chances that the disease will be fatal

Tony Stumbo (Photo by Veronica Turner for KFF Health News)

By Charlotte Huff
KFF Health News

Dr. Tony Stumbo’s heart sank after the doctor shared his mother’s chest X-ray.

“I remember that drive home, bringing her back home, and we basically cried,” said the internal medicine physician, who had started practicing in Eastern Kentucky near his childhood home in Floyd County shortly before his mother began feeling ill. “Nobody wants to get told they’ve got inoperable lung cancer. I cried because I knew what this meant for her.”

Now Stumbo, whose mother died the following year, in 1997, is among a group of Kentucky clinicians and researchers determined to rewrite the script for other families by promoting training and boosting awareness about early detection in the state with the highest lung cancer death rate.

For the past decade, Kentucky researchers have promoted lung cancer screening, first recommended by the U.S. Preventive Services Task Force in 2013. These days the Bluegrass State screens more residents who are at high risk of developing lung cancer than any state except Massachusetts — 10.6% of eligible residents in 2022, more than double the national rate of 4.5% — according to the most recent American Lung Association analysis.

The effort has been driven by a research initiative called the Kentucky LEADS (Lung Cancer Education, Awareness, Detection, and Survivorship) Collaborative, which launched in 2014 to improve screening and prevention in order to identify more tumors earlier, when survival odds are far better. The group has worked with clinicians and hospital administrators statewide to boost screening rates both in urban areas and regions far removed from academic medical centers, such as rural Appalachia.

However, a decade into the program, the researchers face an ongoing challenge as they encourage more people to get tested: the fear and stigma that swirl around cancer.

Lung cancer kills more Americans than any other malignancy, and the death rates are worst in a swath of states including Kentucky and its neighbors Tennessee and West Virginia, and stretching south to Mississippi and Louisiana, according to the Centers for Disease Control and Prevention.

It’s a bit early to see an impact on lung-cancer deaths, because people may live for years with a malignancy, LEADS researchers said. Plus, other factor such as improvements in treatments may also help reduce death rates. Still, data already shows that more cancers in Kentucky are being detected before they become advanced and thus more difficult to treat.

Of total lung cancer cases statewide, the percentage of advanced cases — defined as cancers that had spread to the lymph nodes or beyond — hovered near 81% between 2000 and 2014, according to the Kentucky Cancer Registry. By 2020, that number had declined to 72%, according to the most recent data available.

“We are changing the story of families. And there is hope where there has not been hope before,” said Jennifer Knight, a LEADS principal investigator.

Older adults in their 60s and 70s can hold a particularly bleak view of their mortality odds, given what their loved ones experienced before screening became available, said Ashley Shemwell, a nurse navigator for the lung cancer screening program at Owensboro Health.

“A lot of them will say, ‘It doesn’t matter if I get lung cancer or not because it’s going to kill me. So I don’t want to know,’” said Shemwell. “With that generation, they saw a lot of lung cancers and a lot of deaths. And it was terrible deaths because they were stage 4 lung cancers.” But she reminds them that lung cancer is much more treatable if caught before it spreads.

The collaborative works with several partners, including the University of Kentucky, the University of Louisville, and GO2 for Lung Cancer, and has received grant funding from the Bristol Myers Squibb Foundation. Leaders have provided training and other support to 10 hospital-based screening programs, including a stipend to pay for resources such as educational materials or a nurse navigator, Knight said. In 2022, the state legislature established a statewide lung cancer screening program based in part on the group’s work.

Jacob Sands, a lung-cancer physician at Boston’s Dana-Farber Cancer Institute, credits the LEADS collaborative with encouraging patients to return for annual screening and follow-up testing for any suspicious nodules. “What the Kentucky LEADS program is doing is fantastic, and that is how you really move the needle in implementing lung screening on a larger scale,” said Sands, who isn’t affiliated with the Kentucky program and is a volunteer spokesperson for the American Lung Association.

In 2014, Kentucky expanded Medicaid under the 2010 Patiemt Protection and Affordable Care Act. That increased the number of lower-income people who qualified for lung-cancer screening and related treatment. Adults 50 to 80 years old are advised to get a CT scan every year if they have accumulated at least 20 pack years and still smoke or have quit within the past 15 years, according to the latest task force recommendation, which widened the pool of eligible adults. (To calculate pack years, multiply the packs of cigarettes smoked daily by years of smoking.) The lung association offers an online quiz, called “Saved By The Scan,” to figure out likely eligibility for insurance coverage.

Half of U.S. patients aren’t diagnosed until their cancer has spread beyond the lungs and lymph nodes to elsewhere in the body. By then, the five-year survival rate is 8.2%. Regular screening boosts those odds. When a CT scan detects lung cancer early, patients have an 81% chance of living at least 20 years, according to data published in November in the journal Radiology.

Some adults, like Lisa Ayers, didn’t realize lung-cancer screening was an option. Her family doctor recommended a CT scan last year after she reported breathing difficulties. Ayers, who lives in Ohio near the Kentucky border, got screened at University of Kentucky King’s Daughters Hospital in Ashland. The scan didn’t take much time, and she didn’t have to undress, the 57-year-old said. “It took me longer to park,” she quipped.

She was diagnosed with a type of lung tumor that can grow in various parts of the body. Her cancer was considered too risky for surgery, Ayers said. A biopsy showed the cancer was slow-growing, and her doctors said they would monitor it closely. That type of cancer isn’t typically linked to smoking, but Ayers quit anyway, feeling like she’d been given a second chance to avoid developing a smoking-related cancer: “It was a big wake-up call for me.”

Kentucky is second only to West Virginia in the percentage of adults who smoke. Adults with a smoking history often report being treated poorly by medical professionals, said Jamie Studts, a health psychologist and a LEADS principal investigator, who has been involved with the research from the start.

Studts said the goal should ne to avoid stigmatizing people and instead to build rapport, meeting them where they are that day: “If someone tells us that they’re not ready to quit smoking but they want to have lung cancer screening, awesome; we’d love to help. You know what? You actually develop a relationship with an individual by accepting ‘No’.”

Nationally, screening rates vary widely. Massachusetts reaches 11.9% of eligible residents, while California ranks last, screening just 0.7%, according to the lung association analysis.

In hospitals of Appalachian Regional Healthcare, 3,071 patients were screened in 2023, compared with 372 in 2017. “We’re just scratching the surface of the potential lives that we can have an effect on,” said Stumbo, the chief medical officer in ARH's Big Sandy Region.

The doctor hasn’t shed his own grief about what his family missed after his mother died at age 51, long before annual screening was recommended. “Knowing that my children were born, and never knowing their grandmother,” he said. “Just how sad is that?”

KFF Health News is a national newsroom producing in-depth journalism about health issues. It is a core operating program of the Kaiser Family Foundation, an independent source of health policy research, polling and journalism.

East Kentucky Diabetes symposium to be held in Hazard Nov. 3

The inaugural East Kentucky Diabetes Symposium will be held Friday, Nov. 3 in Hazard.

In Kentucky's Appalachian counties, 16% of adults have diabetes, and the five area development districts with the highest mortality rates are in Eastern Kentucky, according to the 2023 Diabetes Report by the state Cabinet for Health and Family Services and the Personnel Cabinet.

The statewide rate was nearly 14%, reflecting the more than 486,000 Kentuckians who had diabetes in 2021. This rate has more than doubled since 2000, and another 12% of Kentuckians are at risk for developing diabetes.

Scheduled speakers at the symposium include:
· Dr. Steven J. Stack, commissioner, state Department for Public Health 
· Barry Martin, CEO, Primary Care Centers of Eastern Kentucky
· Dr. Kristen R. Stakelin, associate chief medical officer for specialty ambulatory services, Barnstable Brown Diabetes Center at UK HealthCare

· Chlodys Johnstone, Barnstable Brown Diabetes Center 
· Kim Bayes, diabetes prevention coordinator at UK King's Daughters Hospital, Ashland

The symposium will be held from 8 a.m. to 4 p.m. Nov. 3 at Primary Care Centers of Eastern Kentucky, 101 Town and Country Lane, Hazard. It is sponsored by Shaping Our Appalachian Region. The $25 registration fee covers all programming and a diabetic-friendly breakfast, lunch, and snacks. Register here.

CEO of Pikeville Medical Center wins 2023 Gil Friedell Memorial Health Policy Award from the Foundation for a Healthy Kentucky

Donovan Blackburn

By Melissa Patrick
Kentucky Health News

Donovan Blackburn, CEO of Pikeville Medical Center, is the latest winner of the Foundation for a Healthy Kentucky's Gil Friedell Memorial Health Policy Award for his work in changing the landscape of health care in Eastern Kentucky. 

“Donovan Blackburn has been a visionary for Eastern Kentucky and has helped bring the type of high-quality care to the region that its residents have long deserved,” Ben Chandler, president and CEO of the foundation, said in a news release. “A chance for a healthy life shouldn’t be determined by the area of Kentucky in which you live, and Donovan’s work is making the commonwealth a more equitable place to access healthcare.”

Gary Dryden of Louisville, chair of the foundation's Community Advisory Council, noted that the expansion of health-care options in Appalachia facilitated by Blackburn's hospital has provided care that residents previously had to travel hours to larger cities to obtain. 

"Because of his vison," Dryden said Wednesday, "thousands of Kentuckians have access to resources needed to sustain a healthy life." 

Blackburn’s ability to foster consensus through collaboration has helped secure millions in investment in healthcare delivery, the release said.

Under his leadership, in 2020, PMC opened its Appalachian Valley Autism Center.  In 2021, the Mettu Children’s Hospital opened, allowing clinicians to partner with specialists in cardiology, endocrinology, and pulmonology at the University of Kentucky Children’s Hospital. In 2022, a satellite center in Floyd County opened, enabling the Autism Center to provide services to children from Pikeville and Prestonsburg.

PMC also opened its Heart and Vascular Institute of Eastern Kentucky, the result of a $35.2 million capital investment. The new space includes a new cardiac rehabilitation department, 29 exam rooms and three state-of-the-art interventional cardiac catheterization labs. 

“I am deeply honored and humbled and honored," Blackburn said about receiving the award. "I recognize and realize what this award stands for and I wear it as such also as a badge of honor, not for myself, but for the 3,100 employees that I have the opportunity to lead from the back. . . . And so on behalf of our organization, I'm very proud to accept this award."

Donovan Blackburn accepts a $5,000 donation to the non-profit of his choice, Appalachian Valley Autism Center from Ben Chandler, and Gary Dryden. (Foundation for a Healthy Kentucky photo). 

Blackburn also expressed his gratitude for the $5,000 donation to the non-profit of his choice.  Blackburn selected the Autism Center, which provides applied-behavior-analysis therapy to children between the ages of 2 and 12 on the autism spectrum. 

Blackburn explained that his granddaughter, Ava, who is now 6, was the inspiration for the center because she was born with sensory disorder and is on the spectrum. His wife, Debbie Blackford, is the executive director of the center, which is called the AVA Center. 

"We sincerely appreciate not only the award, acknowledging the work that we've done throughout Eastern Kentucky, but also for the generosity and the gift for the AVA Center that is changing so many kids lives in the region as well," he said. 

According to the news release, the center supports 90 children and is projected to double that by the end of 2024.

The winner of the Gil Friedell Memorial Health Policy Award is chosen from recipients of a Healthy Kentucky Champions Award, which recognizes Kentuckians who are working to improve the health of their community and the commonwealth. This year, there was a record number of nominees. Click here to read more about each of them.

The other 2023 Healthy Kentucky Champions are: 

• Dr. Muhammad Babar – Doctors for Healthy Communities, Louisville
• Shelly Baer – Emerald Therapy Center of Murray
• Mark Birdwhistell – UK HealthCare
• Lacretia Dye – Western Kentucky University
• Donald Frazier – UK Science Outreach Center
• Ellen Hahn - UK Kentucky Center for Smoke-free Policy
• Jeremy Harrell – Veteran’s Club of Louisville
• Susan Jones – Western Kentucky University
• Dr. Whitney Jones – Colon Cancer Prevention Project
• Dr. Karl Lange – Mission Health Lexington
• Katherine Marks – Commissioner, state Department of Behavioral Health, Developmental and Intellectual Disabilities
• Rhondell Miller – Hotel Inc. of Bowling Green
• Jerry Ugrin – Lewis County Primary Care Center

UK seeks $2 billion in extra bonding authority to expand hospital

Senate President Stivers and UK President Eli Capilouto
(Image from Manchester Enterprise video)

Kentucky Health News and the Manchester Enterprise

University of Kentucky President Eli Capilouto says UK needs $2 billion in borrowing authority from the state to expand its Albert B. Chandler Hospital to treat patients who are being turned away for lack of room.

“We need ... around $2 billion for a new hospital tower,” Capilouto said after meeting with Senate President Robert Stivers in Manchester, where Stivers lives.

“Unfortunately, we've had an increasing number of people we've had to turn away. These are the sickest of the sick, many from Eastern Kentucky, who've gad to end up going in faraway places, couldn't fimd  a place because our hospital is totally full,” Capilouto said.

The university can finance a hospital expansion with anticipated revenues, but Capilouto said it needs additional bonding authority to do that. It also needs legislative permission to build, Stivers said.

“We'll self-finance that . . . over time,” Capilouto said. “To start construction and further our design, we'll need approval from the General Assembly. . . . This funding is vital to provide the best service we possibly can for the people of the commonwealth. We have to do more and we have to do better.”

Stivers says he receives calls at least monthly about hospital patients who need to be transferred to UK but can't go “because there just aren't any beds. . . . President Capilouto is not only meeting with me; he is going to go meet with others today about what they can do if they have these types of funds.”

One-fourth of Kentuckians say they have ever been diagnosed with depression; only W.Va. was higher in national CDC survey

Centers for Disease Conrol and Prevention map, adapted by Kentucky Health News

By Al Cross
Kentucky Health News

One in four Kentucky adults in a poll taken in 2020 said they had ever been diagnosed with depression, a higher share than in any state but West Virginia.

Kentucky's age-adusted percentage was 25%; West Virginia's was 27.5%. The national figure in the poll, taken by the Centers for Disease Control and Prevention, was 18.4%.

The poll was taken by the Behavioral Risk Factor Surveillance System, an ongoing CDC-state project in which state employees do random-digit–dialed landline and cell phone calls to adults. The question was, “Has a doctor, nurse, or other health professional ever told you that you had a depressive disorder, including depression, major depression, dysthymia, or minor depression?”

In Kentucky, the county with the highest age-adjusted percentage of people answering "yes" was Wolfe County, at an estimated 30.7%. (That was the most likely percentage in a range of 28.8% to 32.5%, at a confidence level of 95%, or 19 out of 20 cases.)

The rest of the top 10 were Harlan, 29.7% (27.9-31.6); Jackson, 28.9% (27.1-30.9); Casey, 28.9% (27.1-30.7); Clay and Magoffin, 28.8% (27.1-30.6); Bell and Knox, 28.7% (27-30.5); Letcher, 28.6% (26.9-30.5); and Lewis, 28.6% (26.9-30.4). Figures for all counties can be downloaded here.

The 29 counties with the highest estimated shares of reported depression, and 38 of the top 40, were in Appalachia as defined by the Appalachian Regional Commission, which includes 54 Kentucky counties. The highest estimated rate, 31.9%, was in Logan County, West Virginia.

Phil Galewitz of KFF Health News went to Logan and reports that stigma around the topic of mental health is a major obstacle to addressing the problem. Psychiatrist David Lewis of Coalfield Health Center, who grew up in the and taught high-school math there, told Galewitz that people in the region often view seeking mental-health help as being “weak in faith.”

Most states with the highest levels of reported depression were in Appalachia, the southern Mississippi Valley, Missouri, Oklahoma, and Washington, the CDC said in reporting the data. It noted, "Depression is a major contributor to death, illness, disability, and economic costs."

In Kentucky, the counties with the lowest rates of reported depression were Oldham, 21.9%; Boone, 22%; Lyon, 23.6%; Shelby, 23.8%; Fayette, Hardin and Woodford, 24%; Jefferson, 24.2%; Christian, 24.3%; Nelson, 24.4%; Jessamine, 24.5%; Scott and Spencer, 24.6%; Bullitt, 24.7%; and Boyle, 24.8%.

Generally, high-income counties had lower rates of reported depression, and low-income counties had higher rates. Reported depression was "higher in women, younger adults, and adults with lower education levels," the CDC said.

Having been diagnosed with depression is not the same thing as having had depression. Another CDC survey in 2020 asked people if they had suffered symnptoms of depression, and at one point 31% of Kentuckians in the poll said they had.

Cancer survivors in Appalachian Kentucky have greater risk of 2nd cancer than those in non-Appalachian counties, study finds

Cancer ribbons (Photo by Panuway Dansungnoen,

iStock/Getty Images Plus)

By Elizabeth Chapin
University of Kentucky

While cancer survivors have an increased risk of developing cancer in the future, that risk is notably higher in Kentucky and Appalachian Kentucky, according to a new UK Markey Cancer Center study.

Published in Frontiers in Oncology, the study shows that cancer survivors in Kentcky's 54 Appalachian counties had a significantly increased risk of developing cancer again (either the same cancer or a new type of cancer) compared to those in non-Appalachian Kentucky.

Survivors of smoking-related cancers in both Appalachian and non-Appalachian Kentucky were more likely to get cancer again, with no ststistical difference between the two regions.

SOAR map, adapted by Kentucky Health News

Kentucky has the nation’s highest rates of cancer incidence and death from cancer, with Appalachian Kentucky bearing the greatest burden, driven by health behaviors such as smoking and lack of screening.

The study's findings highlight the necessity for, and will help to inform, ongoing prevention interventions among cancer survivors in Kentucky.

"The higher risk of subsequent cancers, especially in Appalachia, emphasizes the importance of targeted interventions to address the specific challenges faced by survivors in this region,” said the study’s lead author Jill Kolesar, a professor in UK’s College of Pharmacy, director of the Markey Cancer Center’s Precision Medicine Center and co-director of Markey’s Molecular Tumor Board.

The research team examined data from more than 148,000 adult-onset cancer survivors who were diagnosed with first primary cancers between 2000 and 2014 and followed them for at least five years post-diagnosis. More than 12% of the survivors developed cancer again.

Among both men and women, larynx and lung cancers had the highest risk of redeveloping. While survivors from Kentucky's Appalachian counties have an increased likelihood of subsequent cancers, compared to those in non-Appalachian counties, that was not the case for smoking-related primary cancers, the study found.

Demon Copperhead author and Ky. native Barbara Kingsolver talks about the opioid epidemic and Appalachia's difficulty with it

Barbara Kingsolver (Facebook photo)

Barbara Kingsolver says she intended her Pulitzer Prize-winning novel Demon Copperhead to be her "great Appalachian novel" that told the story of how the opioid epidemic has ravaged the region, and its impact on children. 

Ezra Klein of The New York Times interviewed Kingsolver, who grew up in Nicholas County, for his podcast, "The Ezra Klein Show." The Times transcribed the interview. It is wide-ranging, but a big chunk has her telling Klein how the opioid epidemic has impacted a whole generation of children who have become orphans and are being raised by grandparents and the foster system — and getting the bulk of their social services at school.

 

"We have a generation of orphans coming up through our schools," Kingsolver said, adding later, "There’s so many more kids in need than there are social networks to catch them — but the caseworkers are so overloaded and so pathetically underpaid. . . . This is something that I think the world needs to know about, this country — voters — need to know about. We need to know how this epidemic has left a generation of innocents that nobody’s taking decent care of. . . . These kids have been left behind. Our burdened public school systems are being asked to raise these kids." 

Klein and Kingsolver also talked about how Central Appalachia was targeted by Purdue Pharma with a drug that was so addictive and with doctors who were told otherwise. "This was done to them," Kingsolver said of her neighbors in southwest Virginia and southeastern Kentucky. "Nobody wants to be addicted."

Winner of the 2023 Pulitzer for fiction

Kingsolver also talked about the stigma associated with addiction and how people have been brainwashed to think it is a moral failing, instead of the brain disease that it is. 

"We have been trained, culturally trained, to think of addiction in this way, as a personal failing that needs to be punished. Incarceration does not cure addiction any more than it cures cancer. Addiction is a disease," she said. "It’s impossible to describe how terrible this disease is, not just the dope sickness of it but the fact that your entire life has to become just a really difficult, hard work in process of, every morning, getting your means, getting your fix, getting through another day. And nobody wants to live like that." 

Kingsolver told Klein that she hopes her novel will help people have more compassion and think of people with addiction as having a disease and to get rid of the idea that you don't treat a person with addiction until they "hit bottom." 

"That’s how we treat the disease of addiction. And it’s incredibly inhumane. And effective treatment will only happen after we switch over from putting this in the hands of the police and the prisons to medical workers who can meet addicted people where they live and offer them the first steps of clean needles and fentanyl test strips so that they won’t die in the weeks that it will take for them logistically, physically, emotionally, to get to the beginnings of treatment," she said. 

And to those who maintain a moral objection to such "harm reduction" programs, she said, "It’s as if people feel that addicted people deserve to die. Imagine if we looked at any other disease that way."