As a whole, Kentucky seniors are the third most unhealthy in the nation, ranking better than only Louisiana and Mississippi

Photo from Getty Images via Kentucky Lantern

By Sarah Ladd

Kentucky Lantern

New data shows Kentucky among the worst states for key health points among senior citizens, including tooth extractions, food insecurity, insufficient sleep and more.

The statistics, published in the America’s Health Rankings Senior Report in May, show Kentucky seniors have the most tooth extractions.

As a whole, Kentucky seniors rank second for insufficient sleep, exercise and cognitive difficulties; third for food insecurity, and sixth for obesity.

As a whole, Kentucky seniors are the third most unhealthy, healthier only than their counterparts in Louisiana and Mississippi.

Dr. Michael Stockman, a geriatric physician based in Minnesota, said there is a “bright side” of the report: Older Kentuckians, generally, don’t drink too much or have severe housing insecurities, and they consume sufficient fruits and vegetables.

For older Kentuckians not to drink excessively “is great because excessive drinking can lead to things like liver disease, diabetes,” said Stockman, who works for UnitedHealthcare. “It can also interfere with the medications that people are taking as well.”

The United Health Foundation released the report, which examines the health of older adults with 52 measures including social and economic status, physical environment, clinical care, behaviors and more. The rankings are based on data available up to March 8.

Kentucky had higher rates of physical inactivity than the national average, the report showed, which Stockman said can itself lead to poor health.

Nationally, 31% of seniors 65 and older are physically inactive, while the number jumps to 37% in Kentucky.

“It’s important to do those simple daily things like walking 30 to 45 minutes a day to really make a positive impact on overall health and well being,” Stockman explained.

Exercises like walking, stretching, yoga and tai chi can all help strengthen the body and prevent falls, which can lead to fractures, he said.

Social isolation

Kentucky seniors are at high risk of social isolation, the report says, a fact exacerbated by the Covid-19 pandemic. The report ranks Kentucky ranks fifth in social isolation among older adults.

“The pandemic did really create a social isolation amongst all of us. I think seniors were disproportionately affected and it … worsened during that pandemic,” Stockman said. “Being socially isolated puts people in a very vulnerable situation, particularly as they’re going through stressful life events common with aging, such as losing maybe a close friend or a family member, or as they move into retirement. Being socially isolated can lead to, really, a decline in a person’s cognitive functioning. It can increase the risk of depression and decrease the overall quality of life of older adults.”

The bright side to that point, though, is that there are more households now with access to high-speed internet than in 2019. The internet can help seniors gain access to telehealth appointments, stay in contact with family and friends and participate in social activities.

Kentucky seniors seem to be closing the gap in high-speed internet. From 2019 to 2021, 9 percent more of them used broadband, while the national increase was 7 percent.

Surgeon general issues public-health advisory that warns about the dangers of social-media use to children's mental health

CNN image

By Melissa Patrick

Kentucky Health News

Concerns about the effects of social media on youth mental health prompted America's top public-health official to issue a rare public-health advisory that calls for a multifaceted approach to find ways to minimize the harm. 

"The bottom line is we do not have enough evidence to conclude that social media is sufficiently safe for our kids. In fact, there is increasing evidence that social media use during adolescence — a critical stage of brain development — is associated with harm to mental health and well-being. In light of the ongoing youth mental health crisis, it is no longer possible to ignore social media’s potential contribution to the pain that millions of children and families are experiencing," Surgeon General Vivek H. Murthy writes in an op-ed about the advisory for The Washington Post. 

Social media use among teens is pervasive, with 95 percent of U.S. teenagers using the platforms and more than one-third saying they use social media "almost constantly," the report says. And this isn't just a teenage phenomenon; nearly 40% of children 8 to 12 years old use social media. 

The advisory walks through the benefits and harms of social media for children. 

It says social media may benefit children by allowing them to connect easily with friends and family or those who share abilities interests and identities, and a space to express themselves and find support when they need it. 

But it also says social media use can result in reduced sleep among youth, and expose them to extreme, inappropriate content and online bullying. One study has found that youth who spend more than three hours a day on social media face double the risk of experiencing poor mental health, including symptoms of depression and anxiety. This is of great concern because on average, one survey found that eighth and 10th graders spend about three and a half hours a day on social media, says the report.

"More research is needed to fully understand the impact of social media," says the 19-page advisory, titled "Social Media and Youth Mental Health." Current evidence "indicates that while social media may have benefits for some children and adolescents, there are ample indicators that social media can also have a profound risk of harm to the mental health and well-being of children and adolescents."

The advisory lays out steps that policymakers, technology companies, researchers, families and young people can take to make social media safer for youth. Following are some of the suggestions for various interests. 

Policymakers are encouraged to strengthen safety protections for children interacting with social media platforms and to develop age-appropriate health and safety standards. They are also called on to require higher safety standards of data privacy for children. 

Technology companies are urged to create safety standards for social media that protect youth from exposure to harmful content and online harassment. They are encouraged to limit features that manipulate youth into excessive and unhealthy use of social media. The report also calls on them to be transparent and to share their assessment findings and data with independent researchers. 

Families are asked to model responsible social-media behavior and to create a family media plan. It also asks families to create tech-free zones that encourage other activities. 

Youth are reminded that they can reach out for help if they are negatively affected by social media and to be cautious about what they share.

The American Psychological Association recently issued a health advisory on social-media use in adolescence that included 10 research-based recommendations.

America's Health Rankings provide a snapshot of Kentucky's health challenges, but also of its recent progress

Kentucky page of report from United Health Foundation; to enlarge or download, click on it.

By Ben Chandler
Foundation for a Healthy Kentucky

As we move into another year, the discussion of New Year’s resolutions and the noble quest for doing some things differently and better comes to the forefront. More than half of all such resolutions are health-related – namely losing weight, better diet, and regular exercise.

Each of us will decide individually what, if anything, we would like to improve during 2022. And perhaps collectively, as a commonwealth, we should consider areas for “self-improvement.” A review of the recently released 2021 America’s Health Rankings might be a good thought-starter. The rankings, released by the United Health Foundation, provide a snapshot of Kentucky’s overall health relative to other states. It does not merely “rank” states against one another; it evaluates each state through a set of health, environmental and socioeconomic categories to help shed light on our health challenges and successes.

The rankings are created to help states determine health benchmarks and establish goals moving forward.

This year’s report reinforces the Foundation for a Healthy Kentucky’s priorities regarding how we can collectively create a healthier commonwealth in 2022 and beyond. The foundation’s priorities include combating obesity, reducing diabetes by improving nutrition, and physical exercise.

Indeed, the report validates these priorities. It indicates 36.6 percent of Kentucky adults are obese (compared to 31.9% nationally), a higher percentage than all but five states. Kentucky ranks 50th in two other categories of concern – the amount of vegetables and fruit consumed, and physical activity and exercise.

It is my hope that individual Kentuckians, their communities, their local and state government representatives, and health-care advocates – among others – can have open, candid dialogue about increasing opportunities for physical activity and ensuring more access to healthy food. For Kentucky school children, stronger nutritional standards, increased participation in school nutrition programs, and quality physical education are needed.

As an organization whose mission is to address unmet health needs of Kentuckians by developing and influencing policy, improving access to care, reducing health disparities, and promoting health equity, we view these rankings as a call to action for leaders in government, health care, education and social services … as well as for individual Kentuckians.

Though Kentucky has the second highest percentage of adults who smoke tobacco products, there is a ray of good news: Smoking among adults has declined 26 percent during recent years – from 29% in 2011 to 21.4% in 2021.

While that is a positive trend, there is much more work to be done. Every Kentuckian who smokes should strongly consider quitting as a 2022 resolution. Tobacco-use prevention and cessation programs are available, though more funding is critically needed.

It is encouraging to see we are ranked 14th for percentage of residents (93.6%) covered by private or public health insurance. But barriers to health-care access remain. Consider that Kentucky ranks 42nd for percentage of homes lacking reliable internet. Kentuckians need this access to tap into telehealth services. Though telehealth was less common pre-pandemic, it is here to stay and a necessity for residents with limited access to transportation or who live an hour or more from the nearest health-care provider.

Another noteworthy but negative item from the report: Kentucky ranks 45th for non-medical drug use among adults and 42nd for drug deaths. Kentucky’s substance-use epidemic is spiraling in a dangerous direction. There is a crisis-level need for funding and support for expanded prevention, treatment and mitigation services.

While some may view the rankings as daunting, it’s important we view them as points of reference for Kentuckians’ health. Now is the time to challenge one another – to push for new and better ways to make our entire commonwealth healthier.

Ben Chandler is president and CEO of the Foundation for a Healthy Kentucky.

Where in Ky. is vaccine resistance highest? New interactive tools can help communities target education and outreach efforts

Adapted screenshot of University of Washington interactive map (click here); click map to enlarge it. 

By Melissa Patrick

Kentucky Health News

It's easy to find your locality's coronavirus vaccination rate, but what about its vaccine hesitancy rate, or local interest in vaccination? Two new interactive tools reveal those numbers.

One uses data gathered by polling done through Facebook; the other shows the relative interest in vaccination shown by online searches. 

The Facebook-gathered data are in interactive maps from the University of Washington, showing what counties (and even what Zip codes) are most hesitant to get a shot.

The maps by the university's Institute for Health Metrics and Evaluation reflect answers to this question: "If a vaccine to prevent Covid-19 were offered to you today, would you choose to get vaccinated?" The answers are "Definitely," "Probably," "Probably not" and "Definitely not." People giving one of the last three answers are considered vaccine-hesitant.

The maps do not break down the data by individual answers, but are interactive, and can be switched to show the percentage of people saying "Probably" and "Probably not." That allows simple subtraction to produce the "Definitely not" figure for each area. 

Another tool, called Google Covid-19 Vaccination Search Insights, uses aggregated, anonymized data from Google searches about vaccination. The weekly data is available by region and by county. 

The trends reflect relative interest, broken down three ways: overall interest, vaccination intent, and safety and side effects. Click here to learn more about how the researchers process the data. 

Another tool to help communities get their people vaccinated is the Vaccine Equity Planner, designed by Ariadne Labs and Boston Children's Hospital,  to identify "vaccine desserts" where people have little or no convenient access to the Covid-19 vaccination. 

How can these tools help? 

With barely half of Kentucky's population having received at least one dose of a Covid-19 vaccine and 61% of its adults having done so, the state still has work to do to reach the 70% level, the amount generally thought necessary to create herd immunity. 

Among Kentucky's 120 counties, 31 have one-third or fewer of their residents vaccinated, and only have reached a solid 50%, according to the Centers for Disease Control and Prevention Data Tracker. The  bottom five counties are Spencer (22.6%), Christian (25.4%), Jackson (26.1%), Ballard (26.2%) and Lewis (26.2 %). 

As Kentucky health officials work to get the other half of the state vaccinated, the information gleaned in these Covid-19 vaccine hesitancy tools can provide them with information to help design and evaluate public education campaigns and outreach efforts targeted specifically to people in their communities.

Resistance falls in some places, rises in others

The Facebook survey shows that in Spencer County, which has usually raked last in Covid-19 vaccinations, 9.13% of survey respondents in January said they would definitely not get the vaccine if it was offered. The week ending July 1, that number had dropped only slightly, to 8.51%.  

(That number was calculated by subtracting the total for the somewhat-hesitant category, those who answered "Yes, probably" and "No, probably not," from the "All" category, which includes those who answered "Yes, probably," "No, probably not," and "No, definitely not.")

In the same six-month period, among the other four counties with the lowest vaccination rates, Christian County showed the greatest decrease in those who said they would definitely not get vaccinated. The figure moved from 28% in January to 12% in July. Ballard County also saw a drop, from 22.49% to 17.56%.

But on the other side of the state, in Appalachia, heavily rural Jackson and Lewis counties saw increases in the share of respondents who said they would definitely not get a vaccine. Jackson County's vaccine resistance increased from 20.9% to 24.1%, and Lewis County's rose from 21.5% to 39.6%. 

To get a broader geographic sample, Kentucky Health News checked two counties in Southern Kentucky that are part of official Appalachia but fully outside the Eastern Kentucky Coal Field.

Metcalfe County showed a huge increase in vaccine hesitancy, with the percentage of respondents who said they would definitely not get a vaccine increasing from 13% in January to 33% by July 1. 

But the next county to the east, Adair, showed a decrease in vaccine resistance, moving from 23.3% in January to 17.5% in July.

The survey found that fewer people said they were resistant to getting shot in Laurel and Clay counties too. In Laurel, that number dropped from 27.16% who said they would definitely not get a shot during the first week of January to 23.85%. In Clay, that number dropped from 23.21% to 16.42%. 

Google Covid-19 Vaccination Search Insights

The Google Covid-19 Vaccination Search Insights tool showed that Kentucky's internet searches related to the eligibility, availability and accessibility of Covid-19 vaccines were among the nation's highest in the week ending July 4. 

This surge in searches for intent to get vaccinated was likely driven by the distribution of the first lottery-style incentive for Kentuckians who had received at least one dose of a vaccine and signed up for it. The next million-dollar prize and five post-secondary scholarships will be held July 29, with the announcements made the next day. Go to shotatamillion.ky.gov for more information. 

Google graph shows searches in Spencer County June 21-28.

The Google tool also has trends for each county. For example, searches showing interest and intent to get vaccinated increased in Spencer County between June 21 and June 28. 

In the same week, Laurel County also saw a jump in general Covid-19 vaccination searches and an even bigger jump in searches for intent to get vaccinated. Searches for safety and side effects from the vaccine declined.

Adair County saw a dip in its general vaccine-information searches, but saw an increase in searches for intent to get vaccinated. 

The interactive map shows that in the week ending July 4, searches for intent to get vaccinated were highest in McLean, Marion, Washington, Boyle, Woodford, Montgomery, Nicholas and Bracken counties.

The trend-graphics for the state also show the highest and lowest Google searches for each of the three categories in each Kentucky county. For example, on June 28, searches for intent to get vaccinated were highest in Nicholas County and lowest in Christian County.

Here's a screenshot of the state's vaccination tracker map:

State Dept. for Public Health map, adapted by Ky. Health News; interactive version is here.

Ky. ranked 37th in protecting children in pandemic; in top 3 for hunger; 22% of families with kids said they lacked enough to eat

Chart from Page 17 of national report from Save the Children; for a larger version, click on it.

By Melissa Patrick
Kentucky Health News

Kentucky ranks 37th for how well it's protecting children and providing for them during the coronavirus pandemic, and more than one in five Kentucky families with children didn't have enough to eat in December, according to a report from Save the Children, a global children's-rights organization.

The ranking was based on four months of data from a bi-weekly Household Pulse Survey that is conducted by the Census Bureau. The researchers looked at three hardships they say make it harder for children to reach their full potential: hunger, economic hardship and lack of tools for remote learning.

A scan at the end of November and through most of December found that Kentucky was one of the top three states for hunger, and that nearly half of Kentucky families are struggling to pay their bills.

The year-end analysis found that 22 percent of Kentucky families with children under 18 said they didn't have enough to eat in the prior week; that 11% of homes with at least one school-age child lacked internet access a computer for educational purposes; and that 47% found it somewhat or very difficult to pay for usual household expenses in the prior week.

Alissa Taylor, Save the Children's director for Kentucky rural education programs, told the Public News Service that 60% of low-income students regularly logged in for online instruction in the pandemic, compared to 90% of higher-income students.  

Nationwide, the pandemic is hitting the poorest families the hardest and that because of this, "childhood equity gaps are likely to grow," the report says. "They are about 15 times as likely to struggle with hunger as the wealthiest families, four times as likely to lack internet for educational purposes and nine times as likely to have difficulty paying bills." The challenges were even higher for Black and Hispanic families. 

The analysis also found that the number of coronavirus cases and Covid-19 deaths in a state was not predictive of where a state was ranked. It concluded that what mattered more were the resources and protections that each state has, or lacks, to protect children and families.

What's Kentucky doing to address these issues?

In August, the state allocated $8 million from the federal Coronavirus Aid, Relief and Economic Security Act to help reduce the monthly cost for low-income parents to pay for internet access for K-12 children. The program runs through the school year. Kentucky is working on a statewide broadband initiative that could be paid for by the American Rescue Plan, the successor to the CARES Act. 

Kentucky has provided rent and utility assistance as well as unemployment benefits throughout the pandemic, but the unemployment process has been plagued with long waits to get claims resolved and employment is still well below pre-pandemic numbers. 

The Kentucky Center for Economic Policy reports that while the state added 4,300 jobs in February, according to the federal Bureau of Labor Statistics, it still has 90,400 fewer jobs in February 2021, than it did in February 2020, the month before the pandemic hit. 

The state's 857 Family Resource and Youth Service Centers, which serve the 1,200-plus schools that have 20% or more students who are eligible for free and reduced-price lunch, have also been able to help. The centers say they did more than 49,000 home visits during the initial closure of schools from March to June 2020. 

“During the COVID-19 pandemic, the Family Resource and Youth Services Centers across the state met the increased needs for students and their families by adapting service delivery," Melissa Goins, director of the centers said in an e-mail. " Familiar with community needs, our FRYSCs coordinated home visits, porch drop-offs, and virtual platforms to continue connecting with families during this time.”

In survey about their pandemic response in that period, 98% of the FRYSC coordinators said they had provided food assistance, 85% provided non-traditional instruction packets and educational supports, 85% had provided basic needs and essential products, 65% had made family welfare checks, 56% had provided Covid-19 prevention information, and 35% had provided information about unemployment or jobs. 

Another way the state is working to make sure it's kids are getting enough food is participating in the Pandemic Electronic Benefit Transfer program that provides funds through a benefits card to households with children eligible for free or reduced-price school meals to cover the food costs on the days they learn from home. The P-EBT program will run through the school year.

Flap over food aid to parents owing child support

Gov. Andy Beshear also recently vetoed Senate Bill 65, sponsored by Sen. Stephen West, R-Paris, which would reinstate a 2018 policy to disqualify some non-custodial parents from receiving Supplemental Nutrition Assistance Program benefits, formerly food stamps, if they owe child support. 

More broadly, the bill addresses regulations that have been found deficient after review by a legislative committee, and is meant to ensure that the legislature has ultimate control over policymaking decisions and not the governor. Beshear's administration put a halt to the policy in April 2020, citing the pandemic.

West's bill would reinstate the policy and prevent the Cabinet for Health and Family Services from issuing any similar regulation. Beshear said that would hurt more than 6,000 children in the state. 

"It is a cruel bill at any time, but certainly in a once in 100-year pandemic," Beshear said at a news briefing. "It takes food benefits away from children, and that is wrong. . . . SNAP benefits provide crucial help to so many of Kentucky's children. I'll not allow food to be taken away from children's tables simply because of actions of parents." His veto will likely be overridden by Republican supermajorities in both the House and Senate.

An analysis of the bill's effects by the Kentucky Center for Economic Policy found that the policy is ineffective at significantly increasing child-support payments and would worsen food insecurity across the state, including for kids. 

West noted at a February committee meeting that the interim health committee had asked for this policy to be reinstated because it is not fair to reward noncustodial "deadbeat parents" who haven't paid their child support and that this policy will give them an incentive to do so.

Study cites benefits of telehealth; commentary says mental telehealth services are 'clinically equivalent to in-person care'

As people across the nation have been asked to shelter in place because of the novel coronavirus, never before has the importance of telehealth, especially for mental-health care, become more evident, says a commentary in The Journal of Rural Health. 

The authors assert that mental-health therapy over video platforms "has been demonstrated as clinically equivalent to in-person care." 

Before the pandemic, they write, video-to-home telehealth services for mental-health care was not uniformly offered, but has since gained some traction, especially in rural areas where mental-health provider shortages are great.

The authors note that telehealth visits have ensured continuity of care during stay-at-home orders, all while minimizing physical contact to keep both patients and providers safe.

But they also recognize that this type of care also comes with many challenges, including overburdened networks, poor internet bandwidth, inconsistent internet service, a lack of equipment,  billing and scheduling challenges, and usability issues for both providers and patients. These challenges have resulted in some providers conducting phone-only visits, especially after federal rules were relaxed to allow reimbursement for such visits.

But the authors say that in this time where "the loss of in-person contacts has never been more pronounced," phone-call appointments, while efficient, don't offer the same connection that video-based meetings do.

"During this pandemic, we believe that visual contact remains crucial; thus institutions that work to facilitate the availability of [video-to-home] visits will significantly benefit both patients and providers,"  they write. "Robust telehealth programs require a significant commitment of time and resources, and large health care organizations with the foresight to invest in telehealth are poised to transition [mental health] care from in-person to virtual visits."

The authors say they regularly collect patient input through interviews about virtual appointments, and have found that many patients say the video connection makes it more personal and that seeing their provider during the therapy session is "very important." Further, patients have told them that they are more comfortable getting their mental-health care at home.

"We believe that prioritizing video over phone-only calls will help maintain the integrity of [mental health] care by maintaining important social rhythms, supporting rapport, and offering a more patient-centered care approach," they write.

They add that such visits allow for the re-establishment of "social rhythms" that many patients prefer, and let the patient and the provider see nonverbal communication cues that would otherwise be missed. It also allows the provider a window into their patient's physical space, the authors write.

Video-to-home "may help patients share more with their provider within the context of therapy by enhancing the therapeutic relationship and allowing providers to establish connections that could never be achieved over the phone," they write.

The authors conclude that video-to-home "will become part of the new normal in the post-pandemic period" and say that now is the time to build competency and capacity for it.

In particular, they note that video-to-home care has been quite successful in rural Veterans Health Administration treatment centers.

A study, also published in The Journal of Rural Health and named article of the year, found that over  a six-year period, 2009 to 2015, use of clinical video telemedicine grew from 30 to 124 encounters per 1,000 veterans, with faster growth among rural veterans than urban ones.  It also found that more than 50 percent of the telehealth visits were for mental-health care.

The study adds that in fiscal year 2015, the last year of the study, 3.2% of urban and 7.2% of rural veterans used telemedicine for nearly 725,000 clinical encounters.

The authors said vets were more likely to use telemedicine if they had a "younger age, longer driving distance to VHA facilities," or multiple medical conditions.

The study concludes that the availability of telemedicine "has likely increased access to care for rural veterans, especially for mental-health care."

Rural residents appear less likely to use electronic health records, Indiana study finds; lack of broadband is one reason

UPI.com

Telemedicine, including online health records, is touted as a way to improve rural health. However, rural residents are less likely to use such technology, according to a study of 34 Indiana counties with high rates of cancer deaths, published in the latest issue of the Journal of Rural Health.

The study by researchers at the Indiana University Cancer Center and the university's Center for Survey Research found that rural patients were less likely to use electronic-health-record messaging systems, less likely to look up test results online, and less likely to use electronic medical records to "look for personal health information for someone else's medical record," which a caregiver might do. There was no significant difference in the use of email, texting or social media for health purposes, or in using electronic health records to ask a health-care provider to refill a prescription.

The availability of high-speed internet service, or lack of it, "emerged as a significant factor" in the use of electronic medical records, the researchers wrote. "Rural broadband has more commonly been discussed in terms of the benefit to economic development, but successful policies to expand broadband access also have the potential to improve health through patients’ access to, and use of, their EMR."

House passes optometrists' bill to thwart online eye exams by requiring 'real time' consultation with an eye doctor

The state House has passed a bill to restrict the growing practice of online eye examinations, a threat to one of the most powerful lobbies of the legislature: independent optometrists. The Senate may give it a closer exam.

House Bill 191, which passed the House 90-7 on Feb. 13, would require a visit with an eye doctor in "real time" for an eye exam or prescription online. Its sponsor, Rep. Jim Gooch, R-Providence, said in a news release that it aims to keep patients safe. "Companies like Opternative already have doctors sign off on the results and prescription, but not in real time," notes Garrett Wymer of Lexington's WKYT-TV.

Dr. William "Chip" Richardson, a Georgetown ophthalmologist and secretary-treasurer of the Kentucky Academy of Eye Physicians and Surgeons, testified against the bill in committee, saying online assessments can reach people with eye problems that may otherwise go undiagnosed.

"While allowing those online options may hurt his financial bottom line (particularly with his sales of glasses and contacts), the bottom line, he says, is they improve access to care," Wymer reports. "Richardson said he is afraid the bill would essentially run those online options out of Kentucky and hurt some patients' access to eye care."

"The bill also requires someone wanting an online eye exam or prescription to have had an in-person exam in the last two years," Wymer notes. "Richardson said that part of the bill could be helpful."

Gooch told Wymer that his bill does not ban "safe technology," but improves it by requiring real-time interaction between a person and a doctor. On the House floor, he noted that online exams are unregulated in Kentucky.

Rep. Kim Moser, R-Taylor Mill, unsuccessfully tried to amend the bill. She said it would be "burdensome, especially to those with disabilities This effectively shuts down e-commerce."
The other six House members who voted against the bill were Republicans Robert Benvenuti of Lexington, Brian Linder of Dry Ridge, Sal Santoro of Florence, Diane St. Onge of Fort Wright and Scott Wells of West Liberty, and Democrat Susan Westrom of Lexington.

The bill is now in the Senate Health and Welfare Committee. "South Carolina's legislature passed a similar bill two years ago," Wymer reports. "The governor vetoed the bill, but it was overridden. Just last month a judge threw out a lawsuit challenging the law."

State health plan says online service has saved it $2.5 million

The state says it has saved $2.5 million in the last two and a half years through a health-and-wellness service that allows 300,000 state employees, teachers and others in the state health plan to get doctor consultations and care online.

The “LiveHealth Online Medical + Behavorial Health” initiative, started in June 2015, will continue to expand its services, the state Personnel Cabinet said in a news release. For example, psychiatric “virtual visits” began this month.

“This service is incredibly user-friendly,” Personnel Secretary Tom Stephens said. “It lets you talk face-to-face with a doctor through your mobile device or a computer with a webcam. It’s faster, easier and more convenient than a visit to an urgent care center. . . . There are no appointments, no waiting and no sitting in traffic. It’s quick, easy and connects you to a doctor of your choice in minutes.”

The state plan is Kentucky's largest self-insured health plan, "with benefits designed in partnership with multiple vendors to provide greater access to quality healthcare with increased customer service," the release says. "The Kentucky Executive Branch is the state’s largest employer, with over 30,000 employees."

Price transparency in health care is thwarted by providers and others who want to keep deals secret; crowdsourcing may help

Trudy Lieberman

People seeking information on costs of health procedures are frustrated by the lack of clarity from medical providers. Things are not looking up for Americans seeking health-care price transparency, writes Trudy Lieberman in her latest column for the Rural Health News Service.

True price transparency would allow consumers to evaluate costs and plan for elective procedures or services that aren't covered by their insurance, in order to make informed decisions. Unfortunately, it's not that simple, Lieberman writes. Prices are negotiated, often in secret, between insurance companies, hospitals and doctors. One provider can charge different fees for services according to the type of patient and payment method.

Powerful lobbying interests have prevented health-care price transparency. Ohio passed a law last year to require doctors, hospitals and other health-care providers to disclose prices for their services, "but Gov. John Kasich, the Ohio Hospital Association and other health groups that oppose transparency have stymied implementation," Lieberman reports. "The governor’s budget for next year calls for repealing the law."

Lieberman interviewed patients in Nebraska, South Dakota and California who are “downright angry” and demanding information, she reports. They expressed concerns about hospitals intentionally keeping patients in the dark. A California woman made more than 10 phone calls trying to plan for an outpatient procedure, only to find an expected additional $5,706 on her bill.

Lieberman also spoke with Jeanne Pinder, founder and CEO of ClearHealthCosts. The organization with journalism-based roots seeks to empower people looking for information on medical costs. It gathers from people from all over the U.S. insurance companies' explanations of benefits. Their crowd-sourcing approach to price transparency reveals an inexplicable variety in costs, from hundreds to thousands, and codes for procedures. They use the information to maintain a searchable database that generates price reports by ZIP code and region.

Such information sharing via the internet, with a community approach, could be the key to price transparency, Lieberman ventures. Pinder says the “fix” for public frustration and anger is transparency.

But some caution that knowing prices will not necessarily cut health-care costs. Cost does not always equate with quality, but Americans want more price transparency. One in five have compared costs before seeking treatment, according to a Public Agenda report. And most people think that comparing prices has saved them money.

Public Agenda chart

10 common misconceptions about cancer and the environment

With the advent of the internet, people are swamped with information about cancer and some of it is not based on "sound scientific evidence" or is "at best, anecdotal," which can "hamper efforts to prevent and treat" it, reports Curt DellaValle, a cancer epidemiologist and senior scientist at Environmental Working Group. He writes about some of the most common misconceptions about cancer:

Misconception #1: Getting cancer is almost completely out of your control: DellaValle recognizes that some cancers are caused by genetics and "bad luck" and notes that the World Health Organization reports that 20 percent of cancers are thought to be caused by environmental factors such as pollution, infections and radiation, but he also says "as many as half of cancers may be preventable," noting that smoking, poor diet and lack of exercise are major contributors.

Misconception #2: “Everything” causes cancer: "Not all chemicals, pollutants or guilty pleasures will lead to cancer," DellaValle writes, while also noting that the amount of exposure to the carcinogen plays a role. "The International Agency for Research on Cancer, a research arm of the WHO, has looked into nearly a thousand suspected causes of cancer. Of those suspicious substances and activities, they have concluded that just about half are known or potentially carcinogenic.

Misconception #3: Exposure to a known carcinogen will give you cancer: "Known carcinogens" are substances that have strong evidence that they can cause cancer, but  it is important to recognize that the risk between them differs. "A person exposed to a known carcinogen is not 100 percent certain to develop cancer, not by a long shot," DellaValle writes. For example, he writes that  there is a difference between asbestos exposure, a potent carcinogen, and eating processed meats, which is also a known carcinogen, but one that only modestly increases your chances of getting cancer.

Misconception #4: Natural products are safe and synthetic products are harmful: DellaValle writes that "arsenic, asbestos, formaldehyde, radiation and tobacco occur naturally and are known carcinogens." His advice is to "arm yourself with information" and "know what you're buying and don't assume everything that says 'natural' is harmless."

Misconception #5: Chemicals that the body absorbs and retains for a long time are more dangerous than those that are quickly excreted or metabolized: "The hazard of a substance is determined not just by the degree of exposure but also how it interacts with the body," he writes. For example, nitrates and nitrites in food and water can change into compounds that cause cancer in the body, while chemicals that are excreted quickly, like pesticides and heavy metals, can also cause cancer.

Misconception #6: The cancer risk you accumulate is irreversible: DellaValle writes that certain harmful exposures, like to radiation, does not allow full recovery, but damage from many environmental exposures can be partly reversed with elimination or significantly reducing the exposure. "The Surgeon General’s report on tobacco concluded that quitting smoking at any age reduces a smoker’s risk of cancer by up to 50 percent in just five to 10 years," he writes.

Misconception  #7: Mammograms cause breast cancer: "The risk with the very small amount of radiation emitted during a mammogram is minuscule for most patients," he writes. However, "women who are pregnant should avoid mammograms and X-rays that their doctors don’t consider necessary. Radiation could harm the developing fetus."

Misconception #8: Cell phones, wi-fi, microwaves, power lines and airport X-ray machines will cause cancer: DellaValle writes that cell phones, wi-fi, microwaves and power lines "emit non-ionizing radiation" and is less invasive than "ionizing radiation" that comes from  X-rays, sunlight and uranium. The WHO considers cell phone radiation a possible carcinogen "based on a suspected association between cell phone use and brain cancer,: DellaValle recommends holing your  phones a few millimeters away from your body to "drastically reduce exposure" or use hands-free devices and texting. He does say that it is a good idea to keep wireless routers a few feet from places where people spend long periods of time, though he notes that there is little or no evidence to support that wi-fi signals cause cancer. He also notes that it would take about 1,000 trips through an airport X-ray scanner to equal the radiation exposure from one medical chest X-ray.

Misconception #9: Artificial turf sports fields cause cancer: The jury is out on this one. DellaValle says, "No data exists at this time to say that artificial turf causes cancer, but scientists are just beginning to explore the question. In the meantime, you should play on artificial turf in well-ventilated areas, avoid hand-to-mouth contact while playing and limit direct contact between turf and skin."

Misconception #10: Residential pesticides are safe: DellaValle writes that many of the pesticides suspected to cause cancer in farm workers are being sold for residential use and notes that some evidence exists that they increase the risk of cancer. While recognizing that  homes would use these products less often and at a lower dose, he did caution to not use them around children or pregnant women. He noted that studies have found that children exposed to pesticides while in the womb and in infancy face an increased risk of childhood cancers like leukemia and brain tumors.

Almost one-third of teens have changed their health habits after looking up information on the Internet, study suggests

A decade-long study by researchers at Northwestern University about how teenagers use the Internet for health information found that almost one-third of adolescents report changing health habits after looking for information online, Lena H. Sun writes for the Washington Post.

The study also found that almost 25 percent of teens check the Internet to find information about health conditions their family and friends have. "While most teens rely on digital resources to learn more about puberty, drugs, sex and depression, among other issues, a surprising 88 percent said they did not feel comfortable sharing their health concerns with friends on Facebook or on other social networking sites," Sun writes.

"I mainly find it kind of moving because it really illustrates that a lot of teens are grappling with very real, very important health challenges and that the Internet is empowering them with the information they need to take better care of themselves," said Vicky Rideout, a co-author of the study.

Although the study found that parents are still the leading source of health information—55 percent of teens reported learning "a lot" of health information from parents—and health classes in school, doctors and nurses came in second and third, the Internet is the fourth-largest source of health information. "Eighty-four percent of teens said they turned to the Internet for health information," Sun reports.

Teens are still asking their parents health questions, and only 13 percent of those surveyed said they consult the Internet because they couldn't talk to their parents. "The Internet is not replacing parents, teachers and doctors; it is supplementing them," the researchers wrote.

Participants in the study were 1,156 American teenagers between 13 and 18 years old. "We need to make sure there is good information for teens online," Rideout said. Teenagers need to learn digital literacy skills and acquire the ability to tell the difference between advertising and content. (Read more)

KentuckyOne Health to start around-the-clock online or phone access to health-care providers for $35 a visit on Nov. 1

Hospital group KentuckyOne Health says it will launch a program on Nov. 1 that will let Kentuckians get urgent care at any time by consulting with a medical professional over the phone or web camera. The group says KentuckyOne Anywhere Care is among the first such programs in the nation.

“KentuckyOne Health’s purpose is to expand access to quality health care, no matter where you live in the Commonwealth; is one way we are doing that,” CEO Ruth W. Brinkley said. “We can provide primary care to more Kentuckians, while saving them time, hassle and expense. We can treat conditions before they become more acute, as well as prevent unnecessary and costly emergency room visits.”

The service will cost patients $35 per visit, whether or not they are covered by insurance. "The cost is less than typical urgent care and a fraction of the cost of a normal emergency room visit," KentuckyOne said in a press release. Patients will be able to request a visit online or through a toll-free phone number. They will receive a phone call or video call from a medical provider within 30 minutes, the release promises.

"Patients will have access to board-certified doctors and nurse practitioners," the release says. "If needed, the KentuckyOne Anywhere Care provider will refer patients for a follow-up clinic visit or to an emergency department," and may prescribe medications, but won't prescribe or refill prescriptions for controlled substances.

The system will be operated by Carena Inc., which has been doing such work since 2010 and serves more than 500,000 patients in corporate programs and more than 1 million for the Franciscan Health System in Tacoma, Wash. The firm says it has a 98 percent satisfaction rating among patients.

Before going public, the new service will get a shakedown cruise by serving KentuckyOne employees who live in Kentucky. The group, Kentucky's largest, comprises Jewish Hospital & St. Mary’s HealthCare in Louisville; the Lexington-based Saint Joseph Health System, which includes hospitals in Bardstown, Berea, London, Martin, Mount Sterling and Shelbyville; and the University of Louisville Hospital and James Graham Brown Cancer Center. (Read more)

New website for after-school programs promotes 'Drink Right, Move More and Snack Smart' to fight childhood obesity

To combat the country's childhood obesity epidemic, ChildObesity180, a new initiative from Tufts University, has launched Healthy Kids Hub, a website with resources for out-of-school-time programs, encouraging kids to develop and adopt three universal nutrition and physical activity principles: "Drink Right, Move More and Snack Smart."

The Hub offers free activity, nutrition and equipment support to volunteers, coaches and leaders in out-of-school-time programs, which serve tens of millions of children and have been identified as a promising area for obesity prevention efforts, the site says.

In Kentucky, almost 18 percent of middle-school-age children and 16 percent of elementary-age kids are obese, says a recent report from the University of Kentucky's College of Public Health.

Research shows that foods and beverages, as well as opportunities for physical activity, vary greatly in out-of-school programs, so the Hub promotes greater consistency in such programs and provides resources to help children follow healthy habits while out of school.

The website was launched at the National Afterschool Association convention in Indianapolis last week, according to a release. Visitors to the website can complete a brief survey to get resources tailored to their specific needs. Click here for the website.

Cyber predators have easier access to children because of phones, video games

Child predators have it easier than ever to entice their young victims, due to the ever-growing accessibility of the Internet. "It's a lot easier now than everybody has the Internet in their pocket," Lexington Police Detective David Flannery told Karla Ward of the Lexington Herald-Leader. "Every day that we think of a way to combat it, people are thinking of a way to get around us," Flannery said. "It changes every day, and you have to keep up with it."

Using the World Wide Web to lure children for sex acts has skyrocketed since 1998, when the National Center for Missing and Exploited Children received 707 reports of people trying to entice children via the Internet. In 2008, there were 8,787 reports.

"Computers and cell phones remain the primary means of communication, but game systems including Xbox 360, Nintendo DS and Wii also can be connected to the Internet, giving predators another way to gain access to children," Ward reports.

Though parents are becoming more aware, more education is needed, said Erin May Roth, an assistant U.S. attorney and the Project Safe Childhood coordinator for the Eastern District of Kentucky. "What they don't really think about is the fact that their kids are going to sleep with their phone," she said.

Flannery is the only police officer in Lexington assigned full-time to investigate Internet crimes against children. While he does not go into detail about his methods to track down predators, the concept involves pretending. "Anything that a kid can do, we can do," Flannery said.

Sometimes officers from several agencies and departments work together. The Kentucky State Police administers an Internet Crimes Against Children Task Force, the state attorney general's office has a similar unit, and, because cases can involve a number of jurisdictions, sometimes the Federal Bureau of Investigations, the U.S. Postal Service, the Secret Service and U.S. Immigrations and Customs Enforcement are involved.

Mother Frieda Curry, right, discovered her 14-year-old daughter was entangled with a 38-year-old man who initially pretended to be 16. She contacted the Richmond Police Department and found more than 40 text messages and 10,000 pages of messages and videos on the computer. "I was frantic," she said. "I was in the worst state I've ever been in." (Photo by H-L's David Perry)

But Curry, whose daughter is now in college, dealt with the problem and the predator was sentenced in U.S. District Court to 10 years in prison. Thinking about the crimes can be difficult, but "only by shining a light on the problem will we ever hope to find a solution for it," said Assistant Commonwealth's Attorney Lou Anna Red Corn. (Read more)

Four out of five Americans look on Internet to answer health questions; third most common reason to surf

Finding answers to questions about their health is the third most common reason Americans use the Internet, a survey by the Pew Internet Project has found. Emailing and using searching engines are the top one and two reasons respectively.

A national telephone survey conducted Aug. 9 to Sept. 13, 2010, found 80 percent of Internet users search online for health-related information. The most likely groups to access health-related websites are caregivers, women, whites, younger adults, and adults with at least some college education. Those least likely to look for health-related information are African Americans, Latinos, people with disabilities, older adults and adults with a high school education or less.

The Washington Post's Nancy Szokan reports Pew has been monitoring how Americans use the Internet since 2000. "In many ways," Pew Associate Director Susannah Fox said, "the Internet has become the de facto second opinion." (Read more)