Here's what you need to know about the baby formula shortage

By Heather Chapman
Institute for Rural Journalism and Community Issues, University of Kentucky

Families nationwide are scrambling to find baby formula amid a widespread shortage. Rural families are likely having an even harder time since there are fewer local places to buy formula, and because families who use federal assistance can only buy certain formulas. It's even more difficult to find certain medically necessary specialty formulas. Here's what you need to know:

What happened: In February the Food and Drug Administration ordered Abbott Nutrition, the nation's leading formula maker, to shut down its plant in Sturgis, Michigan, after four infants were hospitalized with bacterial infections from contaminated formula and two of them died. The FDA issued a voluntary recall on three products (Similac, Alimentum, and EleCare) and warned customers not to use certain specialty formulas produced at the facility, but the warning didn't get much public attention, so parents didn't know to stock up. Formula was already low in stock since at least December because of inflation, supply-chain shortages and product recalls.

How bad is it? Formula stockpiles in stores are 43 percent lower than normal, compared to 30-40% short in April, says retail data tracker Datasembly. Only about a quarter of children are exclusively breast-fed up to the age of six months, so most parents and caregivers depend at least partially on formula. 

Why not buy another brand? Almost all formula in the U.S. is manufactured domestically because of strict FDA standards, and 90% of the nation's supply comes from four companies. Abbott makes over 40% and Perrigo Nutritionals, Mead Johnson, Gerber (owned by Nestlé) combined account for another 50%. Perrigo makes store-brand formulas for stores such as Walmart, Kroger and Walgreens formula can't be purchased by people using federal assistance through the Women, Infants and Children nutrition program, which pays for about half of all formula. In addition, many babies require specialty formulas and can become very sick if they switch.

Why not breastfeed? Many babies who require specialty formulas can also get sick from drinking breast milk. Adoptive families and many others also have difficulty accessing or affording a reliable supply of breast milk, and some survivors of sexual violence may find it traumatizing. Some mothers find it difficult to maintain a steady supply of milk, and others can't breastfeed at all because they must take medications that would taint the milk. Though state and federal laws protect women's right to breastfeed in public—including at work—many women are embarrassed, intimidated, or even discouraged from the practice, and many women are not knowledgeable about the health benefits of breast milk.

Is homemade baby formula a safe alternative? No. Homemade formulas can be too high in sodium, too low in calcium, contaminated, and/or lack critical nutrients. Babies can suffer long-term damage after using homemade formula alternatives or straight cow's milk for even a few days, according to the National Committee on Nutrition for the American Academy of Pediatrics. It's also dangerous to dilute baby formula with too much water. If there is absolutely no other alternative, formula made for toddlers can be ok for a few days for infants who are close to a year of age. 

How long could the shortage last? At least 10 weeks. On Monday the FDA agreed to allow Abbott to reopen its Sturgis plant within two weeks, as long as it passes a safety inspection. After that it will take six to eight weeks for formula to hit store shelves. However, inspectors say there are still problems at the plant. In the meantime, Abbott says it's shipping in formula from its FDA-registered plant in Ireland on a daily basis. The FDA has been allowing more formula imports meant for the U.S. since February, and is now allowing some formula meant for foreign markets to enter the U.S., but only after a safety evaluation.

Could this have been prevented? Growing evidence indicates the FDA failed to act quickly about warnings of safety violations at the Sturgis plant. A whistleblower at the plant warned the FDA in October about safety problems, weeks after the children were hospitalized with bacterial infections, but the agency didn't interview the whistleblower until December and didn't inspect the plant until Jan. 31. That dovetails with a recent Poitico investigation that revealed deep-seated issues with the FDA's plant inspections. Current and former employees described the agency as slow to make decisions and lacking enough staff or budget for years to deal with the modern food system even as its regulatory responsibilities have grown.

What is happening in Kentucky? "The state WIC Program quickly requested and began to execute all waivers available to the states as soon as the USDA provided for them. However, that has only been a small part of their response," said Susan Dunlap, spokeswoman for the state Cabinet for Health and Family Services. "They have worked to develop additional infant formula packages in the WIC system and have updated the approved product list to now include a substantial number of additional products in a variety of sizes. All of this was aimed at ensuring WIC families were able to use their benefits to access whatever formula was available on the shelves."

Also, local health departments are being updated and supported, and the state is pushing updates to WIC families via the WIC Shopper App, Dunlap said. "They have been in constant contact with Abbott about reports of regional supply deficiencies so Abbott can work to shift supply to harder hit areas of the state," she said. "However, the supply chain demand and disruption is affecting nearly all families that use infant formula."

In the meantime, if you need formula, here are some do's and don'ts:

• Check with your church or local nonprofits to see if they have any.
• Shop online from reliable sources. 
• Don't make your own.
• Don't hoard formula.
• Network with other families on social media.

Beshear seeks one more month of pandemic food benefits, after leaving impression that the legislature hadn't left that option open

By Melissa Patrick

Kentucky Health News

On March 21, Republicans in Kentucky's legislature overrode Democratic Gov. Andy Beshear's veto of their resolution ending the Covid-19 state of emergency about a month early, and with it an extra $100 a month in food benefits for 544,000 Kentuckians, who will revert to the standard $243 monthly benefit.

Senate President Pro Tem David Givens of Greensburg said any state could apply for an extra month of the benefits after the end of its emergency, but Beshear said there had to be a state-declared state of emergency.

Technically, they were both right. Now Beshear has requested the extra month of additional Supplemental Nutrition Assistance Program benefits, formerly called food stamps, from the U.S. Department of Agriculture.

State spokesman Brice Mitchell told Kentucky Health News that the state asked for the one-month "phase-out" extension of the benefits on Monday, March 28, a week after the legislature overrode his veto.

"Since the General Assembly voted to end food assistance for nearly 500,000 Kentuckians, the Cabinet for Health and Family Services is notifying the USDA today that a transition period is now needed for April to notify recipients that their benefits are ending May 1," Mitchell said in an e-mail. "If the General Assembly would have not taken this action, the cabinet would have been able to have requested that the benefits continue beyond May 1." The emergency had been scheduled to end April 14.

After the legislature overrode the veto of Senate Joint Resolution 150, Beshear said it would take benefits from Kentuckians, because it had barred him from declaring another emergency.

He said March 24, "We could have continued to provide, at no cost to the Commonwealth, extra dollars to help kids and seniors afford food that costs more than before the pandemic. So what this legislature said is no more help. We're going to go back to giving you the same amount pre-pandemic, even though things cost more."

Beshear didn't respond directly to a question asking him if he had investigated the federal guidance that Givens alluded to, instead saying the state needed an emergency declaration to continue the benefits. He said the resolution was passed for political reasons, and "It's not worth any political point that someone's trying to make to take food off the table of those that need it."

The sponsor of SJR 150 is Sen. Donald Douglas of Nicholasville, who was elected in a special election in December and is opposed in the May 17 Republican primary by Andrew Cooperrider of Lexington, who was a fervent opponent of anti-pandemic measures and has said the bill is designed to boost the candidacy of Douglas, a more mainstream candidate.

Senate President Robert Stivers issued a statement on March 22 criticizing the governor's desire to continue the emergency benefits. 

“Twenty-eight states have already declared the end of the emergency, as well as the U.S. Senate,” Stivers said. “Continuing to operate under a false emergency for the sake of pulling down federal dollars is simply fraudulent and unethical.”

Kentucky farmers, often beset by circumstances, can take advantage of a new program to support their mental health

The following story is from The Goldenrod, which normally covers rural Eastern and Central Kentucky. Editor Sarah Baird writes, "If you live in a farming community—or are part of a farming family—I’d ask you to share Michelle’s piece with a friend or loved one this week. It could help save a life."

By Michelle Eigenheer

As dawn broke in the early morning hours of Dec. 11, 2021, residents and aid workers began to get a clearer view of the damage caused by a late-night tornado that left nearly 200 miles of wreckage across 11 counties in Western Kentucky. The EF-4 tornado—one in an outbreak of over 60 that caused $5 billion in estimated damage across six states—killed at least 77 people and sent more than double that number to emergency rooms.

Logo of the program, which began in 2020

Among the neighbors and rescue workers who poured into communities like Mayfield to help pull people from the rubble and offer hot meals in the December cold were Dr. Cheryl Witt and Dale Dobson, who met with farmers to take stock of their unique needs. Witt and Dobson are members of a campaign called Raising Hope, a coalition including the Kentucky Department of Agriculture and Cabinet for Health and Family Services, the Southeast Center for Agricultural Health and Injury Prevention and a number of state universities that formed in 2020 to offer critical resources and education to support the mental health of Kentucky farmers and their families.

Along the tornado’s path, farmers found their buildings demolished, equipment missing or damaged, and livestock killed by the destruction, debris and devastating winds. An estimated 30 poultry barns were leveled in the night; a hatchery and the 8 million eggs inside were destroyed; grain mills and silos were toppled or torn apart, exposing the livestock feed inside to the storm’s rain and rendering it unsafe for consumption. Hundreds of cattle and other livestock were injured and killed, sometimes even carried away by the 190-mph winds. Total estimates for damages and losses are still being assessed, over a month after the supercell storm.

“We’ve had two tornadoes come through . . . and laid flat [farmers’] whole livelihood, just laying there on the ground to pick up and rebuild, and then the snowstorm…you have tragedies,” says Dobson, a KDA farm safety officer and Hodgenville-area farmer who has taught farm safety for 20 years. He joined Witt—a sixth-generation farmer and nurse who teaches at the University of Louisville in addition to serving as the Raising Hope project manager—with the intention of expanding ideas of farm safety to include mental health and physical wellness.

The devastating storms are the latest in a series of acute struggles that farmers across Kentucky and the nation have faced since the start of the pandemic, adding to a growing list of stressors that have negatively impacted the mental health of farmers and their families for decades.

Farmers and agricultural workers have among the highest reported rates of suicide across all occupational groups, according to studies from the CDC. With this in mind, Raising Hope formed and outlined immediate goals: reducing the stigma of mental healthcare among farming communities; increasing education and awareness around mental health; showing farmers appreciation from their communities; and using data collection methods to get a better view of the issue.

State Rep. Brandon Reed's Twitter post about the program

Support from state Rep. Brandon Reed, a Hodgenville Republican, secured funding from the legislature, providing $500,000 for 2020 and again in 2021. The group worked quickly, enacting programs to improve existing infrastructure and build a network of crisis and risk assessment training access throughout the 56 Kentucky counties that showed the highest number of indicators for crisis.

They began QPR training—a method of crisis response that follows a directive of Question, Persuade, Refer, to identify and interrupt a mental health crisis so that the subject can be directed to care—and educated 57 QPR trainers across the state who, in turn, trained 450 key community members on how to recognize and aid those who may be considering self harm or ending their own life.

They invited doctors and nurses to the annual Farm Machinery Show and offered health checkups for attendees. Partnering with Western Kentucky University, they developed a rural suicide prevention training that focuses on “response measures for farmers in crisis and the application of cultural sensitivity and humility.” CRUSHing Farmer Suicide—Cultural Respect, Understanding, Sensitivity, and Humility—is currently available for healthcare professionals in the form of a free, one-hour continuing education program.

They then turned to the state’s crisis hotline. Backup call centers were located in Miami and New York at the time, creating unneeded confusion and complications during critical conversations with rural populations.

“During that time, you want to be able to talk to somebody who understands and can connect and relate to you,” Witt explains, giving examples of how different accents and lack of knowledge about stressors, like those specific to rural or farm life, can be obstacles between the person in crisis and the one who answers the call. “You don’t need a communication barrier at that time.”

Now, at least 95 percent of all in-state calls to the National Suicide Prevention Lifeline (1-800–273-8255) are answered by someone within one of the commonwealth’s own call centers. Callers are now also asked, as part of the existing call intake process, if they’re a farmer or member of a farming family. This was added as part of a data gathering effort to better understand the mental health crisis.

“Because we used our original money to build and expand our projects, that really gave us a lot of ammunition, if you will, to put in for federal funds and be awarded them,” Witt explains. In December 2021, the federal government issued a $500,000 grant to the Department of Agriculture to further expand Raising Hope’s projects and partnerships.

The additional funding has allowed Raising Hope and partners to implement a farmer appreciation grant program. It is also funding the development of a mental health curriculum specifically for rural youth aged 9-12, as well as a peer-to-peer mobile app similar to those used in veterans groups that will center “mental health and wellbeing-focused online interventions” and include access to just-in-time telehealth services. The curriculum is slated to pilot in fall 2022, while the app is entering user testing in the coming weeks.

This grant is part of a nearly $25 million investment by USDA’s National Institute of Food and Agriculture to 50 state-level projects in an effort to expand or create mental health and stress management resources for farmers and ranchers across the country.

The list of stressors and potential crisis factors for farmers is long: they are isolated within the acres of land that they farm; their income is greatly affected by fluctuating commodities pricing and supply chain failures; their crops and livestock are subject to damage or ruination from factors out of their control like climate change and natural disaster; even exposure to insecticides has been linked to higher rates of depression. Farmers are also more likely to suffer chronic pain from a lifetime of manual labor, and have increased access to lethal means, such as firearms and heavy machinery. A number of studies on farmer mental health note that reported rates of suicide are likely low because deaths can easily be misreported or mistaken as farming accidents.

The pandemic compounded many of these stressors. Ongoing tariffs in the trade war with China hit U.S. agriculture hard. And 2020 payments to compensate for those financial losses largely missed small producers and family farms: CNBC reports that two-thirds of the $28 billion Market Facilitation Program went to the top 10 percent of recipients. The report outlines the disparity: companies at the top received an average of $164,814 per payment, while the bottom half of recipients received, on average, less than $2,500 per payment. Meanwhile, bankruptcy rates for farms in the Midwest, including Kentucky, rose 23 percent from June 2019 to June 2020.

In financial turmoil, many small-scale and family farm operations are not facing just a loss of income: losing the farm can also mean losing the house, losing an identity, or failing a family tradition.

Dr. Cheryl Witt on her farm (Photo from Ky. Dept. of Agriculture)

Witt explains: “I farm—six generations now. You talk about something you’re passionate about, it’s all those internalized feelings and attachment to the land. That’s me. I live it every day. Because farming is such an identity, as farmers age and are unable to [continue working], that also mentally affects a lot of farmers. Farmers will define good health by their ability to get up and work. So when they can’t do that, it absolutely does a number on their psyche.”

Dobson’s explanation is more succinct: “Everything is tied into one thing: If I lost my job [at KDA] today, I’ve still got my home and my farm to go to and work. [If] I lose my farm, I lose my home. My living. My identity. My everything.”

When Dobson began mental health outreach with farmers in the communities where he teaches farm safety, he used challenge coins as a prop to turn everyday conversations toward oft-stigmatized mental health subjects. Turning the coin in his hands gave him an opening to incite a promise from those he works with, he explained.

“When you shake my hand and take my coin, you take my challenge,” he tells them. “You give me your word that if you feel down, you’ll call somebody. You call me, you call the 800-number on the back, anytime. You find somebody.”

Breaking through the barrier to a discussion about mental health opens a door for stories and disclosures that may otherwise be withheld for years, even decades. He tells them, “I’m not saying anyone is suicidal, I’m saying some of us have good and bad days.”

“I had one farmer, we’ve been friends for 30 years. We shook hands, he held my hand and says, ‘You been involved in suicide?’” Dobson recounts.

Dobson, who has encountered a number of cases of self harm, including the loss of his best friend, says that the farmer then shared that his first wife had taken her own life in front of their young son—and for 35 years had never said a word about it to Dobson or most others.

He points to this disclosure as a sign that things are changing for the better.

“Raising Hope is going to change the world,” Dobson declared on a phone call from Atlanta, where he was attending a farm safety training. “We ain’t never had a program before that dealt with rural mental health, or mental health, period, out here. There’s a stigma about it, there’ve been no conversations about it. And farmers, some of them, are starting to talk about the bad days and the gloom and doom.”

Dobson continued, “Everyone’s had to go pick up a friend or neighbor and know somebody that took their lives. The world’s changing on that part for the good, because we’re communicating.”

If you’re in crisis, there are options available to help you cope. You can call the National Suicide Prevention Lifeline at any time to speak to someone and get support. For confidential support available 24/7 call 1-800-273-8255 or visit https://go.usa.gov/xftYC.

New federal nutrition guides, which influence school lunches, food stamps and diabetes, ignore experts' calls for less sugar, alcohol

New federal nutritional guidelines unveiled last week, which influence everything from school lunches and military rations to food stamps, ignored scientific advisers' calls to lower recommended sugar and alcohol intake. Agency officials said there wasn't enough evidence to advise stricter limits on sugar and alcohol, but emphasized that people should cut back on both. The advice has meaning for Kentucky, where nearly half the population has diabetes or pre-diabetes.

"The updated guidelines are the first to include dietary advice for infants, toddlers and pregnant women," Ryan McCrimmon reports for Politico's Weekly Agriculture. "They also have a broader theme of encouraging consumers to 'make every bite count' by choosing nutrient-rich foods and beverages, with five categories — fruits, vegetables, grains, dairy and protein — accounting for 85 percent of daily calories."

The Department of Agriculture and the Department for Health and Human Services have jointly released updated guidelines every five years since 1980. The federal government hired an independent panel of 20 doctors, nutritionists and public-health experts from major academic institutions to assist in creating the new guidelines. The Dietary Guidelines Advisory Committee "suggested the guidelines should take a harder line against added sugars, but USDA and HHS decided to keep the Obama-era advice that individuals try to not consume more than 10 percent of their calories from added sugars," Helena Bottemiller Evich reports for Politico. "The committee had recommended dropping the limit down even further to 6 percent."

The committee also "recommended in June that the guidelines should urge men to cut back on alcohol by reducing the government’s definition of 'moderate drinking' from two drinks per day to one. (At the time, the panel recommended keeping the definition of moderate drinking the same for women, at one drink per day.)," Evich reports. "Government officials ultimately decided to not adopt the stricter alcohol recommendation, which had sparked furious pushback and lobbying from the alcohol industry.

The dietary guidelines have long been a political football because of their influence over federal nutrition programs, Evich reports.

Study shows nutrition education for low-income people in eight Southeast states resulted in healthier diets and better budgeting

By Melissa Patrick

Kentucky Health News

A little education goes a long way when it comes to helping people with limited budgets eat healthier and not run out of food before the end of the month. 

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

So says a study by the Public Health Institute's Center for Wellness and Nutrition, published in the Journal of Nutritional Science.

It found that residents with low incomes in eight Southeastern states, including Kentucky, "consumed significantly greater amounts of fruits and vegetables, and improved several other shopping and nutrition-related behaviors" after they participated in the U.S. Department of Agriculture's SNAP-Ed program. SNAP is the Supplemental Nutrition Assistance Program, formerly known as food stamps.

“Healthy foods can be expensive, and a SNAP budget is modest. But SNAP-Ed is helping low-income Americans in the Southeast make strategic choices that stretch their food dollars and empower them to choose more fruits and vegetables and other healthy foods,” Amy DeLisio, the center's director and co-author of the study, said in a news release.

“In the long run,” DeLisio said, “these changes can play an important role in reducing their likelihood of diabetes, hypertension and other nutrition-related diseases, and in reducing health-care costs across the region.” 

SNAP-Ed provides comprehensive nutrition education and obesity-prevention interventions for individuals and families whose incomes are below 185% of the federal poverty line. Participants are not required to get SNAP benefits. 

Using 2017 data from 25 participating agencies in the Southeast, including surveys from more than 43,000 low-income children and adults before and after SNAP-Ed interventions, the study found people were more likely to meet USDA nutrition recommendations and manage their food resources better after participating in the program.   

On average, the study found low-income participants increased their daily consumption of fruit by 1/3 cup; increased their daily consumption of vegetables by 1/4 cup; drank more water and less sugar-sweetened drinks, and were more likely to drink low-fat or nonfat milk.

They were also likelier to choose healthier foods on a budget; read nutrition labels or ingredient lists; compare prices before purchasing foods; identify foods on sale or use coupons; use a list while shopping; and not run out of food before the month's end.

The report notes that in a region that experiences some of the highest rates of obesity and unhealthy dietary behaviors in the nation, "our study shows that SNAP-Ed programs can be part of the solution."

The study also documented 701 policy, systems and environment supports that complement the SNAP-Ed programs in the region, including things like creating edible gardens and improving food displays in school cafeterias. 

What about Kentucky?

In Kentucky, the Nutrition Education Program encompasses two separate USDA programs, SNAP-Ed and the Expanded Food and Nutrition Education Program. The programs are offered in each of the state's 120 counties and are run by extension agents or one of the 96 NEP assistants. 

NEP director Marisa Aull said the program is designed to provide its clients with life skills to promote a healthier lifestyle and to make the healthiest choice the easiest choice. 

"A lot of times it is simply lack of knowledge," Aull said. "Our program really does focus on bringing education to the individual so that they, along with their family, can make those choices and be healthier."

Omolola Adedokun, senior Extension specialist for evaluation, explained, "With education on how to spend the money, by using coupons, by being able to follow what's on sale, what's not on sale, and by budgeting for food, that by looking at cheaper options, like frozen vegetables, or canned vegetables, people will be able to eat healthier and in alignment with USDA guidelines."

Aull said the program is especially important in Kentucky, a state known for its high obesity rates and poor health.

According to America's Health Rankings, Kentucky is one of the worst states for adult obesity, with 36.6% of its adults obese. Thirty-eight percent of the state's children are either obese or overweight, the second highest in the nation, according to the 2020 Kids Count report.

Kentucky also ranks among the 10 worst for heart disease and diabetes, and is No. 1 in cancer deaths -- all conditions that could improve with better nutrition and exercise practices.

The study did not provide any state-specific data, but the 2019 NEP report says 97% of Kentucky's adult participants showed improvement in one or more diet quality indicator, like eating more fruits or vegetables, drinking less sugared soda and cooking dinner at home; 84% increased their physical activity; 92% showed safer food storage and prep; and 91% showed better food resource management. 

Kentucky had more than 4,500 participants in the SNAP-Ed program, said Adedokun. 

As for youth, after participating in the "Super Star Chef" program, which was offered in 53 counties, 99.6% of the state's 789 youth participants reported they could identify healthy foods; 96% said they planned to drink more water every day; and 95% said they planned to try new foods. The report says the two programs had 368,584 children and youth contacts. 

Aull said young people are an important part of the program because they often share their excitement for what they've learned with their families, inspiring them to eat healthier. 

"We often hear anecdotally, that they convince their family to try a new food or they convince their family to go to the farmers market where the family previously was maybe hesitant to go. . . .  The key to the family is often through youth," she said. 

Aull stressed that each of these small changes are important because they could have a lifelong impact, and not just for the individual but society at large.

"If we look at it from a kind of return-on-investment side, it has an effect on generational poverty, it has an effect on their health and well-being, and it also has an effect on those local health care systems," Aull said. "Those small changes lead to big impacts for not just our state as a whole but . . . their community, their city, their family. And we feel like those changes will also break a lot of cycles that need to be broken, that really are just due to lack of resources and lack of opportunity."

Aull encouraged qualifying Kentuckians to participate in the free nutrition-education programs, which are being held virtually during the coronavirus pandemic. 

Denise Rennekamp, assistant NEP director, spoke to the importance of community partnerships to promote the program. For example, she said Feeding Kentucky and other food banks help connect food-insecure Kentuckians with their program. 

The number of Kentuckians on SNAP varies from month to month, with participation increasing since the pandemic came to Kentucky in March. In August, 606,216 Kentuckians received SNAP benefits. 

Click on the Plan, Eat, Move website to learn more about the program. Below is a video that tells more about the program.

Study finds SNAP not enough for healthy diet, as budget plans call for cuts in program on which Ky. is more reliant than most

By Melissa Patrick
Kentucky Health News

The Supplemental Nutrition Assistance Program, formerly known as food stamps, only covers 43 to 60 percent of the cost of the federal nutrition guidelines, according to a study by researchers who say policymakers should consider that as they propose deep cuts to the program.

“Even though SNAP is not designed to cover all of the cost of food – it’s meant to be a supplemental food program – this study makes it clear that there would be many low-income households that would not be able to cover the gap needed to eat a diet consistent with federal dietary guidelines,” Lindsey Haynes-Maslow, co-author of the study, said in a news release.

The report notes that the average gross income for all SNAP participants is $786 a month, and the expectation is that "SNAP households are expected to spend about 30 percent of their resources on food," says the U.S. Department of Agriculture.

The study, published in the Journal of Nutrition Education and Behavior, estimated how much it would cost to fulfill the USDA's MyPlate guidelines, which recommend filling half your plate with vegetables and fruits, the other with a lean protein and grains, along with a serving of low-fat dairy. Then it estimated the additional costs needed by SNAP recipients to adhere to it.

The researchers concluded that SNAP benefits are sufficient to meet the needs of children under the age of 8 and women over the age of 51, but are insufficient for older children, younger women, and men of any age.

It found that while the average monthly SNAP benefit is $254 per household, the cost of feeding a family of four according to the MyPlate guidelines is between $1,000 and $1,200 per month, depending on the number and age of children in the home.

The study used average monthly SNAP benefits for 2015 and monthly retail price data from the USDA to determine food costs. The calculations also took into account the time it takes to shop for and prepare the food, citing previous studies that show that in addition to food costs, the time it takes to prepare nutritious foods is a barrier to eating healthy.

“Even without including labor costs, a household of four would need to spend approximately $200 to $300 in addition to their SNAP benefits to follow the dietary guidelines," said Haynes-Maslow, who is also an assistant professor of agricultural and human sciences at North Carolina State University.

SNAP funding based on guidelines that were replaced in 2010

The researchers pointed out that SNAP funding is based on the 2005 Food Pyramid nutrition guidelines, which MyPlate replaced in 2010. They encouraged policy makers to use current information on "the true costs of healthy eating" as they consider cuts to the program. They say proposed cuts to SNAP would "decrease the amount of benefits available for food purchases, and fewer people would have access to the program."

President Trump's 2018 budget proposal calls for $191 billion in cuts to the SNAP program over 10 years, a cut of more than 25 percent. The cuts would largely come from requiring a "state-match" that would shift 25 percent of the cost of the program to states by 2023, while giving them flexibility to cut benefits.

The U.S. House of Representatives' 2018 budget proposal calls for even deeper cuts, which are "$4.87 billion below last year's level and $2.6 million below the president's budget request," the House Appropriations Committee said in a June 27 news release. The Senate has no budget proposal yet.

“This research highlights how modest these benefits really are, which is something a lot of people, including many policymakers, probably don't realize. In Kentucky, it's just $1.36 per person per meal," Ashley Spalding, research and policy associate for the Kentucky Center for Economic Policy, said in a telephone interview. “And so with benefits already this modest, the recently proposed federal cuts would be devastating for our state.”

As of February, 651,889 Kentuckians received SNAP benefits. Of those, 41 percent were children, 25 percent were elderly or disabled, 52 percent lived in a rural county, and about 36 percent were working, Spalding wrote for the Ky Policy Blog, which details the impacts of the proposed SNAP cuts on Kentucky.

Kentucky Center for Economic Policy table 

Spalding notes that Eastern Kentucky would have the most to lose from cuts, because the state's 5th Congressional District has the sixth largest number of households on the program.

She also cites studies that show how SNAP lifts people out of poverty, and that people who receive SNAP when they are children have improved academic achievements, are more likely to graduate from high school, and ultimately have better long-term health outcomes.

Spalding said Kentucky is in no position to take on additional funding responsibilities for SNAP, as proposed in the Trump budget. The state ended the 2017 fiscal year on June 30 with a $138 million shortfall, and is projected to end the 2018 fiscal year with another $200 million shortfall. Gov. Matt Bevin recently ordered a 17 percent budget cut across most state agencies.

The Kentucky Association of Food Banks, representing seven food banks, distributed the equivalent of 58 million meals last year, which doesn't even meet the demand, Tamara Sandberg, the executive director of the Kentucky Association of Food Banks, said in a Lexington Herald-Leader op-ed .

"Despite the large volume of food distributed by our network each year, we struggle to keep pace with the demand because of the high need for food assistance in Kentucky," she wrote.

Sandberg urged the Kentucky congressional delegation to oppose any budget cuts to SNAP and other poverty-reduction programs. She noted that 65 percent of households served by the food banks also receive SNAP benefits.

She said, "Despite our best efforts to meet the need for food assistance among our neighbors, Kentucky’s food banks could never make up the difference if SNAP was cut."

School lunch rules relaxed: USDA delays lower salt limit, allows 1% milk, lets states exempt schools from whole-grain rule

Lunch at school in Henderson (The Gleaner photo)

Schools won't have to cut salt until 2020, and can serve 1 percent fat milk instead of nonfat milk, and states can allow some schools to serve fewer whole grains, under relaxed nutrition guidelines announced May 1 by U.S. Agriculture Secretary Sonny Perdue.

The announcement reversed the standards championed by former First Lady Michelle Obama in response to increasing obesity among children, but was welcomed by many school nutrition directors.

Mike Sallee, nutrition coordinator for Elizabethtown Inde­pendent Schools, told The News-Enterprise that he had been trying to figure out how to reduce the amount of sodium in meals to 935 milligrams from 1,230 mg, a “huge challenge” because food producers also would have to adjust to using lower amounts of sodium.

Josey Crew, nutrition director for Hardin County Schools, agreed. “It was kind of getting ridiculous with how they wanted to go,” she said, adding that the new rules might also help discourage food waste.

Crew and Sallee told the Elizabethtown newspaper's Katherine Knott that they are waiting for more guidance from the Kentucky Department of Agriculture on the changes. The new rules allow states to "grant exemptions to schools struggling to meet the whole-grain requirement for the 2017-18 school year," Knott writes. "Currently, all grains served must be whole-grain rich."

The National Parent Teacher Association said it was disappointed in the changes. “One in six adolescents is obese, while one in five faces hunger on a daily basis,” President Laura Bay said in a news release. “Critical progress has been made to provide children with healthier foods in schools. It is important that we build on this progress and do not go backward.”

However, "The changes were supported by the School Nutrition Association, the national organization for school nutrition professionals," Knott notes. "They have lobbied for more flexibility since requirements went into place in 2012."

Crew told Knott that complying with the 100 percent whole-grain requirement initially was difficult, especially for pizza: “To find a whole grain crust that tastes good was hard.” However, food manufacturers adapted, and “Now it tastes good. They figured out a good way to make it.”

Though the regulations are being relaxed, they have been in place for several years and the new offerings are "more accepted by students," Knott reports. "For younger students, it’s all they know when it comes to school lunches, Crew said."

With pushes from Obama administration, Kentucky schools focused more on health; example: less junk food is available

Lexington Herald-Leader file photo

Sugary drinks, fatty snacks and chocolate candy are becoming harder to buy in Kentucky schools, which are paying more attention to health issues, according to the latest survey by the federal Centers for Disease Control and Prevention.

The CDC's latest biennial School Health Profiles for 2014 found big declines in the availability of junk food since 2014. Here are the specifics:

• Chocolate candy: 7.8 percent in 2016, down from 22.6 percent in 2014
• Salty snacks that are not low in fat: 13.7 percent in 2016, down from 26.1 percent.
• Cookies, crackers or other baked goods that are not low in fat: 12.0 percent in 2016, down from 24.1 percent.
• Soda or fruit drinks that are not 100 percent juice: 15.7 percent in 2016, down from 33.1 percent in 2014.

There was also a big increase last year in the number of Kentucky schools that banned less nutritious foods and beverages from being sold in fundraising, up to 36 percent from 23 percent in 2014, a news release from the state Department of Education said.

Schools are systematically paying more attention to health issues. The survey found that 66 percent have used the CDC’s School Health Index or another self-assessment tool to evaluate them in the areas of physical activity (66 percent in 2016, 56 percent in 2014), nutrition (62 percent in 2016, 53 percent in 2014) and asthma (35 percent in 2016, 21 percent in 2014).

More schools are offering opportunities for students to participate in physical activity before the school day through organized activities or access to facilities or equipment: 29.4 percent in 2016, up from 19.3 percent in 2014.

"Nearly three-fourths of schools have one or more groups such as a school health council, committee or team that offers guidance on the development of policies or coordinates activities on health topics," the release said. "There were such groups in 74.7 percent of schools in 2016, up from 63.8 percent in 2014."

The department and the Kentucky School Nutrition Association attributed the improvements to the Healthy, Hunger-Free Kids Act that Congress passed 2010, the U.S. Department of Agriculture’s "Smart Snacks in School" regulation of 2014 and a review of the state education department’s Practical Living Career Studies program.

Janet Tietyen Mullins, a University of Kentucky extension professor of food and nutrition, said the improvements are encouraging, "because they can help Kentucky students reduce their risk of developing diabetes and other chronic diseases," Valarie Honeycutt Spears writes for the Lexington Herald-Leader.

Mullins told Spears, “These changes in the school food environment are a positive way to help students choose more nutritious foods. Everyone benefits from an environment where healthy foods are readily available, and the changes could also benefit school staff and guests.”

Read more here: http://www.kentucky.com/news/local/education/article143288254.html#storylink=cpy

Baptist Health Corbin and Mountain Comprehensive Health, Whitesburg, get USDA grants to treat addiction via telemedicine

By Melissa Patrick
Kentucky Health News

The U.S. Department of Agriculture has awarded a $720,000 grant to Baptist Health Foundation Corbin Inc. and Mountain Comprehensive Health Corp. in Whitesburg for telemedicine programs that focus on mental health and addiction treatment.

These grants are part of the $1.4 million that the USDA announced in June for five Appalachian projects in Virginia, Tennessee and Kentucky to fight opioid abuse in the high-poverty "StrikeForce" areas and southeastern Kentucky's "Promise Zone," both Obama administration initiatives that steer federal money to areas with persistent economic hardships.

Baptist Health Corbin was awarded $377,121 to help connect clinical specialists through telemedicine to 10 school-based health centers, two primary-care sites in Williamsburg and Barbourville, and Grace Community Health Center.

“Partnering with Grace Community Health Center, telemedicine will offer a unique opportunity to maximize resources and reach isolated communities with healthcare services that are not otherwise available,” Baptist Health Corbin President Larry Gray said in a news release. "While this project cannot address the economic barrier of poverty directly, a telemedicine program can ease the financial burden of accessing care.”

Baptist Health Corbin has one of the largest behavioral health facilities in Eastern Kentucky, The Briscoe Clinic, which provides services to about 750 people a month and has a 200-person waiting list, according to Chris Holcomb, executive director of behavioral health at Baptist Health Corbin. Holcomb said the hospital has enough providers, but not enough office space.

"By utilizing telemedicine technology, we can meet the needs of more people and reduce the waiting list without the financial burden of expanding space," he said, adding that the technology will also decrease transportation barriers for their patients as many of them travel over one hour to the clinic to receive services.

Baptist Health Corbin expects to start providing behavioral health and addiction services through telemedicine in the summer of 2017.

"Our telemedicine launch will not only treat the opioid epidemic, but will have a generalist approach treating a wide array of behavioral health issues," Holcomb said. "We plan to individualize care plans and provide medication assisted treatment for those suffering from addiction. We will also provide assessments for medical detoxification and possibly offer intensive outpatient groups for those with chemical dependency issues."

The telemedicine program at the 10 school clinics will offer continuing education and training for teachers around suicide prevention and drug awareness and will also provide acute behavioral health and addiction screening and assessment for the students.

"By providing in-school assessments, it should help to reduce academic absences and reduce ED visits," he said.

Mountain Comprehensive Health Corp. was awarded $343,600 for its program to expand its telemedicine services to residents who face economic and transportation challenges.

MCHC will initially only offer primary-care services through its telemedicine program, but will expand its services to include behavioral health and addiction services after it has finished building its behavioral-health program, Chris Bates, corporate compliance officer and grant writer for MCHC, said in a telephone interview.

Bates couldn't promise when the telemedicine program would start offering behavioral health and addicition services, but said he expected it would be within one to two years.

MCHC has only one behavioral-health provider, but will add one more next month, and is looking to add four more. Bates noted that this staff is funded through a grant from the federal Health Resources and Services Administration. 

MCHC will initially offer telemedicine in its 13 school-based clinics and eventually will expand the program to its eight facilities. Bates noted that some of their most rural patients travel hours to the clinics for care and having access to telemedicine will help assure they have access to all of the services they need.

"The demand for behavioral health is unreal," he said. "And the relationship between mental health and physical health is intertwined, so we need the ability to address both," Bates said.

Pineville Community Hospital restructures debt and creates a geriatric psychiatric unit; 326 jobs saved and 12 new ones created

A combination of local, state and federal efforts have saved more than 300 Pineville Community Hospital jobs and created 12 new ones, according to a Kentucky Highlands Investment Corp. news release.

KHIC worked with First State Financial and the hospital to restructure the hospital's existing debt into a $3.1 million Business and Industry Guaranteed Loan from the U.S. Department of Agriculture, which allowed the bank to provide private working capital through a $3 million line of credit from First State, according to the release.

“The $3.1 million USDA loan guarantee is important to the Pineville community in many ways: It provides residents access to quality health care, supports the employment of 326 employees and allowed for the creation of 12 additional jobs,” Tom Fern, Kentucky director for USDA Rural Development, said in the release. “In a time when the region has seen a significant loss of employment, these existing and new jobs being created by Pineville Community Hospital are critical.”

In addition to restructuring its existing debt, the hospital used some of the funds to convert an unused labor-and-deliver wing into a 12-bed geriatric psychiatric unit and used other funds for repairs.

“Research showed this type of service was not being offered within 30-mile radius, which affects more than 38,000 residents," hospital CEO Stace Holland said in the release.

U.S. Rep. Hal Rogers said in the release. “I commend the board of directors for not only diligently working to protect the jobs at this facility, but for having the vision to expand health care in an area under-served for mental-health concerns.”

137 Ky. schools chosen for Fresh Fruit and Vegetable Program; students at one Barren County school have embraced it

Park City Elementary School in Barren County is one of 137 Kentucky elementary schools selected this year to participate in a program that  provides a daily fruit or vegetable snack to every student in the school, Jeff Nations reports for the Glasgow Daily Times.

“Right now we’re doing a lot of fruits, more than vegetables because it seems like our fruits are fresher right now,” Angie Morgan, Park City cafeteria manager, told Nations.“We’re doing bananas, apples, grapes, strawberries, pears — they really like the bananas, they love the grapes.”

Schools chosen for the Fresh Fruit and Vegetable Program, implemented through the U.S. Department of Agriculture as part of the effort to combat childhood obesity, are required to participate in the National School Lunch Program and have 50 percent or more of their students eligible for free/reduced-price meals, according to a Kentucky Department of Education press release. The program requires a yearly application and Park City Elementary is already planning to re-apply. 

Kentucky received $2.95 million in FFVP funding for the 2015-`16 school year, which will provide a fresh fruit or vegetable snack to nearly 59,000 students in the 137 chosen Kentucky schools. Each participating school will receive approximately $50 per student to provide for this program, according to the news release. To see if your school was chosen for this program, click here. 

Teachers say the Park City Elementary students have embraced the daily snack program, but they also note that it offers students an opportunity to demonstrate leadership, connecting the daily responsibility of getting the healthy snack for the classroom to the school's "Leader in Me" initiative. 

“The teachers give the children jobs in their classroom, and (this program) gives a child a job,” Morgan told Nations. “They know that this week, it’s their responsibility to stop and pick up the fruit for the room.”

Teachers have flexibility in when to offer the snacks, with many of them at Park City Elementary incorporating it into daily reading time, Nations reports.

“It becomes almost like a home environment here at school, and they really see it as reading for enjoyment as opposed to reading for an assignment task,” Anthony Janes,  Park City's principal, told Nations. “If you look at data, if you read 20 minutes a day, then you can increase your vocabulary exponentially just by reading for enjoyment.”

Eventually, Park City Elementary plans to offer the students unfamiliar fruits and vegetables, which is one of the goals of the program..

 “Many of our students just aren’t exposed to those options, and to say that they’re going to get kiwi or they’re going to get starfruit, I’m really excited about that for the kids,” Janes told Nations. “It’s an opportunity.”

Students at this elementary school who don't want the snack are asked to place it on a sharing table in their given classroom and any fruits or vegetables not eaten at the end of the day are given to the Run Club for their after-school snack.

UK gets $2.5 million for rural child poverty nutrition center

L-R: Nancy Cox, dean of UK's College of Agriculture, Food
and Environment; Secy. Tom Vilsack; Gov. Steve Beshear.

Kentucky Health News

Agriculture Secretary Tom Vilsack announced at the University of Kentucky Thursday that the Department of Agriculture will give UK $2.5 million to establish the USDA Rural Child Poverty Nutrition Center.

"This program will target child hunger and poverty in persistently poor rural communities by partnering with agencies who have the resources and expertise to make a difference," Gov. Steve Beshear said in a UK news release. "This program will do more than offer aid. It will attack the root causes of child hunger and poverty."

UK will partner with the Altarum Institute and the Southern Rural Development Center to develop the center. They hope to administer grants to as many as 30 impoverished rural areas in up to 15 states. The communities would use the funds to better coordinate existing child-nutrition programs as well as find new ways to target child food insecurity, the release says.

Rural children who live in poverty are some of the most vulnerable, and 85 percent of all persistently poor counties in the U.S are rural. Twenty-six percent of Kentucky's children live in poverty.

Kentucky school nutritionists meet amid some opposition to federal school-lunch guidelines aimed at curbing child obesity

Kentucky schools are working to adjust to the federal nutrition requirements for school lunches, but are facing some opposition from students, parents and some school nutritionists. The U.S. Department of Agriculture guidelines, aimed at curbing childhood obesity, require schools to include a fruit and vegetable with every meal, to switch to 100 percent whole grains by next year, to impose age-based restrictions on calorie and sodium intake, and to serve 1-percent-fat milk. Now the School Nutrition Association, which recently started getting half its money from major food companies, and other groups are supporting legislation to offer a one-year waiver to schools losing money on meal programs.

School nutritionists from all over Kentucky, which ranks high in child obesity, are encouraging students to eat healthier food throughout the school day. "About 700 school cooks, managers and administrators are meeting for a statewide conference this week in Lexington," reports Stu Johnson of WEKU-FM and Kentucky Public Radio. from a meeting of the Kentucky School Nutrition Association.

KSNA President Sabrina Jewell told Johnson that many students in the upper grades are not eating the newfangled meals, and some are even leaving campus to eat elsewhere. Federal funding is based on participation, "so, if they don't eat, then we don't have the money to run our programs. General school taxes and all, they don't pay for school nutrition. We're paid off of the meals that we serve."

However, Jewell said elementary-school children are adapting better to the new standards than middle and high schoolers. The switch "is just taking a little longer than we anticipated," she said. (Read more)

Christian County Public Schools ban brought-in fast food as part of an effort to battle childhood obesity, a big problem in Ky.

Fast food is no longer a lunch option for students in Christian County Public Schools, Margarita Cambest reports for Kentucky New Era after the Board of Education voted to ban "commercially prepared, restaurant meals" Tuesday. Parents have been bringing fast-food meals to schools, even though 14 schools offer free meals under a federal program.

"Prepared foods must now be put in a non-identifiable container to pass the cafeteria doors—essentially meaning no logos," Cambest reports. "Takeout containers and bags must be discarded, and the food placed in a lunch box or brown bag if brought from home. Soda is out as well. The consumption of bottled or canned carbonated beverages during meal times is also forbidden."

Sandra McIntosh, the system's food-service director, "said the decision allows her to enforce a federal mandate that has been questioned by some local principals," Cambest reports. But then she notes that the federal school-lunch program "leaves the authority to control the sale of foods in direct competition with the national program with state and local agencies, according to the United States Department of Agriculture," which runs the program.

Changes in the program, which McIntosh said have made meals "more nutritional" by having "lower fat, more whole-grain and more dark green and red vegetables, have been unpopular with many students and parents.

A study by USDA's Economic Research Service in 2005 showed that "Students in schools that offered greater quantities of fruits and vegetables consumed more of these foods by most measures." And fast food has more calories. Research at the Yale Rudd Center for Food Policy and Obesity says on days that children eat fast food, they consume 126 additional calories and teens consume 310 more calories. The center says 33 percent of children and 41 percent of teens consume fast food daily.

Kentucky children rank third worst among the states for in obesity, with 37.1 percent of them considered either overweight or obese, according to the Child Policy Research Center.

Mayors and AMA say food stamps shouldn't pay for soft drinks

Louisville's Greg Fischer is among 18 mayors asking Congress to ban sugary drinks from purchase under the Supplemental Nutrition Assistance Program, commonly called food stamps.  One day after their June 18 letter, the American Medical Association adopted a policy supporting the removal of sugar-sweetened drinks from SNAP.

In a the letter sent to congressional leaders, the mayors said it is "time to test and evaluate approaches limiting" the use of the subsidies for sugar-laden beverages to fight obesity and diseases linked to obesity, reports Jennifer Peltz of The Associated Press.

At its annual meeting, the AMA took several steps toward controlling the country's increasing obesity problem, including calling obesity a disease, an action that may prompt insurers to cover medical treatments aimed against obesity. “The AMA is working to improve the nation’s health care outcomes, particularly cardiovascular disease and diabetes, which are often linked to obesity,” said AMA President Dr. Ardis Hoven of Lexington. “Removing sugar-sweetened beverages from the Supplemental Nutrition Assistance Program will help encourage healthier beverage choices.”

This isn't the first attempt to ban soda from SNAP. The Department of Agriculture, where the program is housed, turned down such a request from New York City's Mayor Michael Bloomberg in 2010. The city had proposed a two-year experiment to see if a sugary beverage ban would reduce obesity among food-stamp recipients. But, the department rejected the plan and said a soda ban would “perpetuate the myth” that food stamp users make poor shopping decisions, The New York Times reported. Read about Kentucky's SNAP program here.

The soda lobby, the American Beverage Association, said sugary drinks shouldn't be singled out as a cause of obesity. It called obesity "a complex health condition that affects Americans of all income levels." Last year, more than 47 million low-income Americans used food stamps.

Read more here: http://www.kentucky.com/2013/06/18/2683656/18-mayors-limit-use-of-food-stamps.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/06/18/2683656/18-mayors-limit-use-of-food-stamps.html#storylink=cpy

Is there a correlation between food-stamp use and obesity? Some say yes, and that corporations are getting fat in the process

"Who's getting fat off food stamps?" asks ABC News' Alan Farnham, reporting that a record number of Americans -- 46.7 million, or nearly 1 in 7 -- now uses the benefit, known as the Supplemental Nutrition Assistance Program. It cost $72 billion last year, up from $30 billion four years earlier. Budget hawks have targeted the program's swollen size and cost, helping prevent passage of a new Farm Bill. Now Farnham reports, "There are those who say SNAP is making two different constituencies fat -- big corporations and the poor -- the first, figuratively; the second, literally."

In Kentucky -- with its extraordinarily high rate of obesity and, as of June 2012, its 406,689 households on food stamps -- the correlation between those two bears close scrutiny.  Many health advocates who are concerned about Americans' increasing obesity argue that "food stamp purchases should be disallowed for items high in salt or fat or sugar," Farnham notes. Consumer watchdog groups such as Eat Drink Politics similarly argue that food and beverage makers are making a mint from SNAP, and are spending equal portions to oppose legislation antithetical to their interests.

Hard numbers about what the program buys are hard to come by, says the report, in part because the U. S. Department of Agriculture either doesn't have or does not release certain crucial data: "It lacks the legal authority, for example, to require retailers to report what products SNAP participants are purchasing. It knows the dollar value of transactions, but not whether the customer bought Cheesy Puffs or broccoli."

As for the increasing obesity of the poor, data on that problem are readily available, but food stamps' complicity in it is the subject of much debate. Julian Alston, professor of agricultural and resource economics at the University of California, Davis, has studied the question in depth. Alston and his co-authors conclude that food stamp participants are more likely than non-participants to be overweight or obese. Farnham writes that "they don't say food stamps are making them fat. The authors then go on to analyze whether the exclusion of certain food items from program eligibility might make participants healthier." (Read more)