New Kentucky website provides data, maps and charts on how the environment affects human health, county by county

The website's address is Healthtracking.ky.gov.

The state Department for Public Health has launched a new resource for tracking a variety of topics that affect health in Kentucky. 

The website Healthtracking.ky.gov not only includes information and data about how the environment affects human health in a number of ways, but also presents data in map, chart or table formats for subcategories in each topic area. 

For example, under the category of heart disease and stroke, the site also provides information about the age-adjusted rate of hospitalization for heart attacks in each county, the crude rate of hospitalizations for heart attack in each county, and the number of hospitalizations for heart attack in each county. 

Other topics include: air quality, asthma, birth defects, cancer, childhood lead poisoning, chronic obstructive pulmonary disease (COPD), carbon-monoxide poisoning, climate and weather, drinking water, heat-related illness, radon (a naturally occuring, cancer-causing gas) and reproductive and birth outcomes. 

Data on the new site comes from several counrse, including the Centers for Disease Control and Prevention, the Environmental Protection Agency, the Kentucky Cancer Registry, state and local Health Departments and many others. Data can be examined at a state or county level.

The site also offers online maps with information about local health departments, prescription assistance, social vulnerability, and community vulnerability to Covid-19. It is managed by the health department's Environmental Public Health Tracking Program.

Appalachian health researchers discuss work, with three sessions on drugs, and are urged to engage more closely with communities

By Melissa Patrick
Kentucky Health News

A big step toward improving health in Appalachia would be closer relationships between residents of the region and researchers -- who often drop in, gather data and leave.

That's what researchers were told last week as they gathered in Lexington to talk about their work in Appalachia, ranging from opioid disposal programs to air and water quality.

Joyce Bells-Berry of the Mayo Clinic, keynote at the
Appalachian Translational Research Network Summit

Joyce Bells-Berry of the Mayo Clinic said at the eighth annual Appalachian Translational Research Network Summit that it was time for Appalachian researchers to stop "helicopter" research and truly engage with communities in the region.

"Community engagement allows us to get to the why so that we can answer our research questions in a way that is pivotal for changing the lives of those around us, in a way that builds partnerships and mutual respect, while taking into consideration the needs of those around us, not just our needs as the academics," said Bells-Berry, a professor of epidemiology.

Scott Lockard, director of the Kentucky River Health Department, who is collaborating on a syringe-exchange project with the University of Kentucky, said he agreed.

"We don't like helicopter researchers," said Lockard, a native of Wolfe County. "We've been studied enough."

Lockard said Appalachian Kentucky is "ripe for collaboration" with researchers who will come to the region to work with residents and help communities find their own solutions to health issues, and be prepared to answer this question: "At the end of the day, does our research improve the lives of everyday Kentuckians?"

And, for that matter, all Appalachians. The Appalachian Translational Research Network is nine institutions in the major Appalachian states (Kentucky, Ohio, Pennsylvania, North Carolina and Tennessee) that collaborate to strengthen research and training efforts in the region. Its stated mission is to "catalyze translational research among partnering institutions serving Appalachian communities to synergistically improve the health of these communities."

Drug disposal programs questioned

One of the many presentations at the summit, held Sept. 20-21, involved researchers from UK and Wake Forest University who are working on finding ways to improve prescription-drug disposal programs in Appalachia. These programs include drop boxes, organized take-back events and drug-deactivation products that can be used at home.

Mark Wolfson, co-director of Wake Forest's Center for Research on Substance Abuse and Addiction, told the group that "best estimates" show that only 30 percent of all medications with abuse potential are used as prescribed, leaving 70 percent either unused or inappropriately used.

Kentucky has embraced organized drug-disposal programs as part of its strategy to curb the opioid epidemic. The state Office of Drug Control Policy says Kentucky has 198 drop boxes in 116 counties, with sites being added daily; many locations participate in twice-yearly national take-back days for prescription drugs, with the next one on Oct. 27.

A new state law requires pharmacists to tell customers how to safely dispose of controlled substances, and either provide or offer to sell them a product designed to neutralize drugs for disposal -- or provide on-site disposal. Kentucky is participating in a pilot program to provide drug deactivation pouches in Floyd, Henderson, McCracken and Perry counties.

But research indicates that the program is not effective. Wolfson said a study by East Carolina University, using Kentucky data, found that less than 1 percent of controlled medications that were unused were being collected in drop boxes.

Donald Helme, professor in the UK College of Communication and Information, is working with Wolfson. He has found through focus groups, moderated discussions of a few people, that hardly anyone knows about the drop boxes -- and even if they do, there is great skepticism about handing over drugs to government agencies, which house most of the drop boxes. 

"One of the main things that came up" in the focus groups, Helme said, is "Do not use law enforcement, do not use EMS, do not use the fire department to promote this, because they don't trust them."

Helme and Wolfson will design and test a drug-disposal messaging campaign for the five counties in the study, in hopes of justifying a bigger campaign in the future. It is being conducted in conjunction with health departments in Bell, Whitley and Floyd counties in Kentucky and Burke and Wilkes counties in North Carolina.

Environmental health issues explored

Along the theme of community-engaged research, Ellen Hahn, deputy director and community-engagement core leader at UK's Center for Appalachian Research in Environmental Sciences, or UK-CARES, talked about her efforts to "match-make" researchers who are working on air and water quality issues with Appalachian communities.

Hahn, a nursing professor and director of BREATHE (Bridging Research Efforts and Advocacy Toward Healthy Environments), said part of their efforts involve citizen science projects. As an example, she pointed to an air-quality project conducted by students and teachers at Perry County Central High School and UK, described in a video:



Keeping pre-diabetes from becoming diabetes

Dr. James Keck, assistant professor in UK's Department of Family & Community Medicine, talked about his research around increasing access to the Diabetes Prevention Program, an evidence-based lifestyle program that helps people with pre-diabetes to keep the disease from progressing.

Keck said that like the rest of the nation, about one in three Kentuckians have pre-diabetes, a condition that increases the likelihood that a person will eventually be diagnosed with diabetes without preventive intervention.

He said the one-year prevention program has been hamstrung by a general lack of knowledge about it by both patients and clinicians, as well as its cost, which runs about $700 a year. But he added that more and more insurance plans, including UK health insurance and Medicare, now pay for it.

Recognizing the challenges of bringing such a program to rural Kentucky, Keck said his next project will be to to determine if a free, six-week diabetes program offered by Kentucky Homeplace community health workers is as effective as his year-long program.

Studying syringe exchanges

Hilary Surratt, associate professor at UK's College of Medicine, is researching syringe-exchange programs in Appalachian Kentucky.

In collaboration with the Clark, Knox and Pike county health departments, Surratt's research includes  injection-drug users who use the exchanges as well as those who don't. It will also include interviews with community stakeholders, who are both for and against the exchanges. The goal of the research is to understand the many barriers to access and to identify strategies to increase uptake.

Surratt found that among 175 exchange participants, 46 percent said their primary drug of injection was crystal methamphetamine; 27 percent said buprenorphine ( a drug typically used to combat drug addiction), and 17 percent said heroin.

Of particular concern was that more than one in three said they had shared needles and syringes with other injection-drug users in the past three months. And the average number of times they said they had injected in the past month was 80, while the median number of syringes they reported getting was only 50.

One of the main purposes of a syringe-exchange program is to prevent the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among injection-drug users.

Surratt also found that nearly 40 percent of the exchange participants said they had a personal history of overdose, but only 14 percent said they had access to Narcan, an anti-overdose drug.

She showed a map with the ZIP codes of the interviewees, representing 10 counties, illustrating the great distances drug users must travel to get clean needles.

"When I see something like this, it says to me that we need to think of innovative kinds of solutions to keep engaging people," she said. "Because we know over time that distance is a barrier to consistent use of these programs."

Members of the Appalachian Translational Research Network are UK, Wake Forest, East Tennessee State University, The Pennsylvania State University, The Ohio State University, Ohio University, the University of Cincinnati and Marshall University in Huntington, W.Va.

Interior Department official met with coal industry lobbyists before canceling study on health effects of surface mining in Appalachia

A top official in the Department of the Interior met repeatedly with coal-industry lobbyists shortly before canceling a study on the public health effects of surface mining, Jimmy Tobias reports for the Pacific Standard.

Katharine MacGregor

Katharine MacGregor, the principal deputy assistant secretary for land and minerals management, oversees the Office of Surface Mining Reclamation and Enforcement. OSM hired the National Academies of Science, Engineering and Medicine to do the study, but Interior abruptly suspended it last August, as researchers were about to hold their final public meetings on it. The meetings were held, and researchers said they expected to continue after a budget review that Interior had cited as the reason for the suspension, but then Ken Ward Jr. of the Charleston Gazette-Mail revealed that the study was the only one suspended. Later, the contract was canceled and the research committee disbanded.

Tobias writes: "Emails obtained through a FOIA request show that Katharine MacGregor had a hand in ensuring the health study's cancellation. Indeed, she appears to have been keenly interested in the matter." She wrote the OSM director Aug. 17: I thought you told me on the phone that this was postponed?" The next day, OSM suspended the work.

“This is the very essence of what we mean when we describe Appalachia as a sacrifice zone,” said Bob Kincaid, president of Coal River Mountain Watch, a group fighting mountaintop-removal mining. Bo Webb, coordinator of the Appalachian Community Health Emergency campaign, which helped prompt West Virginia officials to ask for the study, said in the same press release, "It’s clear now that canceling this study was a gift to the coal industry.."

Tobias reports that "in the months leading up to the cancellation," MacGregor's calendar "shows that she had no fewer than six meetings with the most powerful mining players in the country. In both April and May of 2017, she met with the National Mining Association. In March and June, meanwhile, she met with Arch Coal, a long-time practitioner of mountaintop removal mining in Appalachia."

The evidence is circumstantial, but Tobias sees a broader trend in MacGregor's calendars: "At the same time she held a mere handful of meetings—fewer than 10, according to my tally—with conservation organizations like The Wilderness Society and Sportsmen for the Boundary Waters." The calendar sshow that she "appears to have a habit of meeting repeatedly with industries and organizations that later receive favorable treatment from agencies she helps oversee," Tobias writes. An Interior spokesperson told him MacGregor is "happy to make time to meet with whomever requests a meeting," including conservation groups. "We have always welcomed input from all citizens and will continue to listen to ideas and concerns from anyone interested in sharing them."

Denied federal funding, study on the health effects of mountaintop-removal coal mining has been abandoned

"After Trump administration officials ordered a halt to a study on the health effects of mountaintop removal last fall, the study’s committee has been released, effectively terminating the project," Kate Mishkin reports for the Charleston Gazette-Mail.

"The National Academies of Sciences, Engineering and Medicine’s study would have looked at the health effects on residents who live near mountaintop removal coal-mining sites. It was put on hold when the Department of the Interior’s Office of Surface Mining announced that it was reviewing grants and agreements that would cost more than $100,000."

An Interior spokesperson did not answer any questions about why the study was terminated and whether it might be revived in the future. Riya Anandwala, a spokesperson for the National Academies, would not speculate on the reason for the study's termination, but told Mishkin it was "not unprecedented, but it's very rare."

Louisville adds electronic cigarettes, hookahs to smoking ban

Electronic cigarettes and hookahs are now included in the smoking ban of Kentucky's largest city. The Louisville Metro Council voted 15-6 Tuesday night to expand its anti-smoking ordinance.

“Neither e-cigs or hookah can be deemed safe or healthy for human consumption,” said Council Member Vicki Aubrey Welch, the legislation's sponsor. Welch, a Democrat, said council members compromised with local business owners who were concerned "about the measure’s likelihood to reduce retail activity," Jacob Ryan reports for WFPL.

"Consumers can still sample electronic cigarette flavors, under the measure, and certain hookah lounges will be exempt from the regulations," Ryan reports.

Mayor Greg Fischer, a Democrat up for re-election next year, asked in February for the expansion of the ban enacted in 2008. Opposition was bipartisan.

Council Member Kevin Kramer, a Republican, "said he’s been provided with little evidence that hookah products are detrimental to users’ health," Ryan reports. Council Member Mary Woolridge, a Democrat, "called the ordinance an overreach of government regulation."

“I don’t know where all this concern is, when we have to breathe the air in West Louisville and Rubbertown,” Woolridge said, referring to chemical plants on the west side of the city. Neighboring Council Member Jessica Green, another Democrat, called the move a Fischer "publicity stunt."

The move drew praise from the Foundation for a Healthy Kentucky. "These products emit dangerous toxins into the air that are known to cause cancer and other debilitating illnesses," said Ben Chandler, president and CEO of the foundation. "While the expanded ordinance includes some regrettable exemptions that will leave some Louisvillians unprotected, this is a step in the right direction toward cleaner air and reduced health disparities."

Federal study in Central Appalachia will try to see if living near a surface coal mine is bad for your health

Scientists from the National Academies of Sciences, Engineering and Medicine will study Eastern Kentucky, West Virginia and the coal regions of Virginia and Tennessee to determine if living near a surface mine increases the risk of health problems, Bill Estep reports for the Lexington Herald-Leader.

"A number of studies have shown that mountaintop mining is associated with higher rates of cancer, heart disease and other health problems in Central Appalachia," Estep writes. "Michael S. Hendryx, a professor who did several of the studies while formerly at West Virginia University, told the Herald-Leader last year that the studies were adjusted to account for factors such as higher rates of smoking and obesity in the region."

"However, the coal industry has fiercely disputed the studies, and a 2012 industry-funded study by a Yale University researcher and others concluded that 'coal mining is not per se the cause of increased mortality in rural Appalachia,'' Estep writes. "The study by the National Academies could identify gaps in existing research and help settle some of the uncertainties about the issue."

The U.S. Office of Surface Mining Reclamation and Enforcement, which commissioned the two-year study, "said the research agency would choose experts to examine a 'growing amount of academic research that relates to possible correlations between increased health risks as a result of living near surface coal mine operations,'" Estep writes. "The study will involve synthesizing existing research, not conducting new field studies." (Read more)

UK research project will create strategies to improve respiratory health for those living in Appalachian Kentucky

Public health researchers at the University of Kentucky will undertake a five-year long research project called "Community-Engaged Research and Action to Reduce Respiratory Disease in Appalachia," Sarah Noble writes in a UK press release.

Funded by the National Institutes of Health's National Institute of Environmental Health Sciences, the project will involve creating strategies to improve respiratory and environmental public health. Kentuckians living in Appalachian counties have the state's highest rates of serious respiratory illness.

"Adults in Appalachian Kentucky are 50 percent more likely to develop asthma or chronic obstructive pulmonary disease than the overall U.S. population," Noble writes. "As many as one in five adults in the region have received a diagnosis of asthma, and rates of COPD are nearly two-and-a-half fold the incidence of the disease in other parts of the country.

Although studies show associations between respiratory health problems and environmental contaminants, data doesn't yet include individual-level assessments or behavioral risk factors common in the area—such as smoking, poor diet and insufficient physical activity. The "Community Response to Environmental Exposures in Eastern Kentucky" project will fill those gaps.

The CREEEK project will include three steps. A community-based assessment will "identify the relationships between indoor air pollutants, behavioral and social determinants and the effects these factors have on risk of respiratory disease," Noble writes. That information "will be shared with local stakeholders in an effort to increase understanding of the environmental exposures present in the region," then the project will put in place "an environmental public health action strategy and will evaluate that strategy's ability to impact short-and long-term outcomes for respiratory health."

West Virginia to involve Kentucky in examination of studies that link health problems to mountaintop-removal coal mining

Kentucky Health News

The administration of Democratic Gov. Earl Ray Tomblin of West Virginia "said Tuesday that it would initiate an evaluation of the growing body of studies that have found residents living near mountaintop removal coal-mining operations face increases risks of serious illnesses and premature death," Ken Ward Jr. reports for The Charleston Gazette. Studies have found correlations between mountaintop removal and cancer, birth defects and the endangerment of freshwater species.

Dr. Rahul Gupta, commissioner of the state Bureau for Public Health, "said that his agency would work with the state Department of Environmental Protection to examine the issue and to seek help from various federal scientific and regulatory agencies to review existing research on the subject," Ward writes. “The analysis is something that is needed going forward,” Gupta said. “The bottom line here is to let science speak for itself. It’s time that we attempt to do that.”

"Gupta said that his plan would 'engage surrounding states' such as Kentucky and Virginia to 'evaluate the scientific research being conducted by academia, non-profit groups, and others with an emphasis on peer-reviewed research to better understand the issues,'" Ward writes. "Also, Gupta said, his agency would work with the DEP to ask 'federal partners'—such as the U.S. Environmental Protection Agency, the Centers for Disease Control, and National Institutes of Health, and the federal Office of Surface Mining—to 'seek relevant subject matter expertise allowing for the exploration of a federal-state, multi-agency partnership to conduct analysis of the existing research in the field.'" (Read more)

Study: Secondhand smoke and road pollution contribute to obesity in children more in combination than separately

Diet and physical activity aren't the only causes for the obesity epidemic that is sweeping our nation; a recent study finds that secondhand smoke and roadway pollution are also contributors, Ryan White writes for Reporting on Health.

Photo by ctvnews.ca

Researchers at the University of Southern California have found that secondhand smoke and roadway pollution contribute to body-mass-index increases and obesity in children. The study is published in Environmental Health Perspectives.

“Our findings strengthen emerging evidence that exposure to tobacco smoke and [near-roadway pollution] contribute to development of childhood obesity and suggest that combined exposures may have synergistic effects,” the study’s authors write.

The study collected data on 3,318 students through home questionnaires about tobacco exposure in homes, and scientifically estimated each student's exposure to roadway pollution, White reports. Meanwhile, the student's BMI was measured annually between ages 10 and 18. "BMI levels estimate body fat based on height and weight. “Normal” weight scores range from 18.5 to 24.9, with higher figures considered overweight and 30 the threshold for obesity"

The study allowed for a long list of "confounding variables," or other factors that might be responsible for these elevated BMIs, including: team sports participation, asthma history, social makeup of family and neighborhood, parents’ education, neighborhood walkability, recreation facilities, population density, unemployment rates and so forth, White reports.

"After crunching the data, researchers found that exposure to high levels of roadway pollution alone was associated with average increases of 0.80 BMI units over the eight-year study, while children with secondhand smoke exposure and low roadway pollution averaged 0.85 units higher, compared to similar peers. But when investigators looked at children with high exposures to both tobacco smoke and air pollution, their BMIs were on average 2.15 higher over eight years," White writes.

This is the first study to look at tobacco smoke and air pollution in combination. Other studies have looked at each of these contributors independently and found "secondhand smoke is associated with increased obesity risk in children and patterns of overweight children from mothers who smoked during pregnancy are well documented," White writes. Another study associates "prenatal exposure to roadway pollution with higher BMI and obesity by age 7."

But White notes that socioeconomic status, while ruled out as a "confounder," must still be considered as those who have a lower socioeconomic status are more likely to smoke, live in neighborhoods bisected by busy roadways, have less access to healthy foods and fewer places to exercise.

In selling proposed limits on CO2, Obama administration emphasizes health improvement, not climate-change fight

By Melissa Landon and Al Cross
Kentucky Health News

As it announced its plan to reduce carbon dioxide emissions from power plants by 30 percent by 2030, the Obama administration emphasized the health angle, not climate change, which has been the driving force for the proposed regulations but is a more controversial cause than improving health.

"For the sake of our families' health and our kids' future, we have a moral obligation to act on climate," EPA administrator Gina McCarthy said in her announcement.

Juliet Eilperin and Steven Mufson note in The Washington Post that when a climate bill stalled in the Senate four years ago, environmental and public health activists began pressuring Preisdent Obama to mandate carbon limits. Opponents to the measure include coal producers, some utilities and many Republicans, who say that the EPA has not proposed a plan that can work using current technology.

Under the new rules, states would use different strategies—such as energy efficiency, shifting from coal to natural gas, investing in renewable energy and making power plant upgrades—to achieve state-by-state goals. The reductions will be measured from 2005 levels; Environmental Protection Agency data reveal that power plants in the U.S. have already diminished carbon dioxide emissions by almost 13 percent since 2005, The Associated Press reports.

EPA estimates the rules will prevent as many as 6,600 premature deaths, 150,000 asthma attacks in children, up to 490,000 missed work and school days—saving $93 billion, Connie Hedegaard writes for EurActiv. The federal Centers for Disease Control reports that "exposure to particle pollution may cause worsening asthma symptoms, breathing problems, adverse birth outcomes, lung cancer and early death," Healio reports.

The new rules are intended to assist Washington in achieving international obligations to reduce U.S. greenhouse gas emissions deemed responsible for global warming, but Obama is focusing on the human health benefits to encourage Americans to adopt the movement, Jeff Mason wres for Reuters.

Although federal law has been employed to regulate other pollutants—such as soot, mercury and lead—this is the first time it has been applied to greenhouse gases, Fox News reports, quoting Obama: "We limit the amount of toxic chemicals like mercury, sulfur and arsenic that power plants put in our air and water. But they can dump unlimited amounts of carbon pollution into the air. It's not smart, it's not safe, and it doesn't make sense."

Poor air quality can make it hard for kids to succeed in school

Poor air quality in schools can affect children's health and inhibit their learning, one Kentucky school board heard recently as it considered a proposal to improve energy efficiency and air quality at a school about to be renovated.

Representatives from Harshaw Trane proposed a computerized energy system to the Christian County Public Schools board that promises to control air quality and cut energy use, and therefore cost, over time, Magarita Cambest reports for the Kentucky New Era of Hopkinsville.

The company said the additional cost of the system at Pembroke Elementary would be more than recouped over time, and "will reduce absenteeism, improve energy efficiency and raise test scores," Cambest reports. Kathy Hancock, the district's chief administrative officer, said dirty air filters make students breathe more carbon monoxide, making it harder for them to stay awake and do well in school.

The district's current system requires changing 2,283 filters monthly, Facilities Coordinator Ted Hautala said.  He suggested that replacing better filters less often would save the district money. Kyle Johnson, a Harshaw Trane representative, said the program saves the Bullitt County School System “at least half a million dollars a year.” (Read more; subscription may be required)

Indoor air study is background for smoking-ban discussion in Elliott; statewide ban sponsor is optimistic about a vote

As the debate over a statewide smoking ban persists, a study shows evidence of harmful air quality levels from second-hand smoke in places where smoking is allowed in Elliot and Lawrence counties. The researcher, the sponsor of a statewide smoking-ban bill and a skeptical legislative leader talked about the issue this month at a meeting of the Elliott County Chamber of Commerce.

The study, funded by the Kentucky Cancer Consortium, found indoor air pollution that slightly exceeded the Environmental Protection Agency's national ambient air quality standard for outdoor air, reports Kenneth Hart of The Independent in Ashland. There is no EPA standard for indoor air,

The study also found that air pollution levels averaged higher in Elliott and Lawrence counties than in Georgetown and Lexington, where laws banning smoking in building have been implemented, Hart writes.

Carol Riker

The study was conducted by trained health department researchers in 11 public venues in the two counties, neither of which have laws prohibiting smoking, from July 2012 to January 2013, Carol Riker, a University of Kentucky nursing professor who reported on the study to the Elliott County chamber.

Smoking was observed in five of the 11 venues tested. Riker said one had a level that was more than double the national outdoor air standard. She said the study pointed to a need for anti-smoking ordinances in the two counties, especially to protect the health of workers in these smoke-filled environments, reports Hart.

According to the Kentucky Center for Smoke-Free Policy at UK, that 38 Kentucky communities have adopted any sort of smoke-free law, and 22 have passed comprehensive ordinances banning smoking in all workplaces and public places.

State Rep. Susan Westrom

The chamber also heard from state Rep. Susan Westrom, D-Lexington, longtime sponsor of a statewide smoking ban. "She was cautiously optimistic that 2014 will be the year the matter finally comes up for a vote in the General Assembly after twice failing to do so," Hart reports. "Westrom said she believed a statewide law was needed to provide some consistency in anti-smoking regulations and because cities and counties have generally been slow to adopt such laws on their own."

House Democratic Floor Leader Rocky Adkins, an Elliott County native, said such decisions should be made locally. "But Adkins — who told the chamber he spent many hours working in tobacco fields and barns as a younger man, but had never taken so much as a drag off a cigarette his entire life — said he was keeping an open mind on the idea a statewide smoke-free law and would consider changing his stance if his constituents indicated they were in favor of it," Hart reports.

Foundation breaks down poll by region to show differences among Kentuckians' views on health topics and issues

The Foundation for a Healthy Kentucky has released regional breakdowns of the Kentucky Health Issues Poll, conducted for it and the Health Foundation of Greater Cincinnati last fall. Each breakdown outlines respondents’ answers to various KHIP questions and then compares regional responses to statewide findings.

Statewide KHIP results showed that most Kentucky adults do not have dental insurance, view health-care costs as a financial burden, favor a statewide smoke-free law, support integration of mental-health and medical services, and say they need more information about how the Patient Protection and Affordable Care Act will impact them personally. The Foundation for a Healthy Kentucky offered these snippets from the regional breakdowns, available by clicking each link:

Western Kentucky: Residents were less likely to have dental insurance and less likely to know someone who had experienced problems as a result of abusing prescription pain relievers.

Greater Louisville: Adults were more likely to have dental insurance, support the legalization of marijuana under any circumstance and be concerned with air quality.

Greater Lexington: Adults were less likely to have been prescribed a pain reliever that could not be purchased over the counter and less likely to change or limit their activities when they hear of an air quality alert being issued.

Northern Kentucky: Adults were less likely to have visited a dentist in the past year and less likely to have a favorable view of the Patient and Affordable Care Act.

Eastern Kentucky: Adults were more likely to rely on home remedies or over the counter drugs instead of going to the doctor and recognize that drug poisonings/overdoses were the leading cause of unintentional death in Kentucky.

“Local health issue data can be extremely useful for policymakers and health officials, especially those working on local initiatives to improve the health of their community,” said Susan Zepeda, president and CEO of the foundation.

The poll was conducted Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati.  A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones.  The poll has a margin of error of plus or 5.3 percentage points. The poll is available online, under the “Data and Reports” tab on the foundation's website.

Kentuckians tell pollsters they are concerned about air quality, but don't seem to put their concern into action

A recent poll shows that more than half of Kentucky adults, especially women, are concerned about air quality in their community, but only 48 percent say they change their behavior when an air quality alert is issued.

Perhaps they have never heard of an air quality alert, which is issued by a local or state air-pollution authority to protect the public's health from air pollution. The U.S. Environmental Protection Agency monitors air quality and uses an Air Quality Index to warn the public when the amount of particle pollution or ozone in the air may harm their health.

When pollution gets to a level of concern, alerts or action days are issued in participating areas, which in Kentucky are Louisville, Lexington and the Mammoth Cave area (primarily Edmonson County). This could explain why almost 30 percent of poll respondents from Louisville said they were very concerned about air quality in their community, and only 13 percent of respondents from Appalachia indicated this level of concern.

Almost 60 percent of Appalachians said they are not concerned at all about the air quality in their community, compared to 26 percent of Louisville respondents that aren't at all concerned. Few Eastern Kentucky counties are part of an air-quality monitoring program. In addition to the areas monitoring for alerts or action days, 37 Kentucky counties (colored in the map) participate in the monitoring program. Click here to compare counties.

Counties covered by an air-quality monitoring program are colored.

The poll indicated that just 20 percent of Kentucky adults said they change or limit their activities a lot when air quality alerts are issued, and about 30 percent said they change their behavior a little.  Respondents from the Louisville region were most likely to change or limit their activities, while those in the Lexington area were the most likely to not change or limit their behavior at all. 

When air quality is at an unhealthy level, people can protect themselves by limiting outdoor activities or avoiding heavy exertion.  These protective measures are even more important for those sensitive to air pollution, such as people with heart or lung disease, the elderly and children.

“The quality of our air impacts all of us, but is particularly important for sensitive groups, such as children with asthma. When an air quality alert is issued, we can protect ourselves and our families by avoiding heavy exertion and limiting outdoor activities,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “We can also do our part to limit emissions and protect our neighbors by turning off our car’s engine while we are waiting.” 

Almost 30 percent of Kentucky adults and 40 percent of Western Kentucky adults said they never turn their car’s engine off when waiting in their car and not moving, as in a traffic jam, train crossing or drive-through. Including those who never turn off their cars, more 60 percent said they wait at least four minutes before turning off their car’s engine when waiting in the car and not moving. Experts recommend turning off a waiting car’s engine after just ten seconds in order to save gas and limit emissions.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati and was conducted last year from Sept. 20 to Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones and the poll has a margin of error of plus or minus 2.5 percentage points.

Study suggesting that coal is a cause of health problems in E. Ky. is disputed by industry and politicians, defended by researcher

By Molly Burchett
Kentucky Health News

A heated debate centers on new research showing that residents in Floyd County, where coal is stripped from the tops of mountains and ridges, report more health problems than those in two nearby communities without such mines, Elliott and Rowan.

The study, published in the online Journal of Rural Health, is the latest by Dr. Michael Hendryx of West Virginia University to suggest that residents of mining areas have poorer health conditions and experience more serious illness. It is available to readers of Kentucky Health News by clicking here.

Unlike some of his West Virginia research, Hendryx does not say there is a correlation between mining and poorer health outcomes in Eastern Kentucky. He does suggest the possibility of a connection by showing residents' self-reported health problems like asthma, chronic obstructive pulmonary disorder and hypertension are more common in mining areas. And in an interview, he said he believes there is a connection.

Stonecrest Golf Course at Prestonsburg in Floyd County,
built on a reclaimed mountaintop-removal coal mine.

The study and its critics highlight the challenges and pitfalls of discussing and reporting such research. The study's underlying motives and methodology are contested. The president of the Kentucky Coal Association, Bill Bissett, said Hendryx has reached a conclusion and is seeking evidence to support it.

"Bissett's accusation is completely false," Hendryx replied. "On the contrary, he is obviously the one with the biased perspective and has a strong financial motivation to try to discredit this work."

Bissett questions the study's use of self-reported health measures that did not consider medical history. Self-reporting is susceptible to bias, which can be reduced by using other sources of data/. This study only included data collected from interviews conducted by volunteers, which may have introduced more bias, Bissett said.

Hendryx replied, "We used undergraduate students from Christian colleges who were trained to be fair and objective in the survey procedures, and to use the same procedures in both the mining and non-mining communities." He said Peter Illyn, who runs the Christian organization Restoring Eden, approached him to do the survey because Illyn "wanted to give the students this experience, and he wanted to replicate the survey that we had done the previous year in West Virginia, this time in Kentucky."

The volunteers interviewed 544 participants lived in Floyd County and 351 in Rowan and Elliot counties, where coal is not mined. It used standard statistical devices to control for factors that might influence health status: age, sex, education, marital status, work as a coal miner, weight and tobacco habits. However, there was no consideration of health behaviors such as drug and alcohol use, wellness measures, exercise or other healthy lifestyle habits that could have positive influences.

"The survey had to be brief with the time and resources we had," said Hendryx. "We did measure overweight and obesity, which is a reflection of diet and exercise. We measured tobacco use. We did not measure alcohol use in this survey but in other studies we have found that heavy alcohol use is not common and is not an explanation for the findings."

Kentucky House Speaker Greg Stumbo, who is from Floyd County, said he disagreed with the use of Rowan County, home of Morehead State University, as a control group due to the higher rates of education attainment and per capita income, reported Ronnie Ellis of Community Newspaper Holdings Inc.

Stumbo told Ellis, “Everybody in the world knows that you can take a population that is less well educated and that has a lower per capita income and you’ll see their health habits are (worse) and hence their rates of diseases are attributable to those two things.” Rowan has a much better health status than surrounding counties, according to the latest national County Health Rankings.

Hendryx defended his research controls and the process of relying on self-reported medical histories. He said the health problems may be caused by tiny particles of dust from coal mining, which have been linked to health problems, can penetrate the lungs to cause health impacts, reported James Bruggers of The Courier-Journal. Hendryx said there are also concerns about polluted water and soil.

The study's data only hint at a connection between surface coal mining and poor health. Hendryx said he can’t prove that mountaintop removal is causing people to get sick, but he believes it is. What is needed, he told Bruggers, is a more thorough and expensive “gold standard” study of air and water quality near residences, and samples of blood, hair and toenails that can reveal exposure to pollutants.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Kentucky rated worst in country for power-plant pollution

Kentucky was ranked first in the country for the amount of pollution from power plants in 2009 and 2010, a study by the Natural Resources Defense Council found.

The Paradise Fossil Plant in Muhlenberg County, left, run by the Tennessee Valley Authority, was ranked the nation's top power-plant polluter in 2010. American Electric Power's Big Sandy plant in Lawrence County was ranked fifth, and the Mill Creek station of Louisville Gas & Electric was seventh.

The NRDC's initial report showed a huge increase in Kentucky power-plant emissions from 2009 to 2010, but after The Courier-Journal raised questions about it, the report was corrected. The corrected figures showed that the state remained No. 1 in power-plant pollution. (Read more)