May is Bladder Cancer Awareness Month, and Kentucky ranks high; UK doctor explains it, and how to detect and manage it

Illustration by irkus Creative, iStock/Getty Images Plus

By Dr. Zin W. Myint

University of Kentucky

Kentucky has one of the highest rates of new cancers in the U.S., with bladder cancer in the top 10 list of new diagnoses. Understanding the signs, risk factors and preventive measures is important for early detection and management.

What are the symptoms and signs? The most common symptom of bladder cancer is the presence of painless blood in urine. If you notice blood in your urine, don't ignore it and go to your doctor right away. Other signs to look out for are more frequent urination and an increased urge to urinate, especially accompanied by pain or discomfort. Persistent pain in the lower back or pelvic region that only gets worse over time is also a symptom.

What can increase the risk of developing bladder cancer?

• Smoking is the biggest risk factor. Tobacco smoke contains many harmful chemicals that can damage the bladder lining, increasing the risk of developing cancer.
• Exposure to certain industrial chemicals such as paint, dye, metal processing and petroleum products.
• Family history and genetics. If your family has a history of bladder cancer, you should be tested if you notice any of the symptoms above.
• Some chemotherapy drugs and medications are linked to bladder cancer increased because they can irritate the bladder.
• Environmental factors, including drinking water contaminated with arsenic.
• Chronic urinary tract infections may contribute to bladder cancer development as chronic inflammation causes damage to the protective layer of cells lining the bladder.
• A personal history of bladder cancer is also a risk factor, due to its high recurrence rate.
• Other risk factors include chronic indwelling urinary catheter or history of radiation to the pelvic area.

Is there a screening for bladder cancer? We do not screen for bladder cancer in the general population because current studies do not show sufficient benefit.

How can you reduce risks? Reducing the risk of bladder cancer stars with adopting healthy lifestyle choices and minimizing exposure to known risk factors:

• Quitting smoking is one of the most effective ways to reduce the risk of bladder cancer, creating a healthy bladder lining. We highly advocate for smoking cessation, and individuals who smoke should be actively encouraged to pursue cessation treatments, which may include medication and counseling. It is advisable to engage in discussions with your healthcare provider to explore effective methods for quitting smoking and receive personalized support tailored to your needs.
• Minimize or avoid chemical exposure and take safety precautions when working with chemicals that are known to be harmful. For instance, remember to wear gloves while using potent cleaning agents at home as numerous chemicals can permeate the skin. If you’re employed in a refinery setting, prioritize the use of protective gear. Similarly, if you’re a painter, ensure to work within well-ventilated areas to minimize exposure to potentially harmful substances.
• Stay hydrated. Drinking plenty of water throughout the day is vital for maintaining bladder health, reducing the risk of urinary tract infections, and facilitating the swift elimination of toxins from your system.

Zin W. Myint, M.D., is a medical oncologist at UK Markey Cancer Center.

Several Ky. water systems exceed new federal limits for 'forever chemicals'; all systems must test for 3 years, correct if needed

WKYT map, adapted by Kentucky Health News

By Al Cross
Kentucky Health News

Several Kentucky water systems, mostly on and near the Ohio River, will have to fund ways to reduce certain cancer-causing substaces for which the first federal limits were issued Wednesday, April 10.

The substances are PFAS, a joint acronym for per-fluoroalkyl and poly-fluoroalkyl substances, which are widespread and last a long time in the environment without breaking down, so they accumulate in the human body. They have been linked to low birth weights, liver disease and kidney cancer.

The substances have been used in waterproof clothing, nonstick frying pans and firefighting foam. For example, PFOS was the key ingredient in the fabric protector Scotchgard and related stain repellents, and PFOA was used in carpeting, cloth and sealants.

Public water systems will test for the chemicals for three years. If the limits are exceeded, the new Environmental Protection Agency rules will give them two more years to install treatment systems.

The state Department for Environmental Protection listed these water systems as exceeding the new limits of 4 parts per trillion: Ashland (4.74 PFOA), Augusta (4.43 PFOA), Cynthiana (8.35 PFOS), Georgetown (5.46 PFOS), Lewisport (Hancock County, 12.7 PFOS), Maysville (5.09 PFOA), North Marshall County Water District (11.8 PFOA), Paducah (4.54 PFOS, 4.07 PFOA), Russell (5.62 PFOA), South Shore (23.2 PFOA, 18.9 PFOS). The last two towns are in Greenup County.

The Louisville Water Co.'s Payne Plant at Prospect had a PFOS level of 4.31, but the level at its Crescent Hill plant was only 2.75.

Some water systems exceeded the EPA requirements in at least one test in 2019 and 2023 but were not listed as exceeding the new limits during the period. Those were Brandenburg, the Graves County Water District, Hardin County Water District No. 2, Henderson (north), Kuttawa, Morganfield, Northern Kentucky Water District (Fort Thomas), Owensboro, Providence, Sturgis and Worthington (Greenup County).

Erin Haynes, chair of epidemiology and environmental health at the University of Kentucky, has studied the chemicals for many years. “It’s all around us,” she told WKYT. “So we need to just be conscientious of different sources and how we can do our best to reduce our exposure. But analyzing it and reducing the levels in our drinking water is a wonderful step in the right direction.”

"Some funds are available to help utilities," The Associated Press reports. "Manufacturer 3M recently agreed to pay more than $10 billion to drinking water providers to settle PFAS litigation. And the bipartisan infrastructure law includes billions to combat the substance. But utilities say more will be needed."

UK researcher says chemicals in plastics can speed Alzheimer's

Researchers at the University of Kentucky are studying chemical compounds used in the production of water bottles and their link to Alzheimer's disease. (Photo by monticelllo, iStock/Getty Images Plus)

By Lindsay Travis
University of Kentucky

Researchers at the University of Kentucky are studying how elements of our natural surroundings can be potential risk factors for Alzheimer’s disease — including chemicals widely used in plastics.

“Bisphenols can accelerate Alzheimer’s disease and lead to cognitive deficits. Simply: Be smart and stay smart by avoiding plastics,” says Anika Hartz, the UK professor leading the study.

Anika Hartz, Ph.D., is the lead resarcher. (Pete Comparoni, UK) 

“Identifying environmental risk factors for Alzheimer’s is critical to mitigate cognitive decline in humans,” said Hartz, who holds positions in the College of Medicine and the College of Pharmacy. She is also affiliated with UK's Sanders-Brown Center on Aging, one of the nation’s leading centers on aging, Alzheimer’s disease and related neurodegenerative disorders. It is one of 33 National Institute on Aging-funded Alzheimer’s research centers in the U.S.

The study is funded by a grant from the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health.

Alzheimer’s is a progressive and irreversible neurological disorder. It’s estimated that 6.2 million Americans aged 65 and older are living with the disease that affects cognitive function, memory and behavior.

Hartz and her colleagues are examining three types of bisphenols, chemical compounds used in the production of polycarbonate plastics and epoxy resins. Theys are commonly found in food containers, water bottles and the lining of cans.

“Human exposure to bisphenols is inevitable due to their widespread presence in the environment,” said Hartz. “Our data show that bisphenols trigger blood-brain barrier dysfunction and memory problems, both hallmarks of Alzheimer’s, indicating that environmental bisphenols are a critical yet underrecognized risk factor for the disease.”

Hartz’s research team provided some of the first evidence that the chemicals are a clinically relevant environmental risk factor for Alzheimer’s. Bisphenols are a concern because previous research has shown they can affect the endocrine system, which regulates hormones. The brain plays a complex role in that system.

UK researchers want to better understand how the chemicals’ disruption of the endocrine system impacts the blood-brain barrier function, potentially driving cognitive decline and accelerating Alzheimer’s disease.

“The goal of this project is to develop fundamental knowledge of environmental impacts on human health that will help promote healthier lives and reduce the burden of diseases and conditions related to aging,” said Hartz. “New insights are expected from our study that will open the door for future evidence-based health management aimed at preserving cognition in health and disease.”

The work builds on preliminary data funded by a pilot grant from the UK Center for Appalachian Research in Environmental Sciences. Hartz said, “Without the pilot funding, the strong support of the UK-CARES leadership Drs. Ellen Hahn and Erin Haynes, the entire UK-CARES team, my colleagues Drs. Bjoern Bauer, Kevin Pearson, Richard Kryscio, Bernhard Hennig, Peter Nelson, Scott Stanley and the continuous support from Dr. Linda Van Eldik and the team at the Sanders-Brown Center on Aging, this would have not been possible.”

This study brings together a multidisciplinary group of researchers spanning the colleges of Medicine, Pharmacy, Public Health and Martin-Gatton College of Agriculture, Food and Environment.

UK gets another 5-year grant to study major environmental health impacts on Kentuckians, keeping focus on Appalachian Kentucky

UK press release

The University of Kentucky Center for Appalachian Research in Environmental Sciences will continue its work to study major environmental health impacts on Kentuckians with a renewed award from the National Institute of Environmental Health Sciences, part of the National Institutes of Health.

The $7.4 million grant will run for the next five years. UK-CARES was established in August 2017, with an initial $7.4 million NIEHS grant, making it an Environmental Health Sciences Core Center to enhance research across all spectrums — basic, clinical, epidemiological, and translational.

UK-CARES is focused on studying environmental health effects of air and water quality that are implicated in environmentally induced disease, as well as emerging threats such as flooding and exposure to new contaminants.

Ellen J. Hahn

“Over these last five years, our commonwealth has been through one major event after another, from the Covid-19 pandemic to historic flooding and devastating tornadoes,” said Ellen J. Hahn, professor in the UK colleges of Nursing and Public Health, and director of UK-CARES. “The members of UK-CARES along with our community partners have done critical research to understand and address environmental health impactsWe will continue to learn with and from the community to tackle the environmental challenges facing the state and the health of its people, especially throughout Appalachia.”

The center provides pilot project funding, research expertise, career development, a faculty fellows program in science communication, mentorship, and community grants to facilitate innovative discovery and new understandings of environmental factors in disease initiation, progression and outcomes and their community impacts. You can learn more about those efforts here.

“The research conducted within UK-CARES is a tangible fulfillment of the University of Kentucky’s mission to serve the commonwealth, specifically the people who face the highest rates of chronic diseases and the regions that face tremendous environmental challenges,” said Lisa Cassis, UK vice president for research. “The renewal of this award will allow investigators across our institution and stakeholders in the community to continue to partner to find solutions to these pressing environmental health issues in Appalachian Kentucky and beyond.”

UK-CARES is housed in the College of Nursing, along with BREATHE (Bridging Research Efforts and Advocacy Toward Healthier Environments), which Hahn also runs. The center has an interdisciplinary team of researchers across the colleges of Medicine, Nursing, Public Health and Engineering, as well as the Gill Heart Institute, Kentucky Water Research Institute, Markey Cancer Center, the UK Center for Excellence in Rural Health and Kentucky Homeplace, and the USA Drone Port in Hazard.

The center offers different types of memberships for those interested in contributing to the breadth of environmental health research at the center. You can find more information here.

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.

UK environmental-health scientist Erin Haynes leads study to track health impact of train derailment in East Palestine, Ohio

Erin Haynes (University of Kentucky photo)

A University of Kentucky environmental scientist is taking steps to learn more about the health symptoms and exposures faced by the residents of East Palestine, Ohio, following a train derailment through an online health tracking survey.

On Feb. 3, a train carrying hazardous materials derailed near East Palestine, raising concerns about both short- and long-term impacts on the health of the area’s residents.

Erin Haynes, chair of the Department of Epidemiology and Environmental Health at the College of Public Health, is leading the research for this project. 

“It’s important that we characterize the health symptoms and exposure concerns from residents in East Palestine and in the surrounding area,” Haynes said in a UK news release. “We do not know exactly how far the chemicals have spread, so we want to include all surrounding counties in this survey.”

The survey is open to anyone aged 18 or older who lives in Columbiana, Mahoning, Stark, Carroll and Jefferson Counties in Ohio and residents of Beaver and Lawrence Counties in Pennsylvania and Hancock County, West Virginia. The survey asks questions about their experiences during the evacuation, concerns about exposures and health symptoms, including stress. 

Residents’ responses will give the research team insight on the experiences and health symptoms they have been facing since the incident. 

The release notes that this survey is the first part of a long-term research study to assess the potential lingering health effects from the toxic chemicals released and formed from the derailment and the subsequent controlled burn of chemicals.

“I have worked with Dr. Haynes for over 10 years on several environmental health projects,” Amanda Kiger, resident of East Palestine, said in the release. “We are excited to see this much-needed health survey launch. The community needs this long-term follow up to assess their health over time.”

Haynes is also the Kurt W. Deuschle Professor of Preventive Medicine and Environmental Health, director of the UK Center for the Environment and deputy director of the UK Center for Appalachian Research in Environmental Sciences (UK-CARES). 

Flooding and recovery cause concerns about health and safety

WEKU-FM photo by Stu Johnson

"Maintaining good physical and mental health is top of mind for health officials in flood-devastated Eastern Kentucky," reports Samantha Morrill of WEKU-FM. "Tetanus and hepatitis are major concerns after a flooding event."

So says Scott Lockard, public health director at the Kentucky River District Health Department. He told Morrill that the agency has been administering vaccinations in the community and going door to door.

“We have partners, and we've done this ourselves, to get on ATVs and side by sides and go up hollers in our communities and people who have not been able to get out and get the care, they need to make sure that they're getting vaccinations and getting, you know, the services that they need right there at their homes,” Lockard said.

He added that volunteers need to take care of their general health. Part of that includes properly treating cuts and scrapes: “They're in the water or the mud, you know, there's just a coating of mud on everything. We have to make sure that individuals are very mindful of treating wounds effectively, don't let these places become infected.”

The mud that coats nearly everything the flooding touched carries contaminants that can cause illness, Lockard said. The mud and debris are hazards for falls, and people should use protective equipment like rubber boots and gloves.

Lockard also said maintaining good mental health is also a concern. "A social worker by training, Lockard said setting boundaries and knowing when to ask for help are important tools," Morrill reports.

Frankfort paper names local health agency Newsmaker of Year

Franklin County Health Department staff pose for a photo taken by Deputy Director Brittany Parker.

The pandemic has been very hard on local health departments, which in many if not most cases haven't received the respect and recognition they deserve for bearing the extra workload and putting up with coronavirus skeptics who harass or abuse them. At least one got very prominent recognition at year's end, as The State Journal of Frankfort named the Franklin County Health Department its Newsmaker of the Year.

"It is because of their tireless efforts to keep the community healthy, while dealing with an increasingly hostile environment and constant threat of possible contamination," Harrison Wagner writes. "From organizing a way to administer tests and multiple doses of the vaccines, to creating informational materials about virus prevention, all while attempting to keep a healthy work-life balance and still perform their normal duties, the Franklin County Health Department has managed to weather the storm of the pandemic."

Health departments also enforce rules at workplaces, and "there were instances of hostility towards health environmentalists, or health inspectors, while they were enforcing safety guidelines at businesses," Wagner reports, quoting Director Judy Mattingly: “There were quite a few scary situations where their strict instructions from me were that if any business owner is hostile with you in any way, shape or form, that you are to leave immediately. There were situations at that time where our environmentalists were able to call our police partners or sheriff partners and be accompanied on those inspections.”

On the bright side, the pandemic has raised the profile of the department "and its other healthy-living initiatives," Wagner writes. "The staff has become closer as a result of working together at the testing and vaccination drive-thrus. Mattingly said this has led to Secret Santa gift exchanges and Friendsgivings, which has made the department more tightly knit."

Early exposure to tobacco smoke may speed the aging process

Early exposure to tobacco smoke, firsthand and secondhand, may make your body age more quickly, a European study suggests. The study in the journal Environment International builds on earlier findings that environmental factors during pregnancy and early childhood can change a child’s metabolism and physiology, sometimes in irreversible ways.

 

Researchers with the Barcelona Institute for Global Health found that smoking during pregnancy and exposure to smoke in early childhood were associated in a small way with a faster aging process, measured by changes in the DNA of 1,173 children aged 6 to 11 in a sample taken across Europe, and additional samples from 83 pregnancies and 103 infants.

UK student maps planting and use of blackberries in Grow Appalachia program; store-bought berries too expensive for many

Lucinda Smith with blackberries (Photo via UK)

By Katie Pratt
University of Kentucky

A University of Kentucky student is contributing to nutrition research that could lead to healthier habits and fewer negative health outcomes in her native region.

“I have always wanted to give back to Eastern Kentucky,” said Lucinda Smith, a senior human-nutrition major from Corbin who is working working with Dawn Brewer, an assistant professor in the Department of Dietetics and Human Nutrition in UK's College of Agriculture, Food and Environment.

Brewer is leader of the Community Engagement Core of UK’s Superfund Research Center, which is funded by the National Institutes of Environmental Health Sciences. The core seeks to help people near hazardous waste find ways they can use nutrition to improve their health and reduce their risks of negative health impacts associated with exposure to pollutants from the sites.

This summer, Smith received undergraduate research funds from the college and department that allowed her to map the location of blackberry bushes distributed through the community engagement core and Berea College’s Grow Appalachia program earlier this year by the Cowan Community Center in Letcher County and the Red Bird Mission Community Outreach Clinic in Clay County. Each participant received six to eight bushes and growing supplies.

“In an earlier survey, many people in the project said they loved blackberries, but they were often too expensive for them to purchase,” Smith said. “Blackberries are also a plant that grows well in Kentucky and are easy to plant and maintain. They contain phytonutrients and antioxidants, which help reduce oxidation and inflammation.”

Smith's project is measuring the amount of fruit each family harvests and how they use it, and mapping where the bushes and the demographic data of the 89 project participants. She collaborated with Josh Knight, UK senior extension associate with the Center for Crop Diversification, to make the maps and received location data from Grow Appalachia.

“Lucinda’s work gives a nice visual to share with our current and potential sponsors so they can see the reach of our program, particularly throughout Eastern Kentucky,” Brewer said.

Along with the maps, Smith has helped develop supplemental material for the BerryCare Extension curriculum, which was Brewer developed to teach people the health benefits of blackberries and ways to incorporate them into their diets.

Smith says she wants to become a family doctor and hopes to practice in Eastern Kentucky, and has developed a better understanding about the connections between nutrition and health.

“Through my human nutrition classes, I have been able to learn about the importance of a good diet, and by working with the Community Engagement Core, I have learned more about the effects of nutrition on the body,” Smith said. “I have also had the opportunity to shadow a family doctor who specializes in chronic care to see how diet has contributed to her patients’ chronic diseases.”

Study shows a link between frequent exposure to insecticides and a higher risk of depression and anxiety in Ecuadorian teenagers

Teenagers with frequent exposure to the most widely form of insecticide may have an increased risk of depression, according to a study published in the International Journal of Hygiene and Environmental Health.

The study was conducted in Ecuador by Dr. Jose Suarez-Lopez, an assistant professor at the University of California-San Diego. He and colleagues "have been tracking the development of children living near agriculture in the Ecuadorian Andes since 2008," a university press release said. "Ecuador is the world’s third-largest exporter of roses, with much of the flower production located near the homes of participants. Like many other agricultural crops, flowers are routinely sprayed with organophosphate insecticides, which are known to affect the human cholinergic system, a key system in the function of the brain and nervous system."

Researchers measured blood levels in 11- to 17-year-olds of an enzyme that is inhibited by organophosphates. Studies in mice had shown that reduced levels of the enzyme were linked to "behaviors of anxiety and depression in mice, and a few existing studies in humans have also suggested such a link," the release says. "However, pesticide exposure assessment in past studies had been only established by self-report of exposure and not using biological measures."

The study found that teens who had reduced enzyme levels, suggesting greater exposure to , showed higher-than-normal symptoms of depression. "The association was stronger for girls, who comprised half of all participants, and for teens younger than 14," the release says. It quotes Suarez-Lopez:  “Agricultural workers and people in these communities have long offered anecdotal reports of a rise in adolescent depression and suicidal tendencies. This is the first study to provide empirical data establishing that link using a biological marker of exposure, and it points to a need for further study.”

Health experts warn people with asthma and chronic lung conditions to be careful when spring cleaning; here are their tips

Asthma.net image

Spring has arrived in Kentucky, prompting many to tackle the annual chore of spring-cleaning, but health experts caution people who suffer from asthma or other chronic lung conditions to proceed with caution because some cleaning supplies can be hazardous to your health, according to a Penn State Health news release.

The key to cleaning safely, if you have one of these conditions, is to take proper precautions when using cleaning supplies such as air fresheners, rug cleaners, bleach, oven cleaners and floor polish, because they can produce vapors that may irritate the nose, throat, eyes and lung, the release says.

“For most people, using chemical cleaners occasionally would not create clinically significant reductions in lung function,” Dr. Timothy Craig, an allergist and immunologist at Penn State, says in the release. “But repeated exposure to harmful chemicals over a lifetime could lead to significant disability later in life, especially for people with asthma, chronic obstructive pulmonary disease or Alpha 1 antitrypsin deficiency, a genetic disorder that may cause lung or liver disease.”

About 11.6% of Kentucky adults have asthma, and rates are significantly higher among women than men: 16% and 6.9% respectively. About 11.4% of Kentucky adults have chronic obstructive pulmonary disease, and those rates are also significantly higher in women, 13.3% to 9.4% for men, according to the 2018 Kentucky Behavioral Risk Factor Survey annual report.

Here are six safety tips that the experts say should be on everyone’s spring cleaning checklist:

1. Don’t combine chemical cleaners, especially not ammonia and bleach.
2. Create proper ventilation. Open a window or door, or run a fan, while cleaning.
3. Wear rubber gloves and a mask.
4. Seek old-fashioned cleaners like warm water, baking soda,and vinegar.
5. Read labels. Look for volatile organic compounds and other potential irritants, even in products labeled as “green” or “healthy.”
6. Look for the “Safer Choice” logo. It’s found on 2,000 products, including cleaners, that the Environmental Protection Agency deems as “safer for human health and the environment.”

"People who experience any coughing, wheezing, throat soreness or eye watering while using chemical cleaners should step into another room or walk outside. If the symptoms persist even after leaving the room, call a doctor," says the release.

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.

Murray City Council passes a smoking ban on 8-2 vote, but the mayor, who pledged to pass it, says it could still be 'tweaked'

Murray City Council members voted 8-2 on June 14 to prohibit smoking in all public places and places of employment within the city limits, but John Wright reports for the Murray Ledger & Times that it may not be a "done deal." After about an hour of debate, Mayor Jack Rose suggested that the council pass the ban, but leave the issue open. (Wright's story is behind a paywall.)

Sperling's Best Places map

“I think we need to go ahead and pass it tonight, then come back and tweak it if need be,” Rose said. “I’m interested in listening if someone has an idea to make this the best situation we can find. If we see that there’s an element of difficulty with it, then we can look at it later.”

The ordinance, which is set to take effect in September, prohibits the smoking of cigarettes, as well as electronic cigarettes and vapor devices, in parking lots and areas within 15 feet of entrances, windows and ventilation systems. In restaurants and bars there must be a 15-foot buffer between outdoor seating and serving areas, and the rules also apply for numerous outdoor areas, Taylor Inman reports for WKMS-FM.

"Heartfelt congratulations to Mayor Jack Rose," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "He committed to getting it done before he retired. And, by gosh, he has done that! Even better, the ordinance that he was able to shepherd through to passage follows all the guidelines for truly making a difference in the health of those who live, play and work in Murray."

Local restaurant owners voiced opposition to the ban. Ron Gladden, owner of the Big Apple Cafe, one of only six restaurants in Murray that still permits smoking, told the council that smokers often outnumber non-smokers in his restaurant, and non-smokers had 62 non-smoking restaurants in the area to choose from.

“The citizens of Murray and Calloway [County] essentially vote every day on where they want to eat," Gladden said, adding that at the Big Apple, "the vote" is pretty clear. “I don’t believe it is the city council’s right to make decisions on smoking. It should be the business owners and the citizens of Murray, Kentucky," he said.

Robin Floyd, a longtime radiologist at the local hospital and also the owner of Tap 216, a restaurant that allows smoking, acknowledged that smoking is unhealthy, but said he thought restaurants that had created ways to separate the smokers from the non-smokers should be allowed to "opt-out" of the ordinance.

Supporters of the ordinance also spoke out. Local hospital CEO Jerry Penner said he had worked to strengthen smoke-free rules at the facility over the past two years, and though he recognized how hard these rules are for smokers, he said, "I think we have to err or the side of health here."

Penner also pointed out that far Western Kentucky, including Murray, ranks first in the state for lung cancer cases and deaths from it. “I’m tired of burying people," he said.

Rose, citing studies proving the danger of secondhand smoke, said the ordinance is needed to improve health in the city, Kentucky's 20th largest. “Let’s just say they get all kinds of secondhand smoke and are lucky and don’t get cancer or some other kind of disease because of that,” Rose said. They’re still more comfortable, so we’re making a comfort level.” Here is a video report from Paducah's WPSD-TV.

Philanthropist Christy Brown gives U of L $5 million for institute to study environmental conditions that affect human health

Christy Brown, U of L President Neeli Benapudi and Dr. Aruni
Bhatnagar, director of the Envirome Institute. (U of L photo)

With a $5 million gift from leading Louisville philanthropist Christina Lee Brown, through the Owsley Brown II Family Foundation, the University of Louisville has established an Envirome Institute in its School of Medicine to "develop integrated knowledge of the environmental determinants of health."

The name of the institute is not missing three letters. The word "envirome" is a knock-off from "genome," which is the "map of our genetic code, revealing how our genes relate to our health, and potentially our susceptibility to disease," the university says in a press release. "Built on a new vision of health, the Envirome Institute pioneers actionable knowledge about all forms of health and how they are affected by the environment beyond genomics. This gift from Brown catalyzes existing resources and adds new capabilities toward the ambitious, long-term mission of studying the human envirome with the same precision and rigor applied to decoding the human genome."

What's an envirome? Wikipedia says it "includes all of the environmental conditions required for successful biological life that affect human health. In genetic epidemiology, an envirome the total set of environmental factors, both present and past, that affect the state, and in particular the disease state, of an organism."

The Envirome Institute is the successor to the university's Kentucky Institute for the Environment and Sustainable Development. "Like KIESD, the institute will support research and applied scholarship, teaching and educational outreach activities, but with greater emphasis on community engagement and health," the university said. "The Envirome Institute is the first institute dedicated to the study of the human envirome. Taking a holistic approach to researching how the human-environment interrelationship impacts peoples’ lives, the institute will build on the pioneering work of Dr. Aruni Bhatnagar, the institute’s director, in the field of environmental cardiology. The institute will incorporate community engagement and citizen science to introduce a singular, new approach to the study of health."

The university has also created a Center for Healthy Air, Water, and Soil as part of the Envirome Institute. Brown had previously created a private nonprofit called the Institute for Healthy Air, Water and Soil. Its work will shift to the center, which "will support outreach activities to promote collaborations and interactions with the community for information exchange, partnership in scientific studies, dissemination of environmental information to the community and consultation by the community on issues relevant to the environment and health," the university said.

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."

Index of readiness for disasters and health emergencies has Ky. about same as U.S.; slips in environmental, occupational health

By Melissa Patrick
Kentucky Health News

Is Kentucky ready to manage a natural disaster or a health emergency? Just as much as the nation as a whole is, according to a recently released Robert Wood Johnson Foundation report.

The annual report, called the 2018 National Health Security Preparedness Index, gives Kentucky an score of 7.1 on a 10-point scale for preparedness, the same as the national average. The state and nation saw a slight improvement from the previous year's score, following continuous improvements since 2013.

"Five years of continuous gains in health security nationally is remarkable progress," Glen Mays, who leads researchers at the University of Kentucky who develop the index, said in a news release. "But achieving equal protection across the U.S. population remains a critical unmet priority."

Kentucky was one of 11 states more or less at the national average. Those below average were largely in the Deep South, Southwest and Mountain West regions. Maryland had the top score of 8.0 and Alaska and Nevada shared the bottom number of 6.4.

Such numbers are becoming more important. "The United States experienced the most active and expensive year on record for disasters and emergency events in 2017, with total economic damages exceeding $300 billion," the report begins, adding that the "uneven pace" of improvement for health security across the U.S. is "leaving large and growing segments of the American population under-protected."

The index analyzes 140 measures, such as the number of pediatricians, flu-vaccination rates, bridge safety and food and water safety, to calculate a composite score of health security for each state and the nation as a whole.

The measures are then grouped into six larger categories including, health security surveillance; community planning and engagement; information and incident management; health-care delivery; countermeasure management; and environmental and occupational health.

Kentucky improved or stayed about the same as the national averages in all but one of those broad areas -- environmental and occupational health, which measures state's ability to maintain the security and safety of water and food supplies, to test for hazards and contaminants in the environment, and to protect workers and emergency responders. Kentucky's score for this measure dropped about 5 percent from the prior year, to 6.0. The national score is 6.6.

Kentucky saw its greatest improvement in health security surveillance, which rose 13.2 percent between 2013 and 2017. This measure looks at the state's ability to monitor and detect health threats, and to identify where hazards start and spread so that they can be contained rapidly. Kentucky's score for this domain was 8.6, compared to the national average of 8.1.

The state's lowest score, 5.2, is in health-care delivery, but that is the same as the national average. This category measures a state's ability to ensure access to high-quality medical services across the continuum of care during and after disasters and emergencies.

Suggestions from the report to to improve health security include: improving data sources and metrics; strengthening networks and coalitions; improving workforce policies, like offering paid leave and health insurance; improving health care delivery preparedness; assuring a dedicated and adequately resourced health security emergency response is in place; assuring adequate funding for an established health security infrastructure; and allowing for flexibility in the existing health security funding mechanisms.

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."

'Straight pipes' foul Ky.'s quest to clean up long-polluted streams

http://www.circleofblue.org/2018/world/straight-pipes-foul-kentuckys-long-quest-clean-soiled-waters/

National Academies of Science say study of surface mining's link to health is only one Interior has suspended, refuting department

When the Interior Department suspended a National Academies of Science, Engineering and Medicine study on the possible health effects of large-scale surface coal mining in Central Appalachia, it said it was part of a review of all grants and partnerships costing more than $100,000. But the study "is the only one of eight current Interior-funded National Academies projects that has been put on even a temporary hold, according to Academies officials," Ken Ward Jr. reports for the Charleston Gazette-Mail.

"Seven other projects with funding of $100,000 or more are continuing without any such orders from the department or anyone else in the Trump administration," Ward reports. "The mountaintop-removal study, with a $1 million price tag, is the largest of the studies. The total Interior funding for the other seven is roughly $2.8 million, according to National Academies officials," who are part of a "private, non-profit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine," Ward notes.

Steve Gardner

The scientific journal Nature objected to the suspension of the study, calling it a rare event and noting that little research has been done in the area, partly due to opposition from the coal industry. "Among the coal industry critics of the research was J. Steven Gardner, a Kentucky mining engineer identified by Environment & Energy News as the front-runner" for director of the Office of Surface Mining Reclamation and Enforcement, which contracted for the study, Ward notes. Citing "multiple sources," reporter Dylan Brown wrote, "Gardner's name has been in the rumor mill since shortly after Election Day."

Gardner "was part of a multi-company team hired to analyze the potential economic impacts of the Stream Protection Rule, the Obama administration's seven-year quest to impose new restrictions on coal-mining pollution," Brown notes. "Gardner testified before Congress that he and other team members refused to change their assumptions for calculating the rule's impact under pressure from OSMRE and were subsequently fired. OSMRE, for its part, argued that work by Gardner and his colleagues was shoddy and both sides parted ways after not renewing their contract."