Legislature, convening Tuesday, is being asked to strengthen laws on sales of cigarettes and vapes to minors, including licensing

Map by Jeremy Chisenhall, Lexington Herald-Leader

"When the General Assembly returns to Frankfort on Jan. 2, one of the many problems it’s been asked to address is youth smoking — particularly vaping, which studies suggest has become more far common for Kentucky high school students than cigarette smoking," reports John Cheves of the Lexington Herald-Leader. "State regulators, public health experts and others are urging lawmakers to strengthen the laws against the sale of smoking products to minors."

From November 2021 through August 2023, the state Department of Alcoholic Beverage Control cited stores 883 times for sales to minors during the 21 months between, Cheves reports: "At least 114 retailers were cited two or more times . . . Penalties ranged from warning letters — the most common response — to civil fines of $100 and $1,000 for state offenses, going as high as $6,397 for federal offenses in a handful of cases involving five or more violations within a 36-month period."

The U.S. Food and Drug Administration can ban sales by "the most serious repeat offenders, but it seldom does," Cheves reports. "The FDA has issued one such no-sale order in Kentucky since 2015." It lasted only 24 days.

The Kentucky ABC enforces the FDA regulations. Forty states require tobacco or vape dealers to be licensed, but Kentucky does not, so there are no state licenses for the state to revoke to punish repeat offenders. ABC officials refused Cheves's request for an interview but gave him a written statement saying that an alcohol retailer with repeated tobacco sales violations could be charged with operating “disorderly premises,” which could lead to suspension or revocation of their alcohol license, but the ABC has never done that.

The ABC, part of Democratic Gov. Andy Beshear's administration, wants the Republican-controlled legislature to pass a licensing law, but acknowledged the difficulty of regulation in its latest annual report on the topic: “Kentucky’s history and culture is tied to the cultivation and processing of tobacco. The role of tobacco in Kentucky’s economy, coupled with the fact that tobacco was the livelihood of many Kentucky families, has created strong norms of acceptance around tobacco that pose a significant challenge to prevention efforts.”

The number of tobacco farmers in Kentucky has declined to fewer than 3,000, but tobacco remains an significant cash crop and the state has the nation's second-highest adult smoking rate, behiund only West Virginia. Among Kentucky minors, vaping is twice as popular as smoking, Cheves notes.

Terry Brooks, executive director of Kentucky Youth Advocates, told Cheves, “All the evidence we’re seeing — and this includes anecdotal evidence that I hear from my two grandchildren — leads me to believe that kids don’t have any problems getting their hands on these things. And I think it’s a much more widespread phenomena than most of us realize.”

Cheves notes, "Attempts in the General Assembly to increase the civil fines on retailers caught selling smoking products to minors have gone nowhere."

While state officials debate the licensing issue, Louisville has had a local law requiring it for two years, "even if it isn’t being fully enforced yet," Cheves reports. "The licensing law and a related zoning law also give the city tools to prevent new stand-alone smoking retail stores from opening within 600 feet of another such store or 1,000 feet of facilities that serve children, such as schools, parks, public playgrounds, day-care centers, outdoor recreation areas, athletic facilities or community centers."

Cheves adds, "Health officials said in a recent interview that they’ve just begun working on the enforcement part of the law. Louisville’s health department was assigned its new duties on tobacco retail licensing around the same time the Covid-19 pandemic hit three years ago, with Covid understandably dominating the agenda for many months, said Nick Hart, director of the city’s Division of Environmental Health. Funding provided by the relatively small licensing fee has not provided enough money for the city to hire more staff at the health department, Hart added."

Bird-flu impact may go beyond eggs, birds; experts call for more surveillance as the virus appears able to spread among mammals

Centers for Disease Control and Prevention chart; for a larger version, click on it.

The U.S. is experiencing a record outbreak of bird flu, a virus that is currently deemed a low risk to humans, but has hiked prices of eggs and poultry. The Biden administration is weighing whether to vaccinate poultry against the disease and it appears that the virus can spread among mammals. 

"Egg prices are up 60%, which means we are paying upwards of $5-7 for a dozen eggs. That is if you can find them," reports epidemiologist Katelyn Jetelina in her newsletter titled Your Local Epidemiologist. "Why? A constellation of reasons, but there is one we can’t ignore: the avian flu is hammering poultry farmers." 

The U.S. Department of Agriculture reported in December: "As a result of recurrent outbreaks, U.S. egg inventories were 29 percent lower in the final week of December 2022 than at the beginning of the year. By the end of December, more than 43 million egg-laying hens were lost to the disease itself or to depopulation since the outbreak began in February 2022. . . . The average shelf-egg price was 267 percent higher during the week leading up to Christmas than at the beginning of the year and 210 percent higher than the same time a year earlier." 

USDA adds that egg prices are expected to decrease as flocks are replenished. 

Bird flu spread among minks at a farm in Spain. (Nature photo) 

Another concern is that that virus appears capable of spreading among mammals, including humans.  

"The virus is primarily a threat to birds," reports The New York Times' Emily Anthes, "but infections in mammals increase the odds that the virus could mutate in ways that make it more of a risk to humans, experts say."

Anthes reports that a new variant of the H5N1 virus has "taken an unusually heavy toll on wild birds and repeatedly spilled over into mammals, such as foxes, raccoons and bears, that might feed on infected birds." 

More recently, it has infected farmed minks, which scientists describe as a "new and troubling development," pointing to an outbreak in Spain where the virus appeared to spread from mink to mink and had an unusual mutation that might be a sign of adaptation to mammals, Anthes reports, adding that experts say the mink outbreak is no cause for panic, but highlights the need for more proactive surveillance.  

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, also told Stat in April 2022 that the presence of bird flu in the U.S. calls for heightened surveillance. Jetelina reports that "from 2003-2021 there have been very few human cases worldwide: 864. But, among these cases, 456 died—a 53% mortality rate." 

Jetelina also notes that the risk of bird flu in humans is "currently very low," citing research from the Centers for Disease Control and Prevention, which tracked the health of more than 5,190 people who have been exposed to infected birds in 2022 and only one human case was reported. The Times reports "fewer than 10 known cases in people since December 2021, and there have been no documented instances of human-to-human transmission, according to the CDC."

Federal scientists are gearing up to test the first vaccines in poultry against the bird flu as a way to counter the growing oubreak, Alexander Tin reports for CBS News. The Biden administration has not yet greenlighted the use of these vaccines. Officials told Tin that one of the concerns about issuing these vaccines is that it could make it harder to export American poultry products. 

"A record 58 million birds — mostly commercially-raised poultry — have died in the outbreak so far, according to figures tallied by the USDA's Animal and Plant Health Inspection Service — either killed by the virus itself or put down in efforts to quash its transmission. Every state has detected the virus spreading among wild birds and 47 have spotted them in poultry," Tin reports.

The virus is spread from an infected bird's nasal secretions, saliva and feces. The USDA says properly prepared and cooked poultry and eggs should pose no risk to consumers. 

"Right now you don’t need to do anything, unless you’re in close contact with birds. A person’s level of risk is dependent on duration and intensity of exposure. In other words, a person with one chicken in their backyard is at much lower risk than someone at a poultry farm," Jetelina writes. 

She adds, "Those around wild birds, such as at parks, lakes, rivers, or other waterways, need to exercise caution, including wearing PPE, washing hands, and changing clothes. If you have backyard poultry, wear a mask and wash your hands. Also, monitor the health of your flock, especially if they come in contact with other wild birds."

Seven Healthy Kentucky Champions named by Foundation for a Healthy Kentucky; finalists for Friedell Award to be given Oct. 17

The Foundation for a Healthy Kentucky has announced its 2022 class of Healthy Kentucky Champions. The awards recognize individuals dedicated to improving the health of Kentuckians at a community level or state level; they are finalists for a statewide award to be announced in October.

“These seven Healthy Kentucky Champions are an inspiration to all working to better the health of our state,” said Ben Chandler, president and CEO of the foundation. “We owe them much gratitude for their dedication to addressing some of the health challenges Kentuckians face. The commonwealth is better because of these Healthy Kentucky Champions.”

The seven Healthy Kentucky Champions are nominees for the 2022 Gil Friedell Memorial Health Policy Champion Award, which comes with a $5,000 grant from the foundation to a Kentucky-based nonprofit of the winner’s choice. This year’s Friedell Award winner will be announced at the Howard L. Bost Memorial Health Policy Forum Oct. 17. The forum will focus upstream the social determinants of health on the connection between educational opportunities and health outcomes of Kentuckians. To learn more and register for this free, virtual event, click here.

The Healthy Kentucky Champions are Dr. Patricia Bautista-Cervera of Louisville, Eric Crawford of Maysville, Terry Gehrke of Louisville, Denise Hall of Trimble County, Michelle Howell of Scottsville, Dr. Patrick Kitzman of the University of Kentucky and Mark Thomas of Todd County.

Dr. Patricia Bautista-Cervera

Dr. Patricia Bautista-Cervera is a pediatrician and pediatric allergist at the La Casita Center, an organization dedicated to enhancing the well-being of Louisville’s Latinx and immigrant community. As health empowerment coordinator, Bautista-Cervera works to promote health through workshops, informational videos, one-on-one communications, and other various means. During the COVID-19 pandemic, she delivered important information to the Spanish-speaking community through the online video series, “Consejos de Salud con la Dra. Paty.” She also was instrumental in developing virtual forums with stores and restaurants to educate the Hispanic community about the virus and promote preventive measures and vaccination. In 2020 she supported 994 Covid-19-positive patients, offering medical guidance and, through an empowering model, connecting them to LCC’s wrap-around services and other resources in the community.

Eric Crawford

Eric Crawford, a Maysville native, joined Kentuckians for Medicinal Marijuana in 2013. Crawford’s education in the endocannabinoid system and cannabis, as well as his experience as a quadriplegic, has fueled his passion for advocating for the legalization of medical marijuana in Kentucky. He has been involved in crafting legislation and has testified at the state Capitol about how cannabis improves his quality of life. He is a member of the Governor’s Medical Cannabis Advisory Committee and has also traveled the state with Kentuckians for Medicinal Marijuana for more than 50 medical cannabis educational seminars. Crawford remains active in the Maysville community by serving on the Lions Club and volunteering at a nursing home. He is a Finis Davis Fellowship recipient through the Kentucky Lions Eye Center and a past member of Kentucky Partners in Policymaking through the Commonwealth Council for Developmental Disabilities.

Terry Gehrke

Terry Gehrke has been in the fitness-wellness industry for more than 30 years. She founded Balanced Wellness LLC in 1999 in Jefferson County and still leads the organization as president and wellness consultant/health educator. Gehrke joined the Kentucky Diabetes Network in 2019 as executive director and has guided the organization to promote better health for Kentuckians at-risk for and living with diabetes. She leads KDN’s symposium committee each year to offer the largest professional education opportunity for diabetes training in the state, the Kentucky Diabetes Symposium. Gehrke’s background includes teaching in the University of Louisville Health and Sport Sciences Department and working with Southeast Christian Church’s Sports & Fitness Ministry. Gehrke is a member of several organizations including the National Wellness Institute, the National Physical Activity Society, and Exercise is Medicine.

Denise Hall

Denise Hall of Trimble County began working in the substance use prevention field in 1998 at Seven Counties Services. In 2003, she became coordinator for Trimble County Family Resource and Youth Services Center before writing two Drug Free Communities grants and directing them. The DFC grant is now in its 10th and final year. Hall’s work includes implementing a Drug Education Series in Trimble County and a Sources of Strength group at Trimble County Junior/Senior High School. She administers a survey to middle and high schoolers to understand the needs for substance-misuse prevention. Hall was crucial in getting vape detectors installed at the high school and is managing director of the Trimble CARES Coalition.

Michelle Howell

Michelle Howell co-owns Need More Acres Farm in Scottsville with her husband Nathan. She has an agriculture degree from Western Kentucky University and previously worked for University of Kentucky Cooperative Extension assisting tobacco farmers as they transitioned to fruit and vegetable production. She collaborates with local and state partners to increase equitable opportunities for farmers. Howell has also been involved in writing grants worth more than $2.4 million to benefit food access, women’s life courses, and urban-rural development. Need More Acres co-founded the Community Farmers Market in Bowling Green, which piloted several Supplemental Nutrition Assistance Program incentives. CFM was essential to growing Kentucky Double Dollars into a statewide program and CFM is one of the organization's pilots of the Fresh Rx MOMs program for expecting mothers on Medicaid. Both programs help under-resourced Kentuckians access fresh, healthy food from farmers markets. Additionally, Howell partners with UK, WKU and Kentucky State University for interactive professional development on diversity and inclusion.

Patrick Kitzman

Dr. Patrick Kitzman is a professor in the University of Kentucky Department of Physical Therapy. He’s also founding director of the Kentucky Appalachian Rural Rehabilitation Network, a team that develops strategies to reduce disability and improve the quality of life for individuals with neurological impairments living in underserved rural Appalachian counties. Kitzman and his team established projects CARAT and CARAT-TOP. In CARAT (Coordinating and Assisting the Reuse of Assistive Technology) students learn to refurbish used medical equipment and donate it to those in need in the community. CARAT-TOP (Coordinating and Assisting the Reuse of Assistive Technology- Together One Priority) is a training program created through a partnership with the UK Center of Excellence in Rural Health. It brings together community members and high-school students of all abilities to learn new skills to help individuals and communities affected by disability.

Mark Thomas

Mark Thomas, Todd County Schools superintendent, was instrumental in establishing the AXIS Program: Centering All Services in the district. In partnership with the Todd County Health Department, the program addresses students’ social and emotional well-being through mental-health case management. The program also assists with basic needs such as nutrition, clothing, toiletries, housing, transportation, and treatment for substance use disorder. Thomas played a crucial role in gaining needed buy-in of the program from staff and the community. Through his support, the program is expanding services to include parenting classes, prenatal classes, and mental health awareness programs for students and staff. Thomas began his career in Shelby County in 1996 as a middle school teacher. He has served in a number of school and district administrative roles across Kentucky before starting his current position in 2020.

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

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

By Michelle Eigenheer

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

Logo of the program, which began in 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ky. efforts at farmer suicide prevention are a national model, UK professor says; Farmer Suicide Prevention Day is Wed., Sept. 23

By Melissa Patrick
Kentucky Health News

Kentucky farmers, like those across the nation, work tirelessly to stay afloat amid plummeting farm incomes, market instabilities, extreme weather conditions, few safety nets and now, a global pandemic. And sometimes those stressors add up, leading some to consider suicide, and others to die by it.

To bring awareness to this issue, the General Assembly passed House Bill 59, sponsored by Rep. Brandon Reed, R-Hodgenville, during the last legislative session to designate the Wednesday of National Farm Safety and Health Week, which is the third week of September, as "Farmer Suicide Prevention Day." This year that date falls on Sept. 23.   

Photo from Talk Business & Politics

"There are significant stress factors across rural America and it's important to know that it's okay for farmers to ask for help," said state Agriculture Commissioner Ryan Quarles. "And one of the more unfortunate issues here is that the farm community is one of the last communities to reach out for help and so we've got to make sure that farmers know that there are resources available if they need to talk with someone."

Quarles pointed to several stressors that are unique to the farming community, including the extended stress that comes with only getting one or two paychecks a year, working under risky market conditions, and not having access to benefits or health insurance through an employer.   

Farmers also worry about losing the family farm, said University of Kentucky professor Joan Mazur. She is deputy director of the Southeast Center for Agricultural Health and Injury Prevention, which has received a $48,000 federal grant to work on suicide prevention.

"No farmer wants to be the person that loses the multi-generational farm, sometimes in the family for decades and decades," Mazur said. "And that can cause huge depression. . . .  Nobody would want  to lose their home, but the additional burden on a farm family ... really can be catastrophic. "

Deborah Reed, a professor of nursing and agricultural health at UK, added that she knows anecdotally and through her own research that farmers also feel "very unappreciated and persecuted by the public."  

One goal of suicide awareness is to reduce the stigma of asking for help, Mazur said: "We know it's hard to ask for help. People talk about physical complaints all the time but it's very difficult for them to talk about any mental health issues that they are having." 

But even though it's hard, she urged anyone thinking about suicide to seek help. 

"Suicide is preventable, it's not inevitable," Mazur said. "That message has to get out to the general public and it has to get out to the farming community as well, and to  farm families so that people can get the help that they need. That's the point of the USDA grant that we have." 

She added, "We can't keep ignoring this. Stress, mental health, depression, suicide are real issues nationwide, and in particular in our farming community, which is our focus." 

2018 Farm Bill spurs action

Mazur said the 2018 Farm Bill has been instrumental to addressing mental health in agriculture, because for the first time it had money included to address the issue. The bill appropriated $50 million over five years for mental-health work with people in agriculture-related occupations, but the impact went beyond money.

"It said to all the farming community, this is a conversation we can have," she said. "You can't overstate enough how important it was that there were mental health components in that 2018 Farm Bill. That was huge." 

Kentucky has also appropriated $500,000 from its Tobacco Settlement Fund for a mental-health and suicide-prevention program. The pilot program brings together a wide range of agencies to focus on increasing awareness of resources, increasing behavioral health care providers in rural areas, increasing  intervention training in communities, and increasing surveillance. It will also create and disseminate a Kentucky farmer cultural humility training for healthcare providers. 

"The concerted effort in Kentucky is remarkable," Mazur said, adding later, "This is really unprecedented nationally to have a state that is so committed to this kind of an issue, to preventing farmer suicide and farmer mental health issues. . . . It's really a model, a national model for how to address an issue."  

Farmer suicide prevention in Kentucky

With its Farm and Ranch Stress Assistance Network grant, Mazur said, the center has created a pilot program to provide suicide-prevention training to a diverse group of community members who largely interact with farmers, such as people from Farm Credit, ministers, Extension agents and their families. The trained community members then go back into their communities and train others. 

The training is called QPR, which stands for "question, persuade, refer," and is designed to teach people how to recognize the warning signs of suicide, how to offer hope and how to get help and save a life. 

Joan Mazur (UK photo)

Mazur said they have enhanced the QPR program with information specific to the culture of farming to help people understand the stressors unique to farmers, their families and their workers. 

As of Aug. 1, she said in the center's annual report, 18 people had completed the training and made a commitment to deliver at least two trainings. She said they expect 100 people to be trained by mid-November.

Mazur said the center is also working with the Suicide Prevention Hotline to help its workers better understand the culture of farming. 

For example, she said, if someone calls the hotline and says it's been a rainy spring and they couldn't plant their crops, the person on the other end of that hotline needs to understand the full implications of what that means to a farmer: "That can be financially devastating and provoke the kinds of situations that cause depression and stress and lead to, that are run-ups to suicide."

Quarles also spoke to the importance of making sure hotline workers understand the "lingo of agriculture" since a farmer's message may get lost in the translation. 

Reed said it's also a problem when health-care providers don't understand farming, because that is who a farmer is likely to see first, given the poor access to mental-health care in most rural areas. 

Reed said farmers have told her "over and over again" that when they actually decide to seek help for their depression or anxiety or mental-health issue, the provider doesn't understand their world: They can't take medicine that makes them sleepy and also work on farm equipment, and can't take time off for therapy. Mazur said efforts are in motion to also work on educating providers about farm culture. 

Prior to the pandemic, Reed said she offered evidence-based community theater programs across Kentucky that focused on health and agriculture safety, including mental health. 

"We're trying to start to move the conversations to where the farm communities themselves will talk about this issue. I think we're having some success," she said, noting that farmers showing up at Extension events that focus on stress, and she is often asked to talk to farm groups about it. 

"What I've seen working with our farmers across the nation, and particularly ones in Kentucky, is they have become much more receptive," she said. "They will attend programs on stress and how to manage their behavioral or mental stress, if you will, now where before they they would not have done that." 

Reed also noted the value of letting farmers know they are appreciated, pointing to the "Heart to Heart Program" at UK where students write letters to farmers expressing their gratitude for what they do. 

"We hear farmers actually say, 'Well, I'd like to get one of those letters,'" she said. "Everybody wants to be thanked so that's an easy step that everyone can do."

"We're really a lot more active on this issue than we have been in years past and I think that is a good thing," said Quarles. 

More data needed

Another challenge is the need for more information about farmer suicides. 

"We don't really understand what the baseline is, that we still are trying to better understand exactly what Kentucky's farmers in rural areas are experiencing right now," Quarles said. 

Mazur said farm suicides are often listed as an accident on death certificates, and reporting systems differ among states. She said through the grant, a doctoral student is working to get better data, including possible factors that contributed to suicide, to guide intervention.  

"We do know that suicide rates have increased among working-age people from 2000 to 2016 by 34 percent," she said. "And rural areas in states with high agricultural populations and small farms like Kentucky are over-represented in that sample."

A 2020 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention looked at 2016 suicide rates by industry and occupation in 32 states and found that the suicide rate among male farmers and ranchers was 43.2 per 100,000, compared to 27.4 per 100,000 among working-age men in all occupations. 

Ty Borders, director of the Rural and Underserved Health Research Center, along with fellow University of Kentucky faculty member Kathi Harp, recently published a study that found, nationwide, rural residents experienced suicide ideation, planning and attempts at a higher rate than those in urban areas.

The study also found that the risk of dying by suicide is greater among lesser educated farmers and at times of economic depression, especially in rural areas that are heavily dependent on a single industry, like farming. Death by suicide is also higher among men.

Borders said that when worked at the federal level on this issue, it became clear that for decades, the national government has needed a better plan to address rural suicide because most suicide-prevention programs have been designed for urban communities and may not be applicable to rural communities. 

The Borders-Harp study calls for new suicide prevention interventions targeted to the unique needs of rural residents.  

Suicide is the 11th leading cause of death in Kentucky, with an average of one person dying by suicide every 12 hours in the state, according to the American Foundation for Suicide Prevention. 

Kentucky is home to about 76,000 farms, and most are small. The average farm in Kentucky has 171 acres, much smaller than the national average of 444 acres. In Kentucky, the industry is dominated by small family farms and about 50,000, or two-thirds, have annual sales of less than $10,000.

If you’re thinking about suicide, are worried about a friend or loved one, or would like support, the Suicide Prevention Lifeline is available 24/7 at 1-800-273-8255.

Webinar Friday at 10 a.m. ET will explore a Kentucky farmer's response to the pandemic, food justice and community health

Kentucky farmer Michelle Howell will share her work on covid-19 responses, including delivery of medically tailored meals for patients and farmers' market safety, in a free webinar at 10 a.m. Friday, July 10. Howell will discuss areas that require a creative response such as farm to school, home deliveries, chronic hunger, and food justice. To register, click here.

Nathan and Michelle Howell of Need More Acres Farm in Scottsville met at Western Kentucky University where they pursued degrees in agriculture. Nathan had grown up on a farm in Hart County, where he and his family grew corn, wheat, cattle. Michelle's food story began when experiencing hunger motivated her to consider ways a community could feed itself. After college the University of Kentucky hired them to help tobacco farmers transition to fruit and vegetable production.

In April 2013 Nathan and Michelle, along with their four children, began farming full time and they are currently growing fruits and vegetables, combining them with meat, milk, cheese, eggs and bread from other farms to provide a multi-farm Community Supported Agriculture service, co-founding Community Farmers Market in Bowling Green, selling to schools, food pantries and restaurants.

Nathan and Michelle want to combine their love for Kentucky farms with the realization that our food system didn't change overnight. With grace and patience, they are working towards a healthier lifestyle for their own family and hope to do the same for others. Community organizing, public speaking, policy change and storytelling is now weaved through their everyday life on the farm.

For questions about registration, contact Rachelle Seger at rseger@healthy-ky.org.

Beshear lets restaurants reopen at 1/3 capacity May 22, though Ky. hasn't met benchmarks he set, following federal guidelines

As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear moved up the date for Kentucky to begin the second phase of its reopening, announcing Thursday that Kentucky's restaurants can reopen May 22 at one-third capacity, and a goal of limited child care on June 15.

He said restaurants will be allowed unlimited outdoor seating as long as they keep tables six feet apart, the standard social-distance guideline.

"I know this isn't the capacity that our restaurants probably want, but the studies that we look at show that we've got to be really careful about this step," Beshear said at his daily briefing. "This allows it to be open for Memorial Day weekend, but please be careful. . . . This is the best compromise between public health and making sure we can restart this part of the economy."

Beshear has been under pressure from Kentucky restaurants, especially in Louisville, because Indiana has allowed its restaurants to reopen. He noted that Indiana and Tennessee have reopened restaurants, but said his conversations with Ohio Gov. Mike DeWine "were a big part of it." Ohio will open its restaurants before Kentucky does, and that would likely have brought the same sort of complaints from Northern Kentucky that have been heard in Louisville.

"We had planned it for a little bit later, but I think this is partial harm reduction," Beshear said. He also cited "the belief that those that we have worked with sincerely want to do this right and only want to re-open if they can do it right. Many will find that they won't be ready for that date. Don't rush."

He added that it's important for restaurants to meet their industry-specific guidance, which will be forthcoming, and the 10 state requirements for opening, including such things as thorough, repeated cleaning; mask-wearing; taking on-site temperature checks of employees; making sure there is adequate hand cleaning access; and having a testing plan for employees with elevated temperatures.

"These aren't easy," Beshear said, adding later, "If we're gonna do this, we're gonna do it safe."

Beshear also announced that movie theaters and fitness centers will be able to reopen June 1, campgrounds will be able to reopen June 11, and some child care with reduced capacity and potentially low-touch, outdoor youth sports on June 15. But he said that wasn't guaranteed.

“This is a goal, a goal, we are pushing for,” he said. “We want to have a safe plan for child care, knowing that it is such a challenge for folks. I will tell you that it will be significantly reduced capacity and it will be very monitored to make sure that it’s safe.”

The gradual reopening of businesses that will begin Monday has increased calls to reopen child-care centers, but Beshear has said that would be risky. Unemployed people who get called back to work but can't find child care will be allowed to keep getting unemployment benefits.

Beshear said bars and groups of 50 or more people may be able to open in July. Groups of 10 or fewer will be able to gather on May 25.

Beshear is accelerating his reopening of the state's economy, even though Kentucky hasn't met the benchmarks that he laid out about three weeks ago, Joe Sonka reports for the Louisville Courier Journal, weaving together several threads pursued by Kentucky Health News and the Lexington Herald-Leader in the last two weeks, and providing more research and analysis.

Bloomberg chart shows positive tests in red and pink,

and negative tests in grays. Flu-like illness is shown by
bars across bottom. Gray rectangle marks last two weeks.

"Covid-19 cases are not declining, testing capacity still lags behind the White House's recommendation and 500 new workers to conduct contact tracing are possibly weeks away from starting," Sonka notes, then digs into each of these measures in detail, adding two analyses that question whether Kentucky is jumping the gun: a Bloomberg analysis and a recent study by the Louisville Metro Department of Public Health & Wellness and the University of Louisville.

The study concludes that if Louisville was able to "practice stronger social-distancing strategies, we could safely open in early June. Therefore, taking new and more effective measures can make a manageable early-June opening more likely." It said "decreasing the current social-distancing measures without efforts in regard to testing, isolating, and contact tracing can move us to an unstable status which can be catastrophic."

Dr. Paul McKinney, director of U of L's Center for Health Hazards Preparedness and co-author of the study, told Sonka that Beshear’s reopening plan likely isn’t perfect, "but it's a very reasonable plan, I think, to do it in steps. . . . The good thing about the staged plan is that if you find we're going too fast, you put the brakes on there. Rather than saying 'We're closing everything down again,' no, 'We're just stopping where we are and not moving any further'."

Beshear said Thursday, "Our goal in having a gradual plan is to be able to pause. And that would be our first step. If we saw a spike, we would pause where we are. We would look at where we've seen them, what type of businesses that we have; we would try to be surgical on those areas."

The governor says another reason the state can start reopening is it will be able to test 2 percent of its population each month, as federal guidelines call for.

He spent a fair amount of time Thursday discussing the state's increased capacity for testing, saying it would soon be able to do 30,000 tests a week. So far the state has only confirmed tests of 81,391 people; Beshear said the actual number is higher, since some labs have not been reporting negative results.

Kentucky now has at least 72 covid-19 testing locations, listed on the kycovid19.ky.gov website. Beshear announced a new partnership with First Care Clinics, which can now provide tests at 13 locations across the state, seven days a week, at no cost.

"Folks, this is big news," Beshear said. "There’s now no excuse" to not get a test. "Now we all have the tools to do the right thing and protect one another."

Politics: Some think Beshear isn't moving fast enough. U.S. Sen. Rand Paul, an ophthalmologist by trade, told Louisville's WDRB-TV that the governor is “drunk with power” and the state is living under the “dictatorship of Beshear” when its economy needs to reopen completely.

Asked to reply, Beshear said, "There is still some partisanship and some politics going on right now; I'm just not doing it. . . . I look forward to getting to the day when we don’t have an emergency."

Prisons: Beshear's office said someone made a mistake by releasing a prison inmate before knowing the result of his coronavirus test, which turned out to be positive. Now Michael Gene Welch, who has no symptoms. is back at the Green River Correctional Complex for at least weeks -- until he can test negative for the virus twice in at least 24 hours, reports John Cheves of the Herald-Leader.

Welch's fiance, who picked him up and "spent hours in confined spaces with him Tuesday before returning home to her family — including her 84-year-old mother — wants to know how this went wrong," Cheves writes. Beshear spokeswoman Crystal Staley told him, "We are investigating the circumstances that led up to the release and will take any and all appropriate action.

Cheves also reports about the coronavirus outbreak at the Federal Medical Center in Lexington where local officials have said the "prison administrators have been unresponsive to questions" from both the mayor's office and the local health department and inmates tell him they are "sitting ducks."

In other covid-19 news Thursday:

• Beshear announced 208 new coronavirus cases in the state, for an adjusted total of 6,128. Counties with five or more new cases include: Jefferson, 45; Warren, 41; Fayette, 22; Daviess, 12; Kenton and Logan, nine each; Scott, eight; and Allen, six. Click here for the summary. 
• He said 356 Kentuckians are hospitalized with the disease, 199 of them in intensive care, and 2,177 have recovered. 
• Eleven more deaths were reported, raising the state's toll to 294. All were from from adjoining counties from Bowling Green to Louisville. Five were from tiny Edmonson County: two women, 80 and 97, and three men, 92, 89 and 86; a 73-year-old man from Warren County; two men in Butler County, 94 and 62; a Grayson County woman, 87; a Hardin County man, 66; and a Jefferson County man, 78.
• Beshear said eight of the deaths were in long-term-care facilities, which have lost 165 residents and two employees to covid-19. In all, 863 residents and 353 staff have tested positive for the virus, in 78 facilities. Click here for a list. 
• As of Wednesday, five facilities had 10 or more resident deaths from covid-19: Rosedale Green in Kenton County, with 20 deaths, and 63 residents and 22 staff with positive tests; Ridgewood Terrace Nursing Home in Hopkins County, with 19 deaths and 61 residents and 21 staff testing positive; Mills Health and Rehab in Graves County, 16 deaths and 65 residents and 31 positive staff; Treyton Oak Towers in Louisville, 15 deaths, 35 positive residents and 15 positive staff; and Jackson Manor in Annville, with 10 deaths, 40 positive residents and 20 positive staff. WKYT-TV reports there are now 12 deaths at Jackson Manor, owned by Signature HealthCare, the state's largest nursing-home operator. It also has Summit Manor in Columbia, which has had nine resident deaths and the only two staff deaths in the state, and 65 positive residents and 17 positive staff.
• Beshear said the Federal Emergency Management Agency will deliver a 14-day supply of personal protective gear to all certified nursing homes.
• He said the many deaths of people in long-term care may have made people think "this isn't something people of all ages can get," so he read the ages of younger people on the list of news cases: "39, 27, 36, 35, 26, 28, 38, 36, 26, 33, 32, 41, 34, 27, 25, 44, 3, 51, 39, 25, 41, 28, 25, 27, 39, 24, 29, 22, 35, 14, 15, 3, 34, 19, 28, 25, 16. So let’s make sure that we remember . . . that it’s still out there and it’s still dangerous, and misinformation can be deadly."
• Beshear announced that Kentucky will get $10.3 million for testing by 25 health centers funded by the Health Resources and Services Administration. Click here for a list. 
• He cautioned against covid-19 scammers, saying he has heard Kentuckians are getting calls threatening to disconnect utilities without immediate payment. He noted that he had issued a order prohibiting disconnections for non-payment and fees for late payments. If you suspect a scam, call the Consumer Protection Hotline at 888-432-9257 or fill out a complaint on ag.ky.gov/scams. 
• Dr. John Barton, a leading authority on high-risk obstetrics at Baptist Health in Lexington, told John Clay of the Herald-Leader that there is still much to learn about the effects of covid-19 and pregnancy, and his best advice is to use common sense. 
• UPS is giving $100,000 to the University of Louisville to fund promising research into blocking the coronavirus from infecting human cells. Mike Stunson of the Herald-Leader wrote about this research, which involves an aptamer, a synthetic DNA and originally developed as a cancer treatment, on April 22.
• Kentucky Health News has republished a column by Becky Barnes, editor of The Cynthiana Democrat, "I will wear a mask . . . for you." Barnes has worked at the paper for 44 years and in early March, when Harrison County had Kentucky's first case of covid-19, she published a special edition about it, giving information that dispelled rumors.
• The Cooperative Extension Service is providing guidelines to farmers to help them safely welcome immigrants with H-2A work visas back to their farms in the midst of the pandemic. "Producers know that if even one person in their operation contracts the virus, it could shutter their entire enterprise for at least two weeks," Katie Pratt reports for the University of Kentucky, noting that about 780 Kentucky producers hired more than 8,300 H 2-A workers in 2019. “The packets included covid-19 information and guidance, best health practices and producer guidelines, all translated into Spanish,” Beau Neal, agriculture and natural resources extension agent from Daviess County, told Pratt. “I also included some guidelines for the employers to maintain a healthy workplace environment for all H-2A employees. Doing this helps those employees and their coworkers stay safe and healthy, and to be on the same page as the producer in developing a plan moving forward to adhere to proper health guidelines in their work environment."

Celebrate National Rural Health Day on Thursday, Nov. 21, with a week of events starting Monday

The Federal Office of Rural Health Policy is planning a week of events to observe National Rural Health Day on Thursday, Nov. 21.

Monday, Nov. 18: From 9:30 a.m. to 12:30 p.m. ET, the National Institutes of Health will hold a seminar on the state of rural health in the U.S. at the main NIH campus in Bethesda, Maryland. For those who can't attend, the event will be videocast online here.

Nov. 19: From noon to 1 p.m. ET, The Health Resources and Services Administration will hold a webinar on addressing the opioid crisis in rural areas as it relates to women who are pregnant or have infants born addicted to opioids. Register here.

From 2 to 3 p.m. ET, the HRSA will host a Twitter chat on mental-health issues of agriculture workers. Find the chat using the hashtag #AgMentalHealth.

From 3:30 to 4:45 p.m. ET, the HRSA will host a webinar on suicide prevention in farm and ranch communities. Join the webinar here.

Nov. 20: From noon to 1 p.m. ET, the Rural Health Information Hub and the Norc Walsh Center for Rural Health Analysis will hold a webinar to discuss the new Rural Chronic Obstructive Pulmonary Disease Toolkit. Register here.

From 1 to 2 p.m. ET, the Centers for Disease Control and Prevention and the HRSA will hold a webinar aimed at rural health providers on improving antibiotic prescribing practices in critical-access hospitals. Register here.

From 2 to 3 p.m. ET, the HRSA will host a Twitter chat on rural substance-use-disorder issues. Find the chat by searching for the hashtag #RuralSUD.

From 6 to 10:15 p.m. ET, HRSA will host a virtual job fair aiming to bring more health-care providers to rural areas. Learn more here.

Nov. 21: From 9:45 a.m. to 3 p.m. ET, HRSA will celebrate National Rural Health Day in its D.C.-area office, including roundtables, lectures, and interactive sessions. The event will be livecast online.

At 1 p.m. ET, the Rural Health Information Hub will host a Twitter chat on how rural health organizations can access funding. Find the chat with the hashtags #RuralHealthChat and #PowerofRural.

From 2 to 3 p.m. ET, the National Organization of State Offices of Rural Health will air The Providers, a documentary about rural health-care providers, and lead a live discussion about it. Find out more here.