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."

March of Dimes gives Ky. D-minus for high rate of pre-term births; maternal deaths spike; new collaborative will work on such issues

By Melissa Patrick
Kentucky Health News

Childbirth, which should be one of life's most joyous occasions, has become more deadly for Kentucky mothers, and remains problematic for many Kentucky babies because it comes too early.

One in nine Kentucky babies are born prematurely, so many that the March of Dimes gave the state a D-minus on its 2019 Premature Birth Report Card. And the rate of Kentucky women who died as a result of pregnancy complications nearly doubled from 2017 to 2018.

A baby is premature if born before 37 completed weeks of pregnancy, which is four weeks short of full term. In 2018, Kentucky had 6,109 pre-term births, 11.3 percent of live births. The national average is 10%, a rate that has risen four years in a row.

Because important growth and development happens in the last weeks of pregnancy, pre-term babies are at an increased risk of neurological disorders, intellectual disabilities, and respiratory and digestive problems. They are also more likely to have vision and hearing problems. Complications from being born early is the main overall cause of newborn death, the March of Dimes says.

Pre-term babies are also more at risk for long-term challenges, including chronic diseases such as heart disease, high blood pressure and diabetes, says University of Kentucky HealthCare.

November is Prematurity Awareness Month. The cause of about half of premature births is unknown, but the March of Dimes says there are common risk factors, the strongest being a history of pre-term birth, multiple pregnancy and certain uterine or cervical conditions.

Other factors in the mother that can increase risk include being underweight or overweight, diabetic or older than average for a mother; smoking or using drugs during pregnancy; or having preeclampsia, a type of high blood pressure that some women get during or right after pregnancy.

Kentucky has one of  the highest rates of smoking during pregnancy in the nation, with nearly 18% of pregnant women in the state smoking cigarettes at some time during their pregnancy. The national rate is 6.9%, according to the United Health Foundation's health rankings.

This year's March of Dimes report also looks at several factors that are linked to adverse maternal and infant health outcomes, such as whether a mother has health insurance or prenatal care or if they live in poverty. It also looks at racial disparities in pre-term birth, beyond the aforementioned factors.

In Kentucky, 7% of women between 15 and 44 were uninsured, and 18.6% of them lived in poverty. Among those who were pregnant, 14% received inadequate prenatal care. The pre-term birth rate among African American women in Kentucky is 30% higher than the overall state rate.

In addition to the increasing rates of pre-term birth, the report notes that more than 22,000 babies a year in the U.S. die before their first birthday. That's about two babies every hour.

Number of maternal deaths nearly doubles

The report also says that a woman in the U.S. dies from pregnancy complications about every 12 hours, and more than 60% of those deaths are preventable.

Kentucky's maternal mortality rate nearly doubled in 2018, said Dr. Connie White, deputy commissioner for clinical affairs in the state Department for Public Health. In 2017, the state had 39 maternal deaths, with substance abuse a factor in 62% of them; in 2018, that number increased to 76, with at least half related to substance abuse, according to death certificates.

White said the state is still reviewing patients' medical records for 2018, but the numbers are evidence that "We are failing as a system" of delivery hospitals and providers, which should prompt all to ask where that failure exists.

To tackle these problems, the state recently launched the Kentucky Perinatal Quality Collaborative. It will work toward reducing premature births, maternal mortality and neonatal abstinence syndrome, and improving maternal and infant health outcomes. "Perinatal" refers to care given before and after the birth of a child.

White said the collaborative will ask key questions: "Are we not getting people into treatment? Are we not connecting them?" she asked. "Are we not following up afterwards? Are we working with women who have had their children taken away from them? What are we doing to really wrap our arms around these women?"

White said the collaborative will also look at data and recommendations from a new Maternal Mortality Review Committee to create evidence-based interventions that all providers and delivery hospitals can implement.

"This quality collaborative can now take those recommendations and we hope start making inroads into decreasing Kentucky's maternal death rate," she said, adding later, "There are evidence-based things that we can do, but we need to all be rowing in the same direction."

The collaborative is funded by a three-year grant from the federal Centers for Disease Control and Prevention. White said there was a great "pent-up" need for this collaborative, shown by 78% of the state's 46 birthing hospitals being represented at the collaborative's Oct. 22 launch in Louisville. Those hospitals represented 91% of the state's births.

White said the state is applying to become part of the Alliance for Innovation on Maternal Health program, which has created "bundles" of evidence-based protocols and training modules to address many of the problems that contribute to poor maternal and child outcomes, such as hypertension, hemorrhage, and maternal opioid use. After the state becomes part of the program, these bundles would be available to all of the state's providers and delivery hospitals.

She noted that six counties in Kentucky offer the Sobriety Treatment and Recovery Teams program to help parents with addictions to keep their children out of foster care while keeping the child safe. The counties with START are Kenton, Jefferson, Boyd, Martin, Daviess and Fayette.

Ky. has a high premature birth rate, but 2 programs are reducing it; one stresses home visitations; the other uses data analysis

By Melissa Patrick
Kentucky Health News

One in nine Kentucky babies are born prematurely, one of the nation's highest rates – so high that the March of Dimes gave the state a "D" on its 2018 Premature Birth Report Card.

A baby is premature if born before 37 completed weeks of pregnancy, four weeks short of full-term. In 2017,  just over 11 percent of Kentucky babies were born preterm. The national average is just under 10 percent, a rate that has risen three years in a row.

Because important growth and development happens during the last weeks of pregnancy, preterm babies are at an increased risk of neurologic, respiratory and digestive problems. Complications from being born early is the main cause of newborn death, says the March of Dimes.

Preterm babies are also at risk for long-term challenges, including behavioral and social-emotional problems, learning difficulties, and increased risk of conditions like attention deficit-hyperactivity disorder and increased risk of Sudden Infant Death Syndrome. As adults, they are more likely to have chronic diseases such as heart disease, high blood pressure and diabetes, says UK Healthcare.

The March of Dimes says that while the cause of about half of premature births is unknown, there are common risk factors, including a multiple pregnancy (twins), smoking or drug use during pregnancy, being underweight, having diabetes or having preeclampsia, a condition that is characterized by high blood pressure and the presence of protein in the mother's urine.

What's Kentucky doing about it?

Several programs work to lower the number of preterm births in Kentucky.

One is a voluntary home-visitation program called Kentucky Health Access Nurturing Development Services. Kentucky's HANDS  serves first-time, high-risk mothers through local health departments. It received a $7.5 million federal grant in October.

The HANDS program provides assistance to overburdened parents from the prenatal period to the child's third birthday. It served about 4,000 people in more than 2,000 homes through nearly 56,000 home visits in 2017, according to a Cabinet for Health and Family Services news release.

Research published in the journal Maternal Child Health, shows that participants in the HANDS program had fewer preterm births and low-birthweight babies, and decreased incidences of child abuse and neglect, especially among those who received seven or more prenatal home visits.

The data shows the rate of preterm births among expectant mothers who received one to three prenatal visits was 12.1 percent, above the state's relatively high average, while the rate for those who received seven or more visits was 9.4 percent, below the national average. Similarly, the rate of low-birthweight babies dropped to 6.5 percent among mothers with seven or more visits, compared to 8 percent who had only one, two or three visits.

The study also found that women in the program had increased access to prenatal care and decreased maternal complications during pregnancy.

The home-visitation program provides the at-risk mother with a family support worker who tailors a plan to meet her needs, including linking participants to community services needed to support a healthy pregnancy and birth. And after the child is born, the program helps families nurture healthy growth and development in the child and teaches them how to create safe homes.

Courtney Embry, a nurse from the Grayson County Health Department, said a family support worker provides education about nutrition in pregnancy and can help expectant mothers sign up for the Women, Infant and Children nutrition program, help them find resources to quit smoking, or help them find transportation to get to their prenatal appointments.

"We see a lot of moms who don't have transportation, so therefore they are not actually getting to their OB appointments," she said. "So we will help them find transportation." She said they do that through community transportation programs, programs that offer gas vouchers or helping them to find employment.

"The HANDS acronym sums up what we do," said Shelly Lambert, director of early-childhood services for the Lincoln Trail District Health Department. "We are a helping hand for parents. We are there to support them, to help them, to nurture them and help with the development of their child."

Carter County HANDS coordinator Jana McGlone said one reason the program is so successful is because it explains the "why" of it all, Lisa Gillespie reported for Louisville's WFPL in October.

“Their doc might say, ‘You need to take your prenatal vitamin,’ but he may not tell them, ‘OK, this is why you should take this’,” McGlone told Gillespie. “When they get that understanding and knowledge, it makes them want to do it more."

CDC photo

Another effort to reduce preterm births in Kentucky is a Passport Health Plan program that uses a maternity-analytics platform to identify at-risk mothers. Passport manages the care of more than 310,000 Kentuckians on Medicaid. The analytics were developed by Lucina Health, a Kentucky-based obstetric data management firm.

In just six months, Passport was able to identify 85 percent of its high-risk pregnant mothers during their first two trimesters and provide them with a personalized care plan designed to reduce their risks, according to a Lucina news release. It says the program has reduced early deliveries by 13 percent, earning Passport millions of dollars.

"Identifying and communicating with at-risk mothers as soon as possible is critical to reducing preterm birth rates in the United States," the release says. "Reducing preterm birth, a national public health priority, can be accomplished by implementing strategies that target modifiable risk factors and provide access to care with potentially high social and financial impact."

November is Prematurity Awareness Month.

Anthem gives hospital group grant to improve perinatal care, including discouraging early, medically unnecessary deliveries

The foundation of Anthem Blue Cross Blue Shield has awarded nearly $259,000 to an arm of the Kentucky Hospital Association to improve perinatal care and outcomes for mothers and their babies by discouraging early, medically unnecessary deliveries and encouraging breastfeeding.

Perinatal care, provided in the time around childbirth, is critical to ensure the good health of newborns, Anthem notes in a news release, pointing out that Kentucky's infant mortality rate is 6.6 deaths per 1,000 births, while the national rate is 6.1, and the state's rate of premature births, almost 14 percent, is well above the 9.6 percent goal set by the March of Dimes.

"The closer the baby is to full term, the better; but sometimes babies are born before they fully develop, weighing only a few pounds," the release notes. "When this occurs, long stays in the hospital neonatal intensive care unit (NICU) are necessary as these babies fight health complications while learning to breathe on their own without the use of a ventilator."

NICU stays are usually expensive. In 2012, Kentucky hospitals charged about $400 million for such treatment.

The hospital association says it has been working to reduce early, elective deliveries, with the Anthem foundation's help, and the latest grant is designed to build on that work. It says the grant to its subsidiary, the Kentucky Institute for Patient Safety and Quality, will also promote breastfeeding, reducing blood infections in the hospital, and reducing complications related to inducing labor, including Cesarean sections.

"KIPSQ will work with all Kentucky hospitals that deliver babies to assure the best care during delivery and the best outcomes for mothers and babies," the KHA release says. "KIPSQ will collect data to measure progress and provide resources, tools and technical assistance in quality improvement techniques to reduce prematurity, unnecessary Cesareans and improve the long-term health of newborns.

KHA says 76 of Kentucky’s 131 hospitals are members of KIPSQ, which is expanding its membership to include long-term care facilities and physicians' practices. "The Anthem grant will improve the delivery of perinatal health care to all of the state’s birthing/neonatal hospitals, regardless of their participation in KIPSQ," the release says.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, an independent licensee of the Blue Cross Blue Shield Association. The Anthem Foundation Inc. is a private, non-profit foundation.

Kids Count shows Ky. tops in smoking by pregnant mothers, has a wide range of local data about children's well-being

By Molly Burchett
Kentucky Health News

The annual Kids Count report on children's well-being, released Tuesday by the Annie E. Casey Foundation and Kentucky Youth Advocates, says the state leads the nation in smoking by pregnant mothers and more than one in four children in Kentucky lived in poverty in 2012. It argues for improvements in preventive care and newborn health throughout the state.

The report is part of the 23rd annual release of the County Data Book, which contains a wide range of county-by-county data that are indicators of children's well-being. Unlike previous annual reports, this one ranks Kentucky counties on overall child well-being and on four domains: economic security, education, health, and family and community strength.

The county-by-county assessment found seven counties that scored substantially higher on overall child well-being rankings: Boone, Calloway, Meade, Oldham, Spencer, Washington, and Woodford. The six counties clearly at the bottom, in descending order, were Owsley, Knox, Elliot, Martin, Fulton, and Clay.

Health affects almost every aspect of child well-being. On the four scores in the Health domain (smoking during pregnancy, low-birthweight babies, asthma hospitalizations and teen births) Oldham and Boone counties scored much higher than other counties, and Bell and Fulton counties, in the southeastern and southwestern corners of the state, scored the lowest.

The chart to the right indicates how much worse Bell and Fulton ranked than similar counties. 

The data from this year’s Kids Count book, as well as new and historical data for the many other indicators Kentucky Youth Advocates tracks, can be found at the Kids Count Data Center by clicking here. The data cover counties, school districts, cities and Metro Louisville council districts.

Based on the latest available data from 34 comparable states, in 2011 Kentucky had the highest rate of women who smoked during pregnancy. Nationally, 9 percent smoked during pregnancy while 23 percent did in Kentucky.


Babies born to mothers who smoked during pregnancy are more likely to suffer low birth weight, premature birth and infant death, and almost one in every 10 babies in Kentucky were born at low birth weight, says the report. While the national average for low-birthweight babies is 8.1 percent of all live births, low-birth-weight babies made up more than 14 percent of births to mothers in Lawrence, Lewis, Martin, and Wolfe counties.

“We know smoke-free policies will reduce smoking during pregnancy and reduce the number of babies born at a low birth weight,” said Terry Brooks, executive director of Kentucky Youth Advocates. “It’s time to do what works and enact a comprehensive, statewide smoke-free law. We need to protect all children, not just those lucky enough to be born in a smoke-free community.”


In addition to babies born to mothers who smoke during pregnancy, those born to teenage mothers are at increased risk of low birth weight and other health problems, says the report.

While the state's rate of births to teenage mothers has declined each year since 2007, it remains higher than the national average, which has shown a similar decline. There were 43 teen births for every 1,000 females aged 15-19 in 2011, compared to the national rate of 31. The report says Oldham County had the lowest rate of teen births (1.3 percent) while McCreary County had the highest (8.6 percent). It also says the most effective way to keep reducing teen births rate is to educate young people about sex and risky sexual behaviors, and to provide access to contraceptive methods.

While Kentucky has made progress in providing health-care coverage for children and newborns, the state is among the leaders in childhood obesity, diabetes and asthma, and has a greater-than-average number of children with disabilities or other chronic health problems like cystic fibrosis or heart disease, the report says. "Yet families face many hurdles when they seek treatment for their children. They may lack health insurance or lack transportation," it says. "Some areas do not have enough health-care providers."

Report calls for investments in Kentucky children

Higher teen-birth rates are found among communities of color, which are also disproportionately affected by poverty, says the report. One in four of Kentucky's children live in poverty.

This rate and the number of unemployed parents, which went up by 24,000 between 2007 and 2012, have increased since the 2008-09 recession. Poverty rates in 2012 were highest among African American children (52 percent) and Hispanic or Latino children (41 percent). Living in a high-poverty area puts a child at greater risk for poor health and educational outcomes.

A widespread lack of economic security is perhaps the greatest concern for many kids in the state, says the report. The Kentucky Cabinet for Health and Family Services recently cut spending for the Child Care Assistance Program and the Kinship Care Program. As a result, 8,700 families lost assistance for child care, and financial support was also eliminated for main relatives who raise children unable to live with their parents. The report calls for restoration of these programs and more investments in Kentucky’s children.

"Taken together, the data tell a clear story: Kentucky kids need the attention of Kentucky leaders," says the report. “It’s time to make children and families a priority in our state by investing in programs that keep parents working and promote economic security,” said Brooks.

Click here to get more information about the Annie E. Casey Foundation or view its policy reports.

U.S. preterm birth rate goes down but Kentucky's maternal smoking rate still second highest, putting preterm babies at risk

For the fifth year in a row, the preterm birth rate in the United States has dropped. Which is great news. But Kentucky again had a significantly high smoking rate for expectant mothers -- at 32.2 percent, putting us behind only West Virginia (at 36 percent) of pregnant women who gave birth preterm and smoked.

Being born before full term puts babies at undue risk. Still, nearly half a million babies in the United States are born prematurely, many unnecessarily, according to the March of Dimes' 2012 Premature Birth Report Card. Serena Gordon of HealthDay reports that "those risks include breathing difficulties, heart defects and bleeding in the brain. Some conditions are only temporary while others can persist." A premature birth is anything that occurs before 37 weeks gestation. Maternal smoking is a major factor respiratory difficulties for the child and in an inability for the mother to go full term.

It is also been found that women without health insurance also have a higher incidence of preterm birth. Texas had the worst rates of uninsured women with 34.2 percent without insurance. Florida and New Mexico had rates of uninsured women of about 30 percent. Kentucky had rates of uninsured women of 21.7 percent. (Read more)

To see the full report and to see how Kentucky fared compared to other states in a number of other categories, go here.

Kentucky doctor honored for her work in bolstering health and preventing deaths of babies born a few weeks early

A Kentucky neonatalogist was honored this week for giving the state "a role in catalyzing a national movement around healthier babies." Ruth Ann Shepherd, M.D., division director for maternal and child health in the Kentucky Department for Public Health, was presented the Association of State and Territorial Health Officials Presidential Meritorious Service Award and recognized as "an early pioneer in recognizing the critical public health problem of preterm births in Kentucky, and that the troubling trend was common to most states in the country."

According to New Public Health, an online publication of the Robert Wood Johnson Foundation,  Shepherd’s research "revealed that babies born at 37 or 38 weeks had far worse health outcomes than babies born at 39 or 40 weeks. With support from the leadership at the Kentucky Department of Health, and many other organizations who have since taken up the cause of helping to create conditions for healthier babies, many states are beginning to make strides in preventing early births."

Charles Kendall, chief of staff at the Kentucky Health Department, told the online magazine that the  prematurity rate for infants in Kentucky was exceptionally high, averaging at about 36 weeks at the time of birth.  "There was a corresponding infant death rate that was far exceeding the national average When she looked at the data, it occurred to her that many of those deaths could have been prevented.," he said. "Much of the prematurity rate had nothing to do with medical issues. The data were telling her that women who smoke are much more likely to deliver early and to have smaller babies. The size of the baby was really the predictor for the infant death rate."

 But what Shepard also understood, said Kendall, was that a lot of these births were actually planned for convenience. "That was one of the more startling pieces of information from the data. In many cases it was not a medical issue but a lack of education or convenience. She also brought the science from her work that showed that the fetal brain is still in critical stages of development in those early weeks, and that it’s not at its full capacity until 39 or 40 weeks. That was very compelling. She also said this is not just a Kentucky issue. This is going on everywhere." ( Read more

Infant mortality, pre-term birth, teenage pregnancy, children living in smokers' homes all drop even as as child poverty goes up

Nationwide, the rates of infants who die, babies who are born prematurely, teens who are having babies, and the percentage of young children who live in a home where someone smokes have all decreased in the last five years. But the percentage of kids who live in poverty has gone up.

These findings are some highlights of the report "America's Children in Brief: Key National Indicators of Well-Being, 2012," compiled by the Federal Interagency Forum on Child and Family Statistics. The report, which does not break down data by state, looks at children's demographic backgrounds, family and social environments, economic circumstances, health care, physical environment and safety, behavior, education and health.

"This year's report contains good news about newborns," said Dr. Alan E. Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. "Fewer infants were born pre-term and fewer died in the first year of life."

Among other findings: In the last five years there has been a five-fold increase in the percentage of teens who have received the vaccine that prevents the most dangerous form of meningitis. Other key findings show:
• A drop in the percentage of children who live in homes that are classified as food insecure.
• A drop in the percentage of teens ages 16 to 19 who don't work and are not enrolled in high school or college.
• A rise in the percentage of children from birth to age 17 who live in counties in which one or more air pollutants were above allowable levels.
• An increase of one statistical point in the average math scores for 4th and 8th graders from 2009 to 2011. For a quick glance at the findings, click here. (Read more)

Ky. premature births declining, but still above national average

Giving birth to a baby before it has been brought to full term has become less common in the U.S. and Kentucky, but the nation still only received a C, and the state a D, in the 2011 Premature Birth Report Cards compiled by the March of Dimes. Each year, nearly half a million babies are born prematurely.

In Kentucky, 13.6 percent of women gave birth to babies prematurely in 2009, down by 0.4 percentage points over 2008. Only Vermont was given an A, with a pre-term birth rate of 9.3 percent, reports Bonnie Rochman of Time Healthland. Three states and Puerto Rico got Fs; 19 got Cs and 11, as well as the District of Columbia, got a D.

Data from 2006 to 2009 were analyzed. In 2009, the preliminary preterm birth rate was 12.2 percent, compared to 12.8 percent in 2006. The March of Dimes wants that number to drop to 9.6 percent by 2020. Pre-term birth is the leading cause of newborn death in the U.S.

The study analyzed three factors that can contribute to pre-term birth, including the percentage of uninsured women in each state and the percentage of women who smoke. Late pre-term birth, which occurs when a baby is born between 34 to 36 weeks gestation, was also considered, as it "has been linked to rising rates of early induction of labor and C-sections," the study says.

In Kentucky, the percentage of uninsured women has remained the same at 22.8 percent from 2006 to 2009. The smoking rate has dropped from 30.5 percent to 27.3 percent, as has the late pre-term birth rate, down to 9.7 percent from 10.2 percent. (For other states, click on the map above, then click on the state in the larger image.)

The pre-term birth rate was calculated by looking at the percentage of all live births in which the babies had reached 37 weeks gestation or less.

March of Dimes President Dr. Jennifer Howse called the study results positive, "given that for the past 30 years, the rate of preterm birth has been increasing."

"It's not a lot, and the rate is still too high, but the good news is some things are starting to work," she said. (Read more)