Kids Count report says hard times in early childhood are more likely in Ky. than rest of U.S.; bad times have long-term effects

By Melissa Patrick
Kentucky Health News

One of every five children in Kentucky, by the time they are 5 years old, has experienced two or more adverse childhood experiences such as child abuse, economic hardship, exposure to violence, living in a household with mental illness or substance abuse, or where a family member has been incarcerated.

That is one of the major points of the 24th annual Kids Count report, released Tuesday by Kentucky Youth Advocates. The report is part of a state-by-state effort with county-by-county data; nationally, only one in eight children by age 5 have had two adverse experiences, defined as events or circumstances that can affect the quality of the child's adult life, including their health and length of life.

"The higher the total number of these events a child experiences, the higher the risk of obesity, chronic illness, substance abuse, smoking and mental health problems," the report says. Another study cited in the report found that "Children who had experienced four or more adverse events had lower incomes, lower education attainment and lost more days of work or school as adults due to problems with physical or mental health."

“We know when children experience traumatic events such as abuse and neglect or having an incarcerated parent, it negatively impacts their health and often causes barriers to success later in life. Kentucky leaders need to enact solutions to prevent these experiences in the first place and when they do happen, help children successfully recover,” Dr. Terry Brooks, executive director of Kentucky Youth Advocates, said in a press release.

This report by Kentucky Youth Advocates measures 16 indicators to determine the overall well-being of children in Kentucky counties and focuses on four areas considered critical to well-being: economic security, education, health, and family and community strength.

The Kentucky counties with the highest overall child well-being rankings are Oldham, Boone, Spencer, Woodford, and Calloway; the lowest are Martin, Owsley, Wolfe, Clay and Elliott.

Overall Child Well-Being, based on four factors:
economic security, education, health, and family and community.

The 2011-12 survey said that Kentucky children are more likely to experience two or more adverse events  (30 percent) than children are nationally (22.6 percent). The four most common adverse events among Kentucky's children, says the report, are economic hardship, living with a parent or guardian who got divorced or separated, living with anyone who had a problem with alcohol or drugs, and living with a parent or guardian who was incarcerated.

This study evaluated four indicators of health: smoking during pregnancy, low-birthweight babies, children and young adults without health insurance and teen births.  Oldham and Boone counties scored higher than the other counties on health and Elliott County ranked last.

Overall Health: County Comparisons.  Based on county
scores for the four indicators in the report.  

The study found Kentucky has the highest rate of mothers who smoke during pregnancy, one in five, compared to states with comparable data, reporting that the county rates varied widely in this area with less than 14 percent of expectant mothers in Fayette, Jefferson, and Oldham counties smoked, compared to 40 percent or more of mothers in Clay, Elliot, Lee, and Owsley counties.

The percentage of low-birthweight babies in Kentucky, often a result of smoking during pregnancy, between 1994-2012 (8.7 percent) was found to be consistently higher than the U.S. percentage (8.0 percent).

“All parents want what is best for their children, and we know that smoke is bad for kids,” Bethany Hodge, a pediatrician in Louisville, said in the release. “Kentucky needs an indoor smoke-free law so working mothers-to-be do not have to choose between their jobs and protecting their unborn babies.”

One in eight under 26 lacked health insurance in this study, but this number is expected to decline.

“Kentucky has effectively connected young people to health insurance, especially with the outreach efforts of KCHIP over the past few years and kynect over the past year,” Brooks said in the press release. “It’s important to build on those successes with innovative ways to connect all young people to coverage. One solution is to automatically enroll youth aging out of foster care in Medicaid to make sure they maintain health insurance as they leave the state’s care.”

As for teen births, in 2012, Kentucky's rate of births to teen mothers (42 per 1,000) "substantially" exceed the national rate (29 per 1000).

Many of Kentucky's children face adverse childhood experiences related to economic security.

According to the report, Kentucky has now had four consecutive years in which more than one in every four children lives in poverty, which is consistently higher than the national average. It also reports that more than two in every five Kentucky children live in a high-poverty area.

The report says, " A family's earnings and its poverty status, the level of poverty in its neighborhood and the affordability of housing can all affect how a child grows, learns and ultimately succeeds as an adult."

Boone, Oldham and Spencer counties have the highest scores for economic security, while Lee, Martin and Wolfe have the lowest.

Economic security, based on scores for the four indicators in the report.

The results of the well-being of Kentucky's children around education are concerning.

More than half (51 percent) of Kentucky's children entering kindergarten are not adequately prepared for school and more than half  (51 percent) of its fourth graders are not proficient in reading and "therefore not on the path to high school graduation," according to the report. The study also found that over half (55 percent) of Kentucky eighth graders are not proficient in math and that one in seven Kentucky high school students did not graduate on time.

Oldham and Lyon counties "stand apart" at the top of the  education county comparison, with Clinton, Knox, Menifee and Clay counties ranking last.

Education, based on scores for the four indicators in the report. 

Family and community indicators in the report found that Kentucky is not putting as many youth in jail as in previous years; nearly one in five births were to moms without a high school degree; the number of children living in a single-parent home has grown to 37 percent from 35 percent; and over the course of 2013, over 12,700 children were placed in foster care due to abuse or neglect.

Oldham, Boone, Carlisle, Ballard and Spencer counties rank at the top of the family and community county comparisons, with Powell, Clay, Elliott, Owsley and Carroll counties ranked at the bottom.

Family and Community, based on scores for the four indicators in the report. 

The report recommends implementation of strong policies to combat children's exposure to adverse childhood experiences. "The best option for Kentucky is to find ways to prevent adverse childhood experiences. Ensuring safe, stable and nurturing environments will shield children from toxic stress and its deleterious effects," says the report.

Click here for the Annie E. Casey Foundation Kids Count Data Center, which includes current and historical data. Note that the indicators included in the 2014 rankings are different than those included in the 2013 County Data Book. Therefore, current rankings should not be compared to last year’s county rankings.

Study shows tailored advocacy for local smoking bans in rural Kentucky gets results

Local smoking bans are only possible if the community is ready for this change, Ellen Hahn, director of the Kentucky Center for Smoke-free Policy, writes in a report of a five-year study she conducted in rural Kentucky.

Readiness for change can be developed in rural communities that participate in smoke-free policy initiatives tailored to their community, Hahn writes in The Journal of Rural Health. The study evaluated six stages of readiness to determine if a community was ready to support smoke-free policy, and then tailored interventions based on how ready the community was.

The study was conducted in 37 rural Kentucky counties that were randomly selected from those without smoking ordinances or regulations. Nineteen of the communities received policy-intervention strategies, tailored to their readiness, from a trained community adviser. The remaining 18 were used for comparison. Data were collected annually and policy outcomes were tracked over five years.

Nearly one-third of the counties that were the target of interventions adopted smoking bans covering restaurants, bars, and all workplaces, while none of the comparison counties did.

Rural, tobacco-growing areas were chosen because they are "disproportionately affected by tobacco use, secondhand smoke, and weak tobacco control policies," Hahn writes in the study, "A Controlled Community-Based Trial to Promote Smoke-Free Policy in Rural Communities."

Study shows students, especially those with ADHD, have improved academic performance after they exercise

Children do better in school when they aren't forced to sit still all day, especially those with attention deficit hyperactivity disorder, Gretchen Reynolds reports in The New York Times.

Recent research, published last year in The Journal of Pediatrics, suggests that even small amounts of exercise enable children to improve their focus and academic performance.

The study looked at 40 boys and girls, age 8 to 10, half of whom had ADHD. Researchers gave the students a baseline academic test and also one that tested their attention. They then gave the same tests two more times, first after they had sat and read quietly for 20 minutes and the other after they had walked briskly or jogged 20 minutes on treadmills. Brain activity was recorded as they repeated the original tests.

Little difference was found in any of the students after quietly reading, but "they all showed marked improvements in their math and reading comprehension scores after the exercise," Reynolds writes. Students with ADHD showed significant increases on their scores and had brain-wave readings that showed them better able to regulate their behavior, which helped them pay attention.

"The results should make administrators question the wisdom of cutting P.E. classes," Reynolds writes.

This information is a valuable tool for educators, especially in Kentucky, which leads the nation with 19 percent of children ages 4 to 17, compared to 11 percent nationally, who have ever been diagnosed with ADHD, according to the federal Centers for Disease Control and Prevention. The level of exercise needed to show academic and attentional improvement involves activities that can be done in the classroom throughout the day, like marching or hopping in place.

Survey finds 1 in 7 Kentuckians over 44 say they have worsening confusion or memory loss; few say they get needed help

Worsening memory loss reported by Kentuckians in a survey could be indicative of a future Alzheimer's or dementia public health crisis, according to a press release from the Alzheimer's Association.

A first-time survey about memory loss shows that 14.1 percent of Kentuckians aged 45 and older report that they have confusion or memory loss that has become more frequent or gotten worse over the last 12 months. In the 21 states that participated in the study, the average was 12.5 percent.

The survey indicated a gap between need and care. Nearly 61 percent of Kentuckians who reported worsening memory problems said  they need assistance, but only 10.3 percent report getting help. And 25 percent of Kentuckians who reported worsening memory loss live alone.

“The data are indicative of a public-health crisis coming to our region,” Teri Shirk, executive director of the Alzheimer’s Association of Greater Kentucky and Southern Indiana, said in the release.

The report was compiled from data gathered for the first time in the Cognitive Decline Module, part of the Behavioral Risk Factor Surveillance System of the federal Centers for Disease Control and Prevention, in 2012.

Of those Kentuckians who reported memory loss in the survey, 75 percent of them haven't talked to their doctor about it. This is a problem, Shirk said in the release.

"Although the data do not indicate the respondents are cognitively impaired, worsening memory problems are often one of the first warning signs of Alzheimer’s or another dementia," she said.

The Alzheimer’s Association estimates that 67,000 Kentuckians have the disease and estimates this number will climb to 86,000 by 2025.

Of those Kentuckians who reported memory loss, 47 percent said it had interfered with household activities, work or social activities, compared to 40 percent of respondents across the 21 states.

"More than 80 percent have at least one other chronic condition, and many – especially in Kentucky – report conditions or behaviors that we know correlate with Alzheimer’s,” Shirk said. For example, more than 31 percent of Kentucky survey respondents reporting memory issues are smokers, and more than 61 percent say they are in fair or poor health, according to the survey.

“Dementia is absolutely not a normal part of aging,” said Shirk. “And worsening memory loss or confusion does not necessarily mean you have Alzheimer’s disease. If the issue is caused by medication, head trauma or other factors, it may be reversible. But if you do have Alzheimer’s, finding out early means you may be able to begin medications that tend to be more effective in the early stages, and it also gives you the opportunity to participate in planning for your future with the disease … where you will live, how your funds will be used and who will care for you as the disease progresses.”

For more information about the Alzheimer's Association, click here. For more information about the annual fundraising Walks to End Alzheimer's, held in September and October each year, click here.

Beshear bans use of tobacco products and e-cigarettes on or near buildings and property the state owns or leases

Gov. Steve Beshear issued an executive order Sept, 4 that soon ban all tobacco products and e-cigarettes from more than 26.4 million square feet of executive branch buildings and grounds on Nov. 20.

All executive-branch buildings are smoke-free inside, but the new ban extends to the use of all tobacco products and e-cigarettes in state-owned or -leased buildings, in state-owned vehicles and on state property.

“Tobacco products have a deadly grip on thousands of Kentuckians. Smoking and tobacco use are the single-biggest causes of preventable illness and death in our state,” Beshear said in a news release. “This policy will protect non-smokers from the effects of secondhand smoke and encourage tobacco users to seek help in quitting.”

Kentucky is only the fifth state to institute such a policy. The release notes that more than 28 percent of adults smoke, leading to 8,000 Kentucky deaths each year from tobacco-related illnesses.

Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, said Beshear's move "sends a clear signal that Kentucky is serious about curbing the negative health consequences of smoking, and committed to improving the health of Kentuckians,” said Zepeda. She noted that polls have shown a clear majority of Kentucky adults favor a statewide smoking ban.

The release from Beshear's office said expanding tobacco-free policies to more executive-branch property is aimed at helping achieve his kyhealthnow goal of reducing smoking rates by 10 percent by 2019. Beshear supports a statewide smoking ban and encourages all state and local government facilities, public and private school districts, universities, and businesses to consider limiting use of tobacco products on their properties.

Amy Barkley, Chair of Smoke-free Kentucky, said in the release, “We are hopeful that this policy will motivate the legislature to pass a comprehensive, statewide, smoke-free law that will protect the rest of Kentucky workers from secondhand smoke exposure in all other indoor workplaces.”

More information about the policy, as well as links to tools to stop tobacco use, are available at http://tobacco-free.ky.gov.

UK cancer-center director urges lawmakers to raise cigarette tax and pass a statewide smoking ban to reduce cancer deaths

The Markey Cancer Center at the University of Kentucky supports a statewide smoking ban and an increase in the state cigarette tax to significantly reduce cancer deaths in the state, the center's director told a legislative committee Sept. 3.

“We are highly supportive, and we hope that you will be supportive as well, of (these) initiatives that we think will improve the overall health of Kentuckians,” Dr. B. Mark Evers told the state legislative Tobacco Settlement Agreement Fund Oversight Committee.

A news release from the Legislative Research Commission said Evers presented the numbers to back up his advice: Kentucky is first nationally in percentage of people who get cancer, and in overall cancer mortality. Lung cancer alone accounts for about 35 percent of Kentucky cancer deaths; nationally, lung cancer's share is 28 percent.

Twenty-eight percent of adult Kentuckians smoke, with approximately 8,000 deaths each year from smoking-related illnesses. The greatest incidence of tobacco-related cancers is in Eastern Kentucky.

That is the highest percentage in the U.S., Evers notes, adding that there is an indirect relationship between cigarette taxes and smoking rates. Kentucky has the 12th lowest cigarette tax among the states.

"Raising the cost of cigarettes and a statewide smoking ban could help cut Kentucky cancer deaths by 50 percent," Evers said. That is the Markey Cancer Center's goal over the next five years.

The center has a new strategic plan, "Conquering Cancer in the Commonwealth," that focuses on the state's "major cancer killers" -- lung, head and neck, colorectal, breast, and cervical cancer.

In response to a question about how to decrease the number of smokers in Kentucky, Evers pointed to local smoke-free policies and increased efforts in Appalachia toward smoking cessation.

When asked what it will take to lower the percentage of Kentucky smokers to less than 10 percent, Evers recommended three things: increasing the cigarette excise tax, a statewide smoking ban, and instituting lung-cancer screening projects like those in place at UK and the University of Louisville.

“Those three things are really going to help drive down those numbers,” he said.

School fundraisers that involve food must meet the new federal nutrition guidelines; state hasn't sought an exemption

Fundraising with foods that don't meet schools' new federal nutrition guidelines will not be allowed during the school day in Kentucky, Valarie Honeycutt Spears reports for the Lexington Herald-Leader.

One of the most popular fundraisers for schools is the sale of candy, which formerly could be sold after lunch.  Those days are over in Kentucky; the state has not requested an exemption to hold such fundraisers.

Fundraisers using foods like cookie dough and frozen pizza, which are meant to be eaten at home, have not been restricted and there are no fundraising restrictions on foods that meet the Smart Snacks standards, the Herald-Leader  reports.

Schools are adapting to these changes.  One in Lexington reports moving to fundraisers that focus on physical fitness rather than food, and Kona Ice, a firm that sells shaved ice, now offers products that meet and exceed the new standards for snacks, company spokesman Jamie Izaks told the newspaper.

Marty Flynn, executive director of the Kentucky School Nutrition Association, told the paper, "Regulations that stem from the Healthy, Hunger-Free Kids Act of 2010, although well-intentioned, have been enacted too quickly, and without attention to the availability of acceptable products, acceptance of students and the financial consequences to the self-sustaining school meal programs. Many food service directors have indicated that for the first time in many years their programs lost money and have been faced with declining participation."

UK-EKU center gets $5 million to address occupational health and safety issues in Central Appalachia and Kentucky

A center based in the University of Kentucky College of Public Health has received a five-year, $5 million grant to advance occupational health and safety in Central Appalachia and Kentucky, the university reports.

The grant was funded by the National Institute for Occupational Safety and Health at the federal Centers for Disease Control and Prevention. It will support the Central Appalachian Regional Education and Research Center as a "cohesive, fully equipped and recognized resource for occupational safety and health research and training in Central Appalachia," a UK release says.

It says Central Appalachia has "high proportions of fatal occupational injuries related to transportation and highway incidents; injuries in agriculture, forestry, fishing and hunting, and mining." However, "Systematic attention to the safety and health concerns of its work force has been limited," CARERC Director Wayne Sanderson said.

CARERC was formed in 2012 by the colleges nursing, public health and engineering at UK as well as the College of Justice and Safety at Eastern Kentucky University. It is one of only 18 such centers in the nation and provides interdisciplinary graduate education for students and health professionals in five programs: agricultural safety and health, occupational epidemiology, mining engineering safety and health, occupational health nursing, and occupational safety.

Seventy percent of the funding will support students in the CARERC program. The center also serves as a resource for industry, labor, government agencies, and other stakeholders and is partnering with stakeholders in the mining industry to develop new methods to reduce miners' coal-dust exposure.

"There aren’t many courses or programs where you're out in the field working with nurses, epidemiologists, and safety experts," Sanderson said in the release. "Everything we do is very interdisciplinary, which is how the real world works — people working together to solve problems."

KET series to explore how chemistry, technology, fast food, "supersizing," marketing, and lobbying have made us fat

KET will air a three-part series, "Men Who Made Us Fat," in which Jacques Peretti blames American obesity on high-fructose corn syrup, fast food, "supersizing," marketing, and lobbying.

In the first episode Jacques Peretti looks at how decisions made in America 40 years ago influence how we eat today. He looks closely at high-fructose corn syrup, which interferes with leptin, the hormone that controls appetite. He also explores the role of fast-food chains in making a society fatter. It will air Monday, Sept. 8 at 10 p.m. EDT.

The second episode explores supersizing's role in how the U.S., once a nation of moderate eaters, started to want more. It will also examine how advertising directed at children has contributed to child obesity. It will air on KET2 Tuesday, Sept. 9 at 8 p.m. and on KET Sept. 11 at 4 a.m. and Sept. 15 at 10 p.m. EDT.

The third episode targets how marketing influences food buying, as well as government initiatives and health campaigns and how food manufacturers and related interests have lobbied hard against these efforts. It will air on KET Thursday, Sept. 18 at 4 a.m. and Monday, Sept. 22 at 10 p.m. EDT.

Free, day-long forum Sept. 16 in Louisville will explore doing health care differently; registration almost full

A free one-day conference will be held Tuesday, Sept. 16, in Louisville to explore policy opportunities and challenges related to doing health care differently for a healthier Kentucky. The focus will be on the shift to a population-health approach, which emphasizes prevention and integration of services while treating the whole person within the context of their community.

This edition of the Foundation for a Healthy Kentucky's annual Howard L. Bost Memorial Health Policy Forum, Doing Care Differently: Journey to a Healthier Kentucky, will have experts on:

• Changing the health-care workforce 
• information-technology applications in health care;
• Measuring, and improving, quality 
• Payment changes that drive care-delivery changes

The keynote speaker will be Dr. Jason Hwang, chief medical officer and one of the founders of PolkaDoc, an "extremely affordable primary care" telehealth company. Other speakers include Dr. Craig Blakely, dean of the University of Louisville School of Public Health and Information Sciences; Brent Wright of the U of L School of Medicine; David Bolt of the Kentucky Primary Care Association; Travis Burgett of KentuckyOne Health; Mark Carter of Passport Health Plan; Fran Feltner, director of the University of Kentucky Center for Excellence in Rural Health; Dr. John Langefeld of the state Cabinet for Health and Family Services; Dr. Raynor Mullins of the UK College of Dentistry; Polly Mullins-Bentley of the Governor's Office of Electronic Health Information; Sheila Schuster, chair of the Kentucky Mental Health Coalition; and Connie White of the state Department for Public Health.

The conference is free to the public, but seating is limited and registration is nearly full. For more information click here; for an agenda, here; to register, here.

As part of UK campus food deal, Aramark puts up $5 million for Food Connection, vows to purchase Kentucky products

By Melissa Patrick
Kentucky Health News

The University of Kentucky has entered a $5 million public-private partnership designed to promote the study and research of food at UK and to promote local food in the state.

L-R: Aramark President and CEO Eric Foss, UK President Eli
Capilouto. Agriculture Commissioner James Comer; College of
Agriculture, Food & Environment Dean Nancy Cox (UK photo)

UK President Eli Capilouto called the Food Connection an "unprecedented public-private partnership" between the university and food-service giant Aramark, which is putting up the money and getting the campus food contract. It will be housed in UK's College of Agriculture, Food and Environment.

Capilouto said the partnership is in various stages of development, including improving facilities, adding high-quality, healthy food options, and providing a greater commitment to Kentucky farmers.

"This partnership is more than just brick and mortar, it's more than simply menus and venues. It's about people," Capilouto said, including learning and research for students.

The Food Connection will partner with the state Department of Agriculture, farmers, community partners, and consumers to enhance the production, distribution, and consumption of local products and those with the Kentucky Proud label.

Aramark's $5 million includes $1 million to endow undergraduate and graduate internships and fellowships, $250,000 in one-time start-up costs for equipment and programmatic needs, and $250,000 a year for 15 years for staff, programming, research grants, and other initiatives.

"Our goal is to make sure that we create a sustainable, healthy and a successful food economy here in Kentucky for generations to come," Aramark CEO Eric Foss said.

State Agriculture Commissioner James Comer said, "This project today is going to have a significant impact on the agriculture economy in Kentucky."

UK will break ground next week on the space designated for the Food Connection facility, near the library where some old fraternity houses have been demolished.

Scott Smith, former dean of the College of Agriculture, will be the interim faculty director of the Food Connection. Dean Nancy Cox said that while the "vision and framework is in place" for the Food Connection related to research opportunities, "This new chapter is yet to be written on exactly what we do at the Connection."

A UK press release said the Food Connection will have programming, such as an annual Kentucky food summit and programs for youth.

Sicker patients, competition for beds and a growing number of patients create long wait times at UK emergency room

The University of Kentucky's emergency room has the longest wait time in Kentucky and this time is also way above the national average, Mary Meehan reports for the Lexington Herald-Leader.

With beds regularly lining the halls of the ER, the average wait time for emergency care at UK — measured from the time a patient comes through the door to reaching a hospital bed — is 10 hours and 44 minutes, Meehan reports. This is 4 1/2 hours longer than the national average, according to Hospital Compare, a government website where Medicare reports data on hospitals.

Hospital officials blame the competition for beds between surgical and ER patients, the growing number of patients, and the fact that UK treats the sickest patients in the state.

Since the expansion of the ER in 2010, it annual patient count has risen to 70,000 from 30,000, chief nurse executive Colleen Swartz told Meehan.

Nearby, comparable hospitals have significantly shorter wait times. The University of Louisville Hospital, Kentucky's other Level 1 adult trauma center, has a wait time three and a half hours shorter.

UK's needs to add more rooms and beds, Dr. Michael Karpf, UK's executive vice president for health affairs, told Meehan, suggesting the hospital's empty, $763 million medical tower needs to be completed.

The UK Chandler Medical Center plans to expand its beds by shifting 35 acute-care beds from UK's Good Samaritan Hospital by the end of the year, and the tower completion is set for 2018 to 2020.

But the hopspital-accrediting Joint Commission and Eugene Litvak, a Harvard University professor and expert in hospital efficiency, think otherwise.  They told Meehan that "better communication, scheduling and staffing is the solution." The commission says those methods are "grossly underused." 

Litvak told Meehan that building more beds is not the answer.  He said that "with increased communication, hospitals can achieve an even tempo of patient flow that will reduce ER wait times," and how surgeries are scheduled is the main reason for wait-time problems.

Surgeons get priority on scheduling, and surgical patients get priority over the ER patients for rooms. Livtak said surgeries are generally covered by insurance, making them more profitable for hospitals, and ER patients often do not have insurance and are less profitable to treat. Things don't change, because "We don't want to upset our cash cows, the surgeons," Livtak told Meehan.

Swartz acknowledged that surgery and ER patients can compete for beds at the hospital, but she said "All UK patients are treated equally whether they have insurance or not."

A Herald-Leader editorial criticized Karpf for saying the ER would "muddle through" while beds are added, saying "Delays like those at UK can easily create patient-safety problems and affect the quality of care, especially as the Affordable Care Act allows more people into the health-care system."

The editorial said "UK HealthCare should not push for spending hundreds of millions on more rooms without making every effort to examine and improve the ER system that could put patients at risk," and take the advice of experts who say that more beds aren't the answer, as well as allowing people with management backgrounds, not medical backgrounds, to improve the system through "streamlining and efficiency."