Kentucky's breastfeeding rate is one of the lowest in the U.S.

Photo: Kybreastfeeding.com
(Click link for more information)

By Melissa Patrick
Kentucky Health News

The federal Centers for Disease Control and Prevention says breastfeeding is a key strategy to improve public health, and Kentucky ranks 48th among the states in the percentage of mothers who breastfeed.

Studies show that children who have been breastfed have less risk of respiratory infections, Sudden Infant Death Syndrome, Type 1 and Type 2 diabetes, obesity and asthma. Mothers who breastfeed have a decreased risk of  breast, ovarian and endometrial cancers and heart disease, all conditions that plague Kentucky.

"I don't think we have any pill, any vitamin, any thing that we can take that can reduce the risk of all these diseases just at once. Like, take this pill once a day and you will be able to decrease all these diseases. There is nothing like that," Ana Maria Linares, an associate professor at the University of Kentucky College of Nursing, said in a telephone interview. "But we can give that to our babies with exclusive breastfeeding."

The American Academy of Pediatrics recommends that infants be only breastfed for the first six months, with continued breastfeeding alongside complementary foods for at least one year.

"Breast milk is especially adapted to be easily absorbed by the baby gut . . . and produces a specific microorganism in the gut that (will) protect the infant," Linares said.

The CDC's 2016 Breastfeeding Report Card says Kentucky's breastfeeding rates are slowly improving, but remain very low.

The U.S. Department of Health and Human Services sets Healthy People goals in a plan to improve the nation's health.

Six months after giving birth, 35.3 percent of Kentucky mothers reported  breastfeeding their infants some of the time, with only Louisiana (31.2 percent) and Mississippi (23.9 percent) having lower rates. Only 19 percent of mothers in Kentucky breastfed exclusively after six months; that was much closer to the national figure of 22.3 percent.

Two-thirds of mothers in Kentucky said they tried breastfeeding at least once, indicating a willingness to do so and perhaps a lack of support to continue, the report said. Nationally, 81 percent of mothers tried breastfeeding at least once.

"We are getting there," said Linares, the UK professor whose research focuses on breastfeeding. "I am really positive about that  because more and more mothers are willing to breastfeed now, at least give it a try. And that is a lot to say because before they wouldn't even consider it."

Rates for Kentucky mothers who have breastfed their infant for six months has improved by almost 34 percent since the CDC started publishing these report cards in 2007, up from 26.4 percent. And improved 153 percent for Kentucky mothers who breastfed exclusively for six months, from 7.5 percent. Data from the 2007 report came from 2004.

Linares said Kentucky is working to teach health-care providers about the importance of breastfeeding and has increased its pre-natal education about breastfeeding. The state offers a peer-counseling program that puts mothers who have had a good breastfeeding experience in touch with new breastfeeding mothers.

"The peer counselor program is one of the most important programs in the state," because it provides support for mothers not only to start breastfeeding, but to also maintain it, Linares said.

The state is also working to get hospitals certified as "Baby Friendly," which, among other requirements, allows the mother and baby to have "skin-to-skin" contact for at least two hours, with has been proven to prompt breastfeeding.

Kentucky has three such hospitals: Norton Women's and Kosair Children's Hospital in Louisville, St. Elizabeth Medical Center in Northern Kentucky, and University of Kentucky Hospital in Lexington.

Linaes said that Kentucky has work to do on its societal views of breastfeeding, because some mothers still feel that they don't have enough support to do it, especially in public places. Kentucky has had a law since 2006 that allows mothers to breastfeed anywhere.

"We need to have a law that protects mothers so that they can have maternity leave, to stay home for at least one month so that they can establish breastfeeding," Linares said, adding that six months would be preferable.

Linares said the U.S. is one of only three developed countries that doesn't offer paid maternity leave, which she said creates a situation which poses a question for mothers: "Should I work or should I breastfeed my baby?" She cited a study indicating if 90 percent of U.S. mothers were able to breastfeed exclusively for the first six months, it would save the country "billions of dollars" and "many lives."

Super-powerful narcotics threaten even more fatal drug overdoses in region; six in Danville area spur community action

“If you’re putting a needle in your arm, you’re playing Russian roulette,” because so many super-powerful narcotics such as fentanyl are in the illegal drug trade, Dr. Eric Guerrant, emergency department medical director at Ephraim McDowell Regional Medical Center in Danville, told Laura Ungar of The Courier-Journal for a story on the threat and his community's reaction to it.

The elephant tranquilizer carfentanil, 100 times as strong as fentanyl, may be the biggest threat. While it "hasn’t been definitively identified in Kentucky or Southern Indiana, the powerful synthetic drug has been confirmed in eight overdose deaths in nearby Hamilton County, Ohio, which includes Cincinnati," he drug is suspected in dozens of overdoses, a few of them fatal, in the Louisville area and Mount Sterling, Ungar notes.

"Carfentanil is cheaper for drug dealers to use as an additive because a tiny amount is so powerful. Addicts typically have no idea what they’re taking, and it can be difficult to discern even if they die. Tests to confirm the drugs can take months," Ungar writes. "While routine toxicology tests can detect fentanyl, they don’t usually pick up carfentanil, said Mike Wynn, a spokesman for the Kentucky Justice and Public Safety Cabinet and the state medical examiner's office. So conceivably, carfentanil could already be here in Kentucky."

Ungar reports, "Officials say carfentanil may be just the closest of several drug threats on the horizon. Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said he’s also worried about related synthetic opioids W-15 and W-18, which are also many times more potent than heroin and have been found in Canada and Pennsylvania. Officials say Kentucky is particularly vulnerable to this new wave of powerful narcotics because addiction is so entrenched. Statistics from the U.S. Centers for Disease Control and Prevention ranked the state’s drug overdose death rate fourth-highest nationally in 2014 – 24.7 per 100,000, reflecting 1,077 deaths. State records show that even more Kentuckians – 1,200 – lost their lives to drug overdoses last year."

Six people in Boyle County overdosed on heroin in two weeks in July. “They were in cardio-pulmonary arrest,” Guerrant told Ungar. “Only one survived the initial resuscitation. They were all young adults. They were from all walks of life, too.” The deaths shook the Danville area into action. The Boyle County Agency for Substance Abuse Policy held a community meeting that drew more than 100 people, including church leaders, substance abuse treatment professionals, emergency workers and local politicians. "Local groups and organizations held a candlelight vigil on Overdose Awareness Day Aug. 31 and a 5K 'Run Against Addiction' a few days later. Danville resident Toni Ward launched a new group with a heavy Facebook presence called Families Into Getting Help Together, hoping to reach more young adults."

To raise awareness of the issue, President Obama has proclaimed Sept. 18-24 Prescription Opioid and Heroin Epidemic Awareness Week.

Louisville man, 73, first this year to die from West Nile virus; officials remind Kentuckians to wear bug repellent when outside

State health officials have confirmed that a 73-year-old Louisville man died from the West Nile Virus during the week ended Sept. 17.

Beth Fisher, spokeswoman for the Cabinet for Health and Family Services, told The Courier- Journal that this is the first death from West Nile reported in the state this year.

Symptoms of the virus may include fever, headache, body aches, skin rash and swollen lymph glands, according to the federal Centers for Disease Control and Prevention. There is no vaccine or specific antiviral treatment for the virus.

The CDC says people over 60 are at the greatest risk for a severe infection. In a separate article, The Courier-Journal notes that people with certain medical conditions, such as cancer, diabetes, hypertension and kidney disease, and anyone who's had an organ transplant also are at greater risk.

Health officials advise people to wear bug repellent and protective clothing outdoors and to stay indoors at dawn, dusk and early evening when mosquitoes are most active.

As coal declines in Central Appalachia, what is its legacy in health, including mental health?

As the coal industry declines, rapidly in Central Appalachia, there are "clues suggesting that health and mental-health issues will pose enormous challenges to the affected coal communities, and will linger for decades," Georgia State University biology professor Roberta Attanasio writes for The Conversation US.

Appalachia's death rates are higher than in the nation as a whole, Attanasio notes: "A study that examined the elevated mortality rates in Appalachian coal mining areas for 1979-2005 linked coal mining to 'socioeconomic disadvantages' and concluded that the human cost of the Appalachian coal mining economy outweighed its economic benefits."

A retired coal miner looks at Kayford Mountain in West
Virginia in 2007. (Photo by Andrea Hopkins for Reuters)

Attanasio notes research showing correlations between mountaintop-removal mining and poor health: "They show that when mountaintop removal increases, well-being decreases. However, they do not show that mountaintop removal directly causes a decline in well-being because of the nature of the pollutants and the nature of the exposure to them. Despite the intricacy of studying this area, links to adverse outcomes such as birth defects, cancer, and lung, respiratory and kidney disease, are undeniable."

Mountaintop mining may also affect some people's mental health, Attanasio writes: "People who gain a strong sense of identity from the land are most likely to experience negative outcomes. Environmental philosopher Glenn Albrecht coined the term solastalgia as 'a feeling of chronic distress caused by negatively perceived changes to a home and its landscape,' which he observed in his native Australia due to the effects of coal mining. People who experience solastalgia lack the solace or comfort provided by their home; they long for the home environment to be the way it was before. In a study of Australia published in 2007, Albrecht and collaborators documented the dominant components of solastalgia linked to open-cut coal mining in the Upper Hunter region of New South Wales – the loss of sense of place, the feeling of threats to personal health and well-being, and a sense of injustice and/or powerlessness."

Attanasio notes a survey-based study in Central Appalachian areas with and without coal "indicated that individuals who experience environmental degradation caused by mountaintop-removal mining are at increased risk for depression. The study showed that the odds of a score indicative of risk for major depression are 40 percent higher in areas subjected to mountaintop-removal mining when compared to non-mining areas. Furthermore, the risk of major depression is statistically elevated only in mountaintop-removal areas, and not in areas subjected to other forms of mining, even after statistical control for income, education and other risks."

Ky. confirms 10 flu cases; vaccination (not nasal spray) urged, but some experts tell seniors to wait a bit for best protection

image: www.lex18.com

State health officials report that Kentucky has 10 confirmed cases of influenza already this year, suggesting flu season could be starting early. The cases are in Bullitt, Fayette and Jefferson counties.

Flu season in Kentucky typically begins in October or November and runs through May. Public-health officials are encouraging Kentuckians to get a flu vaccine.

"Getting the flu can be debilitating and sometimes life-threatening, and vaccination is the best tool we have to prevent illness," Health Commissioner Hiram C. Polk said in a news release.

While health experts agree that vaccination is the best way to prevent the flu and that getting a flu shot early is better than not getting one at all, some are encouraging those 65 and older to wait until at least Halloween to assure optimal protection later in the season, Julie Appleby reports for Kaiser Health News.

"That’s because a combination of factors makes it more difficult for the immune systems of people older than age 65 to respond to the vaccination in the first place. And its protective effects may wear off faster for this age group than it does for young people," she writes.

These experts are citing a study done during the 2011-12 flu season that found the effectiveness of the vaccine declines in the months following vaccination "primarily affecting persons age 65 and older."

Polk also encouraged common-sense precautions to protect against the flu, such as sneezing into your elbow or using a tissue that you throw away when you cough or sneeze; staying home when your are sick; and washing your hands frequently with soap and water.

Other suggestions include avoiding close contact with sick people; not touching your eyes, nose and mouth and keeping surfaces and objects that could be contaminated with germs disinfected.

The federal Centers for Disease Control and Prevention recommends flu vaccine for all individuals 6 months and older. However, it no longer recommends the nasal spray flu vaccine  because it has been shown to be ineffective during several of the past flu seasons.

People who are strongly encouraged to receive the vaccine because they may be at higher risk for complications or negative consequences, include:

• Children, age 6 months through 4 years;
• Pregnant women;
• People 50 years old or older;
• People 6 months and older with chronic health problems;
• Extremely obese people;
• People who live in nursing homes and other long-term care facilities;
• Health care workers, household contacts and caregivers of people who live  with a person at high risk for complications from the flu; and
• Out-of-home caregivers of children less than 5 years, but especially for caregivers of those who are less than 6 months old.

Flu is caused by a virus and is very contagious. Symptoms include fever, headache, cough, sore throat, runny nose, sneezing and body aches.Vaccination can be given any time during the flu season and the release notes there should be an adequate supply of the vaccine this year.

For more information on influenza or the availability of flu vaccine, please contact your local health department or visit http://healthalerts.ky.gov.

Howard L. Bost Health Policy Forum to be held in Lexington Sept. 19; focus will be on 'Health as an Economic Driver'

It's not too late to sign up for the 14th annual Howard L. Bost Health Policy Forum, titled "Health as an Economic Driver," to be held at the Marriott Griffin Gate Resort in Lexington on Monday, Sept. 19.

The annual forum is sponsored by the Foundation for a Healthy Kentucky in memory of Dr. Howard L. Bost, who helped create Medicare and Medicaid, developed the Appalachian Regional Hospital system, improved mental-health services in Kentucky and created the vision for the foundation.

This year's event will open with remarks from the foundation's newly appointed president and CEO, Ben Chandler, followed by state Health Secretary Vickie Yates Brown Glisson. The keynote speaker will be Dr. Gail Christopher of the W.K. Kellogg Foundation.

The forum will also feature a series of TED-style talks and afternoon breakout sessions that will explore three facets of making health a focus of economic development and growth: health care as employer and purchaser; health care system costs; and how a strong economy is good for community health and vice versa.

A reception celebrating the foundation's 15th anniversary will follow the forum in the Marriott Griffin Gate Mansion. Click here to register.

Kentucky Health News reporter gets fellowship to report on rural health workforce issues, with a focus on nurses

Melissa Patrick

Melissa Patrick, reporter for Kentucky Health News, has been named 2016-2017 Nursing and Health Care Workforce Media Fellow for the Center for Health, Media & Policy.

Patrick, a former nurse, will focus on rural health issues that affect nurses and other health care providers within the evolving health care delivery system during her eight-month fellowship.

“We’re thrilled to welcome Melissa as this year’s media fellow. She is strongly committed to raising awareness about the role of nurses and other health care workers in the current and future health care system” Diana Mason, co-founder of CHMP, said in a news release.“This fellowship provides an opportunity to work with some of the top health journalists and nursing workforce experts, hone reporting and production skills, engage in cross-platform reporting, and contribute to the national conversation about health care delivery challenges in the years ahead.”

Patrick's main project will take a multi-part look into a shortage of school nurses throughout the state, a shortage of nurses to serve rural areas, the role of advance practice nurses in meeting some of Kentucky’s health needs and state policy issues impacting nurses.

The fellowship is supported by a grant from the Johnson & Johnson Foundation.

Dr. Michael Karpf to retire as head of UK hospital

Dr. Michael Karpf

Dr. Michael Karpf, who has led the University of Kentucky Medical Center during a decade of major growth, announced Wednesday that he would retire in 2017. At 71, his retirement was not unexpected.

"We have made considerable progress, and I feel that the original goals that we established have been achieved," Karpf said in a statement. "We have built a strong foundation for UK HealthCare," the medical center's brand. "Consequently, I think it is time for an organized transition to a new leader who has boundless energy to address the challenges of a rapidly evolving health care system."

During Karpf's 13 years at the helm, annual discharges from the hospital doubled to 37,789, and transfer of patients from other hospitals for sub-specialty care "astoundingly grew" from 1,000 to more than 18,000, annually, UK President Eli Capilouto said in a news release. "But numbers on tell part of the story."

Capilouto said Karpf, who is paid $882,000 a year, "grew partnerships with hospitals and physicians in 180 clinical locations across the state. . . . I am convinced that UK HealthCare is the greatest success story in modern academic health center history. This is not grandiosity. The numbers show it."

The greatest manifestation of Karpf's work is the new Albert B. Chandler Hospital Pavilion A, which he said will be more than 96 percent complete with projects authorized in June.

"Although Pavilion A is as technologically advanced as any hospital in the country, it is also an exceptionally empathetic facility – comfortable and comforting for our patients, their families, visitors, and, just as important, for our faculty and staff," Karpf said. "We will also have refurbished/repurposed four of the seven floors in Pavilion HA (Kentucky Children’s Hospital). Over the next 18 months we will finally have a state-of-the-art neonatal ICU that appropriately supports a superb NICU staff and faculty."

"Karpf’s emphasis on highly complex medical care, however, sometimes came at a price," reports Linda Blackford of the Lexington Herald-Leader. "In 2012, UK suspended its pediatric cardiology program after an uptick in mortality rates for babies, including at least two babies who died while in UK’s program. An internal review recommended better training for both doctors and nurses and a dedicated ICU. Earlier this year, Karpf announced a partnership where pediatric heart surgeries at UK would be performed by a heart surgeon with a primary appointment at Cincinnati Children’s Hospital."

Blackford adds, "Karpf also is part of a whistleblower lawsuit filed by UK surgeon Paul Kearney, who was stripped of his clinical privileges for using abusive language toward co-workers and one patient. Kearney alleges that Karpf targeted him after the surgeon started asking questions about the financial dealings of UK HealthCare and the Kentucky Medical Services Foundation," which UK contends is not a public agency.

Karpf came to Lexington from UCLA, where he ran that university's medical center. He said he and his wife Ellen will remain in the city, and he plans to "take a part-time faculty position working on health service and health policy issues."

KentuckyOne Health announces diabetes prevention program in Central Kentucky

KentuckyOne Health is launching a program to prevent Type 2 diabetes in Central Kentucky. The year-long program is modeled after a Centers for Disease Control and Prevention program "designed for individuals at high risk for Type 2 diabetes and is proven to help people lose weight and lower their risk of Type 2 diabetes by 58 percent," KentuckyOne said in a news release.

Nearly 30 million Americans have diabetes, and it is "estimated that more than 14 percent of Kentuckians suffer from this chronic condition, which can also lead to heart disease, stroke, amputation, end-stage kidney disease, blindness and death," the release said.

KentuckyOne recommends the program to those who meet any two of the following criteria:
• 18 years or older
• Elevated blood sugar
• Diagnosed with pre-diabetes or gestational diabetes
• Overweight

Informational sessions are being held to provide "details of the 16-week course and the following monthly meetings" to help interested people decide if the course is right for them. Trained lifestyle coaches are leading the group meetings, teaching how to make healthy lifestyle choices.

An introductory session will be held Thursday, Sept. 15, at 6 p.m. in the Medical Office Building at Saint Joseph East, located at 160 Eagle Creek Drive. One will be held in Berea Thursday, Sept. 22, at 5:30 p.m. at Saint Joseph Berea, 305 Estill Street, in the Education Suite on the fourth floor.

To enroll or get more information, call 859-31-2595 or visit KentuckyOneHealth.org/dpp. A physician referral is preferred, but not required to participate. Space is limited.

Kentucky's uninsured rate drops to 6 percent; states that expanded Medicaid, like Kentucky, saw the greatest drops

The share of Kentuckians without health insurance dropped by more than half from 2013 to 2015, bringing it down to only 6 percent of the state's population, from 14.3 percent, according to the U.S. Census Bureau. That was one of the largest decreases in the nation.

U.S. Census Bureau map, based on American Community Survey

The drop reflects a net gain of 355,000 people with insurance, according to the American Community Survey, a continuous poll of the U.S. population. The survey showed an even larger drop among Kentucky children, from 16.6 percent uninsured in 2013 to 4.2 percent in 2015.

Data from 2013 provide a benchmark for comparison because it was the last year before implementation of the Patient Protection and Affordable Care Act, including the expansion of Medicaid in Kentucky to those who earn up to 138 percent of the federal poverty level.

The report found that the 32 states that expanded Medicaid had the largest increases in insurance coverage. Kentucky's decrease in uninsured appeared to be larger than any other state but California.

Advocacy groups credited the expansion for the decrease, and asked Gov. Matt Bevin to consider that when it comes time to negotiate with the Centers for Medicare and Medicaid Services about the governor's new plan for Medicaid. The plan is designed to encourage higher levels of participant involvement through premiums and "community engagement" requirements, conditions that could be denied.

Bevin has said he would negotiate with the federal officials, but his plan says it constitutes the conditions under which Kentucky will continue the expansion. A failure of negotiations could take health insurance away from more than 430,000 Kentuckians who now have health insurance through the expansion.

Kentucky Center for Economic Policy

In its statement, The Kentucky Center for Economic Policy touted the many health and economic benefits that have resulted from the expansion, such as increased preventive care, fewer emergency room visits and reports of improved personal health, and said the current Medicaid proposal creates "barriers to coverage like premiums, lockouts and work requirements that would reduce the number of Kentuckians covered."

“Because Kentucky has seen the greatest gains, we also have the most to lose if harmful changes to Medicaid are approved,” KCEP Executive Director Jason Bailey said. “Our hope is that the Bevin administration will negotiate in earnest with the federal government to find a way to build on our successes and not move backward on our health progress.”

Kentucky Youth Advocates noted that eligibility for children in Medicaid and the Kentucky Children's Health Insurance Program did not change from 2013-15, "indicating that the increases in coverage for children were likely an indirect result of more parents gaining health insurance through Medicaid expansion."

"We know that when parents have health insurance, their children are more likely to have health insurance," Dr. Terry Brooks, executive director of KYA, said in a statement. "We encourage Gov. Bevin to negotiate with CMS on a Medicaid proposal that continues affordable coverage for families and does not result in people losing coverage."

Bevin spokeswoman Amanda Stamper also noted that most of the new enrollment came from the expansion of Medicaid, and painted a different picture of this reality. “This is a sad commentary on the economic state of Kentucky and is not sustainable,” Stamper told John Cheves of the Lexington Herald-Leader. “While some are focused solely on enrollment, Gov. Bevin is focused on driving better health and employment outcomes and the long-term fiscal sustainability of the Medicaid program.”

Bevin's proposal says it "is expected to save taxpayers $2.2 billion over the five-year waiver period," by reducing enrollment in the program by about 88,000 people in the next five years, but only $331 million of that would be state tax money, because the federal government covers the bulk of Medicaid costs.

Sipping on sugary drinks ruins teeth, perhaps more from the acid in them; it's almost as corrosive as battery acid, VA dentist says

Many of us constantly sip on a soft drink, especially in Kentucky, but the habit could be ruining our teeth.

Most soft drinks have sugar, acid or both and repeated exposure to this combination "wears down tooth enamel, which leads to decay and, eventually, tooth loss," Patrick Reed reports for Kentucky Educational Television.

"Mountain Dew mouth"
{Photo from healthline.com)

This "sugar-acid double punch" is especially dangerous for soda drinkers, and particularly to those who sip on them constantly - leading to what is often referred to as "Mountain Dew mouth," a phenomenon most common in Appalachian Kentucky.

As part of KET’s "Inside Oral Health Initiative," funded in part by the Foundation for a Healthy Kentucky, several Kentucky dentists offered tips on how to minimize the effects of sugar and acid on the teeth.

It's an important topic in Kentucky, because the state ranks fifth in daily consumption of soft drinks and fruit drinks, with 43.2 percent of people in the commonwealth, according to the federal Centers for Disease Control and Prevention.

Threats to Tooth Enamel

Tooth enamel, which covers the visible, outer portion of the tooth, "is the strongest material in the human body and can keep teeth healthy for a lifetime," Reed writes. However, repeated exposure to sugar and acid will cause it to erode, and once it's gone, it's gone.

“On a scale of 1 to 10, if battery acid is a 1, then most soft drinks are a 2. That’s how acidic they are,” Robert Henry, chief of dentistry at the Department of Veterans Affairs Medical Center in Lexington, told Reed. “If you add sugar on top of that, you’re just setting up an environment that’s acidic,” he adds. “And then the sugar moves in and basically does the rest. It’s literally like throwing kerosene on an open flame.”

Reed said the erosion is intensified by repeated exposure to not only soda, but also any sugary drinks such as fruit juice, sports drinks, and energy drinks. And while diet soda seems like a good idea because it lacks sugar, many brands contain acid.

"If you take one sip of soda, it’s going to take three to four hours for your mouth to go to a pH of neutral,” Pikeville dentist Bill Collins told Reed. “So, if you’re sipping every 15 to 20 minutes, your acidic level in your mouth is down to a pH of 1 or 2. And you’re keeping it there, and it basically dissolves the enamel on your teeth.” (The numerical figure for neutral is a pH of 7).

Practicing in Eastern Kentucky, Dr. Collins and Dr. Nikki Stone of the University of Kentucky told Reed that even very young children in the region have a habit of sipping soda.

“Drinking pop is our culture – we have an actual ‘pop culture’ in Eastern Kentucky,” said Stone, who has created a "Drink Pyramid" graphic to educate children about healthy habits. It says soda should only be consumed at parties or on weekends.

 Tips for reducing the impact of sugary drinks

• If you must drink soda, do it fast, and once a day at most. This leaves less time for the sugar and acid to wash over the teeth and cause decay.
• Never drink soda before bedtime, and clean your teeth thoroughly at night. Collins recommends that heavy soda drinkers should rinse as much residue as possible from their teeth, with water, before they brush to decrease the risk of scrubbing the acid into their teeth.
• Avoid added sugar in food, as this too can cause enamel erosion and tooth decay.
• Brush twice a day, two minutes per session, in the morning and always before bedtime.

Sept. 23 is deadline to apply for grants that can be used for syringe exchanges; 17 approved, but few in high-risk counties

By Melissa Patrick
Kentucky Health News

The state Office of Drug Control Policy is offering competitive grants to local boards of the Agency for Substance Abuse Policy for them to use toward harm-reduction programs for 2017. The deadline to apply is Sept. 23.

The grant money can be used for syringe exchanges (with some restrictions), Narcan (naloxone) programs, community education and other harm-reduction efforts. While local health, fire and police departments cannot apply directly for the grant, ASAP boards can apply on their behalf. Grant amounts will be considered up to $20,000, depending on the proposal, according to the Office of Drug Control Policy. Click here for a link to your local ASAP chairperson.

This is the second year the grants have been offered. Last year, all 37 ASAP boards that applied got some funds. Elliott and Harlan counties are the only two in the state without ASAP boards.

A 2015 federal Centers for Disease Control and Prevention analysis identified the 220 U.S. counties most vulnerable to an HIV or hepatitis C outbreak among intravenous drug users, and 54 of those counties are in Kentucky.

So far, 17 Kentucky counties have approved syringe exchange programs, according to the Cabinet for Health and Family Services. But only six (Knox, Pike, Grant, Carter, Boyd and Mercer) are in the most vulnerable group.

Stars locate syringe exchanges; green counties are deemed most at risk for HIV and hepatitis outbreaks

Syringe exchanges were authorized in Kentucky under a 2015 anti-heroin law and require local approval and funding. They are meant to slow the spread of HIV and hepatitis C, commonly spread by the sharing of syringes and needles.

"The key to needle exchange is that it is an opportunity to engage someone in treatment," Allen Brenzel, medical director of the state Department for Behavioral Health, Development and Intellectual Disabilities, said in an interview. "There is no evidence to support that they cause people to use more often or to use more drugs. What they do is they help people begin the process of engaging and trusting that people will help them. . . . They are very, very important."

Brenzel said the federal report alone is reason enough for counties to adopt syringe exchange programs. "An HIV epidemic would cost us, in addition to the human lives, millions and millions of dollars to treat and contain," he said.

Hepatitis treatment is also expensive. Dr. John Ward, director of the CDC's Division of Viral Hepatitis, said at a recent conference in Lexington that the cost of testing and treatment for hepatitis C is between $32,000 and $56,000 on most health plans.

Kerry Steinhofer of The Advocate-Messenger in Danville reports that Boyle County, which is considered the 35th most vulnerable by the CDC, is in the early stages of planning a syringe exchange. Its ASAP board plans to apply for one of the aforementioned grants and is hopeful they will be chosen.

Brent Blevins, the county health department, told Steinhofer that he did not expect any problems with the Danville City Commission or the Boyle County Fiscal Court in getting approval of a syringe exchange.

Lincoln County Judge-Executive Jim Adams told Abigail Whitehouse of The Interior Journal in Stanford that he expects some political pushback. The county is ranked 97th most vulnerable nationwide, and is in the early stages of learning about syringe exchange, Whitehouse reports.

Clark County started its exchange program about eight weeks ago and has already seen more clients than it anticipated seeing after six months, indicating a higher number of drug users in the community than expected, Health Director Scott Lockard said in a telephone interview. (On Sept. 2, the exchange saw 14 total clients, collected 199 needles and gave out 289.)

What's important is that disease is being prevented, Lockard said. "We are truly farther along and doing much better than I thought we would be at the six-month window," he said. "Obviously there is a need."

Lockard said Kentuckians are becoming more accepting of syringe exchange programs, and predicted that more counties will soon follow with their own. A Kentucky Health Department Association survey taken in December found that 75 health departments, out of 109 who answered the question, were in some phase of the education process or approval of syringe exchange programs.

"This is an example of public health at its finest," Lockard said. "I think we are going to see positive impacts on our hepatitis C rates in our communities, and hopefully prevention of any HIV outbreaks."