This is Suicide Prevention Week; mother-lawyer-nurse says we can prevent it among children by building their resilience

By Kate Hendrickson

Community columnist, Lexington Herald-Leader

Another parent has lost a child — this time a fourth-grader — to suicide.

Appallingly, suicide is the second-leading cause of death for children in Kentucky. Mental-health issues, a growing sense of individual isolation and our children’s immersion in technology contribute to the increase in this tragic epidemic.

Identification and treatment of risk factors — depression and other mood disorders, suicide ideation, chronic disease or disability, and substance abuse — are the primary aspects of suicide prevention.

Getty Images/Vetta via Lexington Herald-Leader

However, some experts believe that developing resilience may be a solution to this crisis. Resilience, the ability to maintain positive adjustment under challenging life circumstances, allows us to recover from adversity more quickly. Resilience research shifts the focus from suicide treatment to its prevention.

Prevention is more beneficial and substantially less costly than treatment. We vaccinate our children to protect them from childhood diseases, let us work to inoculate them against suicide. We cannot shield our children from life’s traumas, but we can help them build resilience and decrease the likelihood they will contemplate or carry out a suicide attempt.

A stable and committed relationship with a parent, caregiver or other parental figure is the single-most common factor that helps a child build resilience. As parents, we can help our kids develop a sense of control and belief in their ability to achieve goals; develop adaptive skills and the ability to self-regulate behavior; and explore the joy of faith and cultural traditions. By doing so, we increase their ability to deal with life’s challenges.

Resilience begins in infancy when we develop and maintain healthy bonds with our children. We are their security blankets, providing a physically and emotionally stable and safe environment. Our hugs, kisses and physical closeness help inoculate them against life stresses.

Throughout childhood, keeping the lines of communication open is vital. Listening, encouraging, providing humor and perspective during difficult situations help our children develop resilience. Setting reasonable expectations and limits, encouraging appropriate expression of emotions, teaching our children to take care of themselves by exercising, eating properly, having fun and getting enough rest are essential for emotionally healthy children.

In spite of all possible efforts, some children suffer the slings and arrows of life more deeply than others. For them, it is important to intervene early. We must watch for changes in attitudes and behaviors, take any talk of suicide seriously and obtain mental-health treatment for our child and ourselves.

If there is any talk or threats of suicide, it is important to remove access to all firearms and medications. Since our children spend many of their waking hours in an educational setting, schools are uniquely positioned to assist with resilience development and suicide prevention.

All Kentucky public middle and high schools must provide every student with suicide-prevention awareness information. Completion of suicide-prevention training, every other year, is required for school administrators, teachers and counselors. However, these minimal requirements are not sufficient.

Schools must go further by offering programs that assist our children with character development, conflict resolution, compassion, leadership development and bullying prevention. A program effective in preventing not only suicide but also substance use, bullying and violence is available from the Kentucky Department for Behavioral Health.

This peer-led program has been instituted in some Kentucky public school districts but it needs to be available in every district. Not just during September, Suicide Awareness Month, but throughout the year, we must all work to prevent suicide and save our children.

These are our kids; let us join together to be their village.

Kate Hendrickson of Maysville is a writer, lawyer, nurse and mother of four. This was first published in the Lexington Herald-Leader, for which she is a community columnist.

Op-ed calls for smoking bans to include e-cigs and for an e-cig tax to decrease teen use; new e-cigs are easy for teens to hide

A used package of Juul cartridges, found on a
Frankfort sidewalk. (Photo by Al Cross)

As students head back to school and concerns about their increasing use of a new electronic cigarette product called Juul emerge, anti-smoking advocates call for school districts and locales to enact 100 percent smoke-free laws that include electronic cigarettes and for state officials to tax e-cigarette devices and their liquids at the same rate as conventional tobacco products.

"It is alarming that children are not allowed to chew gum in class, but they are using e-cigarettes in school," Ellen J. Hahn and Melinda J. Ickes write in an op-ed for the Lexington Herald-Leader.

Hahn is a professor in the University of Kentucky College of Nursing and the director of BREATHE (for Bridging Research Efforts and Advocacy Toward Healthy Environments) and the Kentucky Center for Smoke-free Policy. Ickes is an associate professor in UK’s Department of Kinesiology and Health Promotion and director of Go Tobacco-free, an initiative to promote tobacco-free college campuses.

The worries Hahn and Ickes write about are widely shared. In April, the U.S. Food and Drug Administration was so concerned about the inappropriate sale of e-cigarettes to kids that it conducted an undercover "blitz" that particularly targeted the hugely popular Juul products. The Washington Post reported that the blitz found dozens of violations of the laws and issued 40 warning letters related to Juul sales.

Taxing e-cigarettes was an idea considered but dropped this year by the Kentucky General Assembly. The legislature raised the state cigarette tax by 50 cents a pack, to $1.10, but in the final hours of the legislative session, a plan to add a 15 percent tax on electronic cigarettes was dropped.

Hahn and Ickes write that the Juul product appeals to youth because it "rids the noxious taste and sensation of the initial smoking experience" and because the devices are easy to hide from parents and teachers because they look like computer USB drives.

The authors add that "the proportion of U.S. high-school students using e-cigarettes went up 800 percent from 2011 to 2014," and that while there was a slight reduction in smoking, or vaping, e-cigarettes in 2016 among youth, "today more youth in Kentucky and the U.S. smoke e-cigarettes than smoke traditional cigarettes."

They also point out that the aerosol in e-cigarettes is not a harmless water vapor as advertisements suggest, but instead "contains nicotine, tiny particles, sweet appealing flavorings and toxic chemicals." They write, "One pod is equivalent to the nicotine content in 20 conventional cigarettes. Nicotine harms brain development in children and young adults, and it is highly addictive."

Experts also worry that the use of these products will lead to use of conventional cigarettes and that they are being used to inhale other drugs.

Some schools have banned the use of USB drives as a way to curb the problem, but the authors write that there is little schools can do to thwart the aggressive e-cigarette advertisements found on social media and at venues, like music festivals, that are frequented by teens. It is also hard to battle the appealing flavors in the products that users say are the main reason they started using them.

Also, "Tobacco companies offer scholarships of $250 to $5,000 to students who write essays on the potential benefits of e-cigarettes," the authors write.

That said, there has been some progress. All 17 companies that were warned in May to stop marketing their electronic cigarette liquids in packaging that resembled "kid-friendly food products", like juice boxes, have stopped doing so, though the FDA warned the companies that it is still watching.

State's new health commissioner, Dr. Jeffrey Howard, is called 'a breath of fresh air' by a local director who's seen six of them

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Kentucky's recently installed health commissioner is a 30-year-old doctor, two years short of being a surgeon, a goal he still plans to achieve. But right now he's in charge of public health in a state with huge health issues, and local health departments with big financial issues.

Dr. Jeffrey Howard is still learning. He will graduate from Harvard University's master's of public health program in May and has enrolled in a master's of business administration program that he plugs away at on Saturday mornings.

He started working at the Kentucky Department of Public Health in July 2017 when then- Commissioner Hiram C. Polk asked him to come on as a senior adviser. Howard said he got to know Polk when he was a surgical resident at the University of Louisville, particularly after he was named the 2014 Hiram C. Polk Jr. Student of the Year. He became acting commissioner in November 2017 after Polk resigned, and was appointed commissioner in July.

Commissioner Jeffrey Howard talks with Kentucky Health News
reporter Melissa Patrick. (Photo by state spokesman Doug Hogan)

Howard said in an interview that one of the reasons he's uniquely qualified for the job is that he's at the beginning of his career, not the end, and is "young, bright and innovative."

Kentucky River District Health Department Director Scott Lockard, who has worked in public health for 28 years, praised Howard at a session on health at the recent Shaping Our Appalachian Region Summit, where Howard spoke.

"We can see that he is sincere. He has a passion for what he is doing," Lockard said. "To me, his willingness to look internally at processes and say, 'We can do better,' is a breath of fresh air."

Howard added that he's also experienced the issues around substance abuse "from the inside out," having lived with an addicted mother and stepfather until he was 14, and because he was "born, bred and raised" in Eastern Kentucky and understands the culture that prevails in rural areas and often leads to poor health outcomes.

Howard told the story of how his grandmother, a "brittle diabetic" with bilateral amputations, kidney failure resulting in dialysis, and early onset Alzheimer's disease, who didn't know much about her disease and like many Eastern Kentucky folks, "you don't talk about your illness." She died at 55.

"I understand probably better than most people why rural Kentuckians make the decisions they do," he said. "We have a culture in Kentucky, and especially rural Kentucky, on how we handle our own personal health that leads to poor outcomes. I do it all the time."

Fran Feltner, director of the University of Kentucky's Center for Excellence in Rural Health, said she was energized by Howard's heart.

"I think that somebody from our region that understands our Appalachian culture will do such a great job at the state to represent us, as well as the rest of the state," Feltner said. "And I'm honored that he is truly from his heart working on the issues that we have in rural Kentucky. I think he's going to make a big difference and I'm ready to join him and work really hard to make that difference."

Howard added that even though his grandmother died when he was 15, she had a "profound impact" on him because when they were alone she would tell him he was going to be a doctor, which he said made no sense since his father had dropped out of high school in ninth grade, his mother and step-father were addicted, and no one in his family had ever gone to college.

"That impact gave me the public-health bug that I didn't know I had until two or three years ago," he said.

Local needs and solutions

Howard said he is driven by his desire to improve health outcomes in Kentucky, which leads the nation in cancer and deaths from it; heart disease; adult asthma and chronic obstructive pulmonary disease; obesity, and diabetes.

He is also working to improve the relationship between the state and local health departments, and has created an advisory committee led by local health department directors that meets weekly to talk about the issues facing the departments.

"My firm belief is that the issues of health and health outcomes in Kentucky exist locally and the solutions are local," Howard said. "I've tried to bring an air of transparency as far as how public health is run from the state to locals, so that they know and understand what we're dealing with here and how our funding streams are driven and how that we can better support them."

Howard said he is also working to make sure that "small wins" in public health are celebrated, by emphasizing them at state and local meetings, and to uplift all health department employees at both levels by sending personal notes that recognize both celebrations and concerns.

"I realized early on that our local health departments felt at arm's length, and I didn't want that," he said. "So one of my goals was to bring those relationships closer together."

Lockard, who sits on the advisory council said, "I feel more a part of the Department of Public Health right now, the statewide department. I feel like there is a more sincere effort being generated right now to be a sincere partner with the local health departments, to really be concerned about what is needed at the local level and how do we work together to make that happen."

Lockard, who has worked with six health commissioners in his 28 years said of Howard: "I've seen many different commissioners, many different styles, all of them had their strengths, all of them had their opportunities for growth, and I'm just very excited to be working with this commissioner. I think he's the right man in the right place at the right time and I just hope he stays a while with us."

Pension crisis and local health departments

Howard said the strength of the state health department is its people, who work with a commitment to their jobs that was "through the roof." He said its weaknesses and threats include lack of money, especially for employee pensions.

This year, the legislature froze for one year the pension contributions of health departments and 11 of the state's 14 community mental health centers, which were facing increases in pensions of 49.5 to 83.4 percent, averaging 69 percent.

Lockard said, "July 1 of 2019 is the cliff that we're all afraid of falling off, so we're doing things differently now. We're trying to look, we're trying to plan. Of course we're going to try to advocate to see if we can postpone this," as the legislature let County Employees Retirement System do, phasing in changes over 10 years. "What can we do? How can we change our mode of operation?"

Lockard said his Kentucky River health department, which serves Lee, Wolfe, Owsley, Leslie, Perry, Knott and Letcher counties, "is in the most challenging financial shape of any health department in the Commonwealth."

Howard said he was working with his advisory committee and the Kentucky Health Departments Association on a plan for what to do if the health departments get no further relief from their pensions.

Howard said making health departments pay more than 49 percent of payroll to fund pensions "isn't sustainable for any business model," and as many as nine departments would have to close in 14 months if the planned increases took effect. He said the "prudent thing to do" is to start sharing resources across jurisdictions, and that must be driven by local health directors.

"I don't want health departments to close, because I know how important those local health departments are," he said. "But we've got to get to the point where we're sharing services, we have to do that." Without sharing, "We are really going to have to look at" redrawing the boundaries of district health departments, "and I know a lot of locals don't want that," he said.

Kentucky's health issues

Opioids: Howard called substance abuse "by far the number one health issue in Kentucky," noting that almost four Kentuckians die a day from it. He said his agency's main role is to gather and analyze data, but "I think you're going to see more education programs, more awareness programs. You're certainly going to see funding for treatment to a degree that you've never seen before."

Adverse childhood experiences: "It's one of those issues that is incorporated into every discussion involved in some manner."

Hepatitis A: In the same month Howard became acting health commissioner, the health department declared an outbreak of hepatitis A in Kentucky. Since August 25, it has reported 1,562 cases, 881 hospitalizations and 12 deaths. Howard said the epidemic will likely last another eight to 12 months in the state. The primary risk factors remain illicit drug use and homelessness; so far, no cases have been linked to a contaminated food source.

Asked what message he wanted to convey about hepatitis A, he said, "I would really like to emphasize that you are OK to go out to eat in your local restaurants. The risk of getting Hepatitis A from an infected food worker as long as they are adhering to normal precautions is very minimal."

Statewide smoking ban: Howard's position is the same as that of Gov. Matt Bevin: "Localities should decide what is right for them, and so I will never go out and say we need a statewide smoking ban. What I will say is smoking is bad and I think you ought to have that conversation locally. If you want me to be a part of that conversation and come into your locality and say smoking is bad, then I'll do that because that's what I believe, but I won't tell you from a state level that this is what I demand you do, and I think that's fairly consistent with our governor's position."

Innovation and partnerships

Howard has several initiatives in motion that involve partnerships with other organizations.

One partners UK and the Foundation for a Healthy Kentucky to adapt how health departments do their community health assessments so they ultimately allow local agendas to drive the state assessment. UK will produce an academic publication of this first-of-its-kind process, and the foundation will spread the word about how important community assessments are.

Community health assessments are a systematic examination of the key problems and assets in a community, which are then used to develop strategies to address community needs. Howard said he considers them to be the "cornerstone to driving public-health outcomes in Kentucky."

Howard has also commissioned research by UK's College of Business and Economics to show how investments in health affect the economy. He expects it to be ready in the spring of 2019.

"One of the things that I want to emphasize is that health and the economy are linked. We talk about it a lot, but I want to be able to give you some numbers," he said. This will help "me to emphasize the role of public health" and to "talk to our citizens and our legislators in really tangible terms."

Howard is also working on an initiative to align the efforts of the department with health-care providers, and with UK to study how state health departments work with medical societies on public-health issues.

260 in Morehead hear speakers on opioid recovery and solutions to the epidemic: rebuilding communities and long-term treatment

By Melissa Patrick
Kentucky Health News

Treating opioid-use disorder as a chronic disease, finding local solutions and restoring communities were the overarching themes of an event in Morehead Sept. 5 for health professionals: "Recovery and Solutions: The Next Chapter in Northeast Kentucky's Opioid Epidemic."

Sam Quinones at Morehead

About 260 people heard keynote speaker Sam Quinones, author of Dreamland: The True Tale of America's Opiate Epidemic, say that he started out to write a book about drug trafficking and marketing, but soon realized it was a "much bigger story" and that "at the root of the problem" was the destruction of American communities.

Quinones' book is named for a now-closed community swimming pool that was once the social epicenter of Portsmouth, Ohio. A town ravaged by the epidemic, it is across the Ohio River from South Shore, Ky.

He told the crowd, "Heroin is a final expression of values that we have fostered for 35 years in this country. A final expression for our fetish for the private at the expense of the public, for isolation at the expense of community It is a final 'stuff' for a culture that is convinced that consumption, that buying stuff, is the path to happiness. Heroin is the final expression of that idea."

Added to this "scourge of isolation," Quinones said the opioid epidemic flourished as Americans became a people who wanted easy answers to complex problems and took on unrealistic expectations of how much pain they should tolerate, both physically and emotionally. And, he added, we became "ferocious" in our efforts to keep our kids from feeling any pain.

"It's all connected," he said, adding later, "Why do we wonder that heroin is everywhere? It seems to me that our search for painlessness, convenience and comfort above all other things is a lot about what led us to it."

Quinones said the epidemic requires not one solution, but a "symphonic" approach that will come from communities working together toward this common goal.

"Isolation is heroin's natural habitat," he said. "I believe more strongly than ever before that the antidote to heroin is not naloxone, it is community. . . . There is no silver bullet, it is only through collaboration that innovation comes."

Asked after his talk if he thought marijuana should be legalized, he said yes, but said we should proceed "slowly, humbly and cautiously," and that it should also be regulated for potency. He added that we also need to learn from the heroin epidemic: "A supply of high potency drugs matters."

Alex Elswick

Alex Elswick and his mother Shelley Elswick, the co-founders of Voices of Hope Lexington, told their stories of addiction and recovery from a family perspective and an individual one. Voices of Hope is a nonprofit that offers recovery support to people with substance-use disorders.

Shelley Elswick simply asked for compassion: "I'm asking for compassion for families when we don't know what's happening in the beginning, when we're looking for solutions once we know we have a problem and at the end when we get our loved ones into recovery and we don't know what to do."

Alex Elswick, a doctoral student in the Department of Family Sciences at the University of Kentucky, told the story of his heroin addiction, which started with prescription oxycodone, and his rocky path to long-term recovery. He stressed that finding a solution to the opioid epidemic must include treating addiction like a "chronic disease."

"Because the inevitable result of mismatching a chronic disease with acute treatment is a huge gap in management," he said. "And it is in that gap that people relapse. And unfortunately in the context of an opioid epidemic, it is in that gap that people we care about lose their lives."

He added later, "I think as soon as we begin to fill gaps in treatment, to create a continuum of care that helps people get to that critical five year mark where the risk of relapse drops below 15 percent, that's when we'll see some changes."

Dr. Michelle Lofwall

Dr. Michelle Lofwall, a UK psychiatry professor and part of the College of Medicine Center on Drug and Alcohol Research, talked about the hope that comes with treatment and recovery, and the need for more of it.

"We see people getting better that have been so, so ill and have suffered so much and that very clearly turn their lives back around and give back to their communities," she said. "It is an illness and it is treatable."

Lofwall also emphasized that people with opioid-use disorders need ongoing care.

"We really need treatment to be more continuous because it is frequently chronic, and the drug supply, the way it is right now is that one single lapse can be deadly . . . It's important that we stop just doing these acute episodes of treatment," she said.

She noted that only a small percentage of people with opioid-use disorder are getting treatment, with only 20 percent getting specialty addiction treatment and among those, only 37 percent receiving medications approved by the Food and Drug Administration. In addition, she said opioid-related inpatient hospital stays are increasing, up 64 percent nationally between 2005 and 2014, often for conditions like heart-valve replacements, which can cost "hundreds of thousands of dollars."

"How senseless is it if we are not treating the underlying disorder -- opiate-use disorder -- especially when we have really effective, evidence based medications," she said. "And we need to couple them with counseling and all the other important wrap around services. That is not rocket science."

Lofwall said we need to make drug screening, treatment, naloxone and syringe exchanges more accessible; improve treatment retention; train a larger work force to treat opioid use disorders; and better link recovery services and treatment.

The event was sponsored by the Northeast Kentucky Area Health Education Center.

Veteran of Medicaid in several states named commissioner in Ky.; health cabinet creates new post to deal with health-care providers

Carol H. Steckel
(Photo via The Lane Report)

The state Cabinet for Health and Family Services has named Carol H. Steckel commissioner of the Department of Medicaid Services.

Steckel is a Medicaid and managed-care expert with more than two decades of experience, having spent the past five years as the senior director of Alliance Development for WellCare Health Plans. WellCare is one of Kentucky's Medicaid managed care organizations.

Doug Hogan, the cabinet's spokesperson, told CNHI Kentucky that Steckel's work with WellCare was based in Florida and that she had no involvement in the firm's work in Kentucky.

Steckel has also served as North Carolina's Medicaid director, oversaw the implementation of Medicaid managed care in Louisiana, managed operations and policy for Louisiana's program and was Medicaid commissioner in Alabama.

In Kentucky, Steckel will oversee the program's $11 billion annual budget, which serves 1.4 million Kentuckians. She also assumes the position in the middle of a controversial overhaul of the program that if approved would require "able-bodied" Kentuckians to work or participate in "community engagement" in order to be on Medicaid.

The plan was vacated by a federal judge just days before it was set to go into effect on July 1 and sent back to the U.S. Department of Health and Human Services for more review. The judge said HHS had not sufficiently considered the public comments or the state's estimate that in five years Kentucky's Medicaid rolls would have 95,000 fewer people with the plan than without it, largely for noncompliance with its requirements.

Steckel will replace Jill Hunter, who has been serving as the acting commissioner since the retirement of Commissioner Steve Miller. Hunter is now senior deputy commissioner. CNHI reports that Steckel will be paid $120,000 and Hunter will be paid $110,000 annually.

“I am excited to announce this leadership team in the Department for Medicaid Services,” Health Secretary Adam Meier said in the news release. “Carol is a nationally known Medicaid leader and will bring additional expertise to the Agency. Jill did an outstanding job serving as commissioner the last several months."

New post to deal with providers: The cabinet also hired David Gray as director of provider relations, a new position that will focus on interactions with, and policy impacts on, health-care providers.

Hogan said in an e-mail that the position wasn't created in reaction to a specific issue, but "is a proactive step to ensure efficient and maximum engagement with health-care providers as we continue to partner in innovation."

Gray is a licensed nursing-home administrator who has been president and CEO of Hardin Memorial Hospital in Elizabethtown and president of Baptist Health Louisville.

Baptist Health names Dr. Jody Prather chief strategy officer

Dr. Jody Prather

Baptist Health, Kentucky's largest hospital company, has named Dr. Jody Prather of Elizabethtown its chief strategy officer, a job in which he will work with other executives "to create strategic initiatives that establish Baptist Health’s direction in business development, growth, partnerships and innovation," Baptist said in a press release.

Prather succeeds Patty Mason, who retired in March as chief strategy and marketing officer. The revised title reflects new responsibilities, since Baptist recently created and filled the job of chief operating officer.

Prather, 43, previously served as Baptist’s first chief medical officer and is now chief strategy officer and vice president for population health at Hardin Memorial Health in Elizabethtown, which is managed by Baptist and will become part of the company in December. He is also chief medical officer for the hospital's group of clinics.

“I am excited to join the Baptist Health leadership team because we have a shared vision of transforming healthcare across our communities to make a real difference in the lives of our patients, both now and in the future,” Prather said. 

Prather graduated from Centre College and the University of Louisville School of Medicine and completed a family medicine residency at the Trover Clinic and Regional Medical Center in Madisonville, now Baptist Health Madisonville. After private practice in Elizabethtown, he joined HMH as vice president and chief medical officer, then held the same jobs with Baptist. In mid-2013, he returned to HMH, where his accomplishments included "overseeing several initiatives that resulted in an average annual revenue increase of 9 percent, expanding health-care services in Hardin County plus the neighboring counties of LaRue, Meade and Nelson to more than 50 locations and growing the medical group to more than 220 providers," the news release said.

Prather’s community involvement includes serving on the Hardin County/Elizabethtown Industrial Foundation board of directors and as secretary/treasurer of the Central Kentucky Community Foundation. He was on Louisville Business First's “40 Under 40” list in 2012 and, the following year, listed by the publication as a “Person to Watch” for business leadership in health care. The Prather name is a big one in Hardin County; the doctor's father, Joe Prather, was a state senator, finance secretary and transportation secretary.

Sept. 18 webinar will explore why rural areas lag in getting children a vaccine that can prevent a major type of cancer

The Rural Health Information Hub will hold a webinar to discuss the Centers for Disease Control and Prevention's recent report showing that rural teens are less likely than their urban peers to know about the human papilloma virus or meningococcal conjugate vaccines or receive them. HPV is the known cause of several genital, anal, and throat cancers. Featured speakers will be:

• Tanja Walker, an epidemiologist at the CDC’s National Center for Immunization and Respiratory Diseases
• Electra D. Paskett, a cancer-research professor at Ohio State University
• Robin C. Vanderpool, an associate professor in the Department of Health, Behavior & Society in the University of Kentucky College of Public Health

The free webinar will take place at noon ET on Sept. 18. A recording will be available on the RHI website afterward. Click here for more information or to register.

Murray Mayor Jack Rose named a Healthy Ky. Policy Champion; among winners eligible for top award to be made Sept. 24

The Foundation for a Healthy Kentucky has named Murray Mayor Jack Rose a Healthy Kentucky Policy Champion for his work to improve local health by successfully pushing for a smoke-free ordinance in the city. It takes effect in October.

"Mayor Rose was the primary impetus behind adoption of a comprehensive smoke-free law in Murray, one of only two such laws in the western third of the state," Dona Rains, director of community outreach at Baptist Health Paducah and a member of the foundation's board of directors, said in the news release. Rains nominated Rose for the award.

Foundation President and CEO Ben Chandler said, "He is an ideal recipient of this award because he did his homework to put forth an ordinance based firmly in science, rounded up the necessary community and city council support, and got it passed without a lot of delay. Murray will see great health and economic benefits from his leadership on this issue."

Rose was elected mayor in 2014. He previously served as Murray State University's faculty regent, was dean of its College of Education in 1998-2003 and was Calloway County school superintendent for 21 years. He has been chairman of the Murray-Calloway County Hospital; president of the board of the Kentucky YMCA Youth Association; and president of the Southern Association of Colleges and Schools, an accreditation organization.

Earlier the same week, the foundation named as champions Paducah Mayor Brandi Harless, for her leadership in enacting a stronger city smoking ban, and Dr. Van Breeding of Whitesburg, for leadership in fighting the substance-use crisis in Eastern Kentucky. Earlier winners were Paducah cardiologist Pat Withrow, 19 Casey County High School students, Lexington Legends owner Andy Shea and Lexington Mayor Jim Gray, all of whom took steps against use of tobacco, a main cause of Kentucky's health problems.

The winners are eligible for the Healthy Kentucky Policy Champion of the Year award, which comes with a $5,000 grant from the foundation to a Kentucky-based nonprofit of the winner's choice. The winner of that award will be announced on Sept. 24 at the foundation's Howard L. Bost Memorial Health Policy Forum in Lexington.

Nominations for the Healthy Kentucky Policy Champion Award are accepted at any time. A nomination must also be supported by a member of the foundation's board or Community Advisory Council; details are on the foundation's website.

U of L seeks nominations for award for Ky., S. Ind. nurses

Monday, Sept. 10 at 5 p.m. is the deadline to nominate outstanding nurses from Kentucky and Southern Indiana for the fifth annual Florence Nightingale Awards in Nursing, presented by the University of Louisville.

Nominators should submit an essay of no more than 400 words about how a registered nurse has excelled in providing patient care, influenced the nursing profession or improved the health of people in the region. Nominees must have a registered-nurse license in Kentucky or Indiana. Nominations are made online.

Winners will receive a cash prize and be celebrated at an awards dinner on Nov. 8. For more information, contact Karen Rose at karen.rose@louisville.edu or 502-852-8300.

State launches latest ad campaign to get Kentuckians to stop using tobacco; our smoking rate is No. 2 among the states

The Kentucky Department of Public Health has launched its latest advertising campaign to encourage Kentuckians to stop using tobacco.

The campaign will feature broadcast, print and digital advertisements, along with a targeted outreach to medical providers and community engagement initiatives aimed at boosting public awareness of state's free tobacco quit line, 1-800-QUIT-NOW (784-8669).

In addition to the ad campaign, the health department is launching a new texting service in which users can text QUITKY to 797979 to connect to the quit line. The online option is www.quitnowkentucky.org. The services are free and confidential.

“Everyone knows that giving up tobacco products is hard to do, but it is easier with counseling and assistance programs like Quit Now Kentucky,” Health Commissioner Jeffrey Howard said in a news release. “Even if you have tried to quit before and didn’t succeed, this service can help you try again – and keep trying – until you are successful."

Tobacco is the leading cause of preventable death in Kentucky and the nation, and Kentucky has the second highest state smoking rate, at 24.6 percent. "More than 8,000 Kentuckians die each year because of tobacco-related diseases," says the release.

The campaign, produced by a Louisville-based advertising agency Red7e, emphasizes the health and lifestyle benefits of quitting tobacco. One commercial features large turkeys out in the snow, suggesting that you don't have to quit "cold turkey." They can all be viewed at red-stash.com/QUIT/

As part of the campaign, physicians and health care professionals will receive marketing materials they can use to promote Quit Now Kentucky with their patients.

“People are often discouraged if a quit attempt isn’t successful, but we are here to tell it’s normal and that having the right supports in place is key to their success," Kerri Verden, who coordinates the state's Tobacco Prevention and Cessation Program, said in the release. "We hope Kentuckians will join us in this campaign to spread the word about the quit line and help more individuals give up smoking or tobacco products.”

Callers to Quit Now Kentucky speak with highly trained cessation specialists who answer calls daily from 8 a.m. until 1 a.m. to help tobacco users develop a quit plan. Quit Now counseling and materials are provided to callers at no charge. Quit Line services are available in English, Spanish, and Arabic at the time of the call, and in more than 190 languages using a translation service.

For employers who want to help employees quit, information is available through the Quit Line and the local health department. Group sessions and cessation materials can be made available at worksites. Visit http://chfs.ky.gov/dph/mch/hp/tobacco.htm for information on other tobacco cessation options.

At first SOAR summit session only about health, speakers agree local cooperation is needed to address Appalachia's health issues

Jeffrey Howard speaks at the health session before
the SOAR Summit. (Photos by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

PIKEVILLE, Ky. – From top to bottom of the health-care system, speakers agreed local cooperation is essential to improving health in Appalachian Kentucky. They spoke Thursday, at the first-ever preliminary sessions for the annual Shaping Our Appalachian Region Summit, held Friday in Pikeville.

Dr. Jeffrey Howard, the state health commissioner, talked briefly about some of the many health issues that plague Appalachia – including diabetes, lung disease, cancer, adverse childhood experiences – but spent most of his time talking about substance abuse.

Howard said some research indicates there is a 141 percent greater risk of  drug-related overdose and overdose death in Appalachia than the rate outside the region, and though there will be an "unprecedented" amount of money available in the next year to fight the problem, the real solutions will need to be found at the local level.

"There is no amount of money that is going to get us out of this crisis," Howard said. "This is a cultural crisis, especially in Appalachia. So we have to come together as a group, we have to embrace one another and really have a grass-roots effort to overcome the issue of substance abuse."

Howard suggested that one community solution that comes at no cost would be to identify at-risk children and families to invite to dinner once a month. He said a family had done this for him growing up, allowing him to "see what a functional family looked like."

The session opened with a video of Howard talking about how he had been raised in Eastern Kentucky by a mother and stepfather who were addicted to drugs, and in and out of recovery. He said it wasn't until he turned 14 and moved in with his father, became involved in sports, found his faith and met the woman who is now his wife, that he was able to overcome the many obstacles that substance abuse had put in his way.

Howard lives in Louisville. He described what it felt like to "come home" in a way that likely rings true to many from the region, and also speaks to the need for local solutions.

"Every time those low, round-top mountains peak up on the horizon, I just get a feeling of tranquility, peace, happiness," he said, adding later, "I know that every time I get that feeling, I know who I am, where I belong, that I'm home. And most importantly, I'm with the people I belong with."

Rural health: A boots-on-the-ground perspective

In the second part of the health session, a rural hospital CEO, a health department director and a federally qualified health center's behavioral-health coordinator and therapist talked about what rural health in Kentucky is really like.

Scott Lockard, public health director of the Kentucky River Health Department District, told the group that one entity can no longer be responsible for providing health care in a community.

"We have to partner. . . . We don't need to be competitors, we need to complement each other," he said. "And I think we are seeing that more and more throughout our communities, throughout our systems and we're all working together, we're playing well in the sandbox and we're sharing our pails and shovels better than we used to."

Sonji Adams, the behavioral health coordinator and therapist at Mountain Comprehensive Health Corp., said she is most proud of their many programs that integrate behavioral and physical health care. For example, Adams said it takes a collaborative, integrated effort to help people with substance-use disorders be successful.

"Let's get everybody together in the same room. Let's share ideas. Let's figure out a hub and spoke model so whenever they come to say I need help, we know exactly where to send them," she said to a room full of applause. "We have to be able to meet them with community resources to get them better so that we're making an entire community better."

From left: Susan Starling, Scott Lockard, and Sonji Adams

Asked for a wish list that would improve rural health, Lockard said to applause that he would wish for a "statewide smoke-free law." And among a long list of other wishes, he said that while everyone recognizes the issues around substance use disorders are "huge," he added that we "can't drop the ball" on other diseases that are killing citizens, such as heart disease, cancer, smoking, and obesity.

Adams said she would wish for a model of care that moves from "sick care" to "health care" for both physical health and mental health issues. She said she would also wish for more behavioral health care providers to work in Eastern Kentucky.

Susan Starling, CEO of Mercy Health-Marcum & Wallace Hospital in Irvine, wished for policy makers in Baltimore (where her hospital's new parent company, Bon Secours Health System, is headquartered) and Washington, D.C., to understand "what rural is" because she said they often don't understand the importance of a hospital that only has 25 beds or how harmful a 1 percent cut to a program can be. Starling's hospital is one of those critical-access hospitals, 27 in Kentucky, that get 1 percent more federal reimbursement in return for limiting their beds and services.

She also said she wished for a way to save rural emergency medical services, saying many of them "don't have the money to survive." She said her hospital often has patients in the emergency room who have to wait two days for transport because "they can't get an EMS truck to come to our hospital and take them back to their community."

Earlier, Starling said she wanted to make sure everyone understood how important hospitals are to rural communities. Listing her hospital's many awards and accreditations, she said "quality health care in a small rural hospital setting" is possible. She said her hospital, in 2016, provided $1.5 million of uncompensated health care, employed over 250 people, spent $12 million on wages, supplies and services, and had a total economic output estimated at $19 million: "That's not chump change for us in Estill County."

Kentucky has very high rate of addicted mothers; rose by double-digit percentages early in decade, seemed to level off in 2015-16

By Melissa Patrick and Al Cross
Kentucky Health News

Kentucky has had a very high rate of opioid-use disorder among women delivering babies in hospitals, according to a study published by the Centers for Disease Control and Prevention.

In Kentucky, 19.3 mothers out of every 1,000 who gave birth in a hospital in 2014 had an opioid-use disorder. Among the 30 states studied, only two were ahead of Kentucky: Vermont, at 48.6 per 1,000, and West Virginia at 32.1. The national rate is 6.5 per 1,000. West Virginia was the only state adjoining Kentucky to be included in the study.

Opioid use during pregnancy, whether it be heroin, prescription painkillers or some other narcotic, is associated with pre-term labor, stillbirth, neonatal abstinence syndrome and maternal death.

The study, published Aug. 10 in CDC's Morbidity and Mortality Weekly Report, analyzed hospital discharge data from 1999 through 2014. Over that time, the national rate of mothers with opioid-use disorders at delivery more than quadrupled, going from 1.5 to 6.5 cases per 1,000.

Kentucky's rate showed big jumps from 2010 through 2014, going from 7.2 to 9.5 to 14 to 15.7 to 19.3. Over the same five years, the national rate rose from 3.9 to 6.5 per 1,000. The Kentucky numbers represented annual increases of 32, 43, 5 and 23 percent.

Kentucky neonatal abstinence syndrome cases. Ky. Dept. for Public Health graphic.

The researchers say that while their study is the first multi-state look at the prevalence of opioid-use disorder diagnosis among women giving birth, this data is "mostly consistent" with  neonatal abstinence syndrome studies between 1999 and 2013 and correlates with state opioid prescribing rates in the general population. They add that the increasing trends could also be a result of improved screening and diagnosis.

Hospital-discharge data for babies born with neonatal abstinence syndrome for 2015 and 2016 show increases of only 2.9 and 2.2 percent in Kentucky, indicating that the problem did not worsen during these years, compared to the five years before that, but remains very bad. 

Additional surveillance by the state Department for Public Health showed more babies were born with neonatal abstinence syndrome at birth than the hospital-discharge data showed, but also showed a decrease in that number from 2015 to 2016.

Precise reporting of the problem can be a challenge, due to the stigma it carries and different state laws on reporting.

As of July, eight states required health-care professionals to test for prenatal drug exposure when it is suspected, and 24 states and the District of Columbia require professionals to report suspected use among pregnant women. Twenty-three states and D.C. consider substance use during pregnancy to be child abuse, and three states consider it to be grounds for admitting a woman involuntarily into a psychiatric hospital. The researchers note that these strict policies could cause women to try to conceal substance use from their providers.

Kentucky began defining neonatal abstinence syndrome, or withdrawal symptoms, as child abuse this year. The legislature added that to a foster care measure (House Bill 1). Under the new law, such a finding could result in the termination of parental rights unless the mother enrolls in a drug-addiction treatment program within 90 days of the birth.

State caseworkers who learn of babies having neonatal abstinence syndrome make recommendations to family court judges on a case-by-case basis, and removing the baby is not an automatic outcome, John Cheves of the Lexington Herald-Leader reports.

The researchers recommend improved access to prescription-drug monitoring programs, increased substance-abuse screening, use of medication-assisted therapy and substance-abuse treatment referrals.

“State-level actions are critical to curbing the opioid epidemic through programs and policies to reduce use of prescription opioids and illegal opioids including heroin and illicitly manufactured fentanyl, both of which contribute to the epidemic,” the report says.