University of Louisville to hold free event in Oldham County on May 10 to discuss aging, pain management and addiction

Kaiser Health News photo

The University of Louisville Trager Institute will offer a free community event to discuss the dangers of medication misuse and addiction for older adults, alternative solutions to chronic pain management and advocacy for making alternative pain strategies accessible for older adults.

“There is often a stigma around talking about pain and pain management, in addition to lack of understanding of options beyond opioids,” Mona Huff, the institute's community organizer, said in a news release. “Good health starts with self-care and loving yourself. It means asking for help when you need it. Asking for help is not a sign of weakness, but rather a sign of strength.”

The event, "Reconciling Pain and Giving Hope to Seniors,” will be held Monday, May 13 from 10 a.m. to 3 p.m. at the John W. Black Community Center in Oldham County.

Lunch will be provided for those who RSVP to the symposium by May 7. For more information contact Mona Huff at 502-845-6849 or rjhuff01@louisville.edu.

This event is held in partnership with the Kentucky Coalition for Healthy Communities, Tri-County Community Action Partnership, Barren River Area Development District, and the Kentuckiana Regional Planning and Development District.

Health experts warn people with asthma and chronic lung conditions to be careful when spring cleaning; here are their tips

Asthma.net image

Spring has arrived in Kentucky, prompting many to tackle the annual chore of spring-cleaning, but health experts caution people who suffer from asthma or other chronic lung conditions to proceed with caution because some cleaning supplies can be hazardous to your health, according to a Penn State Health news release.

The key to cleaning safely, if you have one of these conditions, is to take proper precautions when using cleaning supplies such as air fresheners, rug cleaners, bleach, oven cleaners and floor polish, because they can produce vapors that may irritate the nose, throat, eyes and lung, the release says.

“For most people, using chemical cleaners occasionally would not create clinically significant reductions in lung function,” Dr. Timothy Craig, an allergist and immunologist at Penn State, says in the release. “But repeated exposure to harmful chemicals over a lifetime could lead to significant disability later in life, especially for people with asthma, chronic obstructive pulmonary disease or Alpha 1 antitrypsin deficiency, a genetic disorder that may cause lung or liver disease.”

About 11.6% of Kentucky adults have asthma, and rates are significantly higher among women than men: 16% and 6.9% respectively. About 11.4% of Kentucky adults have chronic obstructive pulmonary disease, and those rates are also significantly higher in women, 13.3% to 9.4% for men, according to the 2018 Kentucky Behavioral Risk Factor Survey annual report.

Here are six safety tips that the experts say should be on everyone’s spring cleaning checklist:

1. Don’t combine chemical cleaners, especially not ammonia and bleach.
2. Create proper ventilation. Open a window or door, or run a fan, while cleaning.
3. Wear rubber gloves and a mask.
4. Seek old-fashioned cleaners like warm water, baking soda,and vinegar.
5. Read labels. Look for volatile organic compounds and other potential irritants, even in products labeled as “green” or “healthy.”
6. Look for the “Safer Choice” logo. It’s found on 2,000 products, including cleaners, that the Environmental Protection Agency deems as “safer for human health and the environment.”

"People who experience any coughing, wheezing, throat soreness or eye watering while using chemical cleaners should step into another room or walk outside. If the symptoms persist even after leaving the room, call a doctor," says the release.

As pensions threaten school-nurse programs, schools can get new Medicaid money for both physical and behavioral health

By Melissa Patrick
Kentucky Health News

Many of Kentucky's school districts have long struggled to pay for school nurses, let alone professionals in behavioral health care. And now some health departments may no longer be able to provide nurses because they will have to pay more into their employees' pension system.

But schools are about to get some help with their students' health needs, under state officials' plan to allow schools to use Medicaid funding to cover both physical- and behavioral-health services. More than two in five of the state's children are covered by Medicaid.

Deputy Secretary Kristi Putnam

Kristi Putnam, deputy secretary of the Kentucky Cabinet for Health and Family Services, who has spearheaded this effort, said that by the start of the next school year, schools will be able to use Medicaid to serve all students enrolled in the program.

"I'm a former school teacher and I know how valuable it is to have health services and behavioral health services for kids right there at your school," Putnam said. Research shows that children who don't get needed care can suffer academically.

What's it all about?

Until December 2014, schools could only bill Medicaid for students who were disabled or met other limited criteria. That's when the Centers for Medicare and Medicaid Services changed the guidelines to allow states to provide services to any student who is enrolled in Medicaid, and get federal reimbursement for those services.

Only now has Kentucky decided to seek the money, a decision that seems largely driven by an increase of behavioral-health issues in schools.

Gaining access to these funds varies by state. In Kentucky, it requires an amendment to the Medicaid state plan and putting an appropriate billing process in place. Putnam said the amendment and fiscal analysis will be submitted May 1, with a request for an Aug. 1 start date and that they are still working on the billing aspect of the requirements.

She said the administration is working on the assumption that the funding will be approved and will start informing schools about it on May 1, because participation is optional.

States must provide matching money to get federal Medicaid dollars, 30% in Kentucky's case. Putnam said existing school-based Medicaid expenditures can count toward the match.

"The state and local funding that is being used right now for any health and behavioral-health service can be used as the match to draw down additional federal funds," she said. "So there is no increased costs to the state or to the school district."

Putnam said the amendment will be broadly written, so the new money can cover both physical- and mental-health care, along with provisions for telehealth.

"You have to have both," she said. "It's just exciting because there has been limited funding for behavioral-health services . . . but this will allow us to expand both, and we need to expand both."

Kentucky adults are strongly supportive of schools taking a more active role in helping families get health care services for their children, with 84% saying in the latest Kentucky Health Issues Poll that they favor such action.

So far, 14 states, including Kentucky, are either considering, actively pursuing or have already taken advantage of this additional Medicaid funding in their schools, according to a policy brief penned by three non-profits dedicated to health: Community Catalyst, Healthy Schools Campaign and Trust for America's Health.

Why does it matter?

For years, Kentucky schools have struggled to find funding for health care in schools. And while Putnam has pointed to the need for more behavioral health funding, school nurses have been on the chopping block for years as school and health-department budgets have decreased.

Kentucky Department of Education photo

These cuts have forced schools to find creative ways to provide health care to students. Some have moved to school-based health centers, which provide care to students through a public-private partnership; others have used fewer nurses to cover more students. Others have relied on health departments, but cuts in federal and state funding have forced the departments to ask for more money from schools to fulfill this role.

That said, health departments' school-nurse programs could be at further risk because of the state's pension crisis, which on July 1 will require health departments to increase their pension obligation from 49.47% to 83.43% of payroll -- unless a special session of the state legislature changes that.

In the regular session, Gov. Matt Bevin vetoed a bill that would have offered some temporary relief to the health departments and has said he will call a special session to deal with the state's pension system early this summer.

The Marshall County Health Department decided last week to end its school-nurse program, in order to help pay for its possible extra pension obligation of $566,200 a year. In a news release, local health officials called it an "agonizing decision."

"The Marshall County Health Department school health program has been in our schools for over 25 years," they said. "Our school nurses have truly made a positive difference in the lives of our children, their families, the school system, and our community. Discontinuing this program is a tremendous loss for all of us."

Meanwhile, the need for health services in Kentucky schools is greater than ever, with students showing up at school with a long list of chronic physical-health and behavioral-health conditions, an electronic-cigarette epidemic that no one saw coming, as well as schools having to deal with issues around bullying, suicide, the drug epidemic and gun violence.

Mahak Kalra, the health policy director at Kentucky Youth Advocates, who has worked with the cabinet on this project, pointed to research that shows students with health problems, whether they be physical or behavioral, struggle to do well in school.

"So, providing those health services in the school setting can address their immediate health-care needs and can connect them to the services they need and really keep them learning," Kalra said.

She added that it will also reduce many of the barriers parents have to get their children health care, like transportation, non-flexible work schedules or simply finding a provider who will accept Medicaid.

Kalra and Putnam both noted that this additional funding will help support the School Safety and Resiliency Act, or Senate Bill 1, that among other things calls for one trained school resource officer in every school and one guidance counselor for every 250 students by July 1, 2021 or as funds and qualified personnel become available. School-based mental health service providers fall under a subsection of the guidance counselor requirements and are listed as optional.The bill has no funding attached to it.

"This is one way to have those school-based mental health providers provide those services," Kalra said.

Eva Stone, district health coordinator for the Jefferson County Public Schools, pointed out that Medicaid will only pay for licensed mental-health providers, not guidance counselors -- unless they have a special certification, which most of them don't.

Stone, who is also an advanced practice registered nurse, added that amending the state plan to define what this additional Medicaid funding will cover provides a great opportunity for Kentucky to meet all of the needs of the state's children, whether they be physical, mental or social -- like whether a child is homeless or has access to food or is being abused at home.

Stone has long said that school nurses are the best situated to coordinate all of these efforts because "that's what nurses are educated to do." Further, she said, making coordination of care reimbursable in the state health plan would allow for that coordination to happen.

"We have the opportunity to craft this in Kentucky in a way that would make all those players work together," she said.

The state says Kentucky has 1,688 students for each school psychologist; the national standard recommends 500 to 700.

The 2018 School Health Profiles Report shows that 41% of all middle and high schools in Kentucky have a part-time registered nurse and 58% have a full-time registered nurse. The Kentucky Health Issues Poll found that 92% of Kentucky adults would support a law to require a nurse in every school.

Kentucky leads the way on many opioid-related efforts, and was well represented at the four-day drug abuse summit in Atlanta

By Melissa Patrick
Kentucky Health News

Kentucky officials, researchers and clinicians were front and center at the eighth annual national summit on prescription drug abuse and heroin, started by Rep. Hal Rogers of Kentucky, participating in panels covering a range of topics, such as caring for babies who are born addicted to drugs and procedures that help with early detection of substance-use disorders among young people.

U.S. Rep. Hal Rogers spoke at the 2019 National Rx Drug
Abuse and Heroin Summit in Atlanta. (Photo via Twitter) 

“This public-health crisis has damaged our nation and ripped families apart. More than 70,000 people died of drug overdoses in 2017 alone and sometimes it’s hard to find hope in the midst of America’s deadliest drug epidemic,” said Rogers in a news release.

The summit was founded by Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education), a Kentucky non-profit created by Rogers that leads education, treatment and law enforcement initiatives in 32 counties in Southern and Eastern Kentucky.

“Operation UNITE leaders were determined eight years ago to reach across state lines and share best practices with other communities looking for life-saving solutions,” Rogers said. “Each year at this summit, a little more hope shines through as we see shifts in more access to treatment, better policy and legislation, and more prevention programs.”

Attendance at the National Rx Drug Abuse and Heroin Summit in Atlanta April 22-25 was the largest yet, about 4,000. Kentucky was well represented, with a large contingent of researchers and health-care providers from the University of Kentucky on several panels. UK President Eli Capilouto, who introduced Rogers on the first day, pointed out in a video about the event that the summit often sets the national agenda that drives the research around this topic.

One panel covered topics that centered around changes to Kentucky's laws and their potential impacts on patient care and the expansion of prescription data for public health surveillance. Another discussed a multidisciplinary model of care that allows people who come into the emergency room or hospital at UKHealthCare to get immediate treatment for their opioid-use disorder with medication assisted treatments, like buprenorphine, and then get an immediate referral to the First Bridge Clinic for further treatment and recovery care. In its first year of operation, over 300 individuals were referred for treatment with over one-third initiated care, according to a university news release.

Dr. Roger Humphries, the chair of emergency department, talked about how his views on addiction have evolved. He said that years ago he would have never considered treating a person with an opioid-use disorder in the emergency room, but that is no longer the case as evidence by his emergency room's participation in this innovative partnership with First Bridge Clinic.

"I used to think responsibility was fully on patients," he said, " but now I know this is a brain disorder -- one of my kids could fall into a problem like this."

President Donald Trump and First Lady Melania Trump addressed the attendees of the summit on Wednesday. She first highlighted her "Be Best" campaign that among other things raises awareness of neonatal abstinence syndrome and maternal health. The president presented a long list of efforts by his administration, including an investment of $6 billion over two years to combat the crisis. "Everyone here today is united by the same vital goal: to liberate our fellow Americans from the grip of drug addiction and to end the opioid crisis once and for all," he said. "We will never stop until our job is done."

Justice Secretary John Tilley at the summit (Photo via Twitter)

Kentucky Justice Secretary John Tilley was one of four speakers to follow Trump's keynote address. A state news release said Tilley spoke about the state's many innovative reforms and initiatives including "strengthening treatment in prisons, establishing the KY Help Call Center, local-option syringe exchange programs, expanded access to naloxone, a three-day prescription limit for acute pain, the Kentucky State Police Angel Initiative, and the newly-announced $87 million Kentucky CAN HEAL Project," which aims aims to reduce opioid-overdose deaths in 16 counties by 40 percent over the next four years with grants from the National Institutes of Health.

Effort mounted to find and treat hepatitis C, which is spreading; most people who have it probably don't know they have it

"A multimillion-dollar effort to fight hepatitis C was introduced Thursday in Louisville with the help of Gov. Matt Bevin as well as medical professionals and health advocates," Darla Carter reports for Insider Louisville.

The five-year, five-state project in Kentucky and four other states will use screenings, community partnerships and prevention programs, and strengthen the health-care infrastructure to fight the liver disease, Carter reports. The project, called HepConnect, will serve Kentucky, Indiana, North Carolina, Tennessee and West Virginia.

"We can't afford to ignore it," Gov. Bevin said. (Darla Carter photo)

Many people who have hepatitis C don’t know it because it often doesn't present symptoms, said Derek Spencer, a lobbyist for Gilead Sciences, the drug maker funding the project. The state of Kentucky estimates that more than 40,000 Kentuckians have the disease, but “The actual number is likely four to five times that amount,” said the state Cabinet for Health and Family Services.

The opioid epidemic is spreading the hep-C virus, Spencer said: “The majority of new HCV infections in the Appalachian region are attributed to the results of syringe-sharing practices and other equipment associated with injecting drugs.”

Carter notes, "Other ways of acquiring the virus include sharing personal items, such as razors and toothbrushes; getting a tattoo or body piercing in an unregulated setting; or even sometimes through sexual activity." If the illness goes undetected, it “can progress to liver damage, liver failure, liver cancer and death,” Spencer said.

Research by the federal Centers for Disease Control and Prevention in Kentucky, Tennessee, Virginia and West Virginia showed a 364% increase in the number of acute hep C cases "from 2006 to 2012 among young people, mainly whites living in urban and non-urban areas," Carter notes.

Gov. Matt Bevin said at the announcement that hep C was once considered a chronic disease of baby boomers, but we’ve now seen it “leap into younger generations,” he said. “We can’t afford to ignore it.”

Other at the April 25 event "talked about the need to lessen the stigma surrounding hepatitis C and drug use, and a panel of experts from the University of Louisville Hepatitis C Center and elsewhere spoke of the need to address not only the person injecting drugs but also family members who might be infected or impacted," Carter reports..

“Pregnant women can pass hepatitis C on to their babies,” nurse practitioner Barbra Cave said.

The first year of the project will cost $11 million. "The project is being led by the Harm Reduction Coalition, a national organization that promotes the health and dignity of people and communities affected by drug use," Carter reports. It has a Kentucky branch.

Kentucky teens' use of electronic cigarettes and vapes doubled from 2016 to 2018, and is higher than national rates, survey finds

Use of electronic cigarettes and vapes, tracked since 2014, is shown by the blue lines.

By Melissa Patrick and Al Cross
Kentucky Health News

A survey of Kentucky teenagers shows that their rate of using electronic cigarettes and vapes doubled from 2016 to 2018, and all four grades surveyed had rates higher than the national rates.

When Kentucky high-school seniors were asked if they had used e-cigarettes or vapes in the past 30 days, 26.7% said they had. That was more than double the 12.2% rate found by the 2016 survey.

Use by sophomores, or 10th graders, increased to 23.2% from 11.3%; researchers consider the 10th-grade figures to be the better indicator for use by high-school students. Use by eighth graders jumped to 14.2% from 7.3%, and sixth-grader use increased to 4.2% from 2.3% over 2016.

The 2018 National Youth Tobacco Survey, which uses slightly different wording, found that 21 percent of students in high school and nearly 5 percent in middle school reported using e-cigarettes and vapes. (Those numbers represented increases of 78 percent 48 percent, respectively, in high-school and middle-school use, from 2017.)

The Kentucky Incentives for Prevention survey is taken every two years. In 2018 it was taken by more than 159,000 students in 151 of the state's 173 public-school districts. For the first time, it included Jefferson County, the state's largest district, but still did not include Fayette County, Hardin County, Warren County, Bowling Green and 18 other districts.

"This unprecedented two-year surge in Kentucky youth vaping and e-cigarette use underscores the urgency of our efforts to warn kids and the adults in their lives about the dangers of these tobacco products for youth," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky.

"E-cigarettes and vapes are chock-full of nicotine that can cause both immediate and permanent brain damage to youth. They prime the developing brain for addictions to other substances. They can cause cancer and lung damage. And they have been known to explode and cause poisoning among very young kids," Chandler said.

"We urge every Kentucky school district that doesn't already have a tobacco-free campus policy to expedite their plans to comply with the new tobacco-free schools bill. We also urge parents, teachers and other adults to talk to kids about e-cigs and help them understand that they are absolutely not safe for kids or young adults."

On April 22, the foundation released public-service announcements and other free resources about youth e-cigarette use. The "I Just Didn't Know" campaign features Kentucky youth sharing with their peers what they've learned about the dangers of e-cigarettes. The PSAs are available on YouTube and are accompanied by a website and an Instagram page.

The survey was released April 25 by the Substance Abuse Prevention Program in Kentucky's Department for Behavioral Health, Developmental and Intellectual Disabilities. A report by region, based on 10th graders, is to be released in early summer.

The survey primarily assesses alcohol, tobacco and other drug use, but also looks at suicide and other high risk behaviors.

It showed continued declines in use of several substances, including alcohol, combustible cigarettes and smokeless tobacco. It found that in 2018, students were less likely than before to perceive that it is easy to obtain alcohol, combustible cigarettes, and marijuana.

However, reported psychological distress and associated mental-health measurements, as well as reports of suicidal behavior, have risen steadily since 2014. Feeling unsafe at school increased substantially in 2018.

These school districts did not participate in the survey: Anchorage, Barbourville, Beechwood, Berea, Bowling Green, Dawson Springs, East Bernstadt, Fayette County, Fort Thomas, Glasgow, Hardin County, Hopkins County, Kenton County, Laurel County, Lee County, Logan County,  Paintsville, Raceland, Rockcastle County, Russellville, Science Hill and Warren County.

Roundtable at Marion County High School explores the phenomenon of electronic cigarettes among teenagers

Marion County High School in Lebanon (Photo from Marion County Public Schools)

By Emily LaForme
The Lebanon Enterprise

“Over the past two years it’s become more common,” said student Brianna Meeks. “I started seeing it more in school this year, in the bathrooms and in the parking lot after school.”

Meeks was talking about the use of electronic cigarettes, including Juuls and other vapes, inside Marion County High School. It isn’t just a fad here; it’s becoming prevalent across the country.

“They hide it in their shirts, or you see them coming up the hill with a big puff of smoke, you kind of know what’s going on, between classes in the bathrooms,” said instructional assistant Robert Spalding.

Student Kelly Miles said, “You’ll see three girls going into one stall in the bathroom.”

Miles and Meeks were among MCHS students who participated in a roundtable discussion with school staff last week about the rise of e-cigarette products in school. Every student said they had at least one friend that smokes an e-cig product or had tried it. The senior students estimated that approximately 75 percent of the senior class use e-cigs, and around 90 percent have tried them.

According to drugfree.org, 3 million high-school students, or 20 percent of the total, are vaping, and the percentage grows every year.

“As far as the effects of it, we don’t necessarily understand it yet, so that is concerning,” said Principal Thad Elmore. “We are treating it much like we would treat the use of tobacco products; we confiscate it and can enforce consequences for repeat offenders, like in-school suspension. We do also try to offer support, medical help in regards to it or other assistance, because it is addictive and we understand that.”

According to the federal Centers for Disease Control and Prevention, studies have shown that young people who use e-cigarettes are more likely to begin smoking cigarettes in the future.

The CDC also reported that e-cigarettes do not release harmless vapor, but contain substances such as nicotine, ultrafine particulate, volatile organic compounds and cancer-causing chemicals, and heavy metals such as nickel, tin and lead, which can be inhaled into the lungs and cause further damage. The flavor chemicals can contain diacetyl, which has been linked to lung disease.

According to the CDC, Juuls have a high level of nicotine. A single pod contains as much nicotine as 20 cigarettes.

The staff members at the roundtable seemed pretty stumped about what goes into the e-cig products, and worry that the students don’t seem to understand how harmful nicotine can be.

“I wonder, is it more concentrated, does it get you some sort of high or hit from it because the nicotine is more concentrated?” asked School Resource Officer William Walsh. No one had an answer to give him. 

Student Elise Carpenter said, “That’s just something I’ve never been interested in. I’ve never taken a hit off one. . . . I’ve heard people say they’ll get a high or a buzz off it, but I don’t understand it.”

Miles said, “I think teens know the effects, but they don’t want to face them. You can’t see the damage it’s doing to your body. If you see someone with a cigarette, you see the ashes and the smoke has a grayer look and distinct smell. With the Juuls and stuff, it doesn’t seem harmful.”

The students said vaping products can cost $20 or more, and you have to pay for the refillable flavor pods, which can become costly.

“It’s expensive. Some kids go through them like crazy,” said Miles. “I hear kids bragging about how often they go through pods. I always wonder, why you would want to spend your money on that?”

So where does MCHS go from here?

“What I would like to do is consider the conversation, work with our Youth Services staff members, and have another conversation next year again and keep the conversation going,” Elmore said. “We definitely need to start talking about further educating our students, and parents, about e-cigarettes.”

Health foundation creates public service announcements about dangers of teen e-cigarette use and offers them free to anyone

By Melissa Patrick
Kentucky Health News

An explosion of electronic-cigarette use by Kentucky teenagers has prompted the launch of a statewide campaign to debunk the myths that many teens have about these products, such as the belief they produce only water vapor. The campaign features Kentucky students and is called "I Just Didn't Know."

In addition to the 30-second public service announcements, the Foundation for a Healthy Kentucky campaign includes an Instagram account, a website with information and tools for both youth and adults, and a YouTube channel. The campaign materials are free to anyone who would like to use them, including schools, health departments, youth groups and all media organizations. The launch was announced Tuesday, April 22.

"We have an epidemic raging right now all across the country and we want to do whatever we can to stem it here in Kentucky," Ben Chandler, CEO and president of the foundation, said in an interview. "One of the best ways to do that is to have young people talking to other young people. . . . and we love the tag line, "I Just Didn't Know," because anybody that we talk to about this, that is typically their response."

A 2018 federal report found that one in five high school students and one in 20 middle schoolers used e-cigarettes in 2018, which was a 78 percent jump for high schoolers over 2017 and a 48 percent jump for middle schoolers. It was reported at the 2019 Tobacco Conference last week that Kentucky data shows that e-cigarette use is as high as 75% among students in some Kentucky high schools.

"For decades we've been making progress in reducing smoking rates among youth in the country and in Kentucky, but recently we've made a u-turn. Now we are going in the wrong direction," he said.

E-cigarette aerosol includes cancer-causing chemicals; ultrafine particles that include heavy metals, such as nickel, tin and lead; flavorings like diacetyl, which has been linked to a serious lung disease called "popcorn lung"; and other toxic gases that pose health risk to users and bystanders, according to the  federal Centers for Disease Control and Prevention. They also have high levels of nicotine, which not only creates a powerful addiction but can also harm the brain development of youth.

In one of the PSAs, Claire Ramsey, a student from Henry County, says: "It has just as much nicotine as a pack of cigarettes does. I could get addicted to this. I'm only 11 years old. . . . I thought it was just water vapor, but it's not. I just didn't know."

Sen. Julie Raque Adams, a Louisville Republican who has long been a champion of tobacco-free policies, said her two teenage boys had told her that they "just didn't know" that there was so much nicotine in e-cigarettes.

Adams applauded the PSAs and said they could also be used to educate policymakers who also "just don't know" about the dangers of e-cigarettes.

Alivia Hackworth and Chloe Dyer of the Community
Problem Solving club at Johnson County Middle School

Alivia Hackworth, a Johnson County Middle School student who was featured in one of the PSAs along with classmate Chloe Dyer, was part of a group that worked with state Sen. Brandon Smith, R-Hazard, to create a bill that would have created an anonymous hotline for students to report concerns about e-cig and tobacco use.

The club won first place for its efforts at the state Governor's Cup competition and will be in an international contest at the University of Massachusetts Amherst in June.

The bill almost passed the General Assembly, and Alivia said the Community Problem Solving club plans to get it introduced again next year.

The legislature did pass a tobacco-free schools bill that Gov. Matt Bevin signed into law. It will take effect July 1, 2020. School districts have three years to opt out of its provisions.

Another thing to worry about, Alivia said, is that these products are causing students in her school to get chemical burns in their mouths and also causing them to have persistent coughs.

"I just want help for my friends, because they are getting sick from this, and they are scared to tell an adult because they feel like they are going to get in trouble," she said.

Richard Hackworth, Alivia's father and a science teacher at her middle school, told Kentucky Health News that their school district had implemented all elements of the students' bill, including an educational component and the recommendations for how to handle violations.

"Until our Community Problem Solving team identified this problem, we just didn't know," he said.

A day after the statewide campaign was announced, Jefferson County Public Schools announced its own anti-vaping campaign, called "Vaping Equals," an intentionally incomplete sentence that is meant to be filled in with facts about e-cigarettes, Spectrum News reports. This campaign includes a classroom component, informational posters and a new website www.vapingequals.com.

E. coli outbreak keeps spreading, but may be slowing down

The outbreak of E. coli infection centered in Kentucky has spread to nine other states, the federal Centers for Disease Control and Prevention announced April 23. However, preliminary evidence suggests the number of new cases is declining.

Officials said they are still trying to find the source of the outbreak, which evidence suggests is ground beef.

"CDC is not recommending that consumers avoid eating ground beef at this time," the agency said. "Consumers and restaurants should handle ground beef safely and cook it thoroughly to avoid foodborne illness. At this time, CDC is not recommending that retailers stop serving or selling ground beef."

Escherichia coli is a common bacterium found in the digestive tracts of mammals. Certain strains, such as the one numbered O103, which is identified with this outbreak, can produce Shiga toxin, which causes diarrhea (often bloody), severe stomach cramps, and vomiting.

The strain of E. coli has been identified in 156 sick people, 20 of whom were hospitalized. No deaths have been reported from the outbreak. Kentucky has 65 cases; Tennessee has 41, Georgia 33 and Ohio eight. A CDC chart indicated that fewer cases have been reported in recent weeks, but it can take as long as four weeks for the disease to develop.

U.S. Centers for Disease Control and Prevention chart, adapted by Kentucky Health News; click on it for a larger version

Boyd County extension agents teach children healthy living

By Katie Pratt and Jeff Franklin
University of Kentucky College of Agriculture, Food and Environment

Young children in Boyd County are learning healthy habits thanks to programming efforts by the University of Kentucky Cooperative Extension Service that include planting their own vegetables.

Susan Grimmett, program assistant for Supplemental Nutrition Assistance Program education, has worked with 300 students at four schools within the county to teach them about the importance of nutrition and physical activity within the school year. To do so, she used Organ Annie and other characters from The OrganWise Guys, a program initiated by two doctors to spread awareness about the importance of a healthy lifestyle to battle childhood obesity. Grimmett has used the program with Boyd County preschool through second-grade students for the past three years as students and teachers continue to request it.

“The students have enjoyed it, and they have learned a lot,” said Kelly Smallwood, a preschool teacher at the Early Childhood Learning Center-North in Ashland. “Every time Susan comes, she has something for them, and they enjoy that also.”

For one of the program’s culminating events this school year, Grimmett collaborated with Lori Bowling, Boyd County horticulture extension agent, to help the children grow their own pots of leaf lettuce. They chose lettuce, because the students could very quickly see growth. After the lettuce sprouts in the classroom, the children will take their pots home with the goal of sharing the message of nutrition and healthy eating with their families, many of which have limited resources and low incomes. The ultimate goal is for the children to harvest the lettuce and work with their parents to incorporate it into a family meal.

“If we teach them at this age about what’s healthy and the kind of diet they should be eating, hopefully as they progress through school, they will make wiser food choices and have a healthier lifestyle,” Bowling said. “We also want them and their parents to understand that you can grow your own food, regardless of where you live, as long as you have a container, seeds, sunlight and water.”

Even though their pots of lettuce are still small, Grimmett has heard many of the children are excited about growing the produce as some teachers have already received positive emails from parents about the project.

“They are eating healthier, and their parents are getting involved more and buying healthier foods at their children’s request,” Grimmett said.

Walgreens will raise age for tobacco sales to 21 on Sept. 1

Photo by Mike Mozart

"Walgreens has decided to raise its minimum age for tobacco sales several weeks after a top federal official chastised the drugstore chain for violating laws restricting access to cigarettes and other tobacco products," starting Sept. 1, The Associated Press reports. The chain has stores in 51 Kentucky cities and towns.

In March, before he resigned as commissioner of the Food and Drug Administration, Dr. Scott Gottlieb called Walgreens a top violator of sales restrictions among pharmacies that sell tobacco products. CVS Health Corp. stopped selling them several years ago.

The American Lung Association says most states have set a minimum legal age of 18 to buy tobacco products, but a dozen have raised that to 21. Several have done so recently at the request of Altria Corp., the nation's largest tobacco company, which recently bought 35 percent of Juul Labs, which makes the most popular electronic cigarette. Altria sees a higher legal age as a way to curb the push for more regulation of e-cigarettes.

The state Senate rebuffed Altria's effort in Kentucky, but in the U.S. Senate, "Majority Leader Mitch McConnell said last week that he plans to introduce legislation to raise the minimum age to 21 nationally," AP notes. "The Kentucky Republican called the legislation a top priority." Like most lobbying interests, Altria is a major giver to McConnell's political causes.

Smoke-free advocates say the policy can be more palatable if part of a wellness campaign; also say to include smokers at the table

By Melissa Patrick
Kentucky Health News

If you're trying to win passage of smoke-free policies in communities that have been resistant to such efforts, you should focus on the broad issue of improving the health of those communities. That's what one told more than 250 attendees at a conference, saying that efforts to make a community healthier naturally lends itself to policies that minimize exposure to second-hand smoke.

Onjewel Smith of the Southern States Regional Project of
the American Nonsmokers' Rights Foundation discussed
smoke-free campaigns in rural communities at the 2019
Kentucky Tobacco Conference. (Photo by Melissa Patrick)

Onjewel Smith, who works for the American Nonsmokers' Rights Foundation Southern States Regional Project, offered examples of how rural communities in Mississippi and Louisiana have successfully passed smoke-free laws by focusing on "healthy community initiatives." She told the group that these strategies have worked because advocates have framed smoke-free in a way that matters to these communities.

"It's about getting people to think about wellness and not necessarily smoke-free," she said. Later adding, "I don't care what the motivation is. I really don't. At the end of the day we want these policies in place. We want people protected. "

She also reminded the group that getting folks ready for a smoke-free policy requires a whole lot of community engagement to bring awareness to the issue. "We can't ask for change until people understand there is a problem," she said.

As of April 1, 35.5% of Kentuckians are protected by smoke-free laws covering all indoor workplaces and public places.

The 2019 Kentucky Tobacco Conference "Envisioning a Smoke-Free Future" was held April 16 and 17 in Lexington. It was hosted by the Kentucky Center for Smoke-Free Policy, the Kentucky Department for Public Health, the University of Kentucky College of Nursing and the Kentucky Tobacco Prevention and Cessation Program.

Another recurring theme at the conference was to make sure people who would be most affected by a smoke-free policy are included at the table. Speakers at a harm-reduction summit shared a similar message last week, stressing the importance of partnering with drug users to make syringe exchanges truly successful.

For example, the speakers said African Americans, people from the LGBTQ community, people in addiction and recovery, and people from low socioeconomic status, all need to be involved in policy making. These groups were mentioned because they tend to use tobacco products at high rates, largely because they have been targeted by the tobacco industry.

Vivian Lasley-Bibbs, acting director of the Office of Health
Equity at the state Department for Public Health, engaged
with the advocates at the conference. (Photo by Melissa Patrick)

Vivian Lasley-Bibbs, acting director of the Office of Health Equity at the state health department, talked about the importance of looking at tobacco policies from the lens of health equity, which she said requires us to think about how a policy, decision or practice is unfair to one group or another.

She asked, "How many times have you worked around an issue or gone into a community and sat around the table where those who are impacted aren't there?"

Dr. Valerie Yerger, an associate professor of health policy at the University of California, San Franscisco, had a similar message as she spoke about the tobacco issue: "Look around; if you are dealing with an issue that affects marginalized people, make sure that they are there and let them participate. And think in terms of how you can make the work very, very relative to them."

Another hot topic at the conference was use of electronic cigarettes among teenagers, which has increased nearly 80 percent in the last year among high-school students.

Mindy Ickes, an associate professor at UK and the director of several programs that promote tobacco-free college campuses, told the group that Kentucky data shows that e-cigarette use is as high as 75% among students in some Kentucky high schools.

Jelaine Harlow, a Lake Cumberland District Health Department health educator who works with youth in Casey and Adair counties, said they have largely focused on e-cigarette education with teachers and youth this year, adding that they have even had to deal with a first-grader on the school bus with a Juul, which is the most popular e-cigarette device among teens.

"Juuling has consumed us," she said. "Our kids are using them and they are using them tremendously, it's unbelievable."

Awards were also given for work in several categories, including:

The city of Williamstown was one of six Kentucky cities to be
recognized for success in enacting a smoke-free workplace
ordinance. Mayor Rick Skinner (far left) was also the recipient
of the Smoke-free Advocate of the Year award. (UK photo) 

The city of Elizabethtown received the Smoke-free Excellence in E-Cigarette Policy Award for expanding its smoke-free ordinance to include e-cigarettes.

The Lee T. Todd Jr. Smoke-free Hero Award recipient was Liz Burrows, health educator for Oldham County Health Department, for her commitment to smoke and tobacco free environments in the face of adversity.

The Timothy W. Mullett M.D. Lung Cancer Prevention Award recipient was Ashley Gibson, research coordinator for St. Claire Healthcare in Morehead, for her devotion and passion for preventing lung cancer through education, advocacy and policy change.

David Nunery received the Brian Early Mattone Esq. Legal Counsel Smoke-free Support award for outstanding smoke-free legal service.

The Smoke-free Youth Advocate Award recipient was Monroe County CARES Youth Prevention Ambassadors for excellence in promoting secondhand smoke education and smoke-free policy.

The Smoke-free Indoor Air Excellence Award recipients were the cities of La Grange, Martin, Murray, Paducah, Stanford and Williamstown, and Hardin and Oldham counties.

The recipient of the David B. Stevens M.D. Smoke-free Advocate of the Year, for promoting the secondhand smoke education and smoke free policy, was Rick Skinner, mayor of Williamstown.