Louisville's Norton Healthcare receives $20 million gift to support Parkinson's disease programming and research

Norton Healthcare has received a $20 million gift for the "Just Imagine" campaign to support programing and research in Parkinson's disease and movement disorders at the Norton Neuroscience Institute.

 
The Just Imagine campaign aims to ensure greater access to medical expertise; expand innovative clinical translational research; and recruit, train and attract even more best-in-class specialists.

The gift comes from the estate of Dr. Elizabeth Pahk Cressman, a Louisville anesthesiologist who died in 2021.

“Dr. Cressman’s vision has helped elevate the care for Parkinson’s patients, helping to create a nationally known program through Norton Neuroscience Institute,” Lynnie Meyer, senior vice president and chief development officer of Norton Healthcare, said in a news release. “She also was the catalyst behind funding Parkinson’s disease research that already has helped transform the lives of many patients and families through access to more groundbreaking treatments.”

Cressman worked at what is now Norton Women’s & Children’s Hospital, while her husband, the late Dr. Frederick K. Cressman, was a pathologist for Norton Healthcare. This latest gift brings Dr. Elizabeth Cressman’s total support of initiatives at Norton to $28 million.

Nearly 1 million Americans have Parkinson’s disease, and that number continues to grow. The movement disorder generally develops in people 55 to 75 with the main symptom being bradykinesia, or slowness of moment. It also can cause tremors and muscle stiffness.

“Parkinson’s disease can be extremely debilitating and, unfortunately, there currently is no cure,”  Dr. Justin T. Phillips, movement-disorders neurologist with Cressman Parkinson’s & Movement Disorders Center, said in the release. “With Dr. Cressman’s generosity, we are able to build upon the work we already do and offer even more options for patients. She has already had a great impact on people with Parkinson’s in our community, and that will continue for years to come.”

Top senators, one of whom lost both parents to smoking, say no advocates spoke to them about increasing anti-tobacco spending

By Al Cross
Kentucky Health News

Kentucky's top two state senators said Tuesday that none of the advocates for more funding of tobacco prevention spoke to them about it during the legislative session that ended Monday night.

"I never heard from those advocates. They never came to meet with me, and they probably should've. . . . I was in the room where it happened, and nobody ever spoke to me," Majority Floor Leader Damon Thayer of Georgetown said in response to a question from Kentucky Health News.

Thayer spoke at a Capitol rotunda press conference where leading Senate Republicans discussed what they considered to be the session's accomplishments. Senate President Robert Stivers told Kentucky Health News afterward that no one ever spoke to him about the proposal to increase tobacco-prevention spending to $10 million a year from $2 million.

Letter to senators (For a larger version, click on it.)

The proposal came from the American Cancer Society and several other groups interested in better health, including the Kentucky Chamber of Commerce. In a letter to senators, they said smoking is the No. 1 cause of preventable death in Kentucky and causes $2.23 billion in health-care costs, including $634 million in the federal-state Medicaid progam that covers more than one in three Kentuckians.

"A well-funded, fact-based tobacco control program is needed to counteract the $251 million per year that tobacco companies are spending to market their deadly and addictive products in Kentucky," the letter concluded. "As Big Tobacco has been working hard to addict future generations with e-cigarettes and other tobacco products, the need for more funding for tobacco-prevention programs has never been greater."

Thayer said after the press conference, "I get stacks and stacks of budget requests, and if they say, "I sent him a letter or an email,' that's not effective."

Kentucky Health News asked Doug Hogan, the Kentucky lobbyist for the cancer society, what legislators the advocates spoke with and why Stivers and Thayer were not included. He replied with this email:

“The American Cancer Society Cancer Action Network (ACS CAN) is proud to have advocated for the health of Kentuckians during this General Assembly session by asking for an increase in funding for the state’s tobacco prevention and cessation program. ACS CAN staff and volunteers were able to contact Senate and House offices to share the importance of this funding. ACS CAN is disappointed that our message was not heard, and a significant investment was not made in programs to help prevent kids from starting to use tobacco products, including e-cigarettes, and help those already addicted to quit.”

Neither side noted that the administration of Gov. Andy Beshear didn't ask for more money, either. Asked why, Cabinet for Health and Family Services spokeswoman Stephanie French said in an email that the legislature "reduced the tobacco prevention and cessation budget by more than $2.6 million" in the previous state budget, and "after flat-funding at $2 million" a year in the current budget, "The legislature has further reduced the tobacco prevention and cessation budget by another $130,700 in the recently enacted ... biennial budget. Both of these reductions were significantly lower than what Governor Beshear proposed in his Executive Branch budget."

French said Beshear put nearly $1 million extra into tobacco control due to increased receipts from the Master Settlement Agreement with cigarette manufacturers. "This was a doubling of the budget for tobacco cessation and prevention investment for this year and that money is being deployed now."

At the press conference, Stivers was asked if tobacco-control spending would be a good investment in the long term, by reducing health-care costs. He gave Thayer the microphone.

Asked if he thinks the current $2 million tobacco-control budget doesn't work, Thayer said, "I honestly don't know that it does. Honestly. I mean, how much money can you spend trying to dissuade people from doing something that everybody knows is unhealthy?"

Earlier, he said, "Everybody knows that smoking cigarettes is bad for you. . . . My dad knew the health risk his whole life and he never quit." Earlier, he said, "Both my parents died of cancer from the fact that my father was a multi-pack-a-day smoker, so this is an issue that's a little sensitive to me."

Thayer told Kentucky Health News after the press conference he believes that smoking killed his father, who died of esophageal cancer, and that secondhand smoke in their home killed his mother, who died first, of multiple myeloma: "I never saw her smoke a cigarette in my life." He acknowledged that more education on the risks of seocndhand smoke is needed.

When the final budget was released, Kentucky Health News asked Senate budget committee Chair Chris McDaniel of Northern Kentucky why there was no increase in tobacco-control spending. He said, "We kind of distributed it more broadly, with increases in funding for cancer research."

Stivers said likewise at the press conference, adding that health departments also got more funding. "What we are trying to do in all areas is to encourage people to have better and healthier lifestyles," he said.

'Momnibus' bill to improve maternal health passes on final day, after being attached to another bill to avoid floor fight on abortion

Rep. Kim Moser presents SB 74
to the state House (Ky. LRC photo)

By Melissa Patrick and Al Cross
Kentucky Health News

On the last day of the 2024 legislative session, a bipartisan bill aimed at improving Kentucky's dismal maternal-mortality rate was finally passed, after parliamentary maneuvering to avoid divisive issues.

Provisions of House Bill 10, known as the "Momnibus" bill for its varied approach, were added to Senate Bill 74, a bill to require analysis of child and maternal fatalities and add reporting requirements.

The Momnibus bill, sponsored by Republican Rep. Kim Moser of Taylor Mill, came from an informal, bipartsan House-Senate workgroup of female legislators who tackled a big problem: the nation's second highest rate of death of mothers in the year following childbirth. 

From that came a multifaceted bill that ensures access to health-insurance coverage for pregnant women by adding pregnancy to the list of exceptions for enrollment outside the normal open-enrollment period, and several other things.

It establishes a mental-health hotline called Lifeline for Moms that allows providers access to an immediate mental-health consultation for a mother in need; expands the Health Access Nurturing Development Services (HANDS) home-visiation program and lets it be available up to three years after birth; covers lactation consultation and needed equipment to encourage breastfeeding; and will educate mothers on the benefits of safe sleep for infants. These services would also be available via telehealth.

Democratic Sen. Cassie Chambers Armstrong of Louisville told the Senate that Moser "brought together a bicameral, bipartisan group of women legislators and "This is a truly great piece of legislation that will absolutely save lives."

The final bill dropped controversial language that added by a Senate committee. It would have required all hospitals, birthing centers and midwives to refer patients to a perinatal palliative-care program if the patient had a prenatal diagnosis that indicated a "baby" might die before or after birth. Kentucky abortion law does not allow for the termination of such pregnancies, though it is considered a standard of care for a nonviable pregnancy.

Abortion prompted the parliamentary maneuvering. Democratic senators filed floor amendments to Moser's HB 10 to change "baby" to "fetus"; let a physician terminate a pregnancy if it is complicated by a fatal fetal anomaly, or in the good-faith belief that the pregnancy was caused by rape or incest. To avoid a Senate floor fight over the issue, Moser looked for another vehicle.

She found SB 74, sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, with an apt title. "I saw 'An act relating to maternal health'," she recalled. "It was germane, and apropos. . . . It works really well with the underlying bill."

Funke Frommyer said SB 74 was viewed favorbaly by a House committee, but didn't get a floor vote before legislators recessed to give Gov. Andy Beshear time to veto legislation and give them time to override his vetoes. Moser said the House considered the bill safe from a veto because it was non-controversial.

The original parts of SB 74 require the Cabinet for Health and Family Services to publish a report on its website for the most recent five years of available data on the number and types of delivery procedures for pregnancy by hospital.  It also has cleanup language for a number of health-cabinet programs.

The revised, combined bill passed the House 91-1, with Rep. Courtney Gilbert, R-Hodgenville, voting against it. On the House floor, Rep. Lindsey Burke, D-Lexington, praised the bill and Moser's work.

 "I have never been more delighted, proud or excited to vote for any single piece of legislation," Burke said. "It is a gift to the families of the commonwealth. I thank her for her hard work." 

The Senate agreed to the changes on a 29-5-2 vote, with Republicans Greg Elkins of Winchester, Jimmy Higdon of Lebanon, Chris McDaniel of Ryland Heights, Robby Mills of Henderson and Stephen West of Paris voting no and Republicans Donald Douglas of Nicholasville and Adrienne Southworth of Lawrenceburg passing. Republican John Schickel was absent.

Sen. Amanda Mays Bledsoe, R-Lexington, told the Senate, "I thought it was fantastic to have a Kentucky-crafted legislation that looked at solutions for us and not other states. . . . I just complement the bill sponsors and members of that working group for the good work."

Abortion did hit the Senate floor late in the day, as Sen. David Yates, D-Louisville, tried to bring up his SB 99, which would have added rape and incest exceptions to state abortion laws. Senate leaders ruled his action out of order, and when he appealed the ruling, senators upheld it largely along party lines.

Legislature rejects pleas, cuts tobacco-prevention spending; passes vape bill that some say could spur youth smoking

Letter requesting much more state funding of tobacco prevention

UPDATE, April 16: Senate President Robert Stivers and Majority Floor Leader Damon Thayer told Kentucky Health News that no one spoke to them about more money for tobacco prevention, and they had no duscussions with the tobacco industry during the session.

By Sarah Ladd

Kentucky Lantern

In a year when the American Cancer Society asked the Kentucky legislature to greatly increase spending on tobacco prevention, lawmakers cut it and passed an anti-vaping bill that some say could increase cigarette use in the state.

The allocation for tobacco prevention in the next two-year state budget — about $8 million shy of advocates’ ask — “certainly is not” enough to combat use in the state, said Doug Hogan, the government relations director in Kentucky for the cancer society and its Cancer Action Network.

The cancer society and others — including the Kentucky Hospital Association, Foundation for a Healthy Kentucky and the Kentucky Chamber of Commerce — signed onto a letter in January asking for a $10 million investment in the state’s Tobacco Prevention and Cessation Program.

Also writing in support of the $10 million for prevention and cessation were Dr. B. Mark Evers, director of the Markey Caner Center at the University of Kentucky, and Jason Chesney, director of the Brown Cancer Center at the University of Louisville.

“A well-funded fact-based tobacco control program is needed to counteract the $251 million per year that tobacco companies are spending to market their deadly and addictive products in Kentucky,” that letter stated. “As Big Tobacco has been working hard to addict future generations with e-cigarettes and other tobacco products, the need for more funding for tobacco prevention programs has never been greater.”

According to that letter, Kentucky sees $55 savings for every $1 it spends on tobacco control programs.

This session, lawmakers passed a bill touted as a way to curb underage vaping. The bill limits vaping products that can be sold in Kentucky to those that have approval from the U.S. Food and Drug Administration, have applied for FDA approval or are challenging denial of FDA approval.

Advocates said that by limiting available vaping products, the bill could result in more Kentuckians turning to cigarettes. Tobacco cigarettes are worse for bodily health.

Vaping has eclipsed traditional smoking among Kentucky youth, advocates say, though Kentucky’s rates for both are higher than the national average.

“The only effective strategy is to adequately fund evidence-based programs,” the Cancer Society’s Hogan said, “that have a meaningful, measurable track record of success.”

Alicia Whatley, policy and advocacy director for Kentucky Youth Advocates, said the state needs a “comprehensive” battle against nicotine use in general. The roughly $2 million going toward cessation is “not nearly enough” to accomplish that goal.

“​​We don’t just want a database of who’s selling vape products,” she said. “We want something comprehensive that tells us who’s selling any of those products” — traditional cigarettes, chew tobacco, nicotine patches, vapes, she said.

Under a new law, the Kentucky secretary of state is required to keep a list of retailers that sell vaping products. That law, HB 11, is meant to curb underage vaping by limiting sales to “authorized products” or those that have “a safe harbor certification” based on their FDA status.

In the final days of the session, this bill absorbed Senate Bill 344, which created an e-cigarette registry. The combined bill was signed into law by Gov. Andy Beshear on April 5. It goes into effect Jan. 1.

“It really should be more comprehensive, but I did not see that that was the case this year,” Whatley said. “I saw a lot of people just talking about vaping.”

Another new law, HB 142, directs boards of education to distribute tobacco prevention and cessation materials to students every year. It also requires schools to confiscate tobacco and vaping products and allows them to suspend students for subsequent violations of the ban on smoking and vaping on school property. It was delivered to Beshear in late March and he signed it on April 9. 

What’s in the state budget for tobacco prevention?

The legislature’s two-year budget slightly cut funding for tobacco control in 2025, according to Cara Stewart, the director of policy advocacy at Kentucky Voices for Health. The funding then flattens out in 2026.

Right now, there’s about $2 million per year set for tobacco prevention efforts, said Hogan. That number drops by about $130,000 for the first year of the new budget. Then, for 2025-2026, it is restored to $2 million.

“Quite frankly, it’s outrageous that lawmakers ignored the urgent need for a significant investment in tobacco prevention and cessation,” Hogan told the Lantern in early April. “Lives are at stake. The health of our next generation is at stake with e-cigarettes and other products.”

Citing Centers for Disease Control and Prevention data, Stewart said Kentucky should be putting closer to $56.4 million every year into tobacco control, considering the state’s population and smoking rate.

Two bills that did not advance this session — HB 813 and SB 335 — would have assisted that goal by moving Juul settlement dollars from the General Fund to the Department for Public Health to support the Smoking and Vaping Cessation Program. Both were dead on arrival.

Public health advocates think that money should indeed be spent on tobacco prevention.

“Tobacco use is our number one preventable cause of disability, disease and death,” said Stewart. “Every single county in the state has a smoking rate above the national average.” 

‘All smokers want to quit’

The CDC reports that “most” vaping products have nicotine in them, an “addictive” chemical that is “toxic to developing fetuses.”

Vaping products can also harm lungs and brain development in youth, the CDC says. E-cigarettes are not safe, the CDC says, though they’re safer than smoking traditional cigarettes, which the CDC reports is a leading cause of preventable death in the country.

Some research suggests vaping can help people quit traditional smoking. That hope helped push Louisville businessman Troy LeBlanc into the vape business.

About 11 years ago, it worked in getting — and keeping — him off cigarettes.

“All smokers want to quit,” LeBlanc said. “I went through Chantix. I did the gum. I did the patches. I did cold turkey. I did all these different things that never worked. Well, you know what did work? Vaping.”

“The whole point of electronic cigarettes” is to get people weaned off, he said, by tapering down their intake over time, eventually stopping.

“I cannot say that every person that walks into my store is doing it with this specific plan to quit vaping,” he said. But he has seen “multiple people quit vaping completely.”

LeBlanc told a legislative committee that the new law’s limits on vaping products “is essentially creating a monopoly for Juul,” an e-cigarette company. 

Will anti-vape bills help public health?

It remains to be seen what effect anti-vaping legislation like HB 11, which takes effect Jan. 1, will have on public health.

Some in the vaping industry say it will drive consumers back to traditional tobacco products — an assertion buttressed by reports from Altria, the parent company of tobacco giant Phillip Morris USA, the leading manufacturer of cigarettes in the United States.

Altria is lobbying legislatures around the country to enact laws like the one Kentucky just passed. Altria also has moved aggressively into marketing its FDA-approved e-cigarette products.

In a February earnings call. Altria CEO Billy Gifford said that “illicit e-vapor” sales last year reduced Phillip Morris cigarette sales by 1.5% to 2%.

The February earnings report said a successful clampdown on disposable e-cig growth could increase Altria’s earnings per share between 5 cents and 15 cents, according to an analyst for Barclays, “if cigarette volumes improve and e-cigs decline or remain steady.”

Since January 2022, Altria has spent more than $500,000 lobbying the Kentucky legislature, according to reports filed with the Legislative Ethics Commission.

“To the extent that this drives people back to smoking, how does this help public health?” said Greg Troutman, a lawyer for the Kentucky Smoke Free Association, which represents vape retailers.

Troutman said the new law will “blackmarket” vape products that have unknown ingredients.

People who smoke increase their risks of heart disease and strokes, according to the CDC. But it doesn’t hurt just them. Nonsmokers who breathe secondhand smoke are much more likely — 20% to 30% — to end up with heart disease or stroke, the CDC says. Kentucky already has dismal rates of heart disease mortality and stroke.

In 2021, a California-based study found that when flavored e-cigarettes were banned, minors turned to traditional cigarettes. At that time, researchers foundthat “reducing access to flavored electronic nicotine delivery systems may motivate youths who would otherwise vape to substitute smoking.”

At the time of publication, study author and assistant professor of health policy at Yale School of Public Health Abigail Friedman, urged caution when passing legislation attacking vapes only.

“While neither smoking cigarettes or vaping nicotine are safe per se, the bulk of current evidence indicates substantially greater harms from smoking, which is responsible for nearly one in five adult deaths annually,” said Friedman. “Even if it is well-intentioned, a law that increases youth smoking could pose a threat to public health.”

Bills to become law on vaping, pharmacy reform, vaccinations, drugs, at-home blood testing, coverage of cancer screening, more

Kentucky State Capitol (Photo via Wikipedia)

By Melissa Patrick
Kentucky Health News

In its 2024 session the Kentucky General Assembly has passed dozens of health-related bills that address a range of topics. With one day left in the session, here are some of them: 

Vaping: House Bill 11 limits legal sale of vaping products to those approved by the U.S. Food and Drug Administration. It also creates a database of retailers that sell the products and sets fines for retailers, manufacturers and wholesalers who violate the law.

HB 142 requires school districts to adopt specific policies that penalize students for possession of "alternative nicotine products, tobacco products or vapor products" and report nicotine-related incidents to the state Department of Education. Changes in the Senate, accepted by the House, allow schools and their governing bodies to apply for grants related to nicotine usage and remove the mandate that schools suspend students with a third possession violation. 

Pharmacy reform: Senate Bill 188 changes laws governing commercial pharmacy benefit managers, with requirements aimed at saving the state's independent pharmacies from closing.  It provides for dispensing fees, bans PBMs from forcing patients to get their drugs through mail order, and keeps them from steering patients to pharmacies that they own.

The bill, sponsored by Sen. Max Wise, R-Campbellsville, also prohibits a PBM from reimbursing a pharmacy that it owns at a higher rate than a community pharmacy, or from keeping a community pharmacy from filling a 90-day prescription for a maintenance drug. And a PBM will not be able to penalize a community pharmacy from sharing information with a patient on the cheapest option to pay for their medications.

Reducing barriers to screening

Cancer detection: HB 52 will require health-insurance plans to cover all preventive cancer screenings and tests that are consistent with nationally recognized clinical practice guidelines without requiring patients to pay any cost-sharing requirements, including a deductible charge for the services.

The sponsor, Rep. Deanna Frazier Gordon, a Republican from Richmond, told Kentucky Health News in February that the cost for screenings is often a barrier for people who often don't get screened because they don't have symptoms.

HB 115 will eliminate co-payments and cost-sharing requirements for high-risk individuals who need follow-up diagnostic imaging to rule out breast cancer. Currently, screening mammograms are covered by insurance, but follow-up exams are often not. 

“Thousands of Kentuckians require diagnostic and supplemental breast imaging every year, yet many forgo them due to out-of-pocket costs. Not any more,"  Molly Guthrie, vice president of policy and advocacy at the breast-cancer foundation Susan G. Komen, said in a news release. "This life-saving legislation means they will now receive the breast imaging they require, leading to an earlier breast cancer diagnosis and often better health outcomes."

Vaccines and drugs  

Vaccinations: HB 274 will allow Kentucky pharmacists to order and administer vaccinations to children as young as 5. The state's routine vaccination rates for kindergarteners remain below pre-pandemic levels.

Pseudoephedrine: HB 386 will raise the annual purchase limits on pseudoephedrine to help people with chronic allergies legally obtain enough of the medication to meet their needs. The bill changes the current 24-gram annual limit to an 86.4 grams, and remove the limit on the number of packages per transaction, said sponsor Robert Duvall, R-Bowling Green.

Kratom: HB 293 will regulate kratom, a natural herbal supplement that is not currently regulated. It is often used for anxiety, pain, PTSD and opioid withdrawal. The bill defines kratom, prohibits sales to people under 21, puts it behind the counter and provides guidelines for manufacturing and labeling. It also says federal law supersedes state law on the matter. 

Blood thinners: HB 31 allows Medicaid patients in Kentucky who are on blood thinners to use at-home machines to test their blood. Patients on some blood thinners, like warfarin, now require a weekly trip to the doctor's office for blood work that looks at how fast their blood clots.

Amanda Crabtree, a registered nurse at University of Kentucky Chandler Hospital, told WKYT-TV that she hopes that other states will follow Kentucky's example in this legislation. Crabtree said she expects that Medicaid patients could receive their at-home machines as soon as this summer.

Health-care business issues

Provider liability: HB 159 will protect health-care providers from criminal liability when a medical error harms a patient unless the harm results from gross negligence or wanton, willful, malicious or intentional misconduct. 

This effort was led by the Kentucky Nurses Association, which said the bill "will prevent health-care professionals from being charged criminally for making a medical error; that makes it good for nurses and nursing, and puts Kentucky at the forefront of developing laws to protect health-care workers." 

Workplace violence: HB 194 extends to contract workers, such as travel nurses, the law that makes violence against health-care workers a third-degree assault. It also extends this protection, now limited to hospitals, to contract employees at health clinics, doctor offices, dental offices and long-term care facilities. 

Sepsis: HB 477 establishes diagnostic criteria for sepsis allow hospitals to preserve current rules used for reimbursement of sepsis care, which allow payment when it is detected early, instead of only allowing reimbursement after organ failure occurs. 

"We know that if sepsis is caught early, the likelihood of survival is great," Jim Musser, vice president for policy with the Kentucky Hospital Association, told Kentucky Health News in March. "But for every hour that we wait, the chance of mortality increases by 7 percent." In sepsis, "The body responds improperly to an infection," says the Mayo Clinic. "Sepsis may progress to septic shock . . . When the damage is severe, it can lead to death."

Other health bills that passed

Youth medical records: HB 174 allows parents have access to their child’s medical records until they turn 18. Right now, children 13 and older must sign a waiver for parents to have access to them. HB 174 also updates the state's Medical Orders for Scope of Treatment form, which defines a person's end-of-life wishes.

Veteran suicide prevention: HB 30 calls on the state Department of Veterans Affairs to create a suicide prevention program for service members, veterans and their families.

Stuttering: SB 111 eliminates some insurance coverage limits on speech therapy for stuttering. It was promoted by former UK basketball star Michael Kidd-Gilchrist, who has overcome stuttering.

Medicaid: SB 71 is designed to keep people from coming to Kentucky to establish residence so that they can sign up for drug treatment to be paid for by Medicaid. One challenge resulting from this practice, according to Rep. Shane Baker, R-Somerset, is that when they leave the program, they are often homeless. 

SB 280 will allow Level II trauma centers that partner with a  university to get the university-hospital rate for services delivered as part of that residency program.

The more health-related social needs factors a woman has, the less likely she is to get a mammogram; that matters in Kentucky

Centers for Disease Control and Prevention graphic

By Melissa Patrick
Kentucky Health News

A Centers for Disease Control and Prevention study says the more health-related social needs a woman has, the less likely she is to get a mammogram. 

The study defines health-related social needs, or HRSNs, as social conditions that adversely affect a person's health. Examples include feeling socially isolated, loss of work or reduced hours, dissatisfaction with life, the cost to access health care, a lack of transportation, and receiving food stamps. HRSNs are some of the social determinants of health. 

Using data from the CDC's 2022 Behavioral Risk Factor Surveillance System, a continuing national survey, the researchers found that mammogram use was almost 20% lower among women between the ages of 50 and 74 who had three or more HRSNs, compared to women who had no such needs.

The report did not provide state-level data, but health-related social needs are more prevalent in Kentucky than in most states.

In Kentucky, 59% of women aged 40-49 and and 72% of women aged 50-74 reported having had a mammogram within the previous two years, according to the 2022 BRFSS data. The rate for younger women 40-49 was the same as the national average, but the rate for those 50-74 was 4.6 percentage points less.

Among U.S. women aged 50 to 74 with no adverse HRSNs, 83 percent had a mammogram in the last two years, while that was true for only 66 percent of those with three or more adverse HRSNs.

“We have to address these health-related social needs to help women get the mammograms they need,” Dr. Debra Houry, chief medical officer at the CDC, said in a news release. “Identifying these challenges and coordinating efforts between health care, social services, community organizations, and public health to help address these needs could improve efforts to increase breast cancer screening and ultimately save these tragic losses to families.”

Breast cancer causes more than 40,000 deaths in U.S. women each year, according to the news release. 

Between 2016 and 2020, Kentucky's breast-cancer rate was 126.7 per 100,000 people and its breast cancer death rate was 21.6 per 100,000, according to the National Cancer Institute State Cancer Profiles. The national rate was 19.6.

The report adds that Black women and women of lower socioeconomic status are more likely to die from breast cancer. 

The U.S. Preventive Services Task Force currently recommends that women aged 50 to 74 get a screening mammogram every two years and that women ages 40 to 49 talk to their health-care providers about when to start and how often to get a mammogram.

Most health-insurance plans cover the full cost of screening mammograms, but follow-up diagnostic imaging is not always covered.

To address this, Kentucky lawmakers recently passed House Bill 115, which eliminates co-payments and cost-sharing requirements for high-risk individuals who need follow-up diagnostic imaging to rule out breast cancer. Gov. Andy Beshear signed HB 115 into law on April 5. It takes effect Jan. 1, 2025. 

“Thousands of Kentuckians require diagnostic and supplemental breast imaging every year, yet many forgo them due to out-of-pocket costs. Not anymore," Molly Guthrie, vice president of policy and advocacy at the breast-cancer foundation Susan G. Komen, said in a news release. "This life-saving legislation means they will now receive the breast imaging they require, leading to an earlier breast cancer diagnosis and often better health outcomes."

Kentucky's rate of teenagers having children is fourth in nation

Centers for Disease Control and Prevention chart, adapted by Kentucky Health News

By John McGary, WEKU

Kentucky has the fourth-highest teenage birth rate in the U.S., according to the latest figures from the Centers for Disease Control and Prevention, which show Kentucky’s teen birthrate to be 38 percent higher than the U.S. average.

At the same time, teen-birth rates are declining in Kentucky and the nation. The state's rate was 22.8 per 1,000 females aged 15 to 19 in 2019-21, down from 31.7 in 2014-16. This rate has decreased steadily since 2014-16 when that rate was 31.7 teen births per 1,000 females 15-19.

In 2020, Christian County had Kentucky's highest rate of birth to teens, 55 per 1,000 females aged 15-19. County-by-county teen birth rates since 2003 are available at https://www.cdc.gov/nchs/data-visualization/county-teen-births/.

Tamarra Wieder, state director for Planned Parenthood Alliance Advocates, said what children don’t learn in school is one reason Kentucky ranks high in teen births: “We're not having conversations around comprehensive sex education, and empowering our youth to know that they can say no to sex, that they can empower them to talk to their providers around birth control.”

Wieder said another reason for the high teen birthrate is a lack of proper medical care in many areas. She said 73 of the state's 120 counties have no practicing obstetrician-gynecologists, and "When you're already not having the these conversations in the classroom, and then you don't have access to providers, this is a huge problem for the commonwealth.”

Wieder said surveys show 83 percent of Kentuckians support comprehensive sex education supported by science and legitimate groups like the American College of Obstetricians and Gynecologists.

Jefferson County Public Schools program will allow students to graduate high school with a licensed practical nurse degree

A program to bring more nurses into the workforce will be offered in the Jefferson County Public Schools. The program will allow high-school seniors to graduate with a licensed practical nurse degree, while they finish their remaining high school credit. 

“We are offering students the ability to graduate from high school ready for a practical nursing career — all while learning within an organization devoted to safe, quality nursing care," Brittany Burke, system director of the Norton Healthcare Institute for Education & Development, said in a news release. 

The LPN program is possible through a partnership with JCPS, Norton Healthcare and the Galen College of Nursing. Norton will provide tuition assistance to the students enrolled in the program, the release said.

LPNs, like registered nurses, are in short supply in Kentucky and across the nation. The Kentucky Hospital Association's 2023 Workforce Survey Report shows an estimated 300 LPN openings statewide, resulting in a nearly 21% vacancy rate. 

"The LPN workforce is also among the professions with the highest rates of employees age 55 or older (21.8 %), behind psychiatric nurses (28.3 %) and ahead of OR/PACU (20.9 %)," says the report. "In other words, nurses that are likely to retire in the next ten years, and discounting new and younger entrants, professions that will experience significant shortages." 

Interested high-school students who will be seniors during the 2024-2025 school year can fill out a form online to learn more about the program. 

Several Ky. water systems exceed new federal limits for 'forever chemicals'; all systems must test for 3 years, correct if needed

WKYT map, adapted by Kentucky Health News

By Al Cross
Kentucky Health News

Several Kentucky water systems, mostly on and near the Ohio River, will have to fund ways to reduce certain cancer-causing substaces for which the first federal limits were issued Wednesday, April 10.

The substances are PFAS, a joint acronym for per-fluoroalkyl and poly-fluoroalkyl substances, which are widespread and last a long time in the environment without breaking down, so they accumulate in the human body. They have been linked to low birth weights, liver disease and kidney cancer.

The substances have been used in waterproof clothing, nonstick frying pans and firefighting foam. For example, PFOS was the key ingredient in the fabric protector Scotchgard and related stain repellents, and PFOA was used in carpeting, cloth and sealants.

Public water systems will test for the chemicals for three years. If the limits are exceeded, the new Environmental Protection Agency rules will give them two more years to install treatment systems.

The state Department for Environmental Protection listed these water systems as exceeding the new limits of 4 parts per trillion: Ashland (4.74 PFOA), Augusta (4.43 PFOA), Cynthiana (8.35 PFOS), Georgetown (5.46 PFOS), Lewisport (Hancock County, 12.7 PFOS), Maysville (5.09 PFOA), North Marshall County Water District (11.8 PFOA), Paducah (4.54 PFOS, 4.07 PFOA), Russell (5.62 PFOA), South Shore (23.2 PFOA, 18.9 PFOS). The last two towns are in Greenup County.

The Louisville Water Co.'s Payne Plant at Prospect had a PFOS level of 4.31, but the level at its Crescent Hill plant was only 2.75.

Some water systems exceeded the EPA requirements in at least one test in 2019 and 2023 but were not listed as exceeding the new limits during the period. Those were Brandenburg, the Graves County Water District, Hardin County Water District No. 2, Henderson (north), Kuttawa, Morganfield, Northern Kentucky Water District (Fort Thomas), Owensboro, Providence, Sturgis and Worthington (Greenup County).

Erin Haynes, chair of epidemiology and environmental health at the University of Kentucky, has studied the chemicals for many years. “It’s all around us,” she told WKYT. “So we need to just be conscientious of different sources and how we can do our best to reduce our exposure. But analyzing it and reducing the levels in our drinking water is a wonderful step in the right direction.”

"Some funds are available to help utilities," The Associated Press reports. "Manufacturer 3M recently agreed to pay more than $10 billion to drinking water providers to settle PFAS litigation. And the bipartisan infrastructure law includes billions to combat the substance. But utilities say more will be needed."

Whether or not you smoke can be influenced by heredity; new research may help identify specific risks, and ways to quit

Photo illustration by Gerd Altmann, Pixabay, via Newswise

Kentucky Health News

If your parents or grandparents smoke, you are more likely to smoke. Perhaps that's one reason smoking persists in Kentucky, which has had a higher rate of adult smoking than any state but West Virginia. 

“Smoking is highly heritable, with genetic differences accounting for 40% to 75% of the differences in people’s smoking behaviors,” says Pamela Romero Villela, a doctoral student at the University of Colorado and main author of a new study of the phenomenon.

The university's Lisa Marshall writes, "Scientists have identified thousands of genetic variants believed to influence everything from when people first try smoking to how good that first cigarette feels to how often they light up and how hard it is to quit. Some variants influence how quickly we metabolize nicotine, while others underlie how sensitive we are to it. But little is known about how they interact with each other and with other genetic differences."

The new study "sheds unprecedented light on these interactions and provides new insight on the most well-known smoking-related variant to date," Marshall reports.

Romero Villela told Marshall, “The more we can understand what those genes do and how they interact, the better equipped we will be to develop personalized approaches to helping people quit.”

She and physiology Professor Marissa Ehringer, a longtime substance-use researcher, focused on the most widely replicated genetic variant associated with smoking behaviors, so important that researchers call it "Mr. Big."

"Mr. Big . . . influences how well nicotine binds to receptors in the brain," Marshall explains. "People with a certain version of Mr. Big, known as the AA version, are less sensitive to nicotine and have been shown to smoke more."

Romero Villela rold her, “It kind of numbs your response so in order for you to feel the same effect as someone who smoked one cigarette you might have to smoke almost one and a half cigarettes.”

The researchers found something new "when analyzing genetic information from about 165,000 current or former smokers of European, South Asian and Finnish descent," Marshall reports. "They discovered genes and variants in a completely different region of the genome that appear to interact with Mr. Big in a way that influences smoking habits. Notably, when people had the risk-boosting version of Mr. Big but also had a genetic variant called rs73586411, they smoked significantly less than expected."

Marshall writes, "More research is needed to understand just what the genes highlighted in the study do. Interestingly, one . . . has previously been associated with Parkinson’s disease. Nicotine is known to blunt some symptoms of the disease.

"The study authors imagine a day when people could be given a 'polygenic risk score' that would consider their gene variants and interactions to provide personalized recommendations for quitting. . . . Eventually, if researchers could determine what a variant does to dull the craving to smoke, they might be able to develop medications that mimic that action."

Comer and committee grill FDA chief about handling of vapes

U.S. Rep. James Comer, R-Ky.
(AP photo by Alex Brandon)

Kentucky Health News

Rep. James Comer of Kentucky and other House members "grilled FDA Commissioner Robert Califf about why the agency has failed to swiftly assess product applications for e-cigarettes while illicit products from China flood store shelves," Luke Zarzecki reports for Inside Health Policy. "Califf defended FDA's approach by saying the agency is not resourced to deal with the flood of millions of applications for vaping products."

Califf appeared Thursday at a hearing of the Comer-chaired House Committee on Oversight & Accountability that last almost five hours. "We covered topics from seafood inspection, all the way to every other topic that I think could be imaginable," Comer told Zoey Becker of FiercePharma.

"Multiple lawmakers blamed FDA’s failure to quickly approve e-cigarette and vaping products from the United States for the proliferation of illegal imports, Zarzecki reports, quoting Comer: “FDA’s failure to regulate has allowed unsafe and illicit products to proliferate.”

"Califf said FDA would be more equipped to deal with illicit products if Congress approved the agency’s request to require e-cigarette manufacturers to pay user fees," Zarzecki reports. "He said FDA will not approve applications for vaping products unless they demonstrate the product will not contribute to nicotine addiction among children and youth." He said no one expected 26 million applications, and FDA has requested more staff to address the backlog.

The agency has asked the Supreme Court to review an appeals court’s ruling that it consider every marketing application for flavored e-cigarette products individually, "rather than rejecting them en masse because of their impact on youth smoking," Zarzecki notes.

"Public health groups have also sued the FDA and HHS over delaying a ban on menthol cigarettes and flavored cigars, and a spokesperson for FDA noted the rule is pending at the White House Office of Management and Budget."

FDA Commissioner Robert Califf (AP photo)

Califf said that in 2023, FDA “issued warning letters to more than 120 manufacturers and distributors and more than 400 retailers; filed over 40 civil money penalty complaints against manufacturers and over 65 against retailers; and collaborated with our federal partners at the U.S. Customs and Border Protection to seize approximately 1.4 million units of unauthorized e-cigarette products with an estimated retail value of more than $18 million; among other actions.”

"Comer criticized FDA for not seizing more illegal products from retailers," Zarzecki reports, and said the agency's approach to e-cigarettes is not what Congress had in mind. Comer said, “Those seeking to play by the rules don’t even know what the rules are because FDA won’t tell them, or FDA won’t put information out, or they will put information out, but they change it.”

Califf said vaping and electronic cigarettes came along after Congress passed the Tiobacco Control Act, under which the FDA operates.

Comer, who represents the state's First Congressional Distict, also criticized FDA for “failing to do the bare minimum to carry out its core mission” under the Biden administration. He said “a pattern of issues” show the agency “appears consistently unprepared for crises.”

He noted that FDA inspections of foreign manufacturing plants, where many drugs sold in the U.S. are made, haven't returned to pre-pandemic levels. He said the agency inspected 79 percent fewer foreign plants in 2022 than it did in 2019.

Califf conceded, “We need to pick up the pace.” He said the FDA recently “completely" reworked its inspection system in India to address problems there. The agency is converting its Office of Regulatory Affairs into an Office of Inspections and Investigations, "reassigning some 1,500 staffers to related roles."

Guthrie warns making telehealth expansion permanent must be paid for; costs uncertain, but projected to be several billion dollars

Kentucky Health News

If telehealth services are to remain expanded as they were in the pandemic, Congress must offset the cost, U.S. Rep. Brett Guthrie of Bowling Green said in opening a House subcommittee hearing Wednesday.

“Virtually overnight, our health-care system underwent a significant transition,” said Guthrie, a Republican who represents the 2nd Congressional District and chairs the health subcommittee of the House Energy and Commerce Committee, according to a press release from the committee.

“Seniors were allowed to use telehealth across the country and could now access their health-care providers from the comfort of their home. Additionally, the number of health care services Medicare would cover if performed through telehealth increased from 118 to over 260.

“Restrictions such as requiring seniors to have an established pre-existing relationship with a health-care provider to receive mental health services through telehealth were waived. Allowing patients to consult with a provider through a simple audio-only phone call if an audio-visual connection wasn’t available.”

All those things were a big help to rural communities, Guthrie said, so Congress has extended them through Dec, 31. But he added that before they can be extended again or made permanent, some problems need to be addressed.

“I want to remind my colleagues that the previous extension was estimated by the Congressional Budget Office to increase costs to the Medicare program by over $2 billion,” Guthrie said. “Making these authorities permanent is likely to cost much more than a short-term extension, and we want to make sure that whatever we move out of committee is paid for and is delivering the best value for seniors. I think that this committee can work together, to move legislation making sure seniors have access to telehealth when they want it while also including appropriate program integrity measures, addressing the costs of such access to the program.”

Politico Pulse reports, “Generally, lawmakers seemed willing to accept higher costs to expand access to virtual care.” Rep. Cathy McMorris Rodgers (R-Wash.), chair of the full committee, said extending telehealth rules would be a “significant investment” but “We can’t afford to go backwards.” Pulse notes, "Harvard researcher Ateev Mehrotra told lawmakers that expanded telehealth is associated with a 'modest' increase in spending but also improved outcomes, particularly in mental health."

Guthrie largely dismissed concerns about increases in waste, fraud, and abuse from telehealth. “It appears that telehealth can be used to deliver care without actually raising those serious concerns. According to the Office of Inspector General, of the over 700,000 providers they studied who provided telehealth care during the pandemic, less than 2,000 warranted further scrutiny resulting from their telehealth billing practices, and mostly because they charged facility fees and for the actual telehealth visit.”

The full committee's ranking Democrat, Rep. Frank Pallone of New Jersey, acknowledged the budget implications of extending telehealth, but noted that the CBO has not estimated the cost yet. "I would like to better understand the offsets for these proposals," he said, "and want to ensure that it would not result in significant funding cuts to the Medicare program or raise health care costs for seniors."

Pallone also said, "I believe that any further expansions of telehealth flexibilities in Medicare must meaningfully increase patient access to care and ensure high quality care for seniors.  . . . Congress must ensure that additional expansions of telehealth policies do not limit access to in-person care. It is important that we preserve patient choice and that Medicare beneficiaries continue to have access to high quality in-person care and robust consumer protections, including network adequacy standards."

The top-ranking Democrat on the subcommittee, Rep. Anna Eshoo of California, voiced concern about the health-care industry “gaming” telehealth to make it into a “cash cow.”