2023 Healthy Kentucky Champion nominations are due May 1

The deadline to nominate someone for a 2023 Healthy Kentucky Champion award is Monday, May 1. 

The award, sponsored by the Foundation for a Health Kentucky, is meant to recognize people leading the change to improve the health of Kentuckians.

The foundation offers some guidelines for whom to consider: 

• A Kentuckian who has invested time, energy and dedication to improving the health of their community and/or the Commonwealth.
• A leader who has demonstrated their commitment by advancing programs, research, policy advocacy, and/or initiatives to address unmet health needs of Kentuckians.
• An exceptional person who has participated, led and/or mentored others in efforts to address and reduce health risks and disparities and promote health equity in Kentucky.

Click here for the nomination form and to view a 20-minute webinar that answers questions about the program.

59% of residents, just 16% of staff in Ky. nursing homes have had Covid-19 booster shots; both rates slightly above national rates

Centers for Disease Control and Prevention photo

By Melissa Patrick
Kentucky Health News

While Kentucky nursing homes' Covid-19 booster rates are higher than the national rates, many staff and residents remain vulnerable to the disease because over 80% of staff and nearly 40% of residents have not received booster shots.

In the week ending April 9, there were 116 new confirmed cases of Covid-19 among Kentucky nursing-home residents, or 5.9 cases per 1,000 resident-weeks; there were 54 cases among staff, or 2.8 cases per 1,000, according to the Nursing Home Vacciation Data Dashboard of the Centers for Disease Control and Prevention.

Through the week ending April 2, reports from about half of Kentucky's nursing homes showed that 59% of their residents were up to date with their Covid-19 vaccines, which means they had received the latest bivalent booster dose or have completed the primary series of vaccines in the last two months.  This was higher than the nationwide rate of 54%. 

Staff rates were much lower. In the week ending April 2, 16% of Kentucky's nursing-home staff were up to date with their Covid-19 boosters, which was still higher than the national rate of 12%. 

That said, 89% of Kentucky nursing-home residents and 42.5% of staff have completed their primary Covid-19 series and received an additional primary or booster shot – just not the recommended bivalent one.

The CDC recommends that people stay up to date with Covid-19 vaccines by completing a primary series and receiving the most recent booster dose for their age group.

At this point in the pandemic, much of the effort to get nursing home residents and staff boosted falls to the facilities.

Susan Dunlap, spokesperson for the Kentucky Department for Public Health, told Kentucky Health News that the department still offers several services to help nursing homes and other long-term care facilities promote Covid-19 vaccinations among residents and staff. 

"KDPH staff are available to provide in-service education and training to residents and staff regarding the safety and benefits of being vaccinated," Dunlap said in an email. "Regional infection preventionists can assist facilities with obtaining vaccines and conducting vaccine clinics by connecting facilities with community provider partners such as pharmacies and other healthcare facilities. Staffing support for vaccine clinics is also available to long-term care facilities by request through a KDPH Nurse STRIKE Team comprised of five nurses who can assist with clinic logistics and vaccine administration." 

While residents and staff in Kentucky's nursing homes are still getting Covid-19, there are fewer deaths from it. 

In the week ending April 9, the Covid-19 death rate among residents in Kentucky nursing homes was 0.1 per 1,000 residents.  But even though this rate is low, it's important to remember that seniors in nursing homes are among the most vulnerable to the disease. 

Virus found by swabbing floors: A recent study found that one way to detect the coronavirus in congregate settings is to do regular floor swabs.  

The study, published in The New England Journal of Medicine in February, found that regularly sampling floor surfaces for the virus in long-term care homes could improve detection of it. 

The researchers sampled floor surfaces in multiple locations weekly in 10 long-term-care homes between September 2021 and November 2022 and analyzed the samples for the presence of the virus. 

They found that "the percentage of positive swabs increased in the days and weeks before an outbreak was declared [and] the percentage of positive swabs also decreased in the days and weeks after an outbreak was declared."

The authors conclude that the detection of virus from these floor swabs "was strongly associated with Covid-19 outbreaks" and that the prevalence of positive floor swabs declined after the cessation of the outbreak. 

"Swabbing the built environment, similar to wastewater surveillance, may provide another tool for infection prevention and control for combating Covid-19 in congregate settings," they write. "Future studies evaluating the implementation and generalizability of this approach are needed."

New cases of the coronavirus continue to decline in Kentucky, but people continue to die from Covid-19; U.S. deaths hit 1.1 million

Centers for Disease Control and Prevention map

By Melissa Patrick

Kentucky Health News

Overall, the Covid-19 metrics in Kentucky are good, but the bad news is that people are still dying from it. 

The latest report from the state Department for Public Health showed there were 2,848 new confirmed cases of the coronavirus in Kentucky last week, or 406 cases per day. That's 12 percent less than the previous week's 3,245 cases. 

The state's new case-rate dropped to 4.28 cases per 100,000 residents, from 5.5 the week before. The top 10 counties were Clinton, 15.38 cases per 100,000; Lewis, 11.84; Wayne, 11.24; Webster, 9.93; Spencer, 8.86; Letcher, 8.62; Bath, 8; Henry, 7.97; Fleming, 7.84; and Hardin, 7.72. 

The weekly Centers for Disease Control and Prevention risk map, based on new cases and hospital numbers, shows all but one of Kentucky's 120 counties have a low risk of Covid-19. That county is Letcher, shown in orange to indicate a high risk of Covid-19 transmission. Low-risk counties are shown in green. 

In high-risk counties, the CDC continues to recommend that you wear a well-fitting, high-quality mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

CDC map; for a larger version, click on it; to download, right-click.

The CDC also provides a community-level transmission map, largely used by health-care facilities and researchers, that shows the level of virus in each county, at one of four levels. The latest map shows 11 counties with a low level of transmission and 67 with a medium level; the rest are either substantial or high. The state says residents should take their guidance from the other map.

 Last week in Kentucky, the state attributed 55 more deaths to Covid-19, down from 57 the week before. The state's death toll from Covid-19 is now 18,404. 

Nationwide, the CDC reports that 1,327 people died from Covid-19 last week, bringing the total number of Covid-related deaths nationwide to 1.1 million. 

Doctor shortages persist in rural America, including Kentucky, and medical residency programs are scarce in rural areas

Centre for Economic Policy Research image

One of the best ways to increase the number of doctors in rural areas is to provide medical residency training there. Kentucky has seen a concerted effort to expand rural residency programs, but their number remains relatively small in the state and nation.

"Experts say expanding the number of medical residency training programs in rural areas is key to filling gaps in care because many doctors — including more than half of family medicine physicians — settle within 100 miles of where they train," Jazmin Orozco Rodriguez reports for KFF Health News. "And while the number of training programs has increased in rural areas during the past few years, research shows 98% of residencies nationwide are in urban areas."

In Kentucky, fewer than 20 of the state's 154 accredited residency programs, listed by specialty, are outside Lexington and Louisville. Seven of them are for family medicine and can be found in Somerset, Owensboro, Edgewood, Hazard, Glasgow, Madisonville and Morehead.  

Rodriguez tells the story of a residency training program in rural northeastern Nevada that is preparing to close, where one resident physician said she must now leave a program that she chose because she knew she would be filling a need and the patients under the care of the residents must now seek care elsewhere, often in emergency departments, 

The program, established in 2017, is shutting for a variety of reasons, including financial struggles, lack of a united support system, and a historical lack of health-care investment in the area, Rodrigue reports. 

The closure of such programs in rural areas only adds to the problem of accessing primary care, which Rodriguez reports impacts more than 100 million people in the U.S., a number that has nearly doubled since 2014.  Further, she writes that provider shortages only got worse during the pandemic, especially in rural areas, which have long struggled to recruit and retain doctors and other health professionals. 

According to the Healthcare Provider Shortage Area tool, every rural county in Kentucky has a shortage of primary health-care providers. 

And, according to a January 2020 report on the primary care workforce shortage compiled by multiple authors by the University of Kentucky, "Kentucky produces and retains only about 55 new PC physicians per year, recruiting 55 to 60 more from out of state. This total of 110 – 115 new physicians falls short of the 124 PC physicians that must be added annually to avoid worsening our shortage, and far below the 246 PC physicians that Kentucky would need to add each year to reach the US median in the coming decade."

Members of Congress have introduced bills to address the health care provider shortage, but to no avail. Meanwhile,  rural medical training programs need more state and federal investment to grow and remain sustainable, Dr. Emily Hawes, associate professor at the University of North Carolina-Chapel Hill School of Medicine, told Rodriguez. 

A federal law fully implemented in 2019 creates more flexibility in funding and accreditation for rural hospitals wanting to establish residency programs. It has sent more than $43 million to 58 organizations in 32 states to state rural residency programs. "As of last fall, the recipients had created 32 accredited training programs in family medicine, internal medicine, psychiatry, and general surgery, and received approval for more than 400 new residency positions in rural areas," reports Rodriguez. 

But it’s not enough, Hawes said. She said a big challenge is that Medicare and Medicaid don't reimburse rural hospitals for residency programs at the same rate they do urban hospitals, despite similar or higher costs. 

Kentucky has passed legislation toward improving the health care workforce in the state. In the most recent legislative session, a bill passed to create the Health Care Workforce Investment Fund, which would use private and public money to increase scholarship opportunities.  Also, a bill to let advanced practice registered nurses prescribe controlled substances on their own after four years passed, which is expected to increase health care access in rural parts of the state.

Catholic Health Initiatives hospitals in Kentucky suffer data breach, say 'no evidence that this information has been misused'

By Melissa Patrick

Kentucky Health News

Kentucky is one of 13 states with hospitals that have been affected by a ransomware attack on the CommonSpirit health-care system, which is the parent organization of Catholic Health Initiatives in Kentucky. 

Mary Branham, spokesperson for CHI Saint Joseph Health, said in an email that it started the notification process about this data breach in December, even as the review of the files was ongoing. 

"We have completed the review and identified additional current and past CommonSpirit locations associated with the data," Branham wrote. "Beginning in April 2023, we issued our last anticipated notification to potentially impacted individuals." 

According to an April 6 CommonSpirit update, these Kentucky facilities were included in the ransomware event:  Flaget Memorial Hospital, Bardstown; Saint Joseph Hospital, Lexington, Nicholasville; Saint Joseph Health Community Pharmacy, Lexington; Saint Joseph Berea; Saint Joseph East, Lexington; Saint Joseph London; Saint Joseph Mount Sterling; Saint Joseph Mount Sterling Outpatient Rehab; Saint Joseph Mount Sterling Outpatient Rehab, Flemingsburg; Continuing Care Hospital, Lexington; and CHI Saint Joseph Medical Groups in Central and Eastern Kentucky, as well as Jewish Hospital in Louisville and Saint Joseph Martin in Floyd County, which were formerly part of CHI. 

CommonSpirit, which has more than 1,000 care sites and 140 hospitals in 21 states, said the ransomware attack was detected Oct. 2 and an investigation determined an unauthorized third party gained access to the network between Sept. 16 and Oct. 3. The party obtained copies of some data, including two file-share servers containing information on individuals going back several years. 

Information in those files included "demographics such as name, address, date of birth, phone number(s), email address, as well as medical information such as dates of service, medical record number, health-care provider’s name, diagnosis/treatment information, medical billing/claims information, patient’s facility associated account/encounter number, and health insurance information," the update said. "For a small number of individuals, Social Security number was also involved."

Branham said, "We immediately took steps to secure the network, which included proactively taking certain systems offline, and began an extensive investigation with the assistance of leading external cybersecurity specialists and law enforcement. . . . We have no evidence that this information has been misused."

That said, the CommonSpirit update advises ongoing caution: “Though CommonSpirit has no evidence that the information has been misused as a result of this event, it is always prudent to review health care statements for accuracy and report any services or charges that were not incurred to the provider or insurance carrier.”

According to CommonSpirit’s most recent quarterly financial statement, the data breach cost the organization about $150 million, which includes lost revenues from the interruption to business and costs to remedy the issue, Modern HealthCare reports. It also reports that the  U.S. Department of Health & Human Services Office for Civil Rights reported that more than 623,700 people were affected.

UK environmental-health scientist Erin Haynes leads study to track health impact of train derailment in East Palestine, Ohio

Erin Haynes (University of Kentucky photo)

A University of Kentucky environmental scientist is taking steps to learn more about the health symptoms and exposures faced by the residents of East Palestine, Ohio, following a train derailment through an online health tracking survey.

On Feb. 3, a train carrying hazardous materials derailed near East Palestine, raising concerns about both short- and long-term impacts on the health of the area’s residents.

Erin Haynes, chair of the Department of Epidemiology and Environmental Health at the College of Public Health, is leading the research for this project. 

“It’s important that we characterize the health symptoms and exposure concerns from residents in East Palestine and in the surrounding area,” Haynes said in a UK news release. “We do not know exactly how far the chemicals have spread, so we want to include all surrounding counties in this survey.”

The survey is open to anyone aged 18 or older who lives in Columbiana, Mahoning, Stark, Carroll and Jefferson Counties in Ohio and residents of Beaver and Lawrence Counties in Pennsylvania and Hancock County, West Virginia. The survey asks questions about their experiences during the evacuation, concerns about exposures and health symptoms, including stress. 

Residents’ responses will give the research team insight on the experiences and health symptoms they have been facing since the incident. 

The release notes that this survey is the first part of a long-term research study to assess the potential lingering health effects from the toxic chemicals released and formed from the derailment and the subsequent controlled burn of chemicals.

“I have worked with Dr. Haynes for over 10 years on several environmental health projects,” Amanda Kiger, resident of East Palestine, said in the release. “We are excited to see this much-needed health survey launch. The community needs this long-term follow up to assess their health over time.”

Haynes is also the Kurt W. Deuschle Professor of Preventive Medicine and Environmental Health, director of the UK Center for the Environment and deputy director of the UK Center for Appalachian Research in Environmental Sciences (UK-CARES). 

New Office of Rural Health is being created at the Centers for Disease Control and Prevention to address rural health disparities

Medical News photo illustration

The newly created Office of Rural Health at the Centers for Disease Control and Prevention will work to combat rural health disparities across the nation by addressing infrastructure needs and  creating a rural health strategic plan that ensures rural health interests are represented in all facets of health care, Maaisha Osman reports for The Nation's Health, a publication of the American Public Health Association.

The need for this office is well-documented, Osman reports, noting that while the 19% of Americans who live in rural areas die from the same causes of death as others in the U.S., they are more likely to die earlier than their urban counterparts. And, she writes, the Covid-19 pandemic added to this challenge with rural residents less likely to get vaccinated and more likely to die from the disease. 

The national government has a Federal Office of Rural Health Policy, but Congress's creation of a rural-health office at the CDC and funding it with $5 million was "a massive victory," said Carrie Cochran-McClain, chief policy officer of the National Rural Health Association.

Cochran-McClain told Osman that the CDC needs a voice inside the agency to speak about the unique challenges of rural areas, and will be responsible for the maintenance and enhancement of the rural public-health infrastructure and for connecting and collaborating with other federal agencies and state offices of rural health. She said the goal is for the office to open this year. 

She said there has long been discussion in the rural-health community about the need for such an office, and disparities between rural and urban populations during the pandemic generated momentum to create it. She said Covid-19 underscored the structural barriers to health care in rural areas and said the office is needed to support rural public-health agencies and workers. 

What can the office accomplish? "Really think about how we can grow the public-health workforce in rural communities, and how we can provide technical support and do research around some of the unique challenges that rural populations face," Cochran-McClain said. She pointed to "worrisome" maternal mortality and illness rates in rural areas, obesity, chronic diseases, the need for more preventive services, and an aging population that would like to age in place. 

And when asked what progress has been made to improve rural health, she ended up listing a whole list of other challenges, including the need for more suicide prevention, health education, more health workers and better health-care infrastructure, and noted closures of rural hospitals and skilled nursing homes. 

Cochran-McClain told Osman that if she could do one thing to improve rural health it would involve making sure rural areas have a robust rural health care workforce and public-health workforce. Further, she said, we need to figure out how to retain and grow a new generation of health-care workers.

Only 1 in 5 Kentuckians at risk for mpox are vaccinated for it

By Sarah Ladd
Kentucky Lantern

About one in five Kentuckians who are at risk for mpox — formerly called monkeypox — are vaccinated for it, according to Gov. Andy Beshear.

The estimated at-risk population in Kentucky is 19,344 people, Beshear said April 7. Of those, 21% got one dose of vaccine and 12% got two doses, compared to 37% and 23% nationally.

Mpox (Getty Images photo via Centers for Disease Control and Prevention)

Mpox is characterized by rashes, swollen lymph nodes, fever, cold-like symptoms and more. The disease comes from a virus in the smallpox family.

Mpox spreads through close contact with an infected person, including sex, kissing, hugging and other intimate contact.

An mpox victim is contagious until their scabs fall off and new skin forms underneath, according to the Centers for Disease Control and Prevention.

Those at higher risk for severe outcomes from mpox, according to the CDC, are those younger than 1 year old, pregnant people, the immunocompromised and people who have had atopic dermatitis or eczema.

The CDC reported that Kentucky had 104 cases as of March 29. The only neighboring state with fewer was West Virginia, with 12 cases.

“We have these (vaccine) doses available for those who are interested,” Beshear said.

For a full list of Kentucky’s health departments offering vaccines, visit: https://www.chfs.ky.gov/agencies/dph/dehp/idb/Documents/MPXVaxLocations.pdf.

The World Health Organization renamed mpox after concerns of “racist and stigmatizing language” associated with the former name.

Carrying naloxone, now available over the counter, saves lives; bystanders are present in more than 1/3 of opioid overdoses

Photo by Pete Comparoni, University of Kentucky

By Trish Freeman

Professor, University of Kentucky College of Pharmacy

Chances are you or someone close to you has been directly impacted by the opioid epidemic, which continues to afflict Kentucky. In 2021, the state's overdose deaths reached an all-time high of 2,250, with 90% involving an opioid.

Because bystanders are present in more than a third of opioid overdoses, hundreds of these deaths could have been prevented with naloxone, a lifesaving medication that is accessible, safe and easy to administer.

What is naloxone? Naloxone is a medication that can save someone’s life if they are overdosing on opioid medications, heroin, or other drugs (such as cocaine or methamphetamine) that are mixed or laced with the opioid fentanyl. Naloxone quickly reverses the effects of opioids and helps restore breathing in someone who is experiencing an overdose.

There are two Food and Drug Administration-approved formulations of naloxone: injectable and prepackaged nasal spray. The nasal spray, which is available as generic naloxone, Narcan or Kloxxado, may be easier for loved ones or bystanders without special training to use.

Who should carry naloxone? People who are at high risk for opioid overdose — including those who take high dose opioid medications and those who use illicit opioids like heroin — should carry naloxone. Families with loved ones who are at risk should also have naloxone nearby. Because opioid overdoses sometimes happen in public places, anyone can carry naloxone and be prepared to respond as a community bystander. If you're at risk for an opioid overdose, let others know you have naloxone and where it is located.

Where can I get naloxone? In Kentucky, naloxone is available without a prescription at many pharmacies and through community-based naloxone programs. Many syringe services programs also offer naloxone, along with clean needles and other harm reduction supplies. Soon, naloxone nasal spray will be available over the counter (OTC) at pharmacies and other retail stores that sell OTC products.

To find a location near you where naloxone is available, visit the Kentucky Office of Drug Control Policy website at https://odcp.ky.gov/Stop-Overdoses/Pages/Locations.aspx.

When to use naloxone: Signs of an opioid overdose may include: unconsciousness, very slow or shallow breathing, a limp body and not responding when called or touched.

If you suspect someone is experiencing an opioid overdose, call 911 immediately and give naloxone as quickly as possible. Naloxone is a temporary treatment that can help restore breathing but it’s not a substitute for emergency medical care.

New coronavirus cases in Ky. rose 46% last week, and CDC says two counties have a medium level of risk: Montgomery and Bath

Centers for Disease Control and Prevention map from data gathered March 29 through April 4

By Melissa Patrick

Kentucky Health News

New coronavirus cases rose 46 percent in Kentucky last week, and deaths attributed to Covod-19 also increased. And after the state had a week in which every county was estimated to have a low risk of infection, two counties, Bath and Montgomery in east-central Kentucky, moved into the medium-risk zone. 

The state Department for Public Health's latest report showed there were 3,245 new confirmed cases of the coronavirus last week, or 463 cases per day. In the prior week, the state reported 2,222 new cases, or 317 per day. 

While the number of new cases went up, the new-case rate fell to 5.5 cases per 100,000 residents from 6.91 the week before. The top 10 counties were Nelson, 12.05 cases per 100,000; Wayne, 11.94; Henry, 11.52; Bath, 11.43; Clinton, 11.18; Hardin, 10.94; Union, 10.93; Adair, 9.67; Taylor, 9.42; and Powell, 9.25. 

The weekly Centers for Disease Control and Prevention risk map shows that all but two of Kentucky's 120 counties have a low risk of Covid-19. The two counties with a medium risk, shown in yellow, are Montgomery and Bath. Low-risk counties are shown in green.

The CDC continues to advise those in medium-risk counties, and those anywhere who are at high risk of getting very sick, to wear a well-fitting mask when indoors and in public; and to consider getting tested before having social contact with someone at high risk for getting very sick, and consider wearing a mask when indoors when you are with them.

The CDC also provides a community level transmission map, largely used by health-care facilities and researchers, that shows the level of virus in each county, at one of four levels. The latest map shows 10 counties with a low level of transmission and 70  with a medium level; the rest are either substantial or high. The state says residents should take their guidance from the other map.

The state attributed 57 more deaths to Covid-19 last week, up from 49 the week before. The state's death toll from Covid-19 is now 18,349. Attribution of a death can be weeks later than the date of death.

Overdose deaths in Ky. workplaces tripled in 2019-2021; in the latter year they were the 2nd leading cause of occupational fatality

Graph by Kentucky Injury Prevention Research Center

By Melissa Patrick

Kentucky Health News

Drug-overdose deaths in Kentucky workplaces tripled from 2019 to 2021, according to the latest annual report from the Kentucky Fatality Assessment and Control Evaluation program.

The program, part of the Kentucky Injury Prevention and Research Center, found that from 2017 to 2021, the state had 47 overdose fatalities in the workplace, reaching its highest number ever of 18 fatalities in 2021. That was a 260 percent increase from 2017.

Of the 96 occupational fatalities recorded in Kentucky in 2021, drug-overdose deaths accounted for 19%, an increase from 13% in 2020 and 8% in 2019. That put overdose deaths second to motor-vehicle crashes, which were 29% of the total. In third place (17%) were "struck by" and "striking against" injuries, forcible contact or impact with an object that creates an injury.

Most of the occupational drug-overdose deaths in 2017-2021 occurred in the trade, transportation and utilities industries (38%), followed by manufacturing (19%), construction (19%) and the leisure and hospitality industry (11%). The remaining 13% took place in services and public administration.

The report notes that all of the occupational overdose deaths in the leisure and hospitality industries happened in 2020 and 2021.

It also points to the jump of occupational-overdose deaths in Jefferson County. In 2021, seven of the state's occupational overdose deaths, nearly 40% of the total, occurred in Jefferson County. That was one short of the total for the previous four years combined.

Drinking while pregnant can have long-lasting effects on children, but almost 1/2 of pregnant Kentuckians report consuming alcohol

Centers for Disease Control and Prevention illustration

Did you know that children of mothers who drink alcohol during pregnancy can undergo changes to their facial features, accompanied by a variety of lifelong mental and physical challenges? And some other changes may not be visible. Exposure to alcohol before birth can also affect systems throughout the body and have lasting impact, Emma Yasinski reports for National Geographic.

"Studies have estimated that fetal alcohol spectrum disorders, or FASD, affect between 1 and 5 percent of the population, though experts suspect the prevalence is even higher," Yasinski reports. 

The FASD United Policy and Training Center website says FASD is the "most commonly known cause of developmental disabilities in the United States," and recent research shows up to one in 20 first graders have a disability from it.

Almost half of Kentucky women with a recent live birth consumed alcohol during the three months before pregnancy. The figure was 48.7% in 2019, according to the America's Health Rankings report from the United Health Foundation. The national rate was even worse, 56.7%.  

FASD-related problems

It wasn't until the early 1970s that researchers found a pattern among babies born to mothers with severe alcohol-use disorders, including hallmark facial features such as a smooth upper lip, a small head, and a flat nasal bridge. These features were generally accompanied by a variety of lifelong mental and physical challenges such as learning disabilities, difficulty reasoning, growth deficiencies, and heart and kidney problems," Yasinski reports.

Since then, researchers have found that prenatal alcohol exposure can disrupt development of the brain and body even without affecting the face, and include a broad range of conditions that are often inconsistent from one patient to another. Yasinski also delves into the details of how FASD changes the brain. 

The FASD center says people with the disorder often have difficulty learning and remembering, understanding and following directions, shifting attention, controlling emotions and impulsivity, communicating and socializing, and performing daily life skills. It says FASD cases are seriously under-diagnosed and often hard to distinguish from other developmental disorders. 

Further, Yasinski reports that diagnosis requires complex tests and treatments that, due to limited resources and awareness, many patients never get.

“Alcohol affects the brain in different ways, depending on when the brain is exposed in pregnancy and how much it's exposed, and what else is going on, like nutritional factors, genetic factors, other things about the mom and the fetus,” Jeffrey Wozniak, a neurobehavioral development researcher at the University of Minnesota, told Yasinski. “So there's a lot of variety in terms of the brain effects.”

How prevalent is drinking during pregnancy? 

According to Kentucky's 2020 births report from the Public Health Neonatal Abstinence Syndrome Reporting Registry, "Alcohol use was reported by mothers of 4.8% of infants with NAS in Kentucky, which may be lower than the actual rate of use."

Centers for Disease Control and Prevention data show that in 2018-20, 13.5% of pregnant U.S. adults reported that they were currently drinking and 5.2% reported they had engaged in binge drinking.

Many women drink without knowing they are pregnant, and that harm a fetus. About half of all U.S. pregnancies are unintended, and most women don't know they are pregnant until four to six weeks into the pregnancy.

While binge drinking and regular heavy drinking put a fetus at the greatest risk for sever problems, even lesser amounts can also cause damage, says the National Institute on Alcohol Abuse and Alcoholism. 

"In fact, there is no known safe level of alcohol consumption during pregnancy" says the institute. 

Looking forward

The good news is that in the early 2000s, "Studies started to show that targeted therapies could help people who were prenatally exposed to alcohol," Yasinski reports.  

For example, Julie Kable, a neurodevelopmental exposure researcher at Emory University in Atlanta, told Yasinski that she and her team found with the CDC that offering adaptive support helped people with FASD better learn and understand math. Yasinski says researchers have also found ways to help people with FASD with executive function and decision making. 

Kanle told Yasinski, “No longer could we allow pediatricians to say, Well, why should I diagnose it when there's nothing we can do about it?”

But Yasinski reports that the U.S. has too few places that can diagnoise FASD, "and some states don’t even have a single FASD diagnostic center. Since diagnosis requires comprehensive evaluations, the centers that do exist have limited capacity to complete them. Many will only see patients who they know were very likely to have been exposed to alcohol in utero, which accounts for a fraction of those believed to be affected."

She adds,, "While most experts agree on the basic characteristics of FASD, there are also minor differences in diagnostic criteria between states, countries, and clinics, with slightly different cutoffs."  And this, she reports "can create challenges for researchers working to build large data sets, but it also has more immediate impact." For example, one FASD specialist told her that individuals with FASD in some states don't qualify for disability services because " the CDC only has consistent diagnostic criteria for fetal alcohol syndrome, not the whole spectrum of disorders." 

Some in Congress are working to provide resources for screening, research and other supportive services for people with FASD, in a bill called the FASD Respect Act. The FASD United Policy and Training Center says a new version of this bill is to be introduced.

Susan Shepard Carlson, who was a district court judge and first lady of Minnesota, told Yasinski that she is advocating for this bill largely because she realized in 1997 that a many children coming through the courts "had the same kind of profile [as] someone with FASD . . . but we weren't really looking at the underlying cause." 

Because of this, Carlson convened a task force that led to the state funding FASD research and treatment. "The court was able to screen children suspected of having an undiagnosed FASD, and she says about 25 percent of the kids they chose to screen did have an undiagnosed disorder," writes Yasinski.

Kable told Yasinski, “It’s really important to know that we can still have dramatic differences in the developmental outcome of these children, if we get them recognized, and get them services as early as possible.” 

Information for this story was also gathered by Melissa Patrick of Kentucky Health News.