Far from the debates about Obamacare and Medicaid in Washington and Frankfort, Eastern Kentucky's poor see benefits

Kentucky Health News

The political debates over the future of Medicaid and the Patient Protection and Affordable Care Act sometimes obscure the human and economic impact of the expansion of Medicaid in Kentucky. That story can be told in any county; a national reporting project chose far Eastern Kentucky as the place to talk with patients, doctors, clinic managers and others, and its story was published on the front page of Sunday's Lexington Herald-Leader. It begins:

WHITESBURG — Lois Smith was paralyzed, but now she can walk again.
Smith, 62, had been to the emergency room off and on since she collapsed one day in her driveway about five years ago and found herself unable to walk. She was uninsured, on disability and incapable of paying a primary care doctor.
In 2013, she enrolled in Medicaid under the expansion created by the Affordable Care Act, also known as Obamacare, and has been seeing Dr. Van Breeding at Mountain Comprehensive Health Corporation in Whitesburg regularly ever since. Breeding determined she suffered nerve damage from diabetes. With treatment, Smith is now back on her feet.

Breeding told Eric Bosco of Crossing the Divide, part of The GroundTruth Project and Boston's WGBH, that his patient count has risen to 34,581 from 25,699 before Obamacare, and the percentage of his patients without insurance dropped to 4 percent, from 16 percent. "Screenings for colon cancer have risen from 19 percent to 60 percent of patients, the clinic now offers dental and vision care, and they are planning to open a Suboxone clinic to help address the opioid crisis," Bosco reports.

The clinic and other health-care providers have funneled billions of federal dollars into the state's economy, but state officials are trying to implement premiums, co-payments and work requirements, citing the state's increasing cost share, which will gradually rise from 5 percent this year to the law's limit of 10 percent in 2020.

"It’s also clear here that Obamacare has real problems," Bosco writes. "Health-care experts note that premiums have risen sharply for individuals purchasing insurance on the federal health exchange. Rising premiums also squeeze small businesses, 60 percent of which support repealing the law, according to a February survey by BizBuySell, a small business marketplace."

David Bolt, chief operating officer of the Kentucky Primary Care Association, "thinks much of the talk about the failings of the health law is political bluster," Bosco reports, quoting him: “The only part that is imploding at all is the individual market, a very, very small piece of the health care coverage.”

About 81,000 Kentuckians have individual insurance policies subsidized by Obamacare; 475,000 have been added to Medicaid by the expansion, which opened the program to anyone in a household with income less than 138 percent of the federal poverty line.

President Trump carried the formerly Democratic area easily, but Breeding "said he thinks many of his patients voted for Trump based on cultural issues, such as immigration, and promises of returning coal jobs," Bosco reports. "Meanwhile, Lois Smith and others who rely on expanded Medicaid wait anxiously to see what Washington does."

Smith told Bosco, “I’m worried, because you never know when they’re going to cut it off.”

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Events scheduled in Ky. for Breast Cancer Awareness Month

October is Breast Cancer Awareness Month. The American Cancer Society's Making Strides Against Breast Cancer campaign is having events in Kentucky this month, including Sunday, Oct. 15 at Whitaker Bank Ballpark in Lexington; Sunday, Oct. 22 at Smothers Park in Owensboro; and Saturday, Oct. 28 at Waterfront Park in Louisville

The National Breast Cancer Foundation has a website where you can get a booklet with general information about cancer and specific information about breast cancer, including how to prevent it with healthy habits, and how to detect it early to prevent its spread and increase the chances of survival. Most women survive it with early detection and treatment.

"Breast cancer is the second most common kind of cancer in women. About one in eight women born today in the United States will get breast cancer at some point," says the breast-cancer website of the U.S. Department of Health and Human Services. It suggests some steps to raise awareness of breast cancer:

• Ask doctors and nurses to speak to women about the importance of getting screened for breast cancer.
• Encourage women between 40 and 50 to talk with their doctors about when to start getting mammograms.
• Organize an event to talk with women ages 50 to 74 about getting mammograms every two years.
• Host a breast cancer walk like those in Lexington, Owensboro and Louisville.

State starts new round of television and digital ads to get Kentuckians to call 800 number for free help to quit smoking

A new round of television and digital advertising from state government encourages Kentuckians to stop using tobacco. The ads direct viewers to the statse's free tobacco counseling service, at 1-800-QUIT-NOW (784-8669).

“We often hear about the dangerous health effects of smoking – so we wanted to create a campaign that emphasizes what is possible when you quit,” said Bobbye Gray, a registered nurse who runs the Quit Line. “We hope people will see these ads and be inspired by the positive message and motivated to seek counseling and support by calling Quit Now Kentucky.”

Tobacco is the leading preventable cause of death in Kentucky and the nation, and especially in Kentucky, which has the naiton's highest smoking rate. "More than 8,000 Kentuckians die each year because of tobacco-related diseases," a state news release says.

"Eighty-five percent of all lung cancers are caused by cigarette smoking, and Kentucky leads the nation in lung cancer deaths. Smoking is a major risk factor for the four leading causes of death: heart disease, cancer, stroke and chronic obstructive pulmonary disease (COPD). Annually, Medicaid and Medicare costs exceed an estimated $1.2 billion for treatment of Kentuckians suffering smoking-related diseases and conditions. This equals $300 for each of the four million people living in Kentucky."

The $499,000 ad campaign emphasizes the health and lifestyle benefits of quitting tobacco. One commercial features a woman underwater holding her breath for 30 seconds and delivering the message with words written on placards. To see a sampling of ads, visit http://red-stash.com/QUIT/. To complement the ads, physicians and health-care professionals will get mail with information about Quit Now Kentucky to encourage them to refer patients to it.

The campaign is funded by a federal grant and annual proceeds from the 1998 Master Settlement Agreement among states and cigarette manufacturers. It was produced by Louisville-based advertising agency Red7e.

Callers to Quit Now Kentucky speak wioth highly trained cessation specialists who answer calls daily from 8 a.m. until 1 a.m. to help tobacco users develop a quit plan. Quit Now counseling and materials are provided to callers at no charge.

For employers wanting to help employees quit, information is available through the Quit Line and the local health department. Group sessions and cessation materials can be made available at worksites.

Visit http://chfs.ky.gov/dph/mch/hp/tobacco.htm for information on other tobacco cessation options.

'Tobacco Nation' report cites Kentucky as example of challenges facing those who want to change public policies on tobacco

Kentucky, which has the nation's highest smoking rate, is of 12 contiguous states where smoking rates are higher than "not only the national average, but that of many of the most tobacco-dependent countries in the world," says a report published by Truth Initiative, a nonprofit organization created by the 1998 agreement among states and cigarette manufacturers.

The report, "Tobacco Nation," cites Kentucky as an example of "the challenge of changing policies" relating to tobacco. It notes that the state has "no broad restrictions exist to prevent smoking in public places and workplaces," and "A statewide smoking ban to prohibit tobacco use on school properties and at school events has yet to be enacted. Moreover, the tax rate hasn’t changed since 2009."

It adds, "In Missouri, the circumstances are even more bleak; the state has the lowest cigarette excise tax per pack in the nation ($0.17) and the rate hasn’t changed in 24 years. One factor clearly suppressing the adoption of tobacco control policies in Tobacco Nation is opposition by Big Tobacco."

Ben Chandler, President and CEO of the Foundation for a Healthy Kentucky, said the report "paints a stark picture of the health benefits policymakers can achieve by enacting stronger laws proven to protect the public from secondhand smoke and reduce smoking rates. The good news is that we know what works to reduce tobacco-related disease and illness. The bad news is that Kentucky leads the other 11 'Tobacco Nation' states in smoking, cancer and COPD. But with stronger laws and ordinances -- including higher state tobacco taxes and local smoke-free ordinances covering indoor workplaces -- Kentucky can lead regional health improvements."

Beshear and other attorneys general ask Congress to let Medicaid pay for in-patient treatment for addiction

Most of the nation's attorneys general, including Andy Beshear of Kentucky, are asking Congress to remove what they say is an unnecessary restriction on the use of Medicaid funds for in-patient treatment for drug dependence.

The "Road to Recovery Act," HR 2938, would allow addiction-treatment facilities to be paid by Medicaid, a program mainly run by states but mainly financed by the federal government. The 1965 Medicaid law banned payments to "institutions for mental diseases," which at that time were "to large, residential mental-health facilities," Beshear said in a news release.

"While the exclusion led to the closure of what were, in many cases, inhumane institutions, it now has the unintended effect of limiting Medicaid funding for residential treatment facilities, which can be one of the most effective ways to treat drug addiction," the release says. The bill would "remove the exclusion for addiction treatment facilities only," it says. "This will help open new avenues for addiction treatment while maintaining appropriate restrictions on mental health facilities."

Kentucky's decade-old program to help children who are at risk from drug-using adults is becoming a model for other states

Recovered opioid addict Raven Mosser credits her success in staying sober to Kentucky's START program. She moved to Ohio to become a recovery coach for other parents struggling with addiction. (Kaiser Health News photo by Sholten Singer)

Kentucky's program to help children placed at risk by adults' drug use has become a model for other states. Ohio's new plan is modeled explicitly on Kentucky's, and Indiana and North Carolina are launching initiatives too, Shefali Luthra reports for Kaiser Health News.

"Kentucky was a pioneer, starting in 2007, when opioid addiction first emerged as a public health concern. The program, called 'Sobriety Treatment and Recovery Teams' — or START — emphasizes a wraparound approach for at-risk parents that includes frequent home visits, vouchers for child care and transportation and mentorship from people in recovery," Luthra writes. "Under the Kentucky model, when child protection specialists learn a child is at risk, authorities specifically assess whether substance abuse could be a factor. If so, the parent is fast-tracked into treatment and assigned a 'recovery team,' which coordinates among agencies such as children’s aid, mental health, social services and recovery mentors."

One of the less-discussed effects of the opioid epidemic has been the strain it places on foster-care systems. Ohio, which has the nation's highest rate of heroin-overdose deaths, has been particularly hard hit. "Ohio's opioid epidemic is seen as the direct cause of an 11 percent increase in children in state custody over the past six years, according to the Public Children Services Association of Ohio," Dina Berliner reports for The Athens News.

Only 7,200 families are registered as foster parents in Ohio, but there are 15,000 children in the state's foster-care system, says state Attorney General Mike DeWine. And half of those kids are in foster care because one or both of their parents are opioid addicts, according to a 2016 survey by the Public Children Services Association.

It's a trend seen in other states. "Data from the U.S. Department of Health and Human Services show that from October 2012 to September 2015, as addiction surged, the number of kids entering the foster system rose 8 percent," Luthra reports.

Foundation for a Healthy Kentucky favors taxes on sugary drinks to fight obesity, in addition to higher cigarette tax to fight smoking

Kentucky Health News

The Foundation for a Healthy Kentucky has taken a tougher stance toward tobacco, advocating a $1-a-pack increase in the state cigarette tax as a way to reduce smoking and its health-care costs. Now its CEO says the foundation also favors taxes on sugary drinks as a way to fight obesity, another bad health statistic in which Kentucky is a national leader.

Ben Chandler

"We think sugar taxes are a good way to go," Ben Chandler, who has headed the foundation for a year and a month, said in an interview with Mark Green, editor of The Lane Report, a Lexington-based business publication.

"You’ve got to figure out a way to get the public to not consume as much sugar," Chandler said. "There isn’t any question that we have a significant obesity problem. And there isn’t any question that it affects the overall health of not only the individuals but the state. And one of the obvious ways to attack that problem is to raise taxes on sugary beverages in particular.

Chandler asked, "Why single out the beverages and not other forms of sugar?" He answered, "These sugary beverages have no other nutritional value. What we’re looking to do is deal with the high-caloric and low-nutritional things. You don’t want things that have high calories and low nutritional value. You would prefer, obviously, high-nutrition and low-calorie."

Chandler, a Versailles Democrat who was state attorney general and then Bluegrass congressman, probably faces a tough fight getting new taxes approved by a state legislature controlled by Republicans, many of them newly elected. Many are also from rural areas, where a shrinking number of farmers still grow a lot of tobacco.

"You hear the argument, for instance, on smoking that tobacco is an economic force in Kentucky and is a positive economically. The costs from smoking far outweigh any kind of economic gain we get from tobacco," Chandler told Green.

"You can’t get an exact figure on it, but I can tell you that the costs are dramatic. For instance, the Campaign for Tobacco-Free Kids estimates that the cost of smoking in the commonwealth of Kentucky is $1.92 billion. And $590 million of that is to the Medicaid program alone. . . . If we were just to get to the national average on smoking, it would mean over 300,000 fewer smokers. It would save taxpayers in the neighborhood of $600 million a year."

The costs aren't just in state and federal spending, Chandler said: "Just as a result of the smoking habit, every household in Kentucky has to pay $1,100 a year more than they otherwise would for health insurance. That’s whether you smoke or not. So that’s an indirect cost. The indirect costs start with loss of productivity and the cost of health insurance."

Under Chandler's predecessor, Susan Zepeda, the foundation more gently promoted various measures to discourage smoking and other bad health behaviors. Now it is being more aggressive.

"We want to move into being active on public policy because we believe the health needle in Kentucky needs to be moved, and we’re not going to do it unless we have strong public policies like the ones I’ve talked about that encourage healthy behaviors," Chandler told Green. "One reason we need to go in that direction is that our budget is about $2 million a year, and it’s just not enough to make the kind of impact we want simply by giving out grants. We’ve got to have a strategy to affect public policy in the state, and that’s what we’re going to try to do."

Chandler added later, "The key to this whole thing is that we’ve got to start focusing on health as opposed to health care. Not to diminish the importance of health care, but if we can have a healthier population on the front end, and if we can invest in policies that cause our population to be healthier, then not only are people going to have more fulfilling lives, but we’re going to help our economy, we’re going to create jobs, and we’re going to help the business climate. We’ve got everything to gain and nothing to lose by taking that position. We just haven’t done a good job of it in this country."

Earlier, he said, "In this country we spend almost all of our money on a rescue system. We wait until people get sick, and then we rescue them. We talk about healthcare all the time, but I have yet to meet a person who wants health care if they can have health. It’s important to have a system that helps people when they’re sick, but it is also the least efficient way to spend your healthcare money. That’s why we spend twice as much per capita in this country as any other country in the world, and our outcomes are, according to the World Health Organization, 37th in the world."

He added later, "What we ought to do is redirect some of that spending to prevention programs. We can do that through the public health departments, for instance. We have 61 public health departments in Kentucky. They need to be the chief health strategists for their communities. Public health departments are underutilized and underfunded, and it’s tremendously important that we utilize them, not just to provide additional clinical services but to actually be the health strategists for their communities."

Chandler said the foundation "has undertaken programs in seven different counties, to bring coalitions together in those counties, schools, governments, hospitals, concerned citizens – anybody who might be interested in joining a coalition – to work to enact healthy policies in that locality. Clinton County, Kentucky, in Appalachia down on the Tennessee line, is a good example. It has enacted policies that allow the school gymnasium to be used by the community after school. Another good policy is complete streets policies: when you’re developing a street, you have to have sidewalks, you have to have bike paths. In other words, being healthy is an easier option that way. Being able to exercise is an easy choice rather than a difficult choice."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Hardin County middle school begins suicide-prevention program; statewide goal is to get it in 100 schools this year

Hardin County North Middle School students talked about what gives them strength during training
that implemented Sources of Strength, a national a suicide-prevention program, at the Radcliff school.

With one in 12 Kentucky high-school sophomores saying they have attempted suicide, the state's schools are stepping up their suicide-prevention efforts.

The main tool is a national program called "Sources of Strength," which "focuses on hope and strength rather than risk factors and warning signs," writes Katherine Knott of The News-Enterprise in Elizabethtown.

The state Department of Behavioral Health and other agencies "have set a goal of implementing Sources of Strength in 100 Kentucky schools during this school year," Knott reports, after seeing the program in action at the first school in Hardin County to use it.

The program involves student peer leaders like Kamar Kennedy, a seventh-grader at North Middle School in Radcliff, who "wants to help others if they are feeling down," Knott reports. “At lunchtime, I can go over and sit by students who are alone,” Kamar told her.

Kamar is one of 32 peer leaders, helped by eight adult advisers. After an all-day trainingto begin the program, he "said they talked about what gives them strength and how to help other students," Knott reports. "The students will organize activities and campaigns during the year to spread a strength-based, positive message to change the climate of the school.

Jodie Bod­nar, the family resource coordinator who brought the program to the school, "said the goal is to raise school connectedness to a new level," Knott reports.

“I’m hoping kids will go back to our school and they’ll be leading a positive movement,” Bodnar told Knott. “We want to change school norms to be more positive.”

Mark Lomurray, who founded Sources of Strength in 1998, was at last week’s training. "He said 20,000 peer leaders are involved with the program across the country, and they’re reaching about 1 million students," Knott reports. "The program uses a strength wheel to highlight different sources, such as family support and spirituality. The wheel prompts students and adults to identify aspects that give them strength and focus on positives."

National speakers will headline conference on patient safety and health-care transparency in Lexington Nov. 3

The 11th annual Conference for Healthcare Transparency and Safety, sponsored by Kentucky-based Health Watch USA and Consumers Union's Safe Patient Project, will be held Nov. 3 at the Four Points Sheraton in Lexington, off Newtown Pike near Interstates 64 and 75. The cost, including lunch, is $48 ($35 for full-time students).

Lisa McGiffert, Consumers Union

Speakers will include Deborah Nelson, a Pulitzer Prize winning-investigative reporter, speaking on conflicts of interest and infectious-disease policy; Dr. Ivan Oranski, distinguished writer in residence at New York University and co-founder of Retraction Watch, on articles that have been retracted from peer-reviewed medical journals; Lisa McGiffert, director of the Safe Patient Project, on patient safety and health-care accountability. For a full list of speakers and presentations, and information on registration and continuing-education credits, go to www.healthconference.org.

Beshear says more in Ky. are arrested for driving drugged than drunk; not so, but drugs may be bigger in collisions and fatalities

By Melissa Patrick
Kentucky Health News

While telling a television reporter about his experience with an overdose victim in Lexington, Attorney General Andy Beshear said fewer people are charged with driving drunk in Kentucky than with driving drugged.

The available statistics don't support that specific claim, but national data indicate that drugs may be a greater problem than alcohol in traffic collisions and fatalities in the U.S.

Miranda Combs of WKYT-TV paraphrased Beshear as saying, "Today, there are more people arrested for driving under the influence of drugs in Kentucky than alcohol."

Like the rest of the nation, more Kentucky drivers than ever are driving under the influence of drugs, and the number of alcohol-related DUIs has decreased. However, in Kentucky, those caused by alcohol still outnumber those caused by drugs.

Kentucky State Police data

According to the Kentucky State Police, alcohol-involved DUI citations in Kentucky decreased 8 percent between 2015 and 2016, from 11,428 to 10,514. During the same period, drug-involved DUIs increased 12 percent, from 6,989 in 2015 to 7,812 in 2016.

So, in 2016, there were still 2,702 more alcohol-related DUIs than drug-related ones. (Total citation data are compiled only annually because reports from some local law-enforcement agencies are entered manually.)

The report also shows citations for DUIs that involved both alcohol and drugs. This number was about the same in 2015 and 2016: respectively, 1,749 and 1,794.

Samantha G. Lickliter, a KSP program coordinator who pulled the report for Kentucky Health News, said there may be some overlap in the data because it is up to the officer to decide how to record the citation. For example, she said some officers may have individually checked the alcohol and drug involved boxes if both were involved and the "both" box, which would make the same person be counted twice in the data.

Beshear's office did not provide any specific information to support his assertion, but did reference two press releases on the topic and referred Kentucky Health News to the University of Kentucky's Transportation Center.

The center's 2015 “Traffic Collision Facts” report also doesn't support the attorney general's claim. It says there were 4,217 collisions with alcohol involvement, 110 of them fatal; and 1,639 collisions with drug involvement, 34 of them were fatal. The figures are based on reports by the investigating officers at the time of the collisions.

A separate report looked at blood samples from those killed in collisions, and found 233 of the fatalities had a drug in their system. Jerry Pigman, a research engineer with the center, advised caution when citing this number related to DUIs because "There are numerous drugs detected without a known level of what constitutes impairment.”

Pigman said the center will conduct research on the differences in reported levels of drug involvement in fatal collisions beginning Oct. 1, with the finished report due Sept. 30, 2018.

Research shows that drugged driving is increasing nationwide, just as it is in Kentucky, and that broadly defined, driving drugged may be more common than driving drunk.

The latest version of the National Highway Traffic Safety Administration's Roadside Survey of Alcohol and Drug Use by Drivers found that the number with alcohol in their system has declined by nearly one-third since 2007, and by more than three-quarters since 1973. But it also found a large increase in the number of drivers with at least one drug that could affect safety in their system.

The 2014 roadside survey, which is voluntary and anonymous, found that 30 percent of drivers tested positive for alcohol in 2007, but only 8 percent did in 2007.

In the same period, the share of drivers with drugs in their systems rose from 16 percent to 20 percent, and the number with marijuana in their system rose by half.

This report also cautions that "drug presence does not equal impairment," noting that some drugs linger in the body long after their impairing effects on driving have passed.

A separate report found that positive drug tests were more common than positive alcohol tests among fatally injured drivers in 2015.

The Governors Highway Safety Association and Foundation for Advancing Alcohol Responsibility report released in April found that of those tested, drugs were present in 43 percent of the motorists who died, while alcohol was present in 37 percent.

Beshear shared the same story he shared with WKYT at the Foundation for a Healthy Kentucky's Howard L. Bost Memorial Policy Forum in Lexington Sept. 25.

Beshear told the group that he and cyber-crimes investigator Josh Keats, who is also a paramedic, were sitting in a traffic jam at about 3 o'clock on a Thursday afternoon in Lexington a few weeks ago when they saw someone jump out of a car and start beating on the window of the car next to them. They were about six cars back.

"And as we turned on our lights and rushed over, he was turning blue, he then started turning purple and as Josh will tell you, the next color is death,” Beshear said. “The person in that car had just overdosed on carfentanil.”

Carfentanil is used as an elephant tranquillizer and is 100 times as strong as fentanyl, a synthetic opioid that is up to 50 times stronger than heroin.

Beshear said he and Keats “wrestled him from the car” to the street and were grateful that the police showed up with a life-saving drug that reverses opioid overdoses.

“Thank God,” he said. “Lexington police showed up in time with Narcan . . . and we were able to revive him.”

He added, "It shows you that if this isn't just the single greatest moral challenge of our time, not only was his life in danger, but he was operating a motor vehicle. Your life was in danger too.”

In an effort to to educate prosecutors and law enforcement officials on the detection, apprehension and prosecution of drugged drivers, Beshear's office, the Governor's Office of Highway Safety and the Unified Prosecutorial System held a three day training in April. Beshear was recognized last year by the Foundation for Advancing Alcohol Responsibility with the 2016 Leadership Award for his work to fight drunk and underage drinking; 

Dr. Hiram Polk quits as state health commissioner, citing unspecified disagreements over spending new funds

Dr. Hiram Polk

Dr. Hiram Polk of Louisville says he quit his job as state health commissioner "amid a dispute over spending agency money," Deborah Yetter reports for The Courier-Journal.

"There was some disagreement at the middle-management level about how to best spend some new funds in public health," Polk told Yetter in a brief interview Friday, declining to elaborate.

The Cabinet for Health and Family Services was recently awarded a $10 million federal grant to integrate primary care and behavioral health care in two regions of the state, as part of an effort to combat the state's opioid epidemic, which Polk has said consumed the plurality of his time. A cabinet spokesman didn't respond to a request for comment.

Polk, 81, was named commissioner of the cabinet's Department for Public Health in June 2016 after a long career as a renowned surgeon and professor of surgery at the University of Louisville.

He had been known for being frank if not blunt, and a few months later he told the Friedell Committee for Health, a health-advocacy group, that they needed to find a way to get Gov. Matt Bevin to modify his policy against a statewide ban on smoking in public places. Kentucky has the nation's highest smoking rate.

Health Secretary Vickie Yates Brown Glisson said in an email to employees, "After serving for more than one year as commissioner of the Department for Public Health, Dr. Hiram Polk has chosen to resign. His drive, determination and commitment to advancing public health is second to none. We thank him for his service and wish him well."

Ky. teens still far below average in getting vaccine that prevents cervical cancer, a disease more common here than most states

By Melissa Patrick
Kentucky Health News

Fewer than half of Kentucky's teenagers are getting the human papillomavirus vaccine, which is known to prevent several cancers, including cervical cancer -- a disease for which Kentucky leads the nation.

A federal Centers for Disease Control and Prevention report, using data from the 2016 National Immunization Survey for teenagers, found that 48 percent of Kentucky's teens between 13 and 17 received one or more doses of the HPV vaccine, but only 34 percent completed the recommended series of doses. Both rates were lower than the national average.

Nationwide, the report found that 60.4 percent of teens received one or more doses of the vaccine in 2016, up from 56.1 percent in 2015; by the age of 17, 43.4 percent had received all recommended doses.

"For a state recognized for high rates of all HPV-related cancers, it's troubling to see HPV vaccination rates among our adolescents lag behind the rest of the country," Dr. Robin Vanderpool, an associate professor at the University of Kentucky College of Public Health, said in an e-mail to Kentucky Health News.

Vanderpool said requiring the vaccine for entry to school would boost the HPV vaccination rates in Kentucky, but she also recommended state and local approaches to improve parents' knowledge of HPV vaccination as cancer prevention -- as well as efforts to increase health-care provider recommendations of the vaccine, a major obstacle.

Experts at an immunization conference last year placed most of the blame for the poor rate of HPV vaccinations on physicians, citing studies that show a "clear, same-day recommendation" from a physician to a parent is the most important factor in whether a child gets vaccinated.

"Through population-level HPV vaccination coverage, a whole generation of Kentucky youth could be protected from ever developing cancer," Vanderpool said. "What a tremendous public health achievement Kentucky could be a part of!"

HPV causes more than 90 percent of anal and cervical cancers; 70 percent of vaginal, vulvar and middle-throat cancers; and more than 60 percent of penile cancers. And two of the HPV strains are associated with more than 90 percent of anal and genital warts.

The report says that every year, an estimated 31,500 newly diagnosed cancers in men and women are attributed to HPV, and approximately 90 percent could be prevented by the HPV vaccine, which protects against nine different strains. Kentucky ranks in the top 10 states for cervical cancer incidence, and the top 20 for deaths from it.

Another obstacle to vaccination is the need for more than one dose. New CDC guidelines recommend a two-dose series if given before the age of 15 and a three-dose series if given after 15. The vaccine is recommended between 11 and 12, but can be given to females up to 26 and males as old as 21.

HPV is most commonly transmitted through sexual intercourse, but it can also be transmitted through intimate skin-to-skin contact.

The report found that HPV vaccine is becoming more common among boys. Nationally, 65 percent of girls received the first dose of HPV vaccine in 2016, compared to 56 percent of boys, a 6 percent increase from 2015 for boys and about the same rate for girls. In Kentucky, 55 percent of girls received at least one dose of the HPV vaccine in 2016, compared to 42 percent of boys.

It also found that HPV vaccination rates were lower in rural areas (50.4 percent) compared to urban areas (65.9 percent).

The CDC news release says that since the introduction of the first HPV vaccine over 10 years ago, "infections with HPV types that cause most of these cancers and genital warts have decreased by 71 percent in teen girls and 61 percent in young women."