U.S. Senate passes 70 opioid bills, two from McConnell; House-Senate compromise in works for final passage

The U.S. Senate passed a comprehensive, bipartisan opioid package Monday that focuses on prevention and treatment that includes two measures sponsored by U.S. Senate Majority Leader Mitch McConnell. A House-Senate compromise is in the works for final passage.

“The CAREER Act will help individuals in recovery find the housing and the job opportunities they need to rebuild lives of sobriety. And the Protecting Mothers and Infants Act will help the federal government do more to support pregnant women and protect unborn children from these drugs," McConnell said in a news release. "This landmark legislation is like a Swiss army knife that will help the federal government fight opioid addiction in many different ways."

The legislation, comprising 70 bills, passed on a 99-1 vote with Sen. Mike Lee, R-Utah, dissenting. The $8.4 billion package "creates, expands and renews programs across multiple agencies," including provisions to prevent the "deadly synthetic drug fentanyl from being shipped through the U.S. Postal Service as well as allowing doctors to prescribe more medication designed to wean addicts off opioids, such as buprenorphine," Colby Itkowitz reports for The Washington Post.

Opioids were responsible for nearly 50,000 deaths last year, 1,565 of them in Kentucky. President Donald Trump declared the opioid epidemic a public-health emergency in October.

While lawmakers say the bill is a "step in the right direction," many health advocates and experts say it's not enough because it doesn't provide enough money to "fully combat" the crisis, Itkowitz reports.

Sarah Wakeman,the medical director for Massachusetts General Hospital’s Substance Use Disorders Initiative, told the Post that “Really targeting the depth of the opioid epidemic would require an infusion of federal dollars on par with the more than $20 billion a year spent on HIV/AIDS. . . . We have historically not thought of addiction as a medical issue and so our health care and public health system are woefully unprepared to respond in a robust way.”

The House passed its opioids package in June. It included 58 opioid bills, with two of the measures sponsored by Rep. Hal Rogers, Republican from Eastern Kentucky's 5th Congressional District.

According to the Senate bill's author, Sen. Lamar Alexander, R-Tennessee, the Senate and House expect to work out their differences by Friday, Sept. 21, so they can vote on a final bill in the next two weeks, and present it to the president by early October, CBS News reports.

One key difference in the bills is a decades-old federal rule that prevents Medicaid for paying for care at inpatient treatment facilities with more than 16 beds, called the IMD exclusion.

"The House bill partially overturns the IMD exclusion for mental-health patients who also have an opioid use disorder, which the Congressional Budget Office says would cost nearly $1 billion over the next 10 years," the Post reports. "The Senate bill makes some changes to the IMD rule, including making sure pregnant and postpartum women continue receiving Medicaid-covered services administered outside such facilities, such as prenatal care. But it doesn’t allow Medicaid to pay for addiction treatment in bigger facilities."

Arkansas drops thousands from Medicaid for non-compliance with work requirements; Ky. official says 'Kentucky is not Arkansas'

By Melissa Patrick
Kentucky Health News

Arkansas is the first state to implement work and community-engagement requirements for some of its "able-bodied" Medicaid beneficiaries, just like Kentucky is trying to do. Three months into the new rules, the state has kicked 4,353 people off Medicaid for noncompliance, and will likely kick thousands more off next month.

Opponents of Kentucky's new plan, called Kentucky HEALTH (for Helping to Engage and Achieve Long Term Health), have long said they expect the same thing to happen in Kentucky if it's allowed to proceed.

"Kentucky’s work requirement is far more complex [than Arkansas'] and will require more reporting from participants. It is likely, then, that many will fail to meet the requirements and lose their Medicaid coverage," Dustin Pugel of the Kentucky Center for Economic Policy wrote Aug. 16 in a paper as part of the latest federal comment period on Kentucky HEALTH.

Cabinet for Health and Family Services spokesman Doug Hogan said the cabinet doesn't expect the same thing to happen in Kentucky.

"Kentucky is not Arkansas," Hogan wrote. "Arkansas operationalized within a few months after getting approval, chose to utilize technology that was not geared toward reporting activity for Medicaid, and had some challenges getting communications out to beneficiaries about the changes. In contrast, Kentucky has worked over the course of more than 1½ years with providers, nonprofits, MCOs [managed-care organizations] and members to get information out, invest in a new IT system, conduct training across the state for all stakeholders, and research ways to better engage citizens."

Kentucky's plan would require "able-bodied" Kentuckians who are not primary caregivers to work, attend school, take job training or volunteer 80 hours a month, or, if appropriate, get into drug treatment. It also includes small, income-based premiums and lockout periods for noncompliance, among other things.

For an Excel file with numbers on expansion and other Medicaid enrollment in each Kentucky county, click here.

A federal judge in Washington, D.C., was worried enough about how many Kentuckians could lose coverage under the state's new plan that he sent it back for review.

District Judge James Boasberg vacated the plan just days before it was set to kick in on July 1, in part because the U.S. Department of Health and Human Services had not sufficiently considered the state's estimate that in five years Kentucky's Medicaid rolls would have 95,000 fewer people with the plan than without it, largely for non-compliance with its requirements.

Medicaid provides coverage to about 1.4 million people in Kentucky, about half of them children and nearly 500,000 through the expansion of the program to those who earn up to 138 percent of the federal poverty level. It is this expansion population that will be most affected by Kentucky HEALTH if it is approved. Most who gained coverage through the expansion are already working.

The cabinet is proceeding as if it expects the Centers for Medicare and Medicaid Services to approve the plan. On Sept. 15, Associated Press Frankfort correspondent Adam Beam wrote on Twitter: "Update on Kentucky's Medicaid work requirements: Joint status report filed in federal court today. It says CMS continues to evaluate Kentucky's application and submitted comments. All parties will provide more info by Oct. 15."

A lawsuit is also pending that seeks to invalidate the Arkansas program and because of its similarities to Kentucky's case, Boasberg is handling that case as well as Kentucky's.

What's happening in Arkansas?

The new Medicaid program called Arkansas Works, which was approved under a waiver of the federal Medicaid rules, took effect in June. The program requires non-exempt enrollees to work or participate in qualifying activities, like job training, education or volunteering, 80 hours a month and report their hours electronically. It is being phased in and now affects only enrollees aged 30 to 49.

Kaiser Family Foundation graphic

The Kaiser Family Foundation reports that of the 60,012 Arkansans who were subject to the new requirements in August, 27 percent, or 16,357, did not report 80 hours of qualifying work activities and "nearly all" of those reported no work activities at all. However, they have three months to report such activities to be in compliance.

Arkansas data shows another 5,076 people are at risk of losing their coverage in October because they have had two months of non-compliance, and 6,174 have not been in compliance for one month.

According to a news release from Gov. Asa Hutchinson's office, the Arkansas Department of Human Services conducted "extensive outreach" from April to August to their beneficiaries to let them know about the new requirements. Hutchinson said some who did not comply may have found work, gained coverage elsewhere or moved out of state without notifying officials.

"Some simply chose not to comply. Those are the ones who will lose their Arkansas Works coverage for the remainder of 2018," Hutchinson said. "Personal responsibility is important. We will continue to do everything we can to ensure those who qualify for the program keep their coverage, but we will also make sure those who no longer qualify are removed.”

Arkansas estimates it will save $30 million by dis-enrolling 4,353 beneficiaries.

Within hours of the announcement, CMS Administrator Seema Verma, a champion of work requirements as a way to lift people out of poverty, said on Twitter: "“I’m excited by the partnerships that Arkansas has fostered to connect Medicaid beneficiaries to work and educational opportunities, and I look forward to our continued collaboration as we thoroughly evaluate the results of their innovative reforms.”

Advisory panel alarmed by Arkansas numbers

Members of a federal advisory panel, the Medicaid and CHIP Payment and Access Commission (MACPAC), "expressed dismay" Sept. 13 over the Arkansas numbers. Some  of the members said "the early numbers are so worrisome that the agency should force the state to put the work requirements on hold," James Romoser reports for Inside Health Policy. Romoser reports that Commissioner Alan Weil called the numbers "a serious red flag" that needed to be brought to CMS's attention as soon as possible, before policymakers adopt Medicaid work requirements in more states.

“This is very important information,” Weil said of the early Arkansas statistics. “These waivers were granted on the belief that they would yield an increase in work, and clearly it takes time to determine the validity of that hypothesis. But I’m not really comfortable with us just offering some sort of retrospective reporting on how many people lose coverage. It does seem to me -- even on the basis of this pretty preliminary information -- that, as of now, we don’t have any evidence of increased engagement with work-related activities, much less work, and we have significant evidence of a large number of people losing coverage.”

Weil added, “It feels to me as MACPAC we have an obligation to state that rapid implementation of large-scale change of this nature across multiple states is a really risky proposition.”

MACPAC Chair Penny Thompson said the commission will consider formally communicating concerns to CMS at its next meeting, which is scheduled for Oct. 25-26, Romoser reports.

CMS has also approved work requirements for Medicaid in Indiana and New Hampshire. Seven other states (Arizona, Kansas, Maine, Mississippi, Ohio, Utah and Wisconsin) have applied for permission to implement them.

Kaiser Family Foundation table; click here for more details; click on chart for a larger version.

Kentucky public-health nurses in N.C. helping deal with Florence

Commissioner Jeffrey Howard, far right, posed with the team headed to North Carolina. Back row, L-R: Nancy Hamilton (Department for Public Health), Sherita Hall (Louisville Metro Public Health and Wellness), Christopher Smith (Lexington-Fayette County Health Department), Angela Kik (Dept. for Public Health), Shelley Wood (Department of Insurance), Heather Toews (Lexington-Fayette County Health Dept.), Rachel Harrison (Bracken County Health Department), Sandra Glover (Dept. for Public Health). Front row, L-R:  Charlene Woodard (Louisville Metro Public Health and Wellness), Stephanie Carpenter (Lexington-Fayette County Health Dept.), Rebecca Hardin (Dept. for Public Health)

Several Kentucky public-health nurses are in areas of North Carolina devastated by Hurricane Florence to provide medical support to victims in medical-support shelters. They will be there for about two weeks, said the state Cabinet for Health and Family Services.

The "strike team" is nine registered nurses and two staff members from health departments in Louisville, Lexington and Bracken County, the state Department of Insurance and the Department for Public Health. “I commend them and thank them for their compassionate service,” CHFS Secretary Adam Meier said in a news release.

People in medical-support shelters "have medical needs and are in relatively stable condition but have a chronic disease or condition such as diabetes or require oxygen or dialysis," the release said. "Nurses will be conducting history and physical exams, providing patient assessments, assisting with medicine administration and providing general nursing care and comfort." Their work can be followed on Twitter at https://twitter.com/chfsky.

The state health department is prepared to deploy environmental-health specialists and support personnel "if requested to address critical public-health issues, including food safety, food salvage and disposal, food and water-related illness, clean water sources, water sampling, solid waste water system analysis and mosquito control," said Health Commissioner Jeffrey Howard Jr., M.D.

Assistance requests are coordinated and authorized through a multi-state compact, under which the requesting state reimburses all associated costs incurred by the provider state, the release said.

State's high-school obesity rate goes up; hope is in pre-school numbers, which have dropped; adult obesity rate is 8th in U.S.

By Melissa Patrick
Kentucky Health News

Kentucky's high-school students have been getting fatter, but obesity among preschoolers in the Women, Infants and Children nutrition program has been dropping, according to the latest national State of Obesity report.

Kentucky's high schoolers ranked third among the 43 states that reported high-school obesity rates in 2017, at 20.2 percent, up from 18.5 percent in 2015. The higher states were Arkansas, at 21.7 percent, and Tennessee, at 20.5 percent.

The figures come from the Youth Risk Behavior Surveillance system, a continuing national survey of that age group. The report said last year was the first in which the poll found any state with a youth obesity rate over 20 percent.

Another survey, the National Survey of Children's Health, says one-third of Kentucky children between the ages of 10 and 17 were either overweight or obese in 2016.

The news was better among children aged 2 to 4. Using figures from the WIC program for low-income mothers and children in 2014, researchers found that 13 percent of Kentucky children in the program were obese, a significant drop from 18 percent in 2010. The 2014 rank was 32nd among the states.

Over the past five years, the Foundation for a Healthy Kentucky has worked with and funded efforts in six Kentucky communities to reduce childhood obesity.

"What we've learned through these grants is that it takes a coalition of partners committed to system-wide changes that make better nutrition and increased physical activity easier and more likely for everyone," Foundation President and CEO Ben Chandler said in a news release. "It's hard work and it takes long-term commitment, but it's imperative to getting Kentucky back on track to better health."

Preventing obesity in children can return long-term dividends. Research shows that children who are obese or overweight often grow up to become obese and overweight adults, and the number of obese adults in Kentucky is not getting any better.

"The obesity rate in the Commonwealth has been on a dangerous trajectory for nearly two decades, tracking a national trend that is costing the state billions in health care and lost productivity, and jeopardizing the health of 1.1 million Kentucky adults every year," Chandler said.

Source: The State of Obesity 2018 report

The percentage of obese Kentucky adults has been about the same since 2015, when the state made a big jump from 31.6 percent to 34.6 percent. (The rate was less than 13 percent in 1990.) In 2017, the rate was 34.3 percent, ranking the state eighth for adult obesity.

The only states with higher obesity rates than Kentucky are West Virginia, Mississippi, Alabama, Arkansas, Louisiana and Tennessee. The report says that seven states had adult obesity rates at or above 35 percent in 2017 and no state had a statistically significant improvement over the past year.

While the report primarily focuses on obesity, it also shows that the number of Kentucky adults who are either obese or overweight is much larger, 67.2 percent.

The figures come from the federal Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, an ongoing poll. Adult obesity rates by county are available at KentuckyHealthFacts.org.

The national report, "The State of Obesity: Better Policies for a Healthier America" was done by the Trust for America's Health and the Robert Wood Johnson Foundation.

It says obesity among Kentuckians is most common between the ages of 26 and 64. The rate is 37.3 percent among those 26-44 and 38.2 percent among those 45-64.

African Americans in Kentucky are the most likely racial or ethnic group to be obese, at 40.2 percent, followed by 34.4 percent of whites and 28.5 percent of Latinos. More men in Kentucky were obese than women: 36 percent and 32.5 percent, respectively.

State ranks last in physical activity, and all this costs us

These numbers cost money, according to a report from the United Health Foundation, the American Public Health Association and Partnership for Prevention. It says that starting this year, Kentucky is expected to spend $6 billion annually in health care costs directly related to obesity.

The State of Obesity report looks at several of those obesity-related health issues.

It shows that Kentucky's diabetes rate has inched down a bit since it hit its highest rate ever in 2015, 13.4 percent, but at 12.9 percent, the state still ranks seventh in the nation. The researchers estimate that nearly 600,000 Kentuckians will have diabetes in 2030.

The state's rate of high blood pressure, at 39.4 percent, has remained about the same since 2013. Kentucky ranks fifth for hypertension and the report projects there will be nearly 1.2 million Kentuckians with it in 2030.

Given the above numbers, it is no surprise that Kentucky ranks first for the percentage of adults who are not physically active, 34.4 percent.

The report calls for widespread implementation of evidence-based programs, policies and practices to reverse the obesity trend, including efforts that take a multi-sector approach, approaches that make the healthy choice the easy choice and investment in programs that narrow health inequities. Toward this end, the researchers offer 40 specific recommendations for federal, state and local policymakers; the restaurant and food industries and the healthcare systems.

“The good news is that there is growing evidence that certain prevention programs can reverse these trends. But we won’t see meaningful declines in state and national obesity rates until they are implemented throughout the nation and receive sustained support," John Auerbach, president and CEO of Trust for America’s Health, said in a news release.

Brief therapy sessions can greatly improve mental health of women caring for children with severe health issues, U of L finds

Just a little therapy can greatly improve the mental health of women who are overwhelmed by caring for children with severe health issues, says a study done at the University of Louisville.

After five sessions of cognitive behavioral therapy, "study participants reported significantly decreased depressive symptoms, negative thinking and chronic stressors, and experienced improved sleep quality," U of L said in a news release.

Lynne Hall, Dr.P.H., R.N. (University of Louisville photo)

Lynne Hall, associate dean of research at the U of L School of Nursing, presented the findings Friday at the Council for the Advancement of Nursing Science State of the Science Congress on Nursing Research in Washington, D.C.

“Women caring for children with chronic conditions such as cerebral palsy and cystic fibrosis are at high risk for depressive symptoms,” Hall said. “They have many things to juggle, including caring for the child, administering medications and coordinating physician and therapy visits. They’re stressed and overwhelmed by the amount of care their children require and the number of hours a day it takes.”

About 15 million American children have special health needs and 72 percent of their caregivers are women, the news release said. Hall said women caring for such children should be screened for depression and that brief cognitive behavioral therapy is an essential treatment for them.

Brief CBT is a short-term, goal-oriented psychotherapy that "takes a hands-on, practical approach to problem solving and focuses on changing patterns of thinking or behavior to decrease negative thoughts and improve recognition of one’s ability to cope," the release said.

Many women in the study “said they felt very isolated and there was no one who would listen to them,” said Catherine Batscha, psychiatric-mental health nurse practitioner who provided CBT to the study participants. “Because of their child’s care requirements, the women had difficulty getting together with friends because they couldn’t hire a babysitter who knows about medical equipment or complex health conditions, so people were cut off from a lot of social support.”

The study was funded by a $75,000 grant from Passport Health Plan’s Improved Health Outcomes Program and a $50,000 grant from Kosair Charities.

Four years into Obamacare, Kentucky's uninsured rate leveled out, and probably rose. Why? It depends on whom you ask

By Melissa Patrick
Kentucky Health News

In the fourth full year since the Patient Protection and Affordable Care Act was implemented, the percentage of Kentuckians without health insurance remained about the same, and probably increased. 2017 was the first year the percentage hasn't dropped since the program's inception in 2014, according to a new report from the U.S. Census Bureau, with data from its year-round American Community Survey.

In 2017, 5.4 percent or 235,000 Kentuckians had no health insurance, up slightly from 5.1 percent in 2016, a change that is statistically insignificant, because the poll's error margin was 0.3 percentage points. But chances are that the uninsured rate rose slightly.

Kentucky's uninsured rate was once relatively high, and the drop in it has been by some measures the greatest in the nation.

Before 2014, when Kentucky used the Patient Protection and Affordable Care Act to expand Medicaid to residents with incomes up to 138 percent of the federal poverty level, 14.3 percent of Kentuckians, about 616,000, didn't have health insurance. The expansion has added nearly 500,000 people to the Medicaid rolls.

Click on chart to view a larger version

“Medicaid expansion has been a game changer in the commonwealth. Because so many more Kentuckians now have coverage, people are getting healthier, hospitals are thriving and our economy is moving ahead,” Dustin Pugel, policy analyst for the left-leaning Kentucky Center for Economic Policy, said in a news release.

In general, the Census report shows that there is a clear divide in the uninsured rate among states that expanded Medicaid and those that haven't. In the 32 expansion states as of Jan. 1, 2017, the average uninsured rate was 6.5 percent, about half the 12.2 percent rate in states that haven't expanded.

Between 2016 and 2017, the rate did not significantly change in expansion states as a whole, and increased by 0.4 percentage points in non-expansion states.

Nationally, the share of Americans without health insurance remained the same in 2017, at 8.8 percent, or 28.5 million people.

The survey also found that 96.2 percent of Kentucky's children had health insurance in 2017, up from 93.6 percent in 2013. Children are covered by the Children's Health Insurance Program, a program similar to Medicaid in which the federal government pays most of the cost. Kentucky calls its part of the program KCHIP.

“Having health insurance means children are able to visit the doctor and the dentist to get the care they need to stay healthy," Terry Brooks, executive director of Kentucky Youth Advocates, said in a news release. "It means parents can take care of their health needs, so they can stay healthy and provide for their family. And, we know there is an undeniable link between parent’s coverage and their child’s coverage. As more parents receive coverage and care, so will their kids."

CommonWealth Magazine image

What the plateau in coverage numbers means depends on whom you ask.

Obamacare opponents blame the stalled progress in reducing the uninsured rate on rising premiums in the individual market, Rachel Roubein reports for Politico.

Supporters of the Affordable Care Act continue to be concerned about the Trump administration's ongoing attempts to repeal and "sabotage" the ACA, noting the shortened window to sign up for subsidized health insurance, huge cuts to the advertising budget and "navigators" who help people find an insurance plan, the removal of the individual mandate to have health insurance, and pending lawsuits to remove the requirement for coverage of pre-existing conditions.

Meanwhile, proponents are closely watching what will happen if Gov. Matt Bevin's new Medicaid plan is approved, after being vacated by a federal judge in Washington, D.C., just days before it was set to start on July 1.

The judge said federal officials had not sufficiently considered public comments about then plan, which were overwhelmingly against it, or the state's estimate that in five years its Medicaid rolls would have 95,000 fewer people with the plan than without it, partly due to noncompliance. The judge sent it back to the U.S. Department of Health and Human Services for more review.

The plan would require "able-bodied" Kentuckians who are not primary caregivers to work, attend school, take job training or volunteer 80 hours a month, or enroll in a drug-treatment program if appropriate. It also includes small, income-based premiums and lockout periods for noncompliance, among other things.

The Bevin administration is proceeding as if the plan will be approved, recently holding a hearing to discuss its regulations and continuing to hold stakeholder meetings to discuss it. At the Sept. 6 stakeholder meeting in Frankfort, asked how long the state expects the approval process to take, Kristi Putnam, deputy secretary of the health cabinet, said, "We don't think it will take a long time."

Bevin has said he will end the expansion if courts block his new Medicaid plan, and has issued an executive order putting the termination into effect six months after a final court judgment.

Health Secretary Adam Meier told lawmakers in August that the state is considering eliminating the expansion because Medicaid is facing a nearly $300 million shortfall. The new plan estimates that it would save $300 million over the next five years if it is allowed to proceed, with most of the savings a result of covering 95,000 fewer people.

Pilot program, 'community paramedicine,' reduces ambulance runs to 'super-utilizers' and gives them appropriate care

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Kentucky has several "community paramedicine" pilot programs that allow specially trained paramedics to visit the homes of patients who frequently use the ambulance service to be taken to the emergency room. The program that has resulted in 2 percent fewer ambulance runs in Lexington since February, Miranda Combs reports for WKYT-TV.

"The old idea of the house calls, it's coming back around now," EMS Medical Director Dr. Ryan Stanton told Combs. "It's kind of an untapped resource," he said, speaking of EMTs and paramedics. "It's a resource that we know can do a lot more than they've been asked to do in the past."

Using community paramedics to care for "super-utilizers" is a relatively new concept in Kentucky, but as the number of ambulance runs kept rising "at a record pace," firefighters and EMS told Combs, something had to change.

"In 2013, Lexington fire and EMS made 33,500 ambulance runs, and in 2017 they were up to 48,000 ambulance calls," Combs writes. At the launch of the program in February, Lexington Mayor Jim Gray added in a news release that 266 people accounted for nearly 9 percent of calls and that medical-run volume had grown 7.5 percent per year in the last three years.

WKYT went on one of the community paramedicine runs to meet Alice, one of their patients who lives in a Lexington apartment and has no family or friends to look out for her. After being put on the community paramedicine list, the crew started visiting Alice in her home and discovered that her dizzy spells were the result of an abnormal heart rhythm that the ER wasn't catching.

Lt. Patrick Branam told Combs that this program allowed them to be able to connect the "pieces of the puzzle" and then get her to the appropriate place for care. They now take her to see a cardiologists, which he said has "made all the difference for her."

Firefighters in Lexington told Combs that they are hoping they will have enough funding to continue the program when the grant runs out. The February news release reports that the Lexington program will run through late 2018 and is funded by a $252,210 federal grant, plus $25,221 in local funds.

Community paramedicine pilots are also being conducted in Louisville, Oldham County, Paducah and Montgomery, according to a University of Kentucky news release.

About 100 Anderson Co. students out of school until they get hepatitis A vaccine; state sees 'overall good compliance' in Ky.

Nearly 100 students had to stay home from school in Anderson County this week because they were not compliant with the state's new hepatitis A vaccination requirement, Ben Carlson reports for The Anderson News.

Since August 2017, Anderson County has had seven reported cases of the highly contagious liver disease, according to a weekly Department of Public Health report. One of them was a student at Anderson County High School.

Carlson reports that the health department said that as of Tuesday, Sept. 11, the high school and Anderson County Middle School had the highest number of non-compliant students, with 48 and 35, respectively, and the rest scattered in elementary schools and an early-childhood center.

County Health Director Tim Wright told Carlson that there was no reason for students to have shown up to school in early August without being in compliance. “We started advertising this in July of 2017,” he said. “The requirement was for August of 2018, so we advertised it for 13 months.”

Lexington's WKYT-TV reported on Sept. 6 that School Supt. Sheila Mitchell said students and their families had been well informed about the new requirement and the Sept. 7 deadline, adding that they had worked closely with the the Anderson County Health Department and Cumberland Family Medical to provide two clinic days at school for all students to get vaccinated or seek exemptions.

Wright told Carlson he was "disappointed" that schools let non-compliant students in on Monday, Sept. 10, even though they had been told not to come if they hadn't been vaccinated for hepatitis A. He was also frustrated that the school district still couldn't tell him how many of the 350 people who could have been exposed to the student who tested positive for the disease had had their vaccine.

Carlson reports that Supt. Mittchell did not respond when asked why non-compliant students were allowed to attend on Monday, nor could she answer why the school's Cumberland Family Medical nurse left Monday in the middle of sorting through which students remained non-compliant. Cumberland Family Medical also refused to comment on why the nurse left.

Despite his many frustrations, Wright told Carlson: "The positive thing is, we don’t have any more confirmed cases. Hopefully we won’t have an outbreak but, as of today, those not in compliance are not in school.”

State Public Health Commissioner Dr. Jeffrey Howard told Kentucky Health News in an e-mail that the state health department has received "sparse reports" from across the state of only a few students being held out of school for not being vaccinated for hepatitis A.

"However, when our team investigated the case of a student with HAV [hepatitis A] in Anderson County, they discovered many students were not in compliance with vaccination recommendations," he said. "Having 100 students without the appropriate vaccination at a single school [district] is an extreme exception to what has been overall good compliance."

Fayette County becomes 11th Kentucky county to recommend that all its residents be vaccinated for hepatitis A

As the number of hepatitis A cases continues to climb in Kentucky, health officials in Fayette County are recommending all Lexington residents get vaccinated, Mike Stunson and Karla Ward report for the Lexington Herald-Leader.

“The best way to prevent hepatitis A is to get vaccinated,” said Dr. Kraig Humbaugh, the Fayette County health commissioner. “The vaccine is effective and has an excellent track record. However, most adults have not yet been immunized, since the vaccine was not given routinely as part of their childhood schedule of shots.” The state recently required all students to prove that they have had the two-dose hepatitis A vaccine.

As of Sept. 1, there have been 1,628 cases of hepatitis A in the state since November. That number includes 919 hospitalizations and 13 deaths, according to the state Department of Public Health. The weekly report also offers county level data. Since August, 86 of the state's 120 counties have reported an "outbreak-associated case."

The Lexington-Fayette County Health Department has reported 12 cases since Aug. 1, 2017, with half of those cases being reported since July, including three this month.

"Humbaugh said a significant percentage of those who have contracted the disease statewide were not part of an at-risk population," the Herald-Leader reports. He said, “We wanted to wait until we thought there was a concern about transmission to the wider community.”

In April, the state health department urged citizens of six counties, including Jefferson, Bullitt, Hardin, Greenup, Carter and Boyd, to get vaccinated for hepatitis A. The Northern Kentucky Health Department urged residents of its Boone, Grant, Kenton and Campbell counties to do the same in August.

The primary risk factors in Kentucky continue to be illicit drug use and homelessness, and so far the state has had no reported transmissions of hepatitis A involving food-service workers.

Dr. Jeffrey Howard, the state health commissioner, told Kentucky Health News that the state health department gets a lot of calls from people who are worried about eating out and said his advice is: "You are OK to go out to eat in your local restaurants. The risk of getting hepatitis A from an infected food worker as long as they are adhering to normal precautions is very minimal."

Howard added that he expects the epidemic to last another eight to 12 months in Kentucky.

Symptoms of hepatitis A include fever, fatigue, loss of appetite, nausea, abdominal discomfort, dark urine and yellowing of the skin and eyes (jaundice). Not everyone with the virus has symptoms and a person with the virus is contagious for up to two weeks before showing symptoms. People can become ill 15 days to 50 days after being exposed to the virus, the health department said.

The disease is “usually spread when a person unknowingly eats or drinks something contaminated by small amounts of stool from an infected person,” according to the health department.

Besides vaccination, thorough hand washing for about 20 seconds with soap and water after using the bathroom, before eating and when returning home from being out in the public is also an important way to decrease the risk of transmission. It's also important to note that hand gels are not an alternative because they do not kill the virus that causes hepatitis A.

Study shows Kentucky ranks fifth for daily electronic cigarette use, which translates to about 80,000 daily vapers in the state

From 2012 to 2014, Kentucky ranked fifth for daily use of electronic cigarettes and was among the top 10 states for current use, which includes occasional use, Darla Carter reports for Insider Louisville. That translates to more than 206,000 (5.9 percent) of Kentuckians vaping either daily or occasionally and 80,000 (2.3 percent) vaping every day, said one of the authors of the study that found the data.

National Adult Tobacco Survey, 2012-14, with estimates of current
use among adults in the U.S. Kentucky is among the top 10 states.

 The study by the American Heart Association Tobacco Regulation and Addiction Center, published in Annals of Internal Medicine, used 2012-14 data from the National Adult Tobacco Survey and the American Lung Association's State of Tobacco Control annual reports for 2012 and 2013 to examine the association between state-level tobacco control measures and e-cigarette use, while also accounting for socio-demographic use.

Aruni Bhatnagar of the University of Louisville, one of the study authors, told Carter that this high use of e-cigarettes is likely related to the state's high smoking rate, which is nearly 25 percent: “If you have a high number of smokers to begin with, you’re going to have a high number of people who are using e-cigs.”

Table from Insider Louisville

The researchers found that 15 percent of e-cig users had not used cigarettes before. They found of the 10.8 million adult e-cigarette users in 2016,  2.8 million of them were 18- to 24-year-olds, which had the highest rate of current use. Over half of current users were under 35.

“That’s interesting and potentially concerning,” Dr. Michael Blaha, senior author and director of clinical research for the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, told Carter.

Many in the medical community continue to be concerned about the safety of e-cigarettes, though a report from the National Academies of Sciences, Engineering and Medicine recently concluded that "while e-cigarettes are not without health risks, they are likely to be far less harmful than conventional cigarettes," Carter writes. 

“E-cigarettes cannot be simply categorized as either beneficial or harmful,” David Eaton, chair of the committee that wrote the report, said in a news release at the time. “In some circumstances, such as their use by non-smoking adolescents and young adults, their adverse effects clearly warrant concern. In other cases, such as when adult smokers use them to quit smoking, they offer an opportunity to reduce smoking-related illness.”

Dr. Sarah Moyer, director of the Louisville Metro Department of Public Health and Wellness, disagreed.

“The growing use of e-cigarettes threatens to reverse the trend of making nicotine addiction less socially acceptable and of falling smoking rates,” Moyer said in a written statement to Insider Louisville. “Their use in public places also poses health dangers to non-users from secondhand exposure."

Bhatnagar, who also directs UofL’s Envirome Institute, made similar comments: “In young people, smoking is no longer cool or socially acceptable, and now with the advent of e-cigarettes, it can erode all the gains that we’ve been making in trying to contain nicotine addiction.”

Bhatnagar told Carter that nicotine isn't good for the developing brains of young adults, can affect their cardiovascular health, and creates an addiction that is hard to kick, making it easier to switch to regular cigarettes.

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

By Kate Hendrickson

Community columnist, Lexington Herald-Leader

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

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

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

Getty Images/Vetta via Lexington Herald-Leader

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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