Free webinar Nov. 28 on why Ky. cities and counties can't pass local laws around the distribution, sale and regulation of tobacco

The Foundation for a Healthy Kentucky is offering a free webinar about how state laws prevent local governments from passing tobacco-control ordinances and other health policies in Kentucky.

The laws "pre-empt" local regulations on distribution, sale and regulation of tobacco products, so if a city or county in Kentucky wants to pass an ordinance to raise the legal age to purchase tobacco products, or ban tobacco flavors in electronic cigarettes that appeal to youth, they can't.

Presenters in the webinar will share their experiences with teh issue and discuss advocacy strategies for countering and repealing pre-emption laws.

They include Tonya Chang, vice president for advocacy with the American Heart Association Great Rivers Affiliate; Ellen J. Hahn, professor, University of Kentucky Colleges of Nursing and Public Health; Traci Kennedy, consultant to Americans for Nonsmokers' Rights; and Mark Pertschuk, director of Grassroots Change: Connecting for Better Health.

The free one-hour webinar is part of the foundation's Health for a Change training series. It will be held Wednesday, Nov. 28 from 1 p.m. to 2 p.m. Click here to register.

Louisville psychiatrist writes book about landmark research that gets to root of why people struggle in their relationships

Nov. 18, 2018: Story updated to reflect Living on Automatic: How Emotional Conditioning Shapes Our Lives and Relationsips was chosen by American Book Fest as a finalist for the "2018 Best Book Award" for best new non-fiction .

By Melissa Patrick
Kentucky Health News

In a world inundated with interpersonal conflicts, a Kentucky psychiatrist has written a groundbreaking new book that explains what lies at the root of these conflicts and offers a way to resolve them.

"It's a book that talks about why the things that go wrong in our relationships go wrong, and why we live on automatic pilot and do things that we sometimes don't even want to do, but we repeat them over and over again and we wish we could stop," Dr. Christine B.L. Adams, one of the book's authors, said in a telephone interview.

The book, Living on Automatic: How Emotional Conditioning Shapes Our Lives and Relationships, is a collaborative effort between Adams, a child psychiatrist in Louisville, and the late Dr. Homer B. Martin, her colleague and mentor. Adams said their landmark research around emotional conditioning is based on 80 combined years of psychotherapy with thousands of patients. It was recently chosen by American Book Fest as a finalist for the "2018 Best Book Award" for best new non-fiction.

The authors write that people are emotionally conditioned within the first two to three years of life by their parents or caretakers to fall into one of two roles that form the basis of their personalities.

The two roles are called omnipotent and impotent. An omnipotent is conditioned to please and do for others; an impotent is conditioned to need constant emotional care and attention from others. Each role is a matter of degree, the authors say; people fall on a continuum from mild to severe for each of these conditioned roles.

The result of this emotional conditioning, Adams says, is that people tend to seek relationships that meet their own needs, rather than relationships that recognize each other as individuals.

But this isn't working, she said, pointing to how interpersonal conflicts have resulted in such high rates of divorce and substance abuse and increasing conflicts between parents and their children.

"So this says to me that the way we've been doing it has not been very successful and perhaps there is a better way," Adams said.

That way, she says, is for people to re-learn how to interact with each other in ways that promote better relationships. She calls it deconditioning, and explains it in the final chapters of the book.

"What you learn to adopt when you try to shed your conditioning is a standard of reasonableness rather than a standard of automatic conditioned responding," she said. "You have to learn a technique of evaluating yourself and the other person simultaneously in every exchange you have with them."

She added that this technique helps a person determine what is called for in each situation.

"In this way you don't automatically respond just to the role of the other person," she said. "You respond according to what each person needs for the particular situation at that particular time."

Adams said people who have gone through this process "have much better lives, are able to manage their lives better and have better relationships," and when one person goes through the process it typically has a "ripple effect" throughout a family and others who are close to them.

Beyond romantic relationships, Adams said the book also has applications for young parents to help them raise "more well-balanced" children, as well as help for agencies that work with children.

She said the book is written for a general audience, in hopes of bringing awareness to this new concept of emotional conditioning, and how this causes us to act on automatic pilot most of the time when it comes to our relationships.

"This is a landmark study of what really happens in relationships," she said. "And when you impart information to people that they've not known before, then a lot of people start thinking about it in new ways and will apply it to themselves and their family and their friends."

Look beyond premium costs when choosing a Medicare plan; Medicare Advantage may not be an advantage for you

By Trudy Lieberman, Rural Health News Service

Making decisions about Medicare coverage has never been easy. Over the years the task has become more complicated as Congress has moved to privatize the system.

Open enrollment, the time for evaluating your coverage and making changes if you can, opens Oct. 15 and runs through Dec. 7 this year. This is the first of two columns that address decisions people about to become eligible for Medicare and those already on the program will have to make.

While some 57 million people are still in traditional Medicare, which remains a social insurance program, the number of beneficiaries in privatized Medicare known as Medicare Advantage has grown steadily. Today one-third of all beneficiaries have joined private plans, many of them responding to sales pitches - sometimes questionable ones - from insurance companies that now regard their Medicare Advantage business as a major profit center.

With a Medicare Advantage plan, generous payments from the federal government to private insurers allow them to provide a person’s Medicare benefits along with some extras like eyeglasses, limited dental care, and gym memberships. The government payments have been so rich they’ve also allowed the plans to entice people to join by offering coverage with no monthly premium or a very low one.

So the first basic choice is whether to select traditional Medicare -- and buy a supplement to fill in what Medicare doesn’t pay -- or to select a Medicare Advantage plan.

Increasingly, though, some people may not have a choice. More employers who fund part of their retirees’ health insurance are automatically enrolling their workers about to retire in Medicare Advantage plans, and those workers may not understand what they are getting, said Tricia Neuman, a senior vice president of the Kaiser Family Foundation: “Employers may see this as an attractive way to shift some of the risk to employees.”

A few years ago, I met a retiree of a computer firm in California who had developed Parkinson’s disease and was seeking help from the state’s insurance counseling program to switch out of the employer’s retiree Medicare Advantage plan. He was having trouble seeing the specialists he needed to treat his disease.

Counselors told him he had few options. He could easily drop his Medicare Advantage plan and return to traditional Medicare. But he was no longer eligible to buy a Medigap policy, which he sorely needed.

California, like almost every other state, says insurers offering Medigap policies may scrutinize senior applicants’ health status once those seniors have passed their initial eligibility period. That period is generally the first six months after they sign up for Medicare Part B, which pays for physician services and hospital outpatient care. After that, if you have a preexisting condition, you’re out of luck.

Only New York, Connecticut, Massachusetts, and Maine allow seniors to buy a Medigap policy anytime. A few other states allow seniors to buy them under certain conditions - like losing retiree coverage. Seniors living outside those states, though, could be making an irrevocable decision by choosing a Medicare Advantage plan or allowing themselves to be placed in one automatically.

Yet the allure of no monthly premium or a cheaper premium than a Medigap policy would require draws seniors to Medicare Advantage plans. A cheaper premium or no premium sounds good when you’re well, but what happens when you’re sick? That’s when many seniors find they want to go back to traditional Medicare.

“Premiums are not a good way to choose a plan. It’s important to look beyond the premium,” Neuman advises.

Still, not much is known about how seniors in Medicare Advantage plans fare when they have a really serious illness. But in late September the Office of the Inspector General reported that insurers offering Medicare Advantage plans may be inappropriately denying services to seniors and called on Medicare to step up its oversight of those plans.

The Office of the Inspector General found that Medicare Advantage plans overturned 75 percent of their denials between 2014 and 2016, raising questions about why seniors were denied in the first place.

“The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided,” the report noted. “This is especially concerning because beneficiaries and providers rarely used the appeals process.” Seniors may be denied services but never register any complaints.

As with all insurance, you make a trade-off. Pay less upfront and more when you get sick, or minimize your risk by paying more in premiums to have better coverage when illness strikes. That is the great-unknown seniors must consider.

Traditional Medicare plus a good Medigap can become your best friends if you have a hospitalization for a serious illness as I had when an infection came out of the blue and kept me in the hospital for four months earlier this year. For doctor, hospital, and rehabilitation charges that totaled some $3.5 million, we paid only about $2,500 out of pocket.

My next column will address finding a good drug benefit.

What experience have you had with Medigap policies or Medicare Advantage plans? Write to Trudy at trudy.lieberman@gmail.com.

Need for improved staffing in nursing homes and hospitals was among timely topics at annual Health Watch USA conference

By Melissa Patrick
Kentucky Health News

Several speakers at the Oct. 4 Health Watch USA Healthcare Transparency and Patient Safety Conference in Lexington talked about the importance of adequate staffing in nursing homes and hospitals to maintain and improve safety for patients and staff.

Sherry Culp of the nonprofit Nursing Home Ombudsman Agency of the Bluegrass said that while regulations issued in 2016 by the Centers for Medicare and Medicaid Services have offered some positive changes, such as requirements for improved training and "appropriate competencies and skills," and better provisions for planning of care, it didn't do enough with staffing.

"The final rule really fell short on nursing staffing standards," she said. "We wanted there to be registered nurses in the building 24 hours a day. . . . We know that an RN level of nursing is the level that has the competence to deal with some of the significant changes in conditions that occur in this vulnerable population."

Culp said the rules only require an RN to be in the building eight hours a day, and that person is often "locked up in an office doing paperwork," while 90 percent of the care is provided by nurse aides, who have less than 100 hours of vocational training. Her agency monitors living conditions at nursing homes and informs residents of their legal rights.

Woodcrest Nursing and Rehabilitation Center in Elsmere has
a one-star rating. In 2016 a resident fell down the stairs in his
motorized wheelchair, died and went undiscovered for
nine hours. (Herald -Leader photo by Marcus Dorsey)

She said the agency gets calls from overwhelmed aides who tell her they have been put into impossible situations to care for as many as 40 people with little orientation and no help. "I think a lot of nurse aides are just thrown to the wolves," Culp said.

As part of a three-part, in-depth report on the dismal state of Kentucky's nursing homes, John Cheves of the Lexington Herald-Leader reports about the staffing issues in Kentucky's nursing homes, noting that collectively Kentucky's nursing homes rank as some of the worst in the country.

As of Aug. 7, he reported that Kentucky had 52 "one-star" nursing homes (18 percent of the state total), which are considered to be "much below average" and 71 "two-star" homes (25 percent), which are "below average." These ratings come from CMS's five-star rating system, which looks at a facility's staffing, health inspections and quality of resident care.

Hospitals have staffing issues, too

Staffing issues are also an issue in hospitals, said Christine Pontus, associate director of health and safety for the Massachusetts Nurses Association.

Pontus pointed out that registered nurses are vital to the care of patients because they are the front line person to recognize and react to a patient's ever-changing health status. She called this process "surveillance" and said that basically, "That's what nurses do."

She shared research to support the importance of nursing surveillance, which found that "greater nurse surveillance capacity was significantly associated with better quality of care and fewer adverse events," and the ability of nurses to provide appropriate surveillance is, among other things, largely dependent on adequate staffing.

Culp said RNs are needed 24 hours a day in nursing homes because it is imperative that someone with appropriate training be able to to determine if further care is needed when residents fall and hit their head. She said some of these fall victims have injuries that go unnoticed, "sometimes ever, or until their death or weeks later."

One study of staffing in hospitals, found that RNs who work in an environment that supports their physical and emotional safety are more able to provide better surveillance, which ultimately leads to improved patient outcomes, more positive patient experiences and higher RN engagement rates.

"National, peer reviewed studies show higher patient assignments are associated with more patient deaths, complications, medication errors and readmissions," Culp said.

Pontus noted that while Medicare requires "adequate" numbers of nurses at all levels, it doesn't define the term or who determines the numbers. Similarly, she said the Joint Commission that accredits hospitals calls for the "number, competency and skill mix of staff in relation to the provision of needed care and treatment," but does not clearly define or offer a formula to determine this mix.

"These ambiguous statements allow health care facilities to continue to operate at or below minimum [staffing] levels," she said. "Something is not working. Regardless of all the regulations and the Joint Commission, it's not working and we need to do something."

Jonathan Rosen, safety and health consultant for AJ Rosen & Associates LLC, cited another study that looked at nurse staffing and hospital deaths: "We estimate that the risk of death increased by 2 percent for each below-target shift and 4 percent for each high-turnover shift to which a patient was exposed."

So far, California is the only state to pass a nurse-to-patient ratio law. Rosen said a study found that since the requirements took effect, nurses' occupational injuries have dropped one-third.

Legislators say nursing-home staffing issues need a hearing soon, but co-chair of health panel suggests there's no time before 2019

State legislators want a hearing on nursing home staffing in Kentucky, following a series of stories in the Lexington Herald-Leader that showed how some residents have died as a result of neglect. "A Republican leader of the key committee on health care said she is getting letters from dozens of concerned nursing home residents in her district, urging her to support minimum staffing standards for the facilities," the newspaper reports.

“It sounds to me like a public discussion is due on this sooner rather than later,” state Sen. Julie Raque Adams, R-Louisville, told reporter John Cheves, who wrote the series. Adams is co-chair of the legislature’s Interim Joint Committee on Health and Welfare and Family Services.

Committee co-chair Rep. Addia Wuchner

The House chair of the panel, retiring Rep. Addia Wuchner, R-Florence, expressed doubt that it would be able to take up a bill pre-filed for the 2019 session to set staffing standards for nursing homes at any of its remaining monthly meetings before the session begins in early January. She told Cheves that the agendas are "jammed full."

"The committee is scheduled to meet Oct. 17, Nov. 27 and Dec. 12," Cheves notes. "An identical bill was ignored during the 2018 legislative session last winter, despite the sponsor, state Rep. Rick Nelson, D-Middlesboro, repeatedly calling for a committee hearing at that time." Nelson is also leaving the legislature.

Read more here: https://www.kentucky.com/news/politics-government/article219496255.html#storylink=cpy

"Meanwhile, Adams said, she plans to meet in coming weeks with her unhappy constituents in their nursing homes to learn more about the risks of having too few nurses and nurse’s aides on duty to care for residents," Cheves reports, quoting her: “I don’t know what’s going on behind the scenes, but there does seem to be some sort of initiative emerging here from the residents. This is clearly an important issue to them.”

About 34,000 Kentuckians live in long-term-care facilities, 12,500 in nursing homes, the Herald-Leader reports.

Another health committee member, Sen. Reginald Thomas, D-Lexington, told Cheves that a hearing is needed. “We have some of the worst nursing-home ratings in the country here in Kentucky,” he said. “We need to have standards for how many employees are on duty taking care of residents. The only time we talk about nursing homes in Frankfort, it’s for tort reform, to stop the so-called frivolous lawsuits after someone gets hurt. Maybe we should stop people from getting hurt.”

The Herald-Leader series reported that 43 percent of Kentucky’s 284 nursing homes were rated as “below average” or “much below average” this year by the Centers for Medicare and Medicaid Services. "That’s among the worst collective ratings for nursing homes in the country," Cheves reports.

In a column, the Herald-Leader's Tom Eblen writes, "The Kentucky Association of Health Care Facilities reported in 2017 that members had raised more than $170,000 in donations for state Senate and House races. That seems to be why bills filed year after year to set minimum nursing home staffing requirements never see the light of day." He urges readers to check the Kentucky Registry of Election Finance website to see who is giving to their legislators.

In an editorial calling for action, the Herald-Leader says, "Shamefully, our legislature has done more to protect the nursing home industry than to protect the Kentuckians who live in nursing homes. . . . We don’t expect easy solutions. The nursing home industry is a powerful lobby. But for the legislature to keep ignoring the problems in the face of so much suffering is cowardly and wrong and must end."

Frankfort fast-food restaurant closes for cleaning after one employee is found to have hepatitis A

A Frankfort fast-food restaurant closed for cleanup after one of its employees was found to have the liver disease hepatitis A, usually caused by ingestion of fecal material.

“The risk of infection from this food-service worker is very low due to hand-hygiene requirements at Hardee’s and all eating establishments,” Franklin County Health Department Director Judy Mattingly said in a news release.

Top of health department news release

The restaurant, at 1248 South US 127, "voluntarily closed . . . for a thorough cleaning and sanitizing after being notified," and ensured that all employees received a hepatitis A vaccination immediately, said the release, posted on the department's Facebook page.

The department later posted, "Prior to Oct. 4 the food service worker was in roles wearing gloves, or roles where there was no contact with food. So, the minimal risk of exposure occurred on Oct. 4. Any concerned community member should get a hepatitis A vaccine before Oct. 18."

"It’s the 22nd case of the virus in Franklin County during the ongoing outbreak in Kentucky — called the worst in the nation," Josh Bergeron of The State Journal reports. "From Aug. 1, 2017, to Sept. 22, 2018, the latest available numbers, the hepatitis A outbreak in Kentucky numbered 1,851 cases, with 1,029 hospitalizations and 14 deaths. In Franklin County, there had been 21 total cases reported as of Sept. 22. A majority of the reported cases in Kentucky have been linked to illicit drug use." 

Hepatitis A can cause fatigue, loss of appetite, nausea, fever, stomach pain, brown urine, light-colored stools, and yellowing of the eyes or skin or eyes. People may have some of these symptoms or none of them; a person can transmit the disease without showing symptoms, and can become ill from the virus up to seven weeks after being exposed to it.

The disease "usually spreads when a person unknowingly ingests the virus from objects, food or drinks contaminated by small, undetected amounts of stool from an infected person," the news release said. "The virus spreads when an infected person does not wash his/her hands adequately after using the toilet, or engages in behaviors that increase risk of infection."

The federal Centers for Disease Control and Prevention recommends the hepatitis A vaccination for the following groups:
• All children at age 1
• Travelers to countries that have high rates of hepatitis A
• Family members and caregivers of recent adoptees from countries where hepatitis A is common
• Men who have sexual contact with other men
• People who use injection and non-injection illegal drugs

• People with chronic (lifelong) liver diseases, such as hepatitis B or hepatitis C

Lexington hepatitis A cases more than double, highlighting local health department's call for vaccination against the liver disease

The number of hepatitis A cases in Fayette County more than doubled last month, says the Lexington-Fayette County Health Department. It confirmed 13 cases in September, increasing its total in the year-long statewide outbreak ro 24.

Of the total, 13 were from drug use, four were homeless people involved with drug use, and two were people who were in contact with a homeless person affected, department spokesman Kevin Hall told Mike Stunson of the Lexington Herald-Leader.

Four of the cases had no risk factors, “so it’s important for everyone in the community to be aware of the need for the hepatitis A vaccine,” Hall said.

Last month, the health department advised all residents of the county to get vaccinated for the liver disease as the outbreak continued to spread. The vaccine is given in two doses, six months apart.

“The best way to prevent hepatitis A is to get vaccinated,” said Dr. Kraig Humbaugh, the 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.”

Health officials also stress the need to wash hands. The disease is “usually spread when a person unknowingly eats or drinks something contaminated by small amounts of stool from an infected person,” the health department says.

As of Sept. 22, there had been 1,851 cases of hepatitis A in Kentucky since November. "The number includes 1,029 hospitalizations and 14 deaths, according to state health department data," Stunson reports.

Hepatitis A symptoms include fever, fatigue, loss of appetite, nausea, abdominal discomfort, dark urine, and yellowing of the eyes and skin. People can become ill 15 days to 50 days after being exposed to the virus.

The Mayo Clinic and the federal Centers for Disease Control and Prevention say there is no treatment for hepatitis A, "which eventually leaves the body on its own," Stunson reports. "Some patients’ symptoms, including nausea, are treatable. Some severe cases with more problems require hospitalization. Liver failure can lead to death."

Read more here: https://www.kentucky.com/news/local/counties/fayette-county/article219480605.html#storylink=cpy

Smoke-Free Coalition will lobby for state law to ban tobacco products and e-cigs from all school property and activities

By Melissa Patrick
Kentucky Health News

Concerned that historic declines in youth tobacco use will be undermined by the "exploding popularity" of Juul and other e-cigarettes, Kentucky's Coalition for a Smoke-Free Tomorrow says it will lobby for a law making all schools in the state 100 percent tobacco-free in the upcoming year.

Photo by The Sentinel-Echo, London, Ky. 

"We're suddenly seeing epidemic levels of kids vaping e-cigarettes, and we've got to get a handle on it before we totally reverse the gains we've made in the last couple of decades in reducing youth tobacco use," Ben Chandler, chair of the coalition, said in a news release.

The latest Kentucky Health Issues Poll  found 87 percent of Kentucky adults would support such a law, and polls since 2013 have found strong support for the policy, but there has been little legislative progress toward it, and fewer than half of local school boards have acted. School-board seats are on the ballot in all districts this fall.

"It's a good time to ask school board candidates what they think about such a policy, and if they would support it or not," said Al Cross, director of the Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News.

Legislative bills to require all school properties and school events to be tobacco-free have gained little to no traction. Two were introduced in the last session, but were not called up in the legislature's education committees. The Senate passed one in 2017, but the House didn't take it up.

The coalition says it will promote a comprehensive policy that "prohibits the use of all tobacco products, including e-cigarettes and vapor products, by staff, students and visitors at all times inside board-owned buildings or vehicles, on school property, and during school-sponsored field trips, sports events and other activities."

It also wants the law to provide adequate funding for signage and other tools to implement the policy, make penalties for violation appropriate and not prevent students from learning, and allow local bodies to enact stronger policies than the state policy.

Fewer than half of Kentucky's school districts have enacted such policies. As of July, 72 of the 173 districts had adopted 100 percent tobacco-free school policies, covering 734 schools and 57 percent of the state's students. Federal law only prohibits smoking inside schools that receive federal funding.

"A statewide tobacco-free schools law would expand a powerful tool already used by 734 schools in the state to all Kentucky public schools, in order to reduce youth exposure and peer pressure to tobacco products and create an atmosphere where tobacco use is not the norm," the coalition said.

Coalition for a Smoke-Free Tomorrow chart

Kentucky's high school students smoke at a much higher rate than the national average, 14.3 percent compared to 8.8 percent. Almost as many, 14.1 percent, use e-cigarettes, a bit above the 13.2 percent nationally, according to the 2017 Youth Risk Behavior Survey.

The e-cigarette figures are probably higher now, health experts have warned, because Juul sales have surged since the survey -- so much that it's prompted the U.S. Food and Drug Administration to crack down on them and other vaping-product companies over their teen marketing strategies.

Juuls and their cheaper knock-offs are especially popular among teens because they are small and look like an oversize USB drive, making them easy to hide from parents and teachers. They also offer flavors that are appealing to youth, and pack a powerful nicotine punch.

Congress sends President Trump a huge, comprehensive, bipartisian bill to fight the opioid epidemic; he says he will sign it

By a 98-1 vote Wednesday, the Senate passed the final version of a comprehensive package to address the opioid epidemic and sent it to President Donald Trump, who is expected to sign it "just in time for lawmakers to campaign on the issue before the November elections," Colby Itkowitz reports for The Washington Post.

Sen. Mike Lee (R-Utah) cast the only opposing vote. The House passed its version of the bill last week 393-8. Trump issued a statement saying "I look forward to signing this historic legislation."

The 653-page bill "unites dozens of smaller proposals sponsored by hundreds of lawmakers, many of whom face tough reelection fights," Itkowitz notes.

Senate Majority Leader Mitch McConnell noted that more people in recovery will have access to housing and work opportunities because of his legislation that was included in the package. "With today’s vote, the Senate will say this to every American affected by the opioid epidemic: America is fighting back against this crisis," said McConnell, who is already running for re-election in 2020.

Considered one of Congress's most significant legislative achievements this year, the legislation "creates, expands and reauthorizes programs and policies" and addresses both law-enforcement and public health measures, particularly around prevention, treatment and recovery, Itkowitz reports.

Associated Press photo by Patrick Sison

Opioid overdoses were responsible for nearly 50,000 U.S. deaths last year, 1,565 in Kentucky.

Itkowitz reports that Sen. Rob Portman (R-Ohio), "who sounded the alarm on opioid addiction four years ago," is credited with the bill's provision that will require the U.S. Postal Service to screen packages for synthetic fentanyl shipped from overseas, mainly China.

Portman said in a floor speech Tuesday, “How many people had to die before Congress stood up and did the right thing with regard to telling our own post office you have to provide better screening?”

Among other things, the legislation allows more health-care providers to prescribe medication for opioid addiction; will make it easier for Medicaid recipients to get inpatient care for substance abuse over the next five years; and provides funds for the research and development of new, non-addictive painkillers. It would also create a grant program for comprehensive recovery centers that include housing and job training, as well as mental and physical health care.

Public-health advocates are pleased with the bill's increased attention to treatment, but "many experts" are concerned that it doesn't dedicate enough long-term funding to fight a crisis of this magnitude, Itkowitz reports.

“This legislation edges us closer to treating addiction as the devastating disease it is, but it neglects to provide the long-term investment we’ve seen in responses to other major public health crises,” Lindsey Vuolo, associate director of health law and policy at Center on Addiction, told Itkowitz. “We won’t be able to make meaningful progress against the tide of addiction unless we make significant changes to incorporate addiction treatment into the existing health care system.”

Congress has appropriated $8.5 billion this year for opioid-related programs, but there’s no guarantee of funding for subsequent years, Itkowitz reports.

Kentucky swears in 325 AmeriCorps service members, state has around 900; they largely work on 'social determinants of health'

By Melissa Patrick
Kentucky Health News

More than 325 new and returning AmeriCorps members were recently sworn in and have committed themselves to a year of service with one of the 20 different AmeriCorps groups across Kentucky.

More than 325 AmeriCorps members were sworn into service
Sept. 25 at the Capitol. (Commonwealth of Kentucky photo)

AmeriCorps is a national service program administered by the bipartisan, governor-appointed group Serve Kentucky, formerly the Kentucky Commission on Community Volunteerism and Service. Serve Kentucky is part of the Cabinet for Health and Family Services and the federal Corporation for National and Community Service.

In all, Kentucky has about 900 AmeriCorps members in 105 of the state's 120 counties. The program is funded by nearly $6.7 million in federal grants and varying local matches.

The 20 Kentucky programs are dedicated to efforts such as providing drug-resistance education, teaching and tutoring children, combating homelessness, empowering victims of domestic violence, promoting post-secondary education opportunities, offering financial-literacy resources and assisting low-income elderly.

Health experts often refer to these unmet social needs as "social determinants of health," and it's been proven that they often have more to do with a person's or a community's health than health care itself.

For example, many of the Kentucky AmeriCorps programs focus on education, which is known to improve a person's social and economic opportunities, factors that ultimately impact health.

"Poverty limits access to healthy foods and safe neighborhoods, and more education is a predictor of better health," says the U.S. Centers for Disease Control and Prevention.

State Health Commissioner and AmeriCorps alumnus Dr. Jeffrey Howard told the members at the kickoff event about the impact service had had on his life and career.

“AmeriCorps gave me the opportunity for experiences and relationships that helped shape my path toward public health services and administration,” Howard said. “Through their service, AmeriCorps members can clearly see the needs of a community and get the chance to fill those needs. Being a part of the Kentucky Department for Public Health is the next step in my service, and I’m so glad AmeriCorps taught me -- as members of this year’s pledge class will learn -- that a commitment to serve can come in many forms.”

Since 1994, more than 12,000 Kentuckians have served approximately 19 million hours and nationally, more than one million men and women have served in AmeriCorps, providing more than 1.4 billion service hours, a news release said.

Serve Kentucky Executive Director Joe Bringardner said, "AmeriCorps members do more than just fulfill a service assignment; they make communities stronger and better prepared for the future.”

U.S. News and World Report ranks Martin County nation's worst performing white-majority county in health outcomes

Gary Ball, editor of the weekly Mountain Citizen, has been reporting on water issues in Martin County for nearly two decades, prompting the state to open the first investigation into the local water district. (Photo: Rich-Joseph Facun for NPR)

U.S. News and World Report ranks Martin County in Eastern Kentucky "as the worst-performing white-majority county in the nation, in a special report released Tuesday that analyzes links between race, geography and health outcomes," Will Wright reports for the Lexington Herald-Leader.

Screenshot of interactive U.S. News and World Report map, showing
data for each Kentucky county. Click here to access the actual map.

The national analysis found that living in a predominantly white county was a strong predictor of communities' overall health and well-being, but that wasn't the case in Martin County, which has been hammered with a two-decades old water crisis, high poverty rates, poor health outcomes and the national opioid epidemic, according to the report. Wright has written extensively about the county's struggles to provide clean water to its residents. So has the Mountain Citizen, the county's weekly newspaper, and NPR aired an eight-minute story Wednesday.

The nationwide analysis looks across 10 factors that drive health outcomes, including such things as job availability, prevalence of diseases, smoking, obesity, housing costs, and air and water quality.

Martin County scored just 10.5 out of a possible 100 points, "faring especially weak in categories that measure economic opportunity," Wright reports. Kentucky's average score was 42.2.

Martin County also scored poorly on health indicators like smoking rates (29 percent), obesity prevalence (39.1 percent), deaths of despair (72.2 per 100,000) and overall life expectancy (72.6 years).

Martin County has been poor for a long time, and was the scene President Lyndon B. Johnson chose for rolling out the War on Poverty in 1964. Since then, Wright reports, the county’s poverty rate has dropped nearly in half, but still remains above 30 percent, which is much higher than the national average. Coal jobs in the county dropped 63 percent between 2011 and 2015, forcing many to move away. The county’s population dropped 11 percent between 2010 and 2017, according to U.S. News.

The U.S. News analysis highlighted one great strength in the community, "measurable improvements in college- and career-readiness among the county’s high school students," Wright reports.

The report found that in 2009, just seven students at the county high school were deemed ready for college, and just 19 percent were deemed ready for a career. By 2016, though, the school had earned a "distinguished" classification and nearly 60 percent of students there earned some college credit before graduating, and more than 70 percent were deemed college ready. Both those marks are higher than the statewide average.

Cheap knockoffs of popular Juul electronic cigarettes are latest FDA target to protect teens from vaping

Cheap knock-offs of the Juul electronic cigarettes popular with teens have been showing up in stores and online, "despite a U.S. Food and Drug Administration rule banning the sale of new e-cigarette products after August 2016 without regulatory approval," Chris Kirkham reports for Reuters.

The FDA applied the August 2016 deadline to new e-cigarette products, while older devices are allowed to continue without regulatory approval until 2022.

"Start-ups and major tobacco firms have launched more than a dozen new high-nicotine devices with Juul-like designs since the FDA imposed the deadline, according to Reuters review' of the companies’ online advertisements, social media posts and public statements," Kirkham writes.

FDA Twitter graphic on efforts it's taking to shut
down the sale and marketing of e-cigarettes to minors.

Earlier this month the FDA threatened to ban Juul and four other vaping-product companies unless they took steps to prevent use by minors, but Kirkham reports that other companies have flooded the market with Juul copycats with no regulatory consequences.

The FDA told Reuters that it was looking into whether certain brands were being improperly sold and plans to take "additional action on this front very soon," focusing on products with high nicotine concentrations and flavors that apparently target youth.

Teens love these products because they are small and look like a computer USB drive, making it easy for them to hide them from parents and teachers. They also come in flavors that appeal to teens and pack a powerful nicotine punch. One Juul pod has the nicotine content of about 20 cigarettes, which is the number in a traditional pack.

Health experts have voiced concern that these high-nicotine products are creating lifelong addictions in young people and will erode decades of progress in reducing youth tobacco use.

According to the national Youth Behavioral Risk Survey, smoking among high-school students declined from 15.8 percent in 2011 to 7.6 percent in 2017, but e-cigarette use grew from 1.5 percent to 11.5 percent over the same period.

In Kentucky, traditional smoking rates and e-cigarette rates have both been on the decline since the Kentucky YBRS started asking about e-cig usage in 2015.

In 2017, about the same number of Kentucky high-school students reported using e-cigarettes as traditional ones, 14 percent. This was down from 23.4 percent and 17 percent respectively in 2015.

That said, it looks like more Kentucky teens are trying e-cigs than traditional cigarettes these days. In 2017, about 45 percent of Kentucky's high-school students said they had ever used an electronic vapor product, compared to about 41 percent who had ever smoked cigarettes.

Health officials have warned that e-cigarette use is likely much higher among teens than reported in 2017, because those numbers don't reflect the surge in Juul sales.

Anti-smoking advocates have called for Kentucky schools and locales to enact 100 percent smoke-free laws that include e-cigarettes and for state officials to tax e-cigarette devices and their liquids at the same rate as conventional tobacco products as a way to address this uptick in teen use of these products.

Another concern is that teens are using Juul and the knockoff devices to smoke marijuana because their design allows a person to replace the liquid nicotine with liquid marijuana or other concentrated marijuana products or be "hacked" to allow for such products. And because there is no odor, this allows a user to smoke it anywhere without others knowing what's inside.