Princess Health and Health ranking of Kentucky seniors moves up, but they are still last in health outcomes, says America's Health Rankings. Princessiccia

Princess Health and Health ranking of Kentucky seniors moves up, but they are still last in health outcomes, says America's Health Rankings. Princessiccia

dental care exercise federal spending health rankings hospitals immunizations local government nursing homes obesity oral health physical activity poverty seniors state government vaccinations

Gusty 12:57 Add Comment

By Melissa Patrick and Al Cross
Kentucky Health News

Kentucky moved up three spots, from 48th to 45th, in the fourth annual Senior America's Health Rankings Report. But the state ranked last in health outcomes and 44th in determiners of those outcomes, so it remains one of the least healthy places in the nation for seniors to live.

Among negative measures, Kentucky seniors ranked first in preventable hospitalizations, second in tooth extractions and premature death; and third in physical inactivity and hospital re-admissions within 30 days of discharge.

Among positive measures, the state also ranked poorly: for example, 46th in the percentage (34%) of seniors who reported that their health status was good or excellent and 48th in the percentage (56.9%) who reported having no disability.

The state's best ranking was No. 3 in influenza vaccinations, reflecting an increase to 70 percent from 62 percent of seniors vaccinated in the past two years. It was No. 8 in the percentage of seniors with arthritis who self-report arthritis or joint pain does not limit their usual activities. It tied for 10th in the percentage of seniors with a "creditable prescription-drug plan" and was 17th in the percentage of senior who reported having a mammogram or a colonoscopy or similar screening.

Kentucky ranked low in volunteer activity by seniors (45th) and nursing home quality (43rd) but has fewer people in nursing homes who perhaps shouldn't be there. Only 7 percent of its nursing-home residents, the No. 7 ranking, were considered "low care" and thus candidates for living in less restrictive environments. However, it was 46th in the number of personal-care and home-health aides per 1,000 adults aged 75 or older.

The state tied for 44th in the percentage (32.1) of seniors who reported falling in the previous 12 months. It was 44th in the percentage (42.8) of seniors who were enrolled in hospice during the last six months of life after being diagnosed with a condition that carried high probability of death.

It was also 44th in a related measure, the percentage (16.6) of seniors who spent seven or more days in an intensive- or critical-care unit during their last six months. Generally, use of an ICU correlates with the number of ICU beds, which "could indicate a supply-induced remand," the report says. "Overusing the critical care system often goes against the wishes of dying patients and is costly. Research indicates many patients receive care they would not choose in their final days."

The rankings are based on 35 measures of health, as well as supplemental measures such as education and mental health. Combined, they paint a picture of how individual behavior, our communities and their environments, health policy and access to care influence health.

One area that Kentucky consistently ranks low in is government support for seniors in poverty. It was 45th again this year, spending $382 per senior when federal, state and local funds were all counted. Massachusetts, which ranked first in overall senior health this year, spends $4,053 per senior in this category, more than any other state but Alaska, which has many rural elderly. The national average, which has been declining, is $811.

Kentucky leads the nation in smoking, so it's no surprise that its seniors also rank in the bottom five states for this negative category (47th). Kentucky seniors' smoking rate is 12.4 percent; the national average is 8.8 percent. Both have declined about 40 percent in the last 15 years.

Smoking is the leading cause of preventable death in the United States," says the report. "Cessation, even in older smokers, can have profound benefits on current health status as well as improve long-term outcomes."

Kentucky was fifth from the bottom in dental visits by seniors, but the good news is that the share of seniors having such visits rose to 57 percent from 53 percent last year.

"Poor oral health is associated with such chronic diseases as diabetes and cardiovascular disease, and can have a large impact on quality of life resulting in pain and affecting the ability to chew or speak," says the report.

Kentucky improved its senior obesity ranking, another negative measurement, to 24th from 41st. About two out of every seven Kentucky seniors are obese, or 27.5 percent, the same as the national average. Last year the rate was 29.6 percent.

"Obese seniors experience more hospitalizations, emergency department visits, and use of outpatient health services than non-obese seniors, leading to higher health care costs," says the report. "Physical activity, healthy diet, supportive communities and social networks, and an environment that encourages exercise all play a role in reducing obesity in older adults."

The report says that between 1999 and 2014, Kentucky's middle-aged population (50-64) saw a 34 percent increase in in obesity and a 68 percent increase in diabetes. These findings were similar across the nation.

The report says Kentucky's senior population is expected to increase 44 percent by 2030. "Over the next 15 years, the health of this population will be challenged by large numbers of new people becoming seniors and the additional health challenges, such as diabetes, that this groups brings with them," it says."These higher rates of diabetes and obesity are expected to put significant strains on the Medicare program and the overall health-care system."

The report, sponsored by the United Health Foundation, is a call to action for states, offering specific benchmarks that can be changed to improve health.

Louisiana again ranked last for overall senior health, followed by Oklahoma. Kentucky, West Virginia, Arkansas and Mississippi had similar scores. The top six states for overall senior health are Massachusetts, Vermont, New Hampshire, Minnesota, Hawaii and Utah. Click here for the full report. (Click on chart for another version that may be clearer)

Princess Health and Study says if Ky. cut its smoking rate to the national average, it could save $1.7 billion in health-care costs the very next year . Princessiccia

Princess Health and Study says if Ky. cut its smoking rate to the national average, it could save $1.7 billion in health-care costs the very next year . Princessiccia

health care costs local government research smokeless tobacco smoking ban smoking bans smoking cessation smoking ordinances state government tobacco prevention

Gusty 14:50 Add Comment

Illustration from University of California-San Francisco

By Melissa Patrick
Kentucky Health News

If Kentucky could cut its smoking rate to the national average, it would save an estimated $1.7 billion on healthcare the following year, a study says.

Kentucky's smoking rate is 26 percent, and the national average is 18 percent.

The study at the University of California-San Francisco estimates that a 10 percent decline in the national rate would save $63 billion the next year in health-care costs.

"What it adds to our knowledge is that we can save money quickly," Ellen Hahn, University of Kentucky nursing professor and director of its smoke-free policy center, told Kentucky Health News. "We are not talking 18 to 20 years down the road. ... If we reduced our smoking rate at least 10 percent, we would see dramatic reductions in health-care cost in just one year."

The study also found that smoking makes Kentucky spend $399 more per person per year on health care than it would if the state's rate equaled the national rate. That was the highest figure of any state.

Conversely, low rates of smoking save Utah and California, respectively, $465 and $416 per person per year compared to what they would spend if their smoking rates were the national rate.

�Regions that have implemented public policies to reduce smoking have substantially lower medical costs,� the study's authors said in a news release. �Likewise, those that have failed to implement tobacco control policies have higher medical costs.�

Lexington's smoking rates dropped 32 percent in just one year after it enacted its smoking ban, which amounted to an estimated $21 million in smoking-related healthcare costs savings, according to a University of Kentucky study led by Hahn and published in the journal Preventive Medicine.

The UCSF study, published in PLOS Medicine, looked at health-care spending in each state and the District of Columbia from 1992 to 2009, and measured the year-to-year relationship between changes in smoking behavior and changes in medical costs.

Many studies have shown that smoking bans and other smoke-free policies decrease smoking rates, reduce smoking prevalence among workers and the general population, and keep youth from starting to smoke.

These have been some of the arguments for a statewide smoking ban, but efforts to pass one have stalled because new Republican Gov. Matt Bevin opposes a statewide ban and says smoke-free policies should be a local decision.

Bevin won big budget cuts from the legislature to set aside hundreds of millions of dollars for shoring up the state's pension systems, but the study hasn't made the administration look at a smoking ban as a source of savings. A ban passed the House last year but died in the Senate.

Asked how this study might affect the administration's position on a statewide smoking ban, Doug Hogan, acting communications director for the Cabinet for Health and Family Services, said in an e-mail, "Smoking bans are a local issue, rather than a one-size-fits-all solution." Bevin's office and Senate President Robert Stivers did not respond to requests for comment.

Hogan said the cabinet is committed to helping people quit smoking: "Education and proper policy incentives are critical tools that the state can use and as our commonwealth crafts its Medicaid wavier, it is looking very closely at ways to best incentivize smoking cessation to improve health and decrease cost to the commonwealth."

Dr. Ellen Hahn

Hahn said, "Kentucky has the dubious honor of leading the nation in cigarette smoking, and we have for many years. ... it is a major driver of health-care cost. And in a climate where we are trying to save every dollar ... I think that we should pay attention to this study because what it really says is that we can save a boatload of money if we help people quit and we can save it quickly."

Other possible tobacco-control measures include raising cigarette taxes, anti-smoking advertising campaigns and better access to smoking-cessation programs. Hahn said the state gets some money from the federal Centers for Disease Control and Prevention and the tobacco master settlement agreement for prevention and cessation efforts, but the state needs to do more.

"We spend very little on the things that we know work, like helping people quit smoking, like doing widespread media campaigns on television, radio and print," she said. "We just don't do that in our state. We never have. In fact, we spend very little, about 8 percent of what the CDC say we should."

The study says significant health-care savings could occur so quickly because the risks for smoke-related diseases decreases rapidly once a smoker quits.

"For example, the risk of heart attack and stroke drop by approximately half in the first year after the smoker quits, and the risk of having a low-birth-weight infant due to smoking almost entirely disappears if a pregnant woman quits smoking during the first trimester," says the report.

"These findings show that state and national policies that reduce smoking not only will improve health, but can be a key part of health care cost containment even in the short run," co-author Stanton Glantz, director of the UCSF Center for Tobacco Control Research and Education, said in the release.

Hahn said, "People don't realize how effective quitting smoking really is, how much money it really saves. So that is the value of this paper. It is a wake-up call for those of us doing this tobacco control work and for elected officials who are trying to save money and redirect funds and shore up the economic health of Kentucky. ... Doing all we can to reduce smoking saves lives and money. What's better than that?"

Princess Health and Shepherdsville bans smoking with children in vehicle. Princessiccia

Princess Health and Shepherdsville bans smoking with children in vehicle. Princessiccia

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Gusty 14:04 Add Comment

In the first such ban in Kentucky, the Shepherdsville City Council has passed an ordinance prohibiting smoking in motor vehicles with children inside them.

Smoking in vehicles with children "is something we see a lot around here," and is "a big problem," Kalynn Walls, a legal assistant who helped write the ordinance, told Laura Ungar of The Courier-Journal. The ordinance "is kind of a common-sense thing" that is designed partly "to spark other cities to adopt policies like this," Walls said.

The ordinance says people can't "use tobacco products with a residue of smoke" in a vehicle occupied by anyone under 18. The ban applies to cigarettes, cigars, pipes and other products, but not to e-cigarettes. It is a secondary offense, meaning drivers can't be pulled over for it, but can be cited if stopped for another violation. Conviction carries a fine of up to $250.

The ordinance was inspired by a similar law in England and is the first in Kentucky, according to Ellen Hahn, a University of Kentucky nursing professor and director of the Kentucky Center for Smoke-Free Policy.

Hahn told The Courier-Journal that she wishes Bullitt County, of which Shepherdsville is the county seat, prohibited smoking in workplaces. The county health board passed a smoking ban three years ago, but the fiscal court sued to overturn it, and the Kentucky Supreme Court said smoking bans should be enacted only by elected officials.

In Bullitt County, 27 percent of adults smoke, about the same rate as statewide. "Kentucky consistently has one of the highest adult smoking rates in the nation," Ungar notes.

Princess Health and State and national smoke-free leaders tell Ky. advocates to focus on local smoking bans because of political climate in Frankfort. Princessiccia

Princess Health and State and national smoke-free leaders tell Ky. advocates to focus on local smoking bans because of political climate in Frankfort. Princessiccia

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Gusty 19:04 Add Comment

By Melissa Patrick
Kentucky Health News

More Kentucky localities are likely to see efforts for smoking bans, as a statewide ban appears less likely and leading advocates are saying to go local.

Stanton Glantz
photo: ucsf.edu

Stanton Glantz, one of the nation's leading advocates of smoke-free policies, said at the Kentucky Center for Smoke-Free Policy's spring conference April 28 that California initially had trouble passing a statewide indoor smoke-free law, which forced advocates to move their efforts to the local level. By the time the statewide law passed, 85 percent of the state was covered by local ordinances.

"I'm glad it worked out that way, because we are really talking about values and social norms and community norms and you just can't impose that from the outside," Glantz said during his keynote address. "And so all of these fights that you are having in all of these towns. ... In the end, when you win, you've won. And the fight itself is an important part of making these laws work."

Ellen Hahn, a University of Kentucky nursing professor and director of the smoke-free policy center, also encouraged her colleagues to shift their efforts to localities, saying the political situation doesn't support a statewide law. New Republican Gov. Matt Bevin doesn't support a statewide ban on smoking on workplaces, saying the issue should be decided locally.

"We are in a very difficult political climate in Frankfort," Hahn said in her opening remarks."We all know it. We all recognize it. And while we would all like to see Frankfort do the right thing � and it will someday, I promise � it is not the time to let somebody else do it. It is the time to go to your local elected officials and say we want this."

Advocates made some headway last year when a smoking-ban bill passed the House, but it was placed in an unfavorable Senate committee and never brought up for discussion. This year's House version of the bill, in an election year with Bevin in the governor's office, was dead on arrival.

Glantz, a University of California-San Francisco professor and tobacco-control researcher, looked at the bright side: "You're in a tough political environment, but you are really doing pretty well." He reminded the advocates that one-third of the state is covered by indoor smoke-free ordinances, with 25 of them comprehensive and 12 of them including electronic cigarettes. He also commended the Kentucky Chamber of Commerce for supporting statewide and local bans.

What's next

Glantz urged the advocates to "empower and mobilize" the 73 percent of Kentuckians who don't smoke and get them to help change the social norms. Two-thirds of Kentucky adults support a comprehensive statewide smoking ban, according to latest Kentucky Health Issues Poll, and have since 2013.

�The whole battle is a battle about social norms and social acceptability, and once you win these fights, and you have a law that�s sticking � which takes a while � you don�t go back,' he said. "And the tobacco companies understand that, and that is why they are fighting us so hard.�

Glantz armed the smoke-free warriors with research data to support smoke-free laws, including: they decrease the number of ambulance calls; hospital admissions for heart attacks, stroke, asthma and chronic obstructive pulmonary disease; and the number of low-birth-weight babies and complications during pregnancy.

"In Kentucky communities with comprehensive smoke-free laws, there was 22 percent fewer hospitalizations for people with COPD," Glantz said, citing one of Hahn's studies. "That is a gigantic effect, absolutely gigantic, at almost no cost and it happened right away."

He noted that politicians are usually most interested in this short-term data, but he also cited long-term statistics about how smoke-free policies in California have decreased heart disease deaths by 9 percent "in just a few years," and lung cancer by 14 percent in about 10 years. Kentucky leads the nation in both of these conditions.

"I would argue that the economic argument is actually on our side," Glantz said, noting that economic benefits of smoke-free laws are almost immediate, especially because "every business, every citizen and every unit of government" is worried about health care costs. He also cited research that found "as you pass stronger laws, you get bigger effects.'

Princess Health and Kenton County embraces its once-controversial smoking ban as chances of a statewide ban have dimmed. Princessiccia

Princess Health and Kenton County embraces its once-controversial smoking ban as chances of a statewide ban have dimmed. Princessiccia

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Gusty 14:01 Add Comment

Five years after Kenton County's smoking ban took effect over great opposition, the county has embraced it, Scott Wartman reports for the Cincinnati Enquirer.

"I'm a smoker, but I'm glad we're non-smoking," Justin Meade, a bartender at Molly Malone's in Covington, told Wartman. "I don't want to smell like smoke."

Kenton is the only Northern Kentucky county with any type of indoor smoking ban. Its partial ban allows establishments that don't serve people under 18, like bars, to have smoking.

Wartman reports having trouble finding anyone who didn't support the smoking ban as he walked among the Covington bar scene, and noted that a Northern Kentucky Health Department report cites very few complaints.

"I think what folks should take away from this is comprehensive smoke-free laws are easy to enforce, that most people like them and that they protect everyone," Stephanie Vogel, population-health director for the health department, told Wartman.

"The nonchalant acceptance, and even enthusiasm from some, of the partial smoking ban in Kenton County contrast with the controversy when it was enacted five years ago," he writes, noting that five years ago some bar owners thought the ban would put them out of business and patrons "lamented" that it was "an attack on their rights."

Amy Kummler, owner of Up Over bar, which can still allow smoking because it doesn't serve anyone under 18, told Wartman that she wouldn't mind if indoor smoking were banned statewide, but "feels smoking bans limited to one county or city are unfair," he writes.

"I don't even want to sit in my bar when it's smoky a lot," Kummler said. "I would be thrilled if the state went non-smoking, but I don't think it would be fair unless everybody did it."

Kentucky legislators have tried to pass a statewide smoke-free workplace law for years, but to no avail. Last year a bill passed out of the House, but was not called up for a vote in the Senate. This year, an election year, the bill wasn't even called up for discussion in committee. New Republican Gov. Matt Bevin opposes a statewide smoking ban.

"Last year we thought it was our year," Heather Wehrheim, chairwoman of Smoke-Free Kentucky, told Wartman. "It was the perfect scenario ... the public support was there; we thought we had the votes. It was Senate leadership that blocked it. Their argument, and whether it's true or not, is that it should be left up to local communities to pass smoke-free laws. We know that is going to take years and years and years."

The latest Kentucky Health Issues Poll found that two-thirds of Kentucky adults support a comprehensive statewide smoking ban, and have since 2013. The ban has support from solid majorities in each political party and has majority support in every region of the state. But more than one-fourth of Kentucky adults are smokers.

Princess Health and Kenton County's approval of a needle exchange inches Northern Kentucky, hit the hardest by heroin, toward getting one. Princessiccia

Princess Health and Kenton County's approval of a needle exchange inches Northern Kentucky, hit the hardest by heroin, toward getting one. Princessiccia

county government county health boards county health departments health departments hepatitis c heroin HIV legislation local government needle exchanges public health

Gusty 16:40 Add Comment

The Kenton County Fiscal Court unanimously approved a mobile needle exchange program March 29, which moves the City of Covington's needle exchange program one step closer to fruition, Terry DeMio reports for the Cincinnati Enquirer.

The Fiscal Court's approval was one of several conditions required by the City of Covington to allow its exchange to move forward. Covington's plan also requires two other counties in the Northern Kentucky Health District to adopt exchanges (only Grant County has); limits access to only resident's of the district's four counties; and would move the exchange to St. Elizabeth Healthcare hospital.

In addition, it requires a one-for-one needle exchange and a mandate that all participants must be tested for hepatitis C, hepatitis B, HIV, and, where applicable, pregnancy. This condition is likely not legal and is being investigated by the Northern Kentucky's Health Board's legal counsel, DeMio reports.

Kenton County's plan differs from Covington's in that it mandates only the offering of these tests, DeMio reports.

Both plans will require the Kenton County Board of Health's approval.

Needle-exchange programs were authorized by the state anti-heroin law passed in 2015, and require both local approval and funding. They are meant to slow the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. Northern Kentucky has been hit the hardest in the state by heroin and its hepatitis C rates have been reported at 19 times the national rate.

The needle exchange would be funded by $250,000 from the R.C. Durr Foundation, and the health department would use its staff and already available testing to further pay for the exchange, DeMio reports.

The Fiscal Court also approved exploring the idea of building a community-wide addiction treatment center on the county jail grounds; putting $25,000 toward a heroin helpline; and approved a resolution to encourage the Northern Kentucky Board of Health to create a high-quality prevention and education program for the community.

The Northern Kentucky Area Development District has already put out proposals for the heroin helpline, DeMio notes. And County Judge-Executive Kris Knochelmann told him that Boone and Campbell counties were willing to consider putting $25,000 each toward it, and that St. Elizabeth had promised $75,000 toward its operation.

The other needle exchanges in the state that are either operating or have been approved are in Louisville and Lexington and in the counties of Pendleton, Carter, Elliott, Franklin, Grant and Jessamine.

Princess Health and 85 percent of Kentucky adults want schools to be tobacco-free, but only 28 percent of the state's school districts are. Princessiccia

Princess Health and 85 percent of Kentucky adults want schools to be tobacco-free, but only 28 percent of the state's school districts are. Princessiccia

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Gusty 09:32 Add Comment

An overwhelming majority of Kentucky adults, 85 percent, want schools to be tobacco-free, according to the latest Kentucky Health Issues Poll.

But only 28 percent of the state's school districts have "protected students, staff members, teachers and guests from secondhand smoke by enacting 100 percent tobacco-free school policies," says a press release from Interact for Health, which co-sponsored the poll with the Foundation for a Healthy Kentucky. A list of the districts is at www.tobaccofreeschoolsky.org.

"Kentucky ranks 50th, the worst state in the nation, in the percentage of secondary school campuses that prohibit tobacco use in all locations at all times," the release says. "Nationally, 65 percent of schools have such a policy." In Kentucky, such policies are set by local boards of education.

The state's tobacco heritage remains strong. In 2015, 23 percent of Kentucky middle-school students reported trying cigarettes, and 28 percent of high school students said they used cigarettes, cigars, or smokeless tobacco.

The poll found large majorities of smokers, former smokers and non-smokers in favor of tobacco-free campus policies, and support was strong across party lines. The greatest opposition was found among the poor, African Americans, people who haven't gone to college and those who said their general health was fair or poor.

Susan Zepeda, president and CEO of the foundation, said in its news release, "A 100 percent tobacco-free campus policy reduces a young person's exposure to second-hand smoke and allows adults to model tobacco-free lifestyles. Notably, Kentucky smokers understand this important issue. Eighty percent of current smokers favor tobacco-free school policies in their communities."

The Kentucky Health Issues Poll was conducted Sept. 17 through Oct. 7 by the Institute for Policy Research at the University of Cincinnati. The sample of 1,608 adults has an error margin of plus or minus 2.4 percentage points.

Princess Health and Rice Leach, battling cancer and headed for hospice, gets Public Health Hero Award that Fayette health board will name for him. Princessiccia

Princess Health and Rice Leach, battling cancer and headed for hospice, gets Public Health Hero Award that Fayette health board will name for him. Princessiccia

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Gusty 05:31 Add Comment

Rice Leach

Dr. Rice Leach, a state and national leader in public health for decades, was honored March 14 with the Public Health Hero Award from the Lexington-Fayette County Board of Health, for which he is commissioner -- but is unable to work because he is battling cancer at home.

�When your peers recognize you, there�s nothing like it,� Leach told a crowd at the health department via Skype. �And when your peers you love recognize you, it�s got to be the best.� The board plans to rename the award for Leach, whose outspoken nature has endeared him to public-health officials not as disposed to strong public statements.

The award is usually given in April, during part of National Public Health Awareness Week. "It was presented Monday because of Leach�s medical condition," Karla Ward reports for the Lexington Herald-Leader. "Leach, 75, sent an email to the health department�s staff two weeks ago, updating them about his lymphoma and telling them he would not be back to work. He said palliative care and hospice would be 'not too far in the future'."

Read more here: http://www.kentucky.com/news/local/counties/fayette-county/article66083207.html#storylink=cpy

Read more here: http://www.kentucky.com/news/local/counties/fayette-county/article66083207.html#storylink=cpy

Ward writes, "Leach�s five-year tenure as Lexington�s health commissioner was preceded by decades of work in the public health field that included a stint as chief of staff to the U.S. surgeon general, and international work in Guatemala, Bolivia and Panama. He was Kentucky commissioner of public health from 1992 to 2004; from 2004 to 2010 he was medical director and executive director of the health department�s primary care center."

Princess Health and Princess Health andState Supreme Court says county boards of health cannot enact smoking bans by regulation.Princessiccia

Princess Health and Princess Health andState Supreme Court says county boards of health cannot enact smoking bans by regulation.Princessiccia

county health boards courts local government smoking smoking ban smoking bans tobacco

Gusty 19:10 Add Comment

By Al Cross
Kentucky Health News

County health boards in Kentucky do not have the power to ban smoking in public places, the Kentucky Supreme Court ruled without dissent Thursday.

The decision was a stiff blow to health officials who see smoking as the primary factor in making Kentucky one of the least healthy states, and have sought state and local smoking bans to limit exposure to second-hand smoke. It struck down a ban in Bullitt County and presumably will do likewise for those enacted by the Clark, Madison and Woodford county health boards, which joined the case. (Click on map for larger version)

Justice Bill Cunningham, who wrote the decision, noted that the U.S. surgeon general has found "many of the chemicals inhaled through second-hand smoke are known carcinogens" and "that even short-term exposure to second-hand smoke can result in serious health consequences. In 2009-10, overall second-hand smoke exposure by Kentucky adults was 51.4 percent, with 30 percent reporting exposure in the workplace and 32.8 percent reporting exposure in public places. Given such dismal data, it is understandable that many health-care professionals and government officials have sought to curtail the prevalence of this noxious fume. Promoting a smoke-free society is a reasonable goal grounded in sound research. However, when promotion becomes enactment, even the most virtuous causes must also be grounded in law."

Health boards enacting bans have relied on a 1954 state law that gives them to power to adopt regulations "necessary to protect the health of the people." To find that law as "sufficient grounding for the regulation," Cunningham wrote, the court would have to construe the law "as delegating the totality of the Commonwealth's police power to the health boards. Nothing would remain to be ceded by the General Assembly, including the critical legislative charge of distinguishing virtue from vice."

Cunningham said such a ruling would "promote an overly broad delegation of legislative sovereignty," in violation of the state constitution. He said the authorization of regulations was limited, and was based that view on what he called the law's legislative history. In 1954, he wrote, "It would have been
commonplace for members of the General Assembly to indulge in a cigarette or cigar in their offices, committee rooms, or even on the floors of the House and Senate chambers. Most likely, the . . . legislation was debated and voted in chambers fogged with a haze of smoke."

Thursday's decision overturned a 2-1 ruling of a Court of Appeals panel that relied partly on the 1984 Supreme Court decision that upheld a Jefferson County regulation on lead paint. Cunningham said that was based on a law that "specifically addressed lead poisoning and expressly authorized and encouraged action at the local level," and "There is no similar statutory mandate" in state law for smoking bans.

Cunningham also noted that most of the Jefferson County board is appointed by local officials, while health boards in other counties are appointed by the state health secretary "and not by duly elected representatives. When regulating controversial issues traditionally within the province of state or local legislative entities, this structure is constitutionally problematic in that it does not comport with traditional notions of representative government." In this case, the Bullitt County Fiscal Court filed a lawsuit challenging the health board's authority.

The appeals court, in rejecting the fiscal court's case and overturning the local circuit court, also relied on a 1967 decision upholding a local health board's regulation of private sewage disposal systems. Cunningham said that decision was strongly based on earlier cases on the topic, and in contrast, there is no "well-established line of authority regarding the need for administrative regulation of smoking and second-hand smoke."

Finally, Cunningham said legal precedents in Kentucky say that "Where reasonable doubt exists concerning the proper scope of an administrative agency's authority, it should be resolved against the agency," and "An increase in the aggregate power of administrative agencies over the recent decades, if left unchecked, invites the ascendance of a fourth branch of government�the regulatory state."

Princess Health and Princess Health andDanville is latest Ky. community to ban indoor use of e-cigarettes, following new law that classifies them as tobacco product.Princessiccia

Princess Health and Princess Health andDanville is latest Ky. community to ban indoor use of e-cigarettes, following new law that classifies them as tobacco product.Princessiccia

e-cigarettes local government smoking smoking ban state government

Gusty 19:44 Add Comment

The Danville City Commission has approved an ordinance that bans the use of e-cigs in enclosed places, placing the same restrictions on them that already exist on traditional tobacco cigarettes, though the health risk of e-cigs has not yet been determined, Todd Kleffman reports for The Advocate-Messenger.

Kleffman notes that Danville is among a few Kentucky communities leading the way on placing restrictions on e-cigs, which are battery-powered devices that emit vaporized nicotine, but not tobacco.

"Bardstown, Manchester and Madison County have placed an outright ban on public use of e-cigs, while Kenton County prohibits their use in the workplace, and Glasgow bans them in bars and restaurants, according to attorney Chris Johnson of the Kentucky League of Cities," Kleffman writes.

E-cigs have become increasingly popular as an alternative to smoking, and because the amount of nicotine can be adjusted in the vapor liquid, many use it as a means to quit smoking, although this claim has not been proven.

�Generally, it�s people who are trying to quit smoking or are looking for a cheaper, healthier, less offensive alternative,� Blayne Hogue, operator of Vapor Visions in Danville, told Kleffman. �With the younger crowd it has appeal because of the taste and because it�s kind of the new thing.�

Speaking to the concern that vaporizing products with a "candy store array of flavors carrying names like Skittles, Pluto, Mother�s Milk and John Wayne" is designed to appeal to an underage crowd, Eric Griffiths, proprietor of the e-cig store Juice Box, asked,  �Why is that we have to be marketing to kids because it has flavors? Just because it�s an adult product doesn�t mean it has to taste bad.�

Neither store allows minors.

The U.S. Food and Drug Administration announced last month that it will begin regulating e-cigs in the future, Kleffman notes, and the Kentucky General Assembly passed a law this year that puts
vapor products in the same class as tobacco cigarettes, prohibiting their sale to those under 18.

The state law, not complaints from local business owners or residents, is what prompted the Danville City Commission to enact its own ordinance banning e-cigs in enclosed public places, City Manager Ron Scott told Kleffman.

�The state now classifies them as a tobacco product. What makes them different? By our ordinance, there is no distinction,� Scott said to Kleffman. �You can�t have it both ways. We had to clarify it for our businesses as to where they can be used. Vapor products contain nicotine, and from a public health point of view, there is an unknown amount of nicotine in the exhaled vapor that could affect others, like second-hand smoke. . . . Do you err on the side of caution, or do you just disregard the potential public health risks?"

The commission vote was 3-2, with Mayor Bernie Hunstad and Commissioner Kevin Caudill voting against the ban after two citizens argued that the prohibition was premature because no reliable research has proven that the devices create a public health concern.

Princess Health and Princess Health andTobacco heritage blocks smoking bans in rural Kentucky.Princessiccia

Princess Health and Princess Health andTobacco heritage blocks smoking bans in rural Kentucky.Princessiccia

cigarettes county health departments local government smoking smoking ban smoking bans smoking ordinances tobacco

Gusty 07:24 Add Comment

"A mural showing a tobacco harvest has been on display high in
the second-floor rotunda of the Bourbon County Courthouse for
than 100 years," Mary Meehan writes. (Herald-Leader photo) 

Bourbon County's strong tobacco heritage is the main obstacle for proponents of a local smoking ban, and similar feelings exist in many Kentucky counties, Mary Meehan reports for the Lexington Herald-Leader in the second of a series of stories about tobacco use in Kentucky.

"At an April political forum at Bourbon County High School, cigarette butts lined the walkway to the auditorium, although the campus is designated smoke-free," Meehan writes. "Onstage, candidates for city council and magistrate were asked whether they would support a smoking ban. Some said they had fathers or sisters who were longtime smokers who had cancer, most said they didn't smoke, and a few said they weren't sure smoking was really a health risk. Of 18 candidates, only one said he would support a smoking ban. He didn't win in last week's primary election."

The forum was organized by Students Making a Change in Our Communities, a youth group advocating a smoking ban. They have helped rejuvenate efforts begun three years ago by the Coalition for a Smoke-Free Bourbon County and Cyndi Steele, health coordinator for the Bourbon County Health Department.

"Twelve of Kentucky's 120 counties and 26 cities have enacted some type of smoke-free ordinance," Meehan notes. "In Kentucky, 34 percent of the population is protected by smoke-free laws. Almost all Kentucky cities with bans are county seats, leaving most of rural Kentucky without smoking regulations. Efforts to enact a statewide ordinance have failed in the legislature.

"Across the country, about half the population lives in places with smoke-free rules, said Cynthia Hallett, executive director of the nonprofit Americans for Nonsmokers' Rights. She said the science on the dangers of smoking and exposure to secondhand smoke was clear, as were the benefits of smoke-free laws. Kids who grow up where smoking is banned in public places are less likely to smoke, she said. People tend to quit when towns go smoke-free." (Read more)

Read more here: http://www.kentucky.com/2014/05/25/3259432/bourbon-countys-tobacco-heritage.html?sp=/99/322/&ihp=1#storylink=cpy

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Princess Health and Princess Health andLouisville jails sign up inmates for health coverage to save the state money; other jails around state may follow suit.Princessiccia

Princess Health and Princess Health andLouisville jails sign up inmates for health coverage to save the state money; other jails around state may follow suit.Princessiccia

health insurance health reform local government Medicaid obamacare Patient Protection and Affordable Care Act state budget

Gusty 10:48 Add Comment

Louisville jails are holding daily health insurance sign-ups for released inmates, Chris Kenning reports for The Courier-Journal.

Most inmates qualify for expanded Medicaid under the Patient Protection and Affordable Care Act, and Medicaid applications can be made at any time, not just during the annual sign-up period. Officials told Kenning that after the first four days, they had processed 18 applications, mostly for Medicaid.

The benefit to prisons and jails is twofold: Inmate hospitalizations lasting more than 24 hours can be billed to Medicaid, and getting coverage for released inmates provides insurance to a population that has a high rate of chronic disease, substance abuse and mental illness -- conditions that often bring them back to prison, Kenning writes.

This treatment is often only a temporary fix, because repeat offenders fail to continue their treatment when released because of a lack of health insurance, officials acknowledged.

"I know some people will think, 'I can't afford health insurance myself. Now a person in jail gets access to health care?'" Mark Bolton, director of Metro Corrections, told Kenning. "But taxpayers are paying for these people anyway."

Kenning reports that in Louisville, "Metro Corrections' health care costs make up $9 million of its $52 million budget � a result of treating medical conditions including diabetes, heart disease, infections and drug problems." The jails house an average of about 2,000 people.

U.S. Sen. Mitch McConnell does not support the signups, telling The Courier-Journal that it adds burdens to an already strained Medicaid program that is hard-pressed to find enough doctors willing to accept Medicaid patients. "This is yet another disturbing aspect of a profoundly troubling piece of legislation," he told Kenning.

Plans to expand to other jails and other parts of the state are in the works, said Barbara Gordon of the Kentuckiana Regional Planning and Development Agency, a Louisville-area government clearinghouse that provides "Kynectors" to help people sign up on Kynect, the state health-insurance exchange. They now spend two hours a day at the jail and hope to eventually have someone there full time, Bolton told Kenning.

About a third of people going in or out of prisons and jails would qualify for expanded Medicaid, and 24 percent would qualify for subsidized private insurance, estimates Dr. Fred Osher, director of health systems and services policy for the nonpartisan Council of State Governments Justice Center.

The state Department of Corrections projects that by shifting the costs of those 24-hour hospital stays to Medicaid, the state prison system would save more than $5 million a year, Kenning reports. The system has seen health costs rise to more than $54 million this year, from $34 million in 2004.

Princess Health and Princess Health andTobacco is top target in Beshear's health plans, but he still praises expansion of plant that makes smokeless tobacco.Princessiccia

Princess Health and Princess Health andTobacco is top target in Beshear's health plans, but he still praises expansion of plant that makes smokeless tobacco.Princessiccia

cigarette tax economy jobs local government smoking state government taxes tobacco

Gusty 14:27 Add Comment

Gov. Steve Beshear says tobacco is the main cause of Kentuckians' relatively poor health, which he is pushing to improve, but on Feb. 27 "his tone shifted as he praised the economic benefits from a tobacco company's plans to expand its Western Kentucky processing operations for smokeless tobacco products," reports Bruce Schreiner of The Associated Press.

U.S. Smokeless Tobacco Co., an Altria Group subsidary that makes Copenhagen and Skoal from local tobacco, says it will spend $118 million and create 42 jobs as it expands its 90-employee plant in Hopkinsville. Beshear called that "proof that Kentucky is a great place to grow a business." If the company creates the predicted number of jobs, it could get $4.5 million and $1.4 million, respectively, in state and local tax breaks.

Tobacco farming is a smaller part of Kentucky's economy today than it was for most of the 20th Century, but Schreiner notes the state has the nation's highest percentage of smokers and "has the worst or near-worst rates for smoking, cancer deaths, heart disease and high blood pressure." Smokeless tobacco is linked to cancer of the mouth, throat and esophagus.

Those are among the reasons Beshear's tax-reform plan would raise levies on cigarettes and smokeless tobacco. "He also touts legislation calling for a statewide smoking ban at workplaces and in public buildings," Schreiner notes. "Altria opposes any tobacco tax increases."

The American Cancer Society says smokeless tobacco can cause nicotine addiction, which can lead to smoking, and can also lead to gum disease and tooth decay. Oral health is one of the seven main points in Beshear's recently announced plan to improve the state's health, Schreiner notes.

Princess Health and Health departments raise, or try to raise, tax rates to offset state cuts, higher benefit costs and Medicaid payment problems.Princessiccia

Princess Health and Health departments raise, or try to raise, tax rates to offset state cuts, higher benefit costs and Medicaid payment problems.Princessiccia

county health departments health departments local government public health taxes

Gusty 11:06 Add Comment

Some county health departments are trying, and others may try, to increase property-tax rates to make up for Medicaid shortfalls, program cuts and the rising costs of employee benefits so they can continue providing essential public health services for their communities.

Anderson County Health Department Director Tim Wright has proposed a 33 percent rate increase from 3 cents per $100 of assessed property value to 4 cents per $100. The increase would add an estimated $150,000, which Wright says he would use to end employee furloughs and make up for $200,000 that has not been paid by the Kentucky Spirit managed-care company, reports Editor Ben Carlson of The Anderson News.

Many departments have already cut positions and implemented furloughs to compensate for Medicaid shortfalls, state program cuts and employee benefit costs, said Scott Lockard, past president of the Kentucky Public Health Association and director of the Clark County Health Department. Most departments have done everything possible to increase efficiency of the departments' resources, he said.

A recent tax increase in Boyle County will make property owners pay a little more to help fund the county health department. The fiscal court recently voted to raise the county's health tax from 2.4 cents per $100 to 2.5 cents.

As funding streams have changed, departments need additional revenue sources, said Brent Blevins, director of the Boyle County Health Department. Blevins said without the rate increase, the already short-staffed department would have to cut services.

Declining property values during the recession have decreased tax revenue, said Marcia Hodge, director of the Garrard County Health Department. It proposed a tax rate increase from 4 cents to 4.25 cents in September that was estimated to bring in about $21,000, but the fiscal court did not approve it, she said.

Another problem that health departments face, Hodge said, is that they are required to participate in the state's insurance and retirement system. Over the 12 years she has been at the department, retirement contributions have increased from 4 percent to 25 percent, while costs of fringe benefits have more than doubled while salaries have only increased 10 percent, she said.

The Floyd County Health Department increased its tax rate last September for the first time in 20 years, primarily because of increased costs of employee benefits and department funding cuts, said Thursa Sloan, director of the department.

Sloan said she anticipates a big change in the services that health departments provide over the next 10 years.  Primary care will take a much more preventive approach, she said, and health departments will have to pull back in such services and go back to the basics.

Princess Health and Beshear endorses statewide smoking ban as bill moves to the House floor; Williamsburg adopts its own ban.Princessiccia

Princess Health and Beshear endorses statewide smoking ban as bill moves to the House floor; Williamsburg adopts its own ban.Princessiccia

General Assembly governor health rankings legislation legislature local government smoking smoking ban state government tobacco tobacco prevention

Gusty 11:52 Add Comment

Gov. Steve Beshear endorsed a statewide smoking ban yesterday at a Frankfort rally to push the bill that would enact the ban.

"Beshear, who later acknowledged that he smoked in college but quit soon afterwards, said Kentucky ranks No. 1 in the nation in smoking and lung cancer," reports Jack Brammer of the Lexington Herald-Leader.

Noting that Kentucky leads the nation in smoking, Beshear said, "Our addiction hurts productivity, jacks up health care costs and literally kills our people. Yet we've never instituted a statewide law to protect Kentuckians from secondhand smoke." Noting that over one-third of Kentuckians live in jurisdictions with smoking bans, he said, "It's time that we extend that protection to all Kentuckians. . . . Years from now, people will wonder why we waited so long."

Republican Rep. Julie Raque Adams  of Louisville, a co-sponsor of the bill, noted at the rally that Williamsburg this week became the 23rd Kentucky locality to adopt a smoking ban.

The statewide measure, House Bill 190, was posted for passage in the House today but is not expected to be called for a vote unless supporters show Speaker Greg Stumbo that they have the votes to pass it.

Read more here: http://www.kentucky.com/2013/02/14/2517025/former-kentucky-basketball-star.html#storylink=cpy

Princess Health and Williamsburg in line to pass smoking ban next month.Princessiccia

Princess Health and Williamsburg in line to pass smoking ban next month.Princessiccia

cigarettes local government smoking smoking ban tobacco tobacco prevention

Gusty 14:00 Add Comment

An ordinance imposing a smoking ban in Williamsburg is ready for a City Council vote. The council listened Monday to the first reading of the ordinance, required before a vote, which could follow the second reading, planned for Feb. 11. If approved, the ban would take effect immediately, reports Mark White of the Corbin-Whitley News Journal.

The new ordinance says �Smoking shall be prohibited in all enclosed areas within all enclosed buildings open to the public and within places of employment,� reports John Ross of The Times-Tribune of Corbin. �Enclosed buildings� includes libraries, bars, bingo houses, child- and adult-care facilities, public and private educational facilities, gaming facilities, restaurants, pool halls, lobby areas and hallways in all multi-residential buildings, such as apartments and condominiums, and hotels and motels, Ross reports. In December 2011, the Corbin City Commission implemented a ban that prohibits smoking in similar locations and within 25 feet of main entrances and exits.

Ross's account of the meeting included no negative comments. Mayor Roddy Harrison said, �I know both sides of the issue � but our job is to protect everybody.� Harrison said he found extensive research to back up the negative effects of secondhand cigarette smoke while researching the ordinance.

Princess Health and How to take local action to improve health at the local level is outlined at Frankfort conference.Princessiccia

Princess Health and How to take local action to improve health at the local level is outlined at Frankfort conference.Princessiccia

county health county health boards county health departments health departments health rankings local government

Gusty 14:51 Add Comment

By Tara Kaprowy
Kentucky Health News

A recipe for how to improve health at the local level in Kentucky was the capstone of a day-long seminar in Frankfort Monday, with experts stressing that partnerships are key and funding will remain tight.

Communities must mobilize, prioritize, "effectivize" their actions, publicize and evaluate, measure and report performance, Trudi Matthews, director of policy and public relations at HealthBridge, summed up at the end of the Kentucky Health Quality Collaborative Conference.

The gathering was hosted by Kentucky Voices for Health in partnership with the Friedell Committee for Health System Transformation. "No single actor or set of stakeholders can solve what's wrong," Matthews said. "We really need to think across silos. We really have to collaborate."

When it comes to funding, governments "have made it very clear they will not increase the number of dollars that will be put into health care," said keynote speaker Dr. Robert Graham, national program director for Aligning Forces for Quality. "We're in a perfect storm," agreed Sue Thomas-Cox, branch manager for chronic disease prevention at the Kentucky Department for Public Health. "Federal, state and local governments don't have enough money . . . so we must work together."

Luckily, health care happens at the local level, Graham said, with hospitals and clinics unique to communities, health insurance agents locally based and consumers grounded in their communities. While there is "no particular model for how to get (change) started," Graham said, the first step is getting all stakeholders � purchasers, insurance agents, providers, consumers, faith-based organizations � around the same table. "You've got to make sure there is a balance of interests," he said. 

Also key are local boards of health and health departments, whose members and staff are charged with safeguarding the health of the people of a county, under state law, and have the advantage of being "relatively untainted by the illness-for-dollars disease," pointed out Dr. Forrest Calico, a rural health consultant and longtime worker in the field.

Health departments must ensure they don't spread themselves too thin, said Dr. Steve Davis, acting commissioner for the Department for Public Health. "One of the biggest reasons why we have not moved the health needle in Kentucky is we need to be an inch wide and a mile deep," he said. Communities need to "come up with five or six things and let's hammer, hammer, hammer it," he said. Of those priorities, Davis pointed out the importance of tackling chronic disease: "That's what's killing our brethren and eating our financial lunch." For adults, he would like to see an increase in breast, cervical, colon and lung cancer screening, as well an increase in immunization rates especially for flu and pneumonia.

For children, Davis has six priorities: reduce preterm and low-birthrate babies; improve injury-prevention programs; decrease tobacco use; reduce obesity; increase immunization rates; and improve oral health.

To get more accomplished, health departments need to team up with local organizations to avoid duplication of services, which Davis said accounts for $300 billion in unnecessary spending nationwide. He added the goal is to make "1 plus 1 equal 3," with health departments needing to adopt a "do or assure" philosophy.

But there are challenges in health departments, with some local health board members failing to "roll up their sleeves," Davis said. "You can go in with nothing in your head and leave with nothing in your head," agreed Henry Bertram, chair of the Pendleton County and Three Rivers District Board of Health.

A survey of health departments showed just 46 percent of local boards of health have a vision for the next three years to improve the health status of their community and just 44 percent say they are tracking compliance for the 10 essential services they are charged with providing. And the real numbers might be worse, because the survey was voluntary.

While about half of the state's health departments are committed to working toward achieving national accreditation, only three departments � Franklin, Northern Kentucky and Three Rivers District � have actually applied for it. 

Also crucial for communities is using data to identify priorities, take action and measure performance, whether using county-specific numbers at www.kentuckyhealthfacts.org or using national data.

"We don't want to get stuck in analysis paralysis," but communities can use the data as "a story you can use as leverage," said Jan O'Neill, community engagement specialist for County Health Rankings & Roadmaps. The County Health Rankings evaluate the morbidity and mortality rates for nearly every county in the country and rank them within a state.  The rankings can act as a motivator for counties interested in effecting health changes, but "We have to be aware of their limitations" given their margins of error, especially for small counties, pointed out Al Cross, director of the Institute for Rural Journalism and Community Issues. 

O'Neill spoke of San Bernadino County in California, which used its low ranking to spur change. The county focused on its built environment, pressing hard for Walk or Wheel to School programs, community gardens and a kids community health center. O'Neill pointed out the changes are about more than infrastructure. "It's the relationships," she said. "It's the human capital ... It's many not all doing it all, but bringing what you do best. That's what mobilizing looks like."

Jodi Mitchell, executive director for Kentucky Voices for Health, said she is "starting to see a tide of change" already in Kentucky. What's important is to keep momentum building and, equally vital, ensure people are willing to participate. "If you're not at the table," she said, "you're on the menu."

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

Princess Health and Floyd County woman is Kentucky's smoke-free advocate of year.Princessiccia

Princess Health and Floyd County woman is Kentucky's smoke-free advocate of year.Princessiccia

awards cigarettes county health departments local government smoking smoking ban smoking ordinances tobacco tobacco prevention

Gusty 08:01 Add Comment

For her work spreading the word about second-hand smoke and founding the coalition that ultimately helped Prestonsburg pass a smoke-free ordinance in 2009, Floyd County's Jean V. Rosenberg was named 2012 advocate of the year at the annual Smoke-Free Policy Conference hosted by the University of Kentucky's Kentucky Center for Smoke-Free Policy. She stands with center Director Dr. Ellen Hahn, left, and Dr. Melissa Walton-Shirley, right, the Glasgow cardiologist who won in 2011.

Rosenberg started her work in 2005 when she began working for the Floyd County Health Department as a program specialist to increase awareness about the dangers of second-hand smoke, reports Ann Blackford reports in a university press release. During that time, she founded the Breathe Easy Floyd County Coalition, which educated people about second-hand smoke and supported local smoke-free initiatives.

On Nov. 1, 2009, the City of Prestonsburg implemented a 100 percent smoke-free ordinance in all workplaces and enclosed public places, with Rosenberg at the helm to propel the effort forward. (Read more)

Princess Health and Mayor will propose smoking ban in Hopkinsville, largest Kentucky city without one.Princessiccia

Princess Health and Mayor will propose smoking ban in Hopkinsville, largest Kentucky city without one.Princessiccia

cigarettes local government smoking ban smoking ordinances tobacco

Gusty 10:31 Add Comment

The largest Kentucky city that has not banned smoking in public places may change that.

Hopkinsville Mayor Dan Kemp's proposal "fundamentally resembles Lexington's ban," reports Nick Tabor for the Kentucky New Era. The law would apply to bars and restaurants but not private clubs; retail tobacco stores and tobacco warehouses; and rented rooms in hotels, hospitals and nursing homes. "The best thing would be to have no exemptions," Kemp said, adding that he recognizes the need for compromise. 

An online survey by the Christian County Health Department two years ago indicated strong support for a ban. A recent, scientific survey of 500 Kentuckians shows 59 percent support a statewide ban, the American Cancer Society found. Kemp said he has "received a mostly positive response from local businesses," Tabor reports.

As for a smoking ban imposing on a person's right to light up, Kemp said, "I just think it's such an overriding health concern that that trumps the individual rights argument." Kemp hopes the council will vote on the proposal June 5. If they ratify it, the ban could take effect July 1. (Read more)