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

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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

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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.