Princess Health and Kids Count report finds Ky. remains in the bottom 1/3 of states for children's well-being; is this a predictor of the state's future?. Princessiccia

Princess Health and Kids Count report finds Ky. remains in the bottom 1/3 of states for children's well-being; is this a predictor of the state's future?. Princessiccia

children children's health economy education poverty pregnancy research teens wellness youth

Gusty 21:01 Add Comment

By Melissa Patrick
Kentucky Health News

If Kentucky's future lies in the well-being of its children, there's reason to worry, because a recent report shows that Kentucky consistently remains in the bottom one-third of states for this measure.

The 2016 Kids Count report ranks Kentucky 35th in the overall well-being of its children, down from 34th last year. The state showed a significant improvement in its health ranking and a further drop in its teen birth rate, but otherwise didn't show much change from last year's report by the Annie E. Casey Foundation and Kentucky Youth Advocates.

"The real issue is not a drop or increase of one position, but rather that Kentucky continues to be in the bottom one-third of all states," KYA Executive Director Terry Brooks said in a news release. "Are we really content with the idea that two-thirds of America's children are better off than Kentucky kids?"

The annual report offers a state-by-state assessment that measures 16 indicators to determine the overall well-being of children. The latest data are for 2014, and is compared with data from the last six or so years earlier. The report focuses on four major domains: economic security, education, health and family and community security.

Kentucky continues to rank highest in health, climbing to 16th from 24th in 2015, 28th in 2014 and 31st in 2013. Contributors included a continued drop in the number of children without health insurance (4 percent); a 15 percent decrease in child and teen mortality, fewer teens abusing alcohol or drugs (4 percent) and improvements in the percentage of low-birthweight babies (8.8 percent).

The state's greatest drop among the rankings was in economic security, going down to 37th from 32nd last year. Education (27th) saw a slight improvement from the past two years and the family and community (38th) rankings remained similar to the past three years.

The release notes that the state now ranks 10th for the percentage of children with health insurance.

"We are seeing better outcomes for kids in Kentucky, and expanded health coverage and access to quality care play a vital role in making that happen," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in the release. "Research shows that when parents have health coverage, their children are more likely to also be signed up for health insurance."

Another bright spot in the report is that the state's teen birth rate continues to drop. It declined 34 percent from 2008 to 2014. While Kentucky still has one of the nation's highest teen birth rates, it dropped to 35 births per 1,000 girls aged 15-19 in 2014, down from 39 per 1,000 in 2013 and 53 per 1,000 in 2008. The national average is 24 per 1,000, an all-time low.

Kentucky consistently ranks lowest in the "family and community" domain, with 35 percent of its children living in single-parent families; 12 percent living in families where the household head lacks a high school degree; and 16 percent living in high-poverty areas, which are neighborhoods where more than 30 percent of residents live in poverty.

"Kentucky will thrive when policies that support the whole family, caregiver and child, are implemented," Adrienne Bush, executive director of Hazard Perry County Community Ministries, said in the release.

And though the state's education ranking improved to 27th from 30th, not much has changed in these indicators since the foundation started doing this report. The bottom line is that more than half of fourth graders (60 percent) still can't read at a national proficiency level and that the majority of eighth graders (72 percent) still aren't proficient in math. (In 2007, these indicators were 67 percent and 73 percent respectively.)

"Student performance should alarm parents and business leaders and jolt Kentucky leaders into making fundamental education reform a policy priority to ensure college and career readiness," Brooks said.

In addition, more than half the state's three-and four-year-olds (58 percent) don't attend pre-school and 17 percent of its high school students don't graduate on time.

Perhaps the direst message from the report is about the state's economic well-being. One in four Kentucky children live in poverty (26 percent), a rate that has remained higher than it was pre-recession when it was 23 percent, says the release. Nationally, the child poverty rate is 22 percent.

"Growing up in poverty is one of the greatest threats to healthy child development," says the report. "Poverty can impede cognitive development and a child's ability to learn."

The report also says 35 percent of Kentucky's children live in homes with parents who don't have secure employment, which places the state in the bottom 10 states for this indicator. It also found that 28 percent live in households with a high housing-cost burden.

The release suggested "bipartisan solutions" to improve the well-being of Kentucky's children, including expanding oral health coverage; supporting school-based health centers; education reform that includes public charter schools, expanded child care assistance and family-focused tax reforms.

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 House Republicans want to make it harder for schools to get free meals for all students; could affect more than 350 Ky. schools. Princessiccia

Princess Health and House Republicans want to make it harder for schools to get free meals for all students; could affect more than 350 Ky. schools. Princessiccia

children children's health food income nutrition poverty school health school lunch schools

Gusty 10:38 Add Comment

Photo from npr.org

By Danielle Ray
Kentucky Health News

Kentucky school officials are concerned about a proposal by Republicans in the U.S. House that would make it harder for schools to offer free meals to all students using federal money.

The House is considering changes to the 2010 Hunger-Free Kids Act, now in its second year, which allows schools who serve a high-poverty population to offer free meals to every student.

Instead of collecting individual applications for free or reduced-price meals, the Community Eligibility Provision uses data that illustrates how many students in a given school may be "food-vulnerable": how many students live in households that receive government assistance, live in foster care, are homeless, and other similar criteria.

Under current CEP rules, schools with greater than 40 percent of students who qualify as food-vulnerable are eligible to offer free meals to all students. A bill approved May 18 by the House Education and Workforce Committee would raise the threshold to 60 percent, forcing schools between 40 and 59 percent range off the program.

"Proponents of community eligibility say it spares schools from paperwork and administrative burdens, and that it allows low-income children to eat free meals without the stigma or red tape of particpation in the free meal program, which is often a barrier for participation," Evie Blad reports for Education Week. "But Republicans on the committee said the provision is wasteful, potentially allowing children from higher-income families access to free meals."

The change could affect more than 350 Kentucky schools. Kentucky has 804 schools eligible to offer free meals under current CEP rules, according to the Center on Budget and Policy Priorities. Under the proposed bill, only 441 would qualify, according to the center.

More than 10,000 students at 17 public schools in Lexington alone would be affected, according to the Lexington Herald-Leader reported. More than 190,000 students statewide could be affected, the Herald-Leader said.

Nick Brake, superintendent of Owensboro schools, told Keith Lawrence of The Messenger-Inquirer that he is hopeful that his district will be spared cuts.

"I have been working with Congressman (Brett) Guthrie�s office on this issue," Brake said. "We are still looking at the overall numbers, but our district average is 63 percent, so it looks favorable that we will be able to continue to provide the benefit of this vital program in the future."

Muhlenberg County Supt. Randy McCarty told Lawrence he thought his district would still qualify. "Once a district goes CEP, it stays in place for four years," he said.

Hopkins County, which recently expanded its use of free meals to all public schools, faces uncertainty if the changes are passed.

"I have no idea if school districts will be grandfathered in, or how Congress will write everything, but I am afraid that if we don't jump on this now, we may not get this opportunity again," Michael Dodridge, food services director of Hopkins County schools, told Laura Buchanan of The Messenger in Madisonville. "I would hate to pass this up."

UPDATE, May 26: The Harlan Independent School Board voted to join the program, Joe Asher reports for the Harlan Daily Enterprise.

The proposed CEP changes are part of House Resolution 5003, the child nutrition reauthorization bill introduced by Indiana Republican Rep. Todd Rokita. For more information on the proposed changes, click here.

Princess Health andSchool nutritionists' lobbying group, freshly funded by grocery makers, wants more funding and flexibility with school-lunch rules.Princessiccia

Princess Health andSchool nutritionists' lobbying group, freshly funded by grocery makers, wants more funding and flexibility with school-lunch rules.Princessiccia

agriculture child obesity childhood obesity education hunger nutrition poverty

Gusty 07:14 Add Comment

School nutrition officials want more flexibility with new school lunch rules to cut down on the waste of unwanted food, Spencer Chase reports for Agri-Pulse, a Washington newsletter. Julia Bauscher, president of the School Nutrition Association, told the House Education and Workforce Committee that the organization supports the rules, but needs more funding to enforce them  and more flexbility to serve foods students will eat. (USDA graphic)

"SNA is requesting 35 cents more in federal funding for each lunch and breakfast that is served in the school lunch program, up from the additional six cents the government provided when the new standards were put in place," Chase writes. Bauscher told the committee, �That will help school food authorities afford the foods that we must serve, but unfortunately that won't make students consume it.�

Bauscher, who said SNA wants Congress "to soften the bill's target levels for more whole grains and less sodium in school meals," said that "in many cases, the new requirements have forced school lunch programs outside of budgetary constraints, forcing them to ask school districts to make up the difference. According to SNA, school districts will absorb $1.2 billion in new food and labor costs in 2010," Agri-Pulse reports. SNA has drawn major funding from some food manufacturers.

Chase writes that 51 percent of students qualify for free or reduced lunches, the first time the number has topped 50 percent in at least 50 years.

Princess Health andStudy of poor but healthy Appalachian counties aims to find community-based approaches to improving the region's health .Princessiccia

Princess Health andStudy of poor but healthy Appalachian counties aims to find community-based approaches to improving the region's health .Princessiccia

Appalachia county health economy health status poverty research

Gusty 06:59 Add Comment

Though some people equate Appalachian areas with poverty, David Krol seeks to "shine a light" on a different picture�one that reflects "how health can flourish across Appalachia," despite data that confirms economic hardship, Krol writes for the Robert Wood Johnson Foundation.

While Krol was reviewing the Appalachian Regional Commission's county-based economic data, which compares economic indicators like poverty and unemployment rates with national averages and then ranks each county, it occurred to him to overlay this county index with the annual County Health Rankings.

For the most part, Krol said he found what he expected, "that the most economically distressed counties in Appalachia would also be in the lowest quartiles of health outcomes and factors for their state." But some counties that were economically distressed ranked in the top quarter of their state in health factors and outcomes.

"What was it about Wirt County, West Virginia; Pickett County, Tennessee; and Oktibbeha County, Mississippi, that helped them overcome significant economic challenges towards better health outcomes when similarly distressed counties in the same state did not?" he wrote.

The need to know why these "unexpected outliers" occurred has prompted Krol, with the help of the ARC and the Foundation for a Healthy Kentucky, to study how these counties have accomplished this and to look at whether this could be re-created in similar communities.

"This approach is rooted in the belief that communities have the best solutions to the problems they face�as opposed to solutions driven by outside experts," he wrote.

It�s an opportunity to �go beyond the data.. to community conversations about what�s important,� Susan Zepeda, CEO of the foundation, told Krol.

Krol wrote, "Quantitative data can get only get us so far�it�s up to us to ask those critical questions of �Why? How? What can be done? It�s up to us to turn data into action."

Princess Health and Princess Health andSchools keep adjusting to national nutrition guidelines.Princessiccia

Princess Health and Princess Health andSchools keep adjusting to national nutrition guidelines.Princessiccia

child obesity nutrition poverty school lunch schools

Gusty 19:47 Add Comment

Paducah-area school districts "continue to adjust school meals to ensure students are fed complete, healthy meals every day," Kathleen Fox reports for The Paducah Sun.

The revised National School Lunch Program "places the emphasis on portion size and healthier food options such as fruits, vegetables and milk," Fox notes. "The requirements to make lunches and breakfasts healthier, which have been phased in over the last two school years, will continue to change for the 2014 school year. All pastas and other grain products in schools will have to be whole-grain rich, defined as 51 percent or more of whole grain, and the first ingredient has to be whole wheat or grain."

Half the grain products in Paducah Public Schools are whole grain, and some are white to head off complaints, Nutrition Director Penny Holt told Fox. Holt "doesn't foresee major issues in switching the remain half to whole grain," Fox writes. "She said many of the whole grain products are popular with students including brown rolls, flatbreads, short slice Domino's pizza crust and honey wheat whole grain wraps."

"The healthier options are growing in popularity, especially with our younger kids who have become more familiar with them," Holt said. All children in the school system receive free breakfast and lunch as part of a special federal program for schools with a large percentage of children in poverty.

"Holt said the greater challenge will be adhering to the stricter sodium guidelines with meals and higher nutritional value for snacks or a-la-carte items," Fox reports. "Items that can be served other than those on the daily menu include baked chips and whole grain cookies, but nothing with minimal nutritional value such as soda or candy."

In the McCracken County Schools, Food Services Director Sara Jane Hedges "said the district already has success with many of its whole grain alternatives, including its pastas and pizza crusts," Fox writes. "She said the change toward healthier a-la-carte options, which now have to provide additional nutritional value, will not be a problem because the district has already worked toward offering foods that meet those guidelines." (Read more; subscription required)

Princess Health and Princess Health andKentucky leads nation in percentage of children who have been diagnosed with attention deficit hyperactive disorder.Princessiccia

Princess Health and Princess Health andKentucky leads nation in percentage of children who have been diagnosed with attention deficit hyperactive disorder.Princessiccia

ADHD attention deficit children disabilities hyperactivity pediatrics poverty research

Gusty 05:55 Add Comment

Kentucky leads the nation in the percentage of children who have been diagnosed with attention deficit hyperactive disorder, according to the latest available data, which "showed that ADHD levels have risen steeply in the past decade across the nation," Laura Ungar reports for The Courier-Journal.

Ungar writes that "19 percent of Kentucky children ages 4-17 have been diagnosed with ADHD at some point, compared with 11 percent nationally and 16 percent in Indiana." Almost 15 percent of Kentucky children had the diagnosis in 2011, based on polling by the U.S. Centers for Disease Control and Prevention.

"We're probably over-diagnosing it to a certain extent," Dr. Christopher Peters, a psychiatrist and assistant professor of pediatrics at the University of Louisville, told Ungar. "But these numbers indicate a problem. There are many kids in need."

The high numbers could "reflect the state's rampant poverty, since ADHD is identified more frequently in the poor," Ungar writes. "Others say more children here may be genetically prone to the disorder or face other risk factors. . . . Studies show that at least a third of parents who had ADHD as children have kids with the diagnosis."

Any over-diagnosis may stem from "overworked primary care doctors who aren't experts in the disorder" and may be over-diagnosing � and possibly over-prescribing � both locally and nationwide," Ungar writes. "Roughly 8 percent of of school-aged boys nationally and nearly 4 percent of girls took ADHD medications in 2012, according to data from the pharmacy benefit management firm Express Scripts."

There are "financial incentives" for an ADHD diagnosis, Ungar notes. "A diagnosis may translate into disability payments if a child has measurable and serious problems, and students with ADHD can get extra help in school. . . . Experts say the higher numbers may also indicate greater awareness of the disorder, meaning the truly needy are getting the medication, therapy and support they deserve."

However, Dr. Carmel Wallace, pediatrics chairman at the University of Kentucky, "said parents rarely push for a diagnosis to get a disability check," Ungar reports. "And the threshold for disability is high."

Still Kentucky has high rates of children and adults getting Social Security disability payments, and ranks high in some risk factors for ADHD.

"Scientists also have linked ADHD to alcohol and tobacco use during pregnancy � although doctors said it's unclear whether smoking is a cause or simply occurs more often in families with afflicted children," Ungar reports. "Kentuckians smoke at the nation's highest rate and also have high rates of substance abuse overall."

Ungar's example of an ADHD child was, in preschool, "a tiny tempest � at times defiant, other times bouncing distractedly from toy to toy at daycare, while other children were absorbed in play," but as a second-grader "is doing well . . . with a mild stimulant and counseling." Here's a C-J video of another ADHD child and her mother discussing how they deal with it: