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 Donna Arnett, new UK public-health dean, says research is important to reducing Kentucky's huge health disparities. Princessiccia

Princess Health and Donna Arnett, new UK public-health dean, says research is important to reducing Kentucky's huge health disparities. Princessiccia

epidemiology public health research University of Kentucky

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Donna Arnett, dean of the College of Public Health at the University of Kentucky, says research is essential to reducing Kentucky's huge health disparities, as illustrated by the recent release of data showing a wide range in life expectancy among counties.

In a UK news release and video, Arnett, a genetic epidemiologist and native of London, noted the "devastating impact" that obesity, diabetes, cancer, drug-abuse and overdose deaths have in her native state.

�Public health is at the heart of answering the challenges of those critical diseases in Kentucky, " Arnett said. "We in public health are really at the forefront of first detecting these epidemics, and then finding strategies and interventions to help eliminate those disparities.�

Arnett's passion for research began during her early career as a nurse when she was working next to a dialysis clinic at a Department for Veterans Affairs hospital and noticed that more African-American men were sent to the clinic than men of other races.

�I�ll never forget, in my hallway in this VA hospital, every day men would be coming down the hallway, and they�re almost all African American,� Arnett said. �I said, �You know, there has to be something about being African American and having kidney failure.��

This prompted her to create an informal hypothesis that this was linked to a genetic code in African American men that put them at a higher risk of kidney failure. She was right. While her original hypothesis evolved, it was validated after numerous studies.

Arnett obtained a doctorate in epidemiology from the University of North Carolina and built a career in public health. She has received research funding from the National Institutes of Health for more than 20 years, and brought three active NIH projects to UK when she became dean of the public-health college in 2015. Among other leadership roles, she has served as the president of the American Heart Association.

Serving as AHA president showed Arnett that "solving the most urgent health problems in the nation requires the collaboration among different professionals and organizations devoted to health and uniting the research efforts and knowledge of diverse investigators," and she is working to establish partnerships across the state, the UK release and video say.

"Science now is really multi-disciplinary," Arnett said, "so we have to function in a team."

Princess Health and Painkillers appear to increase risk of deaths other than overdoses, according to new study of Medicaid patients in Tennessee. Princessiccia

Princess Health and Painkillers appear to increase risk of deaths other than overdoses, according to new study of Medicaid patients in Tennessee. Princessiccia

cardiac care cardiovascular disease heart health narcotics pain pain management prescription drug abuse research

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"Accidental overdoses aren't the only deadly risk from using powerful prescription painkillers," The Associated Press reports. "The drugs may also contribute to heart-related deaths and other fatalities, new research suggests."

A study of of more than 45,000 Medicaid patients in Tennessee from 1999 to 2012 found that "those using opioid painkillers had a 64 percent higher risk of dying within six months of starting treatment compared to patients taking other prescription pain medicine," AP reports. "Unintentional overdoses accounted for about 18 percent of the deaths among opioid users, versus 8 percent of the other patients."

"As bad as people think the problem of opioid use is, it's probably worse," said Vanderbilt University professor Wayne Ray, the lead author of the study report. "They should be a last resort and particular care should be exercised for patients who are at cardiovascular risk."

The report in the Journal of the American Medical Association noted that opioids can slow breathing and worsen the disrupted breathing associated with sleep apnea, which could lead to irregular heartbeats, heart attacks or sudden death.

The patients in the study "were prescribed drugs for chronic pain not caused by cancer but from other ailments including persistent backaches and arthritis," AP reports. "Half received long-acting opioids including controlled-release oxycodone, methadone and fentanyl skin patches. . . . There were 185 deaths among opioid users, versus 87 among other patients. The researchers calculated that for every 145 patients on an opioid drug, there was one excess death versus deaths among those on other painkillers. The two groups were similar in age, medical conditions, risks for heart problems and other characteristics that could have contributed to the outcomes."

Princess Health and Youth injuries from e-cigarettes spike; FDA is starting to regulate them, but study authors say not enough to protect children. Princessiccia

Princess Health and Youth injuries from e-cigarettes spike; FDA is starting to regulate them, but study authors say not enough to protect children. Princessiccia

children's health e-cigarettes federal legislation research vaping

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By Melissa Patrick
Kentucky Health News

The number of young children swallowing or being exposed to the liquid nicotine used in electronic cigarettes has "skyrocketed," jumping 1,500 percent from 2012 to 2015, one co-author of a recent study says.

"E-cigarettes and liquid nicotine can cause serious poisoning, and even death, among young children," Dr. Gary Smith, co-author of the study, told Randy Dotinga for HealthDay. "Like other dangerous poisons, they should be kept out of sight and reach of children, preferably in a locked location."

The research, published online May 9 in the journal Pediatrics, follows an announcement that the U.S. Food and Drug Administration will now regulate e-cigarettes. The rule bans the sale of e-cigarettes to minors, requires health warnings on all packaging and advertisements and requires manufacturers to get federal approval on all products introduced to the market after Feb. 15, 2007. It does not address marketing or advertising. The measure goes into effect Aug. 8, and gives affected industries two years to comply.

E-cigarettes, which are battery-powered devices that heat up fluid that includes nicotine and other ingredients such as flavors and chemicals, have become increasingly popular. They are now the most common form of nicotine use among teenagers. Researchers found that it is the liquid nicotine that poses the greatest danger to children.

The study looked at calls to the National Poison Data System about nicotine and tobacco products from January 2012 to April 2015, and focused on calls about children under the age of 6. The NPDS received 29,141 calls for nicotine and tobacco product exposure during this time, averaging 729 child exposures per month.

It found about 14 percent, or 4,128 of the calls were about exposure to e-cigarettes and involved children aged 2 or younger. Most of the exposures were due to ingestion.

"Children exposed to e-cigarettes had five times higher odds of a health care facility admission and almost 3 times higher odds of having a severe outcome than children exposed to cigarettes," says the report. "One death occurred in association with a nicotine liquid exposure."

"These are not trivial exposures. There were comas, seizures, and even one death in the 40-month period we studied, and these exposures were predictable and preventable," Smith told MedPage Today. "E-cigarettes and vaping liquids are products that should never have entered the market without adequate consideration of the harms they could cause to young children."

Smith, also the director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Ohio, told HealthDay that more needs to be done.

"Other prevention steps include prohibiting the use of flavors, as was done for cigarettes since 2009, restricting the use of packaging and labeling attractive to children, ensuring that liquid nicotine compartments on e-cigarettes are child-resistant, and limiting the concentration and/or quantity of nicotine in refill products," he said.

Gregory Conley, president of the American Vaping Association, a nonprofit group dedicated to education about e-cigarettes and vapor products, told HealthDay that the concern about e-cigarettes is "overblown."

He told HealthDay that the child who died "consumed a homemade nicotine liquid concoction that's much stronger than retail versions." He also pointed out that the number of cases have declined since this study was conducted, saying that this is likely due to increased publicity about the risk.

Co-author Henry Spiller, director of the Central Ohio Poison Center at Nationwide Children's Hospital, encouraged parents of young children who vape to treat liquid nicotine like a poison, suggesting that they keep refill containers "up, away and out of sight, preferably in a locked location" and to not leave vaping devices laying around.

Study authors encourage parents to call the Poison Help Line immediately, at 1-800-222-1222, if their child has been exposed to e-cigarettes.

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 Obama asks public to tell Congress to fund the $1.9 billion Zika fight he wants; Senate passed $1.1 billion, House $622 million. Princessiccia

Princess Health and Obama asks public to tell Congress to fund the $1.9 billion Zika fight he wants; Senate passed $1.1 billion, House $622 million. Princessiccia

birth defects Congress federal spending infectious diseases insects mosquitoes politics research vaccines viral infections

Gusty 12:14 Add Comment

The Zika funding package of Appropriations Committee Chair Hal Rogers and other House Republicans "doesn't make a lot of sense" and the somewhat larger Senate package backed by Majority Leader Mitch McConnell and a bipartisan Senate majority falls well short of what is needed, President Obama told reporters Friday.

The Senate has passed a $1.1 billion package and the House approved $622 million. Obama wants more than three times the House figure, $1.9 billion, to fight the virus that causes a serious birth defect.

"We didn�t just choose the $1.9 billion from the top of our heads," Obama said. "This was based on public-health assessments of all the work that needs to be done. And to the extent that we want to be able to feel safe and secure, and families who are of childbearing years want to feel as if they can have confidence that when they travel, when they want to start a family that this is not an issue -- to the extent that that's something that we think is important, then this is a pretty modest investment for us to get those assurances."

Obama said the House package is not only inadequate, "That money is taken from the fund that we're currently using to continue to monitor and fight against Ebola. So, effectively, there�s no new money there. All that the House has done is said, you can rob Peter to pay Paul. And given that I have, at least, pretty vivid memories of how concerned people were about Ebola, the notion that we would stop monitoring as effectively and dealing with Ebola in order to deal with Zika doesn�t make a lot of sense."

The president added, "This is something that is solvable. It is not something that we have to panic about, but it is something we have to take seriously. And if we make a modest investment on the front end, then this is going to be a problem that we don't have to deal with on the back end." He said each child who has a small brain as a result of Zika "may end up costing up to $10 million over the lifetime of that child in terms of that family providing that child the support that they need. . . .  It doesn�t take a lot of cases for you to get to $1.9 billion. Why wouldn't we want to make that investment now?"

Part of the money would go to develop a vaccine for Zika, and part of that work is going on at the University of Kentucky. "You don't get a vaccine overnight," Obama said. "You have to test it to make sure that any potential vaccine is safe. Then you have to test to make sure that it's effective. You have to conduct trials where you're testing it on a large enough bunch of people that you can make scientific determinations that it's effective. So we've got to get moving."

Obama said the Centers for Disease Control and Prevention and the National Institutes of Health are "taking pots of money from other things -- universal flu funds or Ebola funds or other funds -- just to get the thing rolling. But we have to reimburse those pots of money that have already been depleted and we have to be able to sustain the work that�s going to need to be done to finish the job. So, bottom line is, Congress . . . needs to get me a bill that has sufficient funds to do the job."

The president said that should happen before the summer congressional recess in August, "to provide confidence to the American people that we're handling this piece of business." He said the money would be insurance for young families or couples thinking about having children.

"To the extent that we're not handling this thing on the front end, we're going to have bigger problems on the back end," Obama said. "Tell your members of Congress, get on the job on this. This is something we can handle. We should have confidence in our ability to take care of it. We've got outstanding scientists and researchers who are in the process of getting this done, but they�ve got to have the support from the public in order for us to accomplish our goal."

Princess Health and 1/2 of cancer deaths and maybe 1/2 of new cases could be prevented by exercise, watching food and drink, and not smoking. Princessiccia

Princess Health and 1/2 of cancer deaths and maybe 1/2 of new cases could be prevented by exercise, watching food and drink, and not smoking. Princessiccia

cancer obesity prevention research smoking tobacco tobacco prevention

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Half of all cancer deaths could be prevented "by applying insights that we've had for decades � no smoking, drinking in moderation, maintaining a healthy body weight and exercising," Carolyn Y. Johnson reports for The Washington Post, about a study published in JAMA Oncology.

Those measures could also cut new cancer cases by 40 to 60 percent. Those are big numbers, and especially important for Kentucky, which has some of the nation's leading rates of cancer and death from it � and, not coincidentally, is among the national leaders in smoking and obesity.

"Some of the declines we have already seen in cancer mortality � the large decline in lung cancer � that was because of efforts to stop people from smoking," Siobhan Sutcliffe, an associate professor in the division of public health sciences at Washington University in St. Louis, told Johnson. "Even while we�re making new discoveries, that shouldn�t stop us from acting on the knowledge we already do have."

Sutcliffe was not involved in the study, which used "large ongoing studies that have closely followed the health and lifestyle habits of tens of thousands of female nurses and male health professionals," Johnson reports. "They divided people into two groups: a low-risk group that did not smoke, drank no more than one drink a day for women or two for men, maintained a certain healthy body mass index, and did two-and-a-half hours of moderate aerobic exercise a week or half as much vigorous exercise.

"The team compared cancer cases and cancer deaths between the low- and high-risk groups and found that for individual cancers, the healthy behaviors could have a large effect on some cancers: The vast majority of cases of lung cancer were attributable to lifestyle, as well as more than a fifth of cases of colon cancer, pancreatic cancer and kidney cancer.

"Then, they extrapolated those differences to the U.S. population at large, finding an even larger proportion of potentially preventable cancer cases and deaths. For women, they estimated 41 percent of cancer cases were preventable and 59 percent of cancer deaths. For men, 63 percent of cancer cases were potentially preventable and 67 percent of deaths."

The researchers at Massachusetts General Hospital and the Harvard T.H. Chan School of Public Health noted some caveats: "The high-risk group in the study is healthier than the general U.S. population, so there are reasons the numbers may be slightly overestimated," Johnson writes. "But Mingyang Song, the researcher who led the work, argues the numbers are a good approximation because they may be underestimating the effects of lifestyle, too, because they selected a narrow range of lifestyle factors."