Princess Health and Kentuckians agree regionally on tobacco controls; poll shows wide differences among regions in impact of drug abuse. Princessiccia

Princess Health and Kentuckians agree regionally on tobacco controls; poll shows wide differences among regions in impact of drug abuse. Princessiccia

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Gusty 21:01 Add Comment

By Al Cross
Kentucky Health News

In a state that once had more tobacco farms than any other, Kentuckians in all regions of the state support policies that discourage use of the product, according to the Kentucky Health Issues Poll.

"Such policies could greatly improve Kentucky's overall health," says the Foundation for a Healthy Kentucky, which co-sponsors the poll each fall. It issued a package of reports that broke down a wife range of previously reported poll results on a regional basis.

Kentucky has fewer than 5,000 tobacco farms, down from a high of 60,000 in 1982, but still has one of the nation's highest smoking rates, 26 percent. That leads to an estimated $2 billion in annual health-care costs.

In every region of the state, a majority (ranging from 59 to 70 percent) of people polled said it would be "difficult" or "very difficult" to make the most important change in their personal health behavior, which for most smokers would be to stop smoking.

"Kentucky adults in every region recognize that improving diet, getting more exercise and quitting smoking could help improve personal health, but the changes are difficult," said Susan Zepeda, president and CEO of the foundation. "Policies around these areas could help all Kentuckians improve their personal health."

The policy getting the strongest support in the poll was tobacco-free school campuses, favored by 85 percent statewide. Fewer than a third of Kentucky's school districts have such policies, but enough do to cover almost half the population.

A statewide ban on smoking in workplaces got 66 percent support. Such a ban is unlikely during the administration of Gov. Matt Bevin, who says the issue should be decided locally. About a third of the state's population lives in jurisdictions with comprehensive smoke-free ordinances; another 10 percent or so live in places that have ordinances with varying exceptions.

There was little difference among the five regions in polling on the two issues.

The poll found regional differences in the percentage of Kentucky adults who said they had no insurance, from 18 percent in Western Kentucky to 8 percent in Eastern Kentucky. The statewide uninsured rate reported at the time of the poll was 13 percent. Other surveys have showed the number in the single digits statewide, after expansion of the Medicaid program under federal health reform.

Health reform also provided subsidies for buying insurance, but some consumers have complained about high deductibles and co-payments. In Northern Kentucky, 34 percent of poll respondents said they had difficulties paying their medical bills in the previous 12 months. The figure was 31 percent in Appalachian Kentucky, 30 percent in Greater Louisville, 25 percent in Western Kentucky, and 22 percent in Greater Lexington.

"An increasing number of Kentuckians have health insurance, but many are still delaying or simply can't afford necessary health care," Zepeda said.

Federal health reform was most popular in the Louisville area, at 44 percent support, and least popular in Northern Kentucky, with 33 percent. Generally, the more impact people said reform had on them, the more likely they were to support it. Three of five Northern Kentuckians said they had not been affected by the reforms but only 45 percent in the Louisville area said that.

There are bigger differences in the impact of drug abuse. One-third of Eastern Kentucky residents in the poll reported reported family members or friends struggling with prescription drug abuse, but only 16 percent in Western Kentucky said so.

Heroin use has caused problems for 35 percent of respondents' families and friends in Northern Kentucky, 17 percent in Greater Louisville, 14 percent in Greater Lexington, 10 percent in Eastern Kentucky, and 8 percent in Western Kentucky.

The regional reports for Eastern Kentucky, Greater Lexington, Greater Louisville, Northern Kentucky, and Western Kentucky, and associated news releases, are available at http://healthy-ky.org/news-events/press-releases.

The poll was conducted Sept. 17 through Oct. 7 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,608 adults from throughout Kentucky was interviewed by landlines and cell phones. The statewide poll has a margin of error of plus or minus 2.4 percentage points, but the smaller regional samples have higher error margins. The complete data file, codebook and survey instrument will be posted by June 30 at http://www.oasisdataarchive.org/ with other data files from previous polls.

Princess Health and CDC boss Tom Frieden, at SOAR, gives examples of how communities can improve health, such as smoking bans. Princessiccia

Princess Health and CDC boss Tom Frieden, at SOAR, gives examples of how communities can improve health, such as smoking bans. Princessiccia

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Gusty 13:08 Add Comment

By Al Cross
Kentucky Health News

PIKEVILLE, Ky. -- Speaking to a region with some of the nation's poorest health, the top federal public-health official gave examples of how individual communities and states have made themselves healthier.

"Health is not just about health, it's about society," Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, told more than 1,000 people at the Shaping Our Applalachian Region Innovation Summit in Pikeville. "Healthy societies are more productive, and productive societies are more healthy."

Referring to Kentucky's high rates of disease and factors that cause them, Frieden said bringing Eastern Kentucky's health statistics up to the national average would save more than 1,000 lives a year.

Frieden cited six communities that have tackled specific health issues, such as obesity, lack of physical activity, heart health, smoking and teen pregnancy.

Obesity is one of SOAR's three main health targets, but it's not an easy one, Frieden said. He said Somerville, Mass., reduced obesity in children under 6 by 21 percent by making it a community issue, with creation of farmers' markets for local produce, construction of walking paths and the mayor leading community walks.

"Physical activity is the closest thing to a wonder drug," Frieden said, because it helps prevent heart disease, strokes, diabetes and cancer, improved mood and lengthens life.

The leading preventable cause of death is smoking, Frieden said, calling for ordinances and laws making workplaces smoke-free. "Nobody should have to risk getting cancer to come to their job," he said.

Heart disease is the most preventable major cause of death, Frieden said, explaining how Minnesota and Grace Community Health Centers in Knox, Clay, Leslie and Bell counties have improved heart health by improving treatment of high blood pressure, or hypertension. "It's the single most important thing" to do for heart health, and it's simple, Frieden said, because the medicine is inexpensive and taken once a day with few if any side effects.

Frieden said the CDC thinks a lot about teen pregnancy because "Teen pregnancy perpetuates a cycle of poverty." He said Spartanburg, S.C., reduced teen pregnancy by 61 percent from 2001 to 2014 partly because South Carolina's Medicaid program paid for long-acting, reversible contraception immediately after delivery, and was the first state to give full reimbursement for post-partum insertion of intrauterine devices for birth control. Kentucky Medicaid doesn't cover such services.

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 FDA to regulate e-cigs: ban sales to minors, require warning signs, require federal approval; did not address advertising issues. Princessiccia

Princess Health and FDA to regulate e-cigs: ban sales to minors, require warning signs, require federal approval; did not address advertising issues. Princessiccia

e-cigarettes federal regulation food and drug administration smoking ban teens tobacco tobacco prevention youth

Gusty 08:34 Add Comment

In a long-anticipated move, the U.S. Food and Drug Administration announced May 5 that it is assuming regulatory authority over all tobacco products, including electronic cigarettes, cigars, hookah, tobacco and pipe tobacco that include banning sales to anyone under 18.

�Today�s announcement is an important step in the fight for a tobacco-free generation � it will help us catch up with changes in the marketplace, put into place rules that protect our kids and give adults information they need to make informed decisions," Health and Human Services Secretary Sylvia Burwell said in a news release.

FDA's new tobacco regulations will prohibit sales of e-cigarettes and all tobacco products to anyone under 18, both in person and online, and buyers must now show photo ID.

Health warnings will also be placed on packages and in advertisements, saying, �WARNING: This product contains nicotine. Nicotine is an addictive chemical.� It also bans free samples and the sale of covered products in vending machines not located in adult-only facilities.

The regulation also requires manufacturers of all newly-regulated products introduced to the market after Feb. 15, 2007, a date that is set by the Tobacco Control Act of 2009, to require federal approval. An amendment to the legislation has been submitted to change the date so more e-cigarettes would be grandfathered in, Jayne O'Donnell and Laura Ungar report for USA Today.

The e-cigarette industry is pushing back on these regulations.

"Industry experts say treating e-cigarettes, which don't contain tobacco, the same as cigarettes could lead to such onerous and costly approval that all but the largest tobacco companies would be forced out of the market � and possibly those companies, too," USA Today writes. Jeff Stier, an e-cigarette advocate with the National Center for Public Policy Research and industry officials, told USA Today that it could cost $1 million or more per application.

Vapers also argue that e-cigs help people quit, but studies on that conflict.

Ellen Hahn, a professor at the University of Kentucky College of Nursing and co-chair of the UK Tobacco-free Task Force, told USA Today that the new rule is a good first step toward controlling e-cigarettes, noting "vaping" can get youth addicted to nicotine and threatens to prolong "the tobacco epidemic."

"From a health perspective, to reduce the social acceptance of them is good because frankly, it's the wild, wild West out there," she told the newspaper. "Vape stores are everywhere."

The Robert Wood Johnson Foundation commended the FDA for these regulations, noting the use among high school students has "rocketed from 1.5 percent in 2011 to 16 percent in 2015, an increase of more than 900 percent." But it also said the regulation did not go far enough.

"Studies have proven that tobacco advertising directly influences youth, and that such sweet e-cigarette flavors as gummy bear and cotton candy play a role in children trying these products," Dr. Risa Lavizzo-Mourey, CEO of the RWJF, said in the statement "Today's final rule did not address these issues, and we strongly urge the FDA to take aggressive regulatory and enforcement actions to prevent and reduce youth tobacco use, in any form it takes."

The regulation goes into effect Aug. 8, and gives affected industries two years to comply. The original proposal was introduced in 2014.

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 This year's smoking-ban bill is dead; Senate advocates have bill to make insurers provide all smoking cessation treatments. Princessiccia

Princess Health and This year's smoking-ban bill is dead; Senate advocates have bill to make insurers provide all smoking cessation treatments. Princessiccia

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Gusty 11:56 Add Comment

By Melissa Patrick
Kentucky Health News

Despite early hope, the bill to ban smoking in Kentucky workplaces was likely dead on arrival this year.

"I haven't heard anything about the smoking ban bill in . . . well, really since the start of the session," House Speaker Greg Stumbo, D-Prestonsburg, said in an interview. "So, I would say yes, it's dead."

Rep. Susan Westrom

"The timing has just not been right," said Susan Westrom, D-Lexington, sponsor of the bill. "We don't have the votes. It seems like in every election year, people are afraid to vote on something like this that they perceive to be controversial."

In addition to it being an election year, Westrom elaborated on a long list of other reasons for why the smoking-ban bill hasn't had any support this year, including: it being a budget year, a new Republican governor and Senate leadership that don't support it, less organization from advocates, a quiet public and the loss of several funding streams.

"There's always next year," Westrom said. "This isn't an issue that will go away because we can't ignore that Kentucky is one of the least healthy states in the country. It always has to be at the top of our priority list."

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.

Last year was the first year Westrom's smoking ban bill passed out of the House with a vote of 51-46. The bill was then placed in an unfavorable Senate committee and never brought up for discussion. This is the sixth year she has sponsored this bill.

"I have enjoyed carrying this bill more than anything I've done over the years because it is the right thing to do and because I really, really care about the health of Kentucky," she said wistfully.

Republican Sen. Ralph Alvarado, a Winchester physician, said in an interview that he had worked very hard this session to get a smoke-free bill together in the Senate, but he just couldn't get the votes.

Instead, Republican senators Julie Raque Adams from Louisville and Alvarado have filed Senate Bill 291 that would require insurers in Kentucky to cover all approved smoking cessation treatments, counseling and medication. Currently, many plans only cover some physician-prescribed treatments and/or medications.

A flyer to drum up support for SB291 says the state has nine-thousand smoking related deaths per year; $1.92 billion in smoking related health expenditures; and $590 million in smoking related Medicaid costs. The statewide smoking rate in Kentucky is 26 percent.

"Tobacco is still one of the most expensive cost for our healthcare system in the state," Alvarado said. "Anything that we can do to help get people off of cigarettes voluntarily...I think is going to benefit us financially and is going to save lives."

Adams was pessimistic about the bills chance of passing this year, but said she was hoping for a hearing on it to continue the education process and keep the issue alive.

"The fact that insurance does cover cessation, I think that is a really important thing to get out to the consumer," she said in an interview.

According to Run Switch PR, this bill has the support of the following: American Cancer Society, American Heart Association, American Lung Association, Campaign for Tobacco Free Kids, Kentucky Medical Association, Kentucky Hospital Association, Kentucky Rural Health Association, Kentucky Voices for Health, Kentucky One and Baptist Health. It is currently in the Senate Baking and Insurance committee.