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

drug abuse health insurance health reform heroin obamacare poll polls prescription drug abuse smoking smoking ban smoking bans tobacco

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

blood pressure cardiovascular disease heart disease hypertension obesity physical activity pregnancy smoking smoking ban smoking bans teenagers teens tobacco tobacco prevention walking

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 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

advertising cigarettes General Assembly governor health policy legislature local government politics smoking smoking ban smoking bans smoking ordinances tobacco tobacco prevention

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 If legislature won't help protect Kentuckians from the health threat of tobacco, local governments should, Herald-Leader says. Princessiccia

Princess Health and If legislature won't help protect Kentuckians from the health threat of tobacco, local governments should, Herald-Leader says. Princessiccia

General Assembly health rankings legislature newspapers smoking smoking bans smoking ordinances tobacco tobacco prevention

Gusty 08:51 Add Comment

Since the Kentucky General Assembly "adjourned without tackling the addiction that kills the most Kentuckians, tobacco," local communities need to take up the challenge, the Lexington Herald-Leader said in an editorial Sunday.

To drive home the primary role that tobacco plays in Kentucky's poor health, the newspaper ran a map of the most recent County Health Rankings, showing that "the places where smoking rates are highest have the worst health outcomes."

The Democrat-controlled state House passed a statewide ban on smoking in workplaces last year, but the bill got nowhere in the Republican-controlled Senate, and with new Republican Gov. Matt Bevin opposed to it and all House seats on the ballot this year, the bill didn't get a vote in the House.

Bevin has said smoking bans should be a local decision. The editorial says, "One of the cheapest, most effective ways to do that (since the legislature won�t) would be to join the places across Kentucky that have enacted local smoke-free laws." About one-third of Kentucky's population lives in jurisdictions with comprehensive smoking bans.

Read more here: http://www.kentucky.com/opinion/editorials/article72143017.html#storylink=cpyThe

Read more here: http://www.kentucky.com/opinion/editorials/article72143017.html#storylink=cpy

Princess Health and Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1. Princessiccia

Princess Health and Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1. Princessiccia

cancer colorectal cancer health reform lung cancer Medicaid obamacare Patient Protection and Affordable Care Act rural health rural-urban disparities smoking smoking bans

Gusty 09:11 Add Comment

Health officials in Kentucky, especially in the eastern part of the state, hope to increase lung-cancer screenings by following a successful colon-cancer screening initiative, Jackie Judd reports for PBS NewsHour. (Centers for Disease Control and Prevention graphic: Colon-cancer screenings are up)

In rural Eastern Kentucky, smoking and lung cancer rates are double the national average, while the state is second in adult smoking rates and leads the nation in lung cancer and rates of death from it. That is "fueled by a toxic combination of poverty, medical illiteracy, limited access to care, lifestyle choices like smoking, and a fatalism that says knowing you have cancer won�t save you."

Another challenge is that local bans of smoking in public places have left two-thirds of residents living in areas with no such bans, and a statewide ban seems unlikely because it failed to pass the state House this year after narrowly passing last year. New Republican Gov. Matt Bevin opposes a statewide ban.

Fifteen years ago Kentucky led the nation in "both the highest incidence and mortality rates for colorectal cancer," Allison Perry reports for University of Kentucky News. Rural residents didn't seek care, partly because of a lack of facilities and partly because of a refusal to schedule an appointment. If local residents wouldn't seek care, health officials decided to bring care to local residents.

"In the seven years following this new focus on colorectal cancer, the screenings rates nearly doubled, from 34.7 percent of the age-eligible population receiving screenings to 63.7 percent," Perry writes. "This raised Kentucky�s rank from 49th in the country to 23rd compared to other states. No other state has had such a dramatic increase in colorectal screenings in such a short period of time. As a result, the lives of many Kentuckians have been saved: the incidence rate for colorectal cancer is down nearly 25 percent, and the mortality rate has dropped 30 percent. Through colorectal screenings, doctors can find precancerous lesions and remove them before they become cancer. Screenings also allow physicians to find these cancers at an earlier stages, when they are more likely to respond to treatment."

The number of cancer screenings jumped in 2014 and 2015, as the state expanded eligibility for the Medicaid program under federal health reform, making many more people eligible for free screenings. Bevin is seeking change the state's program in ways that could require co-payments, premiums and deductibles.

In Kentucky "the challenge is to not only encourage certain lifelong smokers to get screened, but to get them to quit, and for others to never start," especially because of the addictive nature of smoking, Judd reports. "It will be even more difficult than changing the profile of colon cancer, because smoking involves addiction. The hope of public health officials is that the model used to bring down colon cancer deaths can be used to the same effect, not only for lung cancer, but for other diseases plaguing this depressed swath of America."

Princess Health and Study outlines historical barriers to tobacco prevention in Kentucky and other tobacco-growing states.Princessiccia

Princess Health and Study outlines historical barriers to tobacco prevention in Kentucky and other tobacco-growing states.Princessiccia

research smoking smoking bans smoking cessation smoking ordinances tobacco tobacco prevention

Gusty 12:22 Add Comment

A University of Kentucky College of Nursing study published in The Milbank Quarterly has shown that five major tobacco-growing states�Kentucky, North Carolina, Virginia, South Carolina and Tennessee�fall behind the rest of the states in enacting laws to reduce tobacco use.

Tobacco and the diseases it causes affect those five states more than others across the nation, and tobacco is the leading cause of preventable death in the U.S. Those states also have fewer smoke-free laws and lower tobacco taxes, which are two evidence-based policies that help reduce tobacco use, write the authors, Amanda Fallin and Stanton A. Glantz.

The researchers used five case studies chronicling the history of tobacco-control policy "based on public records, key informant interviews, media articles and previously secret internal tobacco industry documents available in the Legacy Tobacco Documents Library," they write.

They found that beginning in the late 1960s, tobacco companies focused on creating a pro-tobacco culture to block tobacco-control policies. However, since 2003, tobacco-growing states have seen passage of more state ad local smoking bans, partly because the alliance between tobacco companies and the tobacco farmers dissolved and hospitality organizations stopped objecting to such bans. National Cancer Institute research projects also built infrastructure that led to tobacco-control coalitions. "Although tobacco production has dramatically fallen in these states, pro-tobacco sentiment still hinders tobacco-control policies in the major tobacco-growing states," the researchers write.

To continue the progress, health advocates need to teach the public as well as policymakers about "the changing reality in the tobacco-growing states, notably the great reduction in the number of tobacco farmers as well as in the volume of tobacco produced," Fallin and Glantz write. Kentucky once had about 50,000 tobacco farmers; today it has about 5,000, and production is dominated by large farmers. The study is behind a paywall; to read its abstract, click here.

Princess Health and Lake Cumberland District Health Department using polls in an effort to get school boards to make campuses tobacco-free.Princessiccia

Princess Health and Lake Cumberland District Health Department using polls in an effort to get school boards to make campuses tobacco-free.Princessiccia

education health departments polls schools smokeless tobacco smoking smoking ban smoking bans tobacco tobacco prevention youth

Gusty 17:48 Add Comment

Countywide smoking bans are unlikely to pass anytime soon in most of rural Kentucky, but more county school districts are making their campuses tobacco-free. Now a multi-county health department is trying to get rural school boards to do that, with public-opinion polls showing that county residents overwhelmingly favor the move.

Department logo has been altered to
show Clinton County in yellow.

The Lake Cumberland District Health Department conducted the poll in Clinton County, and said it found that 86.55 percent were in favor and 7.16 percent were opposed. The rest had no opinion.

Making a campus tobacco-free means that members of the public are not free to smoke at school athletic events, so the poll also asked, �Would you like to see our school become tobacco-free at all events?� The results were virtually the same: 85.3 percent answered yes and 8.7 percent answered no, even though one-fourth to one-fifth of the county's residents smoke and it has a long history of raising tobacco.

"The results are perhaps surprising to some, considering the rate of tobacco usage in the county," reports the Clinton County News. The poll of 749 residents has an error margin of plus or minus 3.6 percentage points.

The department also surveyed 100 teachers in the school system and found that 77 percent would "definitely" support making the schools 100 percent tobacco-free.

The health department presented the survey and other findings to the Clinton County Board of Education June 15, but the board took no action. The department noted that a recent survey found that 28 percent of the county's students in eighth through 12th grades had used smokeless tobacco in the previous 30 days. "That level was the highest in the Lake Cumberland District," the Clinton County News reports.

The Casey County Board of Education adopted a smoke-free policy after a poll by the health department showed 70 percent of the county's residents favored it, the Casey County News reported.

Princess Health and Bourbon Co. teen named South's top youth anti-tobacco advocate for his efforts in pushing for county smoking ban.Princessiccia

Princess Health and Bourbon Co. teen named South's top youth anti-tobacco advocate for his efforts in pushing for county smoking ban.Princessiccia

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Gusty 12:53 Add Comment

Tyler Boyle (Photo from
Lexington Herald-Leader)

Tyler Boyle, a Bourbon County High School senior and president of Students Making A Change in the Community, was named the South Region Youth Advocate of the Year by the Campaign for Tobacco Free Kids for his efforts to push a smoking ban in Bourbon County, Lashana Harney reports for the Lexington Herald-Leader.

Boyle has been a part of SMACC since it was re-established in 2013. The club is a place for youth voices to be heard on smoking issues, with the ultimate goal of a countywide smoking ban -- but in the meantime, working for a school regulation that would ban electronic cigarettes.

The smoking ban has yet to pass, but the schools have added e-cigarettes to their comprehensive tobacco policy, which banned tobacco products of any kind on school grounds.

Boyle told the Herald-Leader that he applied for the award in hopes of bringing more attention to the anti-tobacco cause in his county, which has a long history of tobacco production and sales.

"I applied for this award because of all of the work that I've done in my home community and state for tobacco control," he told Harney. "I thought that if I could make national attention, maybe, it would make the officials in my community take this issue more seriously."

Boyle said that he was honored to receive the award, which was presented at a gala in Washington, D.C., in mid-May. He plans to attend a symposium sponsored by the Campaign for Tobacco Free Kids in Washington in July and the Philip Morris Cos. international shareholder meeting next May.

Boyle told Harney that sometimes he gets frustrated because change is slow to take place, but the will to keep pushing forward always comes back.

"After attending the award gala, I was revitalized and I'm ready for the next step in tobacco control," he said.

Boyle will attend Vassar College in the fall to study political science with a focus on advocacy work and said he would continue his work with the Campaign for Tobacco Free Kids.

"Tobacco advocacy is something near to my heart," Boyle said. "Vassar is actually going smoke free in July 2015. So, I plan to work hard to implement and support their new policy."

Princess Health andElementary-school students prompt Middlesboro smoking ban.Princessiccia

Princess Health andElementary-school students prompt Middlesboro smoking ban.Princessiccia

electronic cigarettes smoking smoking ban smoking bans smoking ordinances tobacco tobacco prevention youth

Gusty 08:21 Add Comment

UPDATE, May 20: The council passed the ban with one member opposing it. Gary Mills said, �I don�t think it�s the government�s right to intrude on businesses owned by individuals. If the public doesn�t like it, they won�t come. . . . This is too intrusive by the government.� Two non-smoking business owners expressed similar sentiments.

The Middlesboro City Council has approved on first reading an ordinance that would ban smoking in public, enclosed spaces. "It remains unclear if the ban would apply to the use of e-cigarettes and vaping products," William Tribell reports for the Middlesboro Daily News.

The ordinance was prompted in part by a March presentation and petition from a group of Middlesboro Elementary School students involved in Destination Imagination, "a volunteer-led, educational nonprofit organization whose purpose is to inspire and equip students to become the next generation of leaders," Tribell writes. "The team was awarded the DaVinci Award for Outstanding Creativity for their efforts and will now compete at the world competition May 20 in Knoxville."

The students drafted the ordinance after researching those in other cities, Tribell reports: "In their presentation to the city council, the team said that 33 percent of Bell County�s population smoke, and they discussed the health effects it has on the community at large."

"The council voted unanimously in favor of the ban ordinance, and it will go up for a second-reading vote at their meeting on May 19," Tribell reports.

Princess Health andBurgin, in heart of Kentucky, is state's 40th school district to go tobacco-free; ban, won by students, applies to vapor products.Princessiccia

Princess Health andBurgin, in heart of Kentucky, is state's 40th school district to go tobacco-free; ban, won by students, applies to vapor products.Princessiccia

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Gusty 07:20 Add Comment

Burgin Independent Schools, in the heart of Kentucky, will be the latest 100 percent tobacco-free schools in the state, and the first in Mercer County, which has a strong tobacco heritage.

The Burgin Board of Education voted April 8 to ban all tobacco use, including vapor products, on school grounds and during school-related student trips, Robert Moore reports for The Harrodsburg Herald. The policy becomes effective July 1 and includes any building or vehicle owned or operated by the board and applies to any renters of school property.

Burgin will be the 40th Kentucky school district to become fully tobacco-free. Kentucky has 173 public- school districts, with 1,233 public schools, according to the state Department of Education.

The Kentucky 100 percent Tobacco-Free Schools website says, "Studies show that schools with 100 percent tobacco-free school policies for three years of more have 40 percent fewer smokers than those in non-tobacco free school districts." The 2013 Kentucky Youth Risk Behavior Survey found that 18 percent of Kentucky youth smoke, and 47 percent of them have smoked at least once.

"I�m really proud we�re going to be a tobacco free campus," board member Priscilla Harris told the Herald after the meeting. "We want to set a good example." The independently owned weekly newspaper recently did a three-part series on tobacco in the county, including Burgin students' efforts to get tobacco banned.

Kentucky 100 percent Tobacco Free Schools map, with Burgin added

Princess Health and Princess Health andRussell Co. school board plans to make all campuses tobacco-free, renews free-lunch-for-all plan after breaking even.Princessiccia

Princess Health and Princess Health andRussell Co. school board plans to make all campuses tobacco-free, renews free-lunch-for-all plan after breaking even.Princessiccia

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Gusty 19:25 Add Comment

School districts in Kentucky often deal with health issues. The Russell County Board of Education dealt with two important ones, tobacco use and school lunch, in its meeting last week.

State officials are pushing to get schools to make their campuses tobacco-free as a way of discouraging smoking, since Kentucky has the highest percentage of smokers in the nation and ranks near the top in youth smoking.

The Russell County school board heard first reading of a policy that would ban use of tobacco products on all school campuses at any time, including events such as outdoor athletic contests. "Board Member Gerald Murray indicated that those who attended the meeting were for the complete ban, and wanted the public informed that if they had concerns, either for or against the ban, they need to attend the next board meeting to be heard," The Times Journal of Russell Springs reports. "The next reading and vote will be at a special called meeting on June 30."

June 30 was the original deadline for school districts to decide whether to participate in the federal program that makes free meals available to every student in school districts with certain levels of poverty and public assistance.

The board voted to stay in the program after Nutrition Director Susan Melton reported "the program has resulted in a 73 percent breakfast participation rate, an increase of 28 percent compared to 2012-2013 school year, and nearly double the state breakfast participation rate of 39 percent," the Times Journal reports. "The lunch participation rate was 90 percent over the last school year, up eight percent from 2012-2013."

The newspaper notes that the district has to pay only 6 percent of the cost, compared to 20 percent in the normal program, which charges some students regular or reduced prices for meals based on their family income. Some school districts have not joined the program, saying they might lose money on it, and Russell County feared likewise, but Melton said it "has been essentially 'break even' for the county" and has benefits; research has shown that hungry children are less able to learn.

�We went into this last year understanding we may lose $12,000 to $15,000,� Board Member Steve Kerr said. �But we all agreed that if we did lose that it was still well worth it. And with it being a break even situation you couldn't ask for anything better than that. And with the way it looks for the coming school year, I'm extremely pleased with it. Our students are the ones who benefit so that makes everything worth it.�

The state Department of Education expects about 100 of Kentucky's 173 public school districts to participate during the coming school year in a federal program that makes free meals available to all children in a school if at least 40 percent of its students already qualify for free meals through federal programs, Valarie Honeycutt Spears reports of the Lexington Herald-Leader reports.

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

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

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Gusty 19:10 Add Comment

By Al Cross
Kentucky Health News

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

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

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

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

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

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

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

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

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

Princess Health and Princess Health andFoundation for a Healthy Kentucky reports putting 24 percent more money into grants last year than in 2012.Princessiccia

Princess Health and Princess Health andFoundation for a Healthy Kentucky reports putting 24 percent more money into grants last year than in 2012.Princessiccia

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Gusty 13:33 Add Comment

The Foundation for a Healthy Kentucky made grants totaling $2,355,838 in 2013, a 24 percent increase over the 2012 total of $1,903,660, according to the annual report it released yesterday.

Last year was the first in which the foundation made grants for two major initiatives: Investing in Kentucky's Future, which it calls "a $3 million commitment to seven Kentucky communities where civic leaders have come together and committed to a process and a plan for collective impact on the future health of their children," and Promoting Responsive Health Policy, which tries to see that voices of under-represented populations are part of the health-policy conversation in Kentucky.

The first initiative's seven grantees are Fitness for Life Around Grant County, the Clinton County Schools (for the Healthy Hometown Coalition), the Foundation for Appalachian Kentucky (for the Perry County Health and Wellness Coalition), the Green River Area Development District (for the Partnership for a Healthy McLean County), the Kentucky Heart Foundation (for work in Boyd and Greenup counties), Kentucky River Community Care (for the Breathitt County Health Planning Council for Children) and the Louisville Metro Department of Health and Wellness (for the Coalition for Louisville Youth).

Under the policy initiative, the report says, grantees "are working to improve access to needed health care, support children's health, strengthen local public health and "increase the number of Kentuckians living in communities where workplaces are smoke-free." For a complete list of grants made by the foundation in 2013, click here. For a January press release about them, click here.

The foundation was established in 2001 to settle a lawsuit by then-Attorney General Ben Chandler against Anthem Inc. to recover the charitable assets that Anthem had gained in its merger with the old Kentucky Blue Cross/Blue Shield. The foundation's net assets grew to nearly $56.4 million last year, a 7.7 percent increase over the end of 2012.

The foundation is a non-profit philanthropy with a mission of addressing the unmet health-care needs of Kentuckians. It has invested more than $24 million in health-policy research and pilot-project grants that invests in communities and informs health policy through grant making, research and education. It says it is "committed to improving access to care, reducing health risks and disparities and promoting health equity."

The foundation also acts as a convener, through its annual Howard L. Bost Health Policy Forum, its "Health for a Change" workshops and webinars, funding of conferences held by others and meeting space at its new offices in eastern Jefferson County for more than 21 community and statewide organizations.

It also acts as a communicator, through its annual Kentucky Health Issues Poll and other research, and it funds independent health reporting by Kentucky Educational Television and the Institute for Rural Journalism and Community Issues in the School of Journalism and Telecommunications at the University of Kentucky, which publishes Kentucky Health News.

Princess Health and Princess Health andAltria, parent of Philip Morris, reports spending most on lobbying the 2014 legislature but says it didn't fight smoking ban.Princessiccia

Princess Health and Princess Health andAltria, parent of Philip Morris, reports spending most on lobbying the 2014 legislature but says it didn't fight smoking ban.Princessiccia

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Gusty 13:53 Add Comment

The parent firm of the nation's largest cigarette company again reported spending more than anyone else on lobbying the Kentucky General Assembly, but says it did not fight the bill that would have imposed a statewide smoking ban in most public places.

"Altria Group, the parent company of Philip Morris USA and U.S. Smokeless Tobacco, reported spending $156,200, "far more than any other company or group, Tom Loftus reports for The Courier-Journal. "And it got the things it wanted from Kentucky lawmakers: tobacco taxes were not increased, no new tax was put on electronic cigarettes and the tobacco-industry supported bill to ban the sale of electronic cigarettes to minors passed."

Spokesman David Sutton "said not a penny of Altria's lobbying campaign went to defeat the so-called 'smoke-free' bill, though he said the company opposes such complete smoking bans within private businesses," Loftus reports. "He said he suspected Altria's lobby spending topped the list because 'We fully disclose everything'," including research time of its legal staff and its "grassroots activation" work to rally its supporters in Kentucky.

The Campaign for Tobacco Free Kids, "which reported spending $6,284 during the session, earlier this month blamed Altria for leading the successful defeat of the bill to ban smoking in indoor public places like bars and restaurants," The Courier-Journal reports.

"They've spent a lot of money on lobbying for years," the campaign's Betsy Janes told Loftus. "They've sent their message out for so long and have relationships with legislators. It's hard for us to compete with that." (Read more)

The campaign's Amy Barkley told Kentucky Health News that Altria's assertion "is very hard to believe. That said, I don�t have any hard evidence to dispute their claim. We all know the tobacco industry�s influence is very deep in Frankfort, so perhaps they didn�t need to overtly lobby against the smoke-free bill."

The Kentucky Farm Bureau Federation, which gets funding from Altria for some of its programs, lobbied against the smoking ban. It ranked eighth in lobbying expenses, with $68,821. For The Courier-Journal's lst fo top lobbying interests, click here.

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

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

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Gusty 07:24 Add Comment

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

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

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

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

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

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

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

Read more here:

Princess Health and Princess Health andBeshear says statewide smoking ban 'just a matter of time' .Princessiccia

Princess Health and Princess Health andBeshear says statewide smoking ban 'just a matter of time' .Princessiccia

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Gusty 08:54 Add Comment

Gov. Steve Beshear said in an interview broadcast Sunday that Kentucky will have a statewide smoking ban once Kentuckians get more comfortable with the idea, but he didn't say how comfortable. A poll last fall showed Kentucky adults favor a ban on smoking in most public places, including restaurants and bars, by more than 2 to 1.

Beshear supported a smoking ban in the recent legislative session, but it never came to a floor vote in the House and didn't get out of committee in the Senate. Asked on WKYT-TV's "Newsmakers" program if a ban would eventually pass, Beshear said, "I think it will pass at some point in the future. This is one of those issues that takes time. People have to get comfortable with this."

Beshear noted that when Lexington passed the state's first local ban, there were fears about its effect on business, but "Now everybody knows it doesn't put you out of business." He said a statewide ban "is just a matter of time, but it's just one of those thing you've got to build a comfortable feeling about."

On another topic, Beshear said he would not call a special session to pass anti-heroin legislation without an advance agreement among legislators, to keep the session short and limit costs. He said that if he did call a session, he would probably include other topics, such as state help for redevelopment of Rupp Arena and its surroundings. Both proposals failed in the recent session.

Princess Health and Princess Health andKy. leads U.S. in emphysema (COPD), but study shows fewer COPD hospitalizations in Ky. places with smoke-free laws.Princessiccia

Princess Health and Princess Health andKy. leads U.S. in emphysema (COPD), but study shows fewer COPD hospitalizations in Ky. places with smoke-free laws.Princessiccia

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Gusty 13:04 1 Comment

Click on image for larger version

People who live in smoke-free communities are less likely to be hospitalized for emphysema, according to a study by the University of Kentucky's College of Nursing and College of Public Health and recently published in the American Journal of Public Health.

The study found that people who live in communities with comprehensive smoke-free workplace laws are 22 percent less likely to be hospitalized for chronic obstructive pulmonary disease (COPD), or emphysema. Living in a community with an established law also resulted in a 21 percent lower likelihood of experiencing hospitalization due to emphysema.

Kentucky has the nation's highest rate of chronic obstructive pulmonary disease, 9.3 percent of the population, according to the federal Centers for Disease Control and Prevention. Tobacco use is the primary cause of emphysema, but air pollution and genetics can also play a role.

The study matched 2003 and 2001 data on hospital discharges with communities that were part of the Smoke-free Ordinance database from the Kentucky Center for Smoke-free Policy, Ann Blackford reports for UKnow.

Dr. Ellen Hahn (Herald-Leader photo by Matt Goins)

�Smoke-free public policies, particularly when they cover all workplaces with no exceptions and have been in place for at least one year, may provide protection against exacerbation of COPD that lead to hospitalizations, with potential to save lives and decrease health care costs,� said Nursing Professor Ellen J. Hahn, director of the center and lead author of the study. �Given that such a high percentage of Kentuckians live in at-risk rural areas and lack the protective factor of income or smoke-free laws, the state faces a higher risk of COPD."

Lexington was the first Kentucky city to pass a smoking ban. "Lexington's smoking ordinance, which bans smoking in most indoor public spaces, doesn't specify that smokers be caught in the act. But that has become the default standard since the ban went into effect 10 years ago," Mary Meehan reports for the Lexington Herald-Leader. "As the smoking ban in Lexington has aged, the challenges have lessened. In many cases, Hahn said, the ban has been self-enforcing. Patrons at restaurants complain to management about smokers, or bar employees take it upon themselves to keep people from lighting up. Gradually, she said, smoking just isn't accepted or expected anymore. Non-smoking in most places has become the 'new normal.' There are now only a handful of businesses that receive citations. Most are small bars and strip clubs."

Read more here: http://www.kentucky.com/2014/04/26/3214347/10-years-after-it-became-law-fayette.html#storylink=cpy

Read more here: http://www.kentucky.com/2014/04/26/3214347/10-years-after-it-became-law-fayette.html#storylink=cpy

Princess Health and Princess Health andSponsor of statewide smoking ban says House leaders are blocking a vote to protect some members from political fallout.Princessiccia

Princess Health and Princess Health andSponsor of statewide smoking ban says House leaders are blocking a vote to protect some members from political fallout.Princessiccia

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Gusty 09:01 Add Comment

By Al Cross
Kentucky Health News

The bill for a statewide smoking ban has stalled, with the prime sponsor saying House leaders are blocking a vote to protect members who have told the sponsor they would vote for it, but have told the leaders they don't want a vote because they don't want it to be used against them in their re-election bids.

The prime sponsor, Rep. Susan Westrom, D-Lexington, told Kentucky Health News on Thursday, Feb. 27 that she thinks the bill would pass if Speaker Greg Stumbo would let it be called up for a vote, but he is protecting members who fear how the issue will play politically.

"Wrong," Stumbo replied in an email to KHN Sunday night. "Others in leadership have problems." In another message Monday morning, he said "I'm for [the] bill; may be the only member of leadership supporting it; so you figure out why it's not being called. I told her in all my years as majority floor leader, I never refused to call a bill unless a majority of leadership opposed doing it."

The other leaders of the House Democratic majority are Floor Leader Rocky Adkins of Morehead, who calls bills up for votes; Speaker Pro Tem Larry Clark of Louisville; Majority Whip Tommy Thompson of Owensboro; Democratic Caucus Chair Sannie Overly of Paris.

Westrom told Ryan Alessi of cn|2 that the leaders are divided on the issue. "It depends on what member of leadership you talk to," she said. "It's just a little bit schizophrenic right now."

Adkins said in a prepared statement, "This bill is being handled like other bills that are high profile. It has been House leadership's long-standing position to vet these kinds of bills to our members through a vote count before they are brought to the House floor. As of Friday the votes for passage were not there. We will continue to monitor the count as we move forward in the session."

Stumbo, who has said he supports House Bill 173, said Feb. 26 that he wasn't counting votes but sensed that the bill wasn�t �quite there yet� but was within �striking distance� of passage.

The leaders kept the bill in the House Rules Committee for the maximum five days allowed by House rules, then posted it for passage on Feb. 14.

On Feb. 18, Westrom and the bill's main Republican sponsor, Rep. Julie Raque Adams of Louisville, filed a floor amendment to exempt electronic cigarettes, private clubs and cigar bars. Adams told Alessi that has helped get Republican votes and allay some legislators' concerns about over-regulation of private property.

"When you open up that private property for public purpose, government always involves itself," she said. "This does not cost a business owner any money."

Adams said the larger issue is Kentucky's poor health and what it costs the state. "This is the only proposal that's before lawmakers right now that actually addresses the cost of health care," she said. "The cost to our budget is so dramatic, and it's really on an unsustainable course right now, that if we don't make some significant changes relative to health care and how we deliver it in this state, we're not gonna be able to afford anything else."

Adams acknowledged that the bill might be easier to pass in 2015 because this is an election year. "It absolutely is a factor in people's re-elections," she said. But she and Westrom said that issue cuts both ways, because most Kentuckians don't smoke. However, about 28 percent do, more than in any other state.

Some House members may be reluctant to vote for the bill because its prospects are poor in the Senate, where President Robert Stivers, R-Manchester, opposes it. Some House Democrats say privately that Westrom didn't help her cause by being the only Democrat not to vote for the bill Stumbo has called his top priority, to raise the minimum wage. She passed.

Westrom's harder push for a vote in recent days coincided with a Feb. 26 tweet from the Kentucky Chamber of Commerce, which favors the bill. The message on Twitter read, "The only way to know the vote count is to take a vote. Kentuckians deserve a vote on HB 173, the Smoke-free Kentucky Act."