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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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 finds most smokers are not satisfied with e-cigarettes and don't make the switch; study author wishes they would. Princessiccia

Princess Health and Study finds most smokers are not satisfied with e-cigarettes and don't make the switch; study author wishes they would. Princessiccia

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image www.mirror.co.uk

Although e-cigarettes did help a small group of smokers quit smoking traditional cigarettes, most smokers who tried them didn't find them to be an acceptable alternative, says a recent study.

Study author Terry Pechacek told HealthDay News that smokers ideally would find e-cigarettes more appealing and less dangerous than traditional cigarettes, and suggested that traditional cigarettes should be "degraded" to encourage a switch.

"Even if they're only half as risky, there would be a huge public health benefit if we could switch 40 million smokers to them," said Pechacek, also a professor and interim division director of Health Management and Policy at Georgia State University in Atlanta.

The study, published in the journal Nicotine and Tobacco Research, is one of the first to look at whether smokers find e-cigarettes to be a satisfying alternative to regular cigarettes.It surveyed more than 5,700 Americans in 2014, and focused on the 729 current and former smokers who had tried e-cigarettes. Of the 585 current smokers who had tried e-cigarettes, 58 percent (337 people) self-reported that they didn't use them anymore and 42 percent (248 people), said they smoked both. Among the 144 former smokers, 101 had quit smoking altogether and 43 had switched exclusively to e-cigarettes.

"Greater than fivefold more current smokers did not find them satisfying and stopped using them," says the report, making it unlikely that e-cigarettes "will replace regular cigarettes unless they improve."

Pechacek told HealthDay that follow-up research to be released later suggest the problem is related to nicotine delivery, smell and flavor. In the big picture, "E-cigarettes may help a few people to quit, but mostly they don't. And the suspicion from these data is that they help keep people smoking. That is not something that the e-cigarette advocates want to hear," Thomas Wills, professor and interim director of the Cancer Prevention and Control Program at the University of Hawaii Cancer Center, told HealthDay.

The U.S. Food and Drug Administration acted to regulate e-cigarettes in early May. The rules ban the sale of e-cigarettes to minors, require health warnings on all packaging and advertisements and require manufacturers to get federal approval on all products introduced to the market after Feb. 15, 2007. It did not address advertising and marketing. The measure goes into effect Aug. 8, and gives affected industries two years to comply.

Gregory Conley, president of the American Vaping Association, told HealthDay that the rules will weaken the innovation of e-cigarettes.

He pointed out that the study did not establish if participants used an old model of e-cigarettes or a new one, which have become more appealing. He also noted that most smokers in the study who switched to e-cigarettes were more likely to use a "tank-style" device, which can deliver more nicotine and last longer than devices that look more like cigarettes.

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

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

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Gusty 08:31 Add Comment

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

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

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

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

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

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

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

Princess Health and Effects of new vaping regulations won't be felt immediately; American and British researchers have differing views of e-cigs. Princessiccia

Princess Health and Effects of new vaping regulations won't be felt immediately; American and British researchers have differing views of e-cigs. Princessiccia

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By Danielle Ray
Kentucky Health News

A long time coming, the U.S. Food and Drug Administration released new regulations this month for all tobacco products, including electronic cigarettes, vape pens, hookahs, dissolvables, and pipes. But the effects might not be felt for as long as two years.

Photo: excusemyvapes.com

The regulations require health warnings on packages and advertisements and ban sales to minors. Other regulations include reporting ingredients to the FDA, requiring photo identification to buy, banning free samples and banning the labeling of products as moderate, with words such as "light" or "mild,"

The FDA called the regulations a milestone in consumer protection. It believes the new rules will help prevent misleading claims by manufacturers moving forward and allow for review of new products not yet on the market. The agency already regulated traditional cigarettes, smokeless tobacco, and roll-your-own tobacco prior to the decision.

The new rules will take effect in stages. The ban on sales to minors begins Aug. 8, but according to Phil Galewitz of The Washington Post, the ban will primarily affect Michigan and Pennsylvania, as the other 48 states already ban sales of e-cigarettes to minors. Warning labels will take effect May 2018. The labels will read: �WARNING: This product contains nicotine. Nicotine is an addictive chemical.�

Don't expect changes overnight. Manufacturers have two years to submit products for review and another year for the agency to perform evaluations.

Why did the FDA take on vaping? For one thing, because the market has so far been unregulated, the ingredients in vaping liquid are largely a mystery. However, a 2015 Harvard University study found several dangerous chemicals present in these liquids. The chemicals can destroy tiny passageways in lungs, leading to scar tissue buildup and eventually respiratory disease, according to the study.

For another thing, adolescents and teenagers are vaping at unprecedented rates. More than 3 million middle and high school students used e-cigarettes in 2015, up more than 500,000 from the year before, according to the FDA.

E-cigarettes have been the most commonly used tobacco products among youth for two consecutive years. Sixteen percent of high schoolers and about 5 percent of middle schoolers were vapers of e-cigarettes in 2015, according to the FDA. More than 80 percent of them cited appealing flavors, which include "gummy bear" and "cotton candy," as their primary reason for use.

The science is still out on whether the harmful qualities of vaping negate any potential benefits. Some studies have found e-cigarettes to be less harmful than traditional cigarettes. For example, a 2015 Public Health England review concluded that e-cigarettes are about 95 percent less harmful than traditional cigarettes.

"E-cigarettes are not completely risk free but when compared to smoking, evidence shows they carry just a fraction of the harm," said Professor Kevin Fenton, director of health and well-being at PHE, said in a news release. "The problem is people increasingly think they are at least as harmful and this may be keeping millions of smokers from quitting."

As noted in the Harvard study, e-cigarettes are not harmless. The question remains if vaping can be a tool to help current smokers quit, if they lure in kids who otherwise would not become smokers or if it's a little of both.

According to the British study, there is no evidence that vaping attracts non-smokers. Fewer than 1 percent of either adults or young people who have never smoked are becoming regular e-cigarette users, the study noted.

As for fears that vaping leads to traditional smoking, Linda Bauld, a cancer prevention expert at Cancer Research United Kingdom, said in a news release that those claims are unfounded.

"Fears that e-cigarettes have made smoking seem normal again or even led to people taking up tobacco smoking are not so far being realized," Bauld said. "In fact, the overall evidence points to e-cigarettes actually helping people to give up smoking tobacco."

Attitudes toward vaping have been much more favorable overall in the UK. Public health officials there seem more willing to accept e-cigarettes as a safer alternative and even a stop smoking tool than do U.S. officials.

For more background information on the FDA's new regulations, click here.

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

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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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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.'