Kids Count shows Ky. tops in smoking by pregnant mothers, has a wide range of local data about children's well-being

By Molly Burchett
Kentucky Health News

The annual Kids Count report on children's well-being, released Tuesday by the Annie E. Casey Foundation and Kentucky Youth Advocates, says the state leads the nation in smoking by pregnant mothers and more than one in four children in Kentucky lived in poverty in 2012. It argues for improvements in preventive care and newborn health throughout the state.

The report is part of the 23rd annual release of the County Data Book, which contains a wide range of county-by-county data that are indicators of children's well-being. Unlike previous annual reports, this one ranks Kentucky counties on overall child well-being and on four domains: economic security, education, health, and family and community strength.

The county-by-county assessment found seven counties that scored substantially higher on overall child well-being rankings: Boone, Calloway, Meade, Oldham, Spencer, Washington, and Woodford. The six counties clearly at the bottom, in descending order, were Owsley, Knox, Elliot, Martin, Fulton, and Clay.

Health affects almost every aspect of child well-being. On the four scores in the Health domain (smoking during pregnancy, low-birthweight babies, asthma hospitalizations and teen births) Oldham and Boone counties scored much higher than other counties, and Bell and Fulton counties, in the southeastern and southwestern corners of the state, scored the lowest.

The chart to the right indicates how much worse Bell and Fulton ranked than similar counties. 

The data from this year’s Kids Count book, as well as new and historical data for the many other indicators Kentucky Youth Advocates tracks, can be found at the Kids Count Data Center by clicking here. The data cover counties, school districts, cities and Metro Louisville council districts.

Based on the latest available data from 34 comparable states, in 2011 Kentucky had the highest rate of women who smoked during pregnancy. Nationally, 9 percent smoked during pregnancy while 23 percent did in Kentucky.


Babies born to mothers who smoked during pregnancy are more likely to suffer low birth weight, premature birth and infant death, and almost one in every 10 babies in Kentucky were born at low birth weight, says the report. While the national average for low-birthweight babies is 8.1 percent of all live births, low-birth-weight babies made up more than 14 percent of births to mothers in Lawrence, Lewis, Martin, and Wolfe counties.

“We know smoke-free policies will reduce smoking during pregnancy and reduce the number of babies born at a low birth weight,” said Terry Brooks, executive director of Kentucky Youth Advocates. “It’s time to do what works and enact a comprehensive, statewide smoke-free law. We need to protect all children, not just those lucky enough to be born in a smoke-free community.”


In addition to babies born to mothers who smoke during pregnancy, those born to teenage mothers are at increased risk of low birth weight and other health problems, says the report.

While the state's rate of births to teenage mothers has declined each year since 2007, it remains higher than the national average, which has shown a similar decline. There were 43 teen births for every 1,000 females aged 15-19 in 2011, compared to the national rate of 31. The report says Oldham County had the lowest rate of teen births (1.3 percent) while McCreary County had the highest (8.6 percent). It also says the most effective way to keep reducing teen births rate is to educate young people about sex and risky sexual behaviors, and to provide access to contraceptive methods.

While Kentucky has made progress in providing health-care coverage for children and newborns, the state is among the leaders in childhood obesity, diabetes and asthma, and has a greater-than-average number of children with disabilities or other chronic health problems like cystic fibrosis or heart disease, the report says. "Yet families face many hurdles when they seek treatment for their children. They may lack health insurance or lack transportation," it says. "Some areas do not have enough health-care providers."

Report calls for investments in Kentucky children

Higher teen-birth rates are found among communities of color, which are also disproportionately affected by poverty, says the report. One in four of Kentucky's children live in poverty.

This rate and the number of unemployed parents, which went up by 24,000 between 2007 and 2012, have increased since the 2008-09 recession. Poverty rates in 2012 were highest among African American children (52 percent) and Hispanic or Latino children (41 percent). Living in a high-poverty area puts a child at greater risk for poor health and educational outcomes.

A widespread lack of economic security is perhaps the greatest concern for many kids in the state, says the report. The Kentucky Cabinet for Health and Family Services recently cut spending for the Child Care Assistance Program and the Kinship Care Program. As a result, 8,700 families lost assistance for child care, and financial support was also eliminated for main relatives who raise children unable to live with their parents. The report calls for restoration of these programs and more investments in Kentucky’s children.

"Taken together, the data tell a clear story: Kentucky kids need the attention of Kentucky leaders," says the report. “It’s time to make children and families a priority in our state by investing in programs that keep parents working and promote economic security,” said Brooks.

Click here to get more information about the Annie E. Casey Foundation or view its policy reports.

Poor, rural mothers-to-be have high levels of stress, and few resources to help them handle it, small-scale study concludes

Low-income pregnant women in rural areas experience high levels of stress, but lack the appropriate means to manage their emotional well-being, according to a small-scale study at the University of Missouri. The authors suggest that rural doctors should link these women with resources to help manage stress, Medical Xpress reports.

"Many people think of rural life as being idyllic and peaceful, but in truth, there are a lot of health disparities for residents of rural communities," Mizzou nursing professor Tina Bloom told Medical Xpress. "Chronic, long-term stress is hard on pregnant women's health and on their babies' health. Stress is associated with increased risks for adverse health outcomes, such as low birth weights or pre-terms deliveries, and those outcomes can kill babies."

Researchers studied about 25 rural pregnant women. Through interviews, researchers discovered that financial problems were one of the biggest stressers for them. Financial stress was exacerbated by the women's lack of employment, reliable transportation and affordable housing. The women also said that small-town gossip, isolation and interdependence of their lives with extended family members also increased stress. Almost two out of three women showed symptoms of depression, and one in four displayed symptoms of post-traumatic stress disorder. (Read more)

CDC: Ten swine flu cases reported last week were linked to Ohio's Butler County Fair; warns nation's fairgoers to be cautious

Centers for Disease Control officials in Atlanta say 29 human cases of the new strain of the H3N2 swine flu have been confirmed in the last year, including 12 last week. Ten of the new cases were linked to the Butler County Fair in southwest Ohio. Butler County is just north of Cincinnati's Hamilton County. The fair ended last weekend. None of the cases have been tied to human-to-human transmission and all 12 of the new patients had close contact with swine prior to getting sick. The two other new cases occurred in Hawaii and Indiana. (CBS News photo)

Health official told CBS News that because county and state fair season in full swing, attendees should avoid taking food and drinks into barns and to wash their hands after they have been near animals. Pregnant women, young children, the elderly and people with weakened immune systems are especially at risk for developing the flu strain. So far, the strain hasn't spread easily, and recent cases have been mild. (Read more)

Mothers should try to go to full term in their pregnancies, but many are unaware of the risks of early delivery, UK study finds

Illustration by Michelle Kumata via KRT

Babies who are born before the full term of 40 weeks may have health problems later in life, since important brain development takes place in the very last stages of pregnancy. As such, mothers should try to avoid being induced early or having elective C-sections.

A study conducted at the University of Kentucky College of Communication and Information found women often don't realize the important development that takes place at the end of pregnancy, write UK doctoral student Sarah Vos and H. Dan O'Hair, dean of the college, for the Lexington Herald-Leader.

Evidence shows that early, elective births are expensive. One study found reducing the number of elective births before 39 weeks of gestation to less than 2 percent of all U.S. births would save $1 billion each year.

But many women are uncomfortable at the end of their pregnancy, are anxious to know their children are healthy, and may even ask for early induction of labor because employers aren't flexible about time off. Sometimes doctors and other providers induce women early for their convenience.

Encouraging women to go full term and telling them the disadvantages of early labor — problems feeding and a higher incidence of Sudden Infant Death Syndrome — can influence their decision. As Vos and O'Hair conclude, "Babies are worth the wait." (Read more)

As U.S. teen birthrate reaches 70-year low, Ky. still 7th highest

The teenage birth rate nationwide is the lowest in nearly 70 years, but Kentucky's rate is much higher than the national average — 46.2 births per 1,000 compared to 34.3 across the U.S.

That ranks it seventh highest in the nation, but the figure is down from 53.1 per 1,000 in 2007. Nationwide, the number is down from 61.8 per 1,000 in 1991. "Young people are being more careful," Sarah Brown, CEO of the National Campaign to Prevent Teen and Unplanned Pregnancy, told Sharon Jayson of USA Today.

In 2010, a total of 367,752 infants were born to mothers ages 15 to 19. Mississippi had the highest rate, with 55 teen births per 1,000 and New Hampshire had the lowest with 15.7, according to the National Center for Health Statistics.

Girls who are having sex for the first time are much more likely to use contraception than their predecessors, notes Laura Lindberg, a senior research associate with the non-profit Guttmacher Institute in New York. She credited the lower teen-birth rate to "the elimination of pelvic exams before receiving prescriptions for hormonal methods, as well as use of long-acting methods such as IUDs." (Read more)

Will birth-control mandate cost more or less? Yet to be seen

Will requiring insurance companies to provide contraception be cost-neutral, as the Obama administration claims? It is unclear, and so is whether insurance companies will make Catholic institutions pay more. These were the findings of FactCheck.org, a nonpartisan, nonprofit, consumer-advocate project funded by the Annenberg Public Policy Center of the University of Pennsylvania.

In support of its claim, the administration cites data from Hawaii's birth-control mandate, which shows health insurance premiums "did not appear" to increase. The study also found the number of pregnancies increased after contraception coverage was required.

But when Pennsylvania considered imposing a similar mandate, a state agency found "the amount of possible savings relative to the cost of the legislation is unclear." Findings were also unclear in Connecticut when officials there looked at whether or not insurance plans saved enough because there were fewer pregnancies to offset the cost of providing coverage. A Texas study found insurance companies would not save enough because women would buy contraception on their own.

A recent survey of 15 insurance companies found six thought costs would increase and another three felt the move would be neutral in cost. None felt they would save money because of the mandate.

"Until better data are available, we're unable to conclude whether the Obama birth-control mandate is likely to result in a net cost increase or not," FactCheck reports.

A couple's journey with infertility; similar tale likely in your town

Laura Ungar of The Courier-Journal follows the story of Kelly and James Durst, who turned to in vitro fertilization when they had trouble conceiving a child.

The Dursts are "among the 12 percent of reproductive-age couples in the United States who couldn't conceive without help," Ungar reports.

In April 2010, they gave birth to son Cooper, one of more than 675,000 babies born in the U.S. through assisted reproduction techniques since 1985. "He is literally the light of our lives," Kelly said. "He's why we try to make things better each day."

Ungar follows the Dursts' journey to have a second child, this time using the frozen embryos that were created at the time of Cooper's conception. The embryos will be placed in Kelly's womb.

Given the growing prevalence of assisted reproduction techniques, stories like the Dursts' can likely be found in nearly every community and make for a compelling read. (Read more)

Critics, proponents debate Louisville hospital merger

Questions regarding ectopic pregnancy, end-of-life care and funding for indigent care were addressed Wednesday by proponents and critics of a proposed merger between University Hospital, Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System. The issues were discussed at a meeting of the Louisville Forum.

The merger, which still needs approval by Gov. Steve Beshear, would give St. Joseph majority control over the three systems. Because St. Joseph is owned by Catholic Health Initiatives, University Hospital and Jewish and St. Mary's would have to adhere to Catholic health directives.

As such, "The other merger partners have agreed not to perform certain services forbidden by those directives: elective abortions; sterilizations; contraceptive dispensing for the purpose of contraception only (except in cases of sexual assault when the victim isn't already pregnant); artificial insemination and in-vitro fertilizations; and euthanasia," reports Laura Ungar of The Courier-Journal.

Altogether, there are 72 Catholic health directives, but David Laird, president and chief executive officer of Jewish and St. Mary's, said his organization and University Hospital have not agreed to abide by all of them. "We are not a Catholic hospital," said Laird, left. "University will not become a Catholic hospital," he said. (Photo by Frankie Steele)

Merger critic Beverly Glascock, a Louisville attorney and former nurse, broached the issue of ectopic pregnancies, which occur in the fallopian tube rather than in the womb. In all cases, the fetus cannot survive and there is danger to the mother if the tube bursts.

But, in a merger document released earlier this week, one of the banned procedures includes "elective (direct) abortions." "In the case of extra-uterine pregnancy, no direct abortion will be performed," the document reads.

Dr. Dan Varga, chief medical officer for St. Joseph Health System, addressed the issue, saying "a direct abortion is the termination of a viable pregnancy, and ectopic pregnancies are, by definition, not viable," Ungar reports.

The issue of indigent care was also discussed. Since CHI has said it will invest $320 million in the deal and commit $200 million to improve University and Jewish hospitals, one audience member asked how much of that would be used for indigent care. Laird said a combined $270 million in indigent care is already being spent. As for whether the CHI funds will increase that sum, Laird said he could not say. "How much will these hundreds of millions of dollars will go to help the indigent?" Glasscock asked. "Not one dollar, not a cent."

As for end-of-life care, merger partners said they have "agreed only not to perform euthanasia, which they do now," Ungar said. Continuing to provide food to someone in a vegetative state and honoring living wills should not be a concern. (Read more) To view a video of part of the hospital merger discussion, click here.

Writer weighs in on morning-after pill decision in provocative way, looking at both sides but ultimately saying it protects girls

Freelancer Mariam Williams writes a provocative piece in The Courier-Journal about a federal official's recent rejection of a proposal to allow girls 16 and under to obtain the morning-after pill without a prescription.

Williams speaks to girls who fall in this age group and highlights the advantages and disadvantages of the decision, which was made last week by Health and Human Services Secretary Kathleen Sebelius, despite a recommendation to the contrary by the U.S. Food and Drug Administration.

"Her decision will come at a cost to me and every other adult woman of child-bearing age," Williams writes. "It will set a precedent for every time someone wants to ignore science and embrace an ideology that not everyone else believes. Her actions will tell them that's OK, and when a pharmacist denies a grown woman's request for the morning-after pill, or when people who believe a fertilized egg is a person can't give any scientific reason for the laws they want to pass, they'll point to Kathleen Sebelius.

"But I believe you and girls younger than you are worth the danger her decision put all of us in. She did this to protect you where the adults in your life have failed you, to push you to talk to an adult if you're having sex or if you've been sexually assaulted so that you can get the information you need to be as safe as possible. So I hope you take your behavior seriously. We women do." (Read more)

Ky. premature births declining, but still above national average

Giving birth to a baby before it has been brought to full term has become less common in the U.S. and Kentucky, but the nation still only received a C, and the state a D, in the 2011 Premature Birth Report Cards compiled by the March of Dimes. Each year, nearly half a million babies are born prematurely.

In Kentucky, 13.6 percent of women gave birth to babies prematurely in 2009, down by 0.4 percentage points over 2008. Only Vermont was given an A, with a pre-term birth rate of 9.3 percent, reports Bonnie Rochman of Time Healthland. Three states and Puerto Rico got Fs; 19 got Cs and 11, as well as the District of Columbia, got a D.

Data from 2006 to 2009 were analyzed. In 2009, the preliminary preterm birth rate was 12.2 percent, compared to 12.8 percent in 2006. The March of Dimes wants that number to drop to 9.6 percent by 2020. Pre-term birth is the leading cause of newborn death in the U.S.

The study analyzed three factors that can contribute to pre-term birth, including the percentage of uninsured women in each state and the percentage of women who smoke. Late pre-term birth, which occurs when a baby is born between 34 to 36 weeks gestation, was also considered, as it "has been linked to rising rates of early induction of labor and C-sections," the study says.

In Kentucky, the percentage of uninsured women has remained the same at 22.8 percent from 2006 to 2009. The smoking rate has dropped from 30.5 percent to 27.3 percent, as has the late pre-term birth rate, down to 9.7 percent from 10.2 percent. (For other states, click on the map above, then click on the state in the larger image.)

The pre-term birth rate was calculated by looking at the percentage of all live births in which the babies had reached 37 weeks gestation or less.

March of Dimes President Dr. Jennifer Howse called the study results positive, "given that for the past 30 years, the rate of preterm birth has been increasing."

"It's not a lot, and the rate is still too high, but the good news is some things are starting to work," she said. (Read more)

Study indicates risk of fatal birth defects is higher in counties with mountaintop-removal coal mining

"Children born in counties home to mountaintop coal mines had a 26 percent higher risk of suffering" a fatal birth defect "compared to ones born in non-mining regions," according to a new study, Dan Vergano of USA Today reports. The study, led by health economist Melissa Ahern of Washington State University in Spokane, will appear in the upcoming Environmental Research Journal. (Map shows counties with coal mines in 1996-2003, with "mountaintop" mining counties in darker gray)
Air and water pollution from mountaintop mining led Ahern and her colleagues "to look for health effects on infants" in West Virginia, Kentucky, Tennessee, and Virginia, Vergano writes. The researchers found birth defects in mountaintop mining areas were elevated above non-mining areas in six of seven categories, including heart, lung and gastrointestinal. Because of an already established connection between poverty and birth defects, the researchers then "controlled for social factors such as smoking, drinking, mother's education, race and other poverty-related factors" and found a 26 percent increased risk of fatal birth defects in mountaintop-mining counties, Vergano reports.

A spokesman for the National Mining Association "suggested adding more demographic factors to the study might remove the elevated birth defects," Vergano writes, then quotes environmental and pediatric-health expert Lynn Goldman of George Washington University as saying "It isn't proof of cause and effect" and paraphrases her: "Because the study is the first of its kind, public health researchers will need to reproduce the study results to feel confident it has uncovered a real link, she cautions. Further studies will be needed to show how exposures in mountaintop mining communities could lead to more birth defects." (Read more)

Fewer maternity wards, fewer options for rural Kentucky women

The closing of the maternity ward at Mary Breckinridge Hospital in Hyden last year is part of a larger trend, leading to fewer options for women living in rural areas of the state, contends an op-ed piece in the Daily Yonder, the national online rural journal.

"There's a big dose of irony here," writes Kelli Haywood, a Lamaze certified childbirth educator. "Mary Breckinridge Hospital, located in Appalachian Kentucky, is named for a pioneer in maternal and infant health who brought the nurse midwifery model of care to the United States."

"With the closing of this facility, women of the entire southeastern Kentucky region lost an important and rare option for birth, as well as the expertise of the hospitals' midwives, most of whom either moved to other parts of the state or left Kentucky altogether," Haywood continues.

Similar closures are happening in other states as well, including Virginia, Ohio and Alabama, which has "lost 26 options for maternity care since 1980," Kaywood states. The reason for the closures has to do with numbers and reimbursements. Mary Breckinridge Hospital averaged just 12 births monthly, but in order to break even financially needed to attend more than twice that. In some cases, an aging population is leading to fewer births, but some rural areas are still underserved when it comes to maternity care.

The consequences means rural women will have to travel further, and incur related expenses, to receive maternity care. That will put pressure on other rural hospitals, which will in turn have consequences. Studies show medical interventions, such as cesarean sections, are more common in rural hospitals where "care providers are feeling the pressure of a high patient load," Haywood writes. But these procedures carry risks — a Mayo Clinic study showed the risk of death to the mother was four times greater when she delivered via caesearean section rather than vaginally — and are more costly. An uncomplicated vaginal birth costs between $3,000 and $6,000, while a c-section birth can be between $10,000 and $40,000, Haywood contends.

Haywood points to midwifery and free-standing birth centers as possible solutions, but admits there is no easy answer. However, a solution is needed. "In a healthcare system where maternity care providers are facing the highest malpractice premiums of any physicians, and as obstetricians become fewer in number, it is not surprising that we are seeing closures of maternity services in rural hospitals and increases in the rates of medical interventions. Rather than fighting to keep a system that is not benefitting rural women, healthcare providers, or state governments, we need new models of care and ways in which that care can be obtained safely, close to home." (Read more)

Madisonville hospital earns national award for program that helps pregnant women maintain, improve oral health

For its work in improving oral health in prenatal patients, the Center for Women's Health at Trover Health System in Madisonville has received a national award.

The William J. Gies Award for Outstanding Innovation is given to individuals and organizations dedicated to improving dental education, research and leadership. Trover Health System's program "Centering Pregnancy Smiles" focuses on educating women about the importance of maintaining their oral health while pregnant.

"Women may mistakenly think they can skip dental care when pregnant. However, now more than ever, regular oral health check-ups are very important," said LeAnn Todd-Langston, director of the Center for Women's Health. "Pregnancy causes hormonal changes that put women at increased risk of dental disease. Some studies even suggest that infections in the mouth, including gingivitis and cavities, may increase the risk of delivering early. Additionally, some studies have shown that the bacteria responsible for tooth decay are passed from the mother to the baby. By incorporating oral health education into the care our prenatal patients receive, we have been able to reduce the number of preterm and low birth-weight births at Trover." (Read more)