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.

Book chronicles Hall's 40-year battle for health, against poverty

By Molly Burchett
Kentucky Health News

Eula Hall has been called an angel, dynamite, a force to be reckoned with, and a living legend. She has dedicated her life to combating poverty in Appalachia and providing health care to those in need. Some say that she has done more for health care in Eastern Kentucky than any other single person.

Even at age 86, Hall continues to fight against poverty, providing health care to those who need it. Hall’s story will be told in a new biography, Mud Creek Medicine: The Life of Eula Hall and the Fight for Appalachia, written by Pikeville native Kiran Bhatraju.

Hall grew up in Pike County and moved to the Mud Creek community in adjoining Floyd County at the age of 16. She witnessed the devastating impact of poverty, including lack of health care, and became a staple in the Mud Creek community, someone to whom people would turn when they were sick or hungry.

In 1973, at age 46, Hall opened the doors to The Mud Creek Clinic in Grethel, Ky., a rural community in Floyd County, with a $1,400 donation and the help of two local doctors. The clinic rented space at first, but Hall quickly moved her family out of a nice home in Mud Creek so the home could be converted into a clinic to provide health care regardless of patients' ability to pay.

For 40 years, Hall’s clinic has weathered hard times, reports Jonathan Meador of WKMS in Murray. But, with resiliency and the help of the community, the clinic now operates in five locations and continues its mission: To provide Appalachia’s poorest residents with health care and dental services they can afford.

Hall says things have improved in Appalachia in the last 40 years, but she is still concerned that growing income inequality in America is leaving too many of her patients behind, reports Meador. Appalachians still face numerous economic and health disparities that are deeply rooted in poverty.

"We still have people who don't have enough to meet their needs," Hall told Meador. "These are good people; these are honest people, hard workin' people, when they were able. But you know, they're disadvantaged now, and they just don't have the means to meet their needs and stuff, and somebody has to be concerned; somebody has to look out for 'em."

Bhatraju says that proceeds of his book will go toward funding the clinic. Click here to purchase a copy of the book.

Anthem gift will let Kentucky Homeplace expand diabetes self-management and education project to counties in Western Ky.

Kentucky Homeplace has been awarded a second gift of $150,000 from the Anthem Foundation to continue its diabetes self-management education project in Appalachian Kentucky counties that have high rates of diabetes but lack providers to help address it.

With this gift, Kentucky Homeplace community health workers can continue work to improve diabetes outcomes in Appalachia through a Diabetes Self-Management and Education program, which are designed to help people better manage their diabetes through improved self-testing and lifestyle changes, says a release from the University of Kentucky Center of Excellence in Rural Health.

DIABETES BELT (CDC map)

Sixty-eight of Kentucky's 120 counties are included in the “Diabetes Belt” of the rural Southeast, counties in which 11 percent or more of adults have been diagnosed with having diabetes, compared to the national average of 8.5.

In these areas, about a third of the excess risk of becoming diabetic is associated with risk factors that can be modified, such as sedentary lifestyle and obesity, says the Centers for Disease Control and Prevention.  In Kentucky, the number of certified diabetes educators in these counties is much lower than in other areas of the state, the UK release says.

The first study, in Eastern Kentucky, showed more glucose testing by patients and lower measures of hemoglobin A1c, the key indicator of diabetes. The new grant will let Kentucky Homeplace expand to include parts of Western Kentucky and enroll more than 300 additional participants.

Kentucky Homeplace was originally developed in 1994 by the UK Center for Excellence in Rural Health as a demonstration project. It now gets state funding and has worked for two decades to provide tens of thousands of rural Kentuckians with medical, social and environmental services they might not have had otherwise, says the release.

Community-based solutions to childhood obesity show signs of progress elsewhere; will Kentucky pick up on them?

By Molly Burchett
Kentucky Health News

For decades, researchers reported with alarm the increasing trend of overweight children in America, with one in three kids on the way to developing Type 2 diabetes. Across the country, action has been taken to address this problematic trend, and now some preliminary, scattered results indicate that obesity rates have plateaued or dropped in some areas. Is Kentucky part of this success, and if not, will it learn from it?

The first set of positive signs came last year, with falling child obesity rates in New York City and Philadelphia, reports Lydia DePillis of The Washington Post. And, a recent Robert Wood Johnson Foundation brief shows similar progress in states with a large rural population as well:

• Mississippi posted a decrease from 43.9 percent of kids being overweight and obese in 2005 to 40.9 percent in 2011, three years after passage of the Mississippi Healthy Students Act. 
• In North Carolina, Vance and Granville counties saw significant declines after implementing healthy living programs based on the Centers for Disease Control’s community guide.
• Kids in Kearney, Neb., in grades one through five saw a 13.5 percent decline in obesity rates between 2005 and 2011.
• West Virginia fifth graders posted a 8.6 reduction in obesity rates over a six-year period.

Overall, progress was made through community-based solutions, including changes to make healthy foods available in schools while eliminating fried foods and working to integrate physical activity into people's daily lives while educating them about the importance of doing that, says the brief.

Kentucky, which suffers from one of the highest childhood obesity rates in the country, could learn from these successful programs. The state ties Mississippi for the highest percentage of youth in grades 9 to 12 that are obese (18 percent) and has the third highest percentage of children ages 10 to 17 who are obese (21 percent), compared to 16.4 percent nationally, says a report by Kentucky's Task Force on Childhood Obesity.

The Kentucky General Assembly has not enacted legislation regarding healthy eating and physical activity like many other states, notes a National Conference of State Legislatures report, but established a task force that made various recommendations to the legislature in September for strategies that address the problem of childhood obesity and that encourage better nutrition and increased physical activity among Kentucky children.

Some of the task force's recommendations include: requiring schools to improve nutritional content of school food, including promoting the use of school gardens, adopting a statewide standard for physical activity initiatives and nutrition education in schools and encouraging physical activity through a coordinated school health program. To view that report, click here.

Kentucky has no requirements for physical activity in schools. About 65 percent of Kentucky's youth did not attend physical-education classes in 2010, and 80 percent did not attend such classes five days per week, says a 2011 Center for Disease Control and Prevention survey.

However, the state does have several programs to promote physical activity or healthy eating. They includes the Farm to School program, which has been adopted by 1,243 schools and 174 school districts and is a collaborative effort between federal and state agencies to bring local agricultural products to schools and to educate students about local food production, says the report.

Using the success of other state programs and existing Kentucky programs as a guide, Kentuckians and "the members of the Task Force on Childhood Obesity are encouraged to continue their advocacy efforts to address Kentucky’s health crisis in ways that have the greatest likelihood of preventing and reversing chronic diseases associated with childhood obesity," says the report.

Eastern Kentucky reluctant to accept HPV vaccination that helps prevent cervical, mouth and throat cancers

By Molly Burchett
Kentucky Health News

New research indicates that HPV, the sexually transmitted human papilloma virus, is now the leading cause of mouth and throat cancers in the United States, ranking above both alcohol use and smoking. This problem has a solution, since some cancers caused by HPV can be easily prevented by vaccination, but many Kentucky women are stiff-arming the solution as researchers found they "literally could not give the vaccine away to young women" in Eastern Kentucky.

In Kentucky, vaccination rates remain low, particularly in the east, where the percentage of women who die from cervical cancer is significantly greater than in the rest of state or the nation, notes Tom Collins in a recent Lexington Herald-Leader article. Collins is the associate director of the University of Kentucky's Rural Cancer Prevention Center, which initiated a project to explore the acceptance of the HPV vaccine.

Read more here: http://www.kentucky.com/2013/06/30/2698240/rural-kentucky-slow-to-embrace.html#storylink=cpy

Since 2000, scientists have known that certain strains of HPV are responsible for nearly all cervical cancer in women, and newer studies link HPV to head and neck cancer for many men too. This year, about 14,000 people in the United States will be diagnosed with oropharyngeal cancer, most of them will be young, between 40 and 50 years old and 75 percent will be male, says a Newswise article. A decade ago, patients with head and neck cancer were smokers or drinkers, but now 80 percent of the cancers are caused by HPV.

About half of all Americans will become infected with HPV at least once their lifetime and it's difficult to recognize the symptoms of the virus, making vaccination even more important. The federal Centers for Disease Control and Prevention now recommends that boys and girls both be vaccinated against HPV between the ages of 11 and 12 and up to the age of 26, says Collins.

Collins writes that Eastern Kentucky is slow to accept the vaccine, even when promoted at community events such as hog roasts. Despite the initial reluctance, "Researchers at the center hope that if a community is engaged in the process and allowed to direct the delivery of the necessary change, outcomes can be achieved that will lead to a healthier population," he Collins.

And, there's still hope. The national prevalence of infection in young women has declined by more than half since the introduction of the HPV vaccine, despite low vaccine usage, says recent findings by the CDC. This decline occurred even though only a third of eligible patients received the vaccine, so imagine the benefits afforded to Kentuckians with efforts to improve vaccination acceptance and usage.

Doctor shortage news: Residencies are filling the pond with primary care doctors, but U.S. and Ky. need an ocean of them

Despite a critical shortage of primary care in the country, only 25 percent of newly educated doctors go into this field, and even worse for the mostly-rural Kentucky, less than 5 percent go on to practice in rural areas, says a study by researchers at the George Washington University School of Public Health and Health Services (SPHHS).

The report, which was just released in the “Published Ahead-of-Print” section in Academic Medicine,  suggests that not only are we facing a primary care shortage, but also that the problem is not likely to be solved soon. There's been a lot of talk about the need to get primary care doctors to practice in Kentucky, specifically in the state's rural areas, without mention of the underlying issue that the study makes clear: there are not even close to enough doctors being trained as primary care physicians in the first place.

In addition to finding that just 4.8 percent of the graduate medical education system practiced in rural areas, 198 institutions (26 percent) produced no rural physicians and 283 institutions (37 percent) produced no Federally Qualified Health Center or Rural Health Clinic physicians, which were created to enhance the provision of primary care services in underserved communities.

“If residency programs do not ramp up the training of these physicians the shortage in primary care, especially in remote areas, will get worse,” said lead study author Dr. Candice Chen, a professor at SPHHS. “The study’s findings raise questions about whether federally funded graduate medical education institutions are meeting the nation’s need for more primary care physicians.”

Currently, the U.S. is producing primary care physicians at rates that are “abysmally low” and unless changes are made to the system, the nation will have an even greater shortfall of primary care doctors just as the Affordable Care Act ramps up demand for these services, said Chen in a Newswise release. And in Kentucky, the additional need for primary care doctors as a result Medicaid expansion is piled onto the heap of issues.

The study's authors said policymakers should take a hard look at the skewed incentives and other factors that have led to the current primary care crisis and develop a more accountable graduate medical education system. It is critical to find a better balance in medical specialties and more primary care physicians to build an effective, affordable health system.

Floyd County newspaper editor calls on readers to make lifestyle changes to address area's diabetes health crisis

The editor of an Eastern Kentucky newspaper has joined an advocacy group's call for residents in his county to make simple, healthy lifestyle changes, serving as an example of how local newspapers and community members can engage the public to confront poor health status of the area, which is often put on the back-burner despite alarming warning signs.

Recently, the Tri-County Diabetes Partnership declared the rate of diabetes in Floyd, Johnson and Magoffin counties (map) "a crisis of epidemic proportions." The rate in 2002-10, the latest available, was 14 percent.

If the federal Centers for Disease Control and Prevention "saw a similar increase in any other illness, they would probably declare a national emergency,” said J.D. Miller, vice president of medical affairs for Appalachian Regional Healthcare, who chaired the meeting.

The group's statement was an appropriate response to direct public's attention to the imperative of addressing the area's skyrocketing rate of the disease, Ralph Davis of The Floyd County Times wrote in an editorial.

Diabetes will remain a crisis unless we do something about it, said Davis, and "if you have been waiting for a crisis before making healthy lifestyle changes, we’ve got one for you. In fact, we have several," Davis said.

The Central Appalachian region suffers from disproportionate rates of diabetes, cancer and heart disease, and Floyd, Magoffin and Johnson counties have much higher rates of obesity than state and national averages, Davis notes. Floyd County ranks last among the state’s 120 counties in overall health measures, and Johnson and Magoffin counties are ranked 108th and 104th, respectively.

To do something about this problem, Davis calls for concentrated attention by health care providers and government officials, but the problem won't be solved without action from the community and individuals, he says. Simple, healthy lifestyle changes are needed.

"It’s going to require the conscious decision by everyone in the region to do what they can to improve their diet and exercise habits, and to encourage their friends and family to do the same," said Davis.

Calls like Davis's are needed even more in most of the counties that surround the three counties, based on data from the CDC's Behavioral Risk Surveillance System. The counties in dark blue had rates above 14 percent; the highest was Greenup, at 17 percent.

Rural cancer survivors are less healthy than urban counterparts; 25 percent of rural cancer survivors smoke

A quarter of rural cancer survivors smoke.

Cancer survivors from rural areas live less healthier lives than survivors from urban areas. That's the diagnosis of a study by the Wake Forest Baptist Medical Center in Winston-Salem, N.C., which asked a random sample of rural and urban survivors their body weight, and if they smoked, drank alcohol, and exercised.

The study found that 25 percent of rural cancer survivors smoked, compared to 16 percent from urban areas. It didn't have state-by-state figures, but Kentucky has high rates of both cancer and smoking.

Fifty-one percent of rural survivors didn't participate in any physical activities at all, compared to 39 percent for urban survivors, and 66 percent of rural survivors were obese, while 63 percent of urban ones were. Fewer rural survivors drank alcohol, a difference of 46 percent to 59 percent, and 18 percent of them were more likely to be unemployed because of health reasons, compared to 11 percent for urban survivors.

"Rural cancer survivors may not be receiving messages from their health-care providers about how important quitting smoking and being physical active are after cancer," said Kathryn E. Weaver, assistant professor of social sciences and health policy at Wake Forest Baptist. "It is concerning that we found higher rates of health-compromising behaviors among rural survivors, when we know cancer survivors who smoke, are overweight, or are inactive are at higher risk for poor outcomes, including cancer recurrence and second cancers." (Read more)

Health insurers could exclude one in four Americans from coverage because they don't have bank accounts

By Molly Burchett
Kentucky Health News

Federal Deposit Insurance Corp. graphic

A new study says if corrective action isn't taken, health-insurance companies could exclude 27 percent of qualifying Americans now eligible for premium-assistance tax credits under the health-reform law because they plan to require customers to pay premiums automatically through a bank account. More than 1 in 4 of these people do not have a bank account.

If insurance companies won't do business with them, that will undermine efforts to expand health coverage and equalize access to health care, denying coverage to the more than 8 million "unbanked" Americans, says the report from tax firm Jackson Hewitt.

Unbanked households are those that lack any kind of deposit account, checking or savings, at an insured depository institution, so requiring a checking account for coverage could also worsen the existing disparities in both health-care access and health status of minority groups. African Americans and Hispanics are over 40 percent more likely than whites to be "unbanked," says the report.

Most health plans accept a credit card for the first month’s premium payment and thereafter require monthly payment from a checking account. An estimated 30 percent of U.S. households are "unbanked" or underbanked, with the highest rates among non-Asian minorities and lower-income, younger and unemployed households; underbanked households hold a bank account but also rely on alternative financial services, and one in five households use such check-cashing stores and money lenders instead of a traditional bank, says the Federal Deposit Insurance Corp.

This all goes against the basic ideals behind the health care law's "comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. The law allows all Americans to make health insurance choices that work for them while guaranteeing access to care for our most vulnerable, and provides new ways to bring down costs and improve quality of care," says the White House website.

Law doesn't protect Americans from discrimination

Federal officials are wary taking action that may discourage insurance companies from participating in the exchanges, current and former state health officers who have pressed the U.S Department of Health and Human Services for a ruling told Varney.

“I think there is a dawning awareness that this is a large problem,” Brian Haile told Varney; Haile is senior vice president for health policy at Jackson Hewitt Tax Service and has called on federal official to set a uniform standard requiring all insurers to accept all forms of payment.

Neither the health law nor other laws require insurance companies to accept all forms of payment, says Sarah Varney of Kaiser Health News. Alternative forms of payment include credit cards or pre-paid debit cards that people without bank accounts often use, and although health insurance companies are evaluating these options, they are not required to do so, reports Varney.

“I’ve not seen any specific guidance that says you have to be able to accept these types of payments,” Ray Smithberger, Cigna’s general manager of individual and family plans, told Sarah Kliff of The Washington Post.

Insurance carriers take a risk by accepting credit cards and pre-paid debit cards because transaction fees can run as high as 4 percent and pre-paid cards are popular among low-wage workers, Haile told Varney. 

“If you accept re-loadable debit cards, are you in fact getting folks with lower health status?” Haile told Varney. “That’s a real risk when you’re in the insurance business. So you can’t be the only one picking up those risks.”

The Jackson Hewitt report calls for immediate action by federal policy makers to ensure insurers cannot discriminate against the 'unbanked' through their payment acceptance policies by creating a system-wide rule requiring all forms of payment must be accepted.

"Given the dilemma presented to insurance companies by the strong financial incentives to discourage non-bank payment mechanisms, insurers are unlikely to resolve this issue without federal action," says the report.

U of L's Trover medical campus ranked among best for rural medicine education and addresing rural physician shortage

The University of Louisville School of Medicine Trover Rural Campus in Madisonville was rated third best in the nation for preparing medical students to practice in rural areas, which is critical to the state since most of Kentucky's rural counties are considered to be short of health professionals.

“From the president and the deans to the individual faculty and staff, our team has proven the value of a collaboration of a rural campus and an urban university. The beneficiaries are our students and the rural Kentucky communities who receive these new doctors who are well prepared to care for them,” Dr. Bill Crump, right, associate dean for the Trover campus, said in a UofL press release.
  
The study by researchers at the University of Colorado, which will be published in Academic Medicine in August, ranked 35 programs across the nation and found that 62 percent of Trover graduates practice medicine in rural areas, says the release.

“This national recognition is the fulfillment of Dr. Loman Trover’s vision outlined almost 60 years ago of providing first class medical education in a small town with the goal of producing more physicians for rural Kentucky, and is a testament to the strong support we’ve had from the Louisville Campus over the past 15 years,” said Crump.

Nationally, there is a physician shortage in rural areas because only 3 percent of medical students report want to practice rural medicine, while 16 percent of Americans live in rural areas. This problem is especially large in Kentucky, says the release, since a majority of the state's 59 counties classified as rural are considered to be short of medical professionals..

“Our Trover campus is vital to fulfilling this mission and especially critical now because our state faces such a significant shortage of physicians, especially in rural areas. Dr. Crump’s leadership of the program is one of the reasons for its success. We view the program as a model that has the potential to be implemented in other areas of Kentucky,” said School of Medicine Dean Dr. Toni Ganzel.

Oral health care for the poor in Kentucky suffers under managed care as dentists leave Medicaid; how about your county?

Kentucky's serious oral-health problems are getting worse because fewer dentists are participating in the Medicaid program -- a result of "new paperwork issues compounding Medicaid's reputation" for low payments to providers, Laura Ungar reports for The Courier-Journal.

Ungar's source for that is Dr. Raynor Mullins of the College of Dentistry at the University of Kentucky, who told her that only 700 to 800 of the state's nearly 2,500 dentists, about 30 percent, accept Medicaid patients.

That makes now seem like a good time for journalists to ask their local dentists if they accept Medicaid -- and if not, why not; and if so, whether they are considering dropping it.

Ungar notes that 28 of Kentucky's 120 counties are deemed not to have enough dentists to serve the local population. Most if not all of them are rural. You can find out which counties are under-served by physical, dental or mental health providers at this federal Health Resources and Services Administration website.

Survey shows most rural doctors in Southern Kentucky aren’t ready for electronic health records; grant will help them switch

A recent survey found that 63 percent of rural health providers in Southern Kentucky have not installed electronic health records software, so more than 280 of the small and rural doctor practices surveyed could face financial penalties from Medicaid and Medicare if they do not install it by 2015. Federal grant money will help them make the switch.

Many rural Kentucky providers are near retirement and are deciding between making the necessary investment of capital and personnel that is required to make the switch to electronic records or to just close their practice, according to a release from Kentucky Highlands Investment Corp., which led the effort to get the grant

Decisions to close practices and to avoid using electronic health records could be problematic to rural areas in Kentucky, since the state already has doctor shortages, especially in rural areas. If the state expands the Medicaid program under federal health reform, the number of insured patients could increase much more than the number of physicians in Southern Kentucky, an area where many people are uninsured.

“Large hospitals in the region such as ARH, Baptist Regional and others have successfully installed this software, and they are using the system with quality results,” Richard Murch, an IT consultant who specializes in electronic health records and is working on the project, said in teh release. But he said the process is complicated and requires extra staff and resources that are sometimes difficult to find in the area.

The U.S. Department of Agriculture has funded a project called Stronger Economies Together to improve the biomedical and life-science practices in the region. SET plans to provide resources and training to help providers and health systems make a successful switch to electronic health records, which the release said could create about 100 jobs over the next few years.

The survey showed 73 percent of doctors’ practices have asked for help transferring to and using electronic records. “SET reviewed industry sector research to determine health care and health related businesses as the fastest growing business segment of our rural economy,” said Jerry Rickett, president and CEO of Kentucky Highlands. For more information about SET and its partner programs, click here.

Report says veteran suicide rate is up from 2007

Almost every hour in this country, on average, a veteran commits suicide. The Department of Veterans Affairs reported that 22 veterans per day took their own lives in 2010, up four a day from the 2007 rate. Perhaps contrary to public perception, the report said most suicides occurred among veterans over 50. It recognized Vietnam-era veterans as a risk group, as well as female veterans.

Military service members come disproportionately from rural areas. Kentucky has two army posts, Fort Knox and Fort Campbell.

(Among active service members in 2012, more died from suicide than in combat, we reported here. The Army said Friday that 325 soldiers committed suicides last year; if the tentative number is confirmed, it would be a historical high. "If that bleak total remains at 325, the toll in 2012 would have risen by 15 percent over 2011 when the Army sustained 283 suicides," NBC News reported.)

Reactions to the VA report ranged from encouragement to outrage. The VA pointed out that the daily veteran suicide rate has "remained relatively stable over the past 12 years," but the percentage of the overall national suicide rate accounted for by veteran suicide has actually decreased.  Veteran suicides accounted for about one-fifth of American suicides in 2010, down from one-fourth of suicides in 1999.

The VA said that showed its programs are working, but promised to take "immediate actions." NBC reported that "the top strategy" on the VA's agenda was an already-established task force that could help suicide screening identify warning signs earlier.

Some groups were dismayed by the VA report and demanded more action. Iraq and Afghanistan Veterans of America called for more research and collaboration. "The country should be outraged that we are allowing this tragedy to continue," IAVA found and CEO Paul Rieckhoff told NBC.

On Feb. 13, the U.S. House Committee on Veterans' Affairs will hold a hearing on veterans and mental health care. The Veterans Crisis Line -- 800-273-TALK -- is available for veterans who are concerned about their mental health. (Read more)

Fiscal-cliff deal revives program that helps rural hospitals dependent on Medicare; 200 in nation, 10 in Kentucky

Even though most of the hospital industry wasn't happy with the fiscal-cliff deal that will only pay half the $30 billion needed to avoid a 27 percent Medicare fee cut for doctors, the deal gave about 200 rural hospitals, including 10 in Kentucky, reason to celebrate. It extends a program that pays hospitals up to several millions of dollars a year because they have fewer than 100 beds, are located in rural areas and have a high percentage of Medicare patients, Phil Galewitz of Kaiser Health News reports.

The Medicare Dependent Hospital Program was created in 1990 and is one of several payment programs designed to help small, rural hospitals deal with financial challenges that larger hospitals don't face. The program is based on the idea that "some rural hospitals have such a high percentage of Medicare patients they are unable to get enough money from higher paying privately insured patients to make up for the lower government reimbursements," health lawyer Eric Zimmerman told Galewitz.

The program has come under scrutiny. Congress allowed it to expire in September 2012, but two senators from New York and Iowa made sure $100 million for the program made it into the budget deal. The Medicare Payment Advisory Commission said hospitals in the program will receive about 25 percent higher reimbursements as a result of the funding. (Read more)

The Kentucky hospitals in the program are Clinton County Hospital, Fleming County Hospital, Harrison Memorial Hospital, Jewish Hospital Shelbyville, Logan Memorial Hospital, Monroe County Medical Center, Parkway Regional Hospital in Fulton, Rockcastle Regional Hospital, Taylor Regional Hospital and Westlake Regional Hospital in Columbia. The Appalachian Regional Hospital in Williamson, W.Va., is also considered a Kentucky hospital in the program.

Dollar General to sell tobacco in most of its stores by mid-2013, reflecting 'customer demand' and 'competition pressure'

By the middle of 2013, most of Dollar General's 10,000 U.S. stores will carry cigarettes and other tobacco products.. The company has made the decision in response to “competitive pressures” which came about when Family Dollar Stores, a key competitor, began adding cigarettes to its stores last year. In a press release issued by Dollar General, customer demand also drove the company's decision, citing their perception that their core customers -- mostly based in rural America -- are more likely to smoke than the national average.

A 2012 study by the American Lung Association indicated that while rural Americans do smoke more than urban Americans, geography is less a factor in determining who smokes than socioeconomic status. The study also found that pregnant rural women are far more likely to smoke than their urban counterparts. (See actual numbers from the Centers for Disease Control and the American Lung Association study here.)

G. Chambers Williams III of The Tennessean in Nashville reports that business analysts think the idea is a good one for the company, which tested the product placement last year in Nevada. Analyst Mark Montagna with Avondale Partners in Nashville explained that the company found that the average purchase per customer was $14 where tobacco was sold, versus an average of $11 otherwise. But, he added, the one challenge the company will face with tobacco products, additional shoplifting.
Anti-smoking advocates expressed regret at the business choice. (Read more)

Rural Obesity Prevention Tool Kit created to tackle epidemic: 40 percent of rural adults in U.S. are obese

When the Journal of Rural Health recently reported that 40 percent of adults living in rural areas are obese, compared with 33 percent of adults living in urban areas, the size of the disparity was larger than expected and previously estimated. In response to the severity and urgency of the obesity epidemic, the Rural Assistance Center of the U.S. Department of Health and Human Services has created a Rural Obesity Prevention tool kit which contains resources to help communities develop obesity prevention programs. (Read more)

National Rural Health Day to be celebrated Nov. 15 with free week-long issue-based webinar series

Those almost 60 million Americans who live in rural America do not have as much ready access to health care or to the vast number of health care providers than those who live in more urbanized America. Rural Americans are more likely to arrive on the doorstep of health care facilities without insurance, and that number is growing. These challenges and more have prompted the National Organization of State Offices of Rural Health (NOSORH) to designate Thursday, Nov. 15 as National Rural Health Day. The day, explains NOSORH director Teryl Eisinger, is an effort to increase awareness of rural health-related issues. The event has stretched to a week of activities, celebrations and a daily webinar series on rural health-care issues accessible to anyone interested nationwide.

Here's a schedule of free webinars. All times are Eastern Standard.
Monday, Nov. 12, 3-4 p.m., Basics of Rural Health, with Kristine Sande, program director, Rural Assistance Center; Rebecca David, executive director, National Cooperation of Health Networks; Mike Shimmens, executive director, Rural Recruitment and Retention Network.
Tuesday, Nov. 13, 1-2 p.m., Cultural Awareness While Serving Rural Veterans with Jay H. Shore, MPH, Associate Professor, University of Colorado, Denver.
Wednesday, Nov. 14, 2:30-3:15 p.m., Health Resources and Services Administration Rural Health Update with Mary Wakefield, HRSA administrator.
Thursday, Nov. 15, 3-4 p.m., HRSA's Office of Rural Public Health Policy, Celebrating 25 Years.
Friday, Nov. 16, 3 p.m. Looking Towards the Future of Rural Health Care with Randall Longenecker, MD, Rural Training Track Technical Assistance Program and Jim DeTienne, Montana EMS and Trauma Systems.

All webinars will be recorded and made available to the public at www.celebratepowerofrural.org.(Read more)

Tenn. study suggests rural residents have as much access to care as anyone, if they're insured and don't mind the drive

A health-care study in Tennessee, which started with the premise that people in rural areas have less access to care than urban dwellers, ended with a rather surprising conclusion: They don't. Not if they have health insurance. "When it comes to commercially insured patients, there’s little disparity in access to health care between residents of rural communities and urban areas in Tennessee," said Dr. Steven L. Counter, president of the BlueCross BlueShield of Tennessee Health Institute.

How can this be? The study found that almost half of rural residents pass up the hospitals closest to their homes to go to larger urban hospitals, even if the same services are available locally, writes Getahn Ward of The Tenneseean. "The conclusion we came to is that we’re living in a very mobile society, and the distance is not necessarily a determinant factor in whether people get care or not," said Coulter.

Because the survey did not include consumers, it's only a guess about why they chose to take the time and trouble to go to the big town, but experts says it's a combination of services not being available or a perception that they aren't, even if they are. This raises, again, age-old questions about the viability of rural hospitals, some of which often don’t have the money for capital-intensive technology and services. However, Coulter told the Tennessean that "a recent increase in alliances between rural hospitals and larger hospitals and urban health systems raises hopes that non-urban hospitals may be able to expand their menus of services."

Such partnerships between non-profits and for-profit chains are becoming more common, reports Ward, and some say those efforts will change the perception of those in far-flung regions that great medicine is being practiced close-by. This could be especially important, said Wes Littrell, chief strategy officer and president of Nashville-based Saint Thomas Health, in the new world of health reform. “We expect that when you get more into population management that you need to take care of the patient closer to home in the lower-cost setting,” he said. (Read more)

Looking for 'a few short-term wins' to start, Kentucky Oral Health Coalition formally reorganizes

By Amy Wilson
Kentucky Health News

LOUISVILLE, July 25 – There was no whitewashing the ruinous state of the state's teeth Wednesday when the Kentucky Oral Health Coalition formally reorganized with the goal of fixing as much as they can as fast as it can. With almost a fourth of Kentuckians over 65 having complete tooth loss and almost half of children between 2 and 4 already having twice the national average of cavities, there is work to be done on every front.

As the state with the 49th worst-looking mouths in the country, explained Andrea Bennett, senior policy analyst for Kentucky Youth Advocates, "What we're looking for is a few short-term wins."

It appears that the top priority, as voted by the coalition's members, is to improve oral health literacy and education. That means that members will be looking for ways – including maybe getting themselves a celebrity spokesperson – to explain what good oral hygiene is and how to get it.

Close behind in priorities will be efforts to expand school-based oral health services, including for those in Head Start and all child-care settings. Members also expressed a desire to increase the number of Kentucky dentists who accept Medicaid, thus expanding the numbers of those who can be treated.

How they do that is under discussion. The group, which existed a decade ago but lost momentum, has decided to revitalize into a more active, more inclusive, perhaps even more legislatively inclined group. It all depends on its new leadership, said Dr. James Cecil, a national leader in public health and a former University of Kentucky dental school professor.

Cecil, who now works with KYA, a nonprofit whose staff will handle a lot of the coalition's workload, explained that funding for the initial work of the group is expected to come from the renewal of a grant from DentaQuest, a continuous source of funding for Kentucky dental projects for three years. New programs, as drawn up by and agreed to by the new executive committee elected Wednesday, will seek other sources of funding through corporations and other grants, Cecil said. In their current treasury is $20,000, left over from the old KOHC.

The coaltion is now chaired by Laura Hancock Jones, Western Kentucky Dental Outreach Program director in the University of Kentucky College of Dentistry's Division of Public Health. A well-known and well-respected practicing pediatric dentist, she is self-described "passionate" advocate for education and literacy about oral health. She runs a program that provides a fluoride varnish on children as young as 2.

"I have seen how much we've done and it's not been enough," Hancock-Jones said. "We have not moved the needle." The answer, she said, is "from the bottom. You have to talk to the kids." In her own health-department experience, she dogged one family for three years, she said, through the school Family Resource and Service Center, social workers, and eventually the judicial system, to get their children care. Eventually, she did and "the kids are" getting care and thinking "It really is a good thing to go to the dentist."
 
Members of the coalition include dentists, dental hygienists, insurance providers, public health officers, school nurses and students. Donna Ruley, executive director of the Kentucky Dental Hygienist Association, was elected secretary of the group Wednesday. She said she believes it's important that her profession is at the table when talking about dental priorities and potential scope of job description legislation. "Our impact on education is huge," said Ruley. "The legislature just recently passed a public-health hygienist role that would allow for a greater number of people to be taught prevention services without a dentist's supervision." That, she added, is a great need in a lot of far-flung rural reaches of the state.

The vice chair of the group is Linda Poynter of the Kenton County Health Department. The treasurer is Dr. Lee Mayer of the University of Louisville dental school.

Rural health care is a notch below care in urban areas, but its costs are lower and its emergency rooms are faster, study finds

A national study has found a narrow gap between the quality of health care in rural and urban settings, but it does recognize the "significant differences" differences between urban and rural care.

The report is an update to "Rural Relevance Under Healthcare Reform: A Tracking Study," by iVantage Health Analytics, and evaluates performance measures across physician, outpatient, hospital and emergency room settings. According to a press release, the report reveals that in Medicare could save about $7.2 billion if costs per patient were the same in rural and urban settings. The report also finds that for rural patients, physician payments are 18 percent lower and hospital payments are 2 percent lower than in urban areas, but outpatient payments are 14 percent higher. The overall cost per Medicare patient is 3.7 percent lower for rural patients.

Rural emergency care is faster overall than urban emergency room care, with rural patients seeing a doctor 30 percent faster (once the patient gets to the hospital, we should add). This results in fewer hospital admissions. The full report can be accessed here.