Health reform should make Medicaid and Medicare more interested in preventing chronic diseases in young, expert says

Dr. Wayne Myers

While some rural areas may not have enough doctors (or those who accept Medicaid patients) to treat new patients generated by federal health reform, the key to healthy living is more education, not more physicians, rural medical expert Dr. Wayne Myers opines in The Rural Monitor. As an example, Myers points to Hazard and Perry County, where he once worked. The Appalachian county leads the nation in shortest average life span for women (72.65 years) and is third shortest for men (66.52 years) despite having an abundance of doctors and health facilities. The reason, Myers says, is bad habits that lead to unhealthy lives, something no amount of medical attention can cure.

"In Perry County, as in much of America, medical care is losing to unhealthy behavior," Myers writes. "Clinicians aren’t trained, nor is our clinical system structured, to accomplish changes in long-term cultural behavior, or to respond to the needs of groups of people. Certainly the 15-to-20-minute acute-care visit is a poor situation to try to work with a person on diet, level of activity, his/her addictions. We can’t modify family and social patterns with tools developed to treat strep throat, sprained ankles or breast cancer."

Myers, who headed the federal and Kentucky rural-health offices, said the solution is education at the local level, with "a lot more health educators, community health nurses and nutrition educators" that are trained within the community. Areas with community colleges can build partnerships with schools to receive training, he suggests. His hope is that the Patient Protection and Affordable Care Act will provide the resources and motivation necessary to bring about changes.

As the law generates enrollees, the Center for Medicare and Medicaid Services’ "book of business will shift from old people on Medicare toward younger people on Medicaid," he writes. "When the main business of CMS was Medicare, the rational business strategy was to seek the most economical quality care for those with only a few years to live. As the business shifts toward Medicaid and subsidized private insurance customers, the rational business strategy for CMS shifts toward preventing chronic disease. From an insurer’s point of view, a 70-year-old obese hypertensive diabetic is a self-limited problem. She’ll die soon. A 30-year-old with the same diagnoses will be a very long-term financial drain.  It will be good business for CMS to keep their 'covered lives' healthy."

This, he said, is kind of forward thinking we need to ensure young Americans get healthy. "We need new approaches to keeping people healthy, instead of trying to heal them after they get sick," Myers writes. "Clinicians can’t change the way people live and raise their kids, even if some of the choices the parents make turn out to be pretty dangerous for the kids. These are sensitive life and death issues. We need to tackle them." (Read more)

Kentucky spends less than a penny of its tobacco-settlement money on prevention programs; few states do very much

By Molly Burchett
Kentucky Health News

A new report says that 15 years after the 1998 state tobacco settlement, Kentucky ranks 38th in the nation in funding tobacco prevention and cessation programs, only 3.7 percent of the amount recommended by the federal Centers for Disease Control and Prevention.

The CDC recommends that the state spend $57.2 million a year on programs to help people quit smoking, but Kentucky is only planning to spend $2.1 million in 2014 on them, says the new annual report from the Campaign for Tobacco-Free Kids. Last year's report ranked Kentucky 37th as it planned to spend the same amount.

The goal of these programs is to help kids and adults quit smoking. Of the $320.3 million in revenue the state will get from the settlement in the current fiscal year, Kentucky will spend just 0.7 percent of it on tobacco-prevention programs, or less than a penny of every dollar it collects in revenue, the campaign says in a news release and a chart.

Kentucky has the highest smoking rates in the country, a an estimated 28.3 percent of adults and 24.1 percent of high-school students smoke. Each year, tobacco claims 7,800 lives and costs the state $1.5 billion in health care bills, about $487 million of which are covered by the federal-state Medicaid program, and each Kentucky household pays an estimated $582 per year in taxes to cover smoking-caused government expenditures, the release says.

To reduce smoking and its negative consequences, health advocates are calling on Kentucky leaders to pass a comprehensive, statewide ban on smoking in workplaces and enclosed public spaces. Some advocates also call for an increase in the state's tobacco tax. The report says Kentucky has the 40th lowest cigarette tax in the country at 60 cents per pack, 93 cents below the state average. It was doubled a few years ago.

"Tobacco takes a terrible health and economic toll on Kentucky, but state leaders can do something about it by increasing funding for tobacco prevention and passing a comprehensive, statewide smoke-free law," said Matthew L. Myers, president of the campaign. "The evidence is clear that reducing tobacco use not only saves lives, it also saves money by reducing tobacco-related health care costs. It's one of the smartest investments Kentucky can make."

Nationally, the report finds that most states are failing to adequately fund tobacco prevention and cessation programs. States will collect $25 billion from the tobacco settlement and tobacco taxes in 2014, but will spend just 1.9 percent of it on prevention programs.

States are spending only 13 percent of the CDC's recommended $3.7 billion in funding for these prevention programs, and only two states – Alaska and North Dakota – spend the recommended amount.

Green = State spends 50 percent or more than recommended amount; Orange= 25-45 percent of recommended amount; Yellow = 10-24 percent of recommended amount; Gray = less than 10 percent of recommended amount 

"Tobacco use is the number one cause of preventable death in the U.S., killing more than 400,000 people and costing $96 billion in health care bills each year. Nationally, about 18 percent of adults and 18.1 percent of high school students smoke." says the report.

Since the states settled their lawsuits against the tobacco companies in November 1998, the Campaign for Tobacco-Free Kids has issued annual reports to hold states accountable for settlement spending, an amount estimated to be $246 billion over the first 25 years.

The annual report on states' funding of tobacco prevention programs, titled "A Broken Promise to Our Children: The 1998 State Tobacco Settlement 15 Years Later," was released by the campaign, the American Heart Association, the American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers' Rights.

Advocates hope push in rural areas will help pass statewide smoking ban, at least in the state House

By Justin Richter

University of Kentucky College of Communication and Information

Kentucky has had a love affair with both growing and smoking tobacco, but supporters of a statewide smoking ban believe that smoke should not be shared with people who don’t smoke.

Rep. Susan Westrom

For the fourth straight year, Democratic State Rep. Susan Westrom of Lexington is filing a bill for a smoking ban in workplaces and enclosed public places. She and her allies are focusing increased attention in the state’s rural areas, where smoking is more prevalent.

This summer Westrom visited several towns, from Owensboro to tiny Sandy Hook, to talk with fellow legislators and their constituents about the bill. “We want to be able to access legislators in the rural areas, meet them on their own turf,” showing them their constituents care about secondhand smoke, Westrom said.

A third of the adults in Eastern Kentucky smoke, and almost a third of those in Western Kentucky do, according to the Behavioral Risk Factor Surveillance System, an ongoing telephone survey by the federal Centers for Disease Control and Prevention.

"We're going to need a lot more legislative support, and we're pretty much doing that one legislator at a time," Smoke-Free Kentucky Coordinator Betsy James said at last month's meeting of Kentucky Voices for Health, an association of health lobbying groups. "This is sort of a rural-urban issue, so we do need help out in the counties."

Advocates are hoping to build on the passage of smoking bans in 28 Kentucky cities and 10 counties.  “We’ve got 38 different locations that have smoke-free ordinances and we want to meet the standard we have in Louisville and Lexington,” Westrom said in an interview. 

Louisville and Lexington were two of the first cities to ban smoking in enclosed public places.  Each had exemptions, including bars and clubs, but by 2008 both went to comprehensive bans, unlike some other jurisdictions in the state that have large exceptions.

The Hopkins County Board of Health, for example, passed a regulation in 2009 that permits individuals from smoking in workplaces but has large exceptions that allow individuals to smoke in private clubs, privately rented restaurants, as well as hotel and motel rooms that are rented.

Westrom is working with Dr. Ellen Hahn, director of the Tobacco Policy Research Program at the University of Kentucky College of Nursing, who has led the efforts to pass local smoke-free measures.  After working for years on local bans, she is now working on both local and state fronts. 

Work towards smoke-free public enclosed places has gained ground steadily since Hahn started 10 years ago, but most of the state remains unaffected by any smoking ordinances or regulations.

According to a booklet prepared by the College of Nursing and the state Cabinet for Health and Family Services, “70 percent of Kentuckians are regularly exposed to secondhand smoke in the workplaces and public places.”

Smoking is more common in Kentucky than any other state, with 28.3 percent of adults smoking, compared to 19 percent nationwide according to the CDC. Kentucky Youth Advocates recently released a study done that revealed Kentucky has one of the highest rates of smoking during pregnancy in the nation. 

Westrom and Hahn have been working together since 2011, when Westrom first filed a state-wide smoking ban bill. The first bill did not get out of the House Health and Welfare Committee, but the next two bills did. 

Last year, her bill was then sent to the Judiciary Committee, a sign that it was being taken a bit more seriously, because that panel was more skeptical of it and raised issues that if resolved could help the bill pass.

In 2013 the bill was not given a vote on the House floor, presumably because it did not have enough votes to pass.  Westrom is anticipating getting past the House floor and into the Senate this year. “I think we’re really close in the Senate,” she said, noting that almost every Senate district has at least one smoke-free community.

The Kentucky Chamber of Commerce has supported Westrom’s bill since it was introduced three years ago.  “Over 90 percent of respondents expressed support for a smoke-free law in Kentucky in a recent Chamber survey,” said Ashli Watts, the business lobby’s public-affairs manager.

The chamber is advocating a smoke-free workplace largely because of lost worker productivity due to illnesses causes or worsened by smoking. Research by The Ohio State University's College of Public Health found that every U.S. smoker is costing his /her company an extra $6,000 per year.

Democratic Gov. Steve Beshear said he will continue to support a statewide smoking ban, and that it would be a help to business.  House Speaker Greg Stumbo, D-Prestonsburg, said he hopes the House will pass the bill.

Stumbo spoke at a panel discussion held by the Kentucky Hospital Association with Senate President Robert Stivers, R-Manchester.  Stivers said individual businesses should be able to allow smoking, but said that he would not impose his view on the rest of the Senate.

Great American Smokeout is Thursday, Nov. 21, featuring supportive characters to share on social media and a Twitter chat

The American Cancer Society's annual Great American Smokeout will be held Thursday, Nov. 21. The event encourages smokers to quit smoking, or make a plan to quit smoking, that day.

Quitting, even for one day, according to the Cancer Society, is an important step toward a healthier life, one that can lead to reducing cancer risk.

In Kentucky, according to the Centers for Disease Control and Prevention, 25.2 percent of adults are cigarette smokers, second highest in the nation. The Kentucky Tobacco and Cessation Program reports that each year more than 8,000 Kentuckians die of illnesses caused by tobacco use.

"Tobacco use remains the single largest preventable cause of disease and premature death in the U.S., yet nearly one in every five adults smoke," the Cancer Society says. It also notes that there are 13.2 million cigar smokers in the U.S. and 2.2 million who smoke tobacco in pipes, which are also dangerous and addictive forms of tobacco.

To celebrate quitters and their supporters, the American Cancer Society has designed a series of characters available to share on social networks. (See characters.)

They are also hosting, with Sharecare, a Great American Smokeout Twitter Chat on Wed., Nov. 20. This event allows you to post questions on Twitter to  @Sharecarenow  about how to quit smoking, smoking legislation or anything on your mind related to smoking.  You can also submit questions on Sharecare’s Facebook page.  The answers from the Cancer Society and other experts will roll out on Twitter at #quitforgood on Thurs., Nov. 21, between 11 a.m. and 4 p.m.

The health benefits of quitting are greater if you quit when you are young, but quitting at any age is beneficial. The Cancer Society lists the benefits chronologically:

• In 20 minutes: your heart rate and blood pressure drop
• In 12 hours: the carbon monoxide level in your blood drops to normal
• 2 weeks to 3 months: your circulation improves and your lung function increases
• 1-9 months: coughing and shortness of breath decrease
• 1 year: your risk of coronary heart disease is cut to half that of a continuing smoker
• 5 years: risk of certain cancers is cut in half, and stroke risk can fall to that of a non-smoker
• 10 years: the risk of dying from lung cancer is about half that of a person who still smokes and other cancer risk decrease
• 15 years: the risk of coronary heart disease is that of a non-smoker

The American Cancer Society is available to offer steps to quit smoking and to provide quit-smoking programs. To learn about the available tools, call 1-800-227-2345.

Draft plan for a statewide campaign for better health gets endorsement, much talk at Friedell Committee annual meeting

By Al Cross
Kentucky Health News

A statewide committee of volunteers is on target with its plan for a campaign to make Kentucky a healthier state, an expert in state and local health told the committee Monday.

“You guys are absolutely on the right track,” Julie Willems Van Dijk of the University of Wisconsin told the Friedell Committee for Health System Transformation at its annual meeting in Lexington.

The committee is developing a campaign that would involve many partners around the state, including health-care providers, education and business leaders, state and local health officials, and other groups and individuals interested in improving Kentucky’s poor health. The draft campaign’s working motto is “healthier, wealthier and wiser,” reflecting how education, health and economic development are related.

“Your three-legged stool of health, industry and education fits solidly within the model we’re talking about,” said Van Dijk, deputy director of the County Health Rankings and Roadmaps Program funded by the Robert Wood Johnson Foundation.

Dr. Lee T. Todd Jr.

Kentucky’s health rankings – we’re first in smoking, cancer deaths and preventable hospitalizations – prompted Dr. Lee T. Todd Jr. to dub such statistics “the Kentucky uglies” when he was president of the University of Kentucky. Now part of the group developing the campaign, he told the committee in a keynote speech Sunday night, “Those are things we need to remember and repeat.”

Noting the low life expectancy in many Kentucky counties, and the wide range of life expectancy among Louisville neighborhoods, Todd asked, “Why can’t people get excited about that, or disappointed, or just mad about it?”

Kentucky ranks 44^th among the states in health, and “The bottom line is, it hurts us economically,” Audrey Haynes, secretary of the state Cabinet for Health and Family Services, told the committee Monday.

Todd noted how San Antonio reduced its obesity rate after losing a prospective employer that cited how fat the city’s sixth-graders were. He said local communities should “get mad about something and decide you’re going to change something. . . . We have just got to stop tolerating ill health.”

As examples, he cited Grant County’s successful effort to improve its health ranking, the Hopkins County oral-health program that reduced premature births, and Clark County’s effort – now funded by a small extra tax – to varnish students’ teeth to prevent cavities.

“Why can’t we get this stuff to roll across this state and make a big difference?” Todd asked. He suggested that one reason has been a shortage of leadership and courage, as demonstrated by the political dominance of traditional industries with health implications, such as coal and tobacco.

Todd said the committee needs to find “a market driver” like the state Supreme Court ruling that forced education reform in 1990 or the Russians’ launch of the first man-made satellite in 1957, which prompted national reform of science and math education.

He said the federal health-reform law could provide that spark, because it will bring many people into the health-care system and provide free preventive services. He suggested a targeted effort, such as getting the newly enrolled to check their A1C hemoglobin (a rough measure of blood sugar and an indicator of diabetes), and predicted the tests would show many of them “are diabetic but didn’t know about it.”

While the statewide campaign can focus on certain things, Todd said, it “can’t be viewed as outsiders” giving direction to local communities. He said the effort must be led by people in local communities, focusing on their local health problems. Willems said the committee could set strategic priorities from which communities could select.

As the committee met Monday, Todd and Committee Chair Jane Chiles of Lexington said the campaign needs grant money and a staff. “This subject is too important for us to nickel-and-dime it,” he said.

As Chiles adjourned the meeting, she said of the proposal, “This is a winning concept, a winning strategy.”

For a PDF copy of the committee’s draft proposal, click here.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky. Al Cross is director of the Institute and a member of the Friedell Committee.

Smokers shouldn't get Medicaid or Medicare, says freshman Republican lawmaker who grows tobacco

State Rep. Jonathan Shell of Lancaster, a young Republican who grows tobacco, is against a statewide smoking ban. No surprise there, but how about this: He also says people who use tobacco should't be able to get Medicaid benefits.

“As I don’t think we have should have a smoking ban, I also think if you’re going to be smoking, you should have to sign a waiver that you will not get onto Medicaid or Medicare ... so the taxpayers [don't] have to end up forking over those dollars because you made the wrong decision to smoke and put those carcinogens into your body,” Shell told Ryan Alessi on cn|2's "Pure Politics."

Shell, who is in his first term in the House, sponsored legislation this year to require drug testing for anyone who applies for government benefits such as Medicaid or food stamps, which he said "should be a last resort." His predecessor, Republican Lonnie Napier of Lancaster, was a leading advocate of such legislation.

Most of Alessi's five-and-a-half minute interview with Shell dealt with the workings of the tobacco industry. He said the free market will determine when he switches from growing tobacco to another crop, and he is already raising vegetables and flowers. He said his free-market and indiviphilosophy makes him oppose a smoking ban.

Fewer teens report using tobacco and abusing prescription drugs, but some attribute latter trend to increase in heroin use

By Melissa Patrick and Melissa Landon
Kentucky Health News

Fewer Kentucky teenagers said last year that they used prescription drugs without a doctor's direction, or tobacco, than in the last such survey. But some addiction experts worry that prescription-drug abuse has dropped since 2010 because young people are using heroin instead.

According to a state survey of young people in 88 percent of Kentucky's school districts, their improper use of prescription drugs has declined steadily since 2004, with the greatest decrease between 2010 and 2012.

In 2012, prescription-drug abuse among high-school seniors dropped almost a third, to 9 percent from 13.1 percent in 2010. Among sophomores, it dropped to 7.6 from 11.3 percent; among eighth graders, to 2.9 from 5.3 percent; and among sixth graders, to 0.7 from 1.8 percent.

Some feel there's a disconcerting reason for the decline in prescription-drug abuse. "My concern is the unintended consequence is that people have switched to heroin," Karyn Hascal, president of The Healing Place recovery program in Louisville, told Laura Ungar of The Courier-Journal. "The problem is addiction, not the drug of the day." Hascal said The Healing Place has seen addicts who started out using other types of drugs but eventually turned to heroin as a cheaper option.

Although the survey didn't measure heroin use among teens, it asked if any of their four best friends had used illegal drugs in the past year. The results showed a continued slow decline, to 12.2 percent and 15 percent, respectively, among high-school sophomores and seniors.

"Over the past four years we have significantly stepped our efforts to address prescription-drug abuse," Connie Smith, manager of the Substance Abuse Prevention Branch of the state Division of Behavioral Health, said in a news release. "All of our regional prevention centers have been working very hard with their local coalitions to plan and implement effective programs to reduce illegal use of prescription drugs among youth."

The federally funded survey measures use of drugs, tobacco and inhalants; mental health; school safety issues; and gambling. The division said 153 of the 174 school districts at the time took part, with 122,718 students participating. The survey also measures concerns such as school safety issues and gambling. The report said that almost every other area studied had lower numbers in 2012 than in 2008

The survey asked several questions about tobacco. Among high-school seniors, 25.6 percent reported smoking in the previous 30 days, down from 29.4 percent in 2010. Among sophomores, smoking dropped to 18 percent from 21.7 percent; among eighth graders, to 8.7 from 10.7; and among sixth graders, to 2 percent from 2.5 percent in 2010.

Use of smokeless tobacco by high-school students declined in 2012, after rising in each survey from 2006 to 2010. Among seniors, it fell to 15.7 percent from 17.5 percent in 2010; among sophomores, it dropped to 13.4 percent from 15.9 percent. Among younger students, an eight-year decline continued, but at a sharper rate since 2010.

Marijuana use among high-schoolers declined slightly after increasing in 2008 and 2010. The survey also showed a steady decrease in the risk that teenagers associate with occasional use of marijuana. For the full report, click here.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Here are the basics of buying health insurance on the state exchange that opens Tuesday

On Tuesday, Americans can begin buying health insurance through state exchanges created by federal health reform. Journalists have spent months trying to understand the reform law in an attempt to explain it to their readers, but unraveling the act can be a confusing and tiresome process. With open enrollment knocking at the door, Trudy Lieberman of Columbia Journalism Review asked for advice from Elisabeth Benjamin, a vice president at the Community Service Society in New York, which runs an insurance counseling program. She suggests looking at enrollment as a four-step process that she hopes will make the process easier for people. 

Step 1 is looking at the health insurance buying cycle, Lieberman writes. Initial enrollment is from Oct. 1 through March 31, and can be done at HealthCare.gov. Those eligible include anyone who doesn't have employer coverage, Medicare, Medicaid, or the Children’s Health Insurance Plan, also known as children's Medicaid. Kentuckians can also enroll at the state health insurance exchange, Kynect, by clicking here. Questions about the act can be directed to a call center at 1-855-459-6328 from 8 a.m. to 7 p.m. Monday through Friday, and Saturday from 9 a.m to 4 p.m.

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

Step 2 is the mechanics of enrolling, which includes having an email account and information about your household, residency, immigration status and income, which will let people know what insurance they qualify for, Lieberman writes. "People with employer-provided insurance may still need to visit the exchange to see if they’re eligible for exchange coverage. Employers with more than $500,000 in annual sales that offer group coverage must give all workers a document that tells them about the existence of the exchanges, and the premium that a worker would pay for the lowest-priced plan the employer offers for single coverage. This form lets workers know if their employer coverage is affordable according to the government. If it isn’t, they can shop in the exchange and receive a subsidy. Their families, however, cannot receive a subsidy."

Once a person has entered the information, he or she will find out how much of a subsidy they can get, Lieberman writes. Subsidies can either be applied to each insurance payment, which means lower monthly costs for coverage, or the purchaser can wait and collect it at the end of the year like a tax refund. Kentucky has five providers: Anthem, UnitedHealthcare, Humana, Bluegrass Family Health and the Kentucky Heath Cooperative. Not every company is offering a policy in every area of the state. Rates will be available starting Tuesday.

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

Step 3 is choosing a policy from options given the names of precious metals. "The platinum policies not offered on some exchanges cover about 90 percent of someone’s medical costs; the gold plans 80 percent; the silver 70 percent; and the bronze 60 percent," Lieberman writes. "As a point of reference, the gold plan is basically the old Blue Cross model that most Americans had for the last four decades and was considered good coverage." From there, people have to decide, "Do they want to pay a high premium up front in return for lower co-pays; a set amount for a service; lower coinsurance; a percentage of the bill; or, a lower deductible?"

The premium is calculated on four factors: age, where you live, how many people are on your policy and whether you use tobacco. Depending on the state, tobacco users can face a surcharge of up to 50 percent; Kentucky's is 40 percent.

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

The final step is finding and reading the disclosures, which is something consumers have to take the initiative to find on their own, Lieberman writes. "Shoppers can find out about the policy elements, deductibles (and what they apply to), coinsurance and co-pays for different services (especially common ones like diagnostic tests and outpatient surgery), amounts for different services, and fees. It also spells out some services that are not covered and provides sample charges for common conditions." (Read more)

People who don't sign up for insurance will face a fine of 1 percent of their annual income, or $95, whichever is higher. The fee increases every year. There also is a penalty for not providing coverage for children. (Read more)

Northern Kentucky health board supports statewide smoking ban

The main health board in Northern Kentucky, where local smoking bans have stirred much controversy. has endorsed the idea of a statewide ban on smoking in all places of employment.

"The 32-member board, which represents Boone, Campbell, Grant and Kenton counties, voted to support the ban at its Sept. 11 meeting after Dr. Lynne Saddler, director of the Northern Kentucky Health Department, presented evidence about the dangers of second-hand smoke," The Kentucky Enquirer reported.

The board also authorized the department to promote Smoke-Free Kentucky, the main group advocating smoking bans, and its work in Northern Kentucky.

Efforts to pass a statewide smoking ban have never come to a floor vote in the legislature, but "23 Kentucky communities have passed comprehensive smoke-free laws, covering 34 percent of Kentuckians," the Enquirer noted. "In Northern Kentucky, only Kenton County has a smoke-free law, and it contains exemptions for bars and restaurants." (Read more)

Smokers, take note: Chinese meditation technique offers hope

In 2010, Kentucky had the second highest rate of adult smokers in the U.S., with 24.8 percent of the adult population -- or 1.1 million adults -- smoking, according to statistics from the Cabinet for Health and Family Services. Only West Virginia, at 26.8 percent, had a higher percentage of adult smokers.

So, what can Kentuckians do to cut the cigarette habit?  A Chinese meditation technique may contain the answer. And the kicker is, smokers don't even need to focus on quitting smoking to be successful.

A study by Texas Tech University and the University of Oregon "looked at the effect of the mindfulness meditation known as Integrative Body-Mind Training on the pathways in the brain related to addiction and self-control, discovered that by practicing the meditation exercise, smokers curtailed their habit by 60 percent. The control group that received a relaxation regimen instead showed no reduction in their smoking," reports Newswise, a research-reporting service.

Yi-Yuan Tang, a co-author and director of Texas Tech’s Neuroimaging Institute, told Newswise, “We found that participants who received IBMT training also experienced a significant decrease in their craving for cigarettes. Because mindfulness meditation promotes personal control and has been shown to positively affect attention and an openness to internal and external experiences, we believe that meditation may be helpful for coping with symptoms of addiction.”

The study group consisted of 27 young-adult smokers who averaged 10 cigarettes a day. Fifteen participants received the meditation training over a two-week period. "After two and four weeks, five of the responding smokers whose smoking had been significantly reduced after IBMT reported that they were continuing to maintain the improvement," Newswise reports.

Researchers wrote that "the apparent ability to enhance self-control and reduce stress could make the practice useful in reducing smoking and craving 'even in those who have no intention to quit smoking'" as well as treating individuals with other addictions," Newswise reports. "The meditation regime, they wrote, 'does not force participants to resist craving or quit smoking; instead it focuses on improving self-control capacity to handle craving and smoking behavior.'” (Read more)

10 years ago, Lexington's smoking ban started creating a healthier city and a movement among others in Kentucky

A decade ago, Lexington took a bold step by enacted the state's first public smoking ban, in a city that once proudly touted its status as the "World's largest burley tobacco market." As smoke-free supporters and Lexington residents celebrate the ordinance's 10th anniversary Monday, a recent editorial in the Lexington Herald-Leader highlights the dramatic benefits that have followed this historic step.

After the smoking ban took effect in April 2004, the city had 22 percent fewer emergency room visits for asthma in the next 32 months, and the Fayette County smoking rate has dropped from 26 percent to 17.5 percent, the editorial notes. These positive changes have yielded health-care savings of $21 million a year, says the University of Kentucky's Tobacco Policy Research Program.

"There is nothing quite as cost effective as smoke-free policies," the editorial quotes Ellen Hahn, a UK nursing professor and director of the Kentucky Center for Smoke-Free Policy, as saying. "We predict a 32 percent decline in smoking rates if Kentucky were to go smoke-free. That would save billions in health care costs and reduce premature death and suffering from the chronic diseases that plague Kentucky."

The editorial also says Lexington led the way for Louisville and 20 other municipalities to protect citizens from secondhand smoke; a third of the state's population now lives in a smoke-free environment, and many of the initial fears about a smoking ban are now extinguished.

Kentuckians feared economic harm, the shunning of Lexington restaurants and bars and suffering tourism or downtown attraction, but the opposite predictions came true, says the editorial. The scene in downtown Lexington is "far richer than 10 years ago... It once was an article of faith that tobacco would always be king in Kentucky, yet tobacco declined and agriculture has thrived."

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)

U of L dean says $50 billion in annual health costs could be saved if Americans just walked more

Small changes in health behavior can have a huge impact on the public's overall health and well-being, and during National Public Health Week discussions last week, Dr. Craig Blakely, the new dean of the University of Louisville School of Public Health and Information Sciences, talked about the important role played by public health in promoting healthy behavior, preventing disease and saving both lives and money.

Blakely pointed to obesity as an example of an emerging health-related crisis, which can be addressed with behavioral changes that make a significant difference like adding more physical activity to your day, according to a U of L release.

“If we all took exercise seriously by just walking, we could save $50 billion in cardiovascular disease-related costs,” Blakely said. “A 10 percent weight loss equals a $5,000 savings in health-related complications. A typical desk worker could lose a pound a month by standing two hours a day.”

Blakely also addressed smoking bans, which are becoming popular in Kentucky, even though the state has the highest share of smokers (29 percent) of any state, leads the nation in high-school smokers (24 percent) and spends only a minuscule portion of its tobacco revenues to fight tobacco use, according to the Centers for Disease Control and Prevention.

If every state adopted comprehensive smoke-free policies, said Blakely, $2 billion would be saved in smoking-related deaths, lung cancer treatments and care for related health complications over the course of several years, says the release.

Blakely highlighted several other examples of public health’s potential return on investment. For example, says the release, every dollar spent on childhood immunizations saves $18 on vaccine-preventable disease-related costs, every dollar spent in prenatal care translates to $6 in health care cost savings and for every dollar spent on fluoridated water saves $20 in dental care.

Public health research will continue to find effective ways to generate these cost savings, such as finding researching how to modify environments to encourage exercise or how to send strong messages that promote regular physical activity (Read more)

Survey finds employees pay greater share of health costs, and most large employers penalize them for using tobacco

As large employers respond to changes influenced by health care reform and rising costs of care, employees are paying a greater portion of their health-care costs. That trend that is likely to continue over the next few years, says a new report on employer-based health plans.

Although employers cover most costs of work-based plans, employees contribute 42 percent more for health coverage than they did five years ago, while employers paid 32 percent more, according to the study from the benefits consultant Towers Watson and the National Business Group on Health. Overall, costs went up 34.4 percent.

When employers were asked if they thought health plans would change by 2018, which is the year the excise tax on high-cost plans takes effect, 92 percent said plans would be different, and nearly half said they expect a significant or transformative change. Such change will increase both accountability and engagement for employees.

% of large employers saying they were "very confident" they would offer health benefits in 2022

Nearly two-thirds of employers surveyed offer employees financial rewards to encourage participation in health programs, according to the report, which said tying employee contributions to successful completion of specific tasks, such as health assessments and screenings, remains the most popular contribution strategy. Growth in the use of penalties to engage employees in health-program participation has slowed over the last two years, but the use of surcharges for tobacco use continues to grow. By 2014, 62 percent of surveyed companies are expected to apply tobacco-use surcharges.

"While U.S. employers remain committed to health care benefits for active employees over the next five years," the report says, "they are redifining their financial commitment in the short run and are more reluctant to commit to coverage for employees over a longer period."

The 18th annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care tracks employers' strategies and practices. It was completed by 583 employers,between November 2012 and January 2013. The report says it identifies the actions of the best performing companies as well as current trends in health-care benefit programs of U.S. employers with at least 1,000 employees. Survey respondents collectively employ 11.3 million full-time employees and have 8.5 million employees enrolled in their health care programs. Download a report PDF by clicking here.

Smoking ban gets 'a good scrubbing' before Judiciary Committee

By Al Cross
Kentucky Health News

The bill for a statewide smoking ban is favored by three-fifths of Kentucky adults, but is dead for this session of the General Assembly. However, its supporters think they made some headway Monday as they laid groundwork for getting it through the state House a year from now.

The House Judiciary Committee held an informational hearing on House Bill 190 to "give it a good scrubbing" before a committee that is more skeptical of it than the Health and Welfare Committee, which approved it early in the session, the bill's sponsor, Rep, Susan Westrom, D-Lexington, said afterward.

Westrom said she was encouraged by the hearing because it exposed weaknesses in the bill that she will correct for the next regular session, beginning in January 2014. For example, she said, Rep. Steven Rudy, R-Paducah, argued that the bill's language would make it illegal to use smoke in barns to cure the dark tobacco grown in Western Kentucky, largely for smokeless consumption.

"This is about vetting," Westrom told Rudy. "You have a different mindset that I do sitting on the Health and Welfare Committee."

Rudy acknowledged that secondhand smoke is not beneficial, but asked, "Has there ever been a death certificate that secondhand smoke killed this person?"

Dr. Sylvia Cerel-Suhl, Central Kentucky president of the American Heart Association, replied that Lexington recorded a significant drop in acute heart attacks after enacting a smoking ban, and said "thousands of studies" of secondhand smoke have shown exposure to it can cause premature death.

"The evidence is absolutely overwhelming," she said, and asked if anyone else had any questions. No one did, but the committee was one member short of a quorum.

Advocates told the legislators that 37 jurisdictions, covering 34 percent of the state's population, limit smoking in some way. Mark Hayden, a trial lawyer and former Campbell County commissioner, said a statewide ban is needed because enacting ordinances, writing regulations and enforcing them is a burden for local officials.

The bill would give local health departments power to enforce the ban. Scott Lockard, president of the Kentucky Health Departments Association and the health director in Clark County, said his agency has issued no court charges, only warning citations, since its board passed a ban, and Woodford County has issued only three citations.

Others appearing at the hearing included Dr. Stephanie Mayfield, commissioner of the state Department of Public Health, and Lt. Gov. Jerry Abramson, who was invited by the Kentucky Smoke-Free Kentucky Coalition. He discussed enforcement of of the ban in Louisville, where he was mayor.

Rep. Tom Riner, D-Louisville, said the ban is "one of the most important pieces of legislation that has been brought before this body, because it literally affects every Kentuckian. . . perhaps the most important piece."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Lack of statewide smoking ban represents one part of Kentucky's struggle to deal with tobacco use and the health issues it creates

By Molly Burchett

Kentucky Health News

As the bill for a statewide smoking ban lies on its deathbed in the General Assembly, new federal data show Kentucky still has the highest percentage of smokers (29 percent) of any state, leads the nation in the share of smoking high school students (24 percent) and spends only a minuscule portion of their tobacco revenues to fight tobacco use. Those figures come from the federal Centers for Disease Control and Prevention's Tobacco Control State Highlights 2012 report. (For county-by-county figures, click here.)

The lack of a statewide smoking ban, which nevertheless has become popular among Kentuckians, represents only a small part of the struggle to address Kentuckians' tobacco use and resulting health problems. Kentucky's program to discourage tobacco use has been severely underfunded for years, contributing to the state's lack of or slow progress in reducing its smoking and tobacco use rates and subsequent health problems, said Dr. Ellen Hahn, director of the Kentucky Center for Smoke-Free Policy at the University of Kentucky.

State tobacco revenue (left bar) and spending (right bar)

The CDC says Kentucky should spend $57.2 million a year to have an effective, comprehensive tobacco-prevention program, but the state allocates only $2.1 million a year to such programs -- 3.7 percent of the recommended amount.

By another measure, the amount is only 0.6 percent of the estimated $381 million the state gets from tobacco taxes and the 1998 national settlement with cigarette manufacturers, according to a tobacco settlement report.



Meanwhile, Kentucky's health-care costs attributable to smoking add up to about $1.5 billion a year, and smoking-caused productivity losses total $2.3 billion a year. These amounts do not include health costs caused by exposure to secondhand smoke, smoking-caused fires, smokeless tobacco use or cigar and pipe smoking.

Despite the known health risks that tobacco use poses, smoking in Kentucky remains a part of everyday life in most places. But that is increasingly less so around the country, so there is an increasing gap between heavy-smoking and low-smoking states; smoking in Kentucky is about twice as prevalent as in Utah and California, reports Steven Reinberg of HealthDay. Click here for an interactive map of states' tobacco prevention efforts.

There are proven, multi-pronged strategies to curb smoking. They include combinations of higher tobacco taxes, smoke-free laws, media campaigns, and restricted access to tobacco products. However, Kentucky continues to lag behind other states due to "stagnant policies" and a lack of funding, said Hahn.

Many other factors contribute to Kentucky's lack of tobacco-prevention progress. By failing to substantially reduce adult smoking, the state misses opportunities to encourage younger adults and children not to smoke, Hahn said. Kentucky needs to employ strategies that communicate the success and affordability of tobacco cessation programs, she said; people often lack the encouragement to quit smoking because they don't know how or they don't believe it is possible.

The latest tobacco report is a timely reminder that tobacco use remains a huge public health problem for Kentucky and there are proven strategies that, if implemented, could help Kentuckians live a healthier, tobacco-free life.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Beshear endorses statewide smoking ban as bill moves to the House floor; Williamsburg adopts its own ban

Gov. Steve Beshear endorsed a statewide smoking ban yesterday at a Frankfort rally to push the bill that would enact the ban.

"Beshear, who later acknowledged that he smoked in college but quit soon afterwards, said Kentucky ranks No. 1 in the nation in smoking and lung cancer," reports Jack Brammer of the Lexington Herald-Leader.

Noting that Kentucky leads the nation in smoking, Beshear said, "Our addiction hurts productivity, jacks up health care costs and literally kills our people. Yet we've never instituted a statewide law to protect Kentuckians from secondhand smoke." Noting that over one-third of Kentuckians live in jurisdictions with smoking bans, he said, "It's time that we extend that protection to all Kentuckians. . . . Years from now, people will wonder why we waited so long."

Republican Rep. Julie Raque Adams  of Louisville, a co-sponsor of the bill, noted at the rally that Williamsburg this week became the 23rd Kentucky locality to adopt a smoking ban.

The statewide measure, House Bill 190, was posted for passage in the House today but is not expected to be called for a vote unless supporters show Speaker Greg Stumbo that they have the votes to pass it.

Read more here: http://www.kentucky.com/2013/02/14/2517025/former-kentucky-basketball-star.html#storylink=cpy

Statewide smoking ban close to House vote, Stumbo says

For the second straight year, the state House Health and Welfare Committee has approved a bill that would ban smoking in enclosed public places or workplaces. It is still unlikely to become law, but might get farther in the legislative process.

"The proposal has never been voted on by the full House, and it would probably have a rough road in the Republican-controlled Senate," Beth Musgrave reports for the Lexington Herald-Leader. "Senate President Robert Stivers, R-Manchester, said that the government shouldn't tell businesses they cannot regulate smoking on their own property." (Stivers' hometown does just that; it is one of 22 Kentucky jurisdictions with smoking bans.)

House Speaker Greg Stumbo told Musgrave that he supports the measure, House Bill 190, and that sponsors are close to getting the votes it needs to pass the full House. The House has 100 members, but a bill can pass with as few as 40 votes as long as enough members abstain and it has a plurality.

The bill passed the committee Wednesday by a vote of 11-0, with four Republicans abstaining: Reps. Tim Moore of Elizabethtown, Robert Benvenuti of Lexington, Ben Waide of Madisonville and Addia Wuchner of Burlington.

Rep. Julie Adams of Louisville, the bill's Republican sponsor, told Musgrave that 29 states have statewide smoking bans, 24 with bans like the bill would impose. "This is a mainstream issue," she said. "The Kentucky General Assembly is way behind the general public." (Read more)

Basketball star Derek Anderson will join Smoke-Free Kentucky for its annual lobbying day in Frankfort Thursday, Feb. 14. He said in a press release, “Kentucky has so much to be proud of.   We are known for our hoops and horses.  Unfortunately, we are also number 1 in the number of deaths from lung cancer.  This is unacceptable to me. I want to be a part of the movement to change that.”  He added, “I am a businessman.  Smoke-free workplaces make good economic sense.” (Read more)

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Beshear calls for action to improve state's health, but says only that 'It's time for us to begin looking seriously' at a smoking ban

By Al Cross
Kentucky Health News

His priorities were education and tax reform, but Gov. Steve Beshear mentioned several health issues in his State of the Commonwealth speech tonight to a joint session of the General Assembly.

Beshear called for action to correct the state's "fundamental weaknesses," including "a population whose health ranks among the worst in the nation." Near the end of his speech, he said, "We need to continue improving the health of our people," but after about a minute of discussing tobacco and smoking he stopped short of endorsing a statewide ban on smoking in the workplace. (KET photo)

"It's time for us to begin looking seriously at doing this on a statewide level," he said to some applause, after noting that nearly half of Kentuckians live in jurisdictions where smoking is legally restricted, that the state has the highest or next-to-highest smoking rate overall and among teens and pregnant women, and that "Our smoking-related mortality rate is the worst in the nation. . . . Our addiction hurts productivity, jacks up health care costs and kills our people."

Beshear called for improving prenatal care and newborn screening, and for minor improvements in last year's bill to fight prescription drug abuse. He said the bill has caused a precipitous drop in abuse of prescription painkillers. "Kentucky at one time had the sixth highest rate in the nation, but . . . we improved 24 spots," he said. "Nearly half of the state's known pain management clinics have closed rather than submit to new rules that protect patients." He said use of the Kentucky All Schedule Prescription Electronic Reporting system "has increased nearly seven-fold . . . and prescriptions for some of the most abused drugs have dropped up to 14 percent from a year ago."

However, the problem of babies becoming addicted to drugs in their addicted mothers' wombs has skyrocketed in the last decade or so, Beshear said: "In 2000, reports showed 29 babies in Kentucky born addicted to drugs. But in 2011, there were 730 babies – more than 25 times as many. And that figure is thought to be under-reported." He did not say how he wants to improve screening.

Beshear did not mention perhaps the biggest health policy question facing the commonwealth, whether to use federal subsidies to expand the Medicaid program to people in households earning up to 138 percent of the federal poverty threshold. Now the program covers people in households earning up to 70 percent of the poverty line. The federal government would pay all the cost of the additional enrollees through 2016, when the state would start picking up part of the tab, up to 20 percent in 2020.

Some Republicans say the state can't afford the expansion, while some Democrats say it would be a good long-term investment in the state's health and economy. Beshear has said he wants to do it if the commonwealth can afford it, and expects to get cost estimates around the end of March -- about the time the legislature must adjourn.

For a PDF of the speech text, click here. For an audio recording, go here. For video from KET, here.

Health reform will let insurers charge smokers up to 50 percent higher premiums, which is likely to have a big impact in Kentucky

"Millions of smokers could be priced out of health insurance" because the health-care reform law will let health-insurance companies charge smokers as much as 50 percent more starting next year on individual policies, according to experts who are just now teasing out the potential impact of a little-noted provision in the massive legislation," The Associated Press reports.

The provision is likely to have a major impact in Kentucky, where 29 percent of adults are smokers, a figure exceeded by no other state, and where 25 to 30 percent of people under 65 are estimated to have no health insurance.

"For a 55-year-old smoker, the penalty could reach nearly $4,250 a year" AP reports. "A 60-year-old could wind up paying nearly $5,100 on top of premiums. Younger smokers could be charged lower penalties under rules proposed last fall by the Obama administration."

A state health insurance exchange, now being created under the law, will be a place to buy insurance with tax credits depending on income. Gov. Steve Beshear has said he wants to expand the state Medicaid program to cover people in households with incomes up to 138 percent of the federal poverty level, but many Republicans in the legislature are opposed to that because the state would ultimately have to pay 10 percent of the expansion's cost.

The provisions to discourage smoking would allow employees covered by employer plans to avoid penalties by joining smoking-cessation programs,"but experts say that option is not guaranteed to smokers trying to purchase coverage individually," AP reports.

There is concern about the provision's effect on older smokers who "could face a heavy hit on their household budgets at a time in life when smoking-related illnesses tend to emerge. . . . Several provisions in the federal health care law work together to leave older smokers with a bleak set of financial options," AP reports, citing Karen Pollitz, a health-insurance expert with the Kaiser Family Foundation and former deputy director of the Office of Consumer Support in the U.S. Department of Health and Human Services.

Pollitz notes that the reform law lets insurers charge older customers up to three times as much as their youngest customers; charge the full 50 percent penalty on older smokers while charging less to younger ones; and does not allow smokers to use tax credits to offset the cost of the penalty.

And there's a good argument to charge the full penalty, insurance consultant Robert Laszewski told AP: "If you don’t charge the 50 percent, your competitor is going to do it, and you are going to get a disproportionate share of the less-healthy older smokers,” said Laszewski. “They are going to have to play defense." (Read more)