Hard-hitting TV ads against smoking do motivate smokers, like one mother from Elizabethtown, to quit

Hancock with CDC Director Tom Frieden

A 38-year-old Elizabethtown mother's response to a federally funded anti-smoking advertising campaign has been featured in national news this week, showing that these graphic ads can motivate smokers to quit.

Lisha Hancock's decision to stop her two-decade smoking habit was sparked by her viewing of a Centers for Disease Control and Prevention’s “Tips from Former Smokers” campaign commercial, reports Sarah Bennett of The News-Enterprise in Elizabethtown.

Hancock's husband often urged her to quit, and several of her relatives died from smoking, but she still didn't quit. She continuously had a sore throat and clogged sinuses, but she still didn't quit. Then, she saw the commercial.

The advertisement featured raw images of Terrie Hall, a North Carolina woman who was diagnosed with throat and oral cancers at age 40, getting ready in the morning by putting on a wig, artificial teeth an an artificial voice box inside a small hole in her neck, since throat cancer forced her to have her larynx removed.

TV spokeswoman Terrie Hall with grandson's picture

"The only voice my grandson’s ever heard is this one,” Hall says in a robot-like voice, displaying his picture. UPDATE: Hall died Sept. 16.

The ad made a lasting impression on Hancock, who told Bennett she decided to quit smoking after watching the ad with her son: “One time my son asked me, ‘Mom, why does her voice sound like that?’ I said, ‘Because she smoked.’ Then he asked, ‘So you’ll sound like that?’”

Hancock said she had tried to quit before, but "There's nothing that touched me like Terrie's ad. It definitely impacted my life and, in return, impacted my family's life. We all live happier and healthier now."

Hancock started to quit eight months ago. Using nicotine lozenges and a combination of exercise and healthful eating, she's been able to go without even one cigarette, reports Anahad O'Conner of The New York Times.

Others have also been struck by this hard-hitting campaign, which may have prompted more than 100,000 Americans to quit smoking permanently, says a new CDC study published in The Lancet, the leading British medical journal. The CDC says an estimated 1.6 million U.S. smokers attempted to quit this past year after viewing campaign materials funded by the Affordable Care Act.

"Hard-hitting ads work," said CDC Director Dr. Tom Frieden. The agency paid approximately $50 million to produce and place the spots, the first time the federal government funded a nationwide tobacco-education ad campaign, reports Jonathan Serrie of Fox News.

"The impact is huge because a smoker costs about $2,000 more [per year] than a non-smoker, and about $1,000 more than an ex-smoker, to care for," Frieden said. "And if you do the math, this program pays for itself in a year or two in reduced health-care and societal expenditures."

The campaign also saved an estimated 300,000 years of life that smoking-related diseases would have taken, reports Brady Dennis of The Washington Post. Smoking remains the leading cause of preventable death in the United States, killing more than 1,200 Americans each day, says the CDC.

Click here for the CDC ads and other smoking-cessation resources.

National Childhood Obesity Awareness Month: Policy changes underway in Ky. to lower its very high childhood obesity rate

September is National Childhood Obesity Awareness Month, and a number of policy changes are underway to combat the increasing trend of overweight children in America and Kentucky, where one in three kids are on their way to developing Type 2 diabetes.

Kentucky suffers from one of the highest childhood obesity rates in the country, tying Mississippi for the highest percentage of youth in grades 9 to 12 that are obese (18 percent). It 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 state's efforts to lower childhood obesity rates include two important studies for the Cabinet for Health and Family Services – "Shaping Kentucky’s Future: Policies to Reduce Obesity" and "Unbridled Health: A Plan for Coordinated Chronic Disease Prevention and Health Promotion." These reports contain policy recommendations for work communities, corporations, schools and the state itself to help Kentuckians eat healthy and exercise, The Foundation for a Healthy Kentucky says in a news release.

“Lowering childhood obesity rates is a positive lever for overall health change, reduced risk of chronic disease and an improved quality of life," said Susan Zepeda, president of the foundation. "Foundation polling and recent news reports signal growing awareness among Kentuckians of the importance of and the need for lowering our obesity rates."

Nationally, the recent report "F as in Fat: How Obesity Threatens America’s Future 2013" provides recommendations that could improve health in Kentucky and across the country with funding and effective implementation, including:
 · All food in schools must be healthy
 · Kids should have opportunities to be physically active on a regular basis
 · Restaurants should post calorie information on menus
 · Only healthy products should be marketed to children
 · Transportation plans should encourage walking and biking
 · Everyone should be able to purchase healthy, affordable foods close to home

“Here at home, Kentucky will host the Southern Obesity Summit in 2014 and several organizations are hard at work to advance health policies that support sound nutrition and active living at work, at school and in our communities,” said Zepeda. “These efforts create opportunities to discuss strategy and create more awareness of the compelling need to reduce childhood obesity rates in the commonwealth.”

State picks managed-care outfits for expanded Medicaid

The state awarded contracts Friday to Humana Inc., Passport Health Plan and Wellpoint subsidiary Anthem Blue Cross Blue Shield to manage the health care of Kentuckians who will become eligible for Medicaid when the state expands the program under federal health reform Jan. 1.

The newly eligible, in households with incomes up to 138 percent of the federal poverty line, can start signing up for coverage Oct. 1 through Kynect, the state health benefits exchange that will offer regular insurance policies and federal subsides for those up to 400 percent of the poverty line.

The contracts cover 104 counties. The other 16, in the Louisville region, are already covered by contracts signed last year with Humana, Passport, Coventry Cares and Wellcare of Kentucky for current Medicaid patients in all counties. They will be expanded to cover the newly eligible on Jan. 1.

An estimated 308,000 Kentuckians will become eligible for Medicaid under the federal health-care reform law. The state does not expect all of them to sign up for coverage. Under the reform law, the federal government will pay the extra cost for the first three years, then the state will start picking up part of the cost, topping out at 10 percent in 2020. Currently, federal funds cover about 72 percent of Kentucky Medicaid costs.

McConnell calls for one-year delay in reform law's key requirement, that Americans buy health insurance

U.S. Sen. Mitch McConnell

U.S. Sen. Mitch McConnell is calling for a one-year delay in the requirement for almost all Americans to buy health insurance, followed by repeal of the federal health-reform law. The Obama administration has said it will delay for a year its enforcement of the related requirement that businesses with 50 or more employees insure them.

"But what about everybody else?" McConnell asked in a speech on the Senate floor Sept. 12. "What about the recent college grad in Louisville who’s barely scraping by as it is, and won’t be able to afford a premium increase? What about the families from Covington to Paducah who are worried sick about this law? Doesn’t the administration think these folks deserve some relief too? The same kind of delay, at least, that businesses will get?"

The Senate Republican leader noted that the Republican-majority House "passed a bill on a bipartisan basis before the August recess" to delay the individual mandate, and said he tried to likewise in the Senate but was blocked by that chamber's Democratic leaders. He said he would keep trying.

McConnell also said in his speech, "Now, I know that some of you who supported this law might be thinking, 'Well, they’ll learn to like it.' But it’s precisely that kind of 'We know what’s good for you' attitude that’s so upsetting to my constituents. It’s what got us into this mess in the first place." (Read more)

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.

FDA changes painkiller labels to warn expectant mothers, after 2,500% growth in number of Ky. babies born addicted to drugs

The U.S. Food and Drug Administration (FDA) announced Tuesday drug-safety labeling changes and new post-market study requirements for all extended-release and long-acting opioids, and Kentucky political leaders applauded these measures to curb prescription drug abuse.

Long-acting opioids are intended to treat pain but may also lead to drug abuse, dependence or other complications if taken during pregnancy or misused. Now, as part of new FDA safety measures, the boxed warning labels on these drugs will warn expectant mothers that “the use of the products during pregnancy can result in neonatal opioid withdrawal syndrome (NOWS),” says the FDA release.

NOWS is among a group of problems called Neonatal Abstinence Syndrome (NAS) that occur in a newborn exposed to addictive drugs while in the mother’s womb. The baby's addiction can lead to birth defects, low birth weight, sudden infant death syndrome and other health conditions.

Attorney General Jack Conway and his counterparts in other states asked the FDA to act after several states reported an increase in the number of babies born addicted to prescription drugs. In Kentucky, "Instances of NAS have risen 2,500 percent over the past decade – from 29 incidents in 2001 to 730 in 2011," says a Conway release.

“I applaud the FDA for making this change that will better alert physicians and patients about the dangerous consequences of using these powerful prescription painkillers during pregnancy,” Conway said. Also as part of these safety labeling changes, certain educational materials for patients and health care professionals will be modified to reflect the new labeling.

U.S. Senate Republican Leader Mitch McConnell also praised the FDA's decision, saying it is a positive step forward in the fight against the state's prescription drug abuse problem.

Because little is known about the risks of long-term use of long-acting opioids, the FDA is also requiring the drug companies that make these products to conduct further studies and clinical trials to assess the known serious risks of misuse, abuse, increased sensitivity to pain (hyperalgesia), addiction, overdose and death, says the FDA.

"Altogether, the actions we're now announcing are part of FDA's efforts to make opioids as safe as possible for those who need them," said Dr. Douglas Throckmorton, deputy director of regulatory programs in FDA's Center for Drug Evaluation and Research. "This is not the first or last initiative, and we will continue supporting broader efforts to solve the serious public health problems associated with the misuse and abuse of opioids."

Beshear announces rates in health-insurance exchange, says Kentuckians will like them, especially the federal 'discounts'

By Al Cross
Kentucky Health News

Tossing out the first examples of what Kentuckians will pay for required health coverage through the state health insurance exchange that opens Oct. 1, Gov. Steve Beshear predicted yesterday, "The vast majority of people are going to be very excited about what they find. . . . When they check it out, they’re gonna sign up."

Beshear said there has been much speculation about premiums, but little talk about the federal subsidies (he called them "discounts") that the exchange will offer to individuals and households with incomes up to 400 percent of the federal poverty level. He said subsidies will be available to individuals earning as much as $45,960 a year, and to families of four with income as high as $94,200 a year.

Beshear notes that 15 percent of Kentuckians are uninsured (light green in pie chart); at left is
Kynect Director Carrie Banahan; at right is Health and Family Services Secretary Audrey Haynes.

Tea Party activist David Adams, who recently lost the first round of his court battle to stop the exchange and Medicaid expansion, has said some consumers will have to pay almost double for their current coverage, and he told The Courier-Journal that the subsidies won't make up for that.

About 15 percent of Kentuckians, more than 640,000, have no health coverage. About 308,000 will become eligible for the Medicaid program, which is being expanded under federal health reform to include people with incomes up to 138 percent of the poverty level. Among the other 332,000, 85 percent of those people will qualify for subsidies, Beshear said, and in some cases the subsidy will be 100 percent.

The subsidies are available only through the insurance exchange, which the state has branded Kynect. The exchange will offer five plans, with premiums based only on age, income, geography, number of people on the plan and how many of them use tobacco.

State's example of bronze plan for a smoker earning $30,000

The ceiling for the tobacco surcharge is 40 percent, which has drawn criticism, but the state Department of Insurance said that is the most common surcharge in the state's health-insurance industry. Beshear said a 50-year-old man who smokes and earns $30,000 a year would still pay only $160 a month for coverage under the "bronze" plan, the one with the lowest premiums and highest deductibles and other out-of-pocket costs. Under the plan with the lowest deductibles, he would pay $279.

The bronze plan has a very large $6,300 deductible. The other standard plans are silver, gold and platinum; their deductibles are 20 percent (called "co-insurance") plus $4,600, $2,500 and $1,000, respectively. The exchange will also offer people under 30 a plan that provides only catastrophic coverage with a "very high deductible" and no subsidy, Beshear said.

Among other examples in the bronze plan, which has a $6,300 annual deductible: A nonsmoking farmer in his mid-50s earning $34,000 a year would pay $47; a family of four with no smokers and $70,000 annual income would pay $403; a 32-year-old single mother with two children and $40,000 income would pay $133.

Beshear offered no average cost, saying “There are too many factors to create an average that would be useful. . .. The bottom line is that families must do some research,” which the Kynect website and call center can help them with starting Oct. 1. He said the plans shouldn't be compared to individual plans offered in commercial market, because “the coverages are so much different.”

One big difference is that under the federal health reform law, all plans must cover prescription drugs, hospital care, maternity and newborn services, mental health and substance abuse services, emergency care, rehabilitative services and devices, laboratory services, preventive and wellness services, chronic disease management and pediatric services. Also, they are not allowed to have any dollar limits on coverage.

The law also bans insurance companies from denying or dropping coverage because of someone's health condition, meaning that "For the first time we’re gonna be able to provide affordable health insurance of every single Kentuckian. . . . This is a historic event in the commonwealth." The federal law requires practically every American to have health insurance.

The plans' geography is based on the state's eight Medicaid regions. Beshear said at least two insurance companies will be offering plans in each region, unlike some states. He said four companies have proposed to offer dental insurance, but those plans are still under review by Kynect and the Department of Insurance, which evaluates them for actuarial soundness.

Humana Inc., Anthem Blue Cross and the new Kentucky Health Cooperative will offer policies for individuals, while Anthem, the co-op, Bluegrass Family Health and United Healthcare will provide employee coverage for businesses. Employers with fewer than 50 workers are not required to insure them, and those with fewer than 25 employees can get tax credits for doing so.

The rates are for 2014. Beshear said companies were “understandably cautious” in setting premiums without any experience on which to base them, so he expects rates to decrease in 2015.

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