CDC says state spends less than 8% of what it should on preventing use of tobacco; companies spend 13 times as much

Kentucky spends only 7.6 percent of what it should spend on preventing the use of tobacco, the federal Centers for Disease Control and Prevention says in its latest annual report on the subject.

The state spent $4.33 million on tobacco-control programs in 2011, the year covered by the report. The CDC said spending of $57.2 million was called for, since 29 percent of Kentuckians smoked that year. Tobacco-related illnesses are estimated to cost Kentuckians $3.3 billion a year.

South Carolina and Texas, which spent 6.5 percent and 7 percent of the recommended amounts, were also singled out for criticism by the CDC. Nationally, states spend less than 18 percent of what they should, $3.7 billion, in the agency's view. "Only Alaska and North Dakota funded programs at the CDC-recommended levels, $10.7 million and $9.3 million, respectively," Samantha Ehlinger of McClatchy Newspapers reports.

Read more here: http://www.kentucky.com/2015/06/25/3918046/cdc-says-kentucky-isnt-spending.html#storylink=cpy

"States that made larger investments in tobacco prevention and control have seen larger declines in cigarettes sales than the United States as a whole, and the prevalence of smoking has declined faster as spending for tobacco control programs has increased," the CDC report said. "Evidence suggests that funding tobacco prevention and control efforts at the levels recommended . . . could achieve larger and more rapid reductions in tobacco use and associated morbidity and mortality."

In contrast to the state spending of $658 million on tobacco control, tobacco companies spent more than 13 times as much on advertising and promotion in 2011: $8.8 billion, or $24 million per day, the report noted.

"During the same period, more than 3,200 youth younger than 18 years of age smoked their first cigarette and another 2,100 youth and young adults who are occasional smokers progressed to become daily smokers," the report said. "If current rates continue, 5.6 million Americans younger than 18 years of age who are alive today are projected to die prematurely from smoking-related disease. However, the tobacco-use epidemic can be markedly reduced by implementing interventions that are known to work."

For the CDC's latest comprehensive report on tobacco use in Kentucky, with data from 2012, click here. For county-by-county figures on adults smoking in Kentucky in 2011-13, click here.

14-year-old from Paducah discusses her depression and thoughts of suicide to help others in a similar situation

Sophie Henney of Paducah chose two days after her 14th birthday to tell her story of depression and thoughts of suicide. She wanted to share her story—and her name—to help others who may be in the same situation, Genevieve Postlethwait reports for The Paducah Sun.

In Kentucky, 15 percent of teens say they've thought about committing suicide, according to the 2013 National Youth Risk Behavior Survey. According to the Centers for Disease Control and Prevention's 2013 data, 11 out of every 100,000 young people die by suicide. Every year between 1999 and 2013, Kentucky ranked 16th in the nation for rate of deaths by suicide for individuals between ages 15 and 24.

On the way to church on New Year's Eve night, Sophie told her mom, Peggy, "I wouldn't hurt myself, but I don't want to go back there to that school. I'd rather be dead." Sophie attended a small private school and hadn't had a pleasant fall semester: the other girls in her class were excluding her, and she had thought some of them were her friends, Postlethwait writes. "We found out several months later she was actually formulating a plan to do it," Peggy said. "As much attention as I was paying to her, I still didn't know. I beat myself up for several months, thinking that there was more I could have done."

Both Sophie and her counselor have released Peggy of the blame, but she still feels responsible. "I could have lost my child," Peggy said. "And there are people here who have lost their child. . . . We can talk about texting and driving; we can talk about drinking and driving; but we can't talk about suicide. We've got to start changing something."

The stigma surrounding suicide and a lack of information about it are two main things that stand in the way of changing the way people talk about suicide, said Laurie Ballew, medical director of Lourdes Behavioral Health. She said people didn't used to talk about cancer because of the stigma. "Now we talk about it," Ballew said. "We're out about it, we're loud about it, and we're educating about it. That's what we need to do with suicide and mental health issues."

Gretchen Roof, site administration at Four Rivers Behavioral Health in Paducah, "said at least once a week a child comes to them at Four Rivers who they worry may be a suicide risk." When that happens, there are several options. Children may see a counselor once per week or every other week. They can go to Four Rivers every weekday after school. In more severe cases, "'partial-hospitalization'"is an option, where the child attends school at the center while also participating in therapy from 8 a.m. to 4 p.m. every weekday," Postlethwait writes. Most of the schools in the area allow Four Rivers counselors to spend approximately one day per week in each school, which removes the need for transportation and the stigma associated with entering a mental health facility.

Roof said that parents, teachers, preachers and kids should not be afraid to talk about depression or suicidal thoughts in themselves or observed in others, Postlethwait writes. "If you have or know a child who appears depressed, or is having some sort of significant change in their behavior, a change in appearance even . . . be especially tuned-in to that child," Roof said. "Don't be afraid of saying, 'I'm concerned about you. What's going on?' and don't be afraid of asking, 'Have you thought about hurting yourself?'" Something people are afraid to ask such questions because they think they will give the person ideas, Roof said, but research shows that is false. "They will tell you, and you are the intervention that has been waiting to happen for them."

Sophie said, "I was very relieved when we went to Christmas break, and by New Years Eve, I was like, I don't want to go back. I want this to be over. I don't want to see them again. The only thing I can really think of to say is, get help. That's what made me better. Tell somebody. Talk to somebody. don't just keep it quiet."

New license plate would promote outdoor recreation, support environmental education programs; 900 buyers needed to start

A new "Let's Go Outside" license plate is being offered to give Kentucky motorists the opportunity to promote the health and environmental benefits of outdoor recreation.

First Lady Jane Beshear unveiled the license plate June 10. She said that encouraging children to play outside will help improve their health and noted that "Kentucky has one of the highest childhood obesity rates in the nation," reports to The Lane Report.

Proceeds from the specialty plate will support the work of the Kentucky Environmental Education Council, including coordinating the Kentucky Green and Healthy Schools program and certifying professional environmental educators.

“Kentuckians have said in surveys that children not spending enough time outside is a major concern,” KEEC Executive Director Elizabeth Schmitz said. “One of our goals is to encourage children to embrace the outdoors and to teach them the importance of a clean environment for our health and preservation."

The Kentucky Environmental Education Council needs 900 applications, each accompanied by a $25 donation, before any plates will be manufactured.

Submitting the application does not obligate you to purchase the plate, but your donation will be credited toward the purchase of a plate once they are in production. If not enough applications are received, your $25 will be considered a tax-deductible donation.

A link to download the application is available at www.keec.ky.gov/LetsGoOutside.

In-school health clinics not only meet the health-care needs of students and staff, but also their families

School-based health clinics in Kentucky could become a trend,  especially as the state searches for solutions to meet the health care needs of schools as budgets for school nurses continue to be slashed.

Southern Kentucky has Cumberland Family Medical, based in Burkesville, which has clinics at the five schools in Russell County and a deal to do likewise with the four in adjoining Adair County.

Western Kentucky has three such clinics, with two more likely to open next year, Genevieve Postlethwait reports for The Paducah Sun. 

The clinics are at McCracken County's Reidland Middle School, Lone Oak Elementary School, and Paducah's Morgan Elementary. Next school year a full-time clinic will open in McCracken County High School, hopefully followed by a clinic at McNabb Elementary.

These clinics exist as a partnership between Mercy Medical Associates and the local public school districts; the school districts supply the space, Mercy supplies and staff and the Lourdes Foundation helps with funding, Postlethwait reports.

An advanced practice registered nurse with Mercy Medical, Julie Higdon, said she has seen well over 30 patients at the Lone Oak clinic since it opened in mid-April. "That's not busy by ER standards," she said, "but that's busy for a little clinic that's just softly opened."

The clinics serve the entire "school family," from the students and their parents and siblings to the districts' teachers, staff and administrators, regardless of their ability to pay. "Their goal is to give the community the preventive, acute and critical health care it needs while reducing students' and teachers' time away from school, and parents' time away from work," Postlethwait writes.

"It's a big deal when you start talking about dollars and cents, too," Tennille Rushing, director of clinical operations for Mercy, told Postlethwait.  "Not only in the impact for the schools to have kids staying in the classroom and helping with attendance numbers, but for parents. If you only have a limited number of days that you can take off, and you have to take off half a day to go sit in a lobby somewhere with your child, you've missed a half day of pay."

These clinics will also help those without a primary-care provider, which are in short supply in the Paducah area. The Lone Oak clinic will remain open by appointment only this summer.

"I feel like these clinics really have the potential to meet a need for the community," Higdon told Postlethwait. "I feel like it has great potential to grow, I really do." (This story is behind a paywall.)

Clay County 4th and 5th graders participate in UK research of circadian rhythms and obesity, little studied in children

The University of Kentucky recently partnered with over 100 fourth and fifth grade students in two Clay County schools to study the relationship between circadian rhythms and weight in children.

Sydney Sester, a fifth grade student at Manchester Elementary School, said in a UK news release that in addition to learning more about science and helping others by contributing to research, participating in the study showed her the importance of maintaining a healthy weight and eating well.

"It made me want to be more responsible with food and be patient with what I eat and only eat when I'm hungry," she said.

The project, "Circadian Rhythm Parameters and Metabolic Syndrome Associated Factors in Young Children," also known as the Clay County Clock Study, is led by Dr. Jody Clasey, associate professor of kinesiology and health promotion, and Dr. Karyn Esser, professor of physiology.

The research team says it hopes to learn about the relationship between circadian rhythms, eating, and activity behaviors and the incidence of overweight and obesity in children.

And while the team is in the process of analyzing the data, Esser told a group at the 10th annual Center for Clinical and Translational Science conference in March that early data show 33 percent of the students in the study are considered obese, their initial blood pressure measurements are on the high end of normal, and the students are less active on weekends and nights than during the school week.

The data was gathered through electronic devices that the students wore for seven days to measure activity, heart rate and skin temperature. The students also kept a daily journal to record their sleep and eating activities each day.

Previous studies have shown that disrupting an adult's circadian rhythm is associated with increased risk for metabolic disease, which is a combination of chronic health conditions that puts a person at a higher risk of heart disease and diabetes. Similar research with children has been limited.

Esser noted that "Clay County and many of the counties in Appalachia have a much higher rate of these chronic diseases."

She also said that while it is known that light exposure affects the body clock, recent findings show that the time that we do activities, like exercising and eating, also contribute to circadian health, and that this is also likely true in children.

This research "could not only influence an individual, but school start times, activity intervention, just so many different areas from personal practice or behavioral choices to public policy, all for the metabolic or physiological good of the individual or collective body," Clasey said.

Study suggests that adolescent exposure to alcohol can negatively affect learning, memory and behavior in adulthood

A study at Duke University suggests that repeated exposure to alcohol during adolescence causes long-lasting changes in the part of the brain that controls learning and memory. The study, published in the journal Alcoholism: Clinical & Experimental Research, helped explain how exposure to alcohol before the brain has fully developed can cause cellular and synaptic abnormalities and negatively affect behavior. Kentucky is ranked 9th in the nation for the percentage of children who drank alcohol before age 13 (25.1 percent), according to the state Department for Public Health.

"In the eyes of the law, once people reach the age of 18, they are considered adult, but the brain continues to mature and refine all the way into the mid-20s," said lead author Mary-Louise Risher, a post-doctoral researcher in Duke's Department of Psychiatry and Behavioral Sciences. "It's important for young people to know that when they drink heavily during this period of development, there could be changes occurring that have a lasting impact on memory and other cognitive functions.

Studies had shown that animals exposed to alcohol at an early age do not perform as well in memory tasks as those not exposed to it. The new study, which involved exposing young rodents to alcohol and waiting for them to grow into adulthood, found that the exposure also affects the hippocampus, the area of the brain that controls memory and learning. The researchers measured a cellular mechanism called long-term potentiation, which involves the strengthening of brain synapses being used to learn new tasks or bring up memories. Ideally, LTP should be high, especially in young people. The researchers found that the adult rodents exposed to the alcohol during adolescence had higher levels of LTP, which may seem to be a positive outcome but is actually not.

"If you produce too much LTP in one of these circuits, there is a period of time where you can't produce any more," said senior author Scott Swartzwelder, a Duke professor. "The circuit is saturated, and the animal stops learning. For learning to be efficient, your brain needs a delicate balance of excitation and inhibition—too much in either direction, and the circuits do not work optimally."

The researchers also observed a structural change in individual nerve cells: those exposed to alcohol at a young age have brain cells that appear immature, even in adulthood. "It's quite possible that alcohol disrupts the maturation process, which can affect these cognitive functions later on," Risher said. She also noted that the immature appearance of the cells might be associated with behavioral immaturity.

Southern Kentucky physician expands his in-school clinics; already in Russell County, will be in Adair County next year

Dr. Eric Loy
(Columbia Magazine photo)

An entrepreneurial physician in Southern Kentucky has developed a way to deliver school health services that could have a broader impact on communities.

Cumberland Family Medical, based in Burkesville, has clinics at the five schools in Russell County and now has a deal to do likewise with the four in adjoining Adair County.

Dr. Eric Loy, who owns the clinic, "said that the agreement could have an important impact on the community both short term, by helping create a healthier and more focused student body; and long term, by creating a culture where people get acclimated to seeing doctors and nurses for physicals and regular checkups on a consistent basis," Wes Feese reports for The Adair Progress.

“We have a chance to change the culture of health care in Kentucky,” Loy told the Adair County Board of Education, which voted to spend $80,000 next year on the clinics. That is "roughly the same cost the district currently pays for school nurses," Feese reports. "If the trial run next year is successful, both parties will have options to continue the agreement."

"Cumberland Family Medical will pay two-thirds of the nurse expense and will bill the insurance of the patient," Toni Humphress reports for the Adair County Community Voice.

School Supt. Alan Reed complimented the dedication and service of the county’s school nurses but said costs to employ them were “soaring,” Feese reports. Reed said of Loy's plan, “This is kind of a novel approach, and from all we’ve seen, we really like it. It cuts down on time and any barriers for a kid getting health care.”

Loy agreed, saying, “A lot of times that’s the barrier, that it’s hard [for parents] to miss work.”

School principals said sick students may have to sit in an office or lobby all day because working parents are unavailable to come pick the students up and take them to a doctor. "Director of Pupil Personnel Robbie Harmon said that this move could have a bigger long-term impact on the community than any project he’s worked on in his time in the school system."

Loy's in-school clinics are manned by a full-time nurse practitioner who travels between schools, and is overseen by a physician. "Loy said that all forms of insurance would be accepted, and that all children would be seen and treated, regardless of their ability to pay," Feese reports. "He also said that the clinics could help out with insurance enrollment."

Adair County had one of the state's highest percentages of people without health insurance until the federal-state Medicaid program was expanded under federal health reform. The uninsured rate has dropped dramatically, but some families are still without health coverage.

Researchers discuss physical activity as a way of maintaining or improving health; daily walking is still the best exercise

By Melissa Patrick
Kentucky Health News

Obesity worsens the damage that arthritis does to joints, but simply telling patients to go home and diet and exercise is not working, and health care providers must proactively monitor their patients and help them find affordable solutions to succeed. And daily walking is still the best exercise.

Those were examples of research findings discussed at the 10th annual Center for Clinical and Translational Science conference sponsored by the University of Kentucky on March 25. More than 700 researchers, students, policymakers and guests discussed research with a focus on physical activity across the lifespan.

Stephen Messier, professor and director of a biomechanics laboratory at Wake Forest University, said obesity has a significant effect on joint health, particularly osteoarthritis, which he said is quite painful. He called for closer attention to obese patients with arthritis.

He said a study found that a combination of diet and exercise over an extended period of time offers the best results for less pain and less disability. He said that a separate study found those who lost 10 percent of their body weight had the most "significant outcomes" related to function, which included walking speed.

The conference featured 31 oral presentations and 270 poster presentations, addressing a vast array of topics including physical inactivity in children, physical inactivity in chronic disease and biomedical informatics.

"The conference was designed to raise awareness of the science behind the benefits of exercise and the dangers of physical inactivity," Charlotte Petterson, professor and associate dean of research in the College of Health Sciences, who chaired this year's conference, said in a UK press release.

The keynote speaker, Duke University medicine professor William E. Kraus, encouraged walking as a proven and simple activity that can improve health and actually extend life. "Fitness always trumps fatness," he said, noting that a "culture of convenience" and conditions of built environments, such as absence of sidewalks, deter people from physical activity.

Research on fourth and fifth graders in two Clay County schools, while in the early stages of analysis, found that obesity and inactivity begins early.

Karyn Esser, professor of physiology at the UK College of Medicine, said her research was examining the circadian rhythms and physical activities of students because changes in natural circadian rhythms "can create pre-cursors to disease" in just seven days, even in healthy young people. She said her study is intended to help schools improve students' health by adjusting meal times and offering physical activities to best coincide with circadian rhythms.

The data for Esser's study was gathered through electronic devices that the 136 students wore for seven days to measure activity, heart rate and skin temperature. The students also kept a daily journal to record their activities. So far, Esser said, the data show 33 percent of the students are considered obese, their initial blood pressure measurements are on the high end of normal, and the students are less active on weekends and nights than during the school week.

Another UK study found that students who are more active during the school day do better in mathematics.

Alicia Fedewa and Heather Erwin of the College of Education said they found that increased physical activity levels "significantly improved" math scores and slightly improved reading scores of the students who got an extra 20 minutes of movement on each school day. They recommended two short 15-minute recesses per day, rather than one long one. They also said that classroom "energizers" and stability balls also help students with these behaviors.

The researchers said many studies show that students who participate in recess and physical education during the school day are more focused and less fidgety, show less listlessness, and have better overall classroom behavior. They said more controlled studies need to be conducted, but said most studies to date have found that fit kids have less anxiety and better overall well-being. Also, a regimen of consistent physical activity is best for kids with attention deficit hyperactivity disorder (ADHD).

Study: American children's diets will cause early heart disease; Kentucky kids seem to be on the same track

Kentucky Health News

A study shows that American kids are eating themselves toward early heart disease.

The study, published in the journal Circulation: Cardiovascular Quality and Outcomes, looked at a nationally representative group of children and found that "American kids eat too much sugar and salt, they don't eat enough fruits and vegetables, and far too many are overweight," , Maggie Fox reports for NBC News. And of the 8,900 children aged 2 to 11 surveyed, "most were not meeting the goal on three out of four measures of healthy living."

"Our findings indicate that, in general, children start with pretty good blood pressure," Dr. Donald Lloyd-Jones of the Northwestern University Feinberg School of Medicine, who oversaw the study, told Fox. "But if they have a horrible diet, it will drive a worsening body mass index and cholesterol levels."

The research found that fewer than 1 percent of the children in the study had four or five of the main components of a healthy diet; only 3 percent of boys and 2 percent of girls ate enough whole grains daily; more than half of the children drank too much sugar-sweetened beverages; and fewer than 10 percent ate the recommended amount of fruits and vegetables. The study also found that 30 percent of the children surveyed were overweight or obese, Fox reports.

This poor diet could "put many on the road to heart disease," Fox writes.

And Kentucky's children, who rank eighth in the nation for child obesity, are likely walking down this road to poor health.

The Centers for Disease Control and Prevention 2013 State Indicator Report on Fruits and Vegetables found that only 50 percent of Kentucky adolescents reported eating fruit and 43 percent reported eating vegetables with a median intake of one time per day for both.

As for sugar-sweetened beverages, the 2013 Kentucky High School Youth Risk Behavior Survey found that in the seven days prior to the the survey: 33 percent of high school students drank a sugared soda one or more times a day; 25 percent drank a sugared soda two or more times per day; and 15 percent drank a sugared soda three or more times per day.

"It seems that children in the United States are losing their ideal cardiovascular health status," the researchers wrote, Fox reports. The study found about "40 percent of the kids already had poor to worrying cholesterol levels."

The main components of a healthy diet, according to the study, are: eating four and a half cups or more of fruits and vegetables each day; three servings of whole grains a day; two servings of fish a week; minimal amounts of sugar; and below 1,500 milligrams of sodium a day.

NBC has previously reported that many studies have found that children who have risk factors for heart disease show signs of clogged arteries that are typically found in middle-aged adults.

But another study found that that eating a diet high in fruits and vegetables, low in saturated fats and low on fatty meat "dramatically cuts the risk of heart disease and stroke," Fox writes.

Beshear cites signs toward better health: kids are more active and getting more dental care; adults are getting more screenings

Kentucky Health News

Kentucky is moving toward achieving the broad, ambitious goals for better health that Gov. Steve Beshear laid out when he started the "Kyhealthnow" initiative in February 2014, his office says.

"More Kentuckians have health insurance, are covered by smoke-free policy, can access physical activity resources, seek care for heart disease and cancer prevention, and get dental services" since the initiative began, Beshear said in a press release.

The program builds on federal health reform, which has made Medicaid or private insurance available to hundreds of thousands of Kentuckians, many of whom were previously uninsured and unable to afford health coverage. According to a Gallup Poll released in February, 9.8 percent of Kentucky’s population is uninsured, down from 20.4 percent in 2013.

Kyhealthnow targets seven major health goals to be met by 2019, focusing on increasing health insurance coverage; reducing the smoking rate and tobacco use; lowering the prevalence of obesity; lowering cancer deaths; reducing cardiovascular disease; treating and reducing dental decay; and reducing drug overdoses and mental health issues in Kentucky.

The report said more adults have been screened and identified as having high blood pressure and are able to control their hypertension, and more adults have had their cholesterol checked.

Significantly more children on Medicaid are being seen by dentists, and the number of children enrolled in Medicaid receiving two fluoride dental varnishes per year has increased. The state has given money to five health departments for dental-hygiene programs, and will fund five more this year. "These programs broaden access to hygiene services, such as cleanings, screening and referrals, by providing staff and resources to supply mobile units to deliver care in schools," the release said.

School districts are showing an increase in the amount of time devoted to physical activity, the state reports. The Comprehensive School Physical Activity Program has been implemented at proficient or distinguished levels at all grade levels in 515 of the state's 746 elementary schools, 186 of the 329 middle schools and 109 of the 228 high schools. Also, more schools report they are using body-mass index data to inform school wellness policy.

The state health department is using federal funds to implement physical activity and obesity-prevention curricula in early-childhood care centers. "The goal is to develop healthy habits in children before the age of 5 and prevent obesity," the news release says.

To increase physical activity and deter obesity among older children and adults, the state is establishing “trail towns.” Morehead and Olive Hill were recently certified by the state Office of Adventure Tourism and eight more are expected to be certified this year. The Dawkins Trail, an ongoing rail-to-trail project in Eastern Kentucky, has reached a length of 18 miles.

Diabetes management has improved among adults, and a study of Medicaid patients showed an overall decrease in those with poor diabetes control, the release said. State employees now have easier access to the nationally recognized Diabetes Prevention Program, which helps people who are at risk of developing diabetes reverse the onset of the disease.

Dr. Stephanie Mayfield, the state health commissioner and vice chair of Kyhealthnow, has emphasized the importance of reducing tobacco use to make Kentuckians healthier. Beshear has expanded the ban on tobacco products and e-cigarettes on executive branch properties, making Kentucky one of only five states in the country with such a policy. Smoking bans exist in 24 communities, 37 school districts and 51 college or university campuses.

Kyhealthnow, chaired by Lt. Gov. Crit Luallen, includes people from many areas of state government who develop innovative strategies for addressing the state’s health woes and challenge local governments, businesses, schools, nonprofits and individuals to take meaningful steps toward improving health in their communities, the release said.

Survey shows satisfaction with after-school programs aimed at helping children's health and physical fitness

Kentucky Health News

A household survey for the Afterschool Alliance shows that after-school programs may be key in preventing childhood obesity in Kentucky and across the nation. The "Kids on the Move: After-School Programs Promoting Healthy Eating and Physical Activity" survey showed parentswere generally satisfield with the programs, which are aimed at health and physical fitness.

The great majority of parents (78 percent in Kentucky and 72 percent nationally) report that after-school programs give their children snacks, drinks and/or meals, and 80 percent in Kentucky say that the sustenance provided is healthy. Eighty-six percent of Kentucky parents report that their child's afterschool program provides opportunities for physical activity. To see the rest of the statistics, click here.

"Afterschool programs are a proven, but sometimes underappreciated, weapon in the battle against childhood obesity and physical inactivity," said Afterschool Alliance Executive Director Jodi Grant.  "The healthy habits afterschool programs help instill can last a lifetime."

Key national findings from Kids on the Move:

• Older youth are less likely than younger children to attend an after-school program that offers food and less likely to be physically active in their program.
• Providing healthy food during after-school programs is especially important to low-income, African-American and Hispanic parents.
• Opportunities for physical activity are important to African-American, Hispanic and low-income parents.
• Many parents are unaware that standards for healthy eating and physical activity exist for afterschool programs. The Healthy Eating and Physical Activity Standards recommend best practices related to food and activity, including at least 30 minutes of morning or after-school program time for physical activity (60 minutes for a full day program).

Kids on the Move recommends that providers of afterschool programs make sure they are aware of policies that support such programs. Findings from America After 3PM show that in the last 10 years, afterschool program participation has risen from 6.5 million to 10.2 million, and 19.5 million parents said they would send their children to an afterschool program if one were available.

At least 14 counties had vaccination rates in 2011-12 below level experts say is needed to protect kindergartners from measles

As concern about the spread of measles from lack of vaccination grows, many Kentucky counties probably have vaccination rates below the minimum that experts say is needed to create "herd immunity" and prevent spread of the highly contagious disease among students in kindergarten.

At least 14 Kentucky counties had measles vaccination rates below 90 percent in the 2011-12 school year, according to state data analyzed by USA Today, in a survey of states that track vaccination rates and make them public. The Courier-Journal published the Kentucky figures in an online database.

The counties under 90 percent were Bath (89%), Boyle (83%), Bullitt (88%), Christian (89%), Harlan (88%), Jefferson (86%), Laurel (85%), Lawrence (88%), Lee (80%), Nelson (82%), Robertson (88%), Rowan (86%), Taylor (82%) and Webster (86%). Data from several counties was not available. For the database with county-by-county figures, click here.

The statewide vaccination rate was 93 percent, pulled down by a rate of 86 percent in Jefferson County, the state's most populous. The lowest rates were 80 percent in Lee County and 82 percent in Nelson and Taylor counties.

Jefferson County officials told The Courier-Journal that the county's rate rose above 90 percent in the last two to three years. Bullitt County school-health coordinator Lesa Bodine told the Louisville newspaper that her data show 94.3 percent of the county's kindergarten students "have been properly immunized," The C-J's Darla Carter reports. "However, she said there are some parents who choose not to immunize their children. She also noted that there can be a delay in receiving proof of vaccination because a child has, for example, transferred from another county or state."

Like many states, Kentucky allows parents to exempt their children from required vaccinations for medical or religious reasons. Measles outbreaks in other states have been blamed at least partly on parents who still believe discredited reports that vaccines cause autism or other disorders. Generally, the stricter the laws, the higher the vaccination rate, Stateline reports. Here's a Stateline map showing how states differ:

Ten-county Lake Cumberland District Health Department is the latest to ask schools to foot more of the bill for school nurses

The Lake Cumberland District Health Department told school districts in its 10-county area in December that it would no longer be able to pay for nurses for each school, setting off negotiations with the districts.

Somerset Independent Schools Supt. Boyd Randolph said one option would have the schools employ the nurses but contract them back to the health department in order to bill for the full extent of Medicaid services, Chris Harris reports for The Commonwealth-Journal.

Health Department Executive Director Shawn Crabtree told the Somerset newspaper that his agency was "running a deficit" because it wasn't being paid as much for treating Medicaid patients. 

Schools all over Kentucky have been faced with this "unfunded mandate," as Editor Stevie Lowery called it in an article for the The Lebanon Enterprise. If a student requires medical care in order to attend school, state law requires school districts to provide the care, but doesn't necessarily provide a way to pay for it.

The dwindling number of school nurses last year prompted a new law to allow school personnel who aren't licensed health care professionals to administer or help a student self-administer insulin and otherwise treat diabetes symptoms if they take certain training.

Surrounding Somerset, each school in the Pulaski County School District has its own in-house nurse, as does every school in the regional health department's coverage area, with the cost shared by the school system and the health department, Harris reports. Asst. Supt. Sonya Wilds told the Commonwealth Journal last month that the schools pay approximately $20,000 per nurse.

The department has proposed that the schools pay the full cost of employing 12 nurses, which will fall "in the neighborhood" of $750,000, about three times what they pay now, Supt. Steve Butcher told Harris. “Of course, we would receive money back from the health department on Medicaid claims, but . . . it’s hard for me to wrap my head around how much that would be worth to us,” he said.

As school officials consider all of their options, they are also looking at the individual needs of schools, with the understanding that these needs constantly change and are like a "moving target."

“We’ve got some schools that have kids with feeding tubes, and some schools that are heavy on [students with] diabetes,” Butcher told Harris. “It’s not necessarily bigger schools that have more issues, it’s just schools have specific kids that have got needs that we can’t do anything about and need additional help."

Scheduling lunch after recess, very unusual in elementaries, may lead to less food waste and better nutrition, study says

Scheduling school lunch later in the day could help children to eat more nutritious foods and reduce food waste, according to a study at seven schools in Utah. Researchers found that children threw away more food when they ate lunch before recess instead of afterward, and much of the food they threw away was fruits and vegetables, Roberto A. Ferdman writes for The Washington Post.

Cornell University and Brigham Young University researchers spent 14 days studying the behavior of children during lunch. Three schools served lunch after recess, and the other four before recess. The researchers kept track of how many fruits and vegetables children discarded and how many they ate.

"Students who ate lunch after recess ate 54 percent more fruits and vegetables than those who ate it before," Ferdman reports. The number of students who ate at least one serving of fruit and vegetables was 45 percent greater at the schools that served lunch after recess than the schools who served it beforehand. This is because students are hungrier for lunch after playing, and if they have already had recess, they will not rush eating their lunch so they can go play.

"If recess is held before lunch, students come to lunch with healthy appetites and less urgency and are more likely to eat their fruits and vegetables," David Just, one of the study's authors, told Ferdman.

A 2014 study also concluded, for about the same reasons, that providing lunch before recess leads to more food waste. It is unknown how many schools currently serve lunch before recess, but in 2011, only 4.6 percent of elementary schools reported serving lunch after recess. (Read more)

Foundation for a Healthy Kentucky lists 2014 grants

The Foundation for a Healthy Kentucky has provided more than $1.3 million in 2014 for community programs, polling and policy initiatives to not only advise policymakers but also advocate for better health and health care across the state.

"Our strategies to address the unmet health care needs of Kentuckians are built on investment at the local and state levels," Susan Zepeda, president and CEO of the foundation, said in a news release.

The foundation said it donated $125,000 to Kentucky Voices for Health, a coalition of lobbying groups that support health reform; $50,000 to Kentucky Youth Advocates, an organization dedicated to the improvement of public policies that influence the lives of children and families and $60,000 to the University of Cincinnati for the 2013 Kentucky Health Issues Poll.

As part of a 2012-17 strategic plan to help school-aged children grow up to be healthier than their parents, the foundation provided three grantees money to set in motion the business plans they developed. Recipients included: Clinton County School District ($158,361), Fitness for Life Around Grant County ($182,033) and Louisville Metro Department of Public Health and Wellness ($161,850). The foundation also funds a multi-year study of Kentucky's transition to managed-vcare Medicaid.

The foundation matched a $3 million federal investment to begin nurse-managed clinics, telemedicine, mobile health services, care navigation and and an activities center. These projects "have improved the quality of life for more than 20,000 Kentuckians and provided training for more than 250 providers," according to the release.

To support the improvement of health literacy in Kentucky, the foundation invested $100,000 in health programming on KET, and $25,000 with the Institute for Rural Journalism and Community Issues at the University of Kentucky , mainly for the publication of Kentucky Health News.

Study finds students with heavy fast-food diets have test scores about 20% lower than those who don't east fast food

Eating fast food may cause lower test scores in school, says a recent study of U.S. school children.

The study, published online in the journal Clinical Pediatrics, found that "The more frequently children reported eating fast food in fifth grade, the lower their growth in reading, math and science test scores by the time they reached eighth grade," says an Ohio State University news release.

Specifically, the study found that children who ate fast food four to six times per week, or every day, had test-score gains in all three achievement areas that were about 20 percent less than those of children who did not eat any fast food in the week before the survey.

“There’s a lot of evidence that fast-food consumption is linked to childhood obesity, but the problems don’t end there,” said Kelly Purtell, lead author of the study and assistant professor of human sciences at Ohio State. “Relying too much on fast food could hurt how well children do in the classroom.”

The study included 11,740 students who were tested in reading/literacy, mathematics and science in both fifth and eighth grades. They were also given a food consumption questionnaire in fifth grade.

The researchers tried to accounted for many other reasons that might have influenced the results, including how much children exercised, how much television they watched, what other foods they ate, their family’s socioeconomic status, and characteristics of their neighborhood and school, according to the release.

While this study establishes a correlation between fast-food consumption and lower grades, it does not establish the cause of lower grades. However, Purtell said she and the other authors are "confident fast food explains some of the difference in achievement gains over time."

Other studies have suggested that it may be related to a lack of nutrients found in fast food, such as iron, and another study suggests that diets high in fat and sugar, found in most fast food, hurt immediate memory and learning processes, the news release says.

“We’re not saying that parents should never feed their children fast food, but these results suggest fast-food consumption should be limited as much as possible,” Purtell said.

Spending bill allows schools that show 'hardship' to vary from requirement to serve 100 percent whole grains

By Melissa Patrick
Kentucky Health News

The massive 2015 spending bill signed by President Obama Dec. 16 includes a provision to help schools struggling with the whole-grain and sodium requirements that are part of the Healthy, Hungry-Free Kids Act. It did not allow, as House Republicans had hoped, schools to opt out of the healthier school meal standards if they lost money on meal programs over a six-month period.

Beginning with the 2014 school year, schools had to serve 100 percent whole grains in their meals and snacks, and also follow the first restrictions on sodium, or salt. The sodium restrictions were scheduled to get progressively stricter over the years, with the next move set for 2017.

The law allows schools that demonstrate the rule is a "hardship" to continue serving 50 percent whole grains. It also says sodium standards cannot be tightened until the "latest scientific research establishes the reduction is beneficial for children," Mary Clare Jalonick reports for The Associated Press.

Some schools say they have had trouble complying with these requirements because many of the affordable whole grain pastas have proven difficult to cook en masse and the whole-grain versions of many foods, like biscuits and tortillas, simply don't taste the same.

On salt, schools say budgeting the allowed amounts among meals, snacks and a la carte items is often a challenge. The issue hit Anderson County schools earlier this year when they couldn't find a low-sodium ketchup; their solution was to not offer ketchup. Parent and student complaints prompted a reversal of that move, but to do that, sodium had to be removed elsewhere in the menu.

The new law won't have much effect on Fayette County Schools, Director of School Nutrition Michelle Coker said in a telephone interview. "Basically, we use 100 percent whole grains in everything," she said. "But there are products, like tortilla shells, that aren't as flavorful and this gives us some flexibility."

Fayette County has transitioned slowly to whole grains over the last five to six years to help students adjust to them, Coker said, and as whole-grain products have become "tastier" the transition has not been an issue.

"Whole grain pasta products have come a long way," Coker said. "Three to four years ago they were dark, but now it is difficult to tell the difference. Kentucky has really good vendors."

Coker, a registered dietitian, welcomed the possible delay in lower salt limits, saying most students are active and involved in sports and shouldn't need such low sodium restrictions. "These kids are growing and need electrolytes," she said.

The School Nutrition Association, a group that represents both school nutrition directors and the food companies that produce foods for schools, wanted even deeper rollbacks than the spending bill included, but said it "strongly supports" the budget-bill language.

Alabama Rep. Robert Aderholt, chairman of the House subcommittee that oversees nutrition issues, said the whole-grains waiver is "the best bill that we are going to get" as long as Democrats are in control the Senate, Jalonick reports.

Republicans will control both houses of Congress next year, so the battle is far from over, and the overall law governing child nutrition policy, including school lunches, expires next year and will require legislation to be renewed, Jalonick notes.

First Lady Michelle Obama, champion for improving school's nutrition and decreasing child obesity, said this summer that she would fight "to the bitter end" to make sure kids have good nutrition in schools.

New partnership will provide children in Kentucky with a home for medical and dental care

Community Dental of Kentcky and the University of Louisville Pediatrics are partnering to provide Kentucky children in the Medicaid program with a medical, dental health care home through co-located facilities, says a press release from Gov. Steve Beshear's office.

“One of the most effective ways to combat chronic health conditions is to identify potential problems early and address them," Beshear said in the release. "This means ensuring that our children have easy access to the health care they need and deserve. This partnership seeks to meet that need, not just medical care, but also dental care. Through the creation of a health home for children, we believe we will be able to reverse some of the major health problems facing Kentucky.”

 Community Dental, an Alabama-based non-profit with a clinic in Louisville, is a full-service dental organization that provides health care in underserved communities with the goal of improving the overall health of the population, says the release. 

 “We are honored to partner with the Commonwealth and the University of Louisville,” Jeffrey Parker, chairman of Community Dental of Kentucky, said in the release. “Gov. Beshear has created the environment for preventive care as a major tool for combating the health care problems faced by the people in the state.”

Millions of children on Medicaid are missing free check-ups; Kentucky is a little below the national average

Millions of low-income children across the country aren't getting free preventive exams and screenings guaranteed by Medicaid, and some experts say federal and state health officials aren't doing enough to fix the problem, according to a federal watchdog report.

The report from the Department of Health and Human Services’ Office of Inspector General says that while the Obama administration has boosted rates of participation for children getting regular wellness exams, dental checkups and vision and hearing tests, it needs to do more.

The report says that 63 percent of children on Medicaid received at least one medical screening in 2013, up from 56 percent in 2006, but most states are still falling short of the department’s 80 percent goal. Only Iowa and California met that participation rate goal last year.

In Kentucky, 57 percent of the 381,231 children covered by Medicaid who should have received at least one annual screening exam did so. Most states require at least one annual exam, and more frequent exams for infants. The reports shows that Kentucky's rate is better than 20 other states and equal to the rates in North Carolina, Rhode Island and Florida.

Some experts say state officials bear most of the responsibility for the low rates because they run Medicaid, the state-federal program for the poor, reports Phil Galewitz of Kaiser Health News. The OIG reports says the federal administration should be doing more to encourage states to address the problem.

"Child health advocates cite several factors for the low completion rates, including a shortage of doctors treating Medicaid patients, states’ low pay for providers and parents’ lack of awareness about the importance of the visits," writes Galewitz.

Congress introduced the Medicaid benefit, known as the Early and Periodic Screening, Diagnosis and Treatment program in 1967. In Kentucky, the EPSDT benefit includes screenings and special services, according to the Cabinet for Health and Human Services. Preventive care, such as routine physicals or well-child check ups, is provided under the screenings program.

Last year, 514,298 children were eligible for Kentucky’s EPSDT, says the the cabinet's annual participation report. Based on that number and eligibility periods, about 507,000 screenings were expected, but only 391,079 were, for a ratio of 83%. Additionally, the report says 236,830 children received dental services of any kind, with 208,783 receiving preventive services.

Some states require Medicaid health plans to educate members about the EPSDT benefit and what it covers. Others have implemented incentive plans that offer gift certificates for screenings. According to the National Academy for State Health Policy, Kentucky requires Medicaid managed-care organizations to provide an EPSDT coordinator to coordinate case-management services and continuity of care. Click here for more information about EPSDT screenings in Kentucky.

Laundry detergent pods are sending hundreds of small children to the hospital every year; better to use traditional detergent

Laundry detergent pods, a convenience product that can be tossed into washing machines without having to measure out a liquid or powder, caused more than 700 children to be hospitalized in 2012-2013, with one confirmed death, according to a new study from Nationwide Children’s Hospital.

Photo: University of Virginia Health System

The study, published online in the journal Pediatrics, evaluated U.S. poison-control data from 2012 to 2013 and found 17,230 reports of children younger than six who had been injured from the laundry pods. That is nearly one child every hour, says the news release.

Two-thirds of the cases were one- and two year-olds, with most of the exposures reported due to ingestion.

Because the pods are usually brightly colored, young children, who naturally explore their environments orally, put them in their mouths. The water-soluble covering on the pods is easily penetrated, allowing the concentrated detergent to be ingested.

"Laundry detergent pods are small, colorful, and may look like candy or juice to a young child,” Marcel J. Casavant, co-author of the study, said in the release. “It can take just a few seconds for children to grab them, break them open, and swallow the toxic chemicals they contain, or get the chemicals in their eyes.”

While some manufacturers of laundry detergent pods have changed packaging to make pods less attractive to children, many have not.

“It is not clear that any laundry detergent pods currently available are truly child resistant; a national safety standard is needed to make sure that all pod makers adopt safer packaging and labeling,” said Gary Smith, the study’s senior author. “Parents of young children should use traditional detergent instead of detergent pods.”

Parents and child caregivers can help children stay safe by following these tips:

• Use traditional laundry detergent, it is less toxic than the pods.
• Store laundry detergent pods up, away and out of sight - preferably in a locked cabinet.
• Close laundry detergent pod packages or containers and put away immediately after use.
• Put the national Poison Help Line number (1-800-222-1222) in your cell phone and post it near your home phones.