Centers for Disease Control working to find ways to prevent traumatic brain injury; affects one in five Kentucky households

The federal Centers for Disease Control and Prevention is using a public-health approach to find strategies to prevent traumatic brain injuries and reduce the physical, psychological, economic and social impacts they cause.

Image: brainline.org

Traumatic brain injuries are those that happen because of a blow or jolt to the head, like a fall or a motor vehicle accident. It contributes to 30 percent of all injury deaths in the U.S., killing 138 people every day, according to the CDC.

Nationwide, the most common cause of brain injury is falls, but in Kentucky, most brain injuries and brain-injury-related deaths are caused by traffic accidents. About 5 percent of Kentucky's population has a brain injury, which is double the nation-wide rate, affecting one if five Kentucky households,  according to the Brain Injury Alliance of Kentucky.

Survivors of serious brain injuries have a range of disabilities, from memory issues, personality changes to debilitating physical disabilities, having a lasting effect on families and communities.

In partnership with the traumatic brain injury and rehabilitation communities, the CDC, using research, is working to meet these goals and results of this research can be found in a special issue of the Journal of Head Trauma Rehabilitation.

One article looks at the problems of unemployment after traumatic brain injury, with data showing that 60 percent of patients who received inpatient rehabilitation for TBI are still unemployed after two years of discharge -- and 35 percent of those who were employed two years after injury were employed only part-time. In Kentucky, 45 percent of those with brain injury reported a loss of employment or educational opportunity because of their injury.

Another article focuses on motorcycle crashes as a cause of TBI and says, "People injured in motorcycle crashes use more health-care resources and are three times more likely to die in the emergency department, compared to those with other causes of TBI." Kentucky had 6,552 hospital visits in 2013 for TBI caused by motor vehicle crash and of these 419 were motorcycle related, according to the Brain Injury Alliance. Kentucky no longer has a law requiring motorcyclists to wear helmets.

Other articles look at the high impact of sports- and recreation-related TBIs, reporting that "About 7 percent of all emergency department visits for sports- and recreation-related injuries are TBIs, with at least 3.4 million sports- and recreation-related TBI emergency department visits occurring over a 12-year study period." Kentucky hospitals had 2,600 TBIs in 2013 related to sports and recreation injury, according to the alliance.

CDC says SOAR should focus on substance abuse, obesity and diabetes; idea of mountaintop mining study is largely ignored

By Melissa Patrick
Kentucky Health News

Shaping Our Appalachian Region, the bipartisan effort to revitalize and diversify Eastern Kentucky's economy, will focus its health efforts on substance abuse, obesity and diabetes, SOAR Executive Director Jared Arnett told Kentucky Health News.

"We believe they have the greatest impact on our ability to create jobs and build a world class workforce," Arnett said in an email. He said David Roberts of the federal Centers for Disease Control and Prevention, determined the priorities after spending three months at the SOAR office in Pikeville.

The priorities differ from those put forth by SOAR's Health Working Group, which made two major recommendations after a series of public forums: a coordinated health program in schools, and a study of the health effects of large-scale surface mining. However, when SOAR published the working groups' ideas a few weeks later, it listed only the "shortest-term recommendations" and did not include the mining study. No recommendations appear on the health group's webpage.

At the health session of SOAR's "Strategy Summit" May 11, Dee Davis of the Whitesburg-based Center for Rural Strategies asked the moderator/presenter, Jennifer "Jenna" Seymour of the CDC, what if anything was being done about the recommendation. Seymour replied that she wasn't aware of it, Al Cross reported for the Appalachian Kentucky page of The Rural Blog.  

"That dismayed me," Cross writes. Later, upon raising his hand and being recognized by Seymour, he told her and the audience that it was "disconcerting and almost unbelievable" that she was unaware of the recommendation about mountaintop mining. Seymour replied that she had, in fact, heard about it.

Cross wrote, "Noting that the Pike County Fiscal Court Room was nearly full, I told Seymour that a lot of people had attended meetings and made their concerns known, and that even though this issue was "a hot potato," because of the coal industry's role, she needed to "go back to the powers that be, and tell them there's a room full of people who want answers."

Cross wrote that he was not for or against a study on the health effects of mountaintop mining, and " Unless they're writing opinion pieces, journalists aren't supposed to take sides," he wrote. "But they do need to speak up when issues of broad community concern aren't being addressed, especially when those concerns have been solicited."

The SOAR working groups concluded their meetings last summer and submitted their final reports. Since then, the SOAR executive board has decided to launch a SOAR Advisory Council and hold annual roundtables, or more as needed. They have made a request for a community health representative to be appointed to serve on this council, and Arnett said he expects this person to be appointed by June 1 or so. 

In addition, a follow-up CDC representative will be assigned to the SOAR office for one year beginning in late summer to help put together a strategic plan to address the three areas of focus recommended by the CDC at the summit. This person will also lead a Community Health Action Team for SOAR to work on building a blueprint for improved public health in the region, Arnett said.

"We are focused on working with our corporate partners and the Community Health roundtable to address these issues identified by the CDC on what can have the broadest reach and the greatest impact," Arnett said. A full report of all of the CDCs recommendations is expected in the near future, he said.

Kentucky 's spending of tobacco settlement on tobacco-prevention programs fall far short of what CDC recommends

Kentucky ranks 39th in the country in funding programs that prevent kids from smoking and help smokers quit, according to a national report from a coalition of public-health organizations.

Kentucky ranks sixth in high-school smoking in the 2013 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System report, with 17.9 percent of high schoolers reporting they smoke cigarettes. Nationwide, the rate is 15.7 percent. The report challenges states to get their rates as low as Florida's 7.5 percent.

"If Kentucky reduced its high school smoking rate from 17.9 percent to 7.5 percent, it would prevent 148,150 kids from becoming adult smokers, saving 52,290 lives and $2.6 billion in future health care costs," the Campaign for Tobacco-Free Kids says in a press release.

The campaign says it's not that the state lacks the money to spend on such programs.

"Kentucky will collect $347.3 million in revenue this year from the 1998 tobacco settlement and tobacco taxes but will spend only 0.7 percent of the money on tobacco-prevention programs," says the release. "Kentucky spends $2.5 million per year on tobacco prevention and cessation programs, which is 4.4 percent of the $56.4 million recommended by the Centers for Disease Control and Prevention."

Soon after the settlement, the Kentucky General Assembly decided to spend half the settlement on diversifying and improving the state's agricultural economy, with the rest going to health, early-childhood development and other programs. The legislature later began using the fund for water and sewer projects in rural areas.

Kentucky is not alone in scrimping on such programs. Collectively, states have budgeted just 14.8 percent of the $3.3 billion the CDC recommends. States will collect $25.6 billion this year from the tobacco settlement and tobacco taxes but will spend only 1.9 percent of it ($490.4 million) on tobacco prevention programs, the campaign says.

Meanwhile, kids get plenty of tobacco-company marketing enticing them to smoke. "Tobacco companies spend $271.1 million per year to market their products in Kentucky – 109 times what the state spends on tobacco prevention," says the release.

The campaign says tobacco annually claims 8,900 Kentucky lives and costs the state $1.9 billion in health care bills. "Right now, Kentucky is also putting its children at risk and costing taxpayers money by failing to properly fund tobacco prevention efforts that are proven to save lives and health care dollars," says Matthew Myers, president of the campaign for Tobacco-Free Kids. "We need elected leaders in Kentucky to enact a comprehensive smoke-free law and increase funding for proven tobacco-prevention programs,"

The report is titled "Broken Promises to Our Children: A State-by-State Look at the 1998 State Tobacco Settlement 16 Years Later." It was also released by 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.

CDC sending full-time senior staffer to E. Ky. to help health departments tackle the region's chronic, serious health problems

The federal Centers for Disease Control and Prevention will place a full-time employee in Eastern Kentucky to help public health departments battle the region's serious, chronic health problems, the area's congressman said Tuesday.

Republican Rep. Harold "Hal" Rogers of Somerset, chair of the House Appropriations Committee, said CDC Director Dr. Thomas Frieden, who spent three days with him in his Fifth Congressional District last month, told him he would assign a senior staffer to the job.

Beshear, Rogers (Melissa Newman photo)

Rogers made the announcement at a meeting of the executive committee of Shaping Our Appalachian Region, the economic-development effort he started with Democratic Gov. Steve Beshear. In a meeting at Natural Bridge State Resort Park, the panel heard reports from chairs of SOAR's working groups, which held "listening sessions" around the region this summer.

The Health Working Group "recommended pushing a statewide ban on smoking indoors in public; asking the Centers for Disease Control and Prevention to study poor health in the region and the emerging research on a correlation between mountaintop mining and health problems," Bill Estep reports for the Lexington Herald-Leader.

The working group's PowerPoint slide said, "Invite the CDC to form a task force to accurately map the current state of health in Eastern Kentucky and to create a strategic health plan for the region; start the 'Healthy 5 for the 5th' campaign for individual health in an effort to promote wellness in the region; explore Coordinated School Health programs for our entire region; ramp up oral-health efforts to encourage school-based oral health services are underway in every school district in the region."

Kentucky ranks No. 4 in painkiller prescriptions; neighboring states are first, second and third

Powerful painkillers are a contributing factor in the the rising rate of overdose deaths in the U.S., especially in Kentucky, where officials have recommended more measures be taken to monitor painkiller prescriptions. Now the government is pointing out the states whose doctors write the most prescriptions, and Kentucky ranks fourth, Mike Stobbe reports for The Associated Press.

The reports are part of the federal Centers for Disease Control and Prevention's campaign to prevent deaths from prescription opioids such as Vicodin and OxyContin. Drug overdose deaths reached 41,000 in 2011, and 41 percent of them had to do with prescription painkillers. "The state account comes from a database of U.S. retail pharmacies that fill the bulk of prescriptions," Stobbe writes.

In 2012, Southern states led the list. Kentucky ranked behind Alabama, which had 143 prescriptions for every 100 people; Tennessee, and West Virginia. Southern doctors also prescribed the most antibiotics and stimulants for children. Although chronic disease rates are often higher in the South, research has shown that doesn't explain the disparity.

"Prescriptions go up; deaths go up. Prescriptions go down; deaths go down," said CDC director Dr. Tom Frieden. However, evidence to confirm the connection is lacking. The CDC keeps track of death rates but combines all drug overdoses, including heroin and cocaine. Those rankings are not the same as the prescription list. "But officials cite studies that show higher overdose rates when there are more prescriptions of painkillers and larger doses prescribed," Stobbe writes.

To help fix the problem, officials suggest more prescription drug monitoring programs at the state level and laws to stop "pill mills," which are offices and clinics that prescribe too many addictive medicines. In Florida, pill mills became a big issue in the last 10 years, but from 2010-2011, the state set up stricter pain clinic regulations, and police did some raids. "By 2012, prescriptions for oxycodone alone fell 24 percent, and the death rate for prescription drug overdoses dropped 23 percent," Stobbe writes. (Read more)