A leading authority on bullying in schools offers ideas for recognizing, preventing and dealing with it

By Melissa Landon
Institute for Rural Journalism and Community Issues

How do we recognize, deal with and prevent bullying, particularly in schools? A leading authority on bullying offered some ideas June 12 in a University of Kentucky training session called "The Meanest Generation: Teaching Civility, Empathy, Kindness and Compassion to our Angriest Children," at Eastern State Hospital in Lexington.

Malcolm Smith, right, between sessions

Malcolm Smith, founder and director of the Courage to Care Project who serves on the faculty of Plymouth State University, said one myth about bullying is that it only occurs in large schools. "Actually, I'm more worried about children in a rural school," Smith said. In rural areas, he said, bullying can be a huge problem because there's nowhere to hide, everyone is often into everyone else's business, and an issue can escalate into a feud when families get involved.

Smith defined bullying as a single incident or pattern of written, verbal, electronic or physical actions intended to harm a pupil or his or her property; cause emotional stress; interfere with that student's right to an education; or disrupt the school's operation. Smith debunked a common theory about bullying that became popular in the 1980s—that bullies lack self-esteem. "Bullies are not kids who have low-self-esteem," Smith said. "The average bully is the kid who is a narcissist." Smith believes that a person becomes narcissistic if he or she never learned to bond and love as a child.

He argued that a lack of empathy and rising narcissism—which is characterized by an overinflated view of one's talents and a high level of selfishness—are the true causes of bullying. Empathy is the tendency to react to other people's observed experiences. Research shows that 70 percent of current students score higher in narcissism and lower in empathy than they did 35 years ago. Smith believes this is related to the rise in technology, the culture of self-esteem, the decline of time spent playing—which is often when children gain social competencies—and the overexposure of children to meanness and violence through the media.

Bullies are more likely to have been involved in domestic violence and child abuse; are more likely to commit crimes, drink and smoke; and have a greater propensity toward becoming anti-social adults. Signs that a child is a victim of a bully include exclusion, fear, lack of friends, erratic attendance, depression, withdrawal or clinging to teachers and staff.

Because bullying is characterized by an imbalance of power between the perpetrator and the victim, Smith urged school counselors and teachers not to try mediating a bullying situation, especially not by talking to both the victim and the bully in the same room or worse, leaving them to "work it out." Smith said, "You have to educate the social-emotional deficit in the bully, and you have to comfort the victim." Instead of simply punishing the bully, an authority must discipline him or her, which involves teaching.

To properly discipline a bully, he or she must be required to take responsibility for the behavior and explain to the authority why the behavior was wrong. Then the student must discuss alternative actions that could have been employed. Finally, the student must not only apologize but also perform an act of kindness toward the student he or she bullied.

Smith urged teachers and counselors to recognize and address bullying, explaining that it is not ever a good thing or a positive part of a growing experience, as some people think. He pointed out that adults in the workplace are protected by harassment laws and don't have to face bullying alone, so children shouldn't have to, either. He said to combat bullying, "model good social skills yourself, advocate for safer schools and better laws, work with your school parent-teacher organization, engage parents and students in prevention and work on culture and climate."

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."

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.)

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.

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:

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)

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.

#ThanksMichelleObama: Students use social media to voice their unhappiness with revamped school lunches

School kids around the country are tweeting pictures of their unappetizing school lunches and blaming the most prominent advocate for healthier school meals for their "bowls of mush and mystery proteins," Roberto A. Ferdman reports for The Washington Post.

The tweets use the hashtag #ThanksMichelleObama, which dates back to 2012. They were "being sent out at a rate of 40 per minute last week, but started to gain momentum some 10 days back," Ferdman writes.

The tweets and pictures vary, with some presenting a "mealy substance" or mystery food that is supposed to pass for the entree while others poke fun at how pitiful the presentation is.

"We've seen the photos being tweeted," said Sam Kass, executive director of Let's Move!, the organization Obama founded to fight childhood obesity. "But we don't dictate the food that schools serve—school districts do." He added, "We’ve seen thousands of examples of healthy, delicious school lunches that meet the new standards being made across the country by talented school chefs."

Obama has been a key player in the implementation of the new health standards in schools, which mandate an increase in fruits, vegetables and whole grains and place restrictions on calories,sodium, sugar and fat served in a school day. These restrictions were also added to snacks and beverages this year.

Several studies have reported great success with these new requirements. In Virginia, a recent study found that school lunches were "significantly healthier" than home packed lunches and a study in Massachusetts concluded the same thing.

But others say that this healthy food is not being eaten, but instead thrown away. A Harvard School of Public Health study in Massachusetts supports this conclusion, finding that "some 60 percent of vegetables and 40 percent of fresh fruit are thrown away (for good measure, even more vegetables—some 75 percent—were thrown out before the USDA school meal standards went into effect)," Ferdman reports.

Complaining about cafeteria food in certainly not a new phenomena, what is new is that "everyone has a camera on their phone and a public platform to share pictures," Ferdman writes.

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.

Early-childhood specialists want to help parents teach kids good oral-health habits; 40 percent have cavities by kindergarten

A recent report by the American Academy of Pediatric Dentistry showed that cavities are the most chronic disease for young children in the U.S. More than 40 percent of children suffer from tooth decay before kindergarten, Greg Stotelmyer reports for Public News Service. Groups of early-childhood professionals gathered in Louisville Thursday to learn how to educate parents to help improve their children's oral health.

Dr. Laura Hancock Jones, an outreach dentist with the University of Kentucky, emphasized the importance of teaching children how to brush their teeth and avoid too many sugary drinks before they turn 2. "We really need to foster the oral-health knowledge of those parents and not really delay that until [their children] are into preschool or elementary population," she said.

Molly Oliver, who runs a day-care center for the Trigg County school system, is one of those learning how to teach parents how to foster good health habits in their children. "We want to help build a relationship with our parents to try to help the parents and the children have better oral health for their families," she said.

Jones noted that food and beverage companies' marketing is making it harder for parents to steer their children away from unhealthy products. Parents need to make sure their children are brushing their teeth both morning and night. "And, for parents to understand that until their child is in second grade, they don't have the dexterity to get the job done themselves," she said. "You know, it's not enough for a parent to say, 'Hey, go brush your teeth,' when you're dealing with a 3-year-old. They still need to be in there doing the work themselves."

The Kentucky Oral Health Coalition is partnering with the UCLA Health Care Institute and the Governor's Office of Early Childhood to offer $1,000 grants to train early childhood professionals in 10 communities, Stotelmyer reports. The trainers will strive to provide children with the support of adults—both parents and child care professionals—who can help them understand how to maintain good oral health. (Read more)

Raw milk suspected as cause of bacterial infections among four children in Hardin County and one in Oldham County

Five children in the Louisville region were recently hospitalized with E. coli bacterial infections, and all had consumed unpasteurized milk, state health agencies found. Investigators have not yet proven that raw milk caused the infections, but "found raw milk was the only common factor among the sick children," Forrest Berkshire reports for The Kentucky Standard in Bardstown and The News-Enterprise of Elizabethtown.

Four of the children are from Hardin County, and one is from Oldham. All went to a hospital to be treated for complications of E. coli, which attacked their red blood cells and affected their kidneys. The Lincoln Trail District Health Department said tests of milk from the suspected dairy and distributors were negative for E. coli, a bacterium common to the intestinal tracts of mammals.

"Pasteurization is the process of heating a liquid such as milk to a high enough temperature to destroy disease-causing microorganisms," Berkshire explains. "It also increases the shelf life of milk by destroying spoilage microorganisms and enzymes."

The state Department for Public Health said, "DPH is stressing the dangers of unpasteurized milk after learning all the affected children had consumed it and because it is a known source of E. coli bacteria, as well as numerous other pathogens that can lead to illness."

Selling raw milk is illegal in Kentucky, but is available through a "herd share," which allows members to buy an interest in a cow that allows them to take the milk home. "Northern Kentucky U.S. Rep. Thomas Massie, a Republican, introduced two bills earlier this year he characterized as 'milk freedom legislation' and would strip the U.S. Food and Drug Administration of its authority to police raw milk sales," Berkshire writes. Supporters of raw milk say it helps people resist disease and promotes better growth, stronger teeth and better behavior.

However, the federal Centers for Disease Control and Prevention conducted a study over a decade that found "the risk of outbreaks caused by raw milk is at least 150 times greater than the risk of outbreaks caused by pasteurized milk," Berkshire reports.

Kentucky law requires milk must be pasteurized, and officials encourage buyers to check labels to make sure it is, and throw it out if pasteurization cannot be confirmed. "Even negative tests do not guarantee that raw milk is safe to drink," the CDC says on its "Raw Milk Questions and Answers" webpage. "People have become very sick from drinking raw milk that came from farms that regularly tested their milk for bacteria and whose owners were sure that their milk was safe." (Read more)

Lots of research has established that children with egg allergies can still get a flu shot; those with asthma especially should

Flu season can start as early as October, and  children with egg allergies are now encouraged to get a flu shot, especially if they have asthma, according to a news release from the American College of Allergy, Asthma and Immunology.

Children with egg allergies may have been told in the past to not get a flu shot because of a possible reaction to trace amounts of eggs in which the vaccine is produced, but recent research now says that the vaccine is safe for these kids.

“We now know administration is safe, and children with egg allergies should be vaccinated,” Michael Foggs, president of the American College of Allergy, Asthma and Immunology, said in the news release. “We recommend that, as with any vaccine, all personnel and facilities administering flu shots have procedures in place for the rare instance of anaphylaxis, a life-threatening allergic reaction.”

The release says "a large number of research studies published over the last several years have shown that thousands of egg-allergic children, including those with a severe life-threatening reaction to eating eggs, have received injectable influenza vaccine as a single dose without a reaction."

More than 21,100 children under the age of five are hospitalized annually because of the flu, with only 55 percent of children ages 5-17 getting a flu shot, according to the Centers for Disease Control and Prevention, says the release.

Foggs especially recommended that children with asthma get the vaccine, because even though they are not more likely to get the flu, it can be more serious for those with asthma, says the release.

"Children with asthma really need to get the flu vaccine," Foggs said in the release. “Asthma sufferers are among the most vulnerable because the flu compromises their airways even further than they already are.”

Chickenpox outbreak reported at Crab Orchard

Five students at Crab Orchard Elementary School in Lincoln County have been diagnosed with chickenpox, putting the county school system on alert, Ben Kleppinger reports for The Interior Journal in Stanford. Eva Stone, the schools' health coordinator, told the newspaper that the students had been diagnosed with by at least four health-care providers, and an unknown number of siblings under school age have also been diagnosed.

"A letter was sent home to Crab Orchard parents earlier this week, notifying them of the diagnoses and informing them on how to identify the symptoms," Kleppinger reports. "The letter encouraged parents to make sure their children are vaccinated against chickenpox and warned that people with chickenpox should avoid contact with others who have not had the illness or the vaccination. The chickenpox vaccination is about 80-85 percent effective after one dose, so a second vaccination is routinely recommended, according to the letter."

Kids Count report says hard times in early childhood are more likely in Ky. than rest of U.S.; bad times have long-term effects

By Melissa Patrick
Kentucky Health News

One of every five children in Kentucky, by the time they are 5 years old, has experienced two or more adverse childhood experiences such as child abuse, economic hardship, exposure to violence, living in a household with mental illness or substance abuse, or where a family member has been incarcerated.

That is one of the major points of the 24th annual Kids Count report, released Tuesday by Kentucky Youth Advocates. The report is part of a state-by-state effort with county-by-county data; nationally, only one in eight children by age 5 have had two adverse experiences, defined as events or circumstances that can affect the quality of the child's adult life, including their health and length of life.

"The higher the total number of these events a child experiences, the higher the risk of obesity, chronic illness, substance abuse, smoking and mental health problems," the report says. Another study cited in the report found that "Children who had experienced four or more adverse events had lower incomes, lower education attainment and lost more days of work or school as adults due to problems with physical or mental health."

“We know when children experience traumatic events such as abuse and neglect or having an incarcerated parent, it negatively impacts their health and often causes barriers to success later in life. Kentucky leaders need to enact solutions to prevent these experiences in the first place and when they do happen, help children successfully recover,” Dr. Terry Brooks, executive director of Kentucky Youth Advocates, said in a press release.

This report by Kentucky Youth Advocates measures 16 indicators to determine the overall well-being of children in Kentucky counties and focuses on four areas considered critical to well-being: economic security, education, health, and family and community strength.

The Kentucky counties with the highest overall child well-being rankings are Oldham, Boone, Spencer, Woodford, and Calloway; the lowest are Martin, Owsley, Wolfe, Clay and Elliott.

Overall Child Well-Being, based on four factors:
economic security, education, health, and family and community.

The 2011-12 survey said that Kentucky children are more likely to experience two or more adverse events  (30 percent) than children are nationally (22.6 percent). The four most common adverse events among Kentucky's children, says the report, are economic hardship, living with a parent or guardian who got divorced or separated, living with anyone who had a problem with alcohol or drugs, and living with a parent or guardian who was incarcerated.

This study evaluated four indicators of health: smoking during pregnancy, low-birthweight babies, children and young adults without health insurance and teen births.  Oldham and Boone counties scored higher than the other counties on health and Elliott County ranked last.

Overall Health: County Comparisons.  Based on county
scores for the four indicators in the report.  

The study found Kentucky has the highest rate of mothers who smoke during pregnancy, one in five, compared to states with comparable data, reporting that the county rates varied widely in this area with less than 14 percent of expectant mothers in Fayette, Jefferson, and Oldham counties smoked, compared to 40 percent or more of mothers in Clay, Elliot, Lee, and Owsley counties.

The percentage of low-birthweight babies in Kentucky, often a result of smoking during pregnancy, between 1994-2012 (8.7 percent) was found to be consistently higher than the U.S. percentage (8.0 percent).

“All parents want what is best for their children, and we know that smoke is bad for kids,” Bethany Hodge, a pediatrician in Louisville, said in the release. “Kentucky needs an indoor smoke-free law so working mothers-to-be do not have to choose between their jobs and protecting their unborn babies.”

One in eight under 26 lacked health insurance in this study, but this number is expected to decline.

“Kentucky has effectively connected young people to health insurance, especially with the outreach efforts of KCHIP over the past few years and kynect over the past year,” Brooks said in the press release. “It’s important to build on those successes with innovative ways to connect all young people to coverage. One solution is to automatically enroll youth aging out of foster care in Medicaid to make sure they maintain health insurance as they leave the state’s care.”

As for teen births, in 2012, Kentucky's rate of births to teen mothers (42 per 1,000) "substantially" exceed the national rate (29 per 1000).

Many of Kentucky's children face adverse childhood experiences related to economic security.

According to the report, Kentucky has now had four consecutive years in which more than one in every four children lives in poverty, which is consistently higher than the national average. It also reports that more than two in every five Kentucky children live in a high-poverty area.

The report says, " A family's earnings and its poverty status, the level of poverty in its neighborhood and the affordability of housing can all affect how a child grows, learns and ultimately succeeds as an adult."

Boone, Oldham and Spencer counties have the highest scores for economic security, while Lee, Martin and Wolfe have the lowest.

Economic security, based on scores for the four indicators in the report.

The results of the well-being of Kentucky's children around education are concerning.

More than half (51 percent) of Kentucky's children entering kindergarten are not adequately prepared for school and more than half  (51 percent) of its fourth graders are not proficient in reading and "therefore not on the path to high school graduation," according to the report. The study also found that over half (55 percent) of Kentucky eighth graders are not proficient in math and that one in seven Kentucky high school students did not graduate on time.

Oldham and Lyon counties "stand apart" at the top of the  education county comparison, with Clinton, Knox, Menifee and Clay counties ranking last.

Education, based on scores for the four indicators in the report. 

Family and community indicators in the report found that Kentucky is not putting as many youth in jail as in previous years; nearly one in five births were to moms without a high school degree; the number of children living in a single-parent home has grown to 37 percent from 35 percent; and over the course of 2013, over 12,700 children were placed in foster care due to abuse or neglect.

Oldham, Boone, Carlisle, Ballard and Spencer counties rank at the top of the family and community county comparisons, with Powell, Clay, Elliott, Owsley and Carroll counties ranked at the bottom.

Family and Community, based on scores for the four indicators in the report. 

The report recommends implementation of strong policies to combat children's exposure to adverse childhood experiences. "The best option for Kentucky is to find ways to prevent adverse childhood experiences. Ensuring safe, stable and nurturing environments will shield children from toxic stress and its deleterious effects," says the report.

Click here for the Annie E. Casey Foundation Kids Count Data Center, which includes current and historical data. Note that the indicators included in the 2014 rankings are different than those included in the 2013 County Data Book. Therefore, current rankings should not be compared to last year’s county rankings.

School nutrition beat keeps busy: Ketchup returns to Anderson County, more students eating at school in Allen County

School meal programs continue to make news, as schools, students and parents adjust to the latest round of federal guidelines to combat childhood obesity and make sure no child goes hungry.

The second and third Kentucky counties in the alphabetical list were two of the latest in the news.
In Allen County, expansion of a free-meals program means that almost all children are getting breakfast at school.

Following parental complaints in Anderson County, the schools are again offering ketchup, which had been removed because of its high salt content, Shelley Spillman reports for The Anderson News.

The problem, Food Service Director Ronnie Fields told Spillman, was the unavailability of low-sodium ketchup. All the cafeteria offerings had been configured with it, but there wasn't any available. Regular ketchup pushed the allowable sodium limits too high, so it was removed.

Signs were posted to explain, but this didn't set too well with the parents, who "flooded the Anderson County Schools' office and The Anderson News with questions," Spillman writes.

“They’re micromanaging our children,” Paul Coffey, who has grandchildren in the schools, told Spillman. “A parent knows what’s good for their child and ketchup is not going to hurt them.”

Low-sodium ketchup packets are 10 calories and contain 25 mg of sodium. Regular ketchup packets are 11 calories and 85 mg of sodium, Spillman reports.A teaspoon of salt has 2,300 mg. of sodium, according to the American Heart Association. It adds up quickly, with all the added salt in processed foods, so lunches and breakfasts for middle-school students are supposed to have less than 1,360 mg and 600 mg, respectively. Limits for elementary- and high-school students are slightly lower and higher, respectively.

“A lot people don’t realize how it’s this complicated to feed kids,” Fields told Spillman. There were rumors that the schools wouldn't let students bring their own lunches or condiments. “We’d never ban that,” Fields said. “Kids are always welcome to bring their own lunches and condiments.”

Meanwhile, Allen County reports "promising statistics" in after its elementary and middle schools joined the free-meal program offered by U.S. Department of Agriculture, Rachel Herrington reports for The Citizen-Times of Scottsville.

Of the 1,600 students enrolled in both centers, 95 percent are eating breakfast this year, compared to around 60 percent last year, Food Services Director Mary Hobdy told Herrington.

Hobdy said unclaimed breakfast food does not go to waste. Non-perishable foods are kept in elementary classrooms for students to eat during breaks, and are placed in the Family Resource Center for middle-school students who need extra food during the day. Leftover food is donated to the center's backpack program, which sends easy-to-prepare food home with needy kids on Fridays.

Students in Allen County are allowed to refuse meals if they have eaten breakfast or have brought their lunch.

Logan Co. schools work to keep kids and bus drivers hydrated during hot, humid days; here are tips for dealing with heat

With temperatures soaring into the high 90s and the heat index over 100, the new Logan County school superintendent made sure the students and bus drivers were well hydrated last week, O.J. Stapleton reports for the Russellville News Democrat & Leader.

Dr. Kevin Hub and other members of the central office staff delivered bottled water to all schools for students who would be riding buses in the extreme heat, Stapleton writes.

“I think it’s important to recognize that it’s hot and we do not have air conditioning on our school buses,” Hub told Stapleton. “That makes it hard on our drivers and students. This just falls under the category of ‘a good thing to do’ when it comes to taking care of our students and staff.” He said the gesture was appreciated by both the staff and students.

Signs and symptoms of heat exhaustion, according to the Centers for Disease Control and Prevention, are heavy sweating; weakness; cold pale clammy skin; fast, weak pulse; nausea or vomiting; and fainting. The CDC suggests that if someone has these symptoms they should be moved to a cooler location, lie down and loosen their clothing, apply wet, cool cloths to as much of the body as possible, be offered sips of water and seek medical attention immediately vomiting occurs and continues.

The CDC reports the signs and symptoms of heat stroke, a much more serious condition, as: body temperatures above 103 degree Fahrenheit; hot, red, dry or moist skin; rapid and strong pulse; and possible unconsciousness. These symptoms require immediate medical attention. Call 911 immediately, move the person to a cooler environment, reduce the person's body temperature with cool cloths or even a bath and do NOT give fluids.

Prevention is the best way to avoid these heat-related illnesses, Stapleton reports. He offers some suggestions below on how to protect yourself during these extreme temperatures.

Here are some suggestions to prevent heat stroke:

• Drink more fluids, regardless of your activity level.
• Avoid alcoholic beverages and high-sugar beverages as they can cause you to lose more body fluid.
• Don't wait until you are thirsty to drink.
• Seek the advice of your doctor if you have fluid restrictions or are on water pills.
• Avoid very cold drinks as they can cause stomach cramps.
• Stay indoors in an air-conditioned place if possible.
• Go to the mall or the library for some air-conditioned relief if you do not have home access.
• Seek a heat-relief shelter in your area. Contact your local health department for information.
• Fans do not prevent heat-related illness when the temperatures are in the high 90s.
• Take a cool shower or bath.
• Wear lightweight, light-colored, loose-fitting clothes.
• NEVER leave anyone in a closed, parked vehicle.

Every person is at risk of heat-related illnesses in these extreme temperatures, but some people are at greater risk and need to be checked on regularly, Stapleton writes. High risk adults should be checked on at least twice daily and monitored for signs of heat exhaustion or heat stroke. Infants and children need more frequent watching.

Those at high risk of heat-related illness are:

• Infants and young children
• People aged 65 or older
• People who are ill, especially with heart disease or high blood pressure.

Some advice for being outdoors in the heat:

• Limit your outdoor activities to the morning and evening hours.
• Minimize your outdoor exercise.
• Drink two to four glasses of cool, non-alcoholic fluids each hour if you exercise.
• Drink sports beverages to replace the salt and minerals you lose in sweat. Consult your doctor about the use of sports drinks if you are on a low-salt diet.
• Rest often in shady areas.
• Wear a wide-brimmed hat, sunglasses, and sunscreen.

W. Ky. elementaries use Baptist Health grants to join national program to fight childhood obesity; results encouraging

Two more West Kentucky schools have joined Project Fit America, a fitness program that targets childhood obesity, to help its students become more fit, reports The Paducah Sun.

East Calloway County and Calvert City elementary schools are the seventh and eighth schools in the area to win a $16,500 grant from Baptist Health Paducah for indoor and outdoor fitness equipment, teacher training and curriculum material, all included with the Project Fit America program.

"We believe as educators it is our responsibility to help our young population begin healthy lifestyles that will follow them into adulthood," Kathy Crouch, East Calloway principal, told the Sun.

Kentucky ranks eighth in child obesity, and U.S. adult obesity is expected to grow from 30 percent of the population now to 60 percent by 2030.

Benton Elementary, which joined the program only last year, has already documented improvement in students' fitness, showing a a 27 percent increase in cardiovascular endurance, 18 percent increase in upper body strength, 12 percent increase in abdominal strength and a 38 percent increase in students who could perform pull-ups.

Project Fit America is a national non-profit group that has worked with nearly 900 schools in 45 states to motivate students, parents and faculty to choose fitness over sedentary lifestyle habits. (Read More. This article is behind a pay wall.)

Fort Thomas joins other wealthy school districts in U.S. that have dropped federal school-lunch program

The wealthy Fort Thomas school district in Northern Kentucky is dropping out of the federal school-lunch program because "Kids didn't like their healthful lunches," Jessica Brown reports for The Cincinnati Enquirer.

"The 2,800-student district joins a small but growing number of school districts across the country – mostly wealthy districts who can afford to forfeit the money – who have dropped out of the federal program in the wake of stricter nutritional standards," Brown writes. "Schools said students don't like the unsalted potatoes, low-fat cheese or the mandatory fruits and vegetables. They throw food away or decide not to eat at all."

Forsaking federal funding will cost the district an estimated $260,000 a year, Brown reports. "Children who get free or reduced-price lunches – about 17 percent of the student body – will still get them at that price." (Read more)

UPDATE, Aug. 25: About 150 school districts nationwide have withdrawn from the federal program, Bloomberg BusinessWeek reports.