Combination of tobacco smoke and high radon levels increase Kentuckians' risk of getting lung cancer by a factor of 10

Red counties are expected to have an indoor radon level high
enough to require a radon mitigation system. (USEPA map)

Combined exposure to tobacco smoke and radon, an odorless gas that comes from small amounts of radioactive minerals in limestone bedrock, contribute to increased risk of lung cancer for Kentuckians.

Not only do high smoking rates and lack of smoking bans expose Kentuckians to high levels of tobacco smoke, the state's laws don't require testing and monitoring of radon, Elizabeth Adams notes in a University of Kentucky news release that gives this warning: "The risk of lung cancer increases 10-fold when a person is exposed to both high levels of radon and tobacco smoke." She gives two steps to reduce the risk:

Reduce exposure to second- and third-hand smoke. Do not allow smoking in your home or car, and ask smokers who go outside to smoke need to cover their clothes with a jacket before returning inside, or they will bring third hand smoke in with them. Of course, quitting smoking is the best way to protect your health and the health of your family.

Test your home for radon every two years. One can often obtain a free test kit from the health department or purchase one at a home improvement store. Renters can ask their landlord about radon testing. If the radon level reaches 4.0 or above, a radon mitigation system will become necessary. Opening windows or increasing ventilation won't solve the problem. Instead, call a certified radon mitigation company.

If someone living in your house smokes cigarettes, cigars or pipes, you might be eligible to participate in a UK research study examining the combined effects of smoke and radon. To learn more about the study, send an email to ukfresh@lsv.uky.edu or call 859-323-4587.

Former smokers get newly funded scan for lung cancer and encourage others to do the same, after finding cancer in time

The number of smokers choosing to get low-dose CT scans to see if they have lung cancer is steadily increasing, especially since this screening was recently approved for payment by Medicare, Grace Schneider reports for The Courier-Journal.

Janet Overman and Roger Cross Sr., both 70 and heavy smokers since they were teens, decided to get this screening and both learned they had lung cancer, but with different outcomes.

Overman, a retired administrative assistant from Louisville, told Schneider that she had smoked two packs a day until a health scare in the late 1990s caused her to quit after 35 years of smoking. She said that she knew she was considered a high risk for lung cancer and this prompted her decision to get screened at the James Graham Brown Cancer Center in November 2013.

Her original screening showed she had lung cancer, but a follow-up scan and biopsy showed no cancer. She has been placed on a monitoring program with no treatment necessary, Schneider reports. "I'm sure it was prayer," Overman told Schneider.

Cross, a Bullitt County resident and owner of a small freight-delivery service, said he quit smoking 18 years ago and also credits his diagnosis to "divine intervention," Schneider writes.

He told Schneider that while driving on Interstate 65, he spotted a billboard that urged people to get screened for lung cancer. "The Lord put that right on my windshield," he said.

That happened a year ago, prompting Cross to pay $185 for his screening at Norton Healthcare, where he learned that he had Stage 3 lung cancer. He has since had surgery to remove a lung lobe, plus four rounds of chemotherapy, and is doing well, Schneider reports.

Both survivors spend their time encouraging other longtime smokers and ex-smokers to get screened "while there's a chance to beat the disease," Schneider writes.

Overman's story is an example of why counseling is so important for people who get this lung cancer screening. CT scans are so much more sensitive than traditional chest X-rays, "detecting abnormalities the size of a grain of rice," and can often turn up false positive results, which requires future scans and test, Schneider writes. These scans also reveal other health conditions such as emphysema, coronary-artery disease and chronic obstructive pulmonary disease.

Kentucky leads the nation in lung cancer and deaths from lung cancer, with deaths from the disease nearly 50 percent higher than the national average, according to the Kentucky Cancer Consortium.

Medicare announced in February that it will pay for low-dose CT scans for people at high risk of getting lung cancer. This includes people from 55 to 77 who are either current smokers, have quit smoking within the last 15 years or who have smoked at least a pack a day for 30 years, or the equivalent, two packs a day for 15.

This is welcomed news because early detection is the key to survival. People diagnosed early who have Stage 1 lung cancer have a 57 percent chance of surviving for five years, Schneider reports.

Schneider noted that last November, Kentucky received a $7 million grant to improve survival rates for lung cancer through a project called Kentucky LEADS (Lung Cancer, Education, Awareness, Detection, Survivorship) Collaborative, which will be led by the University of Kentucky, the University of Louisville and the Lung Cancer Alliance.

Senate Republican leaders killed the smoking-ban bill passed by the Democratic House but some of them say its time may come

By Melissa Patrick
Kentucky Health News

On Feb. 13, for the first time, the Kentucky House of Representatives passed a statewide smoking ban to prohibit smoking in workplaces and indoor places. The bill moved to the Senate for consideration. On the same day, a state senator proposed a nearly identical bill. And on Feb. 19, both bills were assigned to a committee that was never going to give them a hearing.

Sen. Julie Raque Adams

Sen. Julie Raque Adams, R-Louisville, sponsor of the Senate bill, said it and the House bill would have been approved by the Senate Health and Welfare Committee, which she chairs. But leaders of the Senate's Republican majority sent it to the Veterans, Military Affairs and Public Protection Committee, chaired by Sen. Albert Robinson, R-London, who, like Senate President Robert Stivers, R-Manchester, opposes it.

“The time has come and gone," Adams said of chances to pass the ban.

If the bill is dead, who killed it? The most common explanation offered during a series of short interviews with senators was the "leadership," members of which have publicly said the bill didn't have the support it needed to bring it to a vote. However, some senators said it did.

“Leadership is not willing to hear it,” said Amy Barkley, chair of the Kentucky Smoke-free Coalition. “It is a small group of people in leadership who don't want to bring it to a vote. Why should a small group hold it up?” Barkley said that she would like leadership to "allow a vote, regardless of the results."

Sen. Tom Buford, R-Nicholasville, said the leadership "makes the decision about whether we hear a bill or not."

Stivers has said he opposes the bill because it would be too much government intervention into private business, and Buford said many other Republicans feel likewise. He said many members of his party "just do not want anybody to tell anybody what to do anymore."

Sen. Perry Clark of Louisville, a libertarian-oriented Democrat and Public Protection Committee member, said Republican leaders strategically placed the bill in the committee.

"It doesn't look like it will [be passed] as long as it is in Albert Robinson's committee," Clark said. "He is adamantly opposed to it. They knew that when they put it in his committee. They could have put it in Julie's committee and she is adamantly for it," he said.

The co-chair of the committee, Sen. C.B. Embry, R-Morgantown, said "Leadership determines what we vote on and when we vote. All the committees serve at the will of the leadership."

"If leadership wants it to pass, it's going to be heard," said Sen. Dennis Parrett, D-Vine Grove, a member of the committee.

Stivers, asked where the leadership stood on the issue, said "Until I see, or other people see in the leadership group, that there is support in the caucus for the issue, it is not going to come to the floor. If there is, it will. I haven't seen that groundswell of support for the issue." Floor Leader Damon Thayer, R-Georgetown, said likewise.

Another obstacle contributing to the bill's death was the Republican policy of not allowing bills to reach the full Senate unless they are favored by a majority Republicans, who have 27 of the 38 Senate seats.

Perhaps another was indicated by the latest lobbying report from the parent firm of Philip Morris Cos., Altria Group, saying that its legislative agents were lobbying against it. The sponsor of the House bill, Rep. Susan Westrom, D-Lexington, has said Kentucky Farm Bureau was her main foe.

Still, some senators thought there were enough votes for it to pass a floor vote.

“It would pass the floor," Buford said. "I think when you turn the light bulb on and they all have to show their hand, it would pass." Parrett agreed, and so did Sen. Morgan McGarvey, D-Louisville, a co-sponsor of the bill.

While Adams said she thought likewise, she also said she could not say that with "full confidence" because she had found in talking to the senators that many of the potential "yes" votes in the Senate wanted a bill without amendments. The House added provisions that these senators needed time to "digest" and "this session just wasn't long enough for us to do it," Adams said.

Advocates and sponsors continued to work on the bill even after its unfavorable assignment. Early on, co-sponsor Dr. Ralph Alvarado, R-Winchester, explored fellow senators' interest in an amendment allowing local governments to opt out of the ban, trying to make it more palatable to those who strongly favor local control. The advocacy groups opposed such an amendment.

"We rolled it out there and I just don't know that we had enough support," Alvarado said. "I asked individual members what their thoughts were and I got a lot to switch their vote and some who came to the fence, but the fence is not a yes, so that makes it a bit tougher. It would probably get some votes."

Buford said the opt-out option "keeps us from getting a vote" because he thought most senators wanted the law, if passed, to be consistent among all 120 counties.

Sen. Julian Carroll, D-Frankfort, a Public Protection Committee member, said he also opposed the amendment. "I think to make it an effective health statement and to attack the problem associated with so many diseases that result from not only smoking, but secondhand smoke, we have got to attack the problem itself," he said.

Senate President Pro Tem David Givens, R-Greensburg, said the opt-out option "never really caught fire" but he was "confident that it would have caught some votes."

Plans to resuscitate the smoking-ban bill are already under discussion.

"It is not going away," Adams said. "It is very near and dear to my heart, not only from a health standpoint, but from an economic development standpoint – it is very good for business in Kentucky – and finally from a fiscal standpoint, because the savings that we could realize from implementing a smoke-free statewide policy are just too dramatic to discount."

Adams said that they "would take up the House bill in the interim and see what those amendments mean and see if we can't get those people a clean smoke-free bill."

But Alvarado remains interested in compromise. "I think having an all or none response is going to probably get more of a none, so you have to find some method of coming to the middle," he said. "We are hoping that as more and more people come to side with us that they will put pressure on legislators to say this is OK."

Even Stivers offered advoctes some hope when he said that he was "one of 38" senators and that he had been known to put bills on the floor for a vote, despite his opposition, if "there was support in this chamber for that issue" and noted that more Republicans were "wanting to push the issue forward."

Republican Caucus Chair Dan Seum of Louisville said, "I think it is an idea whose time will come. It is about education and moving people (forward). It is also a generational thing."

Givens said that he did see a future for a smoke-free Kentucky, complementing the proponents and how they have conducted themselves in the discussion.

"It is an advocacy effort," he said. "What is happening is the same as what happens with lots of pieces of legislation. There is a large educational component to it and by the proponents continuing the conversation, continuing to promote the effort, they are educating the populace and educating people that elect us – when they start to move the electorate, they certainly start to move us."

Polls in the last year have shown that 57 to 66 percent of Kentucky adults support a smoking ban.

Statewide smoking ban passes Kentucky's Democratic House, but its chances don't look good in the Republican Senate

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A statewide smoking ban passed the Democrat-controlled state House Friday for the first time, but its chances appear grim in the Republican-controlled Senate though a clear majority of Kentuckians support the bill.

House Bill 145, which would prohibit smoking in workplaces and indoor places, passed 51-46 after the narrow defeat of two amendments opposed by its advocates and three changes that may have put it over the top. Nine of the 44 Republicans joined 42 of the 56 Democrats to pass it.

Amendments to the bill added exemptions for cigar bars, cigar clubs, tobacco stores, private clubs and market-research facilities; significantly reduced the fine for violation, to $25 for individuals and $50 for businesses; and would preserve any weaker or stronger local bans that are in effect when the bill would become law, in late June.

House Speaker Greg Stumbo told Tom Loftus of The Courier-Journal that the latter amendment was key to the bill's passage. Rep. Tanya Pullin, D-Greenup, told the House that it won her vote because it creates a "window of opportunity" for localities to enact their own bans. It was proposed by Democratic Caucus Chair Johnny Bell of Glasgow.

The defeated amendments would have exempted electronic cigarettes and well-ventilated adult establishments prominently displaying a "Smoking Establishment" sign. The e-cig amendment, proposed by Republican Caucus Chair Stan Lee, lost 46-49; the other one, offered by freshman Rep. Jim DuPlessis, R-Elizabethtown, lost 44-45. For the roll calls, click here.

"A couple of the amendments are problematic," Amy Barkley, chair of the Smoke-free Kentucky Coalition, said in a phone interview. "The existing laws in these communities may not protect all workers," she said. "And localities can pass weak laws (before this bill becomes law) and have that forever."

Nevertheless, Barkley said, "This is really a historic moment."

More compromise may be necessary to get the bill through the Senate, where Republican Sen. Julie Raque Adams of Louisville filed a similar bill as the House measure was coming up for a vote.

Senate President Robert Stivers told Bruce Schreiner of The Associated Press, "I am personally not a fan of smoking, but I just don't believe it is the government's role to tell [a business] that you cannot have a facility that smoking takes place in — be it a pool hall a bar or restaurant." He added, "I don't see there being that type of support in the Senate to pass a bill like that."

Barkley disagrees. "There is a lot of support in the Senate," she said.

The sponsor of HB 145, Rep. Susan Westrom, D-Lexington, said "I cannot predict what will happen in the Senate. Stivers has said from the beginning that he wouldn't let it have a hearing."

Barkley said advocates are asking Senate leaders to "let your members have the vote and go on record with their position." The next clue to the leaders' attitude will be where they send the bill. If it doesn't go to the Health and Welfare Committee, which Adams chairs, that would be a bad sign for it.

Westrom repeately said that the bill does not ban smoking. "This bill just requests that a smoker step outside 15 feet," she said. "Fifteen feet is not too far to walk to know that 950 people in this state won't die from secondhand smoke related illness." That is the estimated number of deaths each year in Kentucky from secondhand smoke.

Westrom said afterward that she had hoped for a larger margin than five votes, but "I couldn't be happier. This is a historic moment and there is lots to be proud of," referring to the many people and organizations that committed themselves to the cause.

The Kentucky Health Issues Poll last fall found that 66 percent of Kentucky adults favored the ban. It won 57 percent support in last year's Bluegrass Poll for news organizations.

During the House debate, opponents of the bill spoke mainly of private-property rights and individual liberty.

I deplore smoking," said Rep. Brian Linder, R-Dry Ridge, "but my love for liberty is greater than my hate, therefore I vote no."

Earlier, Westrom said, "Our freedoms only extend until they begin to affect others."

Democratic Gov. Steve Beshear hailed the House vote as "an extremely important and significant event," adding, "It sends a very strong statement ... that it is time to move in this direction. It is just such a health problem and health issue in the commonwealth; so many of our chronic conditions relate directly back to smoking."

With 55 votes needed instead of the usual 51, it just got harder to pass a smoke-free workplace law in the House

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A bill to ban smoking in public places and places of employment will require the commitment of a supermajority to get a vote on the House floor, making it more difficult to pass.

Rep. Susan Westrom, D-Lexington, said in a telephone interview that when she told leaders of the House's Democratic majority yesterday that her bill had 49 votes, two short of a majority, Democratic Floor Leader Rocky Adkins of Sandy Hook told her she would need 55 votes for him to bring the bill before the House.

Asked why she thought there had been a change from the usual 51 votes needed for a floor vote, Westrom said the only reason she could imagine was "There are some members of leadership that don't want to make anyone uncomfortable . . . don't want to ask them to take a vote."

Last year, House leaders declined to bring the legislation to a vote, and Speaker Greg Stumbo of Prestonsburg said many members didn't want to vote on it during an election year.

Adkins said yesterday that a supermajority requirement is not unusual for any bill that is a "high priority" or "one that has been discussed a lot." He said the rule applied to Stumbo's House Bill 2, to raise the state minimum wage. It passed in the House Tuesday, 56-43.

Democratic Rep. Tom Burch of Louisville, the longest-serving member of the legislature and chairman of the committee that approved the bill, said requiring 55 votes to get a floor vote happens from time to time. He said this will "provide a cushion" because "some of these guys will crawfish," or will back off when they see there are 51 votes.

Offering an example of why it it is best to go into a vote with a cushion, Burch recalled 1980, when new Gov. John Y. Brown Jr. took his gas-tax bill to a vote, thinking he had 51. But someone who had committed to vote for it reneged during the vote, leaving Brown one vote short. Burch said he cast the 51st vote at the request of House leaders, who had told him that his vote wouldnt be needed.

"We need a cushion," Burch said.

Westrom said the request from Adkins for 55 votes "comes as no surprise to me."

"We must roll with the punches and keep moving forward," she said. "I am making connections with those in the middle, providing them with information to help them with their comfort zone."

She said that she and other advocates had been educating her colleagues for five years about the importance and need for a smoking ban, but some were just not receptive.

"There are some freshman legislators from rural areas who get it, and seasoned legislators that still don't," she said.

When House Bill 145 passed the Health and Welfare Committee 11-4 last week, Westrom said, "I feel very confident we will get a floor vote." But at that time, she was aiming for 51.

The bill has never gotten out of committee in the Senate and chances in the Senate this year continues to remain doubtful.

James Sharp, lobbyist for the American Cancer Society's Cancer Action Network, said that with 66 percent of Kentuckians statewide supporting the bill, it is time for state leaders to make "the health and economic viability of our commonwealth" a priority by passing this bill.

"We need our leaders in either chamber, in either party, to step up and lead on this issue," Sharp said. "Bring this bill for a vote. Get it passed for the health of all Kentuckians, sooner than later."

Adkins, asked if leaders are doing enough, said they were listening to and working with their caucuses. "So, I think we are working our way through the process," he said. He commended Westrom and advocacy groups for "an outstanding job of really educating people on this piece of legislation, educating Kentuckians."

Burch said, "I am voting for this bill because it is the right thing to do" and encouraged lawmakers to listen to their constituents.

"If these people would listen to what their districts thought, they would be for this bill 100 percent," he said. "Because 75 percent of Kentuckians don't smoke and don't want somebody blowing smoke in their face and they don't want the results of second-hand smoke."

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

Medicare to pay for CT scans of people at high risk of lung cancer

Medicare will now pay for low-dose CT scans for people at high risk of getting lung cancer, a change welcomed by officials in Kentucky, which leads the nation in lung cancer and deaths from it.

"This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States," Dr. Patrick Conway, chief medical officer for the federal Centers for Medicare and Medicaid Services, said in a press release.

Lung cancer is especially deadly because it doesn't cause symptoms until it's too late, killing nearly 160,000 people a year, according to the American Cancer Society.

This new preventive coverage will allow Medicare to pay for a once-a-year, low-dose CT exam for people aged 55-77 who are either current smokers, have quit smoking within the last 15 years or who have smoked at least a pack a day for 30 years, or the equivalent and have a written order from a doctor, reports Maggie Fox of NBC News.

Some doctors question how many people will benefit from the test, which costs $250 to $300, and have voiced concerns that it doesn't always produce clear results, causing patients to endure further testing than might turn out to have been unnecessary. Federal officials disagree, and experts say it will prevent as many 20 percent of U.S. deaths from lung cancer, "making it akin to mammograms and colonoscopies in terms of saving lives," Fox reports.

Hope is high for a House floor vote and passage of a statewide smoking ban, but the Senate remains doubtful

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to ban smoking in public places and places of employment is headed to the House floor yet again, and its sponsor says it will finally get a vote. But its chances in the Senate remain doubtful.

Rep. Susan Westrom

"I feel very confident that we will get a floor vote," Rep. Susan Westrom, D-Lexington, five-year sponsor of the legislation, said after Thursday's committee meeting. "I am shooting for next Wednesday."

House Bill 145 passed the Health and Welfare Committee 11-4, with all Democrats and two Republicans on the panel for it and four Republicans opposed.

Westrom said the bill is not a smoking ban, but simply asks smokers to step 15 feet outside to smoke. She said, this is "not a huge sacrifice, but the benefits are so incredible."

The bill also requires those smoking electronic cigarettes and hookahs to step outside, which could cause a "battle," Westrom said.

The legislation got to the House floor last year, but didn't get a vote, and has never gotten out of committee in the Senate. Polling shows a clear majority of Kentuckians support banning smoking in indoor public places, but almost 30 percent of Kentuckians smoke, tops in the nation. The state also is No. 1 in lung cancer and deaths from it.

Two Republican senators, pediatrician Ralph Alvarado of Winchester and lawyer Julie Raque Adams of Louisville, chair of the Senate Health and Welfare Committee, sat with Westrom and Rep. David Watkins, D-Henderson, a retired physician, before the committee.

Alvarado gave an impassioned reading of his op-ed that was in the same day's Lexington Herald-Leader to the committee. "Smoking is killing Kentucky, literally and fiscally," he said.

He said an estimated 950 Kentuckians die every year because of secondhand smoke; exposure to it costs Kentucky more than $128 million every year; children exposed to secondhand smoke suffer from repeated ear infections, bronchitis, pneumonia and asthma; and secondhand smoke is a proven cause of heart disease, cancer and stroke in non-smoking adults.

By passing the bill, "The General Assembly can save more lives with this legislation than I can throughout my entire medical career," Alvarado said. Democratic Gov. Steve Beshear supports it.

Adams, who will be sponsoring the legislation in the Senate, told the committee, "We need to see a vote on the floor. We need to talk to our senators. We need to keep up the advocacy because Kentuckians deserve better."

Senate Republican Floor Leader Leader Damon Thayer told Jack Brammer of the Herald-Leader that there is "not much sentiment" for the bill in the Senate: "Let the free market work this out."

Republican Bob DeWeese, a doctor from Louisville, voted for the bill. He said the title of representative was fleeting, but "I'm a doctor for life."

Newly elected Rep. George Brown Jr., D-Lexington, noted that he voted against the smoking ban in Lexington many years ago. "Since that time, I've had an awakening and I understand that the collective rights of citizens are much more important than those of individuals."

Rep. Robert Benvenuti III, R-Lexington, said "liberty interests have to be balanced" between the rights of smokers to smoke in the workplace versus the rights of others to be healthier.

Newly elected Rep. Phil Moffett, R-Louisville, said "I support it at the local level and that is where is should reside," and asked Westrom why the legislature shouldn't just make tobacco illegal "if it is that devastating."

Westrom suggested Moffett ask the Kentucky Farm Bureau Federation about that. She said in December that Farm Bureau has been the main obstacle to the bill.

About 5,000 farmers in Kentucky grow tobacco, a greatly reduced number from the days of the federal tobacco program, which ended 10 years ago. Farm Bureau spokesman Dan Smaldone said in December that the organization continues to oppose the legislation because it invades the private-property rights of business owners.

Asked why a farm organization cares about that, Smaldone wrote in an email, "KFB's membership supports policy for rural issues that fall outside of the agriculture industry, including educational and economic issues that impact their local communities. The organization has policy on the issue because its membership determined it was important to take a position on it."

As for the local approach, Westrom said after the meeting that too many local communities have not taken the initiative to pass smoking bans.

About one-third of Kentuckians are covered by strong local smoke-free laws, with 24 communities with smoke-free laws that cover all workplaces and enclosed public places, according to the Smoke-Free Kentucky Coalition website.

Westrom, Alvarado and committee Chair Tom Burch, D-Louisville, said they thought the bill would pass the House, but none were sure about the Senate. Westrom noted that Senate President Robert Stivers, R-Manchester, has been vocal against the bill.

"The wonderful thing about Sen. Stivers is that he understands how important the cancer research center is at the University of Kentucky," Westrom said, noting Stivers' call to reopen the 2014-16 state budget to authorize the project: "If we are going to invest that amount of money for a cancer research center, the best thing we can do . . . is make sure the entire state is setting the example of a smoke-free state."

Smoke-Free Kentucky Chair Amy Barkley said, "If the House passes it and puts the ball in their court . . . I'm just going to be optimistic that they will listen to their voters. We know that 66 percent of the voters support a statewide smoke-free law and that crosses all parties and regions of the state." That is the figure in the latest Kentucky Health Issues Poll; a Bluegrass Poll put the figure at 57 percent.

Public opinion will make the difference this year, Westrom said. "Some portions of the state are more that 74 percent approval; 70 percent of the people who used to smoke are in favor of this; and an average of 60 percent of those in rural areas are in favor of smoke-free."

Heavy use of e-cigarettes may deliver big doses of formaldehyde, which can be a cause of lung cancer, study suggests

Vapor produced by electronic cigarettes can contain a surprisingly high concentration of formaldehyde—a known carcinogen that can cause lung cancer through prolonged exposure—researchers reported Wednesday in a study published in the New England Journal of Medicine, Rob Stein reports for NPR. (Getty Images by Dan Kilwood)

Use of e-cigarettes among rural teens has risen in recent years, prompting the U.S. Food and Drug Administration to propose rules to give it authority over e-cigarettes, an industry that accounts for about $2.5 billion in annual sales.

"E-cigarettes work by heating a liquid that contains nicotine to create a vapor that users inhale," Stein writes. David Peyton, a chemistry professor at Portland State University who helped conduct the research, told Stein, "We simulated vaping by drawing the vapor—the aerosol—into a syringe, sort of simulating the lungs. That enabled the researchers to conduct a detailed chemical analysis of the vapor. They found something unexpected when the devices were dialed up to their highest settings."

The e-cigarette industry dismissed the report, saying they found formaldehyde only when e-cigarettes were cranked up to their highest voltage levels, Stein writes. Gregory Conley of the American Vaping Association told him, "They clearly did not talk to [people who use e-cigarettes] to understand this. They think, 'Oh, well. If we hit the button for so many seconds and that produces formaldehyde, then we have a new public health crisis to report."

"If you hold the button on an e-cigarette for 100 seconds, you could potentially produce 100 times more formaldehyde than you would ever get from a cigarette," Conley said. "But no human vaper would ever vape at that condition because within one second their lungs would be incredibly uncomfortable." (Read more)

Two-thirds of Kentuckians support a statewide ban on smoking in most public places; Stumbo says it's time for a House floor vote

Kentuckians have remained steady in their support for a comprehensive statewide smoking ban with two-thirds supporting it, according to the latest Kentucky Health Issues Poll. Hours after the poll was released, state House Speaker Greg Stumbo said it is time for a House floor vote on the proposal.

The poll, taken Oct. 8 through Nov. 6, found that 66 percent of adults favored a law that would prohibit smoking in most public places, while 29 percent opposed it. These are virtually the same results as last year when 65 percent supported the ban and 29 percent opposed it. The poll's error margin is plus or minus 2.5 percentage points.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati for the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati.

Majorities in each political party supported a statewide smoke-free law: 68 percent of Democrats, 67 percent of Republicans and 64 percent of independents. These results were also almost the same as last year. Support for a statewide smoke-free ban decreased among those with a high-school education or less, but increased among those who had been to college. For the detailed results, click here.

Not surprisingly,the poll found that 80 percent of Kentucky adults who have never smoked and 71 percent of former smokers support such a law, while only 40 percent of current smokers do; 53 percent said they oppose it and 7 percent said they didn't know or weren't sure.

Those who said they were in excellent or very good health were most likely to favor a ban, at 75 percent. Generally, the unhealthier the respondent, the less likely he or she was to favor it. Among those who said they were in fair or poor health, 55 percent favored a ban.

Lexington (75 percent) and Louisville (74 percent) showed the highest levels of support for the ban. While most of those in Appalachian area-development districts support it, support in Appalachian Kentucky declined to 54 percent in 2014 from 72 percent in 2013. That was offset by gains in other areas. The error margin for this smaller sample is plus or minus 5.4 percentage points.

Twenty-six states and the District of Columbia have comprehensive smoke-free laws. Kentucky has several reasons to pass one. It leads the nation in smoking as well as lung cancer and deaths from it. Second-hand smoke is estimated to kill 950 Kentuckians a year, and research indicates that it increases the risk of heart and lung disease by 20 to 30 percent.

The Foundation for a Healthy Kentucky noted in its news release that the 2006 U.S. Surgeon General Report recommends "eliminating all exposure to secondhand smoke" and last years report "offered evidence that smoke-free indoor air policies are effective in reducing exposure to secondhand smoke."

A smoking ban came closest to a floor vote in the full House last year, but has never gotten out of committee in the Senate. House Speaker Greg Stumbo said on KET's "Kentucky Tonight" Monday that it is time for a floor vote, the best sign yet that it will get one. But Senate President Robert Stivers maintained that smoking bans should be done locally, not statewide.

After four days this week devoted to organization and ethics training, the legislature will recess until early February. The session of 30 legislative days must end by March 31.

Lung cancer gets much less research funding than other cancers, but is deadlier, especially in Kentucky

Lung cancer takes more lives annually than breast, prostate, and colon cancers combined, but the disease "generally doesn't get the public attention or research dollars in proportion to its lethality," Arielle Densen, co-founder of Lung Cancer Free World, writes for CNN.

Lung cancer receives $1,442 in federal research funds per death, compared with $26,398 for breast cancer (lung cancer kills nearly twice as many women as breast cancer) and $13,419 for prostate cancer according to a National Institutes of Health study. Funding by private donations increases the gap even further, she writes.

And though lung cancer is usually thought of as a "smokers disease" and often comes with a stigma attached, "the majority of those diagnosed with lung cancer are former smokers or have never smoked at all," Densen writes.

Densen shares the story of her mother, who was diagnosed with lung cancer but had never smoked. Her mom, being a non-smoker and generally "healthy," was told she had pneumonia despite a "lingering, months-long cough." Because she wasn't a smoker it "didn't trigger any red flags." Eventually, a CT scan found a mass in her lung. She was told she had stage 4 lung cancer and had one year to live. But "thanks to advancements in targeted therapies" she lived for 40 months after the diagnosis. She was 59 when she died.

Lung cancer is especially deadly because it usually doesn't cause symptoms until it's already spread to other parts of the body. Kentucky has more cases of lung cancer than any other state, and its lung cancer mortality rate is nearly 50 percent higher than the national average.

The five-year survival rate for lung cancer is around 16 percent and has been for decades and the survival rate for a stage 4 cancer is 4 percent, Densen reports.

Medicare plans to pay for lung-cancer screening, a boon to Ky.

The Centers for Medicare and Medicaid Services plan to start paying for lung cancer screening with low-dose CT scans for people at high risk.

Spiral CT (computed tomography), which is used to look for lung cancer, is a low-dose form of X-ray that delivers about the same radiation as a mammogram, Maggie Fox reports for NBC News.

“I think after a long effort to get to this point, CMS got it right,” Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance, told Fox. “This has the potential of being one of the most significant cancer mortality-reducing efforts to date. We are finally focusing on what is a quarter of all cancer, and that’s lung cancer.”

Fox reports, "Experts project that the screening test, which costs $250-$300, may prevent as many as 20 percent of future deaths from lung cancer, making it akin to mammograms and colonoscopies in terms of saving lives."

The proposal covers people aged 55-74 who have smoked at least a pack a day for 30 years, or the equivalent. It is now open for a 30-day comment period.

Lung cancer is especially deadly because it usually doesn’t cause symptoms until it’s already spread to other parts of the body. Kentucky has more cases of lung cancer than any other state, and its lung cancer mortality rate is nearly 50 percent higher than the national average. This year alone, 3,500 Kentuckians will die from lung cancer. Nationally, it kills nearly 160,000 people a year, according to the American Cancer Society.

Concerns about using CT scans to screen for ling cancer are that it isn't cheap, it isn't harmless, and the scans aren't always clear, often causing patients to endure further needless testing, Fox reports: "The national lung screening trial showed that for every five to six lives saved by screening, one person died because of procedures done after screening, including surgery and biopsies that collapsed the lung."

That calls for caution. “We strongly advise older current and former heavy smokers to speak with their doctors about whether CT lung cancer screening is right for them,” Dr. Ella Kazerooni, chair of the American College of Radiology Lung Cancer Screening Committee, told Fox. “If they and their doctor decide that screening is warranted, we encourage patients to seek out an ACR lung cancer screening center.” 

Kentucky gets a $7 million grant to improve survival rates for lung cancer, in which it leads the nation

The University of Kentucky, the University of Louisville and the Lung Cancer Alliance have joined in a unique project called Kentucky LEADS (Lung Cancer, Education, Awareness, Detection, Survivorship) Collaborative to assess new approaches for identifying lung cancer earlier to improve survival rates.

These efforts are supported through a $7 million grant from the Bristol-Myers Squibb Foundation’s Bridging Cancer Care initiative.

Kentucky has more cases of lung cancer than any other state and its lung cancer mortality rate is nearly 50 percent higher than the national average. This year alone, 3,500 Kentuckians will die from lung cancer, a UK news release reports.

“As Kentucky leads the nation in lung cancer mortality rates, we must step up to be a leader in finding solutions toward preventing, curing and coping with this destructive disease,” Gov. Steve Beshear said. “I strongly support this collaborative, wide-ranging effort as it coincides with this administration’s KyHealthNow goals of reducing statewide cancer and smoking rates by 10 percent by 2019. By working together, we can and will find a way to diminish the burden of this crisis in Kentucky."

The project will also develop and evaluate interventions to improve quality of life and survivorship for individuals with lung cancer and their caregivers, the release says.

"Historically there's not been a lot of research or effort put into lung-cancer survivorship because, unfortunately, there hasn't been much survivorship," said Jamie Studts, associate professor of behavioral science at UK and director of the Kentucky LEADS Collaborative.

One in two patients diagnosed with lung cancer will die within a year. After five years, only 16 in 100 patients will be alive, UKNow writes.

"Those are sobering statistics,” said John Damonti, president of the Bristol-Myers Squibb Foundation. “The timing of diagnosis is critical. Patients diagnosed at Stage 1 have a 57 percent chance of achieving five-year survival. That drops to 4 percent when patients have a late-stage diagnosis. Early detection and treatment of lung cancer, combined with education and patient support, is key to increased survival for patients living with lung cancer.”

The project will include several components: a review of how physicians treat and refer lung cancer patients across the state; the creation of a sustainable lung cancer-specific survivorship program; and a program that will promote evidence-based prevention and early detection of lung cancer in Kentucky.

Early detection has recently become more attainable because lung cancer screening guidelines have recently changed, allowing Kentucky to implement rigorous, statewide screening programs that can save lives, UKNow writes. And because symptoms of lung cancer usually show up after the disease has spread, early screening is critical to reduce deaths.

McConnell seeks 'timely and fair review' of plan for Medicare coverage of CT scans for those at high risk for lung cancer

U.S. Sen. Mitch McConnell asked Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner to "give a timely and fair review to determine whether low-dose computerized tomography (CT) scans should be covered by Medicare for patients at high-risk for developing lung cancer," a press release form his office said.

"Lung cancer has the highest mortality rate of all cancers in the United States," Mconnell said. "Additionally, my home state of Kentucky has the highest state mortality rate of lung cancer in the country, and the disease claims the lives of approximately 3,000 Kentuckians every year."

CT scans should be used to detect lung cancer early in individuals who who have a high risk for the disease, the U.S. Preventive Services Task Force recommends. High-risk individuals are those between 55 and 80 who have smoked a pack of cigarettes each day for 30 or more days. The task force noted a significant reduction in deaths from the disease as a result of early detection through CT scans. (Read more)

UK cancer-center director urges lawmakers to raise cigarette tax and pass a statewide smoking ban to reduce cancer deaths

The Markey Cancer Center at the University of Kentucky supports a statewide smoking ban and an increase in the state cigarette tax to significantly reduce cancer deaths in the state, the center's director told a legislative committee Sept. 3.

“We are highly supportive, and we hope that you will be supportive as well, of (these) initiatives that we think will improve the overall health of Kentuckians,” Dr. B. Mark Evers told the state legislative Tobacco Settlement Agreement Fund Oversight Committee.

A news release from the Legislative Research Commission said Evers presented the numbers to back up his advice: Kentucky is first nationally in percentage of people who get cancer, and in overall cancer mortality. Lung cancer alone accounts for about 35 percent of Kentucky cancer deaths; nationally, lung cancer's share is 28 percent.

Twenty-eight percent of adult Kentuckians smoke, with approximately 8,000 deaths each year from smoking-related illnesses. The greatest incidence of tobacco-related cancers is in Eastern Kentucky.

That is the highest percentage in the U.S., Evers notes, adding that there is an indirect relationship between cigarette taxes and smoking rates. Kentucky has the 12th lowest cigarette tax among the states.

"Raising the cost of cigarettes and a statewide smoking ban could help cut Kentucky cancer deaths by 50 percent," Evers said. That is the Markey Cancer Center's goal over the next five years.

The center has a new strategic plan, "Conquering Cancer in the Commonwealth," that focuses on the state's "major cancer killers" -- lung, head and neck, colorectal, breast, and cervical cancer.

In response to a question about how to decrease the number of smokers in Kentucky, Evers pointed to local smoke-free policies and increased efforts in Appalachia toward smoking cessation.

When asked what it will take to lower the percentage of Kentucky smokers to less than 10 percent, Evers recommended three things: increasing the cigarette excise tax, a statewide smoking ban, and instituting lung-cancer screening projects like those in place at UK and the University of Louisville.

“Those three things are really going to help drive down those numbers,” he said.

Owensboro commissioners drop pre-existing bars from draft of smoking-ban ordinance

The Owensboro City Commission compromised to gain the support of all five members to vote for a smoking ban, which will come up for a vote on Sept. 2, Steve Vied reports for the Owensboro Messenger-Inquirer.

The original draft of the ordinance eliminated smoking in all public places in the city, and was favored narrowly. The compromise allows smoking to continue in establishments that are already in operation and don't allow entry to anyone under 18, thus exempting bars, as a county ordinance does.

"New bars that open after the ordinance goes into effect, whether they allow customers under 18 or not, will not be permitted to have smoking," Mayor Ron Payne said.

"Thank you so much," said Ashley Oberst, an employee of Rocky's Bar and Grill at Ninth and Crittenden streets. "It means more than you know."

"I'm not here to make choices for adults," Commissioner Jeff Sanford said, but if smoking "is around kids, I can't support it."

Payne told the audience at a meeting, "First and foremost, this commission wants to act in unison. We did not want a split vote. No. 2, we have listened to you. You made some good points that we have considered. We all have wrestled with this. This is a toughie. I have three younger brothers, all gone, two from lung cancer."

The new version also deleted regulation of electronic cigarettes. (Read more; this article is behind a paywall)