Ky.'s pro-Obamacare policies led to more enrollment and support for it, but many poor are still uninsured and under-informed

Update: This story was updated to reflect the study's results for those who said they were hurt  by and not directly impacted by the ACA. 

State policy appears to have a major impact on poor people's thinking about the Patient Protection and Affordable Care Act, as well as how they describe their experience with it, according to a Harvard University study published in the journal Health Affairs.

The study surveyed nearly 3,000 low-income residents in three Southern states that had varying approaches to the ACA and its implementation: "Kentucky, which expanded Medicaid, created a successful state marketplace, and supported outreach efforts; Arkansas, which enacted the private option and a federal-state partnership marketplace, but with legislative limitations on outreach; and Texas, which did not expand Medicaid and passed restrictions on navigators" who help people with the federal and state marketplaces.

The survey found that Kentucky, which has enrolled more than 500,000 people in Medicaid and another 109,000 in private health plans through the Kynect health-insurance exchange, had the highest success in application rates, successful enrollments and positive experiences with the ACA, followed by Arkansas and then Texas.

"This corresponds to the general pattern of state-level engagement and support for the ACA coverage expansions in these three states," the researchers write.

The study also found that limited awareness and poor information continue to be two of the greatest barriers to the ACA. Even in Kentucky, where awareness was the highest, only half of the poor people surveyed said they had heard "some" or "a lot" about the ACA's coverage options. About 10 percent of Kentuckians remain without health insurance.

Another barrier to applying for coverage was the perception that it would cost too much, but for those with incomes below 138 percent of poverty in states that have expanded Medicaid, coverage is available without having to pay a premium.

"This adds to previous evidence that information gaps about the law remain a major challenge, particularly among low-income populations who likely have the most to gain from the coverage expansions," the researchers write.

The study also found that application assistance from navigators and others was the strongest predictor of enrollment, increasing enrollment to 93.1 percent from 84.9 percent. Application assistance was most common in Kentucky (46.2 percent) and least common in Texas (31.9 percent). Navigators help consumers choose health-insurance plans to meet their needs and assist them with the application process.

Kentucky reported an overall better application experience than the other two states in the study, and had a significantly higher enrollment rate (92.4 percent) than Arkansas (87 percent) and Texas (84.8 percent).

The study found that advertising about the law didn't seem to affect whether people applied for coverage or enrolled in a plan. However, ads were strongly associated with perceptions of the law.

About 20 percent of respondents said they had read or heard more negative ads and approximately 12 percent recalled more positive ads, and two-thirds said ads were about equal. (Negative ads were most frequently reported in Arkansas, where Obamacare was an issue in a U.S. Senate race last year.)

Twice as many respondents felt that the ACA had helped them as hurt them, although the majority reported no direct impact. In Kentucky, 40 percent said it had helped them, 12 percent said it had hurt them and 48 percent said it had not impacted them directly;  In Arkansas, 30 percent said it had helped them, 17 percent said it had hurt them and 54 percent said it had not impacted them directly; and in Texas, 21 percent said it had helped them, 14 percent said it had hurt them and 66 percent said it had not directly impacted them.

"Nonetheless, 48 to 66 percent of low-income adults in all three states felt the law had not directly impacted them in 2014," the researchers wrote, "which suggests that the ACA has not yet reached many who might benefit from it."

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

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

Image: brainline.org

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

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

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

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

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

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

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

Eating trans fat weakens memory in younger men, study says

Trans fats, the use of which the U.S. Food and Drug Administration limited last month, are associated with reduced memory function in men 45 and younger, says a University of California San Diego School of Medicine study published in the online journal PLOS ONE.

Researchers asked 1,018 men and women to fill out a dietary survey and take a word-recall memory test. Men 45 and younger remembered an average of 86 words, but for each additional gram of trans fats eaten daily, memory dropped by 0.76 words. Compared to the men who didn't consume trans fats, those in the study who consumed the most recalled 12 fewer words.

"Trans fats were mostly strongly linked to worse memory in men during their high-productivity years," said Beatrice A. Golomb, lead author and professor of medicine at UCSD. "Trans fat consumption has previously shown adverse associations to behavior and mood—other pillars of brain function. However, to our knowledge a relation to memory or cognition had not been shown."

Other research has shown that trans fatty acid consumption is linked to negative effects on lipid profile, metabolic function, insulin resistance, inflammation and cardiac and general health. "As I tell patients: While trans fats increase the shelf life of foods, they reduce the shelf life of people," Golomb said.

Obese children's parents say kids are 'about the right weight,' likely comparing them to other kids instead of growth standards

Most parents of overweight children consider them to be "about the right weight," which poses a real concern because parents aren't likely to help their children change their behaviors toward weight reduction if they don't recognize there is a problem, according to a study from the NYU Langone Medical Center.

Photo: nydailynews.com

"Parental recognition of their child's overweight status is paramount in childhood obesity prevention efforts," says the report. "Previous research has shown that parents with accurate perceptions have a greater readiness to make weight-related changes in health-related behaviors and are more effective in doing so.

Kentucky ranks sixth among the states for obesity among preschoolers, with 15.5 percent of 2-to 4-year-olds from low-income families considered obese, according to the "States of Obesity" report. This percentage has remained consistent for several years, but it's worth noting that in 1989, only 9.4 percent of of this population was considered obese. "Children who are overweight or obese as preschoolers are five times as likely as normal-weight children to be overweight or obese as adults," says the federal Centers for Disease Control and Prevention.

The study, published in the journal Childhood Obesity, analyzed data from two groups of children over two time periods from the National Health and Nutrition Examination Survey, one between 1988 and 1994 and the other between 2007 and 2012, both samples had over 3,000 children. The survey asked parents whether they considered their child, ages 2–5-years-old, to be overweight, underweight, or just about the right weight.

Nearly 97 percent of parents of overweight boys in the earlier group identified their sons as "just about the right weight," compared to 95 percent in the second group; 88 percent of parents of overweight girls thought they were "just about the right weight" in the first group, compared to 93 percent in the later group. Experts have dubbed this misperception "The Goldilocks syndrome."

Notably, the researchers said that "the children in the second study group were significantly more overweight than the children in the first study group, yet the parents’ perception of their children remained relatively unchanged." In fact, "the misperception became more prevalent in the recent survey given that an estimated 30 percent reduction in correct perception was observed, compared to the earlier survey," says the report.

"It shows that essentially we're more obese as a society and we're not recognizing our obesity as a society, in this case in children," Dustin Duncan, lead author of the study and assistant professor in the Department of Population Health at NYU Langone, told Lisa Flam on NBC's "Today" show. "Obesity is a well-known medical condition associated with immediate and long-term health risks for children. This is an alarming finding."

The study also found that these misperceptions were more pronounced among the African-American families. "This was especially concerning because African-American and low-income children in the U.S. have the highest rates of obesity," Duncan said in the release.

One reason given for these misperceptions is that parents often compare their own child to other kids in deciding if their child is overweight instead of using science-backed growth charts. The authors also noted that poor communication between parents and their pediatricians could also contribute to these misperceptions.

“We need effective strategies to encourage clinician discussions with parents about appropriate weight for their child. This will be critical for childhood weight management and obesity prevention," Jian Zhang, senior author of the study, said in the release.

Researchers find genetic biomarker that could indicate mental illness in women

Patients' behaviors and feelings often serve as identifying factors for psychiatric disorders, which can make diagnoses difficult. Researchers at the University of California San Diego School of Medicine have discovered that the over-production of specific genes may indicate mental illness in female psychiatric patients, according to a study published in the journal EBioMedicine.

The gene XIST, which deactivates one of the two X chromosomes in cells responsible for storing genetic material, works too hard in female patients who have mental illnesses such as bipolar disorder, major depression and schizophrenia. According to the study, over-production of XIST and genes from the inactive X chromosome are common factors in patients with psychiatric disorders and rare chromosome disorders like Klinefelter syndrome and Triple X syndrome.

"There has been an utmost urgency to identify biomarkers for mental illness that could significantly impact research and drug development, said XianJin Zhou, assistant professor in the UCSD Department of Psychiatry and lead author of the study.

About half of the participants—most of whom had a family history of mental illness—had unusually higher levels of XIST and other genes related to the X chromosome. Zhou and his team said stopping the abnormal activity of the inactive X chromosome may be a new strategy for treating those with psychiatric disorders. "These results are powerful in that early diagnosis of mental illness could possibly happen with a simple blood test, leading to better interventions, therapy and treatment options," Zhou said.

Study finds that one dose of HPV vaccine that targets only cervical cancer is as effective as three doses, now recommended

By Melissa Patrick
Kentucky Health News

A study has found that one dose of the human papillomavirus vaccine Cervarix appears to be as effective in preventing HPV infections that lead to cervical cancer as do three doses, the recommended course of vaccination. Only 25 percent of Kentucky adolescent women initiate the vaccination, and fewer than one in nine of those who do get three does, according to the Kentucky Cancer Consortium.

"Many women around the world and in the U.S. don't get the full three doses that are recommended, so this is promising news," said Elisia Cohen, an associate professor of communication at the University of Kentucky, who does extensive research on community strategies to improve adolescent and adult vaccinations. However, she cautioned that the drug Cervarix is "only 1 percent of the U.S. market" and that the findings from this study do not apply to Gardasil, the drug most commonly used in the U.S.

Dr. Diane Harper of the University of Louisville, one of the researchers, said in a news release, “Kentucky is one of the states that has not had a program in place to make Cervarix available to all of its citizens, and has very low three-dose completion rates of Gardasil.”

Most health departments and physicians choose Gardasil over Cervarix because it protects against four strains of HPV: two strains that cause 70 percent of all cervical cancers and two strains that cause genital warts and oral and anal cancers, concerns for males as well as females. Cervarix only protects against the two strains that cause cervical cancer. "Generally, the thinking is that protection against four strains is better that two," Cohen said.

She said Gardasil 9, which will protect against 90 percent of HPV strains that cause cervical cancer as well as pre-invasive cervical cancer lesions, has just been approved by the U.S. Food and Drug Administration and is going through its labeling process, and will be recommended for both boys and girls.

HPV is the most common sexually transmitted infection in the U.S., affecting an estimated 79 million individuals, according to the federal Centers for Disease Control and Prevention.

The study, published in The Lancet Oncology, analyzed data from two large trials of Cervarix. In the trials, women were randomly chosen to receive three doses of Cervarix or a control vaccine. All of the women were evaluated, regardless of how many doses of the vaccine they received, for the effectiveness of the vaccine for a period of four years. The analysis found that the protection from one dose was similar to that achieved by three doses of the vaccine.

“Knowing that Cervarix offers protection in one dose reassures public health agencies that they are not wasting money when most of their vaccines are given to those who never complete the three-dose series,” the researchers wrote.

The CDC recommends HPV vaccination for girls 11 and 12 years old, and catch-up vaccination for females from 13 to 26. The second dose should be given one to two months after the first injection; the third dose should be administered six months after the first dose.

Study outlines historical barriers to tobacco prevention in Kentucky and other tobacco-growing states

A University of Kentucky College of Nursing study published in The Milbank Quarterly has shown that five major tobacco-growing states—Kentucky, North Carolina, Virginia, South Carolina and Tennessee—fall behind the rest of the states in enacting laws to reduce tobacco use.

Tobacco and the diseases it causes affect those five states more than others across the nation, and tobacco is the leading cause of preventable death in the U.S. Those states also have fewer smoke-free laws and lower tobacco taxes, which are two evidence-based policies that help reduce tobacco use, write the authors, Amanda Fallin and Stanton A. Glantz.

The researchers used five case studies chronicling the history of tobacco-control policy "based on public records, key informant interviews, media articles and previously secret internal tobacco industry documents available in the Legacy Tobacco Documents Library," they write.

They found that beginning in the late 1960s, tobacco companies focused on creating a pro-tobacco culture to block tobacco-control policies. However, since 2003, tobacco-growing states have seen passage of more state ad local smoking bans, partly because the alliance between tobacco companies and the tobacco farmers dissolved and hospitality organizations stopped objecting to such bans. National Cancer Institute research projects also built infrastructure that led to tobacco-control coalitions. "Although tobacco production has dramatically fallen in these states, pro-tobacco sentiment still hinders tobacco-control policies in the major tobacco-growing states," the researchers write.

To continue the progress, health advocates need to teach the public as well as policymakers about "the changing reality in the tobacco-growing states, notably the great reduction in the number of tobacco farmers as well as in the volume of tobacco produced," Fallin and Glantz write. Kentucky once had about 50,000 tobacco farmers; today it has about 5,000, and production is dominated by large farmers. The study is behind a paywall; to read its abstract, click here.

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."

UK research project will create strategies to improve respiratory health for those living in Appalachian Kentucky

Public health researchers at the University of Kentucky will undertake a five-year long research project called "Community-Engaged Research and Action to Reduce Respiratory Disease in Appalachia," Sarah Noble writes in a UK press release.

Funded by the National Institutes of Health's National Institute of Environmental Health Sciences, the project will involve creating strategies to improve respiratory and environmental public health. Kentuckians living in Appalachian counties have the state's highest rates of serious respiratory illness.

"Adults in Appalachian Kentucky are 50 percent more likely to develop asthma or chronic obstructive pulmonary disease than the overall U.S. population," Noble writes. "As many as one in five adults in the region have received a diagnosis of asthma, and rates of COPD are nearly two-and-a-half fold the incidence of the disease in other parts of the country.

Although studies show associations between respiratory health problems and environmental contaminants, data doesn't yet include individual-level assessments or behavioral risk factors common in the area—such as smoking, poor diet and insufficient physical activity. The "Community Response to Environmental Exposures in Eastern Kentucky" project will fill those gaps.

The CREEEK project will include three steps. A community-based assessment will "identify the relationships between indoor air pollutants, behavioral and social determinants and the effects these factors have on risk of respiratory disease," Noble writes. That information "will be shared with local stakeholders in an effort to increase understanding of the environmental exposures present in the region," then the project will put in place "an environmental public health action strategy and will evaluate that strategy's ability to impact short-and long-term outcomes for respiratory health."

Common heartburn medications are linked to heart attacks

Research made possible by data mining reveals evidence that a common group of heartburn medications is associated with a greater risk of heart attack, according to Stanford University researchers, Lenny Bernstein reports for The Washington Post.

The heartburn drugs in question are known as proton-pump inhibitors, such as Nexium, Prilosec and Prevacid. Bernstein writes that "they are some of the most widely used drugs in the world and that an estimated 113 million prescriptions for the drugs are written for them around the world each year."

Bernstein notes that the Stanford study, published in the online journal PLOS One, recognizes that it was not designed to show cause and effect, and agrees that a large, prospective clinical study could establish whether the drugs are actually causing more heart attacks.

But one of the authors of the study, Nicholas J. Leeper, an assistant professor of cardiovascular medicine and vascular surgery at Stanford, told Bernstein that the U.S. Food and Drug Administration "should be aware of these findings" and "we do think patients should think about their risks and benefits and should discuss their risk with their doctor."

Nigam Shah, lead author of the research, cautioned that because some of these drugs are now available over the counter, it is important to tell your physician if you are taking them.

The research combed through 16 million electronic records of 2.9 million patients in two separate databases (one database was from hospital patients and the other from private office or clinic patients) and found that people who take the medication to suppress the release of stomach acid are 16 to 21 percent more likely to have a heart attack, Bernstein reports.

The research theorizes that proton pump inhibitors may reduce production of nitric oxide from cells that line the inside of the circulatory system, including the heart. Lower levels of nitric oxide have long been associated with cardiovascular problems, Leeper told Bernstein. This theory is being tested in the lab.

The Stanford study found no association between medications that combat heartburn by blocking histamine production, like Zantac and Pepcid, and increased risk of heart attack.

Almost one-third of teens have changed their health habits after looking up information on the Internet, study suggests

A decade-long study by researchers at Northwestern University about how teenagers use the Internet for health information found that almost one-third of adolescents report changing health habits after looking for information online, Lena H. Sun writes for the Washington Post.

The study also found that almost 25 percent of teens check the Internet to find information about health conditions their family and friends have. "While most teens rely on digital resources to learn more about puberty, drugs, sex and depression, among other issues, a surprising 88 percent said they did not feel comfortable sharing their health concerns with friends on Facebook or on other social networking sites," Sun writes.

"I mainly find it kind of moving because it really illustrates that a lot of teens are grappling with very real, very important health challenges and that the Internet is empowering them with the information they need to take better care of themselves," said Vicky Rideout, a co-author of the study.

Although the study found that parents are still the leading source of health information—55 percent of teens reported learning "a lot" of health information from parents—and health classes in school, doctors and nurses came in second and third, the Internet is the fourth-largest source of health information. "Eighty-four percent of teens said they turned to the Internet for health information," Sun reports.

Teens are still asking their parents health questions, and only 13 percent of those surveyed said they consult the Internet because they couldn't talk to their parents. "The Internet is not replacing parents, teachers and doctors; it is supplementing them," the researchers wrote.

Participants in the study were 1,156 American teenagers between 13 and 18 years old. "We need to make sure there is good information for teens online," Rideout said. Teenagers need to learn digital literacy skills and acquire the ability to tell the difference between advertising and content. (Read more)

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

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

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

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

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

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

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

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

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

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

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

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

Use of walking aids is increasing as population ages; study debunks notion that using them makes falls more likely

In the last 10 years, the use of walking aids—such as canes, wheelchairs and scooters—has increased by half, and is expected to grow as the number of seniors doubles in the next 35 years.

Research has shown a correlation between use of walking aids and falling, which is the leading cause of death resulting from injury for people 65 and older. However, a recent study in National Health and Aging Trends shows that people who employ mobility devices are not more likely to fall than those who do not use such devices.

Previous research that indicated the use of walking aids might increase the likelihood of falling "only looked within groups of people . . . who are already more likely to fall," said researcher Nancy Gell, assistant professor of rehabilitation and movement science at the University of Vermont. "This study is the most in-depth since 2004 and shows no link between mobility devices and falls as previously thought."

Gell reports that 16.4 percent of seniors use a cane, 11.6 percent use walkers, 6.1 percent use wheelchairs and 2.3 use scooters. Those who use canes are more likely to say they refrain from certain activities because of the fear of falling. "For many people, a cane is the appropriate device for their circumstance to stay mobile," Gell writes. "However, if worry about falling continues despite using a cane for support, it is worth considering a different device in order to be as active as possible."

"The question is if it's better to be active or sedentary and not risk falling," Gell writes. "We think it's better to be active."

Obesity and depression may contribute to daytime sleepiness

Obesity and depression, not just lack of sleep, contribute to daytime drowsiness, according to Penn State College of Medicine researchers. Daytime drowsiness or sleepiness affects up to 30 percent of the U.S. population. It can reduce work productivity and cause car accidents. According to the States of Obesity report, 33.2 percent of Kentucky adults are obese.

The Penn State study used physiologic sleep data to show a connection between obesity and depression or sleepiness. Study participants filled out a comprehensive sleep history and physical examination and were evaluated in a sleep laboratory. "Obesity and weight gain predicted who was going to have daytime sleepiness," said Julio Fernandez-Mendoza, assistant professor of psychiatry at the Sleep Research and Treatment Center. "Weight loss predicted who was going to stop experiencing daytime sleepiness, reinforcing the causal relationship."

Body mass index and sleepiness association was independent of sleep duration, so obese people might be sleepy during the day regardless of how much sleep they get. Obesity is also associated with sleep apnea. The chief reason heavy people are more tired is that fat cells create immune compounds called cytokines that make one sleepy.

According to the study, depressed people have daytime drowsiness because they have trouble falling asleep and often wake up during the night. "The mechanism that we believe is playing a role here is hyperarousal, which is simply going to bed and being to alert; in other words, people with depression feel fatigued but do not necessarily fall asleep during the day, Fernandez-Mendoza said.

The study showed that a one-size-fits-all method for treating daytime drowsiness will not be effective. Daytime sleepiness doesn't always mean a person doesn't get enough sleep, Fernandez-Mendoza said. "The main causes of a sleepy society are an obese society, a depressed society and, to some extent, people who have a physiological disorder. By looking at our patients more closely, we can start personalizing sleep medicine."

How do diet and exercise influence risk of diabetes? Diet seems more important

Many people think exercising and eating properly are interchangeable, but a paper by Edwards Weiss, associate professor of nutrition and dietetics at Saint Louis University, asserts that exercising and restricting diet results in specific and cumulative benefits in reducing the risk of Type 2 diabetes. According to the 2013 Kentucky Diabetes Report, 6.9 percent of Kentucky adults have diabetes.

Participants in the study were sedentary, overweight middle-aged men and women who reduced their weight 6 to 8 percent through calorie restriction, exercise or both. Researchers measured their insulin sensitivity levels, which determines risk of diabetes. "Your blood sugar may be perfectly normal, but if your insulin sensitivity is low, you are on the way to blood sugar issues and, potentially, Type 2 diabetes," Weiss said.

The researchers measured twice the improvement of insulin sensitivity in the group of participants who both exercised and restricted their diets than in the other two groups. Weiss notes that exercise helps regulate glucose, even if a person isn't losing weight as a result. The researchers also found that exercised-induced weight loss didn't regulate glucoregulation more effectively than calorie restriction. "What we found is that calorie restriction, like exercise, may be providing benefits beyond those associated with weight loss alone," Weiss said.

Weiss said that though it might seem obvious that a combination of diet and exercise would engender the best results, "there are a lot of people who believe that if they maintain a healthy weight, it doesn't matter what they eat. And others have an appropriate food intake but don't exercise."

Many Americans still don't use sunscreen, which has been proven to prevent skin cancer, the most common cancer in the U.S.

Sunscreen has been proven to reduce the risk for all types of skin cancer and to prevent or delay signs of aging, but most Americans still don't use it regularly, according to a new study by the federal Centers for Disease Control and Prevention.

The study, published in the Journal of the American Academy of Dermatology, found that only 14 percent of men and 30 percent of women regularly use sunscreen both on their face and other exposed areas. It also showed that more than 40 percent of men and 27 percent of women never use sunscreen on their face or other areas of exposed skin when outdoors for an hour or more, Carrie Myers reports for HealthDay News.

"The overwhelming majority of melanomas -- the deadliest form of skin cancer -- and non-melanoma skin cancers are associated with exposure to ultraviolet radiation from the sun," Dr. Deborah Sarnoff, senior vice president of the Skin Cancer Foundation, told Myers. "That's why daily sun protection is critical," she said.

The foundation recommends that when you are out in the sun you should seek shade, wear protective clothing, including a broad-brimmed hat, wear UV-blocking sunglasses and wear a broad-spectrum daily sunscreen that has an SPF of 30 or higher and is water-resistant,of which you should check the expiration date, Sarnoff told Myers.

The study also found that nearly 40 percent of sunscreen users didn't know whether their sunscreen provided broad-spectrum protection.

"Broad-spectrum means that the sunscreen protects the skin from both UVA and UVB rays. UVB rays are responsible for sunburns, while UVA rays go deeper into the skin, causing sagging and wrinkling. It is believed that both UVA and UVB rays play a role in skin cancer," Myers writes.

"To take advantage of the full protection your sunscreen offers, it should be applied thickly to all exposed skin and reapplied every two hours and after swimming, sweating, and toweling off," Dawn Holman, lead author of the study, told Myers. "Sunscreen is most effective when paired with other forms of sun protection."

Holman recommended products with physical blocks, such as titanium dioxide and zinc oxide, for those who shy away from sunscreens because they fear the chemicals in them. She also told Myers that everyone should avoid midday sun exposure because that is when the UV rays are most intense and encouraged people to check the UV index before going outdoors, saying, "The higher the UV index, the more sun protection you will need."

Skin cancer is the most common cancer in the United States, according to the CDC. The most severe form, melanoma, causes more than 9,000 deaths a year in the United States, Myers reports.

Deep in the brain may lie the secret of why some smokers quit easily and some find it nearly impossible

When a person tries to quit smoking, the cravings, headaches and lethargy that come from the nicotine withdrawal makes it near impossible for many to be successful. But this lack of success could also be a result of how a smoker's brain is wired, according to a study from Duke University.

The study, published in the journal Neuropsychopharmacology, used magnetic resonance imaging to look at the brain activity of 85 smokers who smoked at least 10 cigarettes a day.

Image from CNN (Click on it to see a larger version)

MRI revealed that "people who had stronger connections between two regions of the brain -- one involved in reward and the other in controlling impulsive behavior-- were more likely to be successful at giving up smoking, at least for 10 weeks," Carina Storrs reports for CNN.

"This is the largest study to date where we've attempted to identify neural markers, or predictors, of later success in quitting smoking," Joseph McClernon, associate professor of psychiatry and behavioral sciences at Duke, who led the current study, told Storrs.

The scans were taken one month before the quit date. Then, on their quit date, participants were given nicotine patches and were asked to check in with the researchers to report any relapses over the following 10 weeks.

The study found that the "key difference" was that those who were able to quit had more activity in the insula, a prune-sized section that lies deep in the brain, than those who did not quit.

Researchers can't explain why,but speculate that the insula "acts like a bridge, connecting the reward region with the behavior control regions," Storrs reports, noting that it has also been linked to other types of drug addictions such as alcoholism.

This study offers hope that doctors might come to identify smokers who have poor connectivity in their insula and offer them treatment to strengthen this connectivity. That could be good news for Kentucky, where almost 30 percent of adults smoke and many are trying to quit. Forty-five percent of Kentuckians reported in the CDC's Behavioral Risk Factor Surveillance System that they had tried to quit in 2012.

Jonathan Foulds, professor of public health sciences and psychiatry at Penn State, was not so hopeful, telling Storrs that not enough is known about specific treatments to tell whether they will increase insula connectivity, and that any such treatments will likely "not be affordable options anyway."

One of every three U.S. adults have a combination of risk factors that increase their risk for heart disease and diabetes

More than one-third of adults in the U.S. have a combination of health conditions that put them at higher risk of heart disease and diabetes, and this condition affects nearly half of adults aged 60 and older, according to a new study recently published in the Journal of the American Medical Association.

Image: healthyanswers.com

This combination of health conditions, when found in one person, is called metabolic syndrome. It includes abdominal obesity, high blood pressure, increased fasting glucose levels and abnormal cholesterol levels.

The study collected data gathered by the federal Centers for Disease Control and Prevention from adults 20 and older from 2003 to 2012. It found that about a third had a metabolic symdrome in 2011-12, and nearly half of those 60 and older did. Among those 20 to 39, the rate was 18 percent.

The study report says these were "concerning observations" because of the country's aging population. Hispanics, at 39 percent, were found to have the highest prevalence of metabolic syndrome among ethnic groups. Women had a higher prevalence than men in all age groups.

The American Heart Association says the best way to control the risk factors contributing to metabolic syndrome are to lose weight and increase physical activity. It also encourages patients to routinely monitor their weight, blood glucose, cholesterol and blood pressure and treat these risk factors according to established guidelines.

Louisville elementaries part of 'up to date' health curriculum study

Jefferson County Public Schools have partnered with researchers at the University of Virginia to study how integrating bi-weekly health and wellness instruction into its elementary curriculum will affect students over the years.

“Our aim is to test – using the best scientific methods – a health education curriculum that is up to date on skills children need for the coming world, and that can have important impact on school engagement and achievement, mental and physical health, and long-term well-being," Patrick Tolan, project leader and professor and director of Youth-Nex, U.Va.'s center to promote effective youth development, associated with the Curry School of Education, told WVIR-TV in Charlottesville.

The Compassionate Schools Project will offer "a 21st-century health curriculum," which includes "mindfulness for stress management and self-control; contemplative movements for physical awareness and agility, nutrition knowledge for healthy eating, and social and emotional skills for effective interpersonal relationships," for all K-5 students in 25 schools by fall 2016. It is being preceded by an introductory year in three schools.

Twenty-five other schools will participate in the research as control schools, where the existing “practical living” curriculum will remain in effect. The Virginia researchers will evaluate the impact of the curriculum for six years, which is expected to include more than 10,000 students.

According to the researchers, "the ability to implement this curriculum at such a large scale will provide sound evidence of how the curriculum works, for whom, and in what areas of academic, behavioral and emotional well-being over the course of several years."

The program was created by the U.Va. in partnership with the Sonima Foundation and with support from the Hemera Foudation, and is funded by private donors.

Kentucky had biggest increases in binge drinking, heavy drinking and any drinking from 2005 to 2012, first county-level study shows

By Melissa Patrick
Kentucky Health News

Kentucky has a relatively small percentage of drinkers compared to the rest of the nation, but it appears it is leading the nation in the increases in the percentage of people who are drinking any alcohol, drinking heavily and binge drinking, especially among women, according to a new analysis of county-level drinking patterns in the U.S.

The study took a look at any drinking, heavy drinking and binge drinking at a state and county level and found that Kentucky leads the nation in the percentage of increase in all three categories. Kentucky showed a 17.6 percent increase in any drinking, compared to no national increase; a 60.8 percent increase in heavy drinking, compared to 17.2 percent nationally; and a 29 percent increase in binge drinking, compared to 8.9 percent nationwide, between 2005 and 2012.

"It is surprising that there has been such a big increase in Kentucky in more people drinking," Ty Borders, professor of health management and policy at the University of Kentucky, said in an interview. "I'm not sure why that would be, especially because it was the only state that had this really big increase in drinking and risky drinking. ... It just really doesn't make sense."

Borders was perplexed at these outcomes, especially for the "any drinking" category, saying that because there is a greater percentage of persons who are members of religious affiliations that forbid drinking in the Southeast, people in this region tend to drink less. He expressed more confidence in the state and national estimates than the county-level estimates because of the often low response rates generated by the Behavioral Risk Factor Surveillance System on which the county estimates are based, but he said, "This is the best we have at the county level." The system is a continuous national poll by the federal Centers for Disease Control and Prevention.

Allen Brenzel, medical director for the state Department for Behavioral Health, Developmental and Intellectual Disabilities, emphasized in an interview that while Kentucky is well below the national alcohol abuse averages, this report shows an "alarming trend, regarding women particularly."

“It really does show that we need to be careful to not become so preoccupied with prescription drug abuse and opiate abuse,” he said. “We need to realize that alcohol is still a major issue when we see trends like this, we need to rebuild our education, prevention and treatment efforts.”

Borders agreed. "If you think about the overall burden on the health of the population, alcohol is still the top in terms of the effect it has on our health status and other downstream factors such as loss work productivity and also health-care costs," he said. "A lot of attention has been focused on obesity and illicit drug use, but alcohol misuse really remains a very big public health concern and it should be at the forefront of issues that we are discussing."

Brenzel said that while the BRFSS data is “more intended to be used across states and across regions of the country,” which makes it “a little bit challenging to break it down specifically” to counties, this data does show a statewide “absolute increase from the 2005 levels.”

He also said that this report conflicted slightly with a recent state report that shows a consistent decline in alcohol use and abuse in both boys and girls during the same time period. “Typically, what we see is that trends in children are usually reflected later in trends in adults,” he said.

Brenzel offered several possible reasons for the increases found in the report, but said it would take a while to “drill down” the specifics. He suggested one thing to investigate regarding the increases shown in women is whether it has become more socially acceptable in Kentucky for women to drink, especially with the increased marketing of liquor to women.

He suggested that the increased number of Kentuckians who are in the active military might have influenced the increases shown in this study, saying studies have shown that if a family has someone actively in the military, it tends to have higher drinking rates. He also noted that the socioeconomic strains that occurred between 2005 and 2012 could have also influenced these increases.

The study, "Drinking patterns in U.S. counties from 2002 to 2012," by the Institute on Health Metrics and Evaluation at the University of Washington, was published in the American Journal of Public Health and is the first study to track trends in alcohol use at the county level.

It defined "any drinking" as one drink in the past 30 days, "heavy drinking" as more than one drink a day for women and two drinks per day for men, and "binge drinking" as at least five drinks for men and four for women on a single occasion during the previous 30 days.

The data are adjusted for age, and the county figures reflect statistical modeling to compensate for small sample sizes. Click here for an interactive map of the data, which shows the possible ranges of percentages, reflecting the poll's error margin.

Drinking in Kentucky

The study found that nationwide, Kentucky showed the greatest increase in drinking, with a 17.6 percent (possible range of 10.6 to 25) increase between 2005 and 2012. No other state was even close; Tennessee ranked second at 11.3 percent and Louisiana was third at 9.8 percent. Nationally, there was no percentage increase in drinking during this time frame.

Kentucky women led the nation in increased drinking, at 21.9 percent, with Tennessee women at 17 percent. Kentucky men also led the nation in this category with an increase of 14.6 percent, followed by Louisiana at 9 percent and Tennessee at 7.3 percent.

In 2012, 43.1 percent of Kentuckians drank at least one drink per month, including 36 percent of women and 50.4 percent of men. Nationwide, 56 percent of Americans have at least one drink a month.

Heavy drinking in Kentucky

Kentucky also showed the nation's largest increase in heavy drinking, up 60.8 percent (possible range 39 to 89.5) between 2005 and 2012. Once again, no other state was close. South Dakota came in at 46.5 percent, Nebraska 45 percent, Kansas 44.5 percent and Washington, D.C., 42.2 percent. Nationally, the increase in heavy drinking was 17.2 percent.

Kentucky's increase was driven largely by women, who showed a 68.2 percent increase in heavy drinking. Nebraska (63.8 percent) and Oklahoma's (60.1 percent) women had the next largest increases in this category. Kentucky men also led the nation in this category with a 57.6 percent increase in heavy drinking, followed by Washington, D.C., at 52.1 percent. Other states were nowhere close to these numbers.

In 2012, 7.2 percent of Kentuckians self-reported as heavy drinkers, including 4.6 percent of women and 10 percent of men. Nationwide, 8.2 percent of Americans identify as a heavy drinker.

Heavy drinking is a risk factor for long-term health effects like cancers, liver damage and heart disease, according to the study.

Binge drinking in Kentucky

Kentucky also led the nation in increased binge drinking, up 29 percent (possible range 17.9 to 42.7) between 2005 and 2012, compared to 8.9 percent nationally. Washington, D.C, up 21.4 percent, and Maryland, up 20.8 percent, were next in the rankings for increased binge drinking.

This increase in Kentucky was also driven by women, with 51.4 percent more of them binge drinking between 2005 and 2012, compared to 17.5 percent nationally. This was far ahead of the next two state leading this category, Maryland women at 34.7 percent and Vermont women at 32.3 percent. Men in Kentucky increased their binge drinking by 20.7 percent, followed by Washington, D.C., at 17.9 percent and Kansas at 17.6 percent. Other states were not close.

In 2012, 15.1 percent of Kentuckians self-reported as binge drinkers, compared to 18.3 percent nationally, including 9.5 percent of Kentucky women and 21 percent of Kentucky men.

Binge drinking is commonly linked to higher risk for serious bodily harm like car crashes, injuries and alcohol poisoning and acute organ damage, says the study.

Nationwide, women showed a much faster escalation in binge drinking than men, with rates rising 17.5 percent between 2005 and 2012; men, on the other hand, saw rates of binge drinking increase 4.9 percent, according to the release.

“We are seeing some very alarming trends in alcohol overconsumption, especially among women,” Dr. Ali Mokdad, a lead author of the study and professor at the Institute for Health Metrics and Evaluation, said in a press release. “We also can’t ignore the fact that in many U.S. counties a quarter of the people, or more, are binge drinkers.”

County data

This report is the first to track trends in alcohol use at the county level, and while the confidence level for the county data are lower than the state data, the report found that every Kentucky county experienced increases in rates of drinking since 2005, with Lawrence County recording the largest increase in drinking at 43.5 percent (possible range 21.4 to 67.8).

Kenton County posted the highest levels of heavy drinking in 2012 (13.1 percent, with a possible range of 10.2 to 16.4), and Bracken County experienced the fastest rise in heavy drinking between 2005 and 2012, increasing 94 percent (possible range 42 to 188.8).

Pike County experienced the largest increase in binge drinking for women, climbing 90 percent (possible range 45.9 to 166.6), says the release.

Campbell County had the highest percentage of binge-drinking residents (27.3 percent with a possible range of 23.9 to 31.8), and Lawrence County recorded the fastest increase in rates of binge drinking, rising 52.8 from 2005 to 2012 (possible range 24 to 88.8).

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.