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

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

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

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

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

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

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

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

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

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

The report is titled "Broken Promises to Our Children: A State-by-State Look at the 1998 State Tobacco Settlement 16 Years Later." It was also released by the American Heart Association, the American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers' Rights.

Anti-obesity program targets preschoolers, will expand to rural Kentucky next year

By Melissa Patrick
Kentucky Health News

The latest America's Health Rankings report ranks Kentucky as the 47th healthiest state, a fall from 45th last year. With the exception of one year, Kentucky has found itself ranked as one of the bottom 10 states since the rankings began in 1990.

How does Kentucky even begin to dig itself out of this hole?

The long-term answer will likely be found in changing the health habits of our children, which is exactly what the Kentucky Department for Public Health is trying to do by participating in the National Early Care and Education Learning Collaborative Project, a childhood obesity-intervention program that targets child-care and education providers for preschool children.

Kentucky is one of a few states in the program, and will be expanding next year to locations in southeastern and western Kentucky.

“Sustained well-being is made possible when people learn the lessons of a healthy lifestyle early on,” Health Commissioner Stephanie Mayfield said in a press release. “By working with the early-care and education community, we are able to reach many of Kentucky’s young children and help them build the foundation for being healthy and active.”

Child obesity has been considered a national epidemic, with 17 percent of U.S. children considered obese and almost 32 percent considered overweight. Kentucky ranks eighth in child obesity, with 19.7 percent between the ages of 10 and 17 obese, according to the Trust for America’s Health and the Robert Wood Johnson Foundation’s annual "The State of Obesity" report.

The same report says nearly 16 percent of low-income children under the age of 5 in Kentucky who are enrolled in federally funded maternal and child health programs are characterized as obese. That is the target population for the project.

The project, which is part of a multi-state pilot funded by the federal Centers for Disease Control and Prevention and managed by Nemours Children’s Health System, aims to fight back against this epidemic by placing a focus on improving nutrition, increasing physical activity, reducing screen time, and providing breast-feeding support through a national curriculum and learning collaborative method with early care and education providers, according to a Nemours press release.

Kentucky received a $275,000 grant from Nemours to be a part of this project. Currently, nine states participate in the National ECELC Project.

The first phase of the Kentucky Early Care and Education Learning Collaborative includes 65 early care environments in Jefferson County, Fayette County and Northern Kentucky. The programs represent Head Start classrooms, non-profit and commercial child care, private preschool and public preschool settings and has reached 7,559 children.

Phase II of the project allows funding to launch four more collaboratives in 2015. The first two will launch in March: a second one in Jefferson County, and one in Laurel County, which will include an invitation to the early-care programs in the surrounding counties to participate. The second launch will happen in October, but these locations, which will be located west of Interstate 65, have not yet been determined.

Child-care centers in the program "participate in group learning and action planning and have access to technical assistance, tools, materials and resources to aid in their continuous improvement. Information is shared within and between teams," the state press release said.

The project is not designed to measure child outcomes, which would add tremendous cost in both time and money to this project, Rebekah Duchette, Kentucky's project coordinator, said in an e-mail. But they are seeing positive results from the program.

"We are seeing changes in environments, policies and practices around nutrition, physical activity, screen time, breastfeeding, family engagement and juice consumption," she said.

One of the missions of the project is to implement and influence policy around childhood obesity. Kentucky has taken this charge to heart both at the program level as well as the state level.

"We are working on some exciting policy changes and equally exciting clarifications for programs. At the program level we see programs implementing policies that go above what the state of Kentucky requires in child-care regulations: centers that are incorporating fresh fruits and vegetables, changing to seasonal menus that expose children to a larger variety of foods, eliminating pre-fried and fried foods from menus, adding more physical activity to the daily schedules and using physical activity time as learning time," Duchette said.

"As part of our sustainability planning we are working with early education stakeholders to develop a proposed list of child care regulations that support the best practices in healthy behaviors. Additionally, we are working with various branches of the state that regulate child care to clarify some existing regulations and send a consistent message to early care programs about how to implement best practices and stay in compliance with all state and local regulations."

“Reaching kids early is the key to combating childhood obesity,” Debbie I. Chang, vice president of policy and prevention at Nemours, said in the press release.

Kentuckians rank high in colorectal cancer deaths; study will use emergency rooms to promote screening to save lives

University of Kentucky College of Nursing Associate Professor Jennifer Hatcher has received a two-year $359,528 grant for her project, “Promoting Colorectal Cancer Screenings in Rural Emergency Departments.”

The grant, given by the National Cancer Institute, will be used to study how effective motivational interventions are in helping non-emergency patients in rural Appalachian emergency departments to get screened for colorectal cancer, Hatcher said in an interview. Patients' companions in the emergency rooms can also participate in the interviews.

Of cancers that affect both men an women, colorectal cancer is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and in women, according to the Centers for Disease Control and Prevention.

Kentucky leads the way in these national health statistics.  It has the highest rate of colorectal cancer in the nation at 55.1 per 100,000 and is the fourth highest in the nation for deaths caused by colorectal cancer at 19.8 per 100,000. And those in Kentucky's Appalachian counties have a higher incidence rate than the rest of the state and nation overall at 57.2 percent, according to a Kentucky Colon Cancer Screening Program annual report.

“Residents of rural Appalachia have a higher incidence and mortality rate from colorectal cancer than residents of any other region of the country," Hatcher said in the release. "In light of the fact that colorectal cancer is one of the few cancers that can actually be prevented by screening, this grant presents a tremendous opportunity for us to address one of the key factors affecting this disparity for rural Appalachians—limited access to the health care system."

The interventions for the study will be conducted by lay health workers, trained local people who are interested in the health of the community and helping their neighbors get screened. They will talk to the patients or their companions about their perceived barriers related to colorectal screening and help them work toward resolving those barriers. All interactions are voluntary, Hatcher said in an inteview.

The lay health workers act as connections between the patients and whatever resources they may need to get screened, or helps alleviate fears they may have about colorectal screening. They are also trained to provide education on what types of screenings are available and discuss what is best for each individual.

Patients who agree to the intervention will get a follow-up call one week after the emergency room intervention to see if they need further assistance in setting up a screening and will receive yet another call in three month.

The project will be the first to address the disproportionate incidence and mortality from colorectal cancer in rural Appalachia utilizing the emergency department as an access point, says the release.

"We believe that using an emergency department as an access point for this project will allow us to reach more individuals who are at risk for developing colorectal cancer, thereby reducing the disparate mortality rates that rural Appalachians suffer from this disease,” Hatcher said in the release.

KET program to host authors of "Life Lessons from Cancer" to discuss inspirational messages of book

"One to One" with Bill Goodman will feature the authors of Life Lessons from Cancer, Keen Babbage and his sister-in-law Laura Babbage, on Sunday, Dec. 21 at 1 p.m. ET to discuss the book and its inspirational messages, especially the importance of family when facing life's challenges.

Keen Babbage, a teacher and native Lexingtonian, was diagnosed with cancer in his late 50s, despite a lifetime of healthy habits. He felt moved to share his experience in print.

With the help of his sister-in-law, a registered nurse and chaplain at the Chandler Medical Center at the University of Kentucky, they wrote Life Lessons from Cancer, published in September.

Keen told an audience at the first promotional event in October that he hoped the lessons in the book would be an inspiration and offer guidance for other patients with cancer as well as a resource for health-care providers.

The show will also air on Tuesday, Dec. 23 at 7:30 p.m. ET on KET2.

Study: Secondhand smoke and road pollution contribute to obesity in children more in combination than separately

Diet and physical activity aren't the only causes for the obesity epidemic that is sweeping our nation; a recent study finds that secondhand smoke and roadway pollution are also contributors, Ryan White writes for Reporting on Health.

Photo by ctvnews.ca

Researchers at the University of Southern California have found that secondhand smoke and roadway pollution contribute to body-mass-index increases and obesity in children. The study is published in Environmental Health Perspectives.

“Our findings strengthen emerging evidence that exposure to tobacco smoke and [near-roadway pollution] contribute to development of childhood obesity and suggest that combined exposures may have synergistic effects,” the study’s authors write.

The study collected data on 3,318 students through home questionnaires about tobacco exposure in homes, and scientifically estimated each student's exposure to roadway pollution, White reports. Meanwhile, the student's BMI was measured annually between ages 10 and 18. "BMI levels estimate body fat based on height and weight. “Normal” weight scores range from 18.5 to 24.9, with higher figures considered overweight and 30 the threshold for obesity"

The study allowed for a long list of "confounding variables," or other factors that might be responsible for these elevated BMIs, including: team sports participation, asthma history, social makeup of family and neighborhood, parents’ education, neighborhood walkability, recreation facilities, population density, unemployment rates and so forth, White reports.

"After crunching the data, researchers found that exposure to high levels of roadway pollution alone was associated with average increases of 0.80 BMI units over the eight-year study, while children with secondhand smoke exposure and low roadway pollution averaged 0.85 units higher, compared to similar peers. But when investigators looked at children with high exposures to both tobacco smoke and air pollution, their BMIs were on average 2.15 higher over eight years," White writes.

This is the first study to look at tobacco smoke and air pollution in combination. Other studies have looked at each of these contributors independently and found "secondhand smoke is associated with increased obesity risk in children and patterns of overweight children from mothers who smoked during pregnancy are well documented," White writes. Another study associates "prenatal exposure to roadway pollution with higher BMI and obesity by age 7."

But White notes that socioeconomic status, while ruled out as a "confounder," must still be considered as those who have a lower socioeconomic status are more likely to smoke, live in neighborhoods bisected by busy roadways, have less access to healthy foods and fewer places to exercise.