Sunday, May 10, 2015

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.

Friday, May 8, 2015

KentuckyOne Health is offering mobile screenings for risk of heart attack and stroke, and cancer prevention, for a price

For a price, KentuckyOne Health is offering a new, mobile, preventive screening program at various locations around the state.

Screening packages range from $179 to $347 and are designed to evaluate an individual’s risk of heart attack, stroke and cancer. Patients are responsible for the cost, since KentuckyOne is not accepting Medicare, Medicaid or private insurance funding to pay for it at the time of service, but patients can submit their final report findings to their health provider and insurer for consideration of reimbursement.

“Through mobile screenings we can now expand cardiovascular and other health screenings throughout the commonwealth, including areas that may have limited access to these tests,” Alice Bridges, KentuckyOne's vice president for healthy communities said in a press release. “A major goal of this program is to help people become more aware of their health status and encourage active involvement in proactively managing their health.”

Tests included in the exam are: echocardiogram; electrocardiogram (ECG or EKG); hardening of the arteries test; stroke/carotid artery ultrasound; abdominal aortic aneurysm ultrasound; peripheral arterial disease test; Know Your Numbers®; high sensitivity c-reactive protein test (hs-CRP); thyroid-stimulating hormone test; testosterone test; and prostate specific antigen test (PSA).

The screening unit has  private exam rooms and the process takes less than an hour, according to the release. Technicians use painless ultrasound technology to examine the patient's heart and arteries to identify potential health risks, and then board certified physicians examine all results before providing patients with the report. The process takes approximately one week. Patients are encouraged to take their report back to their primary health provider for follow-up.

Mobile screenings are also available for partners of KentuckyOne Workplace Care.

 “Mobile screenings will allow us to bring services to the employer to help employees monitor their health and meet wellness goals," Shirley Kron, regional director of KentuckyOne Health Workplace Care, said in the release.

More information, including dates and locations, is available at Kentuckyonehealth.org/screenings or -855-721-8378.

Thursday, May 7, 2015

UK HealthCare offers help to primary-care clinics; university's top health official calls it 'a game changer' for rural health providers

The Kentucky Primary Care Association and the University of Kentucky have announced a new partnership to provide support services to primary care providers throughout Kentucky.

This "groundbreaking partnership" will provide KPCA, which includes more than 800 patient care providers, access to UK HealthCare's support services, such as supply chain contracts, medical professional placement services, practice transformation support and training, and an after-hours pediatric call triage center, according to press release.

The most notable feature of the partnership is that KPCA members will have access to UK's group purchasing contracts, giving them access to services at heavily discounted rates at no charge to the facilities. This is expected to create "significant" savings for more than 250 clinics throughout the state. UK's top health official called it "a game changer."

“Primary care physicians, especially those in rural areas, have the extra burden of high patient volume, limited staff, and stretched resources,” Dr. Michael Karpf, UK's executive vice president for health, said in the release. “By partnering, UK HealthCare and KPCA members can grow important programs and services for their patients while also controlling and reducing operating costs.”

KPCA Executive Director Joe Smith said, "By addressing some of these issues related to costs, clinics with already scarce resources can instead focus on improving the quality of care.We’ve had a longstanding association with the university and UK HealthCare, and this partnership elevates that relationship by adding a strong commitment to assisting rural doctors, nurses and practice managers, who face some of the toughest transitions taking place in medicine today.”

The partnership will also allow KPCA members access to staffing services that link candidates to vacancies across the state; to Patient Centered Medical Home consultants, who help practices transition to quality and value-based models of care; and to UK HealthCare's after-hours pediatric call triage service.

Two weeks of high-fiber, low-fat diet brings changes that protect against colon cancer; high-fat diet brings changes with more risk

Two weeks is all it took for a change in diet to increase production of a substance in the gut that may reduce the risk of colon cancer, according to a recent study, published in Nature Communications.

The study asked 20 African Americans in Pittsburgh and 20 rural South Africans to switch diets for two weeks. The Americans were fed a high-fiber, low-fat diet, with plenty of fruits, vegetables, beans, cornmeal and very little meat, while the Africans were given a diet high in fat with lots of meat and cheese, Sindya N. Bhanoo reports for The New York Times.

“We made them fried chicken, burgers and fries,” Stephen J. D. O’Keefe, a gastroenterologist at the University of Pittsburgh and one of the study’s authors, told Bhanoo. “They loved it.”

After two weeks, colonoscopies on the volunteers found that the African Americans who ate the traditional African diet had "reduced inflammation in the colon and increased production of butyrate, a fatty acid that may protect against colon cancer," Bhanoo writes. Africans who ate the Western diet had changes in their gut bacteria "consistent with an increased cancer risk."

African Americans are disproportionately affected by colon cancer, while the disease affects few people in rural Africa, Bhanno notes.

Colorectal cancer is the second most common cancer in both men and women in the U.S. and is expected to cause about 49,700 deaths during 2015, according to the American Cancer Society. Kentucky leads the nation in both incidences and deaths from colorectal cancer, with 51.4 cases per 100,000 people and 18.7 deaths per 100,000, according to the Kentucky Cancer Registry.

Kentucky gets an $8.1 million federal grant to help teachers, other school personnel recognize students' mental-health needs

The Kentucky Department of Education has been awarded a five-year, $8.1 million federal grant to teach school personnel how to identify mental-health issues and get students the help they need, Brenna R. Kelly reports for Kentucky Teacher.

KDE was one of 120 state and local education agencies to get an Advancing Wellness and Resilience in Education grant last fall as part of President Obama's "Now Is The Time" initiative to decrease gun violence, increase access to mental health services and increase school safety.

It is estimated that up to one out of five children living in the U.S. experience a mental disorder in a given year, according to the National Research Council and Institute of Medicine.

Gretta Hylton of KDE’s Office of Next Generation Learners believes "that both KDE and local districts will be in a better position to get students the mental health help that they need," Kelly writes.

The grant program, Kentucky AWARE, will also create social media marketing campaigns, community events to promote mental health awareness and offer training on trauma-informed care in each of the pilot districts, to be provided by the Center on Trauma and Children at the University of Kentucky.

“More people will be able to recognize and respond appropriately to mental health issues in children,” Hylton told Kelly, “and will know how to connect those individuals with services in their hometown.”

Kentucky AWARE will be piloted in Jefferson County, Fayette County and Pulaski County schools and then move statewide. Hylton told Kelly that the three districts were chosen partly because they already have some mental-health and behavioral-intervention programs.

In addition to KDE, AWARE grants were awarded to Jefferson County, Fayette County, Bullitt County, Corbin Independent, Covington Independent and Henderson County school districts and to the Northern Kentucky Cooperative for Educational Services, Kelly reports.

School personnel, first responders, parents and anyone who interacts with youth in the pilot counties will be offered Youth Mental Health First Aid training, Kelly writes. Hylton told Kelly that she expected more than 10,000 people across the state to be trained at the end of the five-year grant.