U of L dean says $50 billion in annual health costs could be saved if Americans just walked more

Small changes in health behavior can have a huge impact on the public's overall health and well-being, and during National Public Health Week discussions last week, Dr. Craig Blakely, the new dean of the University of Louisville School of Public Health and Information Sciences, talked about the important role played by public health in promoting healthy behavior, preventing disease and saving both lives and money.

Blakely pointed to obesity as an example of an emerging health-related crisis, which can be addressed with behavioral changes that make a significant difference like adding more physical activity to your day, according to a U of L release.

“If we all took exercise seriously by just walking, we could save $50 billion in cardiovascular disease-related costs,” Blakely said. “A 10 percent weight loss equals a $5,000 savings in health-related complications. A typical desk worker could lose a pound a month by standing two hours a day.”

Blakely also addressed smoking bans, which are becoming popular in Kentucky, even though the state has the highest share of smokers (29 percent) of any state, leads the nation in high-school smokers (24 percent) and spends only a minuscule portion of its tobacco revenues to fight tobacco use, according to the Centers for Disease Control and Prevention.

If every state adopted comprehensive smoke-free policies, said Blakely, $2 billion would be saved in smoking-related deaths, lung cancer treatments and care for related health complications over the course of several years, says the release.

Blakely highlighted several other examples of public health’s potential return on investment. For example, says the release, every dollar spent on childhood immunizations saves $18 on vaccine-preventable disease-related costs, every dollar spent in prenatal care translates to $6 in health care cost savings and for every dollar spent on fluoridated water saves $20 in dental care.

Public health research will continue to find effective ways to generate these cost savings, such as finding researching how to modify environments to encourage exercise or how to send strong messages that promote regular physical activity (Read more)

Survey finds employees pay greater share of health costs, and most large employers penalize them for using tobacco

As large employers respond to changes influenced by health care reform and rising costs of care, employees are paying a greater portion of their health-care costs. That trend that is likely to continue over the next few years, says a new report on employer-based health plans.

Although employers cover most costs of work-based plans, employees contribute 42 percent more for health coverage than they did five years ago, while employers paid 32 percent more, according to the study from the benefits consultant Towers Watson and the National Business Group on Health. Overall, costs went up 34.4 percent.

When employers were asked if they thought health plans would change by 2018, which is the year the excise tax on high-cost plans takes effect, 92 percent said plans would be different, and nearly half said they expect a significant or transformative change. Such change will increase both accountability and engagement for employees.

% of large employers saying they were "very confident" they would offer health benefits in 2022

Nearly two-thirds of employers surveyed offer employees financial rewards to encourage participation in health programs, according to the report, which said tying employee contributions to successful completion of specific tasks, such as health assessments and screenings, remains the most popular contribution strategy. Growth in the use of penalties to engage employees in health-program participation has slowed over the last two years, but the use of surcharges for tobacco use continues to grow. By 2014, 62 percent of surveyed companies are expected to apply tobacco-use surcharges.

"While U.S. employers remain committed to health care benefits for active employees over the next five years," the report says, "they are redifining their financial commitment in the short run and are more reluctant to commit to coverage for employees over a longer period."

The 18th annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care tracks employers' strategies and practices. It was completed by 583 employers,between November 2012 and January 2013. The report says it identifies the actions of the best performing companies as well as current trends in health-care benefit programs of U.S. employers with at least 1,000 employees. Survey respondents collectively employ 11.3 million full-time employees and have 8.5 million employees enrolled in their health care programs. Download a report PDF by clicking here.

Smoking ban gets 'a good scrubbing' before Judiciary Committee

By Al Cross
Kentucky Health News

The bill for a statewide smoking ban is favored by three-fifths of Kentucky adults, but is dead for this session of the General Assembly. However, its supporters think they made some headway Monday as they laid groundwork for getting it through the state House a year from now.

The House Judiciary Committee held an informational hearing on House Bill 190 to "give it a good scrubbing" before a committee that is more skeptical of it than the Health and Welfare Committee, which approved it early in the session, the bill's sponsor, Rep, Susan Westrom, D-Lexington, said afterward.

Westrom said she was encouraged by the hearing because it exposed weaknesses in the bill that she will correct for the next regular session, beginning in January 2014. For example, she said, Rep. Steven Rudy, R-Paducah, argued that the bill's language would make it illegal to use smoke in barns to cure the dark tobacco grown in Western Kentucky, largely for smokeless consumption.

"This is about vetting," Westrom told Rudy. "You have a different mindset that I do sitting on the Health and Welfare Committee."

Rudy acknowledged that secondhand smoke is not beneficial, but asked, "Has there ever been a death certificate that secondhand smoke killed this person?"

Dr. Sylvia Cerel-Suhl, Central Kentucky president of the American Heart Association, replied that Lexington recorded a significant drop in acute heart attacks after enacting a smoking ban, and said "thousands of studies" of secondhand smoke have shown exposure to it can cause premature death.

"The evidence is absolutely overwhelming," she said, and asked if anyone else had any questions. No one did, but the committee was one member short of a quorum.

Advocates told the legislators that 37 jurisdictions, covering 34 percent of the state's population, limit smoking in some way. Mark Hayden, a trial lawyer and former Campbell County commissioner, said a statewide ban is needed because enacting ordinances, writing regulations and enforcing them is a burden for local officials.

The bill would give local health departments power to enforce the ban. Scott Lockard, president of the Kentucky Health Departments Association and the health director in Clark County, said his agency has issued no court charges, only warning citations, since its board passed a ban, and Woodford County has issued only three citations.

Others appearing at the hearing included Dr. Stephanie Mayfield, commissioner of the state Department of Public Health, and Lt. Gov. Jerry Abramson, who was invited by the Kentucky Smoke-Free Kentucky Coalition. He discussed enforcement of of the ban in Louisville, where he was mayor.

Rep. Tom Riner, D-Louisville, said the ban is "one of the most important pieces of legislation that has been brought before this body, because it literally affects every Kentuckian. . . perhaps the most important piece."

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

Lack of statewide smoking ban represents one part of Kentucky's struggle to deal with tobacco use and the health issues it creates

By Molly Burchett

Kentucky Health News

As the bill for a statewide smoking ban lies on its deathbed in the General Assembly, new federal data show Kentucky still has the highest percentage of smokers (29 percent) of any state, leads the nation in the share of smoking high school students (24 percent) and spends only a minuscule portion of their tobacco revenues to fight tobacco use. Those figures come from the federal Centers for Disease Control and Prevention's Tobacco Control State Highlights 2012 report. (For county-by-county figures, click here.)

The lack of a statewide smoking ban, which nevertheless has become popular among Kentuckians, represents only a small part of the struggle to address Kentuckians' tobacco use and resulting health problems. Kentucky's program to discourage tobacco use has been severely underfunded for years, contributing to the state's lack of or slow progress in reducing its smoking and tobacco use rates and subsequent health problems, said Dr. Ellen Hahn, director of the Kentucky Center for Smoke-Free Policy at the University of Kentucky.

State tobacco revenue (left bar) and spending (right bar)

The CDC says Kentucky should spend $57.2 million a year to have an effective, comprehensive tobacco-prevention program, but the state allocates only $2.1 million a year to such programs -- 3.7 percent of the recommended amount.

By another measure, the amount is only 0.6 percent of the estimated $381 million the state gets from tobacco taxes and the 1998 national settlement with cigarette manufacturers, according to a tobacco settlement report.



Meanwhile, Kentucky's health-care costs attributable to smoking add up to about $1.5 billion a year, and smoking-caused productivity losses total $2.3 billion a year. These amounts do not include health costs caused by exposure to secondhand smoke, smoking-caused fires, smokeless tobacco use or cigar and pipe smoking.

Despite the known health risks that tobacco use poses, smoking in Kentucky remains a part of everyday life in most places. But that is increasingly less so around the country, so there is an increasing gap between heavy-smoking and low-smoking states; smoking in Kentucky is about twice as prevalent as in Utah and California, reports Steven Reinberg of HealthDay. Click here for an interactive map of states' tobacco prevention efforts.

There are proven, multi-pronged strategies to curb smoking. They include combinations of higher tobacco taxes, smoke-free laws, media campaigns, and restricted access to tobacco products. However, Kentucky continues to lag behind other states due to "stagnant policies" and a lack of funding, said Hahn.

Many other factors contribute to Kentucky's lack of tobacco-prevention progress. By failing to substantially reduce adult smoking, the state misses opportunities to encourage younger adults and children not to smoke, Hahn said. Kentucky needs to employ strategies that communicate the success and affordability of tobacco cessation programs, she said; people often lack the encouragement to quit smoking because they don't know how or they don't believe it is possible.

The latest tobacco report is a timely reminder that tobacco use remains a huge public health problem for Kentucky and there are proven strategies that, if implemented, could help Kentuckians live a healthier, tobacco-free life.

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

Beshear endorses statewide smoking ban as bill moves to the House floor; Williamsburg adopts its own ban

Gov. Steve Beshear endorsed a statewide smoking ban yesterday at a Frankfort rally to push the bill that would enact the ban.

"Beshear, who later acknowledged that he smoked in college but quit soon afterwards, said Kentucky ranks No. 1 in the nation in smoking and lung cancer," reports Jack Brammer of the Lexington Herald-Leader.

Noting that Kentucky leads the nation in smoking, Beshear said, "Our addiction hurts productivity, jacks up health care costs and literally kills our people. Yet we've never instituted a statewide law to protect Kentuckians from secondhand smoke." Noting that over one-third of Kentuckians live in jurisdictions with smoking bans, he said, "It's time that we extend that protection to all Kentuckians. . . . Years from now, people will wonder why we waited so long."

Republican Rep. Julie Raque Adams  of Louisville, a co-sponsor of the bill, noted at the rally that Williamsburg this week became the 23rd Kentucky locality to adopt a smoking ban.

The statewide measure, House Bill 190, was posted for passage in the House today but is not expected to be called for a vote unless supporters show Speaker Greg Stumbo that they have the votes to pass it.

Read more here: http://www.kentucky.com/2013/02/14/2517025/former-kentucky-basketball-star.html#storylink=cpy

Statewide smoking ban close to House vote, Stumbo says

For the second straight year, the state House Health and Welfare Committee has approved a bill that would ban smoking in enclosed public places or workplaces. It is still unlikely to become law, but might get farther in the legislative process.

"The proposal has never been voted on by the full House, and it would probably have a rough road in the Republican-controlled Senate," Beth Musgrave reports for the Lexington Herald-Leader. "Senate President Robert Stivers, R-Manchester, said that the government shouldn't tell businesses they cannot regulate smoking on their own property." (Stivers' hometown does just that; it is one of 22 Kentucky jurisdictions with smoking bans.)

House Speaker Greg Stumbo told Musgrave that he supports the measure, House Bill 190, and that sponsors are close to getting the votes it needs to pass the full House. The House has 100 members, but a bill can pass with as few as 40 votes as long as enough members abstain and it has a plurality.

The bill passed the committee Wednesday by a vote of 11-0, with four Republicans abstaining: Reps. Tim Moore of Elizabethtown, Robert Benvenuti of Lexington, Ben Waide of Madisonville and Addia Wuchner of Burlington.

Rep. Julie Adams of Louisville, the bill's Republican sponsor, told Musgrave that 29 states have statewide smoking bans, 24 with bans like the bill would impose. "This is a mainstream issue," she said. "The Kentucky General Assembly is way behind the general public." (Read more)

Basketball star Derek Anderson will join Smoke-Free Kentucky for its annual lobbying day in Frankfort Thursday, Feb. 14. He said in a press release, “Kentucky has so much to be proud of.   We are known for our hoops and horses.  Unfortunately, we are also number 1 in the number of deaths from lung cancer.  This is unacceptable to me. I want to be a part of the movement to change that.”  He added, “I am a businessman.  Smoke-free workplaces make good economic sense.” (Read more)

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Beshear calls for action to improve state's health, but says only that 'It's time for us to begin looking seriously' at a smoking ban

By Al Cross
Kentucky Health News

His priorities were education and tax reform, but Gov. Steve Beshear mentioned several health issues in his State of the Commonwealth speech tonight to a joint session of the General Assembly.

Beshear called for action to correct the state's "fundamental weaknesses," including "a population whose health ranks among the worst in the nation." Near the end of his speech, he said, "We need to continue improving the health of our people," but after about a minute of discussing tobacco and smoking he stopped short of endorsing a statewide ban on smoking in the workplace. (KET photo)

"It's time for us to begin looking seriously at doing this on a statewide level," he said to some applause, after noting that nearly half of Kentuckians live in jurisdictions where smoking is legally restricted, that the state has the highest or next-to-highest smoking rate overall and among teens and pregnant women, and that "Our smoking-related mortality rate is the worst in the nation. . . . Our addiction hurts productivity, jacks up health care costs and kills our people."

Beshear called for improving prenatal care and newborn screening, and for minor improvements in last year's bill to fight prescription drug abuse. He said the bill has caused a precipitous drop in abuse of prescription painkillers. "Kentucky at one time had the sixth highest rate in the nation, but . . . we improved 24 spots," he said. "Nearly half of the state's known pain management clinics have closed rather than submit to new rules that protect patients." He said use of the Kentucky All Schedule Prescription Electronic Reporting system "has increased nearly seven-fold . . . and prescriptions for some of the most abused drugs have dropped up to 14 percent from a year ago."

However, the problem of babies becoming addicted to drugs in their addicted mothers' wombs has skyrocketed in the last decade or so, Beshear said: "In 2000, reports showed 29 babies in Kentucky born addicted to drugs. But in 2011, there were 730 babies – more than 25 times as many. And that figure is thought to be under-reported." He did not say how he wants to improve screening.

Beshear did not mention perhaps the biggest health policy question facing the commonwealth, whether to use federal subsidies to expand the Medicaid program to people in households earning up to 138 percent of the federal poverty threshold. Now the program covers people in households earning up to 70 percent of the poverty line. The federal government would pay all the cost of the additional enrollees through 2016, when the state would start picking up part of the tab, up to 20 percent in 2020.

Some Republicans say the state can't afford the expansion, while some Democrats say it would be a good long-term investment in the state's health and economy. Beshear has said he wants to do it if the commonwealth can afford it, and expects to get cost estimates around the end of March -- about the time the legislature must adjourn.

For a PDF of the speech text, click here. For an audio recording, go here. For video from KET, here.

Health reform will let insurers charge smokers up to 50 percent higher premiums, which is likely to have a big impact in Kentucky

"Millions of smokers could be priced out of health insurance" because the health-care reform law will let health-insurance companies charge smokers as much as 50 percent more starting next year on individual policies, according to experts who are just now teasing out the potential impact of a little-noted provision in the massive legislation," The Associated Press reports.

The provision is likely to have a major impact in Kentucky, where 29 percent of adults are smokers, a figure exceeded by no other state, and where 25 to 30 percent of people under 65 are estimated to have no health insurance.

"For a 55-year-old smoker, the penalty could reach nearly $4,250 a year" AP reports. "A 60-year-old could wind up paying nearly $5,100 on top of premiums. Younger smokers could be charged lower penalties under rules proposed last fall by the Obama administration."

A state health insurance exchange, now being created under the law, will be a place to buy insurance with tax credits depending on income. Gov. Steve Beshear has said he wants to expand the state Medicaid program to cover people in households with incomes up to 138 percent of the federal poverty level, but many Republicans in the legislature are opposed to that because the state would ultimately have to pay 10 percent of the expansion's cost.

The provisions to discourage smoking would allow employees covered by employer plans to avoid penalties by joining smoking-cessation programs,"but experts say that option is not guaranteed to smokers trying to purchase coverage individually," AP reports.

There is concern about the provision's effect on older smokers who "could face a heavy hit on their household budgets at a time in life when smoking-related illnesses tend to emerge. . . . Several provisions in the federal health care law work together to leave older smokers with a bleak set of financial options," AP reports, citing Karen Pollitz, a health-insurance expert with the Kaiser Family Foundation and former deputy director of the Office of Consumer Support in the U.S. Department of Health and Human Services.

Pollitz notes that the reform law lets insurers charge older customers up to three times as much as their youngest customers; charge the full 50 percent penalty on older smokers while charging less to younger ones; and does not allow smokers to use tax credits to offset the cost of the penalty.

And there's a good argument to charge the full penalty, insurance consultant Robert Laszewski told AP: "If you don’t charge the 50 percent, your competitor is going to do it, and you are going to get a disproportionate share of the less-healthy older smokers,” said Laszewski. “They are going to have to play defense." (Read more)

UK quickens drumbeat of tobacco-free policy through report line

The University of Kentucky promotes compliance and enforcement of its tobacco-free policy through a community report line, among many other measures.  Although the report line was established last spring, its mention in recent campus communications suggests a hightened emphasis on compliance measures. 

The line to report violations of the smoking ban engages the community in developing an environment in which compliance is expected, said Dr. Ellen Hahn, a nursing professor and co-chair of UK's Tobacco-free Taskforce and director of its Kentucky Center for Smoke-free Policy.

"Since these policies are self-enforcing, we need a mechanism by which everyone on campus can easily report violations," Hahn said. "Most people do not feel comfortable approaching a violator, so this is a way to encourage everyone to be involved in promoting compliance." She said the report line was a suggested "best practice" from other campuses with similar policies.

Implementation of the policy, the ultimate goal of the policy is to promote a healthy place to live, work and learn, has been a success, Hahn said: The air is healthier, and exposure to secondhand smoke has decreased. Also, since the policy was established in the fall of 2009, there has been a four-fold increase in the use of nicotine replacement to quit using tobacco, and UK has many low- or no-cost options to help students and employees do so.

Click here to report a violation of the tobacco-free policy, here for a tobacco-free brochure. 

Williamsburg in line to pass smoking ban next month

An ordinance imposing a smoking ban in Williamsburg is ready for a City Council vote. The council listened Monday to the first reading of the ordinance, required before a vote, which could follow the second reading, planned for Feb. 11. If approved, the ban would take effect immediately, reports Mark White of the Corbin-Whitley News Journal.

The new ordinance says “Smoking shall be prohibited in all enclosed areas within all enclosed buildings open to the public and within places of employment,” reports John Ross of The Times-Tribune of Corbin. “Enclosed buildings” includes libraries, bars, bingo houses, child- and adult-care facilities, public and private educational facilities, gaming facilities, restaurants, pool halls, lobby areas and hallways in all multi-residential buildings, such as apartments and condominiums, and hotels and motels, Ross reports. In December 2011, the Corbin City Commission implemented a ban that prohibits smoking in similar locations and within 25 feet of main entrances and exits.

Ross's account of the meeting included no negative comments. Mayor Roddy Harrison said, “I know both sides of the issue — but our job is to protect everybody.” Harrison said he found extensive research to back up the negative effects of secondhand cigarette smoke while researching the ordinance.

Passive smoking causes dementia

While scientists from Moscow State University named after Lomonosov studied the presence of nanotechnology in everyday life, researchers from the University of Melbourne in the state, investigated the effects of passive smoking on people. Despite the fact that the matter was in principle long understood, they were able to make the discovery.

It turns out that passive smoking can cause the development of severe dementia. This study was the first that was able to point out the relationship between passive smoking and neurological diseases.

Previously, passive smoking could cause the development of cardiovascular and respiratory diseases, which include lung cancer and coronary heart disease. But until now, no one knew that passive smoking can cause dementia.

Consider the matter lasted more than 11 years. during the survey polled more than 7,000 respondents, who were more than 60 years. teaching a group of volunteers involved in the survey on the subject of dementia in three time periods: 2001-2003, the 2007-2008, and 2011-2012. They also conducted a survey, which was such a sense of "you are subjected to tobacco smoke?". As it turned out, 10% of respondents had symptoms of severe dementia. It is worth noting that most of the people who had seen the signs of the disease, smoking or quit smoking. Therefore, smokers should think, and come to grips with their health.

Coalition of health groups launches two-week ad campaign to drum up support for a statewide smoking ban

A geographically targeted newspaper and online advertising campaign calling for "a comprehensive, statewide smoke-free law" is hitting Kentucky media outlets this week, as the legislature convenes, and next week. The campaign was launched by Smoke-Free Kentucky Coalition, the Campaign for Tobacco-Free Kids and the Robert Wood Johnson Foundation. The newspaper ad can viewed here.

Twenty-nine percent of Kentucky adults are smokers, giving the state the highest smoking rate in the U.S., and ranks very high in youth smoking, according to the Centers for Disease Control. Kentucky also has the nation's highest lung cancer death rates, 87 percent of which are caused by smoking, according to the National Cancer Institute. The state also "lags behind other states in enacting a comprehensive, statewide smoke-free law that covers all indoor workplaces, including bars and restaurants," a press release about the ad campaign says. Twenty-four states have smoking bans. A fall poll for the Foundation for a Healthy Kentucky showed that 59 percent of Kentucky adults support a smoking ban in workplaces, restaurants and bars. For a story on the poll, click here.

Tobacco-Free Kids communications manager Catherine Butsch said the ad is running in the Lexington Herald-Leader, the Messenger-Inquirer of Owensboro, the Daily Independent of Ashland, the Commonwealth Journal of Somerset, the Kentucky New Era of Hopkinsville, the Glasgow Daily Times, the Paducah Sun, the Paducah-based West Kentucky News, the Sentinel-Echo of London, the Lebanon Enterprise, the Jessamine Journal, the Tompkinsville News, the Carlisle Weekly of Bardwell, the Fulton Leader, the Marshall County Tribune Courier, and the Kentucky Gazette, a government-oriented twice-monthly in Frankfort. The online ad will run on websites of the Herald-Leader, Business Lexington, The Lane Report and CN2, a cable news service. The campaign will cost $93,000, Butsch said.

3 in 5 Kentucky adults favor a statewide smoking ban, according to an independent poll that may have oversampled smokers

By Al Cross
Kentucky Health News

Kentuckians now favor a statewide smoking ban by a margin of 3 to 2, according to the latest Kentucky Health Issues Poll conducted last fall for the Foundation for a Healthy Kentucky. Interestingly, 38 percent of the Kentucky adults polled said they were smokers, much more than the 29 percent found by a year-long federal survey. Among those identified as smokers, 37 percent favored such a law, while it was favored by 68 percent of former smokers and 75 percent of those who said they had never smoked.

Overall, 59 percent of those polled said they supported a state law that would prohibit smoking in most public places, including workplaces, public buildings, offices, restaurants and bars, while 38 percent said they opposed it and 4 percent said they had no opinion. The figures showed a 5-point shift toward support since the last poll, in 2011. The gain was among smokers and former smokers.

Support for the law was higher among registered voters than non-voters, perhaps a consideration for legislators considering the proposal. Among voters, 62 percent favored it while 36 percent opposed it. Only 50 percent of nonvoters supported it. Support was slightly higher among Republicans (64 percent) than among Democrats (59 percent; only 44 percent of independents, who comprise about 7 percent of Kentucky voters, said they supported it. The poll also found that support for the law increases as age and income increase.

As for the apparent oversampling of smokers, pollster Eric Rademacher said self-reporting of such habits is known to vary according to time, and the differences in his poll and the federal survey "are likely due to the different time frames in which they were conducted and the different methodology employed by each study." He added, "For example, a person who regularly smokes might openly disclose that information at one point in the year. However, at another point in the year, that same person might be directly exposed to news or advertising that paints smoking in a negative light from a societal perspective. Hearing that information could make the person more reluctant to discuss their smoking behavior with researchers soon after they have seen or heard it.”

Rademacher is co-director of the Institute for Policy Research at the University of Cincinnati, which did the poll for the foundation and the Health Foundation of Greater Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone from Sept. 20 to Oct. 14. This included 1,360 landline interviews and 320 interviews with cell phone users. In 19 of 20 cases, each statewide figure will be accurate to plus or minus 2.5 percentage points. Smaller samples, such as those of smokers and non-smokers, have larger margins of error. There are other sources of variation inherent in public opinion studies, such as non-response, question wording, or context effects that can introduce error or bias. For a copy of the poll's full questionnaire and guidance to interviewers, click here. For more information, go to www.healthy-ky.org
or www.healthfoundation.org/kentucky-health-issues-poll.

The Foundation for a Healthy Kentucky noted the health implications that a smoke-free law would address: "Secondhand smoke poses serious health risks. Smoke-free environments are the only way to fully protect nonsmokers from these hazards. To reduce these risks, many Kentucky communities have adopted smoke-free policies. On Jan. 1, 2013, Hopkinsville became the 22nd municipality in Kentucky to implement a comprehensive smoke-free ordinance or regulation," bringing to 34 percent the share of Kentuckians who live in jurisdictions covered by comprehensive smoke-free ordinances or health-department regulations. For a list of the communities and percentages, and those with bans that are less than comprehensive, from the Kentucky Center for Smoke-Free Policy, click here.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

U.S. teens' cigarette use drops to a new low, but use of alcohol goes up a bit and more 12th graders are smoking marijuana

Teenagers' cigarette smoking dropped to a record low this year but alcohol use rose slightly after seven years of decline, according to a survey of 45,000 eighth-, 10th- and 12th- graders for the National Institute of Drug Abuse.

The survey also found that the use of illicit drugs dropped slightly among eighth-graders but rose slightly among 12th-graders. Among them, 36.4 percent reported using marijuana in the past year, up from 34.8 percent in 2010, and the share who saw great risk in smoking marijuana occasionally dropped significantly, to 20.6 percent, from 24.5 percent in 2010.

Among all three age groups, only 10.6 percent said they had smoked cigarettes in the past 30 days, down from 11.7 percent in 2010. The University of Michigan researchers who did the survey said the decline was significant, and may have been driven by a big increase in the federal tobacco tax in 2009.

"A 1-percentage-point decline may not sound like a lot, but it represents about a 9 percent reduction in a single year in the number of teens currently smoking," principal researcher Lloyd Johnston said in a news release. Among eighth-graders, the decline was about 20 percent. For other results of the survey, click here; for a PDF version, here. For the full survey report, go here.

"Teen attitudes toward smoking also continued to become more negative. For example, 80 percent of teens said they preferred to date nonsmokers in 2012," Steve Gorman reports for Reuters. "But anti-tobacco advocates said their battle to stamp out teen smoking was far from over, noting that 17 percent of high school seniors still graduate as smokers." And the figure is higher in many rural areas.

Kentucky ranks at or near the top in youth smoking. In 2010, the last year for which state figures are available, 16 percent of Kentucky children aged 12 to 17 (a slightly younger group than the one above) reported smoking a cigarette in the past month. The national rate for that age group was 10 percent, according to the Centers for Disease Control and Prevention.

Dollar General to sell tobacco in most of its stores by mid-2013, reflecting 'customer demand' and 'competition pressure'

By the middle of 2013, most of Dollar General's 10,000 U.S. stores will carry cigarettes and other tobacco products.. The company has made the decision in response to “competitive pressures” which came about when Family Dollar Stores, a key competitor, began adding cigarettes to its stores last year. In a press release issued by Dollar General, customer demand also drove the company's decision, citing their perception that their core customers -- mostly based in rural America -- are more likely to smoke than the national average.

A 2012 study by the American Lung Association indicated that while rural Americans do smoke more than urban Americans, geography is less a factor in determining who smokes than socioeconomic status. The study also found that pregnant rural women are far more likely to smoke than their urban counterparts. (See actual numbers from the Centers for Disease Control and the American Lung Association study here.)

G. Chambers Williams III of The Tennessean in Nashville reports that business analysts think the idea is a good one for the company, which tested the product placement last year in Nevada. Analyst Mark Montagna with Avondale Partners in Nashville explained that the company found that the average purchase per customer was $14 where tobacco was sold, versus an average of $11 otherwise. But, he added, the one challenge the company will face with tobacco products, additional shoplifting.
Anti-smoking advocates expressed regret at the business choice. (Read more)

Court of Appeals panel rules 2-1 that county boards of health can pass smoking bans; appeal in Bullitt County case seems likely

By Al Cross
Kentucky Health News

In Kentucky's first appellate-court ruling on the issue, the state Court of Appeals today upheld the Bullitt County Board of Health's smoking ban, which is virtually the same as others enacted by several other county health boards. However, the panel's 2-1 vote and the strength of the dissent suggests that the ruling will be appealed to the state Supreme Court.

UPDATE, Dec. 19: The county Fiscal Court voted Dec. 18 to appeal, Tom O'Neill of The Courier-Journal reports.

Health boards in Clark, Hopkins, Madison and Woodford counties have enacted smoking bans. The Hopkins County ban was upheld by the local circuit judge, whose ruling was not appealed. (Courier-Journal video story on smoking in Bullitt County bars)


In Bullitt County, the fiscal court and eight towns sued to stop the ban four days before it was to take effect last year. Bullitt Circuit Judge Rodney Burress ruled that the board lacked authority to ban smoking in public places, but the appeals court said the General Assembly had clearly given county health boards the power to impose regulations protecting public health, that secondhand smoke is a public-health issue, and that the board's regulation is reasonable, because it is virtually the same as an ordinance upheld in Lexington.

The majority cited regulations that the Jefferson County Board of Health had enacted in the 1970s to prevent lead poisoning, and cited other court decisions saying that courts should construe public-health laws liberally. The local governments argued that the Bullitt health board has usurped legislative  power held only by them, but the 2-1 majority said the state legislature had granted the board that authority in public-health matters.

Judge Jeff Taylor of Owensboro dissented, writing that the law cited by the majority and the board was passed 58 years ago. "I harbor grave doubt that the General Assembly intended to empower health departments at that time with the authority to regulate smoking as a threat to public health," he wrote. "In 1954, second-hand smoke was not a known public health issue." He said the legislature had specifically authorized the Jefferson County lead program, and the Lexington ban was passed by the local council, not the Fayette County Board of Health.

Taylor noted that the Bullitt board had relied on "national and international studies on the effects of secondhand smoke," with no local studies showing "smoking presents a threat to the health of the citizens of Bullitt County." And even if the board had such studies, he wrote, other state laws "reserve to cities and counties the authority to regulate smoking and secondhand smoke in their respective jurisdictions." The laws he cited do not appear to do that, but he argued that allowing health boards to enact smoking bans, he said, would give them "limitless" power to regulate guns, alcohol, sales of large-size soft drinks or "the number of cheeseburgers sold by fast-food restaurants."

Taylor wrote, "To the extent the cities and county, and their elected officials have failed to address a perceived serious public health issue, the citizens of Bullitt County have an easy method to remedy the problem – the ballot box," Taylor wrote. "Or, in the alternative, the Kentucky General Assembly can expressly authorize health boards to regulate smoking in each county." To read the seven-page majority opinion and the eight-page dissent, click here.

CDC: Kentucky grossly underuses tobacco settlement money when it comes to tobacco prevention and cessation programs

Kentucky is not even remotely up to snuff on state tobacco-prevention programming. According to a new report from the Robert Wood Johnson Foundation and the Centers for Disease Control, the state spends only $2.2 million on such programs. That amount is only 4.5 percent of what the CDC recommends that state, which has the highest incidence of tobacco use in the nation, spend. If the state spent what the nation's most prestigious health institution recommended, state spending to improve Kentucky's collective lungs should be in the $57 million range.

Kentucky ranks 36th in state tobacco control spending nationwide. According to the RWJ Foundation report, states will collect a record $25.7 billion in revenue from the tobacco settlement and from tobacco taxes this year, but will spend just 1.8 percent of that money on programs to prevent kids from smoking and help smokers quit. That's less than two cents of every tobacco dollar sent back to the states. Only Alaska and North Dakota are funding the levels that the CDC has recommended.

Read the report here. To view an interactive national map, with each state's spending outlined at here.

Study: Teenagers may buy fewer cigarettes if the product is not prominently displayed

For Kentucky which has the dubious distinction of having the nation's highest rate of teen smokers, an study published this week in Pediatrics reports that teenagers may be less likely to buy cigarettes at convenience stores if they aren't sold in plain sight. Genevra Pittman of Reuters Health explains that requiring stores to hide tobacco product displays is one option some states are considering to curb teen smoking after the Family Smoking Prevention and Tobacco Control Act of 2009 was passed, according to Annice Kim, the study's lead author. No state has yet banned the displays. (Associated Press photo)

The study was conducted using a virtual reality game where teens, ages 13 to 17, "visited" simulated stores to purchase items. In some cases, the cigarettes were displayed behind the counter; in others, they were covered up. The researchers from RTI International found that 16 to 24 percent of teens tried to buy tobacco when the display was open, compared to 9 to 11 percent when it was closed. Thirty-two percent said they were aware cigarettes were available when the display case was closed , compared to 85 percent of those who had the open version.

Dr. Michael Siegel, of the Boston University School of Public Health, told Pittman that the study was interesting but he was skeptical of extrapolating it into real life. Real life kids, he said, will go to a store when they want to buy cigarettes. "I don't know how many situations there are when a kid is hanging out in a convenience store with nothing to do and says, 'Oh, I'll just try a cigarette as long as they're here.' "(Read more)

American Lung Association calls state's tobacco-cessation benefit inadequate now that Medicaid is under managed care

Kentucky added a robust tobacco cessation benefit to its Medicaid program, only to lose much of it in 2011 by putting the program under managed care by insurance companies, the American Lung Association notes in its annual report. Not only do their plans offer fewer treatments, explained the report, but information was confusing to patients and healthcare providers alike. The report also notes that the state -- which is not alone in this -- offers its smokers who desire to quit inadequate access to medications and counseling.

Robert Preidt of HealthDay reports that the U.S. Department of Health and Human Services late last month published a proposed rule that requires tobacco cessation as an essential health benefit under the Patient Protection and Affordable Care Act. The lung association report how states could put that rule to maximum use. "Giving all smokers access to a comprehensive cessation benefits is not only the right thing to do, it's the smart thing to do," Billings said. "The bottom line is that quitting smoking saves lives and saves money." One recent study, reports Preidt, showed that providing smokers with help to quit has a three-to-one return on investment, meaning $3 is saved for every for $1 spent. (Read more)

To see more about how Kentucky's tobacco cessation coverage rates, according to the American Lung Association, go here.

Study: Raising cigarette taxes does curb even heavy smoking

The more you raise cigarette taxes, the less people smoke. That presumption was confirmed this week in a study by the Washington University School of Medicine in St. Louis. This has some resonance in Kentucky, where just last week the state’s Blue Ribbon Commission on Tax Reform told Gov. Beshear the state should raise taxes on tobacco, to $1 per pack from 60 cents. Other forms of tobacco would get a corresponding tax hike, reports Beth Musgrave of the Lexington Herald-Leader. The changes would raise an estimated $120 million in revenue and, if the research is right, cut down on long-term health care costs.

The researchers are the most adamant about the last point. “Most clinicians and researchers thought these very heavy smokers would be the most resistant to price increases,” says study author Patricia A. Cavazos-Rehg, PhD. “But our study points out that, in fact, change can occur. And that’s very good news.” In fact, in states where taxes on tobacco products rose by at least 35 percent, heavy smokers -- who averaged 40 cigarettes a day or more -- lowered their daily smoking by 14 cigarettes, on average.  In real numbers, the price for a pack of cigarettes increased from an average of $3.96 in 2001 to $4.41 in 2004. (Read more)

In Kentucky last year, almost 30 percent of residents said they were smokers, the highest in the nation. The state also has the highest rates of diabetes and lung cancer, reports Jim Malewitz of Stateline News. Kentucky’s cigarette tax is also among the country's lowest.