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.

Bill for statewide smoking ban appears to have been extinguished

The bill to enact a statewide smoking ban in Kentucky appears to be dead for this session of the General Assembly.

The House sent House Bill 190 back to committee today, and "House Speaker Greg Stumbo said he doesn't expect the bill to make it back to the full House," Sam Dick reported for WKYT-TV.

Rep. Bob Damron, D-Nicholasville, an opponent of the bill, told Kentucky Health News on Feb. 21 that he did not think it had more than 41 votes in the 100-member House.

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

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.

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.

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)

Teen smoking in Kentucky declined more than it did in nation from 2002 to 2010, but state remained in top 10

Like most states, Kentucky showed a drop in reported cigarette smoking among 12- to 17-year-olds from 2002 to 2010, according to a report by the Substance Abuse and Mental Health Services Administration.

Nationwide, teenagers' reported "current use" of cigarettes dropped from 12.6 percent to 8.7 percent. In Kentucky, that decline was even more significant, plummeting from 17.6 percent in 2002 to 11 percent in 2010. The 2002 rate was third in the nation; the latest one is sixth. The surveys defined "current use" as smoking in the past month. (Click on map for larger version)

Strangely, the data showed that during the same period, teens' perception of risk from cigarette smoking remained unchanged in Kentucky and most other states. Tobacco use is the leading cause of premature and preventable death in the United States. (Read more) To read the full report, go here.

Tobacco use higher in rural areas; several factors include tobacco companies' targeting of rural youth, Lung Assn. says

Tobacco use is higher among rural communities than in suburban and urban areas, and smokeless tobacco use is twice as common. According to the American Lung Association, rural youth are more likely to use tobacco and to start earlier than urban youth, perpetuating the cycle of tobacco addiction, death and disease.

In its latest health disparity report, “Cutting Tobacco’s Rural Roots: Tobacco Use in Rural Communities,” ALA says the increased tobacco use is associated with lower education levels and lower incomes, which are both common in rural areas where there may be fewer opportunities for educational and economic advancement.

The exposure to secondhand smoke is also likely to be higher, since rural communities are less likely to have smoke-free air laws in place, and that probably makes residents less likely to ask individuals not to smoke in their homes or other indoor places they control.

The report also pointed out that the tobacco industry "spends millions of dollars targeting rural youth," and "these young people are less likely to be exposed to tobacco counter-marketing campaigns. Rural tobacco users are also less likely to have access to tobacco-cessation programs and services to get the help they need to quit. Promotion of the availability of state counseling services by phone and online resources also lags in rural communities."

To read the full report, go here.

Hopkinsville council, absent a proponent, narrowly replaces smoking ban idea with plan to require posted smoking policies

The effort to pass a smoking ban in the largest Kentucky town without one may have hit a roadblock Thursday night. The Hopkinsville City Council forwarded a smoking ordinance that would merely require businesses to decide whether to allow smoking and post signs at every entrance announcing its policy. The council's vote as a committee of the whole was 6-5, and the one absent council member favors a typical smoking ban.

Mayor Dan Kemp, who can vote to break council ties and does not sit on the committee of the whole, "said after the meeting that he could not support the proposal because it leaves the current law unchanged," Carla Jimenez reports for the Kentucky New Era. The alternative ordinance is scheduled for first reading Sept. 18; a tie vote would block it, and a tie vote in favor of a smoking ban could be broken by Kemp to pass it.

As first presented to the committee, the ordinance would ban smoking in public places, with exemptions for private clubs, age-restricted establishments and businesses with 12 employees or fewer. The small-business exemption was removed on a vote of 10-1. "That left the ordinance as it originally came before the council for its first reading in June," Jimenez reports. But then the committee voted 6-5 for the alternative ordinance, proposed by Councilman Paul Henson, who argued, “We’re not abusing anybody’s rights. We’re not the bad guy, and yet we have the smoking ban, a smoking ordinance, on the books.”

Councilwoman Peggy Rogers-Everett disagreed, saying smoking is a hazard to everyone, and “Murder is illegal.” Henson and Councilwoman Ann Cherry and Henson laughed, and "Everett was not amused," Jimenez reports. Everett said, “I don’t find that funny. I don’t take that lightly.” (Read more)

Smoke Free Kentucky Coalition's multi-city tour launches push for statewide smoking ban in 2013 legislature

Backers of an effort to ban smoking in all public places in Kentucky took their message on the road this week in hopes of getting legislation passed in the 2013 General Assembly. The Smoke Free Kentucky Coalition swept through the state's largest cities to gather support for a final punch to be delivered at the annual Fancy Farm Picnic in Graves County on Saturday. Beth Musgrave of the Lexington Herald-Leader reports that one of the week's first stops was at the Kentucky Chamber of Commerce, a longtime supporter of the statewide smoking ban. "We know that a majority of Kentuckians support a smoke-free Kentucky," said Amy Barkley, chairwoman of the coalition. (KRT graphic)

Rep. Susan Westrom, D-Lexington, has sponsored a statewide smoking ban for several years. During the 2012 legislative session, the House Health and Welfare Committee passed the measure, but the full House did not vote on it. Westrom told the Herald-Leader that said she did not aggressively pursue the matter during the 2012 session because all 100 members of the House are up for re-election in November. "But we've had several members who have said that they will be co-sponsors" next year, she said.

Musgrave notes that even Westrom is unsure how the the Republican-led Senate will vote. Senate President David Williams has said he supports the idea of a statewide smoking ban, while opponents of the proposal have said it represents an overreach of government power. "There are personal property rights that are being trampled," Rep. Ben Waide, R-Madisonville, said when he voted against a statewide smoking ban in March.

Graphic warning labels help smokers remember tobacco health risks, study finds

Study participants looked at these two images while
researchers assessed how effectively they were viewed.
Graphic by Penn Medicine.

Graphic warning labels on cigarette packages can help smokers remember the message and the health risks associated with smoking, a study has found.

Researchers asked 200 smokers to look at either a text-only label advertisement — which is similar to warnings that have been on cigarette packages since 1985 — or a graphic warning label showing a hospitalized patient on a ventilator along with a written warning — which has been proposed by the U.S. Food and Drug Administration.

Researchers used eye-tracking technology to measure how the advertisement was looked at and for how long, reports research-reporting service Newswise. Then participants were asked to rewrite the message they'd seen to show how well they remembered it.

Results showed 50 percent of participants who saw the text-only ad remembered the warning label, while 83 percent of those who saw the graphic image warning remembered what they'd seen.

"In addition to showing the value of adding a graphic warning label, this research also provides insight into how the warning labels may be effective, which may serve to create more effective warning labels in the future," said Andrew A. Strasser, associate professor at the University of Pennsylvania, where the study was conducted. "We're hopeful that once the graphic warning labels are implemented, we will be able to make great strides in helping people to be better informed about their risks, and to convince them to quit smoking."

The 2009 Family Smoking Prevention and Tobacco Control Act mandated the FDA to require graphic warning labels on cigarettes packaging starting in September 2012. The mandate has since been held up in court. (Read more)