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Tuesday, April 30, 2024

Legislative lobbying reports for last session rank pharmacy-benefit managers fifth, hospitals sixth, Altria 11th, Anthem 17th, docs 18th

The legislature meets in the Kentucky State Capitol.
By Al Cross
Kentucky Health News

The trade association for pharmacy benefit managers, which act as middlemen between drug and health-insurance companies, was the fifth largest reported spender on lobbying the state legislature in the first three months of the year, according to a compilation by the Kentucky Legislative Ethics Commission

The Pharmaceutical Care Management Association reported spending $94,694 on lobbying the General Assembly from January through March. The session began Jan. 2 and was over for most purposes by the end of March.

On March 28, the legislature gave final passage to Senate Bill 188, which is intended to keep the state's independent pharmacies from closing. It sets dispensing fees, bans PBMs from forcing patients to get their drugs through mail order, and keeps them from steering patients to pharmacies that they own. The PBMs argued that the law will cause insurance premiums to increase and its mandates in the bill won't allow businesses to gain from savings PBMs offer.

Independent pharmacies say they are losing money because of low fees paid by PBMs. The bill sets a minimum dispensing fee of $10.64 per prescription for the state's independent pharmacies until a study of dispensing costs is completed by the state Department of Insurance. This "gap-fill payment floor" will not be available to chain pharmacies. The results of the study will eventually dictate what the dispensing fee should be going forward. The study is to be repeated every two years, with fee adjustments made accordingly.

The law, sponsored by Sen. Max Wise, R-Campbellsville, also prohibits a PBM from reimbursing a pharmacy that it owns at a higher rate than a community pharmacy, or from keeping a community pharmacy from filling a 90-day prescription for a maintenance drug. And PBM will not be able to penalize a community pharmacy from sharing information with a patient on the cheapest option to pay for their medications.

Several other major lobbying interests dealt with health-care issues. The biggest spender was the Kentucky Chamber of Commerce, at $151,010, followed by the American Civil Liberties Union of Kentucky, at $139,599. Among many other things, the ACLU wants the legislature to enact exceptions to the state's near-total abortion ban.

Ranking sixth, just behind the PBM lobby, was the Kentucky Hospital Association, at $85,835. In 11th place was Altria Client Services, a cigarette company, at $73,309; it supported the successful bill to limit legal sales of vaping products to those approved by the U.S. Food and Drug Administration.

Ranking 17th was Elevance Health and Affiliates doing business as Anthem Inc., at $59,946. The health-insurance firm was followed by the Kentucky Medical Association, the main lobby for physicians, at $54,051, and the Kentucky Primary Care Association, a trade group for health clinics, at $49,416.

Overall, spending on legislative lobbying for the first three months of 2024 was a record of $9.719 million, the Ethics Commission reported Tuesday: "The previous record for the same period was $9.343 million, set last year; 933 businesses and organizations registered to lobby in Kentucky, spending $9.427 million; 727 lobbyists were paid $8.289 million in compensation, and also reported $291,942 in expenses."

Sunday, April 28, 2024

Vaping and substance use in Kentucky schools has spiked in the last five years, especially in the younger grades; up 147% overall

Kentucky Department of Education graph from Infinite Campus data; the overall increase was 147%.
By Melissa Patrick
Kentucky Health News

The number of drug, alcohol and tobacco events recorded by schools have increased in schools all levels across Kentucky, according to data collected by Infinite Campus, an online student information tracking system.

A look at the data from 2017-28 through 2022-23 found that Kentucky's elementary schools saw a 475% increase in drug, alcohol and tobacco events, from 140 events to 805. Kentucky middle schools saw a 281% jump, from 2,336 to 8,912. High schools saw a 107% increase, from 8,995 to 18,651. 

"The biggest increases are with the younger students. So it tells us like forecasting ahead, what we need to be thinking about as we develop the guidance that goes around this," said Florence Chang, with the Kentucky Department of Education's Division of Student Success. "Parallel with this, it would be irresponsible to not also mention that correlated and associated with the increase in substance abuse and vaping that there's also been this increase in psychological distress." 

The data were shared at an April 24 Education Department Student Advisory Council meeting, where students discussed the increase in substance use and what they thought were reasons for it. One said that the real vaping numbers are likely higher because many incidents or events are not recorded.

Department of Education graph from Kentucky
Incemtives for Prevention survey of students
Information from the latest Kentucky Incentives for Prevention survey shows an association between serious psychological distress and substance abuse. The study found that students who experienced and reported having psychological stress were 2.5 times more likely to vape, 2.5 times more likely to use cannabis, 2.2 times more likely to binge drink and 3 times more likely to use cigarettes. 

The students suggested several reasons beyond psychological distress for the increases in vaping, including peer pressure, an increase in use of social media among elementary students, and easy accessibility to the products. 

Another student suggested it was a learned behavior. “We see a lot of adults in our lives, said Ava Benson, a senior at Henderson County High School. “They've had a rough day at work, so they're going to have a glass of wine or they smoke cigarettes because of stress." 

Judi Vanderhaar of the Education Department's Division of Student Success said the department's recommendations for districts and schools include implementing prevention efforts, supportive responses for students and updating school policies.

During its recent session, the General Assembly passed House Bill 142, which requires school districts to adopt specific policies that penalize students for possession of "alternative nicotine products, tobacco products or vapor products" and report nicotine-related incidents to the Education Department. Senate language, adopted by the House, allows schools and governing bodies to apply for grants related to nicotine usage and remove the requirement that schools suspend students with a third possession violation.

London police told Phil Pendleton of WKYT that they have been called to schools to investigate serious situations because of vaping. “We have had several instances where EMS was called to schools, and it came out as an overdose, but it turned out it was more to do with vaping,” London Officer Hobie Daugherty told Pendleton.

University of Kentucky will buy St. Claire Hospital in Morehead

University of Kentucky trustees Friday approved buying St. Claire HealthCare in Morehead. (UK photo)
The University of Kentucky Board of Trustees voted Friday to approve plans to acquire St. Claire HealthCare in Morehead. The targeted date for UK's takeover is July 1. 

The move will expand clinical and academic programs and provide more access to high-quality patient care for more Kentuckians, UK said in a news release.  

“UK is committed to growing clinical services in the Morehead area as well as expanding programs in many clinical areas to grow the future health care workforce for Kentucky,” President Eli Capilouto said in the release.  

St. Claire is one of the largest employers in the Morehead region, with more than 1,300 employees, including over 50 physicians and nearly 50 advanced-practice professionals in more than 20 medical specialties.

St. Claire has partnered with UK on a number of academic and clinical programs since the 1960s, co-developing the Rural Physician Leadership Program along with Morehead State University and establishing a training and residency site for UK's colleges of Medicine, Pharmacy and Health Sciences. It is also home to the College of Health Sciences's Physician Assistant Program.

St. Claire President and CEO Donald H. Lloyd II, who will remain in that position, said in the release that "UK identified as the natural partner that could carry forward the previous work and ongoing investment while growing the health-care workforce."

He added, “In an ever-changing health care landscape, both St. Claire and UK are deeply committed to accessible and high-quality patient care and strategic collaborations that will enhance services to benefit Kentuckians throughout northeastern Kentucky for many decades to come.”

According to the release, St. Claire HealthCare includes a hospital with 139 licensed beds and seven primary-care clinics in five counties, a multi-specialty medical pavilion, two urgent-care centers, a pediatrics clinic, a retail pharmacy, a counseling center, an outpatient center and a medical equipment and supply store. St. Claire also provides home health and hospice services in eight counties.

This is UK's second major foray into hospital care in northeastern Kentucky in recent years. In 2021, the university created a joint venture with King's Daughters Memorial Hospital in Ashland in which UK holds the assets and manages the hospital system.

MedCenter Health, chain based at Bowling Green hospital, to expand medical specialty offices at new building in Glasgow

The ceremonial groundbreaking
(Photo by Michael Crimmins, Glasgow News 1)
Kentucky Health News

The small hospital chain based in Bowling Green, MedCenter Health, is expanding its medical-specialty offerings in its largest close neighbor, Glasgow.

MCH has had a presence in Glasgow for “a number of years,” but will now have a building of its own and start providing specialty medical care, Wade Stone, executive vice president of MCH, said Thursday at the groundbreaking for the facility on South L. Rogers Wells Boulevard.

Stone said the facility will allow MCH to continue combating the nationwide physician shortage, especially with regard to specialty services, spurred by the chain's partnership with the University of Kentucky College of Medicine, reports Jack Dobbs of the Bowling Green Daily News.

“As Med Center Health has evolved into an academic teaching institution we’ve been able to successfully recruit many of those specialties and grow those programs,” Stone said. “We can deploy those specialists to other rural communities.”

MCH Glasgow, which is expected to open in about a year, will also "allow patients to complete pre-op and post-op procedures locally, instead of having to commute to Bowling Green," Dobbs notes.

One of the specialists will be Paul Moore, who has been cardiothoracic surgeon in Bowling Green for 30 years, Dobbs reports: "He said he has been treating patients in Barren and surrounding counties for the past six or seven years, but described MCH Glasgow as a central location."

Dobbs told Glasgow News 1, “We have a number of patients that come from here, not just from Barren County but Adair County, Clinton County, Monroe County; this seems to be a central location they can all get to easily. I’m at the point now where I want to get out and see the patients who really need access and the care I can give that’s not given locally and that’s really important.”

Other specialties listed in a press release were Vascular Surgery, ear/nose/throat, hematology/oncology, neurosurgery, urology and orthopaedics/sports medicine. Stone said three or four full-time primary-care physicians will also practice at MCH Glasgow, which will have 22,000 square fete of floor space,

Glasgow's hospital is the locally owned T.J. Samson Community Hospital, which has a branch in Columbia. MedCenter Health, which grew out of the publicly owned Bowling Green-Warren County Hospital, has hospitals in Albany, Franklin, Horse Cave and Scottsville.

Tuesday, April 23, 2024

Warmer weather means ticks are active and looking to suck your blood; they can make you sick; here's how to deal with them

Mosquito Squad of Louisville graphic, adapted by Kentucky Health News; click on it to enlarge

State wildlife officials are reminding Kentuckians to take precautions against tick bites, which can transmit disease.

“Ticks are common across the state, and whether you’re hunting, hiking or spending time in your backyard, you’re probably going to encounter them,” said Dr. Christine Casey, wildlife veterinarian for the Deparment of Fish and Wildlife Resources. “The key to avoiding any health risk from a tick bite is by taking steps to protect yourself from being bitten in the first place.”

The most common tick species in Kentucky are the blacklegged tick or deer tick, the American dog tick and the lone star tick. The type of tick can determine whether you get sick from a single bite; other factos include where it was acquired and how long it was attached.

"While few ticks transmit disease, tick bites should always be taken seriously," the department said in a news release. "Lyme disease, transmitted by infected blacklegged ticks and common in the northeast and north central U.S., is of growing concern to Kentucky.

"Ticks don’t have to ruin a day outdoors," the department says, offering these precautions to avoid tick bites and deal with them if you are bitten:

Before going outdoors

• Use Environmental Protection Agency-registered insect repellents containing DEET (the oldest, most common and most effective insect repellent), picaridin, or oil of citronella.

• Treat clothing and gear with products containing 0.5% permethrin, which kills ticks on contact. Permethrin should not be applied directly to the skin.

• Take extra precaution if walking through wooded or brushy areas, tall grasses, woodpiles and leaf litter.

After spending time outdoors

• Perform tick checks. Ticks are known to be found under the arms, in and around the ears, the back of the knees, in and around hair, between the legs and around the groin and waist. Be sure to check gear and pets as well.

• Shower soon after coming indoors; this can remove any unattached ticks.

• Tumble-dry clothes in a dryer on high heat for 10 minutes to kill ticks attached to clothes.

If you are bitten by a tick

If a tick is found attached to the skin, remove it as soon as possible. Use tweezers to grab the tick close to the skin and gently pull on the tick with steady pressure. Do not jerk or twist the tick; this can cause mouth parts to break off and remain in the skin.

After removing the tick, clean the bite site and wash hands with soap and water or use an alcohol-based hand sanitizer. Dispose of a tick by submersing it in alcohol, placing it in a sealed bag or other container, wrapping it tightly in tape, or flushing it down the toilet. Do not attempt to crush a tick between the fingers.

If symptoms of a fever, rash, muscle or joint aches, or other types of illness arise within several weeks of removing a tick, consult a health-care professional and tell them about the recent tick bite, when it occurred and where the tick was acquired.

Kentuckians who are interested in contributing to the study of tick-borne diseases and their distribution across the state are encouraged to submit samples of ticks to the Kentucky Tick Surveillance Project. This project, produced by the University of Kentucky Martin-Gatton College of Agriculture, Food and Environment, aims to improve knowledge about where ticks are found and the diseases they might carry.

For more information about ticks and tick prevention, visit www.cdc.gov.

Community pharmacies can help smokers quit, study finds

Photo illustration from QuitSmokingPharmacies.com
Kentucky Health News

Community pharmacies may play a key role in helping smokers quit, according to a study done in California and published in the peer-reviewed journal Pharmacy.

Kentucky' adult smoking rate, 17.4%, is tied for fourth in the nation with MIssissippi. For a partial list of pharmacies that advertise their help with smoking cessation, go to QuitSmokingPharmacies.com.

"Although two-thirds of people who smoke would like to quit, many individuals trying to quit on their own are not successful," notes a news release from the University of California, Davis, where the study was done in cooperation with  other academic institutions across the country and the Community Pharmacy Enhanced Services Network, involving 22 California pharmacists and 26 pharmacy technicians who underwent tobacco cessation training.

"Pharmacists have shown to be effective in helping patients quit," the release said. "They can reach uninsured and under-resourced patients as well as patients living in rural areas who might experience barriers to accessing primary care. However, the study showed certain barriers exist to making pharmacy cessation programs effective," such as billing complexities, software limitations and training gaps for handling complicated patient cases.

“Compatibility with existing workflows, staff buy-in and the crucial role of pharmacy technicians significantly helped” pharmacy custiomers quit smoking, said the study's senior author, Karen Hudmon of the Purdue University College of Pharmacy.

Monday, April 22, 2024

Vape retailers and hemp association file suit to block new law that limits sale of vape products to those approved by the FDA

Only vaping products authorized or pending approval by
the FDA can be sold in Kentucky as of Jan. 1. (Getty Images photo)
By Sarah Ladd
Kentucky Lantern

Four vape shops, the Kentucky Vaping Retailers Association and the Kentucky Hemp Association have filed suit in Franklin Circuit Court seeking to strike down a new state law outlawing the sale of some of their products.

Greg Troutman, a lawyer for the Kentucky Smoke Free Association, which represents vape retailers, said he’s “hoping that we can get a resolution to this well before” the law is scheduled to take effect Jan. 1.

The lawsuit, which was filed Friday, argues that House Bill 11’s definitions of “vapor products” and “other substances” lump electronic cigarettes and vapable hemp and marijuana products together, making it too broad and arbitrary to satisfy the state constitution.

It also violates due process by requiring retailers to comply with a nonexistent regulatory process for hemp and other non-nicotine products, Troutman said.

Retailers will be subject to fines and penalties for selling vapable hemp-derived products once the law takes effect, the lawsuit says.

HB 11’s backers tout the bill as a way to curb underage vaping by limiting sales to “authorized products” or those that have “a safe harbor certification” based on their status with the U.S. Food and Drug Administration.

The bill was backed by Altria, the country’s largest manufacturer of cigarettes, which also markets FDA-approved vape products. Altria has spent more than $500,000 lobbying the legislature since January 2022, according to records filed with the Legislative Ethics Commission.

The suit alleges that the new law requires FDA approval for products that cannot possibly win FDA approval because the FDA has no regulatory process for them, such as those containing amanita muscaria (a mushroom) and hemp-derived products. The law would also apply to vapable marijuana products set to become available in Kentucky 2025 under a law the legislature passed last year, the lawsuit says.

“Unless the manufacturers are making a therapeutic claim — that is, they’re intended to cure, treat, mitigate disease — they’re not subject to an FDA regulatory process,” Troutman said. “So how can you condition market approval in Kentucky upon complying with a nonexistent process? That is absolutely Kafkaesque.”

In 2009, Congress required the FDA to regulate tobacco products to “protect the public health of the U.S. population and create a healthier future.” The FDA began regulating “electronic nicotine delivery systems” — e-cigarettes — under that authority in 2016.

The suit also alleges the new law violates a provision in the state constitution limiting laws to one subject. HB 11 is titled an “Act relating to nicotine products” but applies to non-nicotine vaping products such as those derived from hemp, the lawsuit says.

The defendants are Allyson Taylor, in her capacity as commissioner of the Kentucky Department of Alcoholic Beverage Control, and Secretary of State Michael Adams.

In the final days of the session, lawmakers merged HB 11 with Senate Bill 344, which created an e-cigarette registry. Gov. Andy Beshear signed the combined bill  into law April 5. Some advocates fear it could force more people back to traditional cigarettes, which are worse for bodily health than vaping.

Vape-store owners also testified the law could create a monopoly for big retailers and hurt small businesses.

A spokeswoman for House Republicans said Tuesday that she could not comment on pending litigation, but believes “the legislature’s efforts to keep potentially dangerous e-cigarettes out of the hands of our children will stand the test.”

Tobacco use can lead to all sorts of health problems, according to the Centers for Disease Control and Prevention. They include cancer, diabetes, heart disease and more. Nicotine is the addictive chemical in tobacco and can harm the developing brain, the CDC says.

Sunday, April 21, 2024

Kentucky is No. 4 in smoking, down from No. 2, but at 17.4% of adults, experts say the state's smoking rate is still way too high

By Melissa Patrick
Kentucky Health News

Kentucky still has one of the nation's highest adult smoking rates, but has fallen to fourth among the states, after many years of either ranking first or second. The rate for 2022, the last year for which a rate has been calculated, is 17.4%.

Asked why Kentucky might have seen a drop in its ranking, Amanda Fallin-Bennett, director of the Kentucky Center for Smokefree Policy, said it could be because Kentuckians have good access to treatment programs. 

"Compared to other states, it does have pretty good access to tobacco-treatment services for most all Kentuckians," she said, adding later, "We know, in general, that the majority of people who smoke cigarettes would like to quit. So we know that making cessation services available and accessible is a big help."

Kentuckypassed a law in 2017 to require all insurance policies sold in Kentucky to cover all smoking-cessation medications and counseling approved by the U.S. Food and Drug Administration. This also includes Medicaid, which covers one in three Kentuckians. The law also removed many of the barriers to such treatment, such as co-payments and limits on length of treatment.

Kentucky offers a program called Quit Now Kentucky. The quit line can be reached at 1-800-QUIT-NOW(784-8669); through text QUITKY to 797979; or online at www.quitnowkentucky.org. The services are free and confidential. 

Fallin-Bennett added that it's important to consider that another reason that Kentucky's smoking rate has dropped could be because of increases in the uses of alternative tobacco products, like vapes or heat-not-burn devices.

1 in 4 in Ky. smoked five years ago; now 1 in 6

With 17.4% of Kentucky adults reporting they smoke every day or some days, Kentucky ties with Mississippi for the fourth highest smoking rate in the nation, behind West Virginia (21%); Arkansas (18.7%); and Tennessee (18.5%). The figures are from the Behavioral Risk Factor Surveillance System, a continuing national survey by the Centers for Disease Control and Prevention.

Kentucky's smoking rate has been on a steady decline since 2011, even though it was nearly 20% in 2021 and nearly 25% just five years ago, according to America's Health Rankings, using CDC data.

This means that instead of more than one in four people smoking in Kentucky just five years ago and one in five in 2021, now just over one in six Kentucky adults are considered "current smokers."

Fallin-Bennett said any decrease in smoking is to be celebrated: "Smoking is the leading cause of preventable death and disease and so anytime someone stops smoking, they are dramatically reducing their risk for cancer, heart disease, stroke, preterm birth, just a myriad of adverse health outcomes that are associated with smoking."

Shannon Baker, advocacy director for the American Lung Association for Kentucky and Tennessee, said she had no data to analyze why Kentucky now ranks fourth among states instead of second, and cautioned that the focus should remain on the fact that Kentucky's smoking rate is still among the worst in the nation.

"I can tell you that 17.4% of Kentucky adults smoke compared to the national average rate of 14%. So still, it's still a terrible statistic, right? . . .  So I guess I would caution us to look at that, instead of how we rank," she said. 

Baker said any drop in the state's smoking rate is great news, but noted that Kentucky continues to have the nation's highest rates of lung cancer and lung-cancer deaths: "We still have miles to go." 

What next? 

Asked what needs to happen to bring this rate down further, Fallin-Bennett said increasing tobacco taxes would help, as would more Kentucky counties and cities passing  comprehensive smoke-free policies.

"So only 38% of Kentuckians are covered by comprehensive smoke-free policies where smoking is not allowed in restaurants, bars and workplaces," she said. "So that is an area that Kentucky continues to struggle with and that would likely further reduce smoking rates." 

Baker praised the efforts of the state's Lung Cancer Screening Advisory Committee, but said more Kentuckians and providers need to be educated about the availability of low-dose CT screening for smokers and former smokers who qualify for it.

She said she thinks the committee is the first in the nation "that's really focusing on what we can do to increase the number of eligible individuals actually getting the low-dose CT scan done, and making making it more accessible and affordable statewide," she said. "That's a huge opportunity for us."

A missed opportunity, she said, was in the recent legislative session, when legislators removed strict enforcement measures from House Bill 11, aimed at decreasing youth vaping. She said that the current laws that prohibit retailers from selling nicotine products to youth is "not effectively enforced." 

Baker added, "We need three things: We need licensing, and we need regular compliance checks, and we need penalties for violations that escalate for repeat violations all the way up to the point of suspension and revocation of your license for the worst actors, the scofflaw, and we know that they're out there. And those things together represent a tremendous opportunity to address youth e-cigarette use and nicotine addiction, and we missed the boat."

Gov. Andy Beshear signed HB 11 into law on April 5. It limits legal sale of vape products to those approved by the FDA. It will create a database of retailers that sell the products and set fines for retailers, manufacturers and wholesalers who violate the law, but penalties for retailers are much less than in the bill's original version.

UK hosts national meeting to raise immunization rate for vaccine against cervical and other HPV cancers, in which Ky. leads U.S.

Kentucky Department for Public Health illustration
By Melissa Patrick
Kentucky Health News

Kentucky leads the nation in the rate of cases of and deaths from cervical cancer, a disease that is largely preventable by a vaccine.

The vaccine targets the human papillomavirus, which can cause cancers of the cervix, genitals, anus, neck and head. Kentucky also leads the nation in cancers caused by the HPV.

"The good news is that the HPV vaccine can prevent the vast majority of those cancers, but not everybody knows about it," said Pamela Hull, associate director of population science and community impact for the University of Kentucky's Markey Cancer Center. 

Between the HPV vaccine and cervical screening, cervical cancer could be virtually eliminated, Hull said. The combination wouldn't prevent all cases, she said, but "Within the next few decades, we can eliminate cervical cancer as a public-health threat in this country." 

Cervical cancer screening is done through a pap smear, which looks for cancerous cells on the cervix, which connects the uterus and vagina. It can also find precancerous changes that have not yet developed into cancer. Screenings usually begin at age 21 or three years after the first sexual intercourse.

The HPV vaccine protects against six cancers: cervical, anal, penile, vaginal, vulvar and head or neck. According to the Centers for Disease Control and Prevention, it can prevent over 90% of sexually transmitted cancers caused by the HPV from ever developing, 

Hull said these cancers cause 36,000 new cancer cases every year in the U.S. in men and women, but only about half of Kentucky teenagers have received it because state law does not require it.

The vaccine's greatest obstacle appears to be that that it is associated with a sexually transmitted disease. Researchers have said improving the vaccination rate depands on changing the perception that the vaccine is something that prevents STDs to the knowledge that it primarily prevents cancer.

Conference discusses anti-HPV strategies

Raising awareness about the importance of HPV vaccination was the focus of a national conference held in Lexington on April 16-17 by the Markey center and the National Cancer Institute

Hull, who spke with reporters before the conference, said researchers all over the country are collectively working to answer this question: "How can we work with health-care providers and community organizations and parents to make sure more and more kids get vaccinated to protect them from cancer as they grow older?" 

A "social organization" program called "Operation WIPE OUT Cervical Cancer Alabama" aims to do just that through a program that involves a number of community partners, Isabel Scarinci of the University of Alabama at Birmingham told attendees at the conference in Lexington. 

Scarinci said the program first engaged the support of the Rotary Club of Birmingham and the state health department. Together, they launched a program to increase HPV vaccination rates in the Alabama county that had the highest rates of cervical cancer in the state.

She said through the involvement of groups in the county and the local school superintendent, they started an education program in the school system that resulted in the students organizing an HPV vaccination campaign, which has become part of an official plan for the state. 

Scarinci said there is no official funding for the program because they "want this to belong to everybody." Thus, funding comes from a number of sources. 

According to a post on the Alabama health department website, the program offers free HPV immunizations for children and adults; provides free cervical cancer screenings for low-income and uninsured women; and provides follow-up tests for those who need it. All services are offered through county health departments.   

HPV vaccines and Kentucky

While the HPV vaccine is not required in Kentucky, it is given around the time students enter middle school and are required to get an initial vaccine for meningitis and a booster for diphtheria, tetanus and pertussis (more commonly known as whooping cough), collecitvely called TDaP.

The timing of the two required vaccines and the HPV vaccine create a good opportunity to include it in the children's immunizations. "Even though it's not required," Hull said, "we really, really strongly encourage it because it's one tool that parents can use to prevent cancer for their children."  

Two doses of the HPV vaccine are recommended for all 11- and 12-year-olds, but the series can begin at 9. It is also recommended for those 13 to 26 if unvaccinated; three doses are recommended for people who get their first dose at 15 or later, and for people with certain conditions that weaken immunity.

In addition, it is also recommended that anyone between 27 and 45 who is not vaccinated should talk to their health-care provider about their risk of infection and the benefits of getting vaccinated.

Asked why boys and girls as young as 9 should get the vaccine, Hull said they have a better immune response than older chuildren. As a person gets older, she said, they need an extra dose of the vaccine for protection against the cancers because it takes more of the vaccine to build up their immunity.

"We really want to see our rates of HPV vaccination go up in Kentucky," Hull said. "Right now, just over half of teenagers have gotten the vaccine, all the doses of the vaccine, and we really want to get that up to, closer to, 80% or even higher." 

In 2022, Kentucky ranked 44th in HPV vaccination, with only 55% of teens 13-17 having received all recommended doses, according to America's Health Rankings. That was a decline from the 57% reported in 2021 and well below the national average of 63%.

"What I like to explain to a parent is . . . you're not going to put your seatbelt on after you get in a car accident, you have to have it on before," Hull  said. "So age for the vaccine is really important to get it early, build up the body's defenses so then one day when the body is exposed to the virus, it is ready to fight it." 

Hull said there is an emphasis on getting more people vaccinated in rural areas because HPV vaccination rates are lower in rural areas, and they have higher rates of HPV cancers.

Friday, April 19, 2024

UK professor Alex Elswick overcame opioid addiction to work with others in recovery and start a community organization to aid them


By Grace Sowards
University of Kentucky

Alex Elswick grew up with everything he needed. With two great parents, a roof over his head and good grades in school, he was a young person who wouldn’t lead people to believe drug addiction would be in his future.

Elswick stands in front of the wall of hope at Voices of Hope,
The board is full of reasons to persevere through addiction,
and messages of gratitude. (UK photo by Sabrina Hounshell)
“I come from a really privileged background,” said Elswick. “My dad is a doctor, I grew up in the suburbs and kind of had every advantage. That mattered; it mattered in terms of my addiction and my recovery.”

Today, Elswick is an assistant extension professor in the University of Kentucky's School of Human Environmental Sciences. He has master’s and doctoral degrees from the Martin-Gatton College of Agriculture, Food and Environment, which includes the school. His work focuses on substance-use prevention and recovery across the state. He is a founding member of Lexington’s Voices of Hope, a substance-use disorder community center focused on research-based recovery treatment.

Elswick’s passion for recovery education did not initially blossom from research. For many, addiction can start before an individual ever touches a substance. At age 18, he underwent wisdom-tooth surgery and was prescribed opioid painkillers. Risk factors, such as family history or mental illness, can seriously increase one’s likelihood for addiction. Elswick faced both.

“I took it exactly as it was prescribed by my provider, but with all those risk factors, I got addicted,” Elswick said. “Two years later, I woke up and I had a $200-a-day opioid addiction.”

Elswick describes his addiction in the years following his surgery as ‘nothing special.’ He experienced homelessness, unemployment and isolation. Finally, after checking into a treatment shelter in Dayton, Ohio, Elswick was able to get and stay sober for six months.

While his sobriety was an exciting milestone, Elswick confrontd barriers and questions that many people face when leaving addiction treatment. Where could he go for housing? How would he find employment? This is where his connections to the UK community made him luckier than most.

“I told everybody I was going to do tobacco research, but really I was just digging holes,” Elswick chuckled. “It was such a great job for me early in my recovery. I got to be outside, working with my hands.”

For Elswick there was a sense of healing in this work. Through it, he discovered his own healing wasn’t the whole story; he wanted to work in drug and alcohol counseling. One afternoon, colleague Kenny Hunter asked him if he had put any thought into his future. Elswick shared his new dream of working in recovery, and it opened a door he didn’t even know was there.

Hunter’s wife is Jennifer Hunter, an extension professor and director of the School of Human Environmental Sciences. She and Elswick were introduced, and it wasn’t long before he returned to the classroom.

With the support of Hunter and other UK faculty, Elswick used his own experience with addiction to address needs he noticed in his community.

“We looked at all of the help I had in my recovery,” Elswick said. “With my employment, education, mental and physical health—you could go down the list of everything I had access to that put me in a better position to recover. But 99% of folks who have addictions in our community don’t have access to most of those resources.”

Elswick knew they needed to create a one-stop-shop for recovery. This model already exists in recovery community organizations. After researching as much as they could on the topic, Elswick and his colleagues traveled to see some RCOs making real change in their communities.

Thus was Voices of Hope born. An RCO in the heart of Lexington working to prove to those struggling that change can be made at any stage. The Voices team upholds the unique approach of supporting other pathways of recovery besides complete sobriety, or abstinence. Voices of Hope supports individuals who want to practice abstinence and provides programming from organizations like Alcoholics Anonymous for those interested. However, the team of coaches at Voices encourage any and all steps toward recovery, no matter the pace.

“If you think about any other kind of behavior change, people typically don’t change all at once,” said Elswick. “If I want to lose weight, it’s usually a process. Even if I have 50 pounds to lose, if I go to my doctor and say I’m only willing to lose 10, he or she will not kick me out of their office. It’s an improvement in your health, and at Voices, we recognize that by meeting you where you are.”

Voices of Hope began in 2014 as a group that provided access to naloxone (brand name Narcan), the drug that reverses drug overdoses, when it was very stigmatized and difficult to find. Now, they are a fully operational RCO with two Lexington locations and thousands served.

It provides servics to the deaf and hard-of-hearing, has a partnership with the state Department of Corrections to place recovery coaches in prisons, and has created mobile recovery units to provide resources in hard-to-reach areas of Louisville and Lexington. Those are just a few of the major projects Voices has achieved in the last few years.

Today, Elswick continues to be motivated by the same community that lifted him out of his substance use disorder and into his life of service. This includes his family and those at UK who encouraged him to work and do research in the substance use disorder space.

“It’s a cliché, I suppose, to say I wouldn’t be here without them, but I think it’s literally true,” said Elswick. “There’s no single job on the planet better suited for me than exactly the job that I have, and I believe strongly that if it weren’t for Kenny and Dr. Hunter advocating for me, I would not be where I am now.”

In his college, Elswick teaches the course Addiction is a Chronic Disease and has taught classes on Substance Use, Family and Society, Family Resource Management. Working with students and inspiring change is something he’s immensely grateful for.

“The University of Kentucky, from the beginning, supported me and supported recovery,” Elswick said. “I never experienced stigma and I never experienced shame from the university. I always heard university leadership saying ‘this is an issue that we want to get behind.’”

For more information on Voices of Hope, visit https://voicesofhopelex.org.

Elswick stands outside Voices of Hope at 644 N. Broadway in Lexington. (UK photo by Sabrina Hounshell)

Lottery system will determine who gets 48 licenses for retailers and 10 for processors of medical cannabis in 11 Kentucky regions

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear gave an update on the medical cannabis licensing program Thursday, after signing this year's medical cannabis bill into law the day before.

"We have worked hard to create a safe system that limits or eliminates abuse while still providing relief to that veteran suffering from PTSD or individual suffering from unbearable epileptic seizure after epileptic seizure," Beshear said during his weekly news conference.

Rep. Jason Nemes presents Senate changes to HB 829
on the House floor Monday, April 15. (Legislative photo)
House Bill 829
, sponsored by Rep. Jason Nemes, R-Middletown, has been described as a "clean-up" bill for Senate Bill 47, the measure that legalized medical cannabis during the 2023 session under the sponsorship of Sen. Stephen West, R-Paris. 
"In essence, all 829 does is set up the Office of Medical Cannabis and carries out the provisions of SB 47 as was passed last year," West said while presenting the bill on the Senate floor.

The final version of HB 829 will allow Kentucky to start issuing medical cannabis licenses to businesses in July in hopes that the product will be available to dispensaries in January 2025, when the program is set to go into effect. 

“It does allow these businesses — the growers especially — to get up and running, start growing product so there's actually something there to sell January 1,” West explained at the April 12 meeting of the Senate State and Local Government Committee.

It also allows cities to opt out of the medical cannabis program before Jan. 1, 2025, even if a licensee has been approved before that date. 

"Cities and counties have the opportunity to take a local vote. They can also pass ordinances that prohibit implementation," West said while presenting the bill on the Senate floor. "If someone is licensed before that time, it's buyer beware; they will have to take that into account as they apply for the license."

On Thursday, April 18, Beshear and Sam Flynn, executive director of the Kentucky Medical Cannabis Program in the state health cabinet described how the licensing would work under a regulation filed that day.

The new regulation will allow businesses to apply for a cannabis business license from July 1 through Aug. 31. Beshear said 10 licenses will be available across the state for processors, and 48 for dispensaries, the retail outlets. All their cannabis must be cultivated, processed and produced in Kentucky.

Flynn said the program has created 11 licensing regions to ensure Kentuckians with qualifying conditions have access to the product.

Beshear also announced that the state, in partnership with the Kentucky Lottery Corp., will issue the medical cannabis licenses using a lottery system. The first lottery will be held in October.

"This is what states are moving towards," said Beshear. "It reduces or eliminates litigation and it creates a more fair process, not one where people bid against each other and only then the big companies can be a part of it, but one that provides at least a chance for everyone who can meet the criteria." 

Flynn said the licensing process is designed to ensure that the industry is "stable and sustainable" with a focus on "small business" and meeting demand from people who have cards enabling them to buy medical cannabis.  

And, he said, each region will have at least four dispensary licenses available per region, with no more than one dispensary located in each county, with the exception of the state's two largest counties - Jefferson and Fayette - which are allowed two each. 

HB 829 also allows public and private schools to opt out of the program and says that public school boards are required to establish policies related to the use of medical cannabis no later than Dec. 1, 2024. 

The legislature did not expand the list of conditions that would make Kentucky residents eligible for medical cannabis beyond what was allowed in HB 47. In January, Beshear asked lawmakers to add 15 more medical conditions to the list, and West filed a bill to increase the list from seven to 21 conditions. West's SB 337 died in its assigned Senate committee, having never been called up for a hearing. 

The eligible conditions in the current law, passed by the legislature in 2023, are cancer, multiple sclerosis, muscle spasms or spasticity, chronic pain, epilepsy, chronic nausea and post-traumatic stress disorder.

Eight suicides in a month make for 'mental health crisis' in PIke

Pike County (Wikipedia map)
By Stan Ingold, WEKU

Officials in Eastern Kentucky are dealing with what they are calling a “mental health crisis.” In Pike County, over the last 30 days at least eight people have committed suicide.

To put that into perspective, the county had eight suicides in all of 2023, said Tammy Riley, the county's public health director. She said there are two common occurrences with these incidents.

“In a short span on time, the suicides have all been adults, ranging from the 30's to the 80's as far as years of age, primarily all have been male, and the mode has all been via firearms.”

She said many agencies are banding together to address the issue, including “Mountain Comprehensive Care Center, that's the federally qualified help center that is our primary provider for mental-health services for Pike County. We're also working with the Pike County coroner's office, the judge-executive's office, as well as resources available through the Kentucky Department of Public Health.”

Riley said the county is working on hosting several events in the coming days to make sure people are aware of resources that can help.

She also encouraged the use of the 988 crisis hotline for anyone who may feel they are in some kind of mental distress. Anyone can call or text 988 at any time to speak to someone qualified to help.

Thursday, April 18, 2024

Louisville's Norton Healthcare receives $20 million gift to support Parkinson's disease programming and research


Norton Healthcare has received a $20 million gift for the "Just Imagine" campaign to support programing and research in Parkinson's disease and movement disorders at the Norton Neuroscience Institute.
 
The Just Imagine campaign aims to ensure greater access to medical expertise; expand innovative clinical translational research; and recruit, train and attract even more best-in-class specialists.

The gift comes from the estate of Dr. Elizabeth Pahk Cressman, a Louisville anesthesiologist who died in 2021.

“Dr. Cressman’s vision has helped elevate the care for Parkinson’s patients, helping to create a nationally known program through Norton Neuroscience Institute,” Lynnie Meyer, senior vice president and chief development officer of Norton Healthcare, said in a news release. “She also was the catalyst behind funding Parkinson’s disease research that already has helped transform the lives of many patients and families through access to more groundbreaking treatments.”

Cressman worked at what is now Norton Women’s & Children’s Hospital, while her husband, the late Dr. Frederick K. Cressman, was a pathologist for Norton Healthcare. This latest gift brings Dr. Elizabeth Cressman’s total support of initiatives at Norton to $28 million.

Nearly 1 million Americans have Parkinson’s disease, and that number continues to grow. The movement disorder generally develops in people 55 to 75 with the main symptom being bradykinesia, or slowness of moment. It also can cause tremors and muscle stiffness.

“Parkinson’s disease can be extremely debilitating and, unfortunately, there currently is no cure,”  Dr. Justin T. Phillips, movement-disorders neurologist with Cressman Parkinson’s & Movement Disorders Center, said in the release. “With Dr. Cressman’s generosity, we are able to build upon the work we already do and offer even more options for patients. She has already had a great impact on people with Parkinson’s in our community, and that will continue for years to come.”

Free webinar, Health for a Change: Tackling the Immunization Crisis, is scheduled for Wednesday, May 8, by health foundation

The Foundation for a Healthy Kentucky's next "Health for a Change" webinar is titled "Tackling the Immunization Crisis." It will be held Wednesday, May 8, from 11 a.m. to noon ET. 

The free event will address three main topics, including: why dropping rates of immunizations in children should be considered a public-health crisis; what policies and conspiracies are contributing to the problem; and methods and resources advocates can utilize to improve vaccine access and trust. Click here to register. 

"The rise of vaccine hesitancy is creating a public-health crisis in our communities. In Kentucky and across the country we are now seeing cases of diseases that were once thought to be eliminated," says a foundation news release. "Misinformation and anti-vaccine policies are fostering mistrust, while also making it more difficult to access vaccines in some cases. This webinar will dive into these issues and explore ways advocates and health officials can tackle this crisis." 

The webinar's scheduled speakers are:
  • Dr. Christopher Bolling, volunteer professor of pediatrics, University of Cincinnati; retired pediatrician, Crestview Hills, Ky. 
  • Jessy Sanders, health communicator program manager, Kentucky Rural Health Association – Immunize Kentucky Coalition
  • Kelly Taulbee, director of communications and development, Kentucky Voices for Health

Tuesday, April 16, 2024

Top senators, one of whom lost both parents to smoking, say no advocates spoke to them about increasing anti-tobacco spending

By Al Cross
Kentucky Health News

Kentucky's top two state senators said Tuesday that none of the advocates for more funding of tobacco prevention spoke to them about it during the legislative session that ended Monday night.

"I never heard from those advocates. They never came to meet with me, and they probably should've. . . . I was in the room where it happened, and nobody ever spoke to me," Majority Floor Leader Damon Thayer of Georgetown said in response to a question from Kentucky Health News.

Thayer spoke at a Capitol rotunda press conference where leading Senate Republicans discussed what they considered to be the session's accomplishments. Senate President Robert Stivers told Kentucky Health News afterward that no one ever spoke to him about the proposal to increase tobacco-prevention spending to $10 million a year from $2 million.

Letter to senators (For a larger version, click on it.)
The proposal came from the American Cancer Society and several other groups interested in better health, including the Kentucky Chamber of Commerce. In a letter to senators, they said smoking is the No. 1 cause of preventable death in Kentucky and causes $2.23 billion in health-care costs, including $634 million in the federal-state Medicaid progam that covers more than one in three Kentuckians.

"A well-funded, fact-based tobacco control program is needed to counteract the $251 million per year that tobacco companies are spending to market their deadly and addictive products in Kentucky," the letter concluded. "As Big Tobacco has been working hard to addict future generations with e-cigarettes and other tobacco products, the need for more funding for tobacco-prevention programs has never been greater."

Thayer said after the press conference, "I get stacks and stacks of budget requests, and if they say, "I sent him a letter or an email,' that's not effective."

Kentucky Health News asked Doug Hogan, the Kentucky lobbyist for the cancer society, what legislators the advocates spoke with and why Stivers and Thayer were not included. He replied with this email:

“The American Cancer Society Cancer Action Network (ACS CAN) is proud to have advocated for the health of Kentuckians during this General Assembly session by asking for an increase in funding for the state’s tobacco prevention and cessation program. ACS CAN staff and volunteers were able to contact Senate and House offices to share the importance of this funding. ACS CAN is disappointed that our message was not heard, and a significant investment was not made in programs to help prevent kids from starting to use tobacco products, including e-cigarettes, and help those already addicted to quit.”

At the press conference, Stivers was asked if tobacco-control spending would be a good investment in the long term, by reducing health-care costs. He gave Thayer the microphone.

Asked if he thinks the current $2 million tobacco-control budget doesn't work, Thayer said, "I honestly don't know that it does. Honestly. I mean, how much money can you spend trying to dissuade people from doing something that everybody knows is unhealthy?"

Earlier, he said, "Everybody knows that smoking cigarettes is bad for you. . . . My dad knew the health risk his whole life and he never quit." Earlier, he said, "Both my parents died of cancer from the fact that my father was a multi-pack-a-day smoker, so this is an issue that's a little sensitive to me."

Thayer told Kentucky Health News after the press conference he believes that smoking killed his father, who died of esophageal cancer, and that secondhand smoke in their home killed his mother, who died first, of multiple myeloma: "I never saw her smoke a cigarette in my life." He acknowledged that more education on the risks of seocndhand smoke is needed.

When the final budget was released, Kentucky Health News asked Senate budget committee Chair Chris McDaniel of Northern Kentucky why there was no increase in tobacco-control spending. He said, "We kind of distributed it more broadly, with increases in funding for cancer research."

Stivers said likewise at the press conference, adding that health departments also got more funding. "What we are trying to do in all areas is to encourage people to have better and healthier lifestyles," he said.

Monday, April 15, 2024

'Momnibus' bill to improve maternal health passes on last day, after being attached to another bill to avoid floor fight on abortion

Rep. Kim Moser presents SB 74
to the state House (Ky. LRC photo)
By Melissa Patrick and Al Cross
Kentucky Health News

On the last day of the 2024 legislative session, a bipartisan bill aimed at improving Kentucky's dismal maternal-mortality rate was finally passed, after parliamentary maneuvering to avoid divisive issues.

Provisions of House Bill 10, known as the "Momnibus" bill for its varied approach, were added to Senate Bill 74, a bill to require analysis of child and maternal fatalities and add reporting requirements.

The Momnibus bill, sponsored by Republican Rep. Kim Moser of Taylor Mill, came from an informal, bipartsan House-Senate workgroup of female legislators who tackled a big problem: the nation's second highest rate of death of mothers in the year following childbirth. 

From that came a multifaceted bill that ensures access to health-insurance coverage for pregnant women by adding pregnancy to the list of exceptions for enrollment outside the normal open-enrollment period, and several other things.

It establishes a mental-health hotline called Lifeline for Moms that allows providers access to an immediate mental-health consultation for a mother in need; expands the Health Access Nurturing Development Services (HANDS) home-visiation program and lets it be available up to three years after birth; covers lactation consultation and needed equipment to encourage breastfeeding; and will educate mothers on the benefits of safe sleep for infants. These services would also be available via telehealth.

Democratic Sen. Cassie Chambers Armstrong of Louisville told the Senate that Moser "brought together a bicameral, bipartisan group of women legislators and "This is a truly great piece of legislation that will absolutely save lives."

The final bill dropped controversial language that added by a Senate committee. It would have required all hospitals, birthing centers and midwives to refer patients to a perinatal palliative-care program if the patient had a prenatal diagnosis that indicated a "baby" might die before or after birth. Kentucky abortion law does not allow for the termination of such pregnancies, though it is considered a standard of care for a nonviable pregnancy.

Abortion prompted the parliamentary maneuvering. Democratic senators filed floor amendments to Moser's HB 10 to change "baby" to "fetus"; let a physician terminate a pregnancy if it is complicated by a fatal fetal anomaly, or in the good-faith belief that the pregnancy was caused by rape or incest. To avoid a Senate floor fight over the issue, Moser looked for another vehicle.

She found SB 74, sponsored by sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, with an apt title. "I saw 'An act relating to maternal health'," she recalled. "It was germane, and apropos. . . . It works really well with the underlying bill."

Funke Frommyer said SB 74 was viewed favorbaly by a House committee, but didn't get a floor vote before legislators recessed to give Gov. Andy Beshear time to veto legislation and give them time to override his vetoes. Moser said the House considered the bill safe from a veto because it was non-controversial.

The original parts of SB 74 require the Cabinet for Health and Family Services to publish a report on its website for the most recent five years of available data on the number and types of delivery procedures for pregnancy by hospital.  It also has cleanup language for a number of health-cabinet programs.

The revised, combined bill passed the House 91-1, with Rep. Courtney Gilbert, R-Hodgenville, voting against it. On the House floor, Rep. Lindsey Burke, D-Lexington, praised the bill and Moser's work.

 "I have never been more delighted, proud or excited to vote for any single piece of legislation," Burke said. "It is a gift to the families of the commonwealth. I thank her for her hard work." 

The Senate agreed to the changes on a 29-5-2 vote, with Republicans Greg Elkins of Winchester, Jimmy Higdon of Lebanon, Chris McDaniel of Ryland Heights, Robby Mills of Henderson and Stephen West of Paris voting no and Republicans Donald Douglas of Nicholasville and Adrienne Southworth of Lawrenceburg passing. Republican John Schickel was absent.

Sen. Amanda Mays Bledsoe, R-Lexington, told the Senate, "I thought it was fantastic to have a Kentucky-crafted legislation that looked at solutions for us and not other states. . . . I just complement the bill sponsors and members of that working group for the good work."

Abortion did hit the Senate floor late in the day, as Sen. David Yates, D-Louisville, tried to bring up his SB 99, which would have added rape and incest exceptions to state abortion laws. Senate leaders ruled his action out of order, and when he appealed the ruling, senators upheld it largely along party lines.

Legislature rejects pleas, cuts tobacco-prevention spending; passes vape bill some say could spur youth smoking

By Sarah Ladd 
Kentucky Lantern

In a year when the American Cancer Society asked the Kentucky legislature to increase spending on tobacco prevention, lawmakers cut it and passed an anti-vaping bill that some say could increase cigarette use in the state.

The two-year state budget’s allocation for tobacco prevention — about $8 million shy of advocates’ ask — “certainly is not” enough to combat use in the state, said Doug Hogan, the government relations director in Kentucky for the American Cancer Society and its Cancer Action Network.

The cancer society and others — including the Kentucky Hospital Association, Foundation for a Healthy Kentucky and the Kentucky Chamber of Commerce — signed onto a letter in January asking for a $10 million investment in the state’s Tobacco Prevention and Cessation Program.

Also writing in support of the $10 million for prevention and cessation were Dr. B. Mark Evers, director of the Markey Caner Center at the University of Kentucky, and Jason Chesney, director of the Brown Cancer Center at the University of Louisville.

“A well-funded fact-based tobacco control program is needed to counteract the $251 million per year that tobacco companies are spending to market their deadly and addictive products in Kentucky,” that letter stated. “As Big Tobacco has been working hard to addict future generations with e-cigarettes and other tobacco products, the need for more funding for tobacco prevention programs has never been greater.”

According to that letter, Kentucky sees $55 savings for every $1 it spends on tobacco control programs.

This session, lawmakers passed a bill touted as a way to curb underage vaping. The bill limits vaping products that can be sold in Kentucky to those that have approval from the U.S. Food and Drug Administration, have applied for FDA approval or are challenging denial of FDA approval.

Advocates said that by limiting available vaping products, the bill could result in more Kentuckians turning to cigarettes. Tobacco cigarettes are worse for bodily health.

Vaping has eclipsed traditional smoking among Kentucky youth, advocates say, though Kentucky’s rates for both are higher than the national average.

“The only effective strategy is to adequately fund evidence-based programs,” the Cancer Society’s Hogan said, “that have a meaningful, measurable track record of success.”

Alicia Whatley, policy and advocacy director for Kentucky Youth Advocates, said the state needs a “comprehensive” battle against nicotine use in general. The roughly $2 million going toward cessation is “not nearly enough” to accomplish that goal.

“​​We don’t just want a database of who’s selling vape products,” she said. “We want something comprehensive that tells us who’s selling any of those products” — traditional cigarettes, chew tobacco, nicotine patches, vapes, she said.

Under a new law, the Kentucky secretary of state is required to keep a list of retailers that sell vaping products. That law, HB 11, is meant to curb underage vaping by limiting sales to “authorized products” or those that have “a safe harbor certification” based on their FDA status.

In the final days of the session, this bill absorbed Senate Bill 344, which created an e-cigarette registry. The combined bill was signed into law by Gov. Andy Beshear on April 5. It goes into effect Jan. 1.

“It really should be more comprehensive, but I did not see that that was the case this year,” Whatley said. “I saw a lot of people just talking about vaping.”

Another new law, HB 142, directs boards of education to distribute tobacco prevention and cessation materials to students every year. It also requires schools to confiscate tobacco and vaping products and allows them to suspend students for subsequent violations of the ban on smoking and vaping on school property. It was delivered to Beshear in late March and he signed it on April 9. 

What’s in the state budget for tobacco prevention?

The legislature’s two-year budget slightly cut funding for tobacco control in 2025, according to Cara Stewart, the director of policy advocacy at Kentucky Voices for Health. The funding then flattens out in 2026.

Right now, there’s about $2 million per year set for tobacco prevention efforts, said Hogan. That number drops by about $130,000 for the first year of the new budget. Then, for 2025-2026, it is restored to $2 million.

“Quite frankly, it’s outrageous that lawmakers ignored the urgent need for a significant investment in tobacco prevention and cessation,” Hogan told the Lantern in early April. “Lives are at stake. The health of our next generation is at stake with e-cigarettes and other products.”

Citing Centers for Disease Control and Prevention data, Stewart said Kentucky should be putting closer to $56.4 million every year into tobacco control, considering the state’s population and smoking rate.

Two bills that did not advance this session — HB 813 and SB 335 — would have assisted that goal by moving Juul settlement dollars from the General Fund to the Department for Public Health to support the Smoking and Vaping Cessation Program. Both were dead on arrival.

Public health advocates think that money should indeed be spent on tobacco prevention.

“Tobacco use is our number one preventable cause of disability, disease and death,” said Stewart. “Every single county in the state has a smoking rate above the national average.” 

‘All smokers want to quit’

The CDC reports that “most” vaping products have nicotine in them, an “addictive” chemical that is “toxic to developing fetuses.”

Vaping products can also harm lungs and brain development in youth, the CDC says. E-cigarettes are not safe, the CDC says, though they’re safer than smoking traditional cigarettes, which the CDC reports is a leading cause of preventable death in the country.

Some research suggests vaping can help people quit traditional smoking. That hope helped push Louisville businessman Troy LeBlanc into the vape business.

About 11 years ago, it worked in getting — and keeping — him off cigarettes.

“All smokers want to quit,” LeBlanc said. “I went through Chantix. I did the gum. I did the patches. I did cold turkey. I did all these different things that never worked. Well, you know what did work? Vaping.”

“The whole point of electronic cigarettes” is to get people weaned off, he said, by tapering down their intake over time, eventually stopping.

“I cannot say that every person that walks into my store is doing it with this specific plan to quit vaping,” he said. But he has seen “multiple people quit vaping completely.”

LeBlanc told a legislative committee that the new law’s limits on vaping products “is essentially creating a monopoly for Juul,” an e-cigarette company. 

Will anti-vape bills help public health?

It remains to be seen what effect anti-vaping legislation like HB 11, which takes effect Jan. 1, will have on public health.

Some in the vaping industry say it will drive consumers back to traditional tobacco products — an assertion buttressed by reports from Altria, the parent company of tobacco giant Phillip Morris USA, the leading manufacturer of cigarettes in the United States.

Altria is lobbying legislatures around the country to enact laws like the one Kentucky just passed. Altria also has moved aggressively into marketing its FDA-approved e-cigarette products.

In a February earnings call. Altria CEO Billy Gifford said that “illicit e-vapor” sales last year reduced Phillip Morris cigarette sales by 1.5% to 2%.

The February earnings report said a successful clampdown on disposable e-cig growth could increase Altria’s earnings per share between 5 cents and 15 cents, according to an analyst for Barclays, “if cigarette volumes improve and e-cigs decline or remain steady.”

Since January 2022, Altria has spent more than $500,000 lobbying the Kentucky legislature, according to reports filed with the Legislative Ethics Commission.

“To the extent that this drives people back to smoking, how does this help public health?” said Greg Troutman, a lawyer for the Kentucky Smoke Free Association, which represents vape retailers.

Troutman said the new law will “blackmarket” vape products that have unknown ingredients.

People who smoke increase their risks of heart disease and strokes, according to the CDC. But it doesn’t hurt just them. Nonsmokers who breathe secondhand smoke are much more likely — 20% to 30% — to end up with heart disease or stroke, the CDC says. Kentucky already has dismal rates of heart disease mortality and stroke.

In 2021, a California-based study found that when flavored e-cigarettes were banned, minors turned to traditional cigarettes. At that time, researchers foundthat “reducing access to flavored electronic nicotine delivery systems may motivate youths who would otherwise vape to substitute smoking.”

At the time of publication, study author and assistant professor of health policy at Yale School of Public Health Abigail Friedman, urged caution when passing legislation attacking vapes only.

“While neither smoking cigarettes or vaping nicotine are safe per se, the bulk of current evidence indicates substantially greater harms from smoking, which is 
responsible for nearly one in five adult deaths annually,” said Friedman. “Even if it is well-intentioned, a law that increases youth smoking could pose a threat to public health.”