Kentucky has fewer counties in White House Coronavirus Task Force 'red zone' but nine moved into it while 13 moved out

Table from White House Coronavirus Task Force report; for a larger version, click on it.

Kentucky Health News

Kentucky got a better report from the White House Coronavirus Task Force Monday, with 52 counties in danger zones for the reporting week of Aug. 15-21. The previous week, 63 of the state's 120 counties were on those lists.

Sixteen counties were in the task force's "red zone" for places where new cases of the virus numbered more than 1 per 1,000 residents and the share of residents who tested positive for the virus during the week was greater than 10%, with the other in the red zone. The report put 36 counties in yellow, down from 43 last week.

Moving into the red zone were Clinton, Franklin, Green, Metcalfe, Monroe, Nelson, Oldham, Simpson and Washington counties. Moving out of it were Barren, Bell, Clay, Hardin, Henry, Hickman, Lewis, Logan, Powell, Scott, Spencer and Wayne counties.

The report does not include county-by-county figures, but it has maps showing counties within ranges of new cases and positive tests during the week.

Table from White House Coronavirus Task Force report; for a larger version, click on it.

Statewide, the report says Kentucky had fewer new cases and a lower positive-test rate than it did last week. It had 89 new cases per 100,000 population in the past week, compared to a national average of 93 per 100,000.

The report also includes graphs for many major and red-zone counties, which show the daily new cases and the seven-day rolling average.

Table from White House Coronavirus Task Force report; for a larger version, click on it.

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5 ways to ease pain using the mind-body connection

I smashed my elbow a few weeks ago. There was no bone break — just a bad bruise after slipping in the kitchen and landing on my arm — but at times the pain has been excruciating. So I’ve been following doctor’s orders: babying my elbow, icing it, and taking an occasional over-the-counter painkiller. (PS: I wear sneakers in the kitchen now.)

Something else has helped, too: mind-body therapies. These approaches aim to change our awareness of pain and retrain the way we respond to it. The therapies can help us control pain — such as long-lasting back pain — or live with it better. While these techniques won’t erase pain, they can help change perception of pain intensity through distraction, relaxation, and reframing our thoughts.

Five mind-body therapies to consider for pain relief

Cognitive behavioral therapy (CBT). This talk therapy teaches people to redirect their thoughts, feelings, and behaviors in response to chronic pain. For example, when a pain flare-up strikes, instead of bracing yourself and thinking, “Oh no, here it comes again,” tell yourself you’ve handled this before, and focus instead on your favorite place in the world: picture it in your mind, and feel how happy or relaxed you are when you’re there. A therapist trained in CBT can train you to hone your skills.

Deep breathing. We typically take short little breaths without noticing our breathing, especially when we’re in pain. Focusing on breathing and taking deep breaths quiets the mind and induces the relaxation response, a well-studied physiologic response that counteracts the stress response, and may lessen chronic pain severity. To practice deep breathing:

• Breathe in slowly through your nose, allowing your chest and lower belly to rise as you fill your lungs completely.
• Now exhale slowly through your mouth or nose.
• Practice deep breathing for several minutes.

Meditation. Like deep breathing, meditating triggers the relaxation response and may reduce the perception of pain. You can use many methods to meditate, such as transcendental meditation (repeating a word, phrase, or sound to quiet your thoughts); yoga (a series of strengthening and stretching postures combined with breathing techniques); or mindfulness meditation (focusing objectively on negative thoughts as they move through your mind, so you can achieve a state of calm).

One simple way to meditate:

• Sit quietly, close your eyes, and focus on your breathing.
• Say a word such as “peace” or “one” each time you exhale.
• Don’t worry about thoughts that come to mind; you can come back to them later. Continue to repeat your word and focus on breathing.

Mindfulness-based stress reduction (MBSR). This approach combines mindfulness meditation and yoga to build awareness and acceptance of moment-to-moment experiences, including pain. A 2019 study published in the journal Evidence-Based Mental Health found MBSR was just as effective as CBT at reducing pain and depression, and improving physical functioning, compared with usual care or no care. You’ll find MBSR programs at hospitals, universities, and meditation centers, and online videos.

Relaxation. Relaxation techniques, such as progressive muscle relaxation, may also help reduce the perception of pain. To try progressive muscle relaxation, start with your facial muscles and work your way down the body. Tighten each muscle or muscle group for 20 seconds before slowly releasing the contraction. As the muscle relaxes, concentrate on the release of tension and the sensation of relaxation.

The post 5 ways to ease pain using the mind-body connection appeared first on Harvard Health Blog.

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Convalescent plasma: another controversial clash of politics & science

You’d need a pretty big, stiff broom to sweep away all of the hype dished out by the Trump Administration as it announced an Emergency Use Authorization for convalescent plasma – the liquid component of blood that may be tapped for disease-fighting antibodies from people who’ve been infected with COVID-19.

Before the announcement was even made, President Trump’s press secretary called it “a major therapeutic breakthrough.”

Trump called this “a truly historic announcement” and said that the treatment had reduced mortality by 35% – a “tremendous number” in his words.

Alex Azar, secretary of the Department of Health and Human Services also touted the 35% mortality reduction, calling it “a major advance.”

And FDA commissioner Steven Hahn also said “A 35% improvement in survival is a pretty substantial clinical benefit.”

One of my former co-workers on HealthNewsReview.org wrote on Twitter:

Dear @SteveFDA, please take a moment to review the @HealthNewsRevu primer on absolute vs. relative risk reduction. Clearly you could use a refresher course.

Because, as STAT reported:

The Mayo Clinic study, which enrolled more than 35,000 patients, showed that patients who received transfusions within three days of their Covid-19 diagnosis had a seven-day death rate of 8.7%, while patients who received plasma treatment after four or more days had a mortality rate of 11.9%.

So the absolute risk reduction was not 35%, the number Trump, Azar, and Hahn preferred to use.  It was about 3%.  A survival improvement of about 3 out of 100 – not 35 out of 100.

A physician tweeted in response to Hahn and the FDA:

…your organisation has just trashed its reputation. These claims are wildly inaccurate, without any scientific basis, and globally embarrassing. Resignations should follow.

Another physician on Twitter called it “false advertising.”

There were countless other angry Twitter responses, which you can read here if you wish.

Besides STAT’s original reporting, other news organizations jumped on the confusing statistical gamesmanship employed by the White House and two federal health agency directors.

The Washington Post reported:

(Trump) has seized upon the use of convalescent plasma, trying to sell a moderately promising therapy as a monumental breakthrough in treating the most seriously ill covid patients. He called it “a powerful therapy” with “an incredible rate of success.”

…

The Infectious Diseases Society of America said that while there are “some positive signals that convalescent plasma can be helpful in treating individuals with covid-19,” its benefits needed to be demonstrated in clinical trials that randomly assign patients to receive either plasma or a placebo before it is authorized for wider use.

In a newsletter, the Post included messages of concern from:

• Eric Topol, director of the Scripps Research Translational Institute (“Today’s ‘breakthrough’ announcement is unlikely to be any breakthrough.” Topol also tweeted, “There’s no evidence to support any survival benefit.”)
• Andy Slavitt, former director of the Centers for Medicare and Medicaid Services (“The political FDA arm twisting should be a concern to all Americans….It is very clear Trump thinks science and particularly the FDA is getting in the way.”)

Indeed, Trump had earlier tweeted:

In response, Axios reported:

(The president’s trade advisor, Peter Navarro) had aggressively confronted FDA officials, saying, “You are all Deep State and you need to get on Trump Time.” (That’s the expression Navarro uses to describe the speed that he says Trump demands.)

• • Sources familiar with the situation said Navarro has been venting at the FDA for weeks at what he perceives as its slowness to approve therapeutics to fight COVID-19 and help the U.S. “bring our medical supply chain home.”
  • Navarro has argued that the FDA’s slowness has cost lives during a pandemic.
  • A third senior administration official said Navarro — a fervent proponent of hydroxychloroquine — remained angry at the FDA for saying the drug didn’t work against COVID-19.

And Bloomberg reported:

The Trump administration’s decision to authorize the use of a blood-plasma treatment for Covid-19 with no clear evidence it works could frustrate efforts to better understand the therapy’s benefits.

Remember, just last week, federal health agency officials Dr. Francis Collins and Dr. Anthony Fauci had “urged caution, citing weak data from the country’s largest plasma study.”

 

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Ky. study shows syringe exchange programs decrease infections associated with IV drug use, could result in 'big money saved'

By Melissa Patrick
Kentucky Health News

A new analysis of Medicaid claims data suggests that Kentucky counties with syringe-service programs have slightly lower rates of diseases associated with intravenous drug use, such as HIV and hepatitis C.

The analysis estimated a progressive reduction of 0.5 percent per month, adding up to a 6% increase over a year. That can add up to savings, not only in lives, but money. So said Dr. Connie White, deputy commissioner of clinical affairs for the Kentucky Department for Public Health, at the Kentucky Harm Reduction Summit Aug. 20. 

White said, "As a public-health person, I think of all the emotional tragedy for the patient and for the family with one of these co-morbidities," diseases and conditions that occur together. "But if you're trying to sell this program to a bunch of politicians and legislators, you're talking about money saved, we're talking big money saved."

Kentucky has more syringe-service programs than any other state in the nation, but 56 of the state's 120 counties still don't have one -- and 20 of those are considered highly vulnerable to an HIV or hepatitis C outbreak among IV drug users, according to the Centers for Disease Control and Prevention. Thirty-four of the state's most vulnerable counties have operational syringe exchanges. 

The vulnerable counties without an exchange include Bell and Clinton, which rank sixth and 11th on the national list of 220; Cumberland, Casey, Edmonson, Harlan, Johnson, Lawrence, Lewis, Menifee, Monroe, Rockcastle and Wayne, also in Appalachian Kentucky; and eight in the rest of the state: Carroll, Gallatin, Green, Breckinridge, Grayson, Green, Allen and Hickman. 

Kentucky has 74 operational syringe-service programs in 63 counties, with one more in Christian County approved but not operational. Bracken County's exchange is marked on the state's map as not yet operational, but it started operating July 8. 

Syringe-service programs are more broadly referred to as harm-reduction programs and are designed to prevent outbreaks of HIV and hepatitis C, which are commonly spread by needle sharing among IV drug users. They also provide health screenings and vaccines, and connect drug users to treatment. 

They are allowed by a 2015 state law that requires approval by the county health board, the fiscal court and the city where the exchange is to be located.

Syringe exchanges decrease disease

The Kentucky Office of Health Data and Analytics did the analysis at the request of the Department for Public Health.

One reason the study is so important is that it helps to root the debate about such programs in empirical data, said Mathew Walton, a researcher with the office. 

Walton pointed to a national study that shows a person's political affiliation, income, and amount of stigma they feel about addiction and syringe-service programs are significant predictors of whether or not someone supports these programs -- not the facts.

The study looked at Medicaid claims from January 2015 through June 2019 in any county that had implemented a syringe-service program during that time.

It looked for six infections largely connected to IV drug use and minimally associated with other activities: HIV, hepatitis C, endocarditis, osteomyelitis, and, in people diagnosed with opioid-use disorder, skin and soft-tissue infections. The researchers only included new infections in their analysis. 

The study looked at infection rates before and after the syringe exchange was established in 42 counties. Recognizing that results might not be seen immediately, included lag times of one month, three months and six months. It also adjusted for a list of variables, many related to demographics.

Cameron Bushling, a statistician with the office, said each of the lag-time scenarios showed a decrease in infections after the syringe exchange was established. 

"The infection rate in your county will go down by roughly half a percent each month after you implement a syringe service program," he said. "So some, some may think this is a small number, but it's important to keep in mind that our infection rates were very low. . . . So half a percent is still a pretty big find."

In conclusion, Walton pointed out that most of the counties in the study were rural, outside metro areas. 

"There's an evidence of an association that they were successful in reducing infection, new infections," Walton said. "These do seem to be an effective use of resources for preventing costly and harmful infectious disease." 

He said the savings that would come with even small reductions in infections caused by IV drug use.

"While this analysis revealed that this set of infectious-disease diagnoses was rare, even preventing a small percentage of them can have a significant effect on the Medicaid program," he said. "A single course of treatment for hepatitis C can be as much as $85,000 or more, so even a small outbreak prevention can be both a sort of economic benefit as well as a humanitarian and medical population health benefit."

Advice for resistant counties

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, after a separate presentation, was asked what advice he would give counties that have been resistant to syringe exchanges. 

"I realize these can be controversial in some communities," said Ingram, who was Maysville's police chief before taking the drug-control job, and back then opposed syringe exchanges. Many law-enforcement officers do, believing, that they encourage drug use, despite research to the contrary.

"Well, first, just don't give up," he said. "Second, do everything you can to get the public on your side, the voters on your side. . . . and continue to keep raising this issue."  

He also suggested identifying the thought leaders in a community, those who have influence, and then educating them on why it's important to have one. His last bit of advice was to reach out to public health departments that have already fought this fight successfully and learn from their strategies.

Asked the same advice question, Frankie Haynes, the harm reduction coordinator for the Barren River District Health Department, stressed that educating the public is the key. 

"I can't tell you how many times we went into different entities and just explained to people what harm reduction was, or what needle-exchange services are, what are we doing," she said during a panel discussion about exchanges, "And once you give them a whole rundown on what it looks like to be a part of our program, what to expect within the program, you really start seeing eyes opening to the need for these programs across the state." 

The Bowling Green-based Barren River department is working to expand syringe services into Logan County, which has received approval from its Board of Health, but still needs the approval of the Russellville City Council and the county Fiscal Court. Two of the district's eight counties (Warren and Barren) have exchanges. 

Jennifer Twyman, health-education specialist with the Louisville Metro Public Health and Wellness syringe exchange program, agreed with Haynes. She said discussions with the public put a face on the program: "Talking to people in the community, so that they know what we're doing, makes just a huge difference."

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Kentucky stays in four-week elevated plateau of new coronavirus cases, but hits a new high for its Monday-Sunday reporting week

Kentucky Health News chart based on state data; for a larger version, click on it.

By Melissa Patrick

Kentucky Health News

While Kentucky remains on a rough, elevated plateau of new coronavirus cases, Sunday's addition of 467 cases pushed the state into a new high for a Monday-to-Sunday reporting week -- 4,450 cases reported Aug. 17-23.

The new seven-day rolling average of 636 is the eighth highest of the pandemic, and more than triple what it was two months ago.

“We remain in a plateau with our number of new cases, which is positive, but we have to see those numbers steadily decline,” Gov. Andy Beshear said in a news release. “All of your sacrifices are working, and we must all continue to be patient and do our part to drive those numbers down.”

The new weekly high is 117 more cases than the 4,333 reported last week.

As some school districts and day-care centers push back against Beshear's recommendations around reopening dates and capacity limits, he has taken to reporting the daily number of children newly infected by the virus. Today, he said 79 of the newly reported cases were from people 18 and younger, of which 15 were five or under. The youngest was 3 days old. 

“We are seeing a steady number of coronavirus cases among the young in Kentucky, and make no mistake: Youth is not a guarantee of a good outcome against this virus,” he said.

As usual, Sunday's report did not include some data, including the share of Kentuckians testing positive for the virus in the last seven days. Saturday, it fell below the key level of 5 percent for the first time in 30 days.

Beshear reported nine more deaths from covid-19, raising the state's toll to 881. Two small, rural counties each had two covid-19 deaths. Green County lost two residents, a 90-year-old woman and a 91-year-old man; and Lewis County lost two maen, 73 and 78. 

The other fatalities were a 63-year-old man from Johnson County; a 63-year-old man from Shelby County; a 72-year-old man from Knox County; a 77-year-old woman from Oldham County; and an 88-year-old woman from Scott County. 

Health Commissioner Steven Stack continued to implore Kentuckians to follow public-health guidelines that he said are having a positive impact, saying in the release that even though Kentucky is on an "elevated four-week plateau . . . we remain in a difficult place, and Kentucky could quickly begin a rapid escalation."  

Stack, a physician, joined Beshear in putting gentle heat on school leaders and other local officials. “These are difficult times without simple solutions,” he said. “Through their actions, local leaders have an obligation to keep the virus under control to reduce the risk of medical harm to their students, staff, and larger communities.”

He added basic reminders: “Please, socially distance greater than six feet. Wear a mask at all times when in public and around others. Wash your hands often. Check for signs of infection and get tested if ill. Cooperate with contact tracing if you are called. If we do these things, we can contain the coronavirus and get back to more of the activities we miss.” 

In other covid-19 news Sunday:

• Jefferson County had nearly one-third of the new coronavirus cases Sunday, with 152. Other counties with more than 10 new cases in the daily report were Fayette, 76; Madison, 29; Kenton, 20; Calloway, 11; and Marion, 10.  
• Conflicting orders have left unclear who is and who isn't protected from eviction in Kentucky, Matt Mencarini reports for the Louisville Courier Journal. Cathy Hinko, executive director of the Metropolitan Housing Coalition, told him, "Now we're down to this arm-wrestling between sheriffs and the court system and the governor. . . . The lack of clarity in the face of a pandemic maelstrom of displacement is beyond comprehension." Beshear said at his Thursday briefing that he will make an announcement Monday about an agreement to settle a Northern Kentucky eviction lawsuit and funnel some CARES Act money to landlords. Chris Otts of WDRB also reports on the issue.
• The University of Louisville will require its students to be tested for the coronavirus, after initially only encouraging them to do so, Sarah Ladd reports for the Courier Journal. Free testing will begin Monday and tests must be taken between Aug. 24 and Sept. 4. Failure to comply may lead to "disciplinary action if necessary," according to the university. 
• Chris Kenning of the Courier Journal tells the story of a hospital chaplain and the entries from a journal he has kept since the start of the pandemic: "His journal, alternating in tone between the brevity and stoicism of a sea captain’s log about a gale to passages of emotional storytelling, is filled with instances of front-line health workers scrambling bravely amid the dangers and chaos of life-and-death emergencies."
• Six positive coroanavirus tests have been confirmed at the Eastern Kentucky Veterans Center, a nursing home in Hazard, among one employee and five veterans, Evan Hatter reports for WYMT-TV.

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Substance-use research at UK aims to slash ODs, quash hepatitis C, help pregnant and incarcerated women, and much more

By Melissa Patrick
Kentucky Health News

Research about substance abuse has become a major enterprise at the University of Kentucky, legislators heard last week as they got an update on UK research projects, including one that aims to cut overdose deaths 40 percent in 16 counties and another that aims to eliminate hepatitis C in a county. 

UK Vice President for Research Lisa Cassis told the Substance Use Recovery Task Force Aug. 11 that since substance -use research was added as one of UK's six institutional research priorities in 2018, it has experienced the largest growth in grants and contracts, increasing from 75 projects in 2018 to 105 in 2019, with a 151% increase in funding, to more than $75 million.

Sharon Walsh, director of UK's Center on Drug and Alcohol Research, reviewed a few projects, starting with one that has the largest grant ever awarded to UK: the $87 million, four-year HEALing Communities Study, which has a goal of reducing opioid-overdose deaths by 40 percent in 16 counties that represent more than a third of the state's population.  

Photos are from PowerPoint presentation to the Substance Abuse Recovery Task Force

The 16 counties are Jefferson, Fayette, Jessamine, Clark, Franklin, Boyle, Madison, Bourbon, Kenton, Campbell, Mason, Greenup, Carter, Boyd, Floyd and Knox. 

The grant is part of a larger National Institute on Health initiative called HEAL, which stands for  Helping to End Addiction Long-term. 

Walsh said the UK project is moving into its implementation phase, which involves communication efforts to increase demand for medication for opioid use disorder (MOUD) and naloxone, which negates overdoses; increase MOUD prescribing; increase access to naloxone; and reduce high-risk prescribing. The campaign will also work to decrease the stigma of substance-use disorder. She also pointed to an $8 million grant-funded project, Justice Community Opioid Innovation Network, which is working to increase initiation and maintenance of MOUD to reduce relapse and overdose among women who are in transition from jail to the community. This program will involve about 900 women across nine Kentucky jail sites. It is part of the HEAL initiative. 

Walsh said that in the fiscal year ended June 30, UK had about 133 projects related to substance use, with 69 principal investigators, or head researchers.

One is funded by a a $15 million, five-year grant to treat every resident of Perry County who is chronically infected with hepatitis C, in order to examine the concept of "treatment as prevention." This project, called KeY Treat, not only provides hep-C treatment and training for providers to deliver it, but substance-use-disorder treatment and case management, and harm-reduction services such as a syringe exchange if needed. Intravenous drug users are especially vulnerable to hepatitis C and can spark outbreaks of it.

KeY Treat is led by Jennifer Havens at the UK Center on Drug and Alcohol Research. It builds on her ongoing research project that has followed, for over 10 years, more than 500 people who use drugs in Appalachia. In 2008-10 her research shows a 42.9% of those who injected drugs had hepatitis C; that increased to 65.8% in 2018, Walsh said.

She said 151 people had enrolled in the KeY Treat program, and 97% had started medication to treat their hepatitis C. Among those, 83% have completed treatment, and 97% of them are considered cured. Only about half of those enrolled in treatment are actively using drugs, she said.

As part of the National Rural Opioid Initiative, Walsh said, the CARE2HOPE project has partnered with residents of the 12 counties in the Gateway Health District and Kentucky River Health District to build evidence-based, community-rooted public health responses to the opioid epidemic, overdoses, hepatitis C and HIV. It is funded by a $5.4 million grant.  

Walsh said several of UK's projects fall under the Kentucky Opioid Response Effort, or KORE, which is designed to support services that address the opioid crisis, rather than to drive research. She said KORE currently provides support for 61 different entities across the state and UK is just one of them. 

One of the KORE-funded projects at UK is the First Bridge Clinic, which provides "on-demand" treatment access for those suffering with opioid-use disorder. From its opening in January 2018 to present, this clinic has seen 1,111 patients, and 450 of them began medication to treat their opioid-use disorder, Walsh said.

She said KORE has expanded its model to St. Elizabeth Healthcare, University of Louisville Hospital, the Appalachian Regional Healthcare System, Baptist Health in Lexington and Corbin, and Norton Healthcare in Louisville. 

Another KORE-funded program is the Addiction Consult and Education Services program (ACES) that provides a way for UK hospital patients to get an addiction consultation while hospitalized. It also provides education services for providers. Walsh said this program has done 1,314 consults since October 2018. Of those, 702 initiated medication-assisted treatment while in the hospital. After they were discharged, ACES referred 373 to the First Bridge Clinic, and 190 kept their first appointment. 

The PATHways program was available before KORE funding was available, but has since gotten support from it. The Perinatal Assistance and Treatment Home program works to expand opioid-use disorder treatment access to women immediately before and after giving birth. Since August 2018, 306 mothers have enrolled in PATHways and 251, or 82% of them, initiated MOUD.

Another KORE-funded program, Beyond Birth, provides opioid use disorder treatment to postpartum women, along with comprehensive, wraparound services in coordination with social workers in the Kentucky Department for Community Based Services. 

Walsh also mentioned several other KORE-funded programs, including one that works to increase pharmacists' capacity to administer Vivitrol, a medication for opioid-use disorder; one that trains students in evidence-based practices for opioid-use disorder; one that provides psychiatric care for people who have opioid-use disorders; one that provides treatment for infectious diseases associated with intravenous drug use; and another that is working to build a substance-use-disorder workforce in the Appalachian region.

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Nearly half of teenagers who use electronic cigarettes say they want to quit; there are several programs to help them

By Melissa Patrick

Kentucky Health News

Nearly half of teens who use electronic cigarettes said in a national survey that they wanted to quit, and about a quarter said they had tried to in the past year.

Photo from Your Teen magazine

“This suggests to me that vaping-cessation interventions are urgently needed,” Adam Leventhal, co-author of the study and founding director of the University of Southern California's Institute for Addiction Science, said in a news release. “Youth deserve information about how to quit vaping. And for those not interested in quitting, public education campaigns that increase motivation to quit could be useful.”

A research letter accompanying the study in the journal JAMA Pediatrics says it is the first of its kind and is significant, because programs to help teenagers stop vaping are not widely disseminated and existing programs have received little empirical investigation.

The survey of 14,798 teens found that among the nearly 500 who said they had used electronic cigarettes in the past 30 days, 44.5% said they were seriously interested in quitting and 24.9% said they had tried to quit in the past year. 

 

The researchers say teens who use e-cigarettes are at risk for nicotine addiction, toxicant exposure, and transitioning to traditional tobacco cigarettes. 

"This new data is just one more example that it''s best not to start in the first place, because half of the kids want to quit and are struggling," said Bonnie Hackbarth, vice-president of external affairs at the Foundation for a Healthy Kentucky. "And it's hard to quit. As we've said multiple times, nicotine is one of the most addictive substances on the planet and youth are particularly susceptible because their brains are still developing." 

As part of the Coalition for a Smoke-free Tomorrow, the foundation lobbied during the last legislative session for more funding for tobacco prevention and cessation, with plans to use much of the $10 million on a multimedia campaign that targeted youth. 

But amid the coronavirus pandemic and the financial uncertainty that came with it, Kentucky lawmakers passed a conservative one-year budget that ended up cutting the state's prevention and cessation budget by nearly 40%, to $2 million from $3.3 million in the fiscal year that ended June 30.

"We know that vaping has an immediate effect on youth, in terms of their attention span, in terms of their brain development, so prevention for youth is just critical and our hope would be that the legislature would at least restore that budget to the 2020 levels," Hackbarth said. She also noted that tobacco prevention in youth will save significant amounts of money in healthcare cost down the line, since 90% of smokers started smoking by the age of 18. 

In Kentucky, 26.1% of high-school students reported current use of e-cigs, defined by at least one day of use during the 30 days before the survey, and 8.7% reported daily use, according to the federal Youth Risk Behavior Surveillance System for 2019. Nationally, the survey found 32.7% of high-school students in the U.S. reported current use and 7.2% reported daily use. 

The study, citing the Monitoring the Future survey, says that in 2019, 25.2% of U.S. high-school students reported current use and 11.7% reported daily use, defined as use of electronic nicotine products. 

Elizabeth Anderson-Hoagland, health promotion section supervisor with the Kentucky Chronic Disease Program, said the latest federal survey also showed that about half of all Kentucky teens who use tobacco have tried to quit in the past year. 

"I think there is a myth that teens do not care about their health or that they don’t think about consequences of tobacco use," Anderson-Hoagland said in an e-mail. "We know they absolutely do care about their health. They do care about saving money. They do care about having the trust of their parents and teachers and friends." 

She noted immediate side effects of vaping are dry mouth, throat irritation, cough, and shortness of breath, adding that there are also potential long-term effects, like heart disease or stroke.  

At this time, she said, the state directs youth who want to quit vaping, smoking or using other tobacco products to a program called "My Life, My Quit," a free service for minors. The program includes live support by phone, text, or online chat.

Participants can join by texting START MY QUIT to 855-891-9989 or going to MyLifeMyQuit.com. Teens are eligible for up to five calls with an experienced and trained Quit Coach. The program does not provide nicotine replacement therapy. 

"What teens do need is a support network for a successful quit, because teens need help with creating plans and resisting cravings," Anderson-Hoagland said. "MLMQ is a great resource to provide that support."

Due to low participation, she said, Kentucky no longer offers a program targeting young adults called This is Quitting. She said the state has re-directed its funding to other priorities.

Here are other resources for teens who are looking to quit include:

• Truth Initiative text message program: Text DITCHJUUL to 88709 or visit https://truthinitiative.org/research-resources/quitting-smoking-vaping/quitting-e-cigarettes 
• Not On Tobacco (NOT), a 10-week, voluntary program for small groups of teens aged 14-19: https://www.lung.org/quit-smoking/helping-teens-quit/not-on-tobacco
• Become a Smoke-Free Teen: Quit Vaping explains tools to help you quit and how to use them, from the U.S. Department of Health and Human Services: https://teen.smokefree.gov/

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