Wednesday, April 27, 2016

UnitedHealth will leave Ky. next year, leaving much of the state with only one or two choices for health insurance on exchange

UnitedHealth Group Inc. won't be participating in Kentucky's individual insurance plans offered through the Affordable Care Act marketplace next year, which could leave about 20 percent of the state with just one insurer to choose from for next year and another 22 percent with only two choices, according to an analysis by the Kaiser Family Foundation.

Including Kentucky, this brings the number of states the health insurer is quitting next year to 26, Zachary Tracer reports for Bloomberg.

"The company plans to halt sales of individual plans in Kentucky for 2017, both inside and outside the state’s Affordable Care Act exchange, as well as the small-business exchange," United said in a letter dated March 28 to the state’s insurance department, Tracer reports. Bloomberg noted that it obtained the letter through an open-records request.

United warned in November that this would likely happen after reporting that "low enrollment and high usage cost the company millions of dollars," USA Today reported.

“UnitedHealthcare’s intent to withdraw from the market was not unexpected,” Doug Hogan, a spokesman for the state Public Protection Cabinet, which oversees the state’s insurance regulator, said in an e-mail to Bloomberg. “Insurers across the country have been losing hundreds of millions of dollars in the Obamacare exchanges and can no longer sustain such heavy financial losses.”

The administration of Republican Gov. Matt Bevin is shutting down the state's Kynect exchange and moving its 100,000 or so users to the federal exchange, but plans on that exchange are offered state by state.

Bloomberg says it has confirmed that United is leaving at least 26 of the 34 states where it sold 2016 coverage, but will continue to offer small-business plans off the exchange. New York and Nevada confirmed for Bloomberg that United plans to sell ACA plans in those states next year. The company has also filed plans to participate in Virginia.

Tuesday, April 26, 2016

More than 100 at SOAR Substance Abuse Roundtable committed to work on prevention and treatment efforts in region

By Melissa Patrick
Kentucky Health News

More than 100 people attended the Shaping Our Appalachian Region Substance Abuse Roundtable April 7 to learn about current research and emerging opportunities associated with substance abuse and intravenous drug use in region, according to a SOAR news release.

SOAR is a bipartisan effort to revitalize and diversify the economy in Kentucky's 54 Appalachian counties. It has advisory councils for each of its 10 areas of focus, one of which is community health and wellness.

That council's chair, former state health commissioner Dr. William Hacker, facilitated the roundtable at Natural Bridge State Resort Park.

As part of the solutions-driven discussion, Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, told the attendees that it is important to ask the right questions when gathering information about drug abuse to accurately depict what is going on in the region.

“When you ask people if they have a problem with prescription drugs they, of course, say no,” Zepeda said. “When you ask them if they know someone, like a family member or friend, that answer is very different.”

The group also discussed the importance of getting accurate data about substance abuse and overdose into the right hands to make progress on these issues.

“We want to get data into the hands of legislators and those who can do something about prescription-drug overdose,” said Dana Quesinberry, public-health-policy and program evaluator for the Kentucky Injury Prevention and Research Center at the University of Kentucky. “Sitting in a repository, it doesn’t do anything for anyone.”

The roundtable members also discussed needle-exchange programs, authorized under the state's 2015 anti-heroin law. The program is meant to slow the spread of HIV and hepatis C, which are commonly spread by sharing of needles among intravenous drug users.

“We’ve seen a switch from using pills as an opioid to using intravenous methods,” said Greg Lee, the HIV/AIDS continuing-education program director for the state Cabinet for Health and Family Services.

Clark County Health Director Scott Lockard said the federal Centers for Disease Control and Prevention issued a "wake-up call" with its report identifying 54 Kentucky counties as being among the 220 most vulnerable in the nation for the rapid spread of HIV and hepatitis C infection among intravenous drug users. Most of the counties, and eight of the top 10, were Appalachian.

"We are potentially on the leading edge of one of the biggest public health crises to hit our state," Lockard said in an e-mail to Kentucky Health News. "It will take a combined effort across sectors to prevent an HIV outbreak in the SOAR region such as the one that occurred in Scott County, Indiana," just north of Louisville.

Although many Kentucky county officials are talking about needle-exchange programs, so far only Louisville and Lexington and the counties of Boyd, Carter, Clark, Elliott, Franklin, Grant, Harrison, Jessamine, Knox, Pendleton and Pike are either operating or have approved such programs. Of these, Boyd, Carter, Clark, Elliott, Knox and Pike are part of SOAR.

The news release noted that participants left the discussion with a commitment to continue the conversation and to build a strategic plan to address substance abuse issues in the region, with a focus on clinical practices, health systems, drug screenings and other best practices.

Monday, April 25, 2016

Levels of suspected 'hormone disruptors' in teen girls dropped after they switched to products that didn't contain them

A recent study found that after three days of not using personal-care products that contain "problematic substances," the levels of chemicals that potentially disrupt hormones in the bodies of teenage girls dropped, Environmental Working Group Vice Preisdent Alex Formuzis writes for its Enviroblog.

The study, led by Kim Harley of the Center for Environmental Research and Children’s Health at the University of California-Berkeley, asked 100 Latina girls between 14 and 18 years old to not use personal-care products such as cosmetics, shampoos and soaps, for three days and instead to only use products free of the suspected hormone disruptors: phthalates, parabens and triclosan. The girls, all volunteers, were given products that did not contain these chemicals.

After three days, the teens' urine tests showed a 44 percent decrease in the levels of methyl and propyl parapen, preservatives widely used in cosmetics, shampoos and skin lotions; a 35 percent decrease in triclosan, a commonly used antibacterial chemical that has been linked to the disruption of thyroid and reproductive hormones; and a 27 percent decrease in mono-ethyl phthalates, a common industrial plasticizer found in some nail polishes and fragrances.

“Techniques available to consumers, such as choosing personal care products that are labeled to be free of phthalates, parabens, triclosan, and oxybenzone, can reduce personal exposure to endocrine-disrupting chemicals,” the study authors wrote. “Our study did not test for the presence of these chemicals, but simply used techniques available to the average consumer: reading labels and investigating product safety through web-based databases.”

The study, published in Environmental Health Perspectives, notes that the study shows that "consumers may be able to reduce exposures to these chemicals by seeking out commercially available products with lower levels of these chemicals."

However, Formuzis pointed out that the federal Food and Drug Administration has "virtually no authority" over this industry and notes that this study helps to, "underscores the need to regulate the personal care products industry."

Legislation by U.S. Sens. Dianne Feinstein (D-Calif.) and Susan Collins (R-Maine), proposes to do just that.

"The Feinstein-Collins Personal Care Products Safety Act would give the FDA tools for ensuring the safety of personal care products as strong as those that regulate food and drugs," Formuzis writes. The bill would require the FDA to investigate the safety of five cosmetics ingredients and contaminants yearly; cosmetic makers would have to register their manufacturing facilities,disclose their ingredients, report health incidents related to their products, and label their products with disclosures and warnings as needed; and it would allow the FDA the authority to recall dangerous products.

Formuzis reports that "some of the corporations backing the Feinstein-Collins bill include Revlon, Johnson & Johnson, Proctor & Gamble, Unilever, L’Oreal, California Baby and the industry trade organization, the Personal Care Products Council."

Sunday, April 24, 2016

Zika update: Local anti-mosquito action needed; McConnell, Rogers at center of debate over Obama's request for more funds

Mosquitoes can carry Zika. (NPR photo)
By Melissa Patrick
Kentucky Health News

While all 388 Zika virus cases confirmed in the continental U.S., including six in Kentucky, have been in people who were infected abroad and then returned to the states, a health official said on "Fox News Sunday" that it is likely the U.S. will have its own outbreak.

"It is likely we will have what is called a local outbreak," said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, Diane Bartz reports for Reuters.

Fauci said he did not expect a large number of people to become ill: "We're talking about scores of cases, dozens of cases, at most."

Dr. Ardis Hoven, infectious disease specialist for the Kentucky Department for Public Health, agreed and said the potential exists for Kentucky to have a local outbreak.

"I think it would be unreasonable for us to assume that we would not be at risk," she said in a telephone interview. "So therefore, we have to plan accordingly."

Hoven said mosquito control in the state is a "top priority," but said the bulk of this will have to happen at a local level.

She encouraged Kentuckians to talk about mosquito prevention with their friends and family and ask themselves, "What can I do in my community, in my yard, on my street to prevent mosquitoes from hatching and infecting those around me?"

Zika virus prevention strategy: Dress, Defend and Drain
The state has adopted a "3 D" approach to decrease the risk of infection by mosquitoes: Dress in light-colored long sleeved shirts and pants; Defend against mosquitoes with approved insect repellents; and Drain all standing water.

"If we can control mosquitoes in our region, we will go a long way to minimize the potential risk from infected mosquitoes," Hoven said.

The World Health Organization declared Zika a global health emergency in February. Those who have traveled to affected areas, such as Central and South America, are at the highest risk of contracting the virus, which is spread primarily by infected Aedes aegypti mosquito. It can also be spread through sexual intercourse. Aedes aegypti can be found in about 30 U.S. states, including Kentucky.

Zika virus is especially dangerous to pregnant women because it has been linked to thousands of cases of microcephaly, a condition where the infants head is smaller than normal, as well as other severe fetal brain defects, according to the federal Centers for Disease Control and Prevention. The state health department has reported that one of the confirmed Zika cases in the state is a pregnant woman.

The CDC is investigating the link between Guillain-Barre syndrome, a rare disorder in which the body's immune system attacks its nerves. And Fauci said there could be other neurological conditions caused by Zika that affect adults, Bartz reports.

"There are only individual case reports of significant neurological damage to people, not just the fetuses, but an adult that would get infected. Things that they call meningoencephalitis, which is an inflammation of the brain and the covering around the brain, spinal cord damage due to what we call myelitis," Fauci said. "So far they look unusual, but at least we've seen them and that's concerning."

Common symptoms of the virus are fever, rash, joint pain and red eyes, with symptoms lasting for about a week, though many with the virus have no symptoms. Currently there is no vaccine for Zika.

Funding to fight Zika held up in Congress

In February, President Obama asked Congress for an additional $1.9 billion in emergency funds to fight the Zika virus, including funds to develop a vaccine. This is in addition to $589 million in previously appropriated funds that have already been transferred to the effort.

That money should last through Sept. 30, the end of the federal fiscal year, but "There's going to need to be additional money, I don't think there's any doubt about that," Rep. Tom Cole, R-Okla., who chairs the House health appropriations subcommittee, told Susan Cornwell of Reuters April 13.

Top senators from both parties said "they are getting close to a deal to provide at least some emergency funding to fight the Zika virus, making it likely that the Senate will move ahead on the issue without waiting for the House," David Nather writes for STAT, an online health journal.

Senate Majority Leader Mitch McConnell, R-Ky., said at a news conference April 19 that congressional Republicans were working with the administration on the funding details, Peter Sullivan reports for The Hill.

“We're working with them on it to figure out exactly the right amount of money,” McConnell said at a press conference. “You know, how is it going to be spent? And I don't think, in the end, there will be any opposition to addressing what we think is going to be a fairly significant public health crisis."

Nevertheless, House Republicans kept saying they don't have enough information to approve the request.

On April 20, House Appropriations Committee Chairman Hal Rogers, R-Ky., said the Obama administration “continues to delay response efforts by refusing to provide basic budgetary information to Congress on their Zika funding request. This includes not answering our most basic question: ‘What is needed, right now, over the next 5 months in fiscal year 2016, to fight this disease?’ In the absence of this information, the House Appropriations Committee will work with our colleagues in the House and the Senate to make our own determinations on what is needed and when, and to provide the funding that we believe is necessary and responsible.”

Five days earlier, White House Press Secretary Josh Earnest said Republicans have all the information they need to move forward, ABC reports. He said, “They've had ample opportunity to collect information, to ask questions of senior administration officials, to read letters, to read the legislative proposal that was put forward by the administration.” 

Friday, April 22, 2016

UK study finds e-cigarettes aren't replacing traditional cigarettes, but their sales rise as unregulated TV ads for them increase

A study led by a University of Kentucky researcher found that electronic cigarettes have not become a substitute for traditional cigarettes, but their use is increasing, especially as television commercials for the products increase, Carol Lea Spence reports for UK AgNews.

“Cigarette purchases have dropped a bit, from about 90 percent to 80 percent of all tobacco products during the past 15 years, but it’s still a big player. Other tobacco product sales are growing, though—particularly e-cigarettes,” Yuqing Zheng, lead researcher and an agricultural economist in UK's College of Agriculture, Food and Environment, told Spence.

The study, published in The American Journal of Agricultural Economics, looked at the habit formation of non-cigarette products and studied usage in five categories, including: cigarettes, e-cigarettes, smokeless tobacco, cigarillos and cigars, Spence reports.

The study collected data from convenience stores in 30 U.S. markets, looking for evidence to support that e-cigarettes had become a substitute for traditional cigarettes. It also investigated whether consumers purchased products based on cost and advertising.

They found that when the price of e-cigarettes went up, it did not increase the demand for traditional cigarettes. And not surprisingly, it also found that the purchase of e-cigarettes increased with increased TV advertising, but not with increased magazine advertisements.

“This adds to the policy discussion,” Zheng told Spence. “While cigarettes are strictly regulated in terms of advertising, there are no advertising restrictions on e-cigarettes.”

The study also found that based on consumption patterns, all five tobacco products in the study were habit forming, and e-cigarettes had the "highest degree of habit formation," Zheng told Spence.

Zheng attributed that to three things: Most e-cigarettes contain nicotine, which is addictive; they can be used in places where traditional cigarettes are banned; and because they don't burn out, people use them for longer periods of time, Spence reports.

Zheng told Spence that there is no scientific evidence to prove e-cigarettes are less harmful than cigarettes, and noted that the study found that people will generally buy traditional cigarettes regardless of the price, but in general are "more responsive to price increases" of non-cigarette tobacco.

Thursday, April 21, 2016

National Drug Take-Back Day is April 30; dispose of unused or expired drugs at most State Police posts from 10 a.m. to 2 p.m.

Kentuckians can get rid of their unused or expired prescription drugs Saturday, April 30 from 10 a.m. to 2 p.m. as part of National Drug Take-Back Day. The service is free and anonymous, no questions asked. Most collections will be made at Kentucky State Police posts.

"The goal of these programs is to reduce the volume of drugs that could end up on the streets and then used illegally," says the Kentucky Office of Drug Control Policy website.

All but two of the 16 KSP Posts will have "Take Back" locations on-site. Post 11 will have its collection at the Laurel County Health Department in London, and Post 8 will have a location at the Morehead Covention Center.

Sgt. Michael Webb, KSP spokesperson, said in the news release that the the program is designed to be easy for citizens and offered the following tips for those interested in participating:
  • Participants may dispose of a medication in its original container or by removing the medication from its container and disposing of it directly into the disposal box located at the drop off location.
  • All solid-dosage pharmaceutical products and liquids in consumer containers will be accepted.
  • Liquid products, such as cough syrup, should remain sealed in original containers.
  • The depositor should ensure that the cap is tightly sealed to prevent leakage.
  • Intravenous solutions, injectables and syringes will not be accepted due to potential hazard posed by blood-borne pathogens.
  • Illicit substances such as marijuana or methamphetamine are not a part of this initiative and should not be placed in collection containers.
Not including this Take-Back Day, "Kentucky has collected a total of 59,719 pounds of unused and/or unwanted prescription medications at all Drug Take-Back events and locations since October 2011," says the ODCP website. For more information about the Take-Back program, contact KSP at 502-782-1780 or click here.

Top deputy in state health department named commissioner of Lexington health department

Kraig Humbaugh
Dr. Kraig Humbaugh, senior deputy commissioner of the Kentucky Department for Public Health, has been named the Lexington-Fayette County commissioner of health, starting in June. He will replace Dr. Rice C. Leach, who died April 1 following a battle with cancer.

“I am honored to serve and look forward to working with the Board of Health, the hard-working team at the health department and the community to make Lexington a healthier place to live, work and visit,” Humbaugh said in a news release. “It’s important that we build on Dr. Leach’s legacy and the already strong foundation that the health department has in the community.”

A pediatrician by training, Humbaugh has extensive experience in public health, including epidemiology of communicable diseases and emergency preparedness and response.

“We are very excited to have Dr. Humbaugh join us as the next commissioner of health,” Paula Anderson, chair of the Lexington-Fayette County Board of Health, said in the release. “In addition to his exceptional background in public health, he has widespread leadership experience on the state level. He also knows Kentucky and has worked closely with the Lexington-Fayette County Health Department on many previous projects. All of those attributes made him the right choice to lead our health department.”

Humbaugh earned his undergraduate degree from Vanderbilt University and his medical degree from Yale University. He was a Fulbright Scholar at the University of Otago in New Zealand and received a Master of Public Health degree from Johns Hopkins University.

Want to avoid prostate cancer? Evidence suggests that one thing you could do, if you're a smoker, is to stop smoking

As fewer men are smoking, fewer are dying from prostate cancer, and the trends appear to be related, especially in Kentucky.

"From 1999 through 2010, decreasing prostate cancer mortality rates were consistent with a reduction in cigarette smoking at the population level," says the report, published in the journal Preventing Chronic Disease.

The study looked at four states: Kentucky, with the highest smoking rate (24.8 percent), Utah, with the lowest rate (9.1 percent), and Maryland (15.2 percent) and California (12.1 percent), with average rates.

Researchers found that in Kentucky and Maryland, smoking rates declined by 3 percent and prostate cancer deaths declined by 3.5 percent annually. Among black men in Kentucky, there was little change in the smoking rate or the prostate-cancer death rate.

In California and Utah, smoking declined by 3.5 percent annually, and prostate cancer deaths declined by 2.5 percent and 2.1 percent respectively each year.

The report says current cigarette smoking, rather than past or cumulative smoking, is a risk factor for prostate cancer development, progression, recurrence and death. The U.S. surgeon general named smoking as a cause of prostate cancer in 2014.

Men were classified as current smokers if they reported smoking at least 100 cigarettes in their lifetime and continued to smoke at least occasionally.

The researchers note that these findings do not prove causation, only that the two time trends were similar. They also noted that further studies should be done to include more states.

Tuesday, April 19, 2016

FDA launches its first advertising campaign aimed at rural youth about the dangers of smokeless tobacco

The U.S. Food and Drug Administration today launched a campaign on the dangers of smokeless tobacco among rural teens. FDA is expanding its “The Real Cost” campaign "to educate rural, white male teenagers about the negative health consequences associated with smokeless tobacco use," it says. "For the first time, messages on the dangers of smokeless tobacco use—including nicotine addiction, gum disease, tooth loss, and multiple kinds of cancer—are being highlighted through the placement of advertisements in 35 U.S. markets specifically selected to reach the campaign’s target audience."
FDA’s Population Assessment of Tobacco and Health study found that 31.84 percent of rural, white males ages 12 to 17—629,000 total youths—either experiment with smokeless tobacco or are at-risk, says FDA. "According to the Substance Abuse and Mental Health Services Administration, each day in the U.S. nearly 1,000 males under the age of 18 use smokeless tobacco for the first time—almost as many male teenagers who smoke their first cigarette—making early intervention critical and highlighting a need for targeted youth smokeless tobacco prevention."

The campaign will be conducted through advertisements on television, radio, print, public signs, billboards, the internet and social media, says FDA. The agency is also partnering with Minor League Baseball teams, with stadiums promoting tobacco-free lifestyles "by displaying campaign advertising and providing opportunities for fans to meet and interact with players who support the campaign’s public health messages." (Read more)

Here's a link to the campaign’s bites and B-roll package; the ads are also available on YouTube:

Monday, April 18, 2016

Women in small-town America aren't living as long as before; alcohol, drugs, food, housing, jobs, education, pollution to blame

By Trudy Lieberman
Rural Health News Service

Those of us who grew up in small rural communities in the 1950s and '60s expected to have longer life spans than our parents.

The trends were in our favor. White women born in 1900 could expect to live, on average, just shy of 49 years; white men 46.6 years. Those were our grandparents and our neighbors. By 1950, life expectancy had climbed to 72 years for white women born that year and 66.5 for white men. By 2000, life expectancy was still increasing, with female babies expected to live to nearly 80 and males to almost 75.

America was on the rise, jobs were plentiful, antibiotics kept us from dying of strep throat, and polio vaccine kept us out of the iron lung. We thought things would only keep getting better. So I was dismayed to read a story in The Washington Post in April that blew holes in those childhood expectations.

The Post found “white women have been dying prematurely at higher rates since the turn of this century, passing away in their 30s, 40s, and 50s in a slow-motion crisis driven by decaying health in small town-America.”

That “small town America” was where I grew up. I contrasted the Post’s findings to the claims made by all those politicians who have told us we have the best health care in the world and who point to gobs of money lavished on the National Institutes of Health to find new cures and to hospitals promoting their latest imaging machines.

The Post found that since 2000, the health of all white women has declined, but the trend is most pronounced in rural areas. In 2000, for every 100,000 women in their late 40s living in rural areas, 228 died. Today it’s 296.

If the U.S. really has the best healthcare, why are women dying in their prime, reversing the gains we’ve made since I was a kid? After all, mortality rates are a key measure of the health of a nation’s population.

Post reporters found, however, that those dismal stats probably have less to do with health care – which we like to define today as the latest and greatest technology and insurance coverage albeit with high deductibles – and more to do with what health experts call “the social determinants of health,” such basics as food, housing, employment, air quality, and education.

Landmark studies examining the health of British civil servants who all had access to health insurance under Britain’s National Health Service have found over the years that those at the lowest job levels had worse health outcomes. Some of those outcomes were related to things like work climate and social influences outside work like stress and job uncertainty.

In its analysis, the Post found that the benefits of health interventions that increase longevity, things like taking drugs to lower cholesterol and the risk of heart disease, are being overwhelmed by increased opioid use, heavy drinking, smoking and obesity.

Some researchers have speculated that such destructive health behaviors may stem from people’s struggles to find jobs in small communities and the “dashed expectations” hypothesis. White people today are more pessimistic about their opportunities to advance in life than their parents and grandparents were. They are also more pessimistic than their black and Hispanic contemporaries.

A 42-year-old Bakersfield, California, woman who was addicted to painkillers for a decade explained it this way: “This can be a very stifling place. It’s culturally barren,” she said. There is no place where children can go and see what it’s like to be somewhere else, to be someone else. At first, the drugs are an escape from your problems, from this place, and then you’re trapped,” she told Post reporters.

I recently heard U.S. Surgeon General Dr. Vivek Murthy talk about his upcoming report on substance use. About 2.2 million people need help, he said, but only about one million are actually getting it. Murthy wants his report to have consequences as far reaching as the 1964 surgeon general’s report linking tobacco use to lung cancer. In 1964, Murthy noted, 42 percent of Americans smoked; today fewer than 17 percent do.

The Post story concludes that the lethal habits responsible for increasing mortality rates are cresting in small cities where the biggest manufacturer has moved overseas or in families broken by divorce or substance abuse or in the mind and body of someone doing poorly and just barely hanging on.

The Surgeon General has taken on an enormous task, but his efforts just might help the nation move its life expectancy trends back in the right direction.

What do you think is causing poor health in your community? Write to Trudy at

Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed by the Nebraska Press Association.

Sunday, April 17, 2016

Teens now more likely to use e-cigs than tobacco; health officials call for regulations and better education about the products

By Melissa Patrick
Kentucky Health News

The number of adolescents using electronic cigarettes has risen so much that more of them use e-cigs than tobacco products, says the federal Centers for Disease Control and Prevention.

The findings come from the National Youth Tobacco Survey, which collected data from about 20,000 middle- and high-school students across the country from 2011 to 2015.

Only 1.5 percent of high schoolers used e-cigarettes in 2011, but that zoomed to 16 percent in 2015, with most of the increase seen between 2013 and 2014. The number of middle-school students using e-cigarettes increased from less than 1 percent in 2011 to 5.3 percent in 2015.

Tobacco smoking with hookahs, or water pipes, showed a lesser but significant increase, rising to 7.2 percent from 4.1 percent among high-school students and to 2 percent from 1 percent among middle-school students.

During this same time frame, children's use of cigarettes, cigars and other tobacco products decreased. The share of high-school and middle-school students who reported smoking a cigarette in the last month dropped, respectively, to 9.3 percent from 15.8 percent; and to 2.3 percent from 4.3 percent.

The rise in e-cigarette and hookah use offset the decrease in traditional tobacco use, meaning there was no overall change in use of nicotine or tobacco products among middle and high school students between 2011 and 2015.

An estimated 25.3 percent of high school students and 7.4 percent of middle school students say they have used a tobacco or nicotine product in the past 30 days. That amounts to 3.82 million high school students and 880,000 middle school students.

The study did not give state-by-state figures, but Kentucky has long ranked high in youth tobacco use.

One of the reasons for the rise in popularity of e-cigarettes is that there are no restrictions on buying them on the internet, Carina Storrs reports for CNN after interviewing Brian A. King, deputy director of research translation in the CDC Office on Smoking and Health, who led the current research.

"The fact that we have a flavored product that is easier to access and possibly cheaper has created a perfect storm to lead to increased use," King said.

Also, King said, e-cigarette companies appeal to youth by advertising heavily on social media, selling trendy accessories and employing celebrities to market the products. King said older peers and family members could also be providing e-cigs, just as they have provided conventional cigarettes to.

Pediatricians have called for raising the smoking age to 21 and for the regulation of e-cigarettes.

As of April, 2016, 141 cities in 10 states and the state of Hawaii have raised the legal age to buy tobacco or vaping products to 21, according to the website.

In Kentucky, Democratic Rep. David Watkins, a retired physician from Henderson, filed a bill this year to raise the legal age for buying tobacco or vaping products to 21, which made it out the the House Health and Welfare Committee, but was not called up for a vote on the House floor. Kentucky banned the sale of e-cigarettes to minors in 2014.

The Food and Drug Administration introduced a proposal in 2014 to oversee and regulate electronic cigarettes, but it has still not been finalized.

Dr. M. Brad Drummond, associate professor of pulmonary and critical care medicine at Johns Hopkins University School of Medicine, told Storrs that tighter restrictions are needed around purchasing, taxation, flavoring and advertising of e-cigarettes, noting that this would have an effect on "denormalizing their use." He also said teens need to be better educated about the harms associated with e-cigs.

If legislature won't help protect Kentuckians from the health threat of tobacco, local governments should, Herald-Leader says

Since the Kentucky General Assembly "adjourned without tackling the addiction that kills the most Kentuckians, tobacco," local communities need to take up the challenge, the Lexington Herald-Leader said in an editorial Sunday.

To drive home the primary role that tobacco plays in Kentucky's poor health, the newspaper ran a map of the most recent County Health Rankings, showing that "the places where smoking rates are highest have the worst health outcomes."

The Democrat-controlled state House passed a statewide ban on smoking in workplaces last year, but the bill got nowhere in the Republican-controlled Senate, and with new Republican Gov. Matt Bevin opposed to it and all House seats on the ballot this year, the bill didn't get a vote in the House.

Bevin has said smoking bans should be a local decision. The editorial says, "One of the cheapest, most effective ways to do that (since the legislature won’t) would be to join the places across Kentucky that have enacted local smoke-free laws." About one-third of Kentucky's population lives in jurisdictions with comprehensive smoking bans.

Read more here:
Read more here: