Wednesday, April 26, 2017

Community health workers aren't medically trained but help rural people manage their health care and their health

By Melissa Patrick
Kentucky Health News

As health advocates at the April 24 Kentucky Voices for Health annual meeting discussed how to reduce health disparities and assure health equity in the state, a model of integrated care that includes community health workers resonated as a possible solution.

MCHD Community Health Worker helping a client
"I really believe in the community health worker model," said Keisha Cornett, health education coordinator for the Montgomery County Health Department in Mount Sterling. She added later, "Everything that we've talked about, about health equity, community health workers can play a very important role in. The goal is to empower individuals to take an active role in their health care, their health and also in their environment."

CHWs aren't trained medically, but are trained as patient advocates who come from the communities they serve. They help their clients coordinate care, provide access to medical, social and environmental services, work to improve health literacy and deliver education on prevention and disease self-management.

Cornett noted that patients will often tell their CHW things they would never tell their doctor, such as not having adequate transportation to get to the pharmacy or not having enough money to buy their medications. CHWs work to understand what their clients need on an individual level and then meet them where they are, she said.

The federal Bureau of Labor Statistics says Kentucky had 710 CHWs in May 2016 with an annual average wage of $38,290.

Cornett said some providers have voiced concerns about CHWs providing health education. But she said it's important to allow CHWs to work at the top of their skill set, adding, "We are just encouragers" who "never go out of the scope of what we can do."

Montgomery County's CHW program, called "The Bridge" ("El Puente" for Latino clients) is funded by a federal Health Resources & Services Administration grant and focuses on chronic disease self-management and education. It largely serves clients whose incomes are less than 150 percent of the federal poverty level.

Cornett explained that CHWs connect people to services that help improve their health, like the Kentucky Diabetes Prevention and Control Program, which teaches diabetes self-management, or the Kentucky CARE Collaborative, a heart-disease and stroke-prevention program with a focus on high blood pressure.

Cornett pointed to an ongoing survey that shows clients have reduced emergency room visits; are more likely to have a medical home; have better medication adherence and have shown a drop in their A1C levels, a test for blood sugar.

She said the local diabetes self-management education class recently increased from four participants to 12, and 11 of the participants were from the CHW program. The CHWs have also created a diabetes support group, which they will lead for a month before turning it over to the members.

CHWs recently formed the Community Health Worker Association, which is working with the CHW Workgroup of the state Department for Public Health to standardize training across the state. Cornett said they are getting close to having the certification and curriculum approved.

"CHWs are an evidence-based model to address the health care concerns that we have . . . and really [gets] people involved in their own health care," she said.

Tuesday, April 25, 2017

Rep. Yarmuth tells health advocates how to fix ACA: restore and maintain subsidies, offer public option to help small, rural counties

Dustin Pugel and Rep. Yarmuth at the meeting (AARP Ky. photo)
By Melissa Patrick
Kentucky Health News

Congress needs to maintain subsidies for buyers of Obama insurance policies, reestablish subsidies for insurance companies that cover more than their share of sick people, and create a public insurance option that would help small, rural counties, U.S. Rep. John Yarmuth said at the Kentucky Voices For Health annual meeting in Frankfort April 24.

"The primary problem that we've had and the most obvious fix would be to re-establish the risk corridors," the law's name for the subsidies to insurance companies, the Louisville Democrat said. "The fundamental problem with the markets now is they [Republicans in Congress] eliminated the risk corridors."

That happened in the 2014 omnibus spending bill, which barred the Obama administration from using federal funds to make up risk-corridor shortfalls. The move led directly to the failure of the Kentucky Health Cooperative, which was expecting $77 million in risk-corridor subsidies but only got $9.7 million.

Yarmuth said a public option is necessary because a third of U.S. counties (and almost half in Kentucky) have only one insurance company offering Obamacare policies, partly because many of those counties have so few people.

"No insurance company is going to find it worth their while to go into a market, negotiate with providers, do the marketing, find prospects for 1,000 or so customers," he said. "So that is why we will need to have a national option for those population groups. It is really essential."

The Patient Protection and Affordable Care Act also authorizes subsidies that help low- to mid-income people afford insurance. Congress hasn't appropriated money for the subsidies, but the Obama administration paid them anyway, and now the Trump administration and Congress are talking about ending them.

"They have set out to sabotage the law in as many ways as possible," he said. "The uncertainty is causing a great deal of problems right now because if the cost-sharing reductions go away, more insurance companies will either abandon the individual market or they will raise premiums." He noted that insurance companies have said an end to the subsidies would mean 20 to 30 percent increases in premiums.

Kentucky has extended its deadline for filing 2018 Obamacare plans to June 7, from May 17, "to allow insurers more time to obtain relevant data, including enrollment and claims data for the beginning of 2017, for use in developing assumptions utilized by actuaries to determine necessary plan pricing," Ronda Sloan, spokeswoman for the state Department of Insurance, said in an e-mail.

The U.S. House of Representatives sued the Obama administration to stop the cost-sharing subsidies, and won, but the administration's appeal is still pending. "The worst case scenario is that the Trump administration drops the appeal if they are allowed to . . . then the lower-court ruling stands [and] the money stops," Yarmuth said.

He said later, "I'm relatively optimistic that those payments will continue because if Republicans act in any way that the money goes away, there will be a causal line between their actions and the insurance companies bailing or raising rates and that line would be like in a matter of days. So there would be no confusing the fact that Republicans acted and people got hurt."

Flexibility and cost concerns

The other big part of Obamacare in Kentucky and most other states is the expansion of Medicaid to those who earn up to 138 percent of the federal poverty line.

Kentucky has applied for changes to its Medicaid program through a waiver that would charge small, income-based premiums and would require "able-bodied" recipients to either work, volunteer or take job training, gradually increasing in hours to a maximum of 20 hours a week after one year, among other things. State officials say they expect the Trump administration to approve the waiver in June, and that it will go into effect Jan. 1.

Gov. Matt Bevin, a Republican, says the state can't afford to pay its part of the expansion unless the program is made more restrictive. Yarmuth, Kentucky's only Democrat in Congress, said he understood the concern about cost, but the real question is affordability "in terms of the overall health and well-being of the citizens of a particular state, and . . . job creation [and] reduction in uncompensated care" at health facilities.

Dustin Pugel, a research and policy associate for the Kentucky Center for Economic Policy, said at the start of the discussion that uncompensated care has dropped 67 percent and the state has added 13,000 jobs in the health sector since Medicaid was expanded in 2014.

Pugel also said people are using more primary care, having more preventive screenings and are getting routine care for their chronic conditions. Dr. Gil Liu, the Kentucky Department of Medicaid Services medical director, said at the meeting that about 1.4 million Kentuckians are on Medicaid.

Looking forward

Yarmuth spoke before conservative and moderate Republicans reached a tentative agreement Wednesday to revive the party's proposed American Health Care Act. He predicted the failure of the bill "or any iteration of it because they don't have the votes. Republicans are finding that there is no alternative to the Affordable Care Act, except single payer and they are not willing to go there."

He said the benefit of the current debate is that it shows how hard it is to come up with an alternative to the ACA, and creating a free-market health care system is "like searching for a unicorn" because it doesn't exist anywhere in the world.

"So, I don't really worry about Congress passing anything that is going to undermine the Affordable Care Act," Yarmuth said. "I do worry about the administration potentially doing more to sabotage the ACT, but again there will be a causal effect and then some repercussions."

Sunday, April 23, 2017

Southern Ky. doctor charged with illegal prescriptions that feds say caused 3 deaths; another will serve a year on similar charges

One Southern Kentucky physician was sentenced this month to a year and a day in prison for illegally prescribing painkillers to five people, three of whom died; and another was indicted on charges of doing likewise to six people, three of whom died.

Clella Louise Hayes of Glasgow, who practiced medicine in Tompkinsville, pleaded guilty in September and was sentenced April 20. Dr. Michael Cummings of Albany was indicted April 13 and faces penalties of up to life in prison and fines of up to $3.25 million.

Hayes, 41, wrote prescriptions for six painkillers "outside the course of professional medical practice" from 2008 to 2014, the U.S. attorney's office for the Western District of Kentucky said in a press release.

In the three fatal cases, she did so without a legitimate diagnosis of the patient's pain complaints, "failed to establish an individualized treatment plan, failed to take into account significant risk factors for abuse, and failed to take into account multiple inconsistent urine drug screens which reflected drug abuse and diversion."

The release identified the three patients only by their initials. "On September 19, 2011, Dr. Hayes prescribed fentanyl to A.R.," it said. "On September 23, 2011, at age 55, A.R. died as a result of a fentanyl overdose, with post-mortem toxicology reports reflecting fentanyl at five times the therapeutic range in A.R.’s blood."

Another patient, A.H., received prescriptions from Hayes over a year then "died at age 48 as a result of a poly-pharmacy overdose, with post-mortem toxicology reports reflecting high blood concentrations of medications Dr. Hayes prescribed to A.H."

In the third case connected with a death, "On January 1, 2014, K.S. died at age 53 as a result of a poly-pharmacy overdose, with post-mortem toxicology results reflecting oxycodone, and hydrocodone at 10 times the therapeutic dose, both of which Dr. Hayes prescribed to K.S. in December 2013."

The other doctor, Cummings, was charged with 18 counts of dispensing pain killers "without a medical purpose and outside the course of professional medical practice, and resulting in the deaths of three patients" in 2014, said a release from U.S. Attorney John Kuhn, which also used initials to identify the decedents.

The indictment says Cummings, 61, dispensed 120 Oxycodone pills and 60 Oxycontin pills that caused the death of a patient identified as S.F. on April 7, 2014; and combined hydrocodone-acetaminophen pills that caused the deaths of patients identified as S.C. and P.G. on April 2 and June 3, 2014.

"The investigation has been ongoing for at least two years," reports the Clinton County News of Albany. "In May 2015, authorities executed a search warrant at the location of Cummings’ practice located in the Twin Lakes Medical Arts facility."

10-year study: Having one or more diet sodas a day nearly triples the risk of having a stroke or Alzheimer's; overall risk is still low

A study suggests a connection between diet soda and both stroke and dementia, "with people drinking diet soda daily being almost three times as likely to develop stroke and dementia as those who consumed it weekly or less," Fred Barbash reports for The Washington Post.

The lead researcher, Matthew Pase of Boston University, said the findings “included a higher risk of ischemic stroke, where blood vessels in the brain become obstructed, and Alzheimer’s disease dementia, the most common form of dementia.”

Pase stressed that the study, published in the journal Stroke, showed only correlation, not causation, and a low overall risk of stroke and dementia, but said diet drinks “might not be a healthy alternative” to sugary ones. And he cautioned that diet-soda drinkers shouldn't go back to sugared drinks.

"They have been associated not only with obesity and its consequences, such as diabetes, but with poorer memory and smaller overall brain volumes," Barbash notes. "A parallel study of sugary drinks did not find an association with stroke or dementia."

The 10-year study looked at 2,888 people 45 and over for the development of a stroke, and 1,484 older than 59. It “found that those who reported consuming at least one artificially sweetened drink a day, compared to less than one a week, were 2.96 times as likely to have an ischemic stroke, caused by blood vessel blockage, and 2.89 times as likely to be diagnosed with dementia due to Alzheimer’s disease,” the American Heart Association said.

“So, the bottom line is, ‘Have more water and have less diet soda,” Christopher Gardner, director of Nutrition Studies at the Stanford Prevention Research Center, said in the AHA news release.

Barbash writes, "The artificial sweeteners consumed by those in the study included saccharin, acesulfame-K, and aspartame. Other sweeteners, including sucralose, neotame and stevia have been approved by the FDA since, the study said."

The American Beverage Association replied:  “Low-calorie sweeteners have been proven safe by worldwide government safety authorities as well as hundreds of scientific studies and there is nothing in this research that counters this well-established fact. . . . While we respect the mission of these organizations to help prevent conditions like stroke and dementia, the authors of this study acknowledge that their conclusions do not — and cannot — prove cause and effect.”

Proposed changes in Medicaid, especially making beneficiaries earn dental and vision benefits, alarm them and health advocates

Family Health Centers in Louisville built a dental clinic after Medicaid
expanded; under proposed changes people in the expansion would
have to engage in self-improvement activities to get dental or vision
benefits. (Angela Shoemaker photo, special to The Courier-Journal)
Gov. Matt Bevin's plans to change Kentucky Medicaid alarm people who are on the federal-state program, reports Deborah Yetter of The Courier-Journal.

The first example is Louisville construction worker David Thompson, who was able to get his first heath coverage in years through then-Gov. Steve Beshear's expansion of Medicaid under the Patient Protection and Affordable Care Act in 2014. "Thompson is hurrying to schedule dental and eye exams — care he said he urgently needs but realizes could be eliminated," Yetter reports.

Bevin's changes would initially eliminate basic dental and vision benefits for "able-bodied" adults in the expansion, which covers people with household incomes up to 138 percent of the federal poverty level. That makes a family of four with annual income of as much as $33,400 eligible for Medicaid.

For the first three years of the expansion, the federal government paid the full cost. Now states are paying 5 percent, and by 2020 that share will rise in annual steps to 10 percent, the ACA's limit — unless the ACA is changed, which also seems likely.

Bevin says the state can't afford the cost and expects the Trump administration to let him make changes that his aides say will leave Kentucky Medicaid with 85,000 fewer people on its rolls in five years than it would have without the changes. About 1.3 million Kentuckians are on Medicaid.

The governor and other state officials say the changes aren't just about saving money. Doug Hogan, a spokesman for the Kentucky Cabinet for Health and Family Services, said the plan will "better engage members in their own health, wellness, education and employability," as well as improving Kentuckians' health outcomes.

The plan would charge small, income-based premiums and co-payments for Medicaid coverage of people with incomes above the poverty line, and would require able-bodied people on the program to work, look for work or take job training unless they are a primary caregiver. They could earn rewards points to get dental or vision benefits by "passing a GED exam, completing job training or completing wellness activities such as stop-smoking classes.," Yetter notes.

"Advocates and public-health officials are increasingly concerned about what they believe will be an adverse effect on Kentuckians," Yetter reports. "Advocates worry consumers won't understand the complex changes to the program and, as a result, will lose coverage."

They especially worry about the "loss of dental benefits in a state with poor overall dental health," Yetter writes. She quotes Muriel Harris, associate professor of public health at the University of Louisville and board chair of Family Health Centers: "We're all very, very concerned. Those who have made the decisions are not considering the population we serve. It's just undermining any gains we have made in the past."

As for vision benefits, Yetter reports, "Kentucky optometrists have argued routine eye exams often uncover other serious health problems including diabetes, high blood pressure and eye disease that can result in blindness."

Yetter writes, "Collecting premiums and co-payments, tracking work or volunteer activity and managing the rewards accounts all will involve major technology systems changes and likely, hiring of outside vendors to manage such systems, advocates say. That adds to expense and potential complications, they said. . . . Kentucky is proposing monthly premiums of $1 to $37.50 per month, based on income and length of time enrolled in Medicaid. The longer people remain in Medicaid, the more it will cost, since Bevin's plan is aimed at pushing people to move to the commercial insurance market through employer coverage when available."

Most private employers in Kentucky don't offer health insurance to employees. The Kentucky Health Issues Poll has found that the percentage of Kentuckians on employer-provided insurance rose from 37 percent to 50 percent in 2014, but fell to 41 percent in 2015 and rose to 45 percent last year.

Saturday, April 22, 2017

Free webinar on impact of Patient Protection and Affordable Care Act in Kentucky scheduled for Thursday, April 27

(Image from
The Foundation for a Healthy Kentucky will offer a free webinar, "Impacts of Implementation of the Affordable Care Act in Kentucky," from 2 to 3 p.m. Thursday, April 27.

Participants will have a chance to listen in and ask questions as the team from the University of Minnesota State Health Access Data Center presents findings from their multi-year study of the impact of Kentucky's implementation of the Patient Protection and Affordable Care Act.

During the project, which was funded by the foundation, researchers monitored pre- and post-ACA trends in five domains: health insurance coverage, access, costs, quality and health outcomes. These findings are reflected in the study's final report.

The webinar is the next in the foundation's training series, "Health for a Change," meant to prepare non-profit leaders across the state for the work of advancing important health issues. The free training series combines in-person workshops with webinars, which participants can join remotely from their computers.

Register for the webinar here.

Friday, April 21, 2017

Somerset doctor convicted of Medicaid fraud; sentenced to five years for falsifying smoking-cessation counseling sessions

Dr. Ezekiel Akande
(Photo from Twitter)
A Pulaski County judge sentenced a Somerset doctor on Friday, April 21, to five years in prison for felony Medicaid fraud.

A Pulaski County jury convicted Ezekiel Akande, who ran the Somerset Regional Pain Center, in March for receiving Medicaid payments for tobacco-cessation counseling sessions that he did not perform. The jury also convicted Akande of theft and ordered that he pay $10,000 in restitution.

The state Office of Medicaid Fraud and Abuse accused Akande of billing Medicaid for counseling sessions with patients who were not smokers, and smokers who did not wish to quit.

"Holding accountable those who defraud the government and Kentuckians is a responsibility my office takes very seriously," Attorney General Andy Beshear said in a news release. "We are working every day to protect Kentucky families from those who seek to exploit our health services for personal gain."

Only 1.4 percent of Kentucky Medicaid members who smoke received smoking-cessation counseling in 2015, the state said last year; 17 percent received smoking-cessation medications.

Thursday, April 20, 2017

It's time to clean out your medicine cabinet for the National Prescription Drug Take Back Day on April 29

Do you know the expiration dates of the medicines that have been piling up in your kitchen cabinet? If not, you might want to check those dates and throw away old medicine as part of the National Prescription Drug Take Back Day Saturday, April 29. The Kentucky State Police are partnering with the U.S. Drug Enforcement Agency to not only encourage citizens to remove potentially dangerous medicines from their homes, but to also dispose of them safely.

"Prescription medications play an important role in the health of millions of Americans. However, leftover or expired drugs can be harmful in a variety of ways,” KSP Commissioner Rick Sanders said in a press release. He noted that expired medications can lose their effectiveness and pollute water supplies if disposed of improperly. He warns, “Unused medicines in homes can also be accidentally ingested by children, stolen, misused and abused."

Rates of prescription drug abuse in the U.S. are at alarming levels and are showing no signs of slowing down. According to the DEA, "the majority of prescription drug abusers report that they get their drugs from friends and family including the home medicine cabinet," the release said.

Americans disposed of 447 tons of unneeded medications during last year’s National Prescription Drug Take-Back Day. Kentucky had 50 collection sites totaling 9,752 pounds in 2016.

This year, KSP has again set up 16 locations throughout Kentucky to serve as collection points for the safe, convenient and responsible disposal of unused or expired prescription drugs. For a list of locations click here. Collection activities will take place from 10:00 a.m. through 2:00 p.m. on Saturday, April 29. For more information about the ‘Take Back’ program, contact KSP at 502-782-1780 or visit the DEA website.

Wednesday, April 19, 2017

KentuckyOne Health announces another round of layoffs at hospitals, says most will be in corporate service jobs

KentuckyOne Health is laying off 150 people at its hospitals around the state, and 100 others will be transferred to the University of Louisville or accept retirement offers.

"Challenges brought by the continuing evolution of health-care reform and reimbursement structures have proven difficult for our organization and many others across Kentucky," the subsidiary of financially stressed Catholic Health Initiatives said, adding that most of the layoffs would be in corporate service units.

Grace Schneider of The Courier-Journal reports, "Executives couldn't say how many Louisville-area workers are being let go, but all of those affected will receive severance, assistance finding new jobs and counseling, spokeswoman Barbara Mackovic said in an email." KentuckyOne is giving up control of University Hospital on July 1.

"Interim U of L president Gregory Postel estimated [in December] that 3,000 employees at U of L Hospital who now work for KentuckyOne would become employees of University Medical Center," Schneider reports. "On Tuesday, Ken Marshall, interim chief executive for University Medical Center, said that roughly 2,200 current KentuckyOne Health employees were offered jobs by University Medical Center. It's not clear how many of the 100 KentuckyOne employees may join the U of L staff, spokesman Gary Mans said."

KentuckyOne laid off 500 employees in 2014 and eliminated 200 positions that were vacant, Schneider notes, adding: "Last July, a state inspection found that nursing deficiencies had endangered three patients at University Hospital. The state later found the hospital had corrected the problems."

Tuesday, April 18, 2017

Poll: Almost half of Ky. adults know someone who is depressed, and 30 percent say they don't know where to call for treatment

By Melissa Patrick
Kentucky Health News

Nearly half of Kentucky adults know someone who has a serious problem with depression, and most say they know who to contact for treatment, according to the latest Kentucky Health Issues Poll.

"Depression is common in Kentucky, as it is elsewhere in the country, and it's important to understand that it is a serious mood disorder that can and should be treated," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. "Knowing where to find help is an important first step in getting treatment or counseling, but lack of health insurance and access to integrated care can be a barrier for those trying to get help."

The poll, taken Sept. 11 through Oct. 19, found that 49 percent of Kentucky adults know someone who is seriously depressed. More women than men, 53 percent to 45 percent, said they knew such a person.

Nearly 70 percent of those polled said they knew who to contact for services or treatment for depression, while 30 percent said they didn't know who to contact. Adults 30-64 were most likely to know about available treatment (74 percent), compared to younger adults (63 percent) and older adults (58 percent).

The poll's overall error margin is plus or minus 2.5 percentage points, but more for subsamples such as age groups.

Nearly one in five Kentucky adults at some time in their life have been told by a health-care provider that they are depressed, according to polling by the federal Behavioral Risk Factor Surveillance System. However, fewer than half who have a mental illness have received treatment or counseling, according to a federal report on Kentucky's behavioral health.

Sheila Schuster, the executive director of the Kentucky Mental Health Coalition, said in the news release that she was troubled by the number of Kentuckians who are feeling depressed, but don't seek treatment.

"We know that depression is treatable; we also know that it should be treated and not ignored, nor handled with self-medication through alcohol or other substances," she said. "It is very important for Kentuckians to know the mental health resources and to encourage family members and friends who are struggling with depression to seek help."

The American Psychiatric Association says depression symptoms can vary from mild to severe, and must last at least two weeks to be diagnosed. It notes that depression affects an estimated one in 15 adults in any given year, and one in six people will experience depression at some time in their life.

The APA says symptoms of depression include: feeling sad or having a depressed mood; loss of interest or pleasure in activities one enjoyed; changes in appetite, with weight loss or gain unrelated to dieting; trouble sleeping or sleeping too much; loss of energy or increased fatigue; increase in purposeless physical activity, like pacing, or slowed movements and speech; feeling worthless or guilty; difficulty thinking, concentrating or making decisions; or thoughts of death or suicide.

Click here for the state Cabinet for Health and Family Services directory of behavioral health-care providers, sorted by county and health plan. Click here for a list of community mental health centers and psychiatric hospitals, including phone numbers for 24-hour crisis intervention.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati and was funded by the foundation and Interact for Health. It surveyed a random sample of 1,580 Kentucky adults via landlines and cell phones.

Anti-smoking expert: Cigarettes kill 8,900 Kentuckians a year, so it's time to raise cigarette tax and pass statewide smoking ban

By Melissa Patrick
Kentucky Health News

"Smoking is the single most preventable cause of death that we know of," Ellen Hahn, director of the Kentucky Center for Smoke-free Policy, said Sunday on KET's "Kentucky Health."

Hahn told Dr. Wayne Tuckson, host of the "Smoking & Health" series, that 480,000 Americans die each year from smoking; that one in five deaths are caused by cigarette smoking; that one-third of cancer deaths are caused by it; and that smoking is the leading cause of heart disease, which kills more people than any other disease.

"We talk about heroin and opioid addiction; they are awful, but cigarette smoking is the drug of choice," Hahn said. "When you talk about Kentucky, we are talking about 8,900 a year who are dying from cigarette smoking." (In 2015, 1,297 Kentuckians died from an overdose.)

Hahn, a University of Kentucky nursing professor and the director of the Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE) initiative, said there are many reasons Kentucky has the nation's highest smoking rate, 26 percent.

Those include the influence of peers and family members who smoke, as well as "insidious" advertisements that encourage smoking.

Hahn called the tobacco industry the "vector" of smoking, referring to the way they advertise their products such as placing them at the "point of purchase," placing them at the eye level of children, targeting specific populations and strategically placing them in movies.

"There is no product that we know is going to kill you that people can just sell pretty freely with very little regulation," she said.

Hahn explained that first-hand smoke is what the smoker is exposed to; second-hand smoke is what a bystander is exposed to, both from the product and the exhalation; and third-hand smoke is what is left behind on all of the surfaces.

And while she said most people worry about the 69 chemicals in smoke that are known to cause cancer, it is the tiny, toxic particles that we breathe in from the smoke that put us at risk of heart and lung disease, such as chronic obstructive pulmonary disease (COPD).

"But I think that now that we know so much about first- and second-hand and third-hand smoke, there is really no reason that anybody should be smoking inside a vehicle or inside their home for that matter, or inside a public place," Hahn said. "There is really no reason to do that because we know how much harm it causes."

Hahn said the "most effective, high impact policy" to decrease smoking rates would be to increase the state's cigarette tax, now one of the nation's lowest at 60 cents per pack. Hahn recommended that it should be raised by $1, which would still be below the national average of $1.69 per pack.

"The more expensive something is, the less people will buy, and particularly people who don't have a lot of money," she said.

Hahn also called for a statewide law that would ban smoking in public spaces and the workplace. The latest Kentucky Health Issues Poll found that 71 percent of Kentuckians support such a measure and 25 percent oppose it.  Right now only one-third of Kentucky is covered by comprehensive smoke-free policies.

"We are not saying people can't smoke," Hahn said. "those laws are only saying that you can't smoke and harm others with your smoke."

However, a statewide ban isn't likely any time soon, since Republican Gov. Matt Bevin has said this is an issue for local governments.

Hahn said smoking is a powerful addiction. She encouraged people who want to quit to call 1-800-QUIT-NOW, to visit or to contact their health-care provider, because both medications and behavioral support are often needed to quit.

A new state law will make it easier for Kentuckians to gain access to smoking cessation medications by removing the barriers that insurance companies often place on them, like co-payments and prior authorizations.

As for electronic cigarettes as a means to quit smoking, Hahn said that studies have found that smokers who use e-cigarettes to help them quit smoking are less likely to do so, and that they often become "dual users."

She added: "Electronic smoking devices are considered by the FDA as a tobacco product. They are not considered as a quit-aid and we do not recommend them as a quit-aid."

Click here for the schedule of future airings of this program.

UK gets $11.2 million, five-year grant to study links between cancer and obesity, two of Kentucky's biggest health problems

Kentucky leads the nation in some forms of cancer, and is among the leaders in obesity. Is there a connection? The federal government is giving the University of Kentucky $11.2 million to explore the connection over the next five years, through a new Center for Cancer and Metabolism.

"The center will focus on the underlying mechanisms that link dysfunctional metabolism to cancer. Recent studies have shown that the mitochondria of cells can influence how aggressive a cancer becomes," Linda Blackford reports for the Lexington Herald-Leader. "According to the U.S. Centers for Disease Control and Prevention, Kentucky ranks first in the nation in incidences of colorectal cancer in men and women, and seventh in deaths. People who are obese are about 30 percent more likely to develop that kind of cancer."

Lisa Cassis, UK's vice president for research, said the grant from the National Institutes of Health will also “enable the university to foster the development of the next generation of scientists who will lead our efforts in translating basic research findings into promising new therapies.”

Cassis said, “Research is at the heart of any progress we hope to make in bridging health gaps in the commonwealth.” She recently crticized the proposed cut of 20 percent to NIH funding in President Trump’s federal budget, saying the move would reduce UK’s federal funding from $92.4 million in 2016 to $75 million, meaning a loss of 219 jobs.

“It is not just reductions in NIH funding that are important; it is the types of research that would be reduced if these reductions were realized,” she wrote. “This is especially important, as health conditions that devastate our citizens exist at higher rates in Kentucky than the rest of the U.S. More Kentuckians die of cancer, and Kentucky ranks in the top 10 in heart attacks, drug deaths, strokes, diabetes, cardiovascular deaths and obesity.”

"UK officials said U.S. Senate Majority Leader Mitch McConnell contacted the NIH in support of the grant," Blackford reports. "In March, the Kentucky Republican said he didn’t support Trump’s proposed cuts to medical research funding."