Tuesday, September 16, 2014

Public hearing to be held in Bowling Green Sept .19 to discuss fiscal health of Kentucky's rural hospitals

On Sept. 19 in Bowling Green, state Auditor of Public Accounts Adam Edelen will hold the last of 11 public hearings, which have been held across Kentucky this summer, to talk about the financial health of rural hospitals.

These hearings, along with a study by the auditor's office, are meant to help understand the challenges that face small, community hospitals, which provide health care to 45 percent of Kentuckians and are key economic drivers in those communities, an Edelen press release says.

The auditor is looking at some 66 public, non-profit and for-profit hospitals in rural Western and Eastern Kentucky. His office will conduct a survey about the fiscal health of these hospitals and plans to issue a report later this year.

The hearing will be held at the Holiday Inn University Plaza, 1021 Wilkinson Trace, Bowling Green, on Friday, Sept. 19 at 11 a.m. CDT, following the conclusion of the Kentucky Rural Health Hospital Association annual meeting.

Sunday, September 14, 2014

State won't estimate cost of greater-than-expected Medicaid expansion for 'a few additional months' – after Nov. election

By Al Cross
Kentucky Health News

The Republican-controlled state Senate's budget committee chair wants to know how much Democratic Gov. Steve Beshear's expansion of the Medicaid program will cost, since enrollment in the federal-state program has exceeded the administration's expectations.

Medicaid Commissioner Lawrence Kissner told Sen. Bob Leeper of Paducah in a letter Sept. 8 that the administration won't be able to update the estimates "until a few additional months have passed and more data [are] collected" and "after the newly insured population has stabilized."

That pushes the date for new estimates past the Nov. 4 election, in which Republicans are making issues of the expansion's cost and the federal health-reform law that allowed it. U.S. Sen. Mitch McConnell has mentioned it in attacking "Obamacare," and Republicans trying to take over the state House have done likewise.

When Beshear announced in May 2013 that he would expand Medicaid eligibility to people with incomes up to 138 percent of the federal poverty level, using entirely federal money for the first three calendar years, he said it would cost the state $30 million in the 2016-17 fiscal year and $70 million in the 2017-18 fiscal year.

Those figures were based on an estimate by the Price Waterhouse Coopers accounting firm that 308,000 Kentuckians would become eligible for Medicaid but only 188,000 would enroll by 2017, based on calculations by the Congressional Budget Office. But so far, about 320,000 people have enrolled, more than double the 148,000 that the firm estimated would sign up by June 30.

At last report, about 521,000 people had obtained coverage through the state's Kynect health-insurance exchange. About 80,000 of them bought private insurance, and 120,000 qualified for what state officials call "old Medicaid" for a variety of reasons: they were children, blind, disabled or had income less than 69 percent of the federal poverty level, the old limit for the program.

The federal government pays about 71 percent of "old Medicaid" costs and, until the end of 2016, 100 percent of the newly eligibles' coverage. In 2017, it will pay 95 percent of the new costs, falling to the reform law's floor of 90 percent in 2020.

Kissner told Leeper that the administration needed more experience with the new enrollees, and better estimates of projected employment in 2017-18, other "key economic indicators" and how many Kentucky households will have incomes above or below 138 percent of the federal poverty level.

Leeper could not be reached for comment. For a copy of Kissner's letter and related materials, click here.

Expert says Ky. is one of 13 states where people in individual insurance market are better off than before reform law

By Molly Burchett and Al Cross
Kentucky Health News

Most of the focus on Obamacare has been on people who are no longer uninsured, or those who had to get new policies, but Kentucky is one of the 13 states in which the Patient Protection and Affordable Care Act helped people in the individual insurance market, according to a study by a fellow of the Brookings Institution.

To make comparisons across states, assessing the health law's impact on coverage, costs and other factors, economics fellow Amanda Kowalski put each state in one of five groups based on how they implemented the law.

Kentucky and seven other states – Colorado, Connecticut, New York, Rhode Island, Vermont and Washington – as well as the District of Columbia, embraced the law completely by setting up their own health-insurance exchanges and expanding the Medicaid program to households with income up to 138 percent of the federal poverty level.

Overall, average premiums grew remarkably in these states, says Kowalski. On average, premiums in Kentucky rose by 16 percent, less than the national average of 24.4 percent, says the report. In the table, states with their own exchanges are represented by blue and states without their own are in red.
However, under Obamacare, premiums don't tell the whole story, because people earning up to 400 percent of the poverty level are eligible for tax credits that reduce their monthly premium cost. Kentucky’s average cost decreased 19 percent.
This cost decrease, combined with an increase in coverage, suggests that Kentucky’s individual market had been adversely selected. Adverse selection is the tendency for people to avoid buying insurance until they need it, which often drives up insurance premiums. Individual health-insurance coverage in Kentucky increased by 38 percent, with exchange enrollment representing 43 percent of the increase, Kowalski reports.

Kowalski compared states that allowed or did not allow renewal of non-grandfathered insurance plans, in response to complaints that cancellation of their plans contradicted the promise made by advocates of the law that if people “liked their plan they could keep it.” Kentucky and 26 other states grandfathered such plans, and Kowalski concluded that it cost people in their individual markets $220 a year because the people keeping non-grandfathered plans were healthier.

Kentucky was among 41 states that saw increased health-insurance markups, additional amounts charged by insurers beyond the average cost of paying claims. These increases appear to reflect uncertainty about the insurance market; insurance companies had to set premiums without knowing the health status of enrollees and likely protected themselves with markups.

Kowalski's analysis relies on data from the first half of 2014. "The national experience might evolve over time" and as regulations become more defined within the law itself, the impact of the law will be better understood, she writes.

The study may come as a surprise to critics of the law, who have focused on the many Kentuckians who had to get new health-insurance policies because their old once did not cover the 10 things the law requires.

Some critics continue to say those Kentuckians numbered 280,000, but that number is outdated and incorrect, according to the state Department of Insurance. It's more like 130,000.

"The 280,000 represented the number of people in the individual and small group markets at the time who potentially could have received a letter saying their health insurance policies were being discontinued because benefits were changing," department spokesman Ronda Sloan said in an email.

"Those receiving the letters were told the current plan didn’t meet the requirements of the ACA but were offered a new plan that did," Sloan wrote. "They also were free to shop around either on or off the exchange."

Of the 280,000 who could have been in jeopardy, "48,302 were in grandfathered plans, so they were not affected," Sloan wrote. "Another 63,832 were offered transitional relief (President Obama’s request that companies be given the option to extend policies). Most of the remaining group had an option to take early renewal, which would have continued their pre-ACA policies" through at least Dec. 1 of this year. "So, from our perspective, almost everyone in the original 280,000 group had some option to continue existing coverage – and all of them could have moved to an ACA-compliant plan either on or off the exchange."

Saturday, September 13, 2014

Most overweight diabetics don't know how much to exercise for weight loss, and they don't exercise enough

By Melissa Patrick
Kentucky Health News

Many overweight people with diabetes don't exercise enough for weight loss, and they also don't have a clear understanding of the recommended amount of exercise, according to a study reported by the Health Behavior News Service, part of the Center for Advancing Health.

The study, which looked at the exercise habits in people with diabetes, found that men with diabetes exercise more than women with diabetes, and, not surprisingly, that diabetic women who are trying to lose weight exercise more than those who aren't. But no one in the study was exercising the recommended amount for weight loss, according to the study report, published in American Journal of Health Promotion.

“We were not surprised that, overall, people with diabetes trying to lose weight were not engaging in enough physical activity,” study co-author Gina Pariser, associate professor at Bellarmine University in Louisville, said in a press release. "This finding emphasizes the need for health care professionals to provide more detailed and individualized education on exercise.”

Kentucky ranks 17th in diabetes and fifth in obesity, according to the 2014 "The State of Obesity: Better Policies for a Healthier America" report. It also says that more than 80 percent of people with diabetes are overweight or obese.

"Adults who are overweight or obese are at an increased risk for developing diabetes," the release notes. "Regular participation in physical activity may not only help reduce weight, but also help treat diabetes, and may prevent consequences associated with physical inactivity."

Health-care professionals need to do more than just encourage their diabetic patients to exercise, the researchers say in the release.

“Education about specific amounts of physical activity is needed to achieve goals such as weight loss and blood sugar control,” Pariser said. “Plus, instruction in the use of tools to objectively measure the amount of physical activity, like pedometers, should be provided.”

This study analyzed the association between exercise and weight control in 733 adults with diabetes and 4,572 without diabetes. Participants used a device to measure their physical activity and were asked if they were trying to lose weight, trying to maintain their weight or neither trying to lose nor maintain weight. For more information about diabetes and exercise, click here.

Friday, September 12, 2014

Respiratory virus that is sweeping Midwest has found its way to Kentucky; frequent handwashing remains best defense

The respiratory virus that has been hospitalizing children in the Midwest has come to Kentucky, reports Chris Kenning of The Courier-Journal: "Kraig Humbaugh, deputy commissioner of the Kentucky Department of Public Health, said the Centers for Disease Control and Prevention recently confirmed that five of 10 cases it tested from Kentucky were enterovirus D68."

Enteroviruses are common and tend to peak at this time of year, and enterovirus D68, a less common strain of this common virus, causes mostly respiratory illness. The CDC says symptoms for enterovirus D68 can range from mild to severe respiratory illness and that mild symptoms look very much like a cold: fever, runny nose, sneezing, cough, and body and muscle aches.

But it is the severe respiratory symptoms that are causing hospitalizations, particularly among children with asthma or underlying medical conditions, Kenning notes.

"In Kentucky, the spike in respiratory illnesses was first noticed in the central part of the state several weeks ago. But it is now being reported elsewhere, including in Louisville, although D68 has not been confirmed in Louisville," he reports. No deaths have been reported in Kentucky or in other states, officials told him.

"Hospitals in Colorado, Missouri and potentially eight other states are admitting hundreds of children for treatment of an uncommon but severe respiratory virus," probably enterovirus D68, The Washington Post reports.

From mid-August to Sept. 12, 97 people in Colorado, Illinois, Iowa, Kansas, Kentucky and Missouri were confirmed to have respiratory illness caused by enterovirus D68, according to the CDC.

The virus is spread when the infected person coughs, sneezes or touches a contaminated surface. There is no treatment or vaccine for the virus.

The best ways to reduce your risk are: frequent hand washing; keeping unwashed hands off of your eyes, nose and mouth; avoiding contact with people who are sick; and disinfecting communal surfaces frequently.

Humbaugh told Kenning that he is encouraging families who have children with cold-like symptoms that cause difficulty breathing to consult with their doctor. If you're sick, he said, stay home.

Ky. newspapers support Beshear's expanded smoking ban for state-government sites, back statewide smoking ban

The Kentucky New Era in Hopkinsville stands firmly in favor of the executive order put in place last week to ban employees and visitors from using all tobacco products in most state government buildings, says a recent editorial, republished by the Georgetown News-Graphic.

The paper also joined in the governor's hope that the General Assembly in 2015 will pass a law barring smoking in workplaces and enclosed public spaces, saying, "It is time for Kentucky lawmakers to adopt a statewide smoking ban."

“When it comes to preventable illnesses and death, nothing in Kentucky is as devastating as smoking and tobacco use,” Beshear said. “Yet Kentuckians continue to use tobacco more than the residents of any other state. And as a result we lead the nation in cancer deaths.”

The New Era reminded its readers that the rights of nonsmokers who are exposed to secondhand smoke are just as important as the rights of the private business owners.  It also added that the complaint that smoking bans hurt businesses, doesn't hold up.

"Kentucky cities that have approved public smoking bans — including Hopkinsville — have proven that restaurants survive just fine without smoking sections," the New Era said. "In fact, many businesses gain customers who previously stayed away because they did not want to breathe secondhand smoke."

The editorial reminds its reader that the governor's executive order is a temporary solution and the real solution is to enact a smoking ban before the governor leaves office in December 2015. ANo smoking-ban bill has ever gotten a vote in either chamber of the legislature.

Wednesday, September 10, 2014

Kentucky ranks fifth in obesity and its high-schoolers rank first

By Melissa Patrick
Kentucky Health News

Obesity and health problems go hand in hand, and Kentuckians are known for both.

Kentucky now has the fifth highest adult obesity rate in the nation, up from ninth last year, and Kentucky's high-school students are the nation's most obese, according to a report by the Trust for America's Health and the Robert Wood Johnson Foundation.

At least one out of every three adults in Kentucky is considered obese (33.2 percent). This rate keeps going up; significantly higher than the 25.3 percent rate in 2004 or the 12.7 percent rate in 1990.

Baby boomers are the heaviest adults, with 37.1 percent of them considered obese. The report also found that 42 percent of black adults, 24.5 percent of Latino adults and 31 percent of white adults are obese.

Kentucky is joined by 20 other states with obesity rates of at least 30 percent. In 1980, no state was above 15 percent, according to the report, but times have changed. West Virginia and Mississippi tied for the highest rates of adult obesity at 35.1 percent and Colorado has the lowest rate at 21.3 percent, well above that long ago 15 percent.


Not only are the adults in Kentucky obese, so are its children, and kids who are heavy, tend to remain heavy as adults.

Kentucky's high schoolers have the worst obesity rate in the nation at 18 percent. The national average, according to the Youth Risk Behavior Surveillance System, is 13.7 percent. Utah has the fewest obese kids with only 6.4 percent of its high schoolers considered obese.


Obesity rates among 10-to 17-year-olds in Kentucky is also high, ranking 8th with 19.7 percent considered obese. Mississippi ranks highest in this category at 21.7 percent. Obesity rates among Kentucky's 2-to 4-year-olds from low-income families also fall in the top ten of most obese, ranking sixth with a rate of 15.5 percent.

Why does it matter? Obesity takes a huge toll on health, particularly with diabetes, high blood pressure, heart disease, arthritis and certain cancers. Kentucky struggles with each of these diseases.

Kentucky ranks 17th in diabetes. The foundation projects an increase of 51 percent of people with diabetes by 2030, going from 394,029 people with diabetes in 2010 (or 10.6 percent) to 594,058. More than 80 percent of people with diabetes are overweight or obese, says the report.

The projection for high blood pressure in Kentucky is an increase of 33 percent by 2030, going from 881,343 people with high blood pressure in 2010 to 1,175,750 in 2030. Kentucky ranks fifth among states for high blood pressure. High blood pressure is a leading cause of stroke and people who are overweight are more likely to have high blood pressure, says the report.

The foundation projects a whopping 382 percent increase in heart disease in Kentucky by 2030, going from 264,958 people with heart disease in 2010 to 1,278,342 in 2030. Heart disease is the leading cause of death - responsible for one in three deaths - in the U.S., says the report.

Obesity related cancer is expected to increase 158 percent, from 68,075 cases to 176,260 in 2030. Approximately 20 percent of cancer in women and 15 percent of cancer is attributable to obesity, says the report.

Arthritis, however, is projected to decrease by 15 percent from 876,143 cases in 2010 to 748,558 cases in 2030. Almost 70 percent of individuals with arthritis are overweight or obese, says the report.

“Obesity in America is at a critical juncture. Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling,” Jeffrey Levi, executive director of Trust for America’s Health, said in a release. “We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities – so every American has the greatest opportunity to have a healthy weight and live a healthy life.”

The annual report, titled "The State of Obesity: Better Policies for a Healthier America," was formerly known as "F as in Fat." Adults in the study are considered obese if their BMI is 30 or more.Children are graded on the curve, so to speak; a child is considered obese if his or her BMI is above the 95th percentile for children of the same age and sex.

Tuesday, September 9, 2014

Depression should not be a taboo subject; rural Kentucky news editor details writes about her victory over it

By Tim Mandell
Institute for Rural Journalism and Community Issues

Depression is a subject people often shy away from discussing, but a large percentage of Americans suffer from, or have suffered from, serious depression. Around 50 million have become seriously depressed at some point during their lives, according to a report by the University of Kentucky Cooperative Extension Service. ­

The suicide last month of actor Robin Williams brought depression to the forefront of the national news for a few weeks, but as the national focus shifted to other stories, community journalists should continue to talk about depression, especially in rural areas where people might feel they will be ostracized if they express how they feel.

That’s why it’s important when journalists like Shelley Spillman, news editor of The Anderson News in Lawrenceburg, Ky., step forward and write columns detailing their own battles with depression. Spillman, who was inspired to write a column after Williams’ death and the suicide of a local man who suffered from depression, said in an interview, “This is not something we normally talk about and maybe we should. Maybe these people wouldn’t feel so alone."

"As journalists we’re part of the community too," she said. "I really enjoy people getting to know me, my real struggles in life and the things I’ve been through. It’s amazing how relating to people on a human to human level is one of the most difficult things to do. But it’s so important.”

In her column, Spillman wrote: “I, too, have suffered from the cold, metallic grip of depression. I know what it’s like to be in a room full of people and still feel alone. You’d give anything to feel the warmth of company without having to go through the mental gymnastics of plastering on a fake smile just so you don’t have to be berated with ‘are you OK?’ or ‘what’s wrong?’ It’s not their fault. Most people don’t know how to deal with people who suffer from depression. Even in our daily interactions people stop and ask ‘How are you doing?’ without sticking around long enough to hear anything other than a one-word utterance of ‘Fine.’”

“It does get better; give it time. I understand, though, that giving depression time, when a day with it can feel like carrying around the weight of a giant boulder, seems impossible, but you can. Sometimes when I think about my time with depression it seems so far away, like I’m at the fair soaring on one of those giant swings, examining bad memories of someone else’s life. I can feel black fog of depression permeating in my brain, trying to find a way back in, but I immediately recognize the intruder and sent it packing. Like I said, it’s a parasite, it’s always looking for a host to attach to.”

Spillman added, “You’ll find that you are a lot stronger than you may even realize now. You can make it out of this, and one day the clouds will part and you’ll be able to see the sun again. Let me tell you the sun feels glorious on your skin after a longtime in the dark.”

Spillman told The Rural Blog: “Readers who have called appreciate my honesty in my columns. It’s hard to put yourself out there and be that vulnerable, but I like for my columns to be honest and real. It’s a way for people to know who I am.” She said that writing a column like this is “a good way to get the ball rolling to get people talking about (depression).” She said she hopes columns like this can lead to there being more resources for people with depression, especially in small communities, and lead to depression being a subject that’s less taboo to discuss. (The Anderson News is behind a paywall but can be reached by clicking here.)

The Extension Service report details signs and types of depression, suggestions for those suffering from depression and suggestions for friends and family members of people who are depressed. Other valuable sources are available here, here, here, here and here.

Kids Count report says hard times in early childhood are more likely in Ky. than rest of U.S.; bad times have long-term effects

By Melissa Patrick
Kentucky Health News

One of every five children in Kentucky, by the time they are 5 years old, has experienced two or more adverse childhood experiences such as child abuse, economic hardship, exposure to violence, living in a household with mental illness or substance abuse, or where a family member has been incarcerated.

That is one of the major points of the 24th annual Kids Count report, released Tuesday by Kentucky Youth Advocates. The report is part of a state-by-state effort with county-by-county data; nationally, only one in eight children by age 5 have had two adverse experiences, defined as events or circumstances that can affect the quality of the child's adult life, including their health and length of life.

"The higher the total number of these events a child experiences, the higher the risk of obesity, chronic illness, substance abuse, smoking and mental health problems," the report says. Another study cited in the report found that "Children who had experienced four or more adverse events had lower incomes, lower education attainment and lost more days of work or school as adults due to problems with physical or mental health."

“We know when children experience traumatic events such as abuse and neglect or having an incarcerated parent, it negatively impacts their health and often causes barriers to success later in life. Kentucky leaders need to enact solutions to prevent these experiences in the first place and when they do happen, help children successfully recover,” Dr. Terry Brooks, executive director of Kentucky Youth Advocates, said in a press release.

This report by Kentucky Youth Advocates measures 16 indicators to determine the overall well-being of children in Kentucky counties and focuses on four areas considered critical to well-being: economic security, education, health, and family and community strength.


The Kentucky counties with the highest overall child well-being rankings are Oldham, Boone, Spencer, Woodford, and Calloway; the lowest are Martin, Owsley, Wolfe, Clay and Elliott.
Overall Child Well-Being, based on four factors:
economic security, education, health, and family and community.
The 2011-12 survey said that Kentucky children are more likely to experience two or more adverse events  (30 percent) than children are nationally (22.6 percent). The four most common adverse events among Kentucky's children, says the report, are economic hardship, living with a parent or guardian who got divorced or separated, living with anyone who had a problem with alcohol or drugs, and living with a parent or guardian who was incarcerated.

This study evaluated four indicators of health: smoking during pregnancy, low-birthweight babies, children and young adults without health insurance and teen births.  Oldham and Boone counties scored higher than the other counties on health and Elliott County ranked last.
Overall Health: County Comparisons.  Based on county
scores for the four indicators in the report.  
The study found Kentucky has the highest rate of mothers who smoke during pregnancy, one in five, compared to states with comparable data, reporting that the county rates varied widely in this area with less than 14 percent of expectant mothers in Fayette, Jefferson, and Oldham counties smoked, compared to 40 percent or more of mothers in Clay, Elliot, Lee, and Owsley counties.

The percentage of low-birthweight babies in Kentucky, often a result of smoking during pregnancy, between 1994-2012 (8.7 percent) was found to be consistently higher than the U.S. percentage (8.0 percent).

“All parents want what is best for their children, and we know that smoke is bad for kids,” Bethany Hodge, a pediatrician in Louisville, said in the release. “Kentucky needs an indoor smoke-free law so working mothers-to-be do not have to choose between their jobs and protecting their unborn babies.”

One in eight under 26 lacked health insurance in this study, but this number is expected to decline.

“Kentucky has effectively connected young people to health insurance, especially with the outreach efforts of KCHIP over the past few years and kynect over the past year,” Brooks said in the press release. “It’s important to build on those successes with innovative ways to connect all young people to coverage. One solution is to automatically enroll youth aging out of foster care in Medicaid to make sure they maintain health insurance as they leave the state’s care.”

As for teen births, in 2012, Kentucky's rate of births to teen mothers (42 per 1,000) "substantially" exceed the national rate (29 per 1000).

Many of Kentucky's children face adverse childhood experiences related to economic security.

According to the report, Kentucky has now had four consecutive years in which more than one in every four children lives in poverty, which is consistently higher than the national average. It also reports that more than two in every five Kentucky children live in a high-poverty area.

The report says, " A family's earnings and its poverty status, the level of poverty in its neighborhood and the affordability of housing can all affect how a child grows, learns and ultimately succeeds as an adult."

Boone, Oldham and Spencer counties have the highest scores for economic security, while Lee, Martin and Wolfe have the lowest.
Economic security, based on scores for the four indicators in the report.
The results of the well-being of Kentucky's children around education are concerning.

More than half (51 percent) of Kentucky's children entering kindergarten are not adequately prepared for school and more than half  (51 percent) of its fourth graders are not proficient in reading and "therefore not on the path to high school graduation," according to the report. The study also found that over half (55 percent) of Kentucky eighth graders are not proficient in math and that one in seven Kentucky high school students did not graduate on time.

Oldham and Lyon counties "stand apart" at the top of the  education county comparison, with Clinton, Knox, Menifee and Clay counties ranking last.
Education, based on scores for the four indicators in the report. 
Family and community indicators in the report found that Kentucky is not putting as many youth in jail as in previous years; nearly one in five births were to moms without a high school degree; the number of children living in a single-parent home has grown to 37 percent from 35 percent; and over the course of 2013, over 12,700 children were placed in foster care due to abuse or neglect.

Oldham, Boone, Carlisle, Ballard and Spencer counties rank at the top of the family and community county comparisons, with Powell, Clay, Elliott, Owsley and Carroll counties ranked at the bottom.
Family and Community, based on scores for the four indicators in the report. 
The report recommends implementation of strong policies to combat children's exposure to adverse childhood experiences. "The best option for Kentucky is to find ways to prevent adverse childhood experiences. Ensuring safe, stable and nurturing environments will shield children from toxic stress and its deleterious effects," says the report.

Click here for the Annie E. Casey Foundation Kids Count Data Center, which includes current and historical data. Note that the indicators included in the 2014 rankings are different than those included in the 2013 County Data Book. Therefore, current rankings should not be compared to last year’s county rankings.

Friday, September 5, 2014

Study shows tailored advocacy for local smoking bans in rural Kentucky gets results

Local smoking bans are only possible if the community is ready for this change, Ellen Hahn, director of the Kentucky Center for Smoke-free Policy, writes in a report of a five-year study she conducted in rural Kentucky.

Readiness for change can be developed in rural communities that participate in smoke-free policy initiatives tailored to their community, Hahn writes in The Journal of Rural HealthThe study evaluated six stages of readiness to determine if a community was ready to support smoke-free policy, and then tailored interventions based on how ready the community was.

The study was conducted in 37 rural Kentucky counties that were randomly selected from those without smoking ordinances or regulations. Nineteen of the communities received policy-intervention strategies, tailored to their readiness, from a trained community adviser. The remaining 18 were used for comparison. Data were collected annually and policy outcomes were tracked over five years.

Nearly one-third of the counties that were the target of interventions adopted smoking bans covering restaurants, bars, and all workplaces, while none of the comparison counties did.

Rural, tobacco-growing areas were chosen because they are "disproportionately affected by tobacco use, secondhand smoke, and weak tobacco control policies," Hahn writes in the study, "A Controlled Community-Based Trial to Promote Smoke-Free Policy in Rural Communities."

Study shows students, especially those with ADHD, have improved academic performance after they exercise

Children do better in school when they aren't forced to sit still all day, especially those with attention deficit hyperactivity disorder, Gretchen Reynolds reports in The New York Times.

Recent research, published last year in The Journal of Pediatrics, suggests that even small amounts of exercise enable children to improve their focus and academic performance.

The study looked at 40 boys and girls, age 8 to 10, half of whom had ADHD. Researchers gave the students a baseline academic test and also one that tested their attention. They then gave the same tests two more times, first after they had sat and read quietly for 20 minutes and the other after they had walked briskly or jogged 20 minutes on treadmills. Brain activity was recorded as they repeated the original tests.

Little difference was found in any of the students after quietly reading, but "they all showed marked improvements in their math and reading comprehension scores after the exercise," Reynolds writes. Students with ADHD showed significant increases on their scores and had brain-wave readings that showed them better able to regulate their behavior, which helped them pay attention.

"The results should make administrators question the wisdom of cutting P.E. classes," Reynolds writes.

This information is a valuable tool for educators, especially in Kentucky, which leads the nation with 19 percent of children ages 4 to 17, compared to 11 percent nationally, who have ever been diagnosed with ADHD, according to the federal Centers for Disease Control and Prevention. The level of exercise needed to show academic and attentional improvement involves activities that can be done in the classroom throughout the day, like marching or hopping in place.

Survey finds 1 in 7 Kentuckians over 44 say they have worsening confusion or memory loss; few say they get needed help

Worsening memory loss reported by Kentuckians in a survey could be indicative of a future Alzheimer's or dementia public health crisis, according to a press release from the Alzheimer's Association.

A first-time survey about memory loss shows that 14.1 percent of Kentuckians aged 45 and older report that they have confusion or memory loss that has become more frequent or gotten worse over the last 12 months. In the 21 states that participated in the study, the average was 12.5 percent.

The survey indicated a gap between need and care. Nearly 61 percent of Kentuckians who reported worsening memory problems said  they need assistance, but only 10.3 percent report getting help. And 25 percent of Kentuckians who reported worsening memory loss live alone.

“The data are indicative of a public-health crisis coming to our region,” Teri Shirk, executive director of the Alzheimer’s Association of Greater Kentucky and Southern Indiana, said in the release.

The report was compiled from data gathered for the first time in the Cognitive Decline Module, part of the Behavioral Risk Factor Surveillance System of the federal Centers for Disease Control and Prevention, in 2012.

Of those Kentuckians who reported memory loss in the survey, 75 percent of them haven't talked to their doctor about it. This is a problem, Shirk said in the release.

"Although the data do not indicate the respondents are cognitively impaired, worsening memory problems are often one of the first warning signs of Alzheimer’s or another dementia," she said.

The Alzheimer’s Association estimates that 67,000 Kentuckians have the disease and estimates this number will climb to 86,000 by 2025.

Of those Kentuckians who reported memory loss, 47 percent said it had interfered with household activities, work or social activities, compared to 40 percent of respondents across the 21 states.

"More than 80 percent have at least one other chronic condition, and many – especially in Kentucky – report conditions or behaviors that we know correlate with Alzheimer’s,” Shirk said. For example, more than 31 percent of Kentucky survey respondents reporting memory issues are smokers, and more than 61 percent say they are in fair or poor health, according to the survey.

“Dementia is absolutely not a normal part of aging,” said Shirk. “And worsening memory loss or confusion does not necessarily mean you have Alzheimer’s disease. If the issue is caused by medication, head trauma or other factors, it may be reversible. But if you do have Alzheimer’s, finding out early means you may be able to begin medications that tend to be more effective in the early stages, and it also gives you the opportunity to participate in planning for your future with the disease … where you will live, how your funds will be used and who will care for you as the disease progresses.”

For more information about the Alzheimer's Association, click here. For more information about the annual fundraising Walks to End Alzheimer's, held in September and October each year, click here.